TOC and Sample Chapters - McGraw-Hill Professional
TOC and Sample Chapters - McGraw-Hill Professional
TOC and Sample Chapters - McGraw-Hill Professional
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234 Part I Disorders Presenting in the Skin <strong>and</strong> Mucous Membranes<br />
Figure 11-7. Squamous cell carcinoma: invasive on the lip A large but subtle nodule, which is better felt than<br />
seen, on the vermilion border of the lower lip with areas of yellowish hyperkeratosis. This nodule can be felt to infiltrate<br />
the entire lip.<br />
keratotic scale or hyperkeratosis (Figs. 11-1,<br />
11-7–11-9 <strong>and</strong> 11-12); when eroded or ulcerated,<br />
the lesion may have a crust in the center <strong>and</strong> a<br />
firm, hyperkeratotic, elevated margin (Figs. 11-8<br />
<strong>and</strong> 11-9). Horny material may be expressed<br />
from the margin or the center of the lesion (Figs.<br />
11-8, 11-9 <strong>and</strong> 11-11). Erythematous, yellowish,<br />
skin color; hard; polygonal, oval, round (Figs.<br />
11-7 <strong>and</strong> 11-11), or umbilicated <strong>and</strong> ulcerated.<br />
Distribution. Usually isolated but may be multiple.<br />
Usually exposed areas (Fig. 11-6). Sun-induced<br />
keratotic <strong>and</strong>/or ulcerated lesions especially on<br />
the bald scalp (Fig. 11-1), cheeks, nose, lower<br />
lips (Fig. 11-7), ears (Fig. 11-12), preauricular area,<br />
dorsa of the h<strong>and</strong>s (Fig. 11-11), forearms, trunk,<br />
<strong>and</strong> shins (females).<br />
Other Physical Findings. Regional lymphadenopathy<br />
due to metastases.<br />
Special Features. In UV-related SCC evidence<br />
of dermatoheliosis <strong>and</strong> solar keratoses. SCCs of<br />
the lips develop from leukoplasia or actinic<br />
cheilitis; in 90% of cases they are found on
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