atypical squamous proliferation skin cancer

Conjunctival squamous cell carcinoma (conjunctival SCC) and corneal intraepithelial neoplasia comprise what are called ocular surface squamous cell neoplasias. AREG is overexpressed in a wide spectrum of epithelial diseases, including squamous cell carcinoma of the head and neck, colon cancer, lung cancer and psoriasis (12-15). Histologically, atypical keratinocytes proliferate within the dermis. If this happens, treatments such as radiation therapy, immunotherapy, and/or chemotherapy may be needed. Most squamous cell carcinomas of the skin result from prolonged exposure to ultraviolet (UV) radiation, either from sunlight or from tanning beds or lamps. To get new article updates from a journal on your personalized homepage, please log in first, or sign up for a DeepDyve account if you dont already have one. Atrophy is a term used to describe a shrinkage of prostate tissue (when it is seen under the microscope). Search PMID: 8396271. There are two primary types of skin cancer that arise from keratinocytes, the most common type of skin cells. Before An important question raised by our results is the functional status of the p53 . All of the tumors showed a distinct exophytic papillary configuration with prominent fibrovascular cores lined by an atypical squamous proliferation composed of smaller cells at the base with indistinct cell membranes . other information we have about you. P63 and its isoforms are essential to regulate epidermal homeostasis. The lesions may ulcerate and cause scarring of skin The treatment of choice is a surgical excision with clear margins followed by radiation therapy or chemotherapy, as decided by the healthcare provider. We couldnt do what we do without our volunteers and donors. AKs are widely accepted as precancerous lesions which act as precursors to SCC formation. KASP: keratoacanthomatous atypical squamous proliferation SCC: squamous cell carcinoma STSG: split-thickness skin graft From the Department of Dermatology, Feinberg School of Med-icine, Northwestern University. Is squamous cell carcinoma a serious disease? These cells form in the deep basal-cell layer of the skin, and take about a month to reach the surface. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Cancer.org is provided courtesy of the Leo and Gloria Rosen family. Click here for an email preview. Non-Small Cell Lung Cancer Treatment (PDQ®)Health Professional Version. Along with basal cells, melanocytes are located in the deepest section of your epidermis. Keratinocytes are the most common type of skin cells. Its not often used as the first treatment for younger patients because of the possible risk of long-term problems. Skin cancers in basal or squamous cells may require removal with electrodessication and curettage, surgical excision, or Mohs surgery, which could reconstruct the skin and surrounding tissue. Require these words, in this exact order. What are the symptoms of squamous cell cancer? Squamous cells, which resemble fish scales, are thin, flat cells found in the tissue that makes up the skins surface, the lining of the bodys hollow organs, and the lining of the respiratory and digestive tracts. AKs are defined at the histologic level by dysplasia and consist of keratinocytes manifesting atypical nuclei that are enlarged, irregular, and hyperchromatic. To save an article, log in first, or sign up for a DeepDyve account if you dont already have one. Excision: Cutting out the tumor, along with a small margin of normal skin, is often used to treat squamous cell cancers. Article. They are also seen in the middle layers of the skin. Skin cancer has a high cure rate, but only if caught early. Even normal aging can make cells appear abnormal. They can also be found in the skins middle layers. (2021). Philadelphia, Pa.: Elsevier; 2020. https://www.clinicalkey.com. 2019. A dermatologist can recommend an appropriate brand. Sign up today, get DeepDyve free for 14 days. Squamous cell carcinoma of the skin most often occurs on sun-exposed skin, such as your scalp, the backs of your hands, your ears or your lips. Learn more here. Identifying & Treating Skin Cancer on the Face, Skin Cancer Facts and Statistics: What You Need to Know, Are Gel Manicures Safe? Ann Dermatol. Risk factors for the disease are exposure to sun (specifically . Protect your skin during winter as well because winter UV rays can be especially dangerous. At a molecular level, squamous cell carcinomas have a higher degree of chromosomal instability. Talk with your doctor about any potential scarring or biopsy concerns. Examine