Dysplastic nevus differential diagnosis: Difference between revisions
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[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Dysplastic_nevus]] | |||
{{ | {{CMG}} | ||
==Overview== | |||
Dysplastic nevus should be differentiated from common moles and melanoma. | |||
==Dysplastic nevus differential diagnosis== | |||
Dysplastic should be differentiated from: | |||
*Common moles | |||
*Melanoma | |||
Biopsy is the only way to differentiate above mentioned conditions from dysplastic nevus. | |||
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" | |||
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Disease or Condition'''}} | |||
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Differentiating Signs and Symptoms'''}} | |||
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Differentiating Tests'''}} | |||
|- | |||
| '''Microcystic adnexal carcinoma'''||AKA sclerosing sweat duct carcinoma; simulate morpheaform variants of BCC; higher recurrence rate than BCC||Histopathology: there are more ductal structures lined by a cuticle of keratin, which are not prevalent in BCCs; it will occasionally be positive with [[cytokeratin]] 7 and CEA (usually negative in BCCs)<ref>{{cite journal| author=Smeets NW, Stavast-Kooy AJ, Krekels GA, Daemen MJ, Neumann HA| title=Adjuvant cytokeratin staining in Mohs micrographic surgery for basal cell carcinoma. | journal=Dermatol Surg | year= 2003 | volume= 29 | issue= 4 | pages= 375-7 | pmid=12656816 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12656816}}</ref> | |||
|- | |||
| '''Trichoepithelioma/trichoblastoma'''||There is a formation of papillary-mesenchymal bodies (follicular units that simulate bulb of the hair follicle); a characteristic stroma-stroma split; a lower [[apoptotic]] and mitotic rate than seen in BCC<ref>{{cite journal| author=Ackerman AB, Gottlieb GJ| title=Fibroepithelial tumor of pinkus is trichoblastic (Basal-cell) carcinoma. | journal=Am J Dermatopathol | year= 2005 | volume= 27 | issue= 2 | pages= 155-9 | pmid=15798443 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15798443}}</ref>||Histopathology: the characteristic stroma-epithelium split and increase in apoptotic bodies and mitotic figures is not seen; Immunohistochemical: a characteristic perinuclear dot-like pattern and high molecular weight cytokeratin cocktail | |||
|- | |||
| '''Merkel cell carcinoma'''||This is a highly malignant neoplasm derived from cutaneous [[neuroendocrine]] cells<ref>{{cite journal| author=Massari LP, Kastelan M, Gruber F| title=Epidermal malignant tumors: pathogenesis, influence of UV light and apoptosis. | journal=Coll Antropol | year= 2007 | volume= 31 Suppl 1 | issue= | pages= 83-5 | pmid=17469758 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17469758}}</ref>||Histopathology: opaque nuclei, no nucleoli, and increased nuclear/cytoplasmic ratio, peripheral palisading might be present | |||
|- | |||
| '''Squamous cell carcinoma (SCC)'''||It may impossible to distinguish between BCC and SCC<ref>{{cite journal| author=Raasch BA, Buettner PG, Garbe C| title=Basal cell carcinoma: histological classification and body-site distribution. | journal=Br J Dermatol | year= 2006 | volume= 155 | issue= 2 | pages= 401-7 | pmid=16882181 | doi=10.1111/j.1365-2133.2006.07234.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16882181}}</ref>||Histopathology: larger cells with prominent [[nucleoli]], foci of keratinization and formation of squamous whorls where the [[neoplastic]] cells tightly wrap around each other | |||
|} | |||
[[Mouth|Oral]] [[melanoma]] must be differentiated from other [[mouth]] lesions such as [[Mouth|oral]] [[candidiasis]] and [[aphthous ulcer]]<div style="width: 70%;"> | |||
<small><small> | |||
{| class="wikitable" | |||
!Disease | |||
!Presentation | |||
!Risk Factors | |||
!Diagnosis | |||
!Affected Organ Systems | |||
