SEBORRHOEIC KERATOSIS

A. Senile Keratosis/Seborrhoeic Keratosis

Seborrhoeic keratosis are very common, harmless, growths on the skin. They can be pink or light
brown to almost black in colour. They have a number of different names including seborrhoeic
warts and basal cell papillomas. They are made up of a build upof normal skin cells. (SEBORRHOEIC
KERATOSIS)
B. What Causes Seborrhoeic Keratoses
Seborrhoeic keratosis appear as a common part of the skin aging process and are best considered
as localized areas of wear and tear.
They usually start to appear after the age of 40 and become more common with increasing age.
They can occur in younger individuals too. The majority of older individuals have at least a few
seborrhoeic keratosis, while some individuals are prone to developing large numbers of lesions.
(SEBORRHOEIC KERATOSIS)
C. Clinical Features
Seborrheic keratosis (SK) appears in people in their 20s and is seen in nearly everyone in their 80s
or older. Flat-topped papules of 1 cm to 2 cm in diameter, varying in color from brown to blackish
brown occur on the face, head and trunk. The palms and soles are unaffected. The surface of the
papules is keratotic and often papillary or granular, resembling clay adhered to the skin. Itching
and pain are not usually present. As the synonym senile warts suggests, SK occurs as a skin aging
change. Senile freckles often elevate to form SK. (SENILE KERATOSIS)
D. Pathology
There is upward intraepidermal proliferation of basal cells and suprabasal cells (exophytic lesion).
The ratio of proliferative cells to normal cells varies. Dysplasia is not present, but melanin
pigmentation occurs in each proliferative cell to a varying degree. Pseudohorn cyst formation
presents as milia-like cyst by dermoscopy. (SENILE KERATOSIS)
E. Differential Diagnosis
The disease should be differentiated from actinic keratosis, Bowens disease (papular type), basal
cell carcinoma, squamous cell carcinoma, keratoacanthoma, follicular tumor, syringoma, flat
warts, verruca vulgaris and lentigo simplex. (SENILE KERATOSIS)
F. Treatment
Treatment is not necessary except when there are cosmetic concerns or suspected malignancy.
The lesions do not disappear spontaneously but increase in number with age. If necessary,
cryotherapy, laser therapy or surgical removal is conducted. (SENILE KERATOSIS)

RADIODERMATITIS (semua ambil dari file RADIODERMATITIS 1)

One of the treatment courses for breast cancer is teletherapy, which makes use of ionising radiation. This
damages the cell components, with DNA as the main target. Radiotherapy brings about changes or even
mutations to the genetic material, and also leads to changes in cell function, until the death of the cell.
Thus, ionising radiation causes damage to all living and normal cells, as well as malignant ones, thereby
causing side effects.
Among local toxic effects, cutaneous reactions are highlighted, known as radiodermatitis: erythema,
hyperpigmentation, dry scaling and moist scaling. What characterizes the latter is the exposure of the
dermis and seepage of fluid, sometimes accompanied by exudate and crust or ulceration, or even necrosis.

The degree of skin reaction depends on several factors, such as: irradiation in places where there is contact
between surfaces, areas where the epidermis is thin or where skin integrity has been ruptured, like in the
case of burns, concurrent chemotherapy, immunotherapy, associated medical conditions or co-morbidity,
chronic exposure to the sun, smoking, localization of the tumor or field treated, tumor staging, large
irradiated volume, high dose of total radiation, dose with a fraction of more than 2.0 Gy, and the type of
energy used.

In about 80% of the patients, radiation leads to dermatitis, varying in severity from moderate to severe
erythema and moist scaling. The consequences are many, including decreased quality of life due to pain
and interruption of treatment, which can be harmful for local control.

Several studies have been conducted to assess the results of preventive interventions, and the
management of skin reactions caused by radiotherapy. There is a continuous lack of evidence to
recommend many courses of intervention or products used in clinical practice though. Studies focus on
prevention more than management, and are wanting in methodological rigor, making it difficult to repair
studies with a view to elaborating specific recommendations. Other methodology problems include small
sample size, wide variety in the terms used to describe reactions and measurement tools.

Considering that radiodermatitis tends to occur quite often and harms the quality of life of radiotherapy
patients, and also the lack of consensus about the topical products used in prevention, the main purpose
of this study is to analyze knowledge on the topical products used in the prevention of radiodermatitis,
with a view to supporting care delivery to women with breast cancer during teletherapy.

