Zagadnienia dotyczące diagnostyki dermoskopowej oraz leczenia rogowacenia słonecznego i raka śródnaskórkowego

Among non-melanoma skin cancers, squamous cell carcinoma (SSC) ranks second after basal cell carcinoma. It can grow “de novo” or as a result of actinic keratosis (AK) foci and intraepidermal carcinoma (IEC) malignancy [1].
The aim is to familiarize practitioners with the use of dermoscopy in the diagnosis of AK and IEC.
Patient A., 72 years old, went to the hospital with complaints about the presence of a single rash element on the right cheek and periodic itching. The lesion appeared many years ago, gradually increased in size and became covered with scales. The patient was often in the open sun for a long time without protection. Objectively, in the projection of the right cheek, an inhomogeneous pink spot up to 5 cm in size is observed with hyperkeratotic layers on the surface and signs of multiple injuries. On the periphery of the lesion, the erythema is more pronounced (fig. 1 A).
Dermoscopy shows that the morphology of lesion is chaotic, with surface crusted scale on a background of a red vascular pseudonetwork, representing dilated vessels of the horizontal dermal plexus (fig. 1 B).
The patient was diagnosed with AK and prescribed cryotherapy. On control examination, the area of the scar showed no features. The patient was recommended to avoid UV, use sunscreens, and attend follow-up visits once a year.
Patient B., 46 years old, went to the hospital with complaints about the presence of a single rash element in the area of the upper pole of the cartilage of the right auricle. The rash appeared more than a year ago. It has been itching lately. Objectively, in the specified area an erythematous spot of 1 x 0.8 cm, oval in shape with peeling on the surface was seen (fig. 2 A).
Dermoscopy reveals glomerular vessels in a random arrangement. Peripherally linear vessels are apparent, being the normal dermal plexus vessels at that location (fig. 2 B).
On the basis of the clinical and dermoscopic features, IEC was diagnosed, and the lesion was treated by cryosurgery with uneventful recovery, follow-up visits once a year are recommended.
Actinic keratosis typically represents as red scaly macules and plaques of chronically sun-exposed areas. Lesions can be single, located in different anatomical areas or multiple [2].
In case of insufficient or contradictory clinical data, the use of dermoscopy is recommended. When using this method, it is possible to see the signs of AK with greater reliability than when...


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