!Important features | |||
!Picture | |||
|- | |||
! colspan="3" |Diseases predominantly affecting the oral cavity | |||
! | |||
! | |||
! | |||
! | |||
|- | |||
|[[Oral candidiasis|Oral Candidiasis]] | |||
| | |||
* [[Dysphagia]] or [[odynophagia]] | |||
* White patches on the mouth and tongue | |||
| | |||
*[[Newborn]] babies | |||
*Denture users | |||
*Poorly controlled [[diabetes]] | |||
*As a side effect of medication, most commonly having taken [[antibiotic]]s. Inhaled [[corticosteroids]] for the treatment of lung conditions (e.g, [[asthma]] or [[COPD]]) may also result in oral candidiasis which may be reduced by regularly rinsing the mouth with water after taking the medication. | |||
*People with poor [[nutrition]], specifically [[vitamin A]], [[Iron deficiency anemia|iron]] and [[Folate deficiency|folate deficiencies]]. | |||
*People with an [[immune deficiency]] (e.g. as a result of [[AIDS]]/[[HIV]] or [[chemotherapy]] treatment). | |||
*Women undergoing hormonal changes, like [[pregnancy]] or those on [[birth control pills]]. | |||
*[[Organ transplantation]] patients | |||
| | |||
* Clinical diagnosis | |||
* Confirmatory tests rarely needed | |||
|'''Localized candidiasis''' | |||
* [[Oral candidiasis|Oral]] and [[Esophageal candidiasis|esophageal candidasis]] | |||
* [[Candida vulvovaginitis]] | |||
* [[Chronic mucocutaneous candidiasis]] | |||
'''Invasive candidasis''' | |||
* [[Candidiasis|Candidaemia]] | |||
* [[Endocarditis|Candida endocarditis]] | |||
* [[Osteoarthritis|Candida osteoarticular disease]] | |||
| | |||
* [[Osteoarthritis|Oral candidiaisis is]] a benign self limiting disease unless accompanied by [[immunosuppression]]. | |||
|[[File:Human tongue infected with oral candidiasis--By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|thumb|Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|400x400px]] | |||
|- | |||
|[[Herpes simplex|Herpes simplex oral lesions]] | |||
| | |||
* [[Fever]] | |||
* [[Sore throat]] | |||
* Painful [[ulcer]]s | |||
| | |||
* Stress | |||
* Recent [[URTI]] | |||
* Female sex | |||
| | |||
* Physical examination | |||
* [[Viral culture]] | |||
* [[Tzanck smear]] | |||
| | |||
* Orofacial Infection | |||
* [[Herpes simplex anogenital infection|Anogenital Infection]] | |||
* [[Herpes simplex ocular infection|Ocular Infection]] | |||
* [[Herpes simplex encephalitis|Herpes Encephalitis]] | |||
* [[Herpes simplex neonatorum|Neonatal Herpes]] | |||
* [[Herpetic whitlow|Herpetic Whitlow]] | |||
* [[Herpes gladiatorum|Herpes Gladiatorum]] | |||
| | |||
* The symptoms of primary [[HSV]] infection generally resolve within two weeks | |||
|[[File:Herpesinfection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|thumb|Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|400x400px]] | |||
|- | |||
|[[Aphthous ulcer|Aphthous ulcers]] | |||
| | |||
* Painful, red spot or bump that develops into an open [[ulcer]] | |||
| | |||
* Being a female | |||
* Between the ages of 10-40 | |||
* Family history of [[Aphthous ulcer|aphthous ulcers]] | |||
| | |||
* Physical examination | |||
* Diagnosis of exclusion | |||
| | |||
* Oral cavity | |||
| | |||
* Self-limiting , [[Pain]] decreases in 7 to 10 days, with complete healing in 1 to 3 weeks | |||
|[[File:Afta foto - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358.jpg|thumb|Apthous ulcer on the under surface of the tongue|By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358|400x400px]] | |||
|- | |||
|[[Squamous cell carcinoma]] | |||
| | |||
*Non healing [[ulcer]], [[nodule]], indurated plaque or mass | |||
*May involve [[skin]], [[lips]], inside the [[mouth]], [[throat]] or [[esophagus]] | |||
| | |||
* Chronic sun or [[Ultraviolet|UV exposure]] | |||
* Fair [[skin]] | |||
* [[Elderly]] age (>45 yrs) | |||
* [[Male sex]] | |||
* [[Smoking]] | |||
| | |||
*[[Physical exam]] | |||
*[[Biopsy]] | |||
| | |||
*[[Oral Cavity]] | |||