your skin often for new skin growths or changes in existing moles, freckles, bumps and birthmarks. Signs and symptoms of squamous cell carcinoma of the skin include: A firm, red nodule 2023 American Cancer Society, Inc. All rights reserved. Depending on the type, skin cancer can grow rapidly and become life-threatening. Another type of skin cancer, melanoma, is more dangerous but less common. DeepDyve's default query mode: search by keyword or DOI. A single copy of these materials may be reprinted for noncommercial personal use only. Arsenic is known to perturb epidermal homeostasis and induce abnormal keratinocyte proliferation, leading to skin carcinogenesis. Xu YG, Aylward JL, Swanson AM, et al. Here's how to tell them apart. The process of creating new skin cells is controlled by a basal cell's DNA. You will also government site. However, these drugs havent been studied in people with weakened immune systems, such as people who take medicines for autoimmune diseases or who have had an organ transplant, so the balance between benefits and risks for these people isnt clear. Some companies also sell protective clothing. It develops in squamous cells, which are the thin, flat cells that make up the outermost layer of. Anyone can get skin cancer, but it is more common in people who : Medically reviewed by Jing-Yi Chern, MD, gynecologic oncologist. Thank you, {{form.email}}, for signing up. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Radiation therapy is often a good option for patients with large cancers, especially in areas where surgery would be hard to do (such as the eyelids, ears, or nose), or for patients who cant have surgery. Squamous cell carcinoma of the skin occurs when the flat, thin squamous cells in the middle and outer layers of your skin develop changes (mutations) in their DNA. : Saunders Elsevier; 2016. https://www.clinicalkey.com. 2018;78:560. The 2023 edition of ICD-10-CM D23.9 became effective on October 1, 2022. The oncologist will assign the tumor one of the following squamous cell carcinoma stages after evaluating these factors: Stage 0 Cancer only affects the epidermis (the top layer of skin). Although cSCC isnt life threatening, it can become dangerous if it goes untreated. At the American Cancer Society, we have a vision to end cancer as we know it, for everyone. This site complies with the HONcode standard for trustworthy health information: verify here. health information, we will treat all of that information as protected health The mutations tell the squamous cells to grow out of control and to continue living when normal cells would die. Unable to load your collection due to an error, Unable to load your delegates due to an error. However, it's still important to make sure there's no cancer present or that a cancer isn't just starting to develop. Abeloffs Clinical Oncology. Squamous cell lung cancer. This is the American ICD-10-CM version of D23.9 - other international versions of ICD-10 D23.9 may differ. How to get nutrition during cancer treatment, Infographic: Scalp Cooling Therapy for Cancer, Stem cells: What they are and what they do, Thalidomide: Research advances in cancer and other conditions, TVEC (Talimogene laherparepvec) injection, When cancer returns: How to cope with cancer recurrence, Advertising and sponsorship opportunities. According to the American Academy of Dermatology, cSCC is most commonly red or pink. Advertising revenue supports our not-for-profit mission. All rights reserved. Cryosurgery. . Be sure to tell your healthcare provider if you have a personal history or family history of skin cancer. If you are a Mayo Clinic patient, this could Like cSCC, basal cell cancer typically develops in areas exposed to UV rays, particularly your face and neck. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. First lady Jill Biden is undergoing Mohs surgery to remove a skin lesion above her eye. MOHS MICROGRAPHIC SURGERY- special procedure names after . Her treatment is a reminder of the importance of regular skin, Basal cell carcinoma is the most common and treatable type of skin cancer. A more general warning sign of skin cancer comes as a sore that won't heal, or that repeatedly bleeds and scabs over. An early diagnosis and treatment are critical for preventing complications. We then investigated the expression of p53, which is a key protein involved in the regulation of cell proliferation. Christensen SR, Wilson LD, Leffell DJ. Subscribe for free and receive an in-depth guide to coping Atypical Squamous Proliferation: What Lies Beneath?, Dermatologic Surgery | 