Actinic keratosis is squamous cell carcinoma.

BACKGROUND: The prevalence of nonmelanoma skin cancer in the United States is alarming. It can be most appropriately treated if the earliest manifestation of cutaneous squamous cell carcinoma is recognized. METHODS: Clinical, histologic, and molecular biology, considerations were reviewed to determine whether actinic keratosis is the earliest clinical manifestation of cutaneous squamous cell carcinoma. RESULTS: The clinical, histologic, and molecular parameters of actinic keratosis are those of squamous cell carcinoma. CONCLUSION: Actinic keratosis does not transform, convert, or progress into cutaneous squamous cell carcinoma but is the earliest clinically recognizable manifestation of this malignancy.

Organizing state dermatologic societies.

Each year state legislatures, boards of medicine, departments of insurance, and other authorities promulgate laws and rules that affect the daily practice of dermatology. It is critical that dermatologists in each state form and maintain a strong state dermatologic society. Specific suggestions for forming and strengthening such societies are described and available resources are reviewed.

Dermatology. Positioned for health care reform.

Dermatologic services will of necessity be a fundamental part of any quality, cost-conscious health care system because (1) we treat medically necessary and economically significant diseases, (2) our area of expertise includes a distinct body of medical knowledge over which no other health professional has comparable expertise, and (3) our services are provided in a cost-effective manner.

Microcystic adnexal carcinoma (sclerosing sweat duct carcinoma).

Microcystic adnexal carcinoma is a relatively uncommon tumor first described in 1982. Most commonly presenting as a facial plaque or nodule, this highly invasive tumor is characterized by slow growth and relentless local destruction. We report the presence of microcystic adnexal carcinoma in the neck, a previously unreported site. The patient was a 48-year-old man who had received radiation therapy at age 5 to shrink the thymus gland and subsequent radiation therapy after excision of a thyroid tumor at age 35. The results of immunohistochemical stains were consistent with the hypothesis that this tumor develops from pluripotential cells capable of follicular and eccrine differentiation.

Universal health coverage.

Although over 12% of our gross national product is spent on health care, approximately 14% to 17% of Americans are not covered by any form of health insurance. The cost, benefits, and deficiencies of private insurance and government programs are discussed in this article. The increasing percentage of persons surviving into older age, improved technology, patient demands and expectations, administrative costs, medical malpractice and defensive medicine, and other factors contribute to the steadily increasing cost of care. Physicians must participate in health care reform or passively accept determinations made in their absence.

Physician advertising.

Practically nonexistent until the late 1970s, advertising by physicians has become commonplace. Although informational and educational advertising may contain information that potential patients may find to be useful, laudatory and predatory advertising are unethical and may be patently illegal. There is a conflict between the obligations of a physician to his patients and the intentions of advertising. The role of the Federal Trade Commission and state regulations are discussed.

Ethics in pharmaceutical advertising.

Pharmaceutical manufacturing is one of the most financially lucrative industries in America due, in part, to massive marketing and advertising. The content of many symposia and medical journals as well as physician prescribing decisions seems to be influenced by the promotional efforts of pharmaceutical companies. In an effort to increase sales, the industry now advertises directly to the public. The role of the Food and Drug Administration and ethical standards established by medical organizations are discussed.

Dysplastic (atypical) nevi: significance and management.

The frequency of malignant melanoma is rising at an alarming rate. Familial dysplastic nevi have been shown to be markers for and perhaps even precursors of malignant melanoma. This paper addresses the clinical and histologic features of these lesions, the structural and functional abnormalities of the melanocytes present in dysplastic nevi, the systemic and genetic abnormalities seen in patients with the dysplastic nevus syndrome, and the risk of melanoma in persons with dysplastic nevi. Management of persons with dysplastic nevi should include stressing sunlight avoidance and self-examination, deciding which lesion(s) to surgically excise, a schedule of visits to the physician, the possible use of photography, and the need to individualize patient management.

Cutaneous aging: effect of intrinsic changes on surgical considerations.

Intrinsic age-related structural and functional changes in the skin, independent of sun-induced damage, directly affect wound healing in the elderly. These alterations, as well as concomitant medical illness, pharmaceutical intake, and dietary changes, result in delayed wound healing, decreased ultimate tensile strength, and increased rates of wound dehiscence, ecchymosis, tape-strip injuries, infection, and persistent contact dermatitis.

Basal cell, squamous cell, and sebaceous gland carcinomas of the periorbital region.

It is important that clinicians suspect malignancy in patients who have persistent or nonhealing periorbital lesions. Basal cell carcinoma, squamous cell carcinoma, and sebaceous gland carcinoma of the eyelids are frequently misdiagnosed clinically and, in the case of squamous cell and sebaceous gland carcinomas, histologically as well. Prompt and adequate biopsy can facilitate early diagnosis and thus avoid unnecessary metastatic spread in the case of squamous cell carcinoma and sebaceous gland carcinoma, as well as the extensive local destruction that basal cell carcinoma may produce.

Dowling-Degos disease, hidradenitis suppurativa, and multiple keratoacanthomas. A disorder that may be caused by a single underlying defect in pilosebaceous epithelial proliferation.

We report a case in which one patient had Dowling-Degos disease (reticulate pigmented anomaly of the flexures), hidradenitis suppurativa, and multiple keratoacanthomas. Abnormal epithelial proliferation involving mainly the pilosebaceous apparatus has been recognized in all three conditions. We speculate that a single underlying defect in follicular epithelial proliferation, characterized by variable expressivity, accounts for the coexistence of these clinically distinct disorders of follicular derivation.

Photoaging and the skin: differentiation and clinical response.

Extrinsic aging changes caused by habitual exposure to ultraviolet light are often erroneously confused with intrinsic aging alterations due to chronologic aging. We compare the clinical, histologic, and biochemical changes related to chronic sun exposure--photoaging--with normal skin changes related to aging.

Skin changes of aging: pathological implications.

Skin changes caused by the natural aging process (intrinsic aging), as opposed to environmental assault (extrinsic aging), are now recognized and delineated. These alterations play a role in the etiopathogenesis of many of the skin problems that develop in elderly patients. Structural and functional changes that occur in normal aging skin are discussed with respect to their relationship to common skin disorders in the elderly.