Genital Warts Detection

Since genital warts are not always visible, it is necessary that sexually active individuals undergo physical examinations from time to time.
Genital warts are skin bumps or skin growths, which can be raised or flat on the skin. These warts are caused by HPV viruses or human
papillomavirus.genital warts treatment Many people are concerned about genital warts but are not sure how to cure them.

The reason why these warts are not visible, nor are detectable, is that there are no symptoms for it.  They don’t cause skin itching or pain. They are almost the color of flesh, not to mention the fact that they are small in size and are found at the genital areas. It takes a physician to check with a magnifying glass to check if what a patient has are mere skin growths or genital warts.

It is important because when warts are left untreated, it can lead to cervical cancer for women and cancer of the penis for men.

Genital Warts…

* They can begin to retreat back into the skin until they vanish!

* They can begin to get mushy and dissolve away until there is no trace left

* They can simply dry up and flake off like a scab!

Everyone is in shock when they first discover their genital warts! The good news is that warts are very treatable. The most important thing with genital wart symptoms is to treat them as soon as you notice them. Seeking treatment should be your number 1 priority! Get rid of the embarassement! They may eventually go away on their own, but not before growing and spreading and becoming itchy and possibly bleeding.

Below is a home genital treatment guide based on all of the information we have collected and reports that GenitalWartsFAQ.com has online.

This is not medical advice, this is not to replace the treatments or directions of your doctor. This is something you can think about, maybe it’s midnight and your doctor isn’t open. We still do recommend that if you haven’t seen a doctor that you do so. We’ll start here.

What type of doctor should I see for Genital Wart / HPV treatment?
Depending on what area you’re in, the cheapest solution is to visit a clinic specializing in sexual transmittable diseases (STDs). Planned Parenthood is one such clinic.

Home Treatments that have in many cases reduce the spread or killed the genital warts
Before we cover the home treatments, we are going to make these recommendations that should go with any treatment that you choose.

* Quit Smoking
The carbon monoxide in smoke robs our body of oxygen, which is the most important part of the immune system. White Blood cells attack viruses and they require oxygen. Additionally, there are many other carcinogens and poisons in smoke that reduce the bodies ability to focus on it’s job – healing and preventing viruses and infections.

* Switch to cotton underwear
Genital warts thrive in dark and moist areas. Polyester and other materials do not breathe as well as cotton. Cotton will help prevent moisture from accumulating and keep the area more dry, which will keep the genital warts out of their ideal conditions.

* Get rest
Rest is important for the immune system. If you do not get rest, your body does not have the energy to perform all of it’s functions correctly.
“Sleep deprivation weakens the immune system leaving us more susceptible to other diseases and disorders like diabetes, cancer and even the common cold” – About.com Sleep Disorders

* Drink plenty of water
Sodas, particularly Diet sodas act as diuretics which remove more water from our body than they put in. We are 2/3 water, and water is how our body flushes toxins.

* Take a multi-vitamin
Most people are not meeting RDA requirements for vitamins. As well all know, vitamins are important to the function of all aspects of the body.

Vitamins to make sure you’re getting:

1. Vitamin C
“Vitamin C is an antioxidant that is required for at least three hundred metabolic functions in the body, including tissue growth and repair, adrenal gland function, and healthy gums. It also aids in the production of anti-stress hormones and interferon, an important immune system protein, and is needed for the metabolism of folic acid, tyrosine, and phenylalanine. Studies have shown that taking vitamin C can reduce symptoms of asthma. It protects against the harmful effects of pollution, helps to prevent cancer, protects against infection, and enhances immunity. Vitamin C increases the absorption of iron. It can combine with toxic substances, such as certain heavy metals, and render them harmless so that they can be eliminated from the body.” -