10.1111/j.1524-4725.2011.01895.x | DeepDyve Enterprise Plans Free Trial Browse Features Pricing DeepDyve Get 20M+ Full-Text Papers For Less Than $1.50/day. National Library of Medicine Preventive Medicine Reports. Squamous cell carcinomas can appear in the skin as flat reddish or brownish patches with a rough, scaly, or crusted surface. Squamous cell carcinoma Clin Cancer Res. Individuals with immunocompromised states have more aggressive tumors. and transmitted securely. This type of cancer tends to grow slowly, and it rarely spreads to other parts of your body. An atypical mole is not a skin cancer but having these moles is a risk factor for developing melanoma. Connect with others like you for support and answers to your questions in the Cancer support group on Mayo Clinic Connect, a patient community. 2018 May;80(2):303-317. doi:10.1016/j.jaad.2018.03.060, Iannacone MR, Wang W, Stockwell HG, et al. Atypical Squamous Proliferation: What Lies Beneath? Squamous cell carcinoma can spread to the sinuses, skull base, and other parts of the brain. May occur on foot or on sun damaged skin (Arch Dermatol 1994;130:1042, J Dermatol 2007; . The tumor typically appears as a papule or nodule, An analysis of 69 cases and review of the literature. UpToDate. In: Clinical Dermatology: A Color Guide to Diagnosis and Therapy. . Cutaneous squamous cell carcinoma accounts for just one of every five cases but it is the more dangerous of the two. Background: The current standards of treatment for oral squamous cell carcinoma (OSCC) include surgery, radiotherapy, and chemotherapy. When these cells become cancerous, they typically develop into rounded skin tumors that can be flat or raised. doi:10.1172/jci.insight.134783, Nagarajan P, Asgari MM, Green AC, et al. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. National Cancer Institute. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. However, having less pigment (melanin) in your skin provides less protection from damaging UV radiation. Keratinocyte carcinomas: current concepts and future research priorities. Submitting a report will send us an email through our customer support system. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Avoiding UV light helps reduce your risk of squamous cell carcinoma of the skin and other forms of skin cancer. Mohs surgery might also be done after an excision if it didnt remove all of the cancer (if the surgical margins were positive). Your in-depth coping with cancer guide will be in your inbox shortly. If you've noticed skin changes, or symptoms like sores that won't heal, it may be time to find out why. Background: Fine needle aspiration cytology (FNAC) is a valuable tool for evaluating lymphadenopathy. It is normal for many of these cells to die off in the process. What are basal and squamous cell skin cancers? AskMayoExpert. https://www.nccn.org/professionals/physician_gls/default.aspx. This content does not have an Arabic version. American Cancer Society medical information is copyrightedmaterial. Skin Discoloration: Causes and Treatments, Pictures of Melanoma and Other Skin Cancers, Genetic and environmental factors underlying keratinocyte carcinoma risk, Keratinocyte carcinomas: current concepts and future research priorities, Skin cancer types: basal cell carcinoma signs and symptoms, Patterns and timing of sunlight exposure and risk of basal cell and squamous cell carcinomas of the skin a casecontrol study, Tanning bed use and melanoma: Establishing risk and improving prevention interventions, A case-control study of skin cancer and exposure of toxic heavy metals, Guidelines of care for the management of cutaneous squamous cell carcinoma. SCC is the most common malignancy of the conjunctiva in the US, with a yearly incidence of 1-2.8 per 100,000. Skin squamous cell carcinoma is usually non-life-threatening, but it can be aggressive. Accessed Oct. 1, 2020. This is most often caused by hormones or radiation therapy to the prostate. Small squamous cell cancers can usually be cured with these treatments. Sun safety. AREG transgenic animals show epidermal acanthosis, keratinocyte hyperproliferation, hyperkeratosis, cutaneous immune cell infiltration and angiogenesis in the skin ( 16 , 17 ). with cancer, plus helpful information on how to get a second opinion. Electrodessication and Curettage Low-risk tumors benefit from this very common treatment for squamous cell carcinoma. Become a volunteer, make a tax-deductible donation, or participate in a fundraising event to help us save lives. There were 86 deaths from non-melanoma skin cancer registered in New Zealand in 