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Paget’s Disease

Key Points Mammary Paget's disease (MPD) is almost always associated with underlying breast carcinoma. If an underlying mass is palpated, the patient should be referred for a fine needle biopsy of the mass or an excisional biopsy. The immunostaining pattern of MPD and extramammary Paget's disease (EMPD) show substantial overlap, but EMPD is more likely to stain positively for gross cystic disease fluid protein 15 and…

Adnexal Carcinomas of the Skin

Key Points Adnexal carcinomas are rare and often misdiagnosed both clinically and histologically. Lesions can develop de novo or in conjunction with a pre-existing benign adenoma. Recognition and separation of these lesions into distinct entities is important, given the therapeutic and prognostic implications. Complete excision with clear margins, including by Mohs micrographic surgery, is the primary treatment of choice. Introduction Adnexal carcinomas are rare and troublesome…

Squamous Cell Carcinoma

Key Points The incidence of squamous cell carcinoma (SCC) is rising and thought to occur secondary to numerous factors including increasing UV exposure, prevalence of human papillomavirus, and immunosuppression. Awareness of the varied clinical and histologic presentations of SCC is essential for appropriate workup and management. Several limitations exist in the current AJCC staging system for SCC. Proposed changes to the staging classification system consist of…

Basal Cell Carcinoma

Key Points Basal cell carcinoma (BCC) is the most common malignancy occurring in humans, appearing most often as a translucent papule with rolled borders and telangiectasias. Although most lesions are related to excess ultraviolet exposure, BCC is multifactorial in origin. Clinical–pathological correlation is critical when planning the treatment of a BCC. Many modalities exist for removal of BCC, with Mohs micrographic surgery offering the highest cure…

Actinic Keratoses and Other Precursors of Keratinocytic Cutaneous Malignancies

Key Points Actinic keratoses are common lesions representing an early stage in the development of invasive squamous cell carcinoma that require clinical management. Actinic keratoses serve as a marker of skin damage from ultraviolet light due to sun exposure. Bowen's disease and its variants are intraepithelial malignancies and should be removed or destroyed. Introduction The recognition of risk factors, skin lesions and other conditions that predispose…

Current Concepts in Photoprotection

Key Points Photoprotection includes the complementary strategies of seeking shade when outdoors, using protective clothing, wearing a wide-brimmed hat, application of sunscreen, and wearing sunglasses. Protection from both UVB and UVA is important, and knowledge is also emerging regarding the cutaneous biological effects of visible light and infrared radiation. Avobenzone is currently the only organic ultraviolet filter available in the United States with effective protection within…

Chemoprevention of Skin Cancers

Key Points Interest in chemoprevention strategies for skin cancer is increasing. Retinoids may play a significant role. Oral agents are more effective for melanoma than are topicals. As cell and cancer biology in the skin continues to be explored, it is likely that there will be an even greater interest in the study of chemopreventative therapies. Introduction Skin cancers account for half of all cancers in…

The Importance of Primary and Secondary Prevention Programs for Skin Cancer

Key Points As the US population of adults 65 and older increases, the number of people developing and dying from new skin cancers will rise. Skin self-examination (SSE) with the assistance of a partner may achieve some reduction in the estimated 8400 deaths from cutaneous melanoma (CM) and reduce the physical and emotional burden of non-melanoma skin cancer (NMSC) and CM. Technologic advances, such as computer-assisted…

Etiological Factors in Skin Cancers: Environmental and Biological

Key Points Exposure to ultraviolet radiation plays a major role in the causation of squamous cell carcinoma, basal cell carcinoma, and melanoma. The timing and character of exposure to ultraviolet radiation may affect differently the risk of different skin cancers and of the same cancer at different body locations. Interaction with several other factors, including host-related factors, e.g. skin phenotype, and environmental factors, such as viruses,…

Epidemiology of Skin Cancer

Key Points Melanoma is 20 times more common today than it was 60 years ago. Melanoma incidence continues to increase. Overall melanoma mortality is increasing in the United States, especially for older men, but is declining in younger generations. Keratinocyte carcinoma is the most common malignancy in the United States. Introduction Skin cancer is the most common malignancy in the United States (US) and in many…