**Floor of [[mouth]] | |||
**Lateral [[tongue]] | |||
*[[Throat]] | |||
*[[Esophagus]] | |||
| | |||
*[[Malignant]] | |||
*Can spread to [[TMJ]] | |||
*Some times associated with [[leukoplakia]] | |||
|[[File:PLoS oral cancer.png|thumb|400x400px|Squamous cell carcinoma - By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632]] | |||
|- | |||
|[[Leukoplakia]] | |||
| | |||
*White leathery spots on the [[mucous membranes]] of the [[tongue]] and inside of the [[mouth]] | |||
*Lateral borders of [[tongue]] | |||
| | |||
*Atypical [[Tobacco]] use | |||
*Chronic [[irritation]] | |||
*[[Immunodeficiency]] | |||
*[[Bloodroot]] ([[Sanguinarine|sanguinaria]]) | |||
| | |||
*[[Physical exam]] | |||
*Diagnosis of exclusion | |||
*[[Biopsy]] | |||
| | |||
*[[Vulva|Vulvar]] lesions occur independent of oral lesions | |||
| | |||
*Associated with [[HIV]] | |||
*Persistant white spots | |||
*[[Benign]] but can progress to [[carcinoma]] after almost 10 years | |||
*Oral proliferative [[Leukoplakia|verrucous leukoplakia]] is an aggressive sub type with multiple lesions and higher conversion to [[warts]] or [[carcinoma]]<ref>{{Cite journal | |||
| author = [[Ann M. Gillenwater]], [[Nadarajah Vigneswaran]], [[Hanadi Fatani]], [[Pierre Saintigny]] & [[Adel K. El-Naggar]] | |||
| title = Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity! | |||
| journal = [[Advances in anatomic pathology]] | |||
| volume = 20 | |||
| issue = 6 | |||
| pages = 416–423 | |||
| year = 2013 | |||
| month = November | |||
| doi = 10.1097/PAP.0b013e3182a92df1 | |||
| pmid = 24113312 | |||
}}</ref> | |||
|[[File:Oral hairy leukoplakia (EBV, in HIV)a.jpg|thumb|400x300px|Leukoplakia - By Aitor III - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9873087]] | |||
|- | |||
|[[Melanoma]] | |||
| | |||
*A lesion with [[ABCD]] | |||
**[[Asymmetry]] | |||
**Border irregularity | |||
**Color variation | |||
**[[Diamete]]r changes | |||
*[[Bleeding]] from the lesion | |||
| | |||
*[[Ultraviolet|UV radiations]] | |||
*[[Genetic predisposition]] | |||
*[[Old age]] | |||
*[[Male gender]] | |||
*Family or personal history of [[melanoma]] | |||
*Multiple benign or atypical [[Nevus|nevi]] | |||
| | |||
*[[ABCD]] characteristics | |||
*[[Bleeding]] or [[ulceration]] may show [[malignancy]] | |||
*Serum [[LDH]] may be elevated in case of [[malignancy]] | |||
*[[Biopsy]] | |||
| | |||
*Can [[metastasize]] | |||
*All [[UV radiation]] or sun exposed areas can be effected independently | |||
*1-2 to hundreds of [[granules]] | |||
| | |||
*[[Neural crest cell]] derivative | |||
*Development begins with disruption of [[nevus]] growth control | |||
*Progression involves [[MAPK/ERK pathway]] | |||
*[[RAS|N-RAS]] or [[BRAF]] [[oncogene]] also involved | |||
|[[File:Palate malign melanoma 01.jpg|thumb|400x400px|Oral melanoma - By Emmanouil K Symvoulakis, Dionysios E Kyrmizakis, Emmanouil I Drivas, Anastassios V Koutsopoulos, Stylianos G Malandrakis, Charalambos E Skoulakis and John G Bizakis - Symvoulakis et al. Head & Face Medicine 2006 2:7 doi:10.1186/1746-160X-2-7 (Open Access), [1], CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=9839811]] | |||
|- | |||
|[[Fordyce spots]] | |||
| | |||
*Rice-like [[granules]] or [[spots]] | |||
*Small, [[painless]], [[raised]], [[pale]], red or white | |||
*1 to 3 mm in [[diameter]] | |||
| | |||
*Greasy skin types | |||
*Some [[Rheumatic|rheumatic disorders]] | |||
*[[Hereditary nonpolyposis colorectal cancer]] | |||
**Lower [[gingiva]] (gums) | |||
**[[Vestibular system|Vestibular mucosa]] | |||
| | |||
*[[Physical exam]] | |||
*Small [[keratin]]-filled [[pseudocysts]] | |||
*May be seen on [[incidental]] [[mucosal]] [[biopsy]] | |||
**[[Biopsy]] not done for them primarily | |||
| | |||
*[[Oral cavity]] | |||
**[[Vermillion border|Vermilion border]] of the lips | |||
**[[Oral mucosa]] of the upper lip | |||
*[[Buccal mucosa]] in the commissural region often bilaterally | |||
*[[Genitals]] | |||
