Elderly persons may have benign skin tumors (such as seborrheic keratoses, acrochordons, and keratoacanthomas), premalignant tumors (such as actinic keratoses and Bowen’s disease), and malignant tumors (such as basal cell carcinoma, squamous cell carcinoma, Kaposi’s sarcoma, cutaneous T-cell lymphoma, lentigo maligna melanoma, nodular melanoma, and superficial spreading melanoma). BENIGN TUMORS The association of benign tumors [...]
The association of benign tumors with aging is obvious to most patients, and health care professionals must understand the psychologic impact of these lesions. Such lesions must be distinguished from malignant tumors. Seborrheic Keratoses (Seborrheic Warts) These waxy, raised, verrueous lesions vary in color from flesh tone to black and in size from barely perceptible [...]
Actinic Keratoses These scaly, sandpaper-like patches appear on sun-exposed areas. Although actinic keratosis may evolve into squamous cell carcinoma, the latent period is long, and the squamous cell carcinoma usually grows very slowly and has little metastatic potential. Nevertheless, patients with multiple lesions anywhere on their exposed skin should be screened every 6 to 12 [...]
Basal and squamous cell carcinomas are the most common malignant skin tumors. Environmental exposure to ultraviolet light is the major risk factor, although ionizing radiation and chemical carcinogens are also predisposing factors. Basal Cell Carcinoma The typical basal cell carcinoma or rodent ulcer has a pearly appearance, rolled edges, and telangiectasia on its surface. More [...]
The typical basal cell carcinoma or rodent ulcer has a pearly appearance, rolled edges, and telangiectasia on its surface. More than 90% of these lesions appear on the head and neck. Some are superficial; others are multicentric, appearing as a scaly plaque with a raised pearly edge. Pigmented basal cell carcinomas are sometimes mistaken for [...]
These tumors usually occur in sun-damaged skin, although up to 25% occur in sites of chronic inflammation, persistent ulceration (eg, longstanding lupus vulgaris or chronic venous ulcers), and radiodermatitis. Fair-skinned people, who have less protection from melanin, have a higher incidence of squamous cell carcinoma. The earliest signs are usually erythema and induration. The overlying [...]
Cutaneous T-cell lymphoma is a rare cutaneous malignancy, previously called mycosis fungoides because of the fungating or mushroom-like tumors of the advanced disease. Caused by a subset of T lymphocytes that normally migrate to the skin, the disease begins as poorly defined eczematous or psoriasiform patches that evolve into plaques and finally tumors or diffuse [...]
Lentigo maligna (Hutchinson’s freckle) is a primalignant pigmented macular lesion, often > 1 cm in diameter with an irregular border. The lesion appears predominantly on sun-exposed areas (most commonly, the cheeks and forehead). Pigmentation is characteristically varied,with brown, black, red, and white areas often found in a single lesion. Lentigo maligna gradually enlarges and becomes [...]
Nodular melanoma accounts for about 15% of all melanomas and is more common in the elderly than in the young. The lesions are small, darkly pigmented papules that often enlarge rapidly. Rarely, the melanoma may be amelanotic and therefore pink. Whenever melanoma is suspected, a deep excisional or incisional biopsy should be performed. An experienced [...]
This lesion accounts for about 60% of all melanomas and is the most common form in the elderly. Although the overall incidence of this melanoma peaks in middle age, its age-specific incidence increases through the eighth decade. This type of melanoma appears as a pigmented plaque with an irregular border and variable pigmentation. Like all [...]