2000; most of these were SCC. To provide you with the most relevant and helpful information, and understand which Its possible for the cancer to return, so its critical to check your skin for any signs of cancer or precancer at least once per month. Basal cell carcinoma is the far more common of this skin cancer type. information is beneficial, we may combine your email and website usage information with If we combine this information with your protected Squamous cells are small, flat cells in the outer layer of skin. 2019. We're improving the lives of cancer patients and their families through advocacy, research, and patient support to ensure that everyone has an opportunity to prevent, detect, treat, and survive cancer. Atypical Melanocytic lesions are irregular moles and skin spots that require further examination. Eating during cancer treatment: Tips to make food tastier. High-risk tumors, on the other hand, have a less favorable prognosis, with a risk of metastasis of up to 48%. To subscribe to email alerts, please log in first, or sign up for a DeepDyve account if you dont already have one. Most of the DNA mutations in skin cells are caused by ultraviolet (UV) radiation found in sunlight and in commercial tanning lamps and tanning beds. What exactly are atypical squamous cells in this regard? Member. And sometimes, your doctor may need to obtain a sample of tissue such as a biopsy to make sure you don't have cancer or another serious condition. FOIA What are the top 10 largest cities in Wisconsin? Squamous cell carcinoma in situ (essentially synonymous with Bowen's disease) often presents as an erythematous, well-demarcated, scaly patch or plaque, with a fairly irregular border. UV radiation is the most common cause of the DNA mutations that lead to cSCC and other skin cancers. EXCISION - numb the area with local anesthesia, remove skin cancer or atypical mole and stitch it closed. On occasion you may see a report from a Pap test or tissue biopsy stating "atypical cells present." What are the causes and risk factors for squamous cell cancer? It's important to be aware of these moles, because they can turn into melanomas. What terminal is Frontier Airlines at LGA? Radiation can also be used to treat cancers that have come back after surgery and have become too large or deep to be removed surgically. Or it can be the result of a specific treatment. If you have an uneven skin texture, you can't help but notice how bumpy your skin feels. In the past few years there has been an increase in the . Search and discover articles on DeepDyve, PubMed, and Google Scholar, Organize articles with folders and bookmarks, Collaborate on and share articles and folders. As a stand-along diagnosis, I would code "atypical melanocytic proliferation" or "melanocytic proliferation" D48.5 (neoplasm of uncertain behavior). Histologic features that favor an invasive squamous cell carcinoma include greater pleomorphism of proliferating tumor cells, abnormal mitoses, ulceration, and stromal desmoplasia. An atypical mole, also sometimes called a dysplastic nevus, is a benign but unusual-looking mole that can look a lot like a melanoma . When cancer develops in melanocytes, the condition is known as malignant melanoma. Most cases of cSCC are attributed to exposure to UV radiation from sunlight or indoor tanning equipment like tanning lamps and beds. In: Abeloff's Clinical Oncology. If you've recently received abnormal Pap smear results involving the presence of atypical squamous cells, call 1-888-663-3488 or submit a new patient registration form online to request an appointment with one of Moffitt's gynecologic oncologists. Accessed May 14, 2019. Premalignant and malignant nonmelanoma skin tumors. EricInNC. Philadelphia, Pa: Elsevier; 2020. 4 The . Squamous (flat, scaly) cells, the most abundant type of cell in the epidermis, undergo malignant transformation and proliferation. Systemic chemotherapy and/or targeted therapy: Chemotherapy and targeted therapy drugs (EGFR inhibitors) might be other options for patients with squamous cell cancer that has spread to lymph nodes or distant organs. The increased proliferative activity of endothelial cells in CIN IIIII lesions suggests that they are angiogenically more active than condylomas and CIN I lesions, which does not, however, depend on the HPV or p53 status. 