| | |||
*[[Benign neoplasms]] with [[sebaceous]] features | |||
*Visible [[sebaceous glands]] | |||
*No surrounding [[mucosal]] change | |||
*Several adjacent [[glands]] may coalesce into a larger cauliflower-like cluster | |||
|[[File:Fospot.jpg|thumb|400x400px|Fordyce spots - Por Perene - Obra do próprio, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19772899]] | |||
|- | |||
|[[Burning mouth syndrome]] | |||
| | |||
*Burning or [[tingling]] on the [[lips]], [[tongue]], or entire [[mouth]] | |||
| | |||
*[[Nutritional deficiencies]] | |||
*Chronic [[anxiety]] or [[depression]] | |||
*[[Diabetes type 2]] | |||
*[[Menopause]] | |||
*[[Oral thrush]] or [[dry mouth]], or damaged [[nerves]] transmitting taste | |||
*[[Female gender ]] | |||
*[[Menopause]] | |||
| | |||
*[[Presentation]] | |||
*[[Physical exam]] | |||
| | |||
*[[Oral cavity]] | |||
| | |||
*Pain typically is low in the morning and builds up over the day | |||
*Low dosages of [[benzodiazepines]], [[tricyclic antidepressants]] or [[anticonvulsants]] may be effective | |||
| | |||
|- | |||
|[[Torus palatinus]] | |||
| | |||
*Bony growth on midline of the [[hard palate]] | |||
*[[Nodular]] mass covered with normal [[mucosa]] | |||
| | |||
*[[Genetic predisposition]] | |||
**[[Autosomal dominant]] | |||
| | |||
*[[Physical exam]] | |||
*Types | |||
**[[Torus palatinus|Flat tori]] | |||
**[[Torus palatinus|Spindle tori]] | |||
**[[Torus palatinus|Nodular tori]] | |||
**[[Torus palatinus|Lobular tori]] | |||
| | |||
*[[Hard palate]] | |||
| | |||
*More common in [[Asian]] and Inuit populations | |||
*Twice more common in [[females]] | |||
*Repeated [[trauma]] can cause [[bleeding]] | |||
*[[Surgery]] may be required in symptomatic | |||
|[[File:06-06-06palataltoria.jpg|thumb|Torus palatinus|400x400px|Torus palatinus - By Photo taken by dozenist, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=846591]] | |||
|- | |||
| colspan="4" |'''Diseases involving oral cavity and other organ systems''' | |||
| | |||
| | |||
| | |||
|- | |||
|[[Behçet's disease|Behcet's disease]] | |||
| | |||
*Painful [[mouth sores]] | |||
*[[Acne]] like skin lesions | |||
*Headache, [[fever]], poor [[balance]], [[disorientation]] | |||
*[[Abdominal pain]], [[diarrhea]] or [[bleeding]] | |||
*[[Uveitis]] | |||
*Joint [[swelling]] and joint [[pain]] | |||
*Genital [[sores]] wit [[pain]] and [[scaring]] | |||
*[[Aneurysms]] | |||
| | |||
*Over active [[immune system]] | |||
| | |||
*[[Physical examination]] | |||
| | |||
*[[Mouth]] | |||
*[[Genitals]] | |||
*[[GIT]] | |||
*[[Eye]] | |||
*[[Joints]] | |||
*[[Skin]] | |||
*[[Vascular system]] | |||
*[[Brain]] | |||
| | |||
*[[Outbreaks]] of exaggerated [[inflammation]] | |||
*Affects smaller [[blood vessels]] | |||
|[[File:Behcets disease.jpg|thumb|400x400px|Behcet's disease - By Ahmet Altiner MD, Rajni Mandal MD - http://dermatology.cdlib.org/1611/articles/18_2009-10-20/2.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17863021]] | |||
|- | |||
|[[Crohn's disease]] | |||
| | |||
*Chronic, episodic [[diarrhea]] or [[constipation]] | |||
*[[Abdominal pain]] | |||
*[[Vomiting]] | |||
*[[Weight loss]] or [[weight gain]] | |||
| | |||
*[[Smoking]] | |||
*[[Whites]] and [[European]] [[Jews]] | |||
*[[Hormonal contraception]] | |||
*Diets high in microparticles, sweet, fatty or refined foods | |||
*Industrialized country | |||
| | |||
*Typical [[history]] and [[symptoms]] | |||
*[[Skip lesions]] on [[biopsy]] | |||
*[[Anti saccharomyces cerevisiae antibodies|Anti-Saccharomyces cerevisiae antibodies (ASCA)]] | |||
*[[Anti-neutrophil cytoplasmic antibodies]] ([[ANCA]]) | |||
| | |||
*[[Eyes]] | |||
*[[Joints]] | |||
*[[Skin]] | |||
| | |||
*May lead to | |||
**[[Obstruction]]s | |||
**[[Abscess]]es | |||
**Free [[perforation]] | |||
**[[Hemorrhage]] | |||
| | |||
|- | |||
|[[Agranulocytosis]] | |||
| | |||
*[[Fever]] or [[chills]] | |||
*Frequent [[infections]] | |||