Prescription for Nutritional Healing

2. Zinc
“The immune system is adversely affected by even moderate degrees of zinc deficiency. Severe zinc deficiency depresses immune function. Zinc is required for the development and activation of T-lymphocytes, a kind of white blood cell that helps fight infection (2, 28). When zinc supplements are given to individuals with low zinc levels, the numbers of T-cell lymphocytes circulating in the blood increase and the ability of lymphocytes to fight infection improves. Studies show that poor, malnourished children in India, Africa, South America, and Southeast Asia experience shorter courses of infectious diarrhea after taking zinc supplements (29). Amounts of zinc provided in these studies ranged from 4 mg a day up to 40 mg per day and were provided in a variety of forms (zinc acetate, zinc gluconate, or zinc sulfate) (29). Zinc supplements are often given to help heal skin ulcers or bed sores (30), but they do not increase rates of wound healing when zinc levels are normal.” – National Institute of Health, Office of Dietary Supplements

Apple Cider Vinegar
There are no clinical studies to support Apple Cider Vinegar(ACV) as a genital wart treatment, however many people have tried it including members of GenitalWartsFAQ.com with success.

ACV can be purchased from you local drug or grocery store. To apply ACV, dip the tip of a cotton swap into the ACV then apply it to the wart and hold for up to 15 minutes. Repeat this process 3 times daily.

In one particular confirmed GenitalWartsFAQ.com member case, this killed several of the warts, and stopped the spreading allowing the smaller warts to also be treated without any new growth.

Salicylic Acid
Salicylic acid has shown to be an effective treatment for warts. Salycylic acid is available at drug and grocery stores – it is the active ingredient in the swabs used for acne. Use this product as described and intended – the package does not state that it is for treatment of genital warts.
40% Salicylic Acid
Dr. Scholl’s Soft Salicylic Acid Corn Remover Pads - $2.85 to $5.39

17% Salicylic Acid
Wart-Off Maxiumum Strength - $7.49 - $8.80

2% Salicylic Acid
Nuetrogena Acne Rapid Clear Daily Pads - $8.49 - $12.34

Stridex Triple Action Acne Pads -  $4.29 - $6.49

Cryotherapy
This treatment is only available at a doctors office, however if you have warts in areas other than the genitals these are good solutions. These products available at your grocery store. These usually include a small can with an applicator tip. When the applicator tip is put on, and the bottom is pressed against the skin – the wart is frozen and dies.

Compound W Freeze Off Wart                  $23.00 - $27.00
Dr. Scholls Dual Action Freeze Away      $17.35 - $21.59
Wartner Wart Removal System                $23.09 - $24.19

Message from GenitalWartsFAQ.com
We cannot stress the importance enough of visiting a dermatologist or health clinic as soon as you notice symptoms. This is the quickest way to get rid of symptoms and to be evaluated by the doctor. If circumstances prevent this, then we encourage you to use this guide to help find a possible solution for your needs. Always use commercial products as directed. None of this replaces your doctors opinion about treatment.

For images on genital warts, click on this link:  http://cancer.about.com/od/hpv/a/HPVpictures.htm

Treating Warts on Children

Many of us have had a wart somewhere on our bodies at some time. Other than being a nuisance, most warts are harmless and go away on their own.  More common in kids than in adults, warts are skin infections caused by viruses of the human papillomavirus (HPV) family. They can affect any area of the body, but tend to invade warm, moist places, like small cuts or scratches on the fingers, hands, and feet. Warts are usually painless unless they’re on the soles of the feet or another part of the body that gets bumped or touched all the time.

Kids can pick up HPV — and get warts — from touching anything someone with a wart has used, like towels and surfaces. Kids who bite their fingernails or pick at hangnails tend to get warts more often than kids who don’t because they can expose less-protected skin and create open areas for a virus to enter and cause the wart.

Types of warts include:

* common warts. Usually found on fingers, hands, knees, and elbows, a common wart is a small, hard bump that’s dome-shaped and usually
grayish-brown. It has a rough surface that may look like the head of a cauliflower, with black dots inside.
* flat warts. These are about the size of a pinhead, are smoother than other kinds of warts, and have flat tops. Flat warts may be pink, light brown, or yellow. Most kids who get flat warts have them on their faces, but they can also grow on arms, knees, or hands and can appear in clusters.
* plantar warts. Found on the bottom of the foot, plantar warts can be very uncomfortable — like walking on a small stone.
* filiform warts. These have a finger-like shape, are usually flesh-colored, and often grow on or around the mouth, eyes, or nose.

