Our topic now, we'll go through a bunch
of names that sound quite a like,
so I really need you to focus
on the manner in which
I’m describing and
pronouncing these names, okay?
The last time we’ve seen
the term seborrheic
is something that you want to make sure
that you are firmly, firmly familiar with.
When we talked about --
Well do you remember that waxy,
greasy, yellow type of appearance
in an infant known
as a cradle cap?
What was that called?
So if you’re not familiar
with seborrheic dermatitis,
go back and review that
in our discussion.
Our topic here is seborrheic keratosis.
Where you’ve learned about
this and where you’ve seen
this in medical school in
your education has been with
Leser-Trélat sign, but I’m really
going to go into further detail.
Because it’s not always that.
Very common in the elderly.
Has nothing to do with GI cancer.
Nothing to do with
Is that clear at this point?
Very common in the elderly.
Greater than 65% of
persons older than 80
may have quite a number of these
seborrheic keratosis or keratoses.
Thought to be inherited in an autosomal
dominant fashion with a cherry angioma.
You know, with cherry angioma.
A cherry angioma versus a
A strawberry hemangioma
was seen in a child
and here, the size of that particular rash
literally looks like a peel of strawberry.
You would recommend that it would
get bigger then it would subside
over maybe weeks, months, years
A cherry hemangioma or cherry
angioma will be permanent
and once again will be a benign
accumulation of blood in your blood vessel.
And say that you have these cherry
hemangiomas that are then going to give
what’s known as a dark brown, almost
like a chocolate-like appearance.
In pathology, we describe this
as being a stuck on appearance.
What do we mean by that?
It means that you’re --
work with me here --
chewing on a piece of
chocolate maybe like toffee ,
took it out of your mouth and literally
placed it on the back of your patient.
That’s what seborrheic
keratosis looks like.
It could be inherited in terms and with
cherry angioma also being associated.
Possesses absolutely no
Seborrheic keratosis in this case,
here is something that I’m giving you,
without the association of GI cancer.
Morphology would be
Literally like taking a piece of chocolate
and putting it on a person’s back.
We call this
brown in appearance.
Well, requires really no treatment.
Seborrheic keratosis, SK,
doesn’t require a treatment.
If inflamed, traumatized or
they may be destroyed.
What I wish to bring to attention
is something that we talked about.
Is that if you do have a
patient that has GI cancer,
maybe a primary gastric adenocarcinoma
or maybe colorectal cancer,
there is every possibility that you
might have a sudden outcropping
of the seborrheic keratosis.
It has nothing to do autosomal
dominant, not inherited,
and has nothing to do with elderly.
It’s an association that you
might find with your GI cancer.
So this type of GI cancer and this type
of seborrheic keratosis appearing,
you would then call this what?
Leser-Trélat sign, that
we’ve talked about in GI.
At this point, our strict discussion
is in terms of dermatology.
Seborrheic keratosis not to be
confused with seborrheic dermatitis
and definitely not to be confused with, later
on, we’ll talk about actinic keratosis.
You see as to how terminologies --
everything in derm.
What does that mean to you?
Thickened epidermis with
sharply demarcated base.
It looks like, as I told you earlier,
a piece of chocolate that
has been placed on the back
and therefore if you take a
look at the histology here,
It will be sharply demarcated because of
increased thickness of your keratinocytes.
Hyperkeratosis, as you can see
in the histologic picture here.
As a general rule, 50%
have regressed by age 5.
Seventy percent by age 7.
Ninety percent by age 9.
High dose oral steroids
can be used for lesions
threatening vital structures
if it gets to be that massive.
Surgery is reserved only for those
that are threatening vital structures
and that then failed to respond
to high dose steroids.
But as a general rule,
you pay attention to
50-5, 70-7, 90-9.
Most of these will be
self-limited, they will regress
and exactly these percentages that
I’ve given you as a rule of thumb.
Here, we move on to actinic
keratoses or actinic keratosis.
Pause here for a second
and make sure that you know that
our topic is actinic keratosis
So what does actinic
keratosis mean to you?
This is premalignant.
Is that clear?
really no chance of
going on to malignancy.
So if you’re thinking about malignancy,
then you’re thinking about on
your skin exposure to UV rays.
So therefore, actinic keratosis is
premalignant caused by UV exposure.
Have a potential to move on --
Now of the type of skin cancers that
we will discuss in this section,
which will then include squamous
cell cancer, which is our topic,
squamous cell cancer of the
skin or cutaneous squamous cell
is what you must think of actinic
keratosis as being premalignant to.
Is that clear?
Clinically feels gritty,
like sand paper.
as far as the skin is concerned,
what kind of cells are these?
So therefore, upon
exposure to UV rays,
maybe premalignant condition such as
actinic as you see in the picture here
and worst case scenario,
may go on to squamous
cell cancer of the skin.
Our first true