*Unusual [[redness]], [[pain]], or [[swelling]] around a wound | |||
*Mouth [[ulcers]] | |||
*[[Abdominal pain]] | |||
*[[Burning sensation when urinating]] | |||
*[[Sore throat]] | |||
| | |||
*[[Medications]]<ref name="PMID17142169">{{cite journal |author=Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. |title=Idiosyncratic drug-induced agranulocytosis: Update of an old disorder. |journal=Eur J Intern Med. |volume=17|issue=8 |pages=529-35 |year=2006|pmid 17142169|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/17142169}}</ref> | |||
*[[List of chemotherapeutic agents#Cytotoxic Chemotherapy|Cytotoxic chemotherapy]] | |||
*[[Hematological malignancy|Hematologic malignancies]] | |||
*[[Autoimmune disorders]] | |||
| | |||
*[[Neutropenia]] <100 cells per micro litre | |||
*[[Eosinopenia]] | |||
*[[Basopenia]] | |||
| | |||
*[[Oral cavity]] | |||
*[[Skin]] | |||
*[[GIT]] | |||
*[[Urinary system]] | |||
*[[Conjunctiva]] | |||
| | |||
*[[Immunocompromised|Immunocompromization]] | |||
*Types | |||
**[[Drug-induced]] | |||
**[[Malignant]] | |||
**[[Autoimmune]] | |||
| | |||
|- | |||
|[[Syphilis]]<ref>title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"</ref> | |||
| | |||
*[[Chancre]] | |||
*Regional [[lymphadenopathy]] | |||
| | |||
*[[Multiple sexual partners]] | |||
*Illicit [[drug use]] | |||
*[[Unprotected sex]] | |||
*[[Homosexual men|Men who have sex with men]] | |||
*Residence in highly prevalent areas | |||
*[[Human Immunodeficiency Virus (HIV)|HIV]] infection | |||
*Presence of other [[STI]]s | |||
*Previous history of [[Sexually transmitted disease|STIs]] | |||
*[[Intravenous drug use]] | |||
| | |||
*[[Darkfield microscope|Darkfield microscopy]] | |||
*Non [[Treponema|treponemal]] tests like [[VDRL]] and [[RPR test]]) | |||
*[[Treponema|Treponemal]] tests[[FTA-ABS|FTA-ABS tests]], (TP-PA) assay, [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]]) | |||
| | |||
*[[Oral cavity]] | |||
*[[Penis]] | |||
*[[Cervix]] | |||
*[[Labia]] | |||
*[[Anal canal]] | |||
*[[Rectum ]] | |||
*[[CNS]] | |||
*[[Cardiovascular|CVS]] | |||
| | |||
*[[Primary syphilis]] | |||
**[[Chancre]] | |||
*[[Secondary syphilis]] | |||
**[[Condyloma latum|Condylomata lata]] | |||
*[[Latent syphilis]] | |||
**[[Asymptomatic]] | |||
*[[Tertiary syphilis]] | |||
**[[Gumma|Gummas]] | |||
**[[Neurosyphilis]] | |||
|[[File:Hutchinson teeth congenital syphilis PHIL 2385.rsh.jpg|thumb|400x400px|oral syphilis - By CDC/Susan Lindsley - http://phil.cdc.gov/phil_images/20021114/34/PHIL_2385_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2134349]] | |||
|- | |||
|[[Coxsackie virus]] | |||
| | |||
*[[Fever]] | |||
*[[Sores]] in the [[mouth]] | |||
*[[Rash]] with [[blisters]] | |||
*[[Aches]] | |||
| | |||
*[[Pregnancy]] | |||
*[[immunodeficiency]] | |||
| | |||
*[[History]] and [[Physical exam]] | |||
*[[Swabbing|Throat swabs]] | |||
*Swabs from the lesion | |||
*[[Tzanck test]] | |||
| | |||
*[[Oral cavity]] | |||
*[[Skin]] | |||
| | |||
*Symptomatic treatment | |||
|[[File:Hand foot mouth disease 07a.jpg|Hand-foot-and-mouth disease|400x400px]] | |||
|- | |||
|[[Chickenpox|Chicken pox]] | |||
| | |||
*[[Conjunctival]] symptoms | |||
*[[Catarrhal]] symptoms | |||
*Characteristic [[spots]] on the trunk appearing in two or three waves | |||
*[[Itching]] | |||
| | |||
*[[Pregnancy]] | |||
*[[Premature infants]] born to susceptible mothers | |||
*All [[infants]] born at less than 28 weeks [[gestation]] or who weigh =1000 grams | |||
*[[Immunocompromised]] | |||
| | |||
*[[History]] and [[physical exam]] | |||
*[[PCR]] to detect [[VZV]] in [[skin lesions]] ([[vesicles]], [[scabs]], [[Maculopapular|maculopapular lesions]]) | |||
| | |||
*[[Oral cavity]] | |||
*[[Skin]] | |||
| | |||
*[[Sodium bicarbonate]] in baths or [[antihistamines]] for [[itching]] | |||
*[[Paracetamol]] ([[acetaminophen]]) for [[fever]] | |||
*[[Prednisolone]] is [[contraindicated]] | |||