Sometimes warts are sexually transmitted and appear in the genital area, but most warts appear on the fingers, hands, and feet.

Are Warts Contagious?

Simply touching a wart on someone doesn’t guarantee that you’ll get one, too. But the viruses that cause warts are passed from person to person by close physical contact or from a surface that a person with a wart touches, like a bathmat or a shower floor. (You can’t, however, get a wart from holding a frog or toad, as your child might have wondered!)

A tiny cut or scratch can make any area of skin more vulnerable to warts. Also, picking at a wart can spread warts to other parts of the body.
The length of time between when someone is exposed to the virus that causes warts and when a wart appears varies. Warts can grow very slowly and may take weeks or longer, in some cases, to develop.

Preventing Warts

Although there’s no way to prevent warts, it’s always a good idea to encourage kids to wash their hands and skin regularly and well. If your child has a cut or scratch, use soap and water to clean the area because open wounds are more susceptible to warts and other infections.

It’s also wise to have kids wear waterproof sandals or flip-flops in public showers, locker rooms, and around public pools (this can help protect against plantar warts and other infections, like athlete’s foot).

Treating Warts

Warts don’t generally cause any problems, so it’s not always necessary to have them removed. Without treatment, it can take anywhere from 6 months to 2 years for a wart to go away. A doctor might decide to remove a wart if it’s painful or interferes with activities because of the discomfort.

Doctors have different ways of removing warts, including:

* using over-the-counter or prescription medications to put on the wart
* burning the wart off using a light electrical current)
* freezing the wart with liquid nitrogen (called cryosurgery)
* using laser treatment (with recalcitrant warts)

Within a few days after the doctor’s treatment, the wart may fall off, but several treatments might be necessary. Doctors don’t usually cut off a wart because it can cause scarring and the wart may return.

If an older child has a simple wart on the finger, ask the doctor about using an over-the-counter wart remedy that can help remove the wart. This treatment can take several weeks or months before you see results, but eventually the wart should crumble away from the healthy skin. Wart medicines contain strong chemicals and should be used with care because they can also damage the areas of healthy skin. Talk with your doctor before using any over-the-counter wart medicine on the face or genitals.

Also make sure that your child:

* soaks the wart in warm water and removes dead skin on the surface of the wart with an emery board (that’s never going to be used for nails) before applying the medicine. Be careful not to file into it.
* keeps the area of the wart covered while the medicine works
* knows not to rub, scratch, or pick at it to avoid spreading the virus to another part of the body or causing the wart to become infected

You might also have heard that you can use duct tape to remove a wart. Talk to your doctor about whether this type of home treatment is OK for your child.

Seborrheic Keratosis or Seborrheic Verrucas

A seborrheic keratosis (also known as “Seborrheic verruca,” “Senile keratosis,” and “Senile wart” [1,2]  is a noncancerous benign skin growth that originates in keratinocytes. Like liver spots, seborrheic keratoses are seen more often as people age.[3] In fact they are sometimes humorously referred to as the “barnacles of old age”. [1]

They appear in various colors, from light tan to black. They are round or oval, feel flat or slightly elevated (like the scab from a healing wound), and range in size from very small to more than 2.5 centimetres (1.0 in) across.[4] They can resemble warts[3], though they have no viral origins. They can also resemble melanoma skin cancer, though they are unrelated to melanoma as well.

Because only the top layers of the epidermis are involved, seborrheic keratoses are often described as having a “pasted on” appearance. Some dermatologists refer to seborrheic keratoses as “seborrheic warts”, however these lesions are usually not associated with HPV, and therefore such nomenclature should be discouraged.

