The term “precancerous lesions” refers to diseases that appear with an elevated risk of developing cancer. With an early and appropriate treatment, we succeed in having high percentages of cure.

The term refers to conditions which are a result of long-term accumulating harmful effect of sunlight. They are usually observed at ages over 40 and are slightly more frequent to men. People who have fair skin, that do not react with “normal” tanning when exposed to solar radiation develop those lesions more often. On the contrary, dark-skinned individuals scarcely develop actinic keratosis. This fact is related to the protection that melanin provides to the skin.

The keratoacanthoma is a relatively ordinary tumor, which causes worry to the patient due to its speedy growth. It often poses a problem of differential diagnosis with its highly malignant squamous cell carcinoma. It appears on the face at a percentage of 70%, on the palmar surface of the hands at a percentage of 15-20% and more seldom on the chest, thigh, shoulder and perigenital area.

The cutaneous corn is a hyperkeratotic conical projection on the surface of the skin. It appears mainly on men between the sixth and seventh decade of their lives. The lesion is more often detected on the skin of solar radiated areas of the body, mainly on the face, on the auricle of the ears and on the dorsal surface of the hands. This is connected in most circumstances with the destruction which has been made on the skin with the long term effect of solar radiation. It is less appeared on non-solar exposed areas.

Chondrodermatitis nodularis helicis is about exceptional sensitive and persistent lesion, which usually is detected on the horizontal part of the helix of the ear. It appears on people over 40 years old, more often on men. In most cases women are contracted by the lesion on the antihelix of the ear. The pain is acute and during the day it remits slightly. The pressure applied by the pillow exacerbates the pain, forcing the patient to change the side and affecting the quality of sleep.

The term refers to an intraepidermic (“in situ”) carcinoma of the skin. It affects men slightly more often than women. It appears on exposed or relatively safe from the sum areas of the skin. The lesions may be caused by sunlight, other types of radiation, chemical substances or the viruses of the human papillomas (HPV – Human Papillomavirus).

Refers to congenital lesion where on all occasions is already visible on the newly born or is developed during early childhood. It is located more often on the scalp, on forehead or postauricular area.

The nevus sebaceous of Jadasshon remains stable during childhood while at the beginning of puberty there appear significant changes. Depending on the area of its detection it may cause aesthetic problems to the patient.

While the possibility of malignant spreading during adulthood of patient is quite large (3-20 %), preventive surgical excision and biopsy of the lesion is recommended.

Leukoplakia is a descriptive clinic term and refers to white spots or plague of the oral mucosa, for which biopsies have not been executed yet and for this reason definite diagnosis has not been confirmed. There is an increased danger of malignant transformation of the lesion in the course of time especially when it is detected on the bottom surface of the tongue or on the floor of the oral cavity. The factors that foster the malignant transformation are smoking, chronic trauma, alcohol, ultraviolet radiation and some types of the human papilloma virus (HPV).

Erythroplakia of Queyrat is about clinical disease of the mucous, which histologically presents the image of intraepidermic (“in situ”) carcinoma. The most frequent detection is under the foreskin of the penis, on people who have not been submitted to circumcision. Least appeared positions of detection of this lesion are the tongue, oral and vaginal mucosa.

The factors that predispose to the penal development of the disease are the sebum, inadequate local sanitation, regression of herpes simplex virus of the genitals, high temperature conditions, mechanical friction and injuries.

It is possible that the disease may persist after many years. Erythroplakia of Queyrat is defined with a greater tense of infiltrative carcinoma development, in comparison to the Bowen’s disease. These squamous cell carcinomas metastasize to a percentage of 10 -30%. Lesions that clinically do not resemble the carcinoma may give metastasis.

Surgical removal is considered the treatment of choice and at the same time a histological examination is always required for clarification of the malignant or non-malignant nature of the lesions.

Chronic actinic dermatitis refers to chronic lesions which appear secondary to radiotherapy or after exposure to ionize radiation for occupational reasons. These chronic deteriorations are a result of harmful effects of ionized radiation on a cellular level. Affected cells lose either partially or totally the ability of division or reproduction.

Degeneration and edema are observed on the skin which appears as a crumbly and atrophic skin surface. On the dermis appears cell dilution, mainly of the fibroblasts, resulting on decreased endurance and elasticity of the skin. On vascular tissue it presents thickening and fibrosis which leads to decreased vascular perfusion with serious healing problems. The subcutaneous fat is also affected and becomes atrophic. The follicles of hair also suffer resulting in thinning of hair line or total losing of hair. Also sebaceous and sweat glands are affected. As a consequence the skin surface becomes dry and rough.

Atrophy of tissue from radiation finally ends up to ulceration. The ulcer appear in the course of 5-20 years from the moment of radiotherapy and it usually begins as a minor injury. The possibility of development of cancer on a skin with radiotherapy after the passing of many years is increased. The most frequent tumors that appear are basal and squamous cell carcinomas. Squamous cell carcinomas which develop on the ground of a radiated area are considered as bad biological behavior and prediction because they often give metastasis. Less frequent appears a sarcoma which also has bad prediction.

The first therapeutical approach must be conservative treatment of ulcers. In the case where these ulcers do not show signs of improvement after a few weeks or when there is a confirmation of malignant transformation, the only effective therapy is the radical surgical removal of involved tissues. The excision includes all the radiated area. The reconstruction of the tissue defect is done with a flap of rich vascular perfusion.

Xeroderma pigmentosum is a rare and serious hereditary disease in which cutaneous effects are mainly appeared as multiple skin tumors. These people have an epidermal cell incompetency to repair the damage which is provoked by ultraviolet radiation in their DNA.

Firstly the areas exposed to sunlight react with the appearance of intense erythema. Later small dark spots-freckles appear. Small diameter atrophic skin zones are blended with hypopigmented lesions. These are covered with spider veins and therefore form a diverse image typical of the disease.

The appearance of tumors mostly modifies the course of the disease. 45-62 percent of these people develop basal cell or squamous cell carcinoma at an age between 1-32 years old. 97% of carcinomas are detected on the head or neck. Skin melanomas are seldom and complicate the freckles.

Very bad prognosis of xeroderma pigmentosum requests the execution of preventive measures and as much as possible the decrease of birth of children who shall appear with this syndrome. This is managed with provision of genetic nature advice and with prenatal diagnosis. To improve the prognosis we try to protect these people from the environmental factors which may spark the developing procedure and the appearance of carcinomas.