2005-2023 Healthline Media a Red Ventures Company. Learn. The five visual characteristics used to identify an atypical melanocytic lesion are the same as the characteristics used to identify signs of invasive melanoma. Squamous cell carcinomas are relatively slow-growing malignant (cancerous) tumors that, if left untreated, can spread (metastasize) to surrounding tissue. It is easily treated and cured when it is confined to the skin. Squamous cells are also found in other parts of your body such as your lungs, mucous membranes, digestive tract, and urinary tract. Marmosets can be kept as pets, What are the six main characteristics of a pure market economy? Squamous cell carcinoma is usually a small, red, painless lump or patch of skin that grows and ulcerates over time. . The risk of aggressive squamous cell carcinoma of the skin may be increased in cases where the cancer: Most squamous cell carcinomas of the skin can be prevented. A much smaller number occur on the torso and legs. Bethesda, MD 20894, Web Policies Start a 14-Day Trial for You or Your Team. (Also known as/Synonyms) Ackerman's Tumor Cutaneous Verrucous Squamous Cell Carcinoma Metastatic disease is uncommon. Understanding cervical changes: Next steps after an abnormal screening test. As a result, these specimens are often signed out as atypical squamous proliferations (ASPs). One type of skin cancer called basal cell carcinoma begins in the basal cells, which make skin cells that continuously push older cells toward the surface. Squamous cell carcinoma of the skin is usually not life . It has a lower malignancy potential than conventional squamous cell carcinomas. The atypical skin lesions are a diverse group of tumors that are uncommon but clinically important. Check your skin each month for any new or abnormal growths. Other potential causes include: Treatment for cSCC varies. Many factors can make normal cells appear atypical, including inflammation and infection. Alam M, et al. Accessed at https://www.uptodate.com/contents/treatment-and-prognosis-of-low-risk-cutaneous-squamous-cell-carcinoma on June 4, 2019. information and will only use or disclose that information as set forth in our notice of Bookshelf BCCs usually develop on sun-exposed parts of your body, especially your head and neck. In rare cases, squamous cell cancers can spread to lymph nodes or distant parts of the body. There is a problem with Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2019. You can see your Bookmarks on your DeepDyve Library. All rights reserved. Can a Pap smear detect atypical squamous cells? } 2019;25(8):2379-2391. doi: 10.1158/1078-0432.CCR-18-1122. Verrucous carcinoma is a rare, well-differentiated variant of squamous cell carcinoma that commonly arises on the feet. Joined: Nov 2009. This includes two types of non-melanoma skin cancers: basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). Choquet H, Ashrafzadeh S, Kim Y, Asgari MM, Jorgenson E. Genetic and environmental factors underlying keratinocyte carcinoma risk. clip-path: url(#SVGID_2_); Squamous cells can be found in a variety of locations throughout the body. the unsubscribe link in the e-mail. The majority of SCC patients have a good prognosis. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Joined: Nov 2009. . 6th ed. Skin cancer is an early-forming skin cancer that is limited to the upper layers of the skin and is known as in-situ. Reset filters. Our surgeons may need to remove more tissue if we have squamous cell cancer, which can be aggressive. This suggests that other factors may contribute to your risk of skin cancer. Different types of cancer start in the skin. Squamous cell carcinoma of the skin is usually not life-threatening, though it can be aggressive. (2021). a topic. Research. Its a rapidly growing tumor that appears out of nowhere and can grow to a large size. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. In rare cases, squamous cell cancers can spread to lymph nodes or distant parts of the body. Stage I (stage 1 squamous cell carcinoma): A cancer that is less than 2 centimeters long, about 4/5 of an inch wide, has not spread to nearby lymph nodes or organs, and exhibits one or fewer high-risk characteristics. To help reduce your risk of cSCC, follow these tips when possible: Early detection of cSCC is key to successful treatment. For reprint requests, please see our Content Usage Policy. People with weakened immune systems due to certain medical conditions, such as HIV, AIDS, or leukemia, have a greater risk of developing more serious forms of cSCC. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. BCC accounts for some 80% of these cancers, though they rarely cause death. According to the Skin Cancer Foundation, about 1.8 million people in the United States are diagnosed with cSCC each year. However, as we'll expand on below, their presence is an indicator of an increased melanoma risk in general. Squamous cell carcinoma of the skin with signet ring cell morphology is very rare. St. Louis, Mo. The most common types of skin cancer are squamous cell carcinoma, which forms in the squamous cells and basal cell carcinoma, which forms in the basal cells. Skin cancer is the most common form of cancer in the United States. Version 2.2019. Squamous cells can be found in the mouth, lips, and cervix. But sun exposure doesn't explain skin cancers that develop on skin not ordinarily exposed to sunlight. Accessibility This retrospective study was carried out on 60 patients, including 40 cases with atypical squamous proliferation (10 cases with AK, 10 cases with BD and 20 cases with cSCC) and 20 normal controls. 2023 DeepDyve, Inc. All rights reserved. It might appear in the upper region of the chest, and sometimes in the back. The ICD code D485 is used to code Dysplastic nevus. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Lung SCC makes up about 30 percent of a group of lung cancers called non-small cell lung cancer and about 25 percent of lung cancers overall. Read and print from thousands of top scholarly journals. Squamous epithelial cells are a type of flat cell found throughout the body, including in the mouth, on the lips, and on the cervix. After basal cell carcinoma, squamous cell carcinoma is the second most common variant of skin cancer. 11th ed. Copyright 2023 Elsevier Inc. All rights reserved. Thanks for helping us catch any problems with articles on DeepDyve. SCC presents as an irregular keratinous nodule or a firm erythematous plaque, and frequently ulcerates. If you dont receive our email within 5 minutes, check your SPAM folder, then contact us Treating Basal and Squamous Cell Skin Cancer, About Basal and Squamous Cell Skin Cancer, Making Strides Against Breast Cancer Walks, ACS Center for Diversity in Research Training, Surgery for Basal and Squamous Cell Skin Cancers, Local Treatments Other than Surgery for Basal and Squamous Cell Skin Cancers, Radiation Therapy for Basal and Squamous Cell Skin Cancers, Systemic Chemotherapy for Basal and Squamous Cell Skin Cancers, Targeted Therapy for Basal and Squamous Cell Skin Cancers, Immunotherapy for Advanced Basal or Squamous Cell Skin Cancers, Treating Squamous Cell Carcinoma of the Skin, Treating Actinic Keratosis and Bowen Disease. National Cancer Institute. This is based on a consult with a dermamtopathologist. In 1992, the NIH recommended that the term "dysplastic nevus" be avoided in favor of the term "atypical mole". Habif TP. Mohs surgery: Mohs surgery is especially useful for squamous cell cancers that pose a higher risk for coming back, such as tumors larger than 2 cm (about 4/5 inch) across or with poorly defined edges, cancers that have come back after other treatments, cancers that are spreading along nerves under the skin, and cancers on certain areas of the face or genital area. Advertising revenue supports our not-for-profit mission. 2023 Dotdash Media, Inc. All rights reserved. Wear a hat and cover your skin when working outside. Facial Plast Surg Clin North Am. However, it's still important to make sure there's no cancer present or that a cancer isn't just starting to develop. An official website of the United States government. UpToDate. All rights reserved. Skin cancer on the scalp is more common than you may think. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Available Sun Protection Products at Mayo Clinic Store, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. Although rare, melanoma can arise in association with atypical moles. Mayo Clinic does not endorse companies or products. EricInNC OP. Make an appointment with your healthcare provider if you have any signs or symptoms that worry you. It develops in squamous cells, which are the thin, flat cells that make up the outermost layer of your skin. Mouth sores caused by cancer treatment: How to cope, No appetite? When a squamous cell carcinoma is diagnosed, most people are only familiar with the term. 2023 DeepDyve, Inc. All rights reserved. Disclaimer. Review/update the Whether you want to learn about treatment options, get advice on coping with side effects, or have questions about health insurance, were here to help. To provide you with the most relevant and helpful information, and understand which BCC occurs when one of the basal cells of the epidermis develops a mutation, or change, in its DNA. Semin Diagn Pathol 1993 May;10 (2):148-58. include protected health information.

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