* 1 Classification
* 2 Variances of Seborrheic Keratosis
o 2.1 Dermatosis Papulosis Nigra
o 2.2 Stucco Keratosis
* 3 Diagnosis
* 4 Treatment
* 5 Cause
* 6 Etymology
* 7 References
* 8 External links

Classification

Seborrheic keratoses may be divided into the following types:[1]

* Common seborrheic keratosis (Basal cell papilloma, Solid seborrheic keratosis)
* Reticulated seborrheic keratosis (Adenoid seborrheic keratosis)
* Stucco keratosis (Digitate seborrheic keratosis, Hyperkeratotic seborrheic keratosis, Serrated seborrheic keratosis, Verrucous seborrheic keratosis)
* Clonal seborrheic keratosis
* Irritated seborrheic keratosis (Basosquamous cell acanthoma, Inflamed seborrheic keratosis)
* Seborrheic keratosis with squamous atypia
* Melanoacanthoma (Pigmented seborrheic keratosis)
* Dermatosis papulosa nigra

Also see:

* The sign of Leser-Trélat
Variances of Seborrheic Keratosis or Dermatosis Papulosis Nigra

Often are small papules. Pinpoint to a few millimeters in size. More commonly found in dark-skinned persons.[5]

Stucco Keratosis

Often are light brown to off-white. Pinpoint to a few millimeters in size. Often found on the distal tibia, ankle, and foot.[6]

Diagnosis

Visual diagnosis is made by the “stuck on” appearance, horny pearls or cysts embedded in the structure. Darkly pigmented lesions can be hard to distinguish from nodular melanomas. [7] If in doubt, a skin biopsy should be performed. Thin seborrheic keratoses on facial skin can be very difficult to differentiate from lentigo maligna even with dermatoscopy. Clinically, epidermal nevi are similar to seborrheic keratoses in appearance. Epidermal nevi are usually present at or near birth. Condylomas and warts can clinically resemble seborrheic keratoses, and dermatoscopy can be helpful. On the penis and genital skin, differentiation between condylomas and seborrheic keratoses can be difficult and may require a skin biopsy.

Treatment

When correctly diagnosed, no treatment is necessary[3]. There is a small risk of localized infection caused by picking at the lesion. If a growth becomes excessively itchy or is irritated by clothing or jewelry, it can be removed by cryosurgery.  Small lesions can be treated with light electrocautery. Larger lesions can be treated with electrodessication and curettage, shave excision, or cryotherapy. When correctly performed, removal of seborrheic keratoses will not cause much visible scarring except in darkly colored persons.

Cause

The cause of seborrheic keratosis is unclear[3]. Because they are common on sun-exposed areas such as the back, arms, face, and neck, ultraviolet light may play a role, as may genetics.[8] A mutation of a gene coding for a growth factor receptor, (FGFR3), has been associated with seborrheic keratosis.[9]

Etymology
The term “seborrheic keratosis” combines the adjective form of seborrhea[10], keratinocyte (referring to the part of the epidermis that produces keratin), and the suffix -osis, meaning abnormal.[11]

References

1. ^ a b Freedberg, et. al. (2003). Fitzpatrick’s Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0071380760.
2. ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews’ Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921

-0.
3. ^ a b c d Moles, Freckles, Skin Tags, Benign Lentigines, and Seborrheic Keratoses from the Cleveland Clinic website
4. ^ Seborrheic keratosis: Symptoms, from the Mayo Clinic website
5. ^ http://www.emedicine.com/derm/topic99.htm
6. ^ http://www.emedicine.com/derm/TOPIC407.HTM
7. ^ http://www.dermadoctor.com/article_Seborrheic-Keratoses_91.html
8. ^ Seborrheic keratosis: Causes, from the Mayo Clinic website
9. ^ Hafner C, Hartmann A, Vogt T (2007). “FGFR3 mutations in epidermal nevi and seborrheic keratoses: lessons from urothelium and skin”. J.

Invest. Dermatol. 127 (7): 1572–3. doi:10.1038/sj.jid.5700772. PMID 17568799.
10. ^ Seborrheic, from Merriam-Webster’s online medical dictionary
11. ^ Suffix “-osis” from the Merriam-Webster website

Skin Biopsies and Skin Lesions

Skin biopsy is a biopsy technique in which a skin lesion is removed and sent to the pathologist to render a microscopic diagnosis. It is usually done under local anesthetic in a physician’s office, and results are often available in 4 to 10 days. It is commonly performed by dermatologists.

