Dr. Sushil Kakkar
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My mother fell on her right arm. A few days later she noticed a wound on the dorsum of the right arm but was not sure if it was from the fall. She did not care for it nor treat it. About a week later she started disinfecting and covering it but decided to visit a dermatologist as she was afraid it might be something else. Upon the looks of it, the doctor wanted a biopsy as she said it could be cancerous too. While waiting for the results the wound closed and decreased in size and signs of inflammation are gone.
Today we got the results and it says ” hypodermis and dermis with hyperkeratosis, severe dysplasia of the squamous epithelium, chronic inflammatory changes in the dermis”. Now I started reading to try and understand and what confuses me is the ” severe dysplasia of squamous epithelium” Is that carcinoma in situ? In some literature they differentiate the two in others they claim it is the same.
I also came upon the fact that when there is an ulcer or inflammation reactive atypia and dysplasia may look the same hence the dysplasia may be from the inflammation. How is that determined? Is it a wound that is in the stages of healing or is it precancerous? What should be done in this case?
Can we wait for one or two weeks to see if the crust will fall as in a healing wound and then perhaps have a biopsy on clean skin or should it be removed immediately with a suspicion that it might progress to cancer? If it should be removed what is the time frame? Should it be done immediately? I also talked to a surgeon friend who thinks if it is cut immediately it would cause a bigger wound which might be slow to heal again. I have attached the progression of the wound.
Hi,
Welcome to icliniq.com.
I have seen the attachment. (attachment removed to protect patient identity).
This could be cancer. However, there is no harm in waiting for a week or 10 days and then perhaps go for an excision if it does not heal by then. Cutaneous SCC (squamous cell carcinoma) is usually not very aggressive and in most cases excision surgery with a margin of normal skin is curative.
Patient's Query
Thank you doctor,
But what does the histology report mean? What is severe dysplasia? I read a lot and came upon the fact that dysplasia is, one is cancer, and another is low to high grade dysplasia, then in situ? Is that true? If the material for the biopsy was a syringe, is it probably a needle aspiration?
Hi,
Welcome back to icliniq.com.
Dysplasia is an epidermal precancerous lesion. It may be mild, moderate or severe depending on the degree of atypicality. As long as this process is above the basement membrane (BM), it is in situ and noninvasive. It becomes invasive if it extends below the BM zone. The best way to know whether it is invasive or in situ is by excision biopsy. Needle aspiration would not be able to tell whether it is epidermal or invasive.
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Dermatology
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