Skin Cancer : Burden of Disease

Key Points The burden of skin cancer is measured by incidence and cost, and by newer approaches such as non-traditional measures that take into account the impact of skin cancer on the psychological, social, and economical aspects on an affected individual's life. Costs associated with treatment significantly increase with advanced disease. With the rising rates of skin cancer, the burden of this disease will continue to…

The Biology of the Melanocyte

Key Points The major determinant of human skin color and sensitivity to ultraviolet radiation (UVR) is the activity of melanocytes, i.e. the quantity and quality of pigment production, not the density of melanocytes. Melanocytes contain a unique lysosome-related intracytoplasmic organelle, the melanosome, which is the site of melanin biosynthesis. Compared with lightly pigmented skin, darkly pigmented skin has more numerous, larger melanosomes that contain more melanin;…

Genetics of Skin Cancer

Key Points Specific genes implicated in causing each major form of skin cancer have been identified through genetic studies on hereditary and/or sporadic skin cancer. Their role in promoting cutaneous neoplasia is supported and confirmed by functional studies in animal model systems. Defects in the CDKN2A tumor suppressor locus are associated with both familial and sporadic cutaneous malignant melanoma and may cooperate with RAS or RAF…

The Biology of Skin Cancer Invasion and Metastasis

Key Points Malignant tumors are characterized by biologic heterogeneity, made of cells with different metastatic potentials. Metastasis is a sequential and selective process involving the tumor cell and the surrounding stroma (or microenvironment). Skin cancer deaths are mainly due to chemoresistant metastases. The role of cancer stem cells is becoming increasingly important in understanding the metastatic process. Therapy of metastasis should be directed against the unique…

Subcision: Cellulite Reduction

Key Messages Subcision is a simple procedure to correct depressed cellulite lesions There is relationship between fibrous septa and depressed lesions, as shown in the literature Performed under local anesthesia, subcision is an outpatient procedure in which subcutaneous fibrous septa that pull the skin down are cut Good results are achieved with proper technique and when performed by experienced physicians The procedure is usually performed using…

Radiofrequency and Ultrasound: Cellulite Reduction

Key Messages Radiofrequency and ultrasound devices are at the forefront of medical advances in the treatment of cellulite Radiofrequency generates heat in the tissue, resulting in shrinkage of collagen fibers, stimulation of new collagen and elastin, and destruction of adipocytes Ultrasound uses focused sound waves to cause mechanical and thermal damage to the tissue, resulting in lysis of adipocytes, stimulation of collagen and improvement in circulation…

Lasers and Lights: Cellulite Reduction

Key Messages Laser and light-based modalities are one of the latest advances in the treatment of cellulite External light irradiation has the capacity to trigger a photobiomodulatory effect in the targeted tissue stimulating several cellular functions such as neocollagenesis or adipocyte lipolysis. The therapeutic benefit stems from a thermogenic or nonthermogenetic effect Green (532 nm), red (650 nm) and infrared (700–2000 nm) laser light in a low- or high-energy…

Massage/Mechanical Techniques: Cellulite Reduction

Key Messages Cellulite is a multifactorial condition which benefits from a combination approach to treatment Reduced blood flow and lymphatic drainage, which worsen the appearance of cellulite, can be improved by mechanical manipulation Mechanical manipulation, while beneficial as a safe, noninvasive technique, does not result in the permanent resolution of cellulite The etiology of cellulite has long been debated and several mechanisms have been proposed. While…

Cellulite: Anatomy, Etiology, Treatment Indications

Key Messages Cellulite is an architectural condition of human adipose tissue Cellulite is characterized by a padded and nodular appearance of the skin in cellulite-prone areas, such as posterolateral thighs and buttocks in post-pubertal females Fundamental knowledge regarding its pathophysiology is lacking, which makes understanding and treating this condition a challenge Introduction Cellulite is thought of as a localized metabolic phenomenon that evokes an alteration in…

Injectable Fat-reducing Therapies: Fat Reduction

Key Messages Adipocytolysis refers to the subcutaneous injection of chemicals, such as the detergent sodium deoxycholate, which ablates or lyses rather than shrinks fat cells Injection lipolysis, otherwise known as pharmaceutical lipoplasty, refers to the subcutaneous injection of compounds, such as the beta agonist, salmeterol xinafoate, which mobilizes triglyceride and reduces fat cell size without lysing or ablating the fat cell While there are currently no…