Skin biopsies are also done by family physicians, internists, surgeons, and other specialties. However, performed incorrectly, and without appropriate clinical information, a pathologist’s interpretation of a skin biopsy can be severely limited. There are four main types of skin biopsies: shave biopsy, punch biopsy, excisional biopsy, and incisional biopsy. The choice of the different skin biopsies is dependent on the suspected diagnosis of the skin lesion.

Like most biopsies, patient consent and anesthesia (usually lidocaine injected into the skin) are prerequisites.

Different types of skin biopsies

Shave biopsy

This is done with either a small scalpel blade, a curved razor blade, or a broken piece of “safety” razor. The technique is very much user skill dependent, as some surgeons can remove a small fragment of skin with minimal blemish using any one of the above tools, while others have great difficulty securing the devices. Ideally, the razor will shave only a small fragment of protruding tumor and leaving the skin relatively flat after the procedure. Hemostasis is obtained using light electrocautery, Monsel solution, or aluminum chloride. This is the ideal method of diagnosis for basal cell
cancer.

It can be used to diagnose squamous cell carcinoma and melanoma-in-situ, however, the doctor’s understanding of the growth of these last two cancers should be considered before one uses the shave method. The punch or incisional method is better for the latter two cancers as a false negative is less likely to occur (i.e. calling a squamous cell cancer an actinic keratosis or keratinous debris). Hemostasis for the shave technique can be difficult if one relied on electrocautery alone. A small “shave” biopsy often ends up being a large burn defect when the surgeon tries to control the bleeding with electrocautery alone. Pressure dressing or chemical astringent can help in hemostasis in patients taking anticoagulants.

Punch biopsy

This is done with a round shaped knife ranging in size from 1mm to 8 mm. Some punch biopsies are shaped like an ellipse, although one can accomplish the same desired shape with a standard scalpel. The 1 mm and 1.5 mm punch are ideal for locations where cosmetic appearance is difficult to accomplish with the shave method. Minimal bleeding is noted with the 1 mm punch, and often the wound is left to heal without stitching for the smaller punch biopsies. Disadvantage of the 1 mm punch is that the tissue obtained is almost impossible to see at times due to small size, and the 1.5 mm biopsy is preferred in most cases. The common punch size use to diagnose most inflammatory skin condition is the 3.5 or 4 mm punch. Ideally, the punch biopsy include the full thickness skin and subcutanous fat in the diagnosis of skin disease

Incisional biopsy

When a cut is made through the entire dermis down to the subcutanous fat. A punch biopsy is essentially an incisional biopsy, except it is round rather than elliptical as in most incisional biopsies done with a scalpel. Incisional biopsies can include the whole lesion (excisional), part of a lesion, or part of the affected skin plus part of the normal skin (to show the interface between normal and abnormal skin). Incisional biopsy often yield better diagnosis for deep pannicular skin diseases and more subcutanous tissue can be obtained than a punch biopsy. Long and thin deep incisional biopsy are excellent on the lower extremities as they allow a large amount of tissue to be harvested with minimal tension on the surgical wound. Advantage of the incisional biopsy over the punch method is that hemostasis can be done more easily due to better visualization. Dog ear defects are rarely seen in incisional biopsies with length at least twice as long as the width.

Excisional biopsy

This is essentially the same as incisional biopsy, except the entire lesion or tumor is included. This is the ideal method of diagnosis of small melanomas (when performed as an excision). Ideally, an entire melanoma should be submitted for diagnosis if it can be done safely and cosmetically. This “excisional” biopsy is often done with a narrow margin to make sure the deepest thickness of the melanoma is given before prognosis is decided. However, as many melanoma-in-situs are large and on the face, a physician will often chose to do multiple small punch biopsies before committing to a large excision for diagnostic purpose alone. Many prefer the small punch method for initial diagnostic value before resorting to the excisional biopsy. An initial small punch biopsy of a melanoma might say “severe cellular atypia, recommend wider excision”. At this point, the clinician can be confident that an excisional biopsy can be performed without risking committing a “false positive” clinical diagnosis.