Some studies show controversy about the efficiency of using topical corticosteroids in radiodermatitis
treatment. In initial trials, the use of less potent corticosteroids, variations in the location and also the
period to start the application, patients heterogeneity in terms of cancer types, doses, regimens and
application region of of radiotherapy and subjective analysis methods suggest that there is a lack of
preventive effect for this substance. However, in the studies analyzed, we observed a clinical reduction in
the severity of the symptoms shown, less damage to the skin permeability barrier and improvement of
inflammatory response, resulting from the radiation-induced rupture of the barrier, as well as the
significant reduction in the risk of developing moist scaling in patients using corticosteroids compared
with those using other products.

Treatment with steroids should start together with the start of radiotherapy, for maximum effect. The
importance of applications from the start of treatment is due to the fact that skin toxicity signs caused by
radiotherapy may occur soon after the first dose of radiation.

The protective effect of corticosteroids could be linked to their anti-inflammatory properties. Short-term
observations have not shown any increase in the rate of telangiectasias, skin atrophy or the risk of
suppression of the axis formed by the pituitary and adrenal glands. These factors limit their long-term use
(18).
Among the products analyzed, Betamesanone 0.1%, Mometasone Fuorate and Beclometasone spray
were the products that showed the best results and are also the most recommended for prophylactic use
in the prevention of this co-morbidity.

LEUKOPLAKIA (semua ambil dari file LEUKOPLAKIA 1)

A. Leukoplakia

The term leukokeratosis is often used generically to describe any white, plaquelike lesion of the oral
cavity. Leukoplakia is similarly applied by some authors.6 Others reserve the term leukoplakia for
lesions that show dyskeratosis on histologic examination; they designate the remaining lesions
pachyderma orale.

Leukokeratosis, which can arise at any site in the oral cavity, occurs most often on the buccal mucosa and
least often on the soft palate and gingiva. Peak incidence is in midlife, and men are more frequently
affected. The lesions are generally asymptomatic, although patients may occasionally complain of burning
or an area of roughness. In most cases, the lesion is discovered during a routine physical or dental
examination.

Because it is virtually impossible to distinguish between these benign entities and carcinoma, biopsy is
essential. If dysplasia is demonstrated, consider such lesions premalignant. They have the propensity to
transform into carcinoma in situ or invasive squamous cell carcinoma. Thus, such leukoplakic growths
must be excised completely and the region observed closely for recurrence.

Always attempt to identify and eliminate the irritant that caused the lesion. Many lesions involute when
this is done, but new ones may appear. Periodic follow-up examination and repeated biopsy are essential.
If oral disease is widespread, sample multiple areas.

B. Microscopic Characteristics

Hyperkeratosis (thickening of the outer keratin layers), parakeratosis (persistence of pyknotic nuclei in
the outer epithelial layer), acanthosis (enlargement or edema of the spinous layer of the skin), and
dyskeratosis may be seen. The presence of dyskeratosis implies disordered maturation of the various
epithelial layers; loss of polarity of the basal cells; and such cytologic features as hyperchromatism,
pleomorphism, enlarged nucleoli, increased mitoses, and an increased nuclear-cytoplasmic ratio. Studies
of biopsy specimens of white lesions of the oral cavity revealed a 2% to 4% incidence of dyskeratosis; in
2% to 11% of these cases of dyskeratosis, invasive carcinoma was present.

C. Treatment

After biopsy, residual lesions may be destroyed with a carbon dioxide laser. To decrease keratinization,
oral retinoid therapy has been tried, but no clinical benefit was demonstrated.

D. Hairy Leukoplakia

This lesion requires special consideration because it occurs only in patients with HIV infection. Hairy
leukoplakia (so called because of the filamentous nature of the plaques) arises principally on the lateral
border of the tongue, but it may also involve the buccal and labial mucosa. It is a classic example of virally
induced epithelial hyperplasia. Histologic examination reveals hyperkeratosis, parakeratosis, and
koilocytes. A koilocyte shows ballooning degeneration and has an inclusion body that is believed to
represent opportunistic Epstein-Barr virus infection. Biopsy establishes the diagnosis, but no treatment is
necessary. Hairy leukoplakia is asymptomatic and benign.

Rajpar, Sajjad. Dr, December 2013, Seborrhoeic Keratosis. Dermatology Queen Elizabeth Hospital.
Edition 1. www.uhb.nhs.uk/patients-informations-leaflets.htm.

de Andrade, Marceila et al, May 2012, Prevention of skin reactions due to teletherapy in women with
breast cancer: a comprehensive review. www.eerp.usp.br/rlae.

Lawson, William, April 2012, White Oral Lesions: How to Distinguish the Benign From the Deadly. Mount
Sinai School of Medicine. www.consultant360.com