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Field cancerization
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Field cancerization

Contributors: Casey P. Schukow DO, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

The concept of field cancerization (FC) was first used to describe the presence of islands of pathologic tissue in the normal tissue of patients with oropharyngeal carcinomas. Cutaneous FC describes the presence of widespread epidermal atypia, including multiple actinic keratoses (AK), keratinocyte carcinomas (squamous cell carcinomas in situ [SCCis], and invasive squamous cell cancers [SCCs]) arising in chronically sun-damaged skin (the "field").

Ultraviolet radiation (UVR) is the greatest risk factor for FC of the skin. UVR causes FC by inducing key genetic mutations that alter appropriate epidermal cell recycling and apoptotic regulators. Mutations in these markers, especially TP53 and NOTCH, allow for the progression from AK to invasive cutaneous cancers (eg, SCC).

Present data, although limited, suggests both a steady increase in AK prevalence and keratinocyte carcinoma incidence in the United States. At-risk populations include persons of increasing age, chronic UVR exposure, fair skin, male sex, and immunosuppression (eg, solid organ transplant recipients, patients with chronic lymphocytic leukemia).

Codes

ICD10CM:
C44.92 – Squamous cell carcinoma of skin, unspecified
D04.9 – Carcinoma in situ of skin, unspecified
L57.0 – Actinic keratosis

SNOMEDCT:
189565007 – Squamous cell carcinoma in situ
201101007 – Actinic keratosis
402815007 – Squamous cell carcinoma

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Differential diagnosis of multiple AKs:

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:02/09/2022
Last Updated:02/16/2022
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Field cancerization
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A medical illustration showing key findings of Field cancerization
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