|[[File:Herpangina2016.jpg|thumb|400x400px|Chickenpox - By James Heilman, MD - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52872565]] | |||
|- | |||
|[[Measles]] | |||
| | |||
*[[Fever]] | |||
*[[Rash]] | |||
*[[Cough]] | |||
*[[Coryza]] (runny nose) | |||
*[[Conjunctivitis]] (pink eye) | |||
*[[Malaise]] | |||
*[[Koplick spots]] in mouth | |||
| | |||
*Unvaccinated individuals<ref name="pmid11135778">{{cite journal| author=Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE| title=Individual and community risks of measles and pertussis associated with personal exemptions to immunization. | journal=JAMA | year= 2000 | volume= 284 | issue= 24 | pages= 3145-50 | pmid=11135778 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11135778 }} </ref><ref name="pmid9009400">{{cite journal| author=Ratnam S, West R, Gadag V, Williams B, Oates E| title=Immunity against measles in school-aged children: implications for measles revaccination strategies. | journal=Can J Public Health | year= 1996 | volume= 87 | issue= 6 | pages= 407-10 | pmid=9009400 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9009400 }} </ref> | |||
*Crowded and/or unsanitary conditions | |||
*Traveling to less developed and developing countries | |||
*Immunocompromized | |||
*Winter and [[spring]] seasons | |||
*Born after 1956 and never fully vaccinated | |||
*Health care workers | |||
| | |||
*[[History]] and [[examination]] | |||
*[[PCR]] for [[Measles]]-specific [[IgM|IgM antibody]] | |||
*[[PCR]] for [[Measles]] [[RNA]] | |||
| | |||
*[[Oral cavity]] | |||
*[[Skin]] | |||
*[[Respiratory tract]] | |||
*[[Eyes]] | |||
*[[Throat]] | |||
| | |||
*Caused by [[Morbillivirus]] | |||
*Primary site of infection is the [[respiratory epithelium]] of the [[nasopharynx]] | |||
*Transmitted in [[respiratory secretions]], via [[aerosol droplets]] containing [[Virus|virus particles]] | |||
|[[File:Koplik spots, measles 6111 lores.jpg|thumb|400x400px|Koplick spots (Measles) - By CDC - http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=824483]] | |||
|}</small></small> | |||
</div> | |||
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" | |||
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Subtype'''}} | |||
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Frequency'''}} | |||
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Clinical Features'''}} | |||
|- | |||
| colspan="3" |'''''Common Subtypes''''' | |||
|- | |||
|[[Superficial (human anatomy)|Superficial]] spreading [[melanoma]]||70%|| | |||
*Most common sub-type | |||
*Usually affects sun exposed sites among both men and women aged 50-70 years | |||
*Characterized by the ''presence'' of abundant junctional [[Epidermis (skin)|intra-epidermal]] spread of [[malignant]] [[Melanocyte|melanocytes]] | |||
|- | |||
|[[Nodular melanoma]]||15-25%|| | |||
*Second most common subtype | |||
*Usually affects sun exposed sites among both men and women aged 50-70 years | |||
*Characterized by the ''absence'' of junctional [[Epidermis (skin)|intra-epidermal]] spread of [[malignant]] [[Melanocyte|melanocytes]] | |||
|- | |||
|[[Acral lentiginous melanoma]]||5%|| | |||
*Not associated with [[Chronic (medical)|chronic]] [[ultraviolet]] exposure | |||
*Affects the [[Limb (anatomy)|extremities]] of individuals of all [[Race|races]] | |||
*Common among the elderly Caucasian and non-Caucasian individuals | |||
|- | |||
|[[Lentigo maligna melanoma]]||1-5%|| | |||
*Preceded by [[lentigo maligna]] | |||
*Common among the elderly Caucasian [[Patient|patients]] | |||
*Usually appears as a flat, non-palpable [[lesion]] that affects sun exposed sites, especially the [[head]] and [[neck]] ([[Lesion|lesions]] on [[Limb (anatomy)|extremities]] are less common) | |||
|- | |||
| [[Skin|Non-cutaneous]] [[melanoma]]||5%|| | |||
*[[Melanoma]] that does not affect the [[skin]] | |||
*Usually affects the [[eye]] ([[ocular]] [[melanoma]]) or the [[Mucous membrane|mucus membranes]] ([[Mucous membrane|mucosal]] [[melanoma]]) | |||
