Pain and itch associated with histologic features of skin cancers

1. Both itch (36.9%) and pain (28.2%) were highly prevalent in skin cancers. 

2. Intensity of both pain and itch associated with degree of inflammation and prevalence of eosinophils, though intensity of pain also associated with factors that conveyed deeper processes. 

Evidence Rating Level: 2 (Good)            

Study Rundown: Itch and pain are features common to many cutaneous carcinomas. However, few studies have sought to evaluate pathologic factors that may be linked to the intensity of itch and pain. These authors sought to determine the correlation between itch and pain with histologic components of skin cancers. Among patients with squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and melanoma, itch and pain were found to have a prevalence of 36.9% and 28.2%, respectively. Both itch and pain were found to be associated with presence of eosinophils and degree of inflammation, though pain intensity was also found to be associated with other histologic findings (e.g. ulceration, depth, ect). A strength of this study was that the analysis allowed for comparisons on both a per-lesion basis and per-patient basis, as multiple skin cancers in the same patients were common.  A weakness was the sparse number of melanoma cases.

Click to read the study in JAMA Dermatology

Relevant Reading:  Evaluation of prospectively collected presenting signs/symptoms of biopsy-proven melanoma, basal cell carcinoma, squamous cell carcinoma, and seborrheic keratosis in an elderly male population

In-Depth [prospective cohort]: Three hundred and thirty-nine confirmed cutaneous neoplasms from 268 patients at Wake Forest University Baptist Medical Center from July 2010 to March 2011 were studied to understand the relationship between itch and pain and histologic features of skin cancer. Questionnaires were given to patients who presented to the surgical unit for treatment. Itch was prevalent in 46.6% of SCC and 31.9% of BCC patients. Pain was prevalent in 42.5% of SCC and 19.9% of BCC patients. Though a small number of patients were seen for melanoma, itch and pain were less often seen in these patients 14.8% and 3.7%, respectively. Additionally, histopathologic features such as presence of eosinophils and high degree of inflammation were found to be associated with itch and pain respectively (p<0.05). Pain intensity was also found to be associated with processes that suggested a deeper component such as presence of neutrophils (p=0.003), ulceration (p=0.003), perineural invasion (p=0.001), increasing depth of invasion (p=0.001), and largest diameter of skin lesion (p<0.003).

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Image: PD 

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