Curettage biopsy

This can be done on the surface of tumors or on small epidermal lesions with minimal to no topical anesthetic using a round curette blade. Diagnosis of basal cell cancer can be made with some limitation, as morphology of the tumor is often disrupted. The pathologist must be informed about the type of anesthetic used, as topical anesthetic can cause artifact in the epidermal cells. Liquid nitrogen or cryotherapy can be used as a topical anesthetic, however, freezing artifact can severely hamper the dianosis of malignant skin cancers.

Fine needle aspirate

Needle aspiration biopsy[1] is done with the rapid stabbing motion of the hand guiding a needle tipped syringe and the rapid sucking motion applied to the syringe. It is a method used to diagnose tumor deep in the skin or lymphnodes under the skin. The cellular aspirate is mounted on a glass slide and immediate diagnosis can be made with proper staining or submitted to a laboratory for final diagnosis. A fine needle aspirate can be done with simply a small bore needle and a small syringe (1 cc) that can generate rapid changes in suction pressure. Fine needle aspirate can be used to distinguish a cystic lesion from a lipoma. Both the surgeon and the pathologist must be familiar with the method of procuring, fixing, and reading of the slide. Many center have dedicated team used in the harvest of fine needle aspirate.

Saucerization biopsy

Also known as “scoop”, “scallop”, or “shave” excisional biopsy[2], or “shave” excision. A trend has occurred in dermatology over the last 10 years with the advocacy of a deep shave excision of a pigmented lesion [3] [4] [5] An author published the result of this method and advocated it as better than standard excision and less time consuming. The added economic benefit is that many surgeons bill the procedure as an excision, rather than a shave biopsy. This saves the added time for hemostasis, instruments, and suture cost. The great disadvantage, seen years later is the numerous scallop scars, and a very difficult to deal with lesions called a “recurrent melanocytic nevus”, see recurrent nevus. What has happened is that many “shave” excisions do not adequately penetrate the dermis or subcutanous fat enough to include the entire melanocytic lesion. Residual melanocytes regrow into the scar. The combination of scarring, inflammation, blood vessels, and atypical pigmented streaks seen in these recurrent nevus gives the perfect
dermatoscopic picture of a melanoma[6][7][8][9]. When a second physician re-examines the patient, he or she has no choice but to recommend the reexcision of the scar.

If one does not have access to the original pathology report, it is impossible to tell a recurring nevus from a severely dysplastic nevus or a melanoma. As the procedure is widely practiced, it is not unusual to see a patient with dozens of scallop scars, with as many as 20% of the scar showing residual pigmentation. The second issue with the shave excision is fat herniation, iatrogenic anetoderma, and hypertrophic scarring. As the deep shave excision either completely removes the full thickness of the dermis or greatly diminishes the dermal thickness, subcutanous fat can
herniate outward or pucker the skin out in an unattractive way. In areas prone to friction, this can result in pain, itching, or hypertrophic scarring.

The Pathology Report

A pathology report is highly dependent on the quality of the biopsy that is submitted. It is not unusual to miss the diagnosis of a skin tumor or a skin biopsy due to a poorly performed or inappropriately performed skin biopsy. The clinical information provided to the pathologist will also affect the final diagnosis. An example would be a rapidly growing dome shaped tumor of the sun exposed skin. Despite doing a large wedge incision, a pathologist might call the biopsy keratin debris with characteristics of actinic keratosis. But provided with an accurate clinical information, he/she might consider the diagnosis of a well differentiated squamous cell carcinoma or keratoacanthoma. It is not infrequent for two, three or more biopsies to be performed by different doctors for the same skin condition, before the correct diagnosis is made on the final biopsy.