|- | |||
| colspan="3" | '''''Less Common Subtypes''''' | |||
|- | |||
| [[Desmoplasia|Desmoplastic]]/[[Spindle cell]] [[melanoma]]||Rare|| | |||
*[[Lesion]] typically amelanotic and has a [[morphology]] similar to a [[scar tissue]] | |||
*Appears indolent but is highly [[Infiltration (medical)|infiltrative]] | |||
*Characterized by local recurrence and [[Perineurium|perineural]] spread | |||
*Usually affects males aged 60-70 years in sun exposed sites | |||
*May be [[de novo]] or can be associated with a pre-existing [[melanoma]] | |||
*Has several subtypes: | |||
::*Pure: paucicellular | |||
::*[[Desmoplasia|Desmoplastic]]-neurotropic [[melanoma]]: characterized by neurotropism | |||
::*Pure neurotropic [[melanoma]]: no [[desmoplasia]] with [[spindle cell]] [[melanoma]] of neurotropic [[phenotype]] | |||
::*Mixed/Combined: [[Epithelium|epithelial]] and [[spindle cells]] | |||
|- | |||
| [[Nevoid melanoma]]||Rare|| | |||
*[[Lesion]] has features of both [[melanoma]] and [[melanocytic nevus]] on [[Histopathology|histopathological]] [[analysis]] | |||
*Clinical features resemble those of a typical [[melanoma]] | |||
|- | |||
| [[Spitzoid melanoma|Spitzoid melanocytic neoplasm]]||Rare|| | |||
*[[Lesion]] has features of both [[melanoma]] and Spitz ([[epithelioid]]) [[tumor]] | |||
*Typically affects sun exposed sites among children and young adults, but adults with Spitz [[Tumor|tumors]] are more often [[Diagnosis|diagnosed]] with [[Spitzoid melanoma]] | |||
*Compared to [[benign]] Spitz [[Tumor|tumors]], [[Spitzoid melanoma|Spitzoid melanomas]] are usually large (>5 mm) | |||
|- | |||
| [[Angiotropic melanoma]]||Rare|| | |||
*[[Lesion]] characterized by angiotropism, whereby the [[melanoma]] grows in proximity (within 1-2 mm) to [[blood]] and/or [[Lymphatic system|lymphatic tissue]] but no [[tumor]] within the [[vascular]] [[lamina]] itself | |||
*The [[tumor]] may originally be another sub-type of [[melanoma]] | |||
*Clinical features similar to typical [[melanoma]] | |||
|- | |||
| [[Blue nevus]]-like [[melanoma]]||Rare|| | |||
*[[Melanoma]] that develops from a pre-existing [[blue nevus]] | |||
*One of the rarest forms of [[melanoma]] | |||
*Appears as a [[blue nevus]] that has recently been rapidly expanding with irregular contours | |||
*Typically affects middle-aged men | |||
|- | |||
| [[Composite melanoma]]||Rare|| | |||
*[[Melanoma]] that develops in the proximity of other pre-existing [[Epithelium|epithelial]] [[Cancer|malignancies]] (e.g. [[Basal cell carcinoma|basal]]/[[squamous cell carcinoma]]) | |||
*May be characterized by one of the following: | |||
::*Collision [[tumor]]: Collision of [[melanoma]] and another nearby [[malignant]] [[tumor]] | |||
::*Colonization: Colonization of [[Melanocyte|melanocytes]] in a [[tumor]] | |||
::*Combined: Two distinct [[Tumor|tumors]] appear to have mixed features of the [[melanoma]] and the other [[tumor]] | |||
::*[[Biphenotypic melanoma|Biphenotypic]]: One [[tumor]] that has features of [[melanoma]] and another [[Epithelium|epithelial]] [[Cancer|malignancy]] | |||
|} | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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[[Category:Needs content]] | [[Category:Needs content]] | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category:Types of cancer]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Oncology]] | [[Category:Oncology]] | ||
[[Category: | [[Category:Medicine]] | ||
[[Category:Dermatology]] | |||
[[Category:Surgery]] |
Latest revision as of 04:59, 4 June 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Dysplastic nevus should be differentiated from common moles and melanoma.
Dysplastic nevus differential diagnosis
Dysplastic should be differentiated from:
- Common moles
- Melanoma
Biopsy is the only way to differentiate above mentioned conditions from dysplastic nevus.
Disease or Condition | Differentiating Signs and Symptoms | Differentiating Tests |
Microcystic adnexal carcinoma | AKA sclerosing sweat duct carcinoma; simulate morpheaform variants of BCC; higher recurrence rate than BCC | Histopathology: there are more ductal structures lined by a cuticle of keratin, which are not prevalent in BCCs; it will occasionally be positive with cytokeratin 7 and CEA (usually negative in BCCs)[1] |
Trichoepithelioma/trichoblastoma | There is a formation of papillary-mesenchymal bodies (follicular units that simulate bulb of the hair follicle); a characteristic stroma-stroma split; a lower apoptotic and mitotic rate than seen in BCC[2] | Histopathology: the characteristic stroma-epithelium split and increase in apoptotic bodies and mitotic figures is not seen; Immunohistochemical: a characteristic perinuclear dot-like pattern and high molecular weight cytokeratin cocktail |
Merkel cell carcinoma | This is a highly malignant neoplasm derived from cutaneous neuroendocrine cells[3] | Histopathology: opaque nuclei, no nucleoli, and increased nuclear/cytoplasmic ratio, peripheral palisading might be present |
Squamous cell carcinoma (SCC) | It may impossible to distinguish between BCC and SCC[4] | Histopathology: larger cells with prominent nucleoli, foci of keratinization and formation of squamous whorls where the neoplastic cells tightly wrap around each other |
Oral melanoma must be differentiated from other mouth lesions such as oral candidiasis and aphthous ulcer
Disease | Presentation | Risk Factors | Diagnosis | Affected Organ Systems | Important features | Picture |
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Diseases predominantly affecting the oral cavity | ||||||
Oral Candidiasis |
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Localized candidiasis
Invasive candidasis |
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Herpes simplex oral lesions |
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Aphthous ulcers |
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Squamous cell carcinoma |
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Leukoplakia |
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Melanoma |
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Fordyce spots |
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Burning mouth syndrome |
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Torus palatinus |
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Diseases involving oral cavity and other organ systems | ||||||
Behcet's disease |
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Crohn's disease |
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Agranulocytosis |
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Syphilis[7] |
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Coxsackie virus |
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Chicken pox |
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Measles |
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Subtype | Frequency | Clinical Features |
Common Subtypes | ||
Superficial spreading melanoma | 70% |
|
Nodular melanoma | 15-25% |
|
Acral lentiginous melanoma | 5% |
|
Lentigo maligna melanoma | 1-5% |
|
Non-cutaneous melanoma | 5% | |
Less Common Subtypes | ||
Desmoplastic/Spindle cell melanoma | Rare |
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Nevoid melanoma | Rare |
|
Spitzoid melanocytic neoplasm | Rare |
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Angiotropic melanoma | Rare | |
Blue nevus-like melanoma | Rare |
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Composite melanoma | Rare |
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References
- ↑ Smeets NW, Stavast-Kooy AJ, Krekels GA, Daemen MJ, Neumann HA (2003). "Adjuvant cytokeratin staining in Mohs micrographic surgery for basal cell carcinoma". Dermatol Surg. 29 (4): 375–7. PMID 12656816.
- ↑ Ackerman AB, Gottlieb GJ (2005). "Fibroepithelial tumor of pinkus is trichoblastic (Basal-cell) carcinoma". Am J Dermatopathol. 27 (2): 155–9. PMID 15798443.
- ↑ Massari LP, Kastelan M, Gruber F (2007). "Epidermal malignant tumors: pathogenesis, influence of UV light and apoptosis". Coll Antropol. 31 Suppl 1: 83–5. PMID 17469758.
- ↑ Raasch BA, Buettner PG, Garbe C (2006). "Basal cell carcinoma: histological classification and body-site distribution". Br J Dermatol. 155 (2): 401–7. doi:10.1111/j.1365-2133.2006.07234.x. PMID 16882181.
- ↑ Ann M. Gillenwater, Nadarajah Vigneswaran, Hanadi Fatani, Pierre Saintigny & Adel K. El-Naggar (2013). "Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!". Advances in anatomic pathology. 20 (6): 416–423. doi:10.1097/PAP.0b013e3182a92df1. PMID 24113312. Unknown parameter
|month=
ignored (help) - ↑ Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. (2006). "Idiosyncratic drug-induced agranulocytosis: Update of an old disorder". Eur J Intern Med. 17 (8): 529–35. Text "pmid 17142169" ignored (help)
- ↑ title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"
- ↑ Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE (2000). "Individual and community risks of measles and pertussis associated with personal exemptions to immunization". JAMA. 284 (24): 3145–50. PMID 11135778.
- ↑ Ratnam S, West R, Gadag V, Williams B, Oates E (1996). "Immunity against measles in school-aged children: implications for measles revaccination strategies". Can J Public Health. 87 (6): 407–10. PMID 9009400.