The method, depth, and quality of clinical data will all affect the yield of a skin biopsy. For this reason, doctors specializing in skin diseases are invaluable in the diagnosis of skin cancers and difficult skin diseases. Specific stains (PAS, DIF, etc), and certain type of sectioning (vertical and horizontal) are often requested by an astute physician to
make sure that the pathologist will have all the necessary information to make a good histological diagnosis.

References

1. ^ http://www.virtualcancercentre.com/investigations.asp?sid=3
2. ^ Saucerization biopsy of pigmented lesions . Clinics in Dermatology , Volume 23 , Issue 6 , Pages 631 - 635 J . Ho , R . Brodell , S . Helms
3. ^ http://escholarship.umassmed.edu/ssp/46/
4. ^ http://www.clinmedres.org/cgi/content/full/6/2/86
5. ^ http://www.aafp.org/afp/20021101/letters.html
6. ^ http://www.springerlink.com/content/u353473367570111/
7. ^ http://www.pathology-skin-rjreed.com/html/recurrent_nevus__c20t3_.htm
8. ^ http://dermoscopic.blogspot.com/2007/11/recurrent-nevus.html
9. ^ http://www.pathology-skin-rjreed.com/congenital_nevust_c7bt2_.HTM

Pseudomelanoma AKA Recurrent Nevus

Pseudomelanoma (also known as a “Recurrent nevus”) is a cutaneous condition in which melantic skin lesions clinically resemble a superficial spreading melanoma at the site of a recent shave removal of a melanocytic nevus.

Problem with the Recurrent Nevus

The melanocytes left behind in the wound regrows in an abnormal pattern. Rather than the even and regular lace like network, the pigments tends to grow in streaks of varying width within the scar. This is often accompanied by scarring, inflammation, and blood vessel changes - giving both the clinical and histologic impression of a melanoma or a severe dysplastic nevus. When the patient is reexamined years later without the assistance of the original biopsy report, the physician will often require the removal of the scar with the recurrent nevus to assure that a melanoma is not missed.

Saucerization biopsy

Also known as “scoop”, “scallop”, or “shave” excisional biopsy, or “shave” excision. A trend has occurred in dermatology over the last 10 years with the advocacy of a deep shave excision of a pigmented lesion. An author published the result of this method and advocated it as better than standard excision and less time consuming. The added economic benefit is that many surgeons bill the procedure as an excision, rather than a shave biopsy.

This save the added time for hemostasis, instruments, and suture cost. The great disadvantage, seen years later is the numerous scallop scars, and a very difficult to deal with lesions called a “recurrent melanocytic nevus”. What has happened is that many “shave” excisions does not adequately penetrate the dermis or subcutanous fat enough to include the entire melanocytic lesion. Residual melanocytes regrow into the scar. The combination of scarring, inflammation, blood vessels, and atypical pigmented streaks seen in these recurrent nevus gives the perfect dermatoscopic picture of a melanoma.

When a second physicians re-examine the patient, he or she has no choice but to recommend the reexcision of the scar. If one does not have access to the original pathology report, it is impossible to tell a recurring nevus from a severely dysplastic nevus or a melanoma. As the procedure is widely practiced, it is not unusual to see a patient with dozens of scallop scars, with as many as 20% of the scar showing residual pigmentation. The second issue with the shave excision is fat herniation, iatrogenic anetoderma, and hypertrophic scarring. As the deep shave excision either completely remove the full thickness of the dermis or greatly diminishing the dermal thickness, subcutanous fat can herniate outward or pucker the skin out in an unattractive way. In areas prone to friction, this can result in pain, itching, or hypertrophic scarring.

See also

* Ballon cell nevus ; Balloon cell nevi are a cutaneous condition characterized histologically by large, pale, polyhedral balloon cells.

* Skin lesion; Most dermatoses present with skin lesions of more or less distinct characteristics. Macroscopically, these original lesions are known as the “primary lesion”, and identification of such lesions is “…the most important aspect of dermatologic examination.” However, these lesions may continue to develop or be modified by regression or trauma, producing “secondary lesions”. Additionally, on the microscopic level, these lesions can also be characterized by a distinct set of vocabulary.