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Topic:Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) is a type of malignant tumor that arises from squamous epithelial cells, commonly affecting horses' skin, eyes, and mucous membranes. It is one of the most frequently diagnosed cancers in equine species. This carcinoma is associated with prolonged exposure to ultraviolet light, particularly in areas with minimal pigmentation or hair coverage. SCC can present as ulcerated lesions or proliferative masses and may lead to local tissue destruction and metastasis if untreated. Diagnosis typically involves clinical examination, biopsy, and histopathological analysis. Treatment options vary depending on the tumor's location and stage and may include surgical excision, cryotherapy, or chemotherapy. This section aggregates peer-reviewed studies and scholarly articles that explore the pathogenesis, risk factors, diagnostic methods, and treatment approaches for squamous cell carcinoma in horses.
Limbal squamous cell carcinoma in Haflinger horses.
Veterinary ophthalmology    October 14, 2014   Volume 18, Issue 5 404-408 doi: 10.1111/vop.12229
Lassaline M, Cranford TL, Latimer CA, Bellone RR.To describe the prevalence of LSCC in Haflinger horses and to analyze affected horses' pedigrees investigating the genetic mode of inheritance. Methods: Fifteen horses met inclusion criterion of (i) being of the Haflinger breed, as confirmed by North American Haflinger Registry pedigree and (ii) being diagnosed with LSCC, as confirmed by clinical examination by a veterinary ophthalmologist or by histopathology. Pedigrees could not be obtained for four additional horses diagnosed with LSCC that had been identified as Haflingers. Methods: Retrospective medical record review of all 19 horses was ...
Expression of epidermal growth factor receptor and human epidermal growth factor receptor 2 in periocular squamous cell carcinomas of horses.
American journal of veterinary research    September 26, 2014   Volume 75, Issue 10 912-917 doi: 10.2460/ajvr.75.10.912
Hendrix DV, Newkirk KM.To determine whether epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) are expressed in periocular squamous cell carcinomas (SCCs) of horses. Methods: Biopsy specimens of SCCs from 46 horses. Methods: Pathology records were searched retrospectively for biopsy specimens of periocular SCCs obtained from horses. Slides of the specimens were reviewed histologically to confirm the SCC diagnosis and stained for EGFR and HER2 by immunohistochemical methods. For both EGFR and HER2, the immunohistochemical staining intensity and percentage of stain-positive cel...
Characterization and outcome following excision of masses in the nictitating membranes of horses: 50 cases (1998-2012).
Journal of the American Veterinary Medical Association    September 18, 2014   Volume 245, Issue 7 812-815 doi: 10.2460/javma.245.7.812
Scherrer NM, Lassaline-Utter M, McKenna BC.To determine the histologic findings associated with masses in the nictitating membranes (third eyelids) of horses and to identify prognostic factors associated with recurrence and the outcome. Methods: Retrospective case series. Methods: 50 horses with masses in a third eyelid. Methods: Medical records of horses with partial or complete excision of a third eyelid and submission for histologic evaluation between September 1998 and November 2012 were reviewed. Horses were included if follow-up information for at least 1 year after surgery was available. Information regarding signalment and trea...
Local photodynamic therapy delays recurrence of equine periocular squamous cell carcinoma compared to cryotherapy.
Veterinary ophthalmology    August 16, 2014   Volume 17 Suppl 1 37-45 doi: 10.1111/vop.12099
Giuliano EA, Johnson PJ, Delgado C, Pearce JW, Moore CP.(i) To report the successful treatment of 10 cases of equine periocular squamous cell carcinoma (PSCC) with surgical excision and photodynamic therapy (PDT) using verteporfin. (ii) To evaluate time to first tumor recurrence between PDT-treated horses and horses treated with surgical excision and cryotherapy. Methods: A total of 24 equine PSCC cases were included: group 1 (n = 14) had excision and cryotherapy (1993–2003), group 2 (n = 10), excision and local PDT (2006–2010). Evaluated data: signalment, treatment method, tumor location, size, and time to first recurrence. Groups were compare...
Comparison of the effect of two doses of omeprazole on the squamous gastric mucosa in thoroughbred racehorses.
The Veterinary record    August 5, 2014   Volume 175, Issue 10 249 doi: 10.1136/vr.102622
Sykes BW, Sykes K, Hallowell GD.No abstract available
Serum antibodies and DNA indicate a high prevalence of equine papillomavirus 2 (EcPV2) among horses in Switzerland.
Veterinary dermatology    May 21, 2014   Volume 25, Issue 3 210-e54 doi: 10.1111/vde.12129
Fischer NM, Favrot C, Birkmann K, Jackson M, Schwarzwald CC, Müller M, Tobler K, Geisseler M, Lange CE.The DNA of equine papillomavirus type 2 (EcPV2) is consistently found in equine papillomas and squamous cell carcinomas, indicating a causal association of EcPV2 in the pathogenesis of these tumours; however, little is known about the prevalence of this virus. Objective: The aim of this study was to determine the geno- and seroprevalence of EcPV2 in clinically healthy horses in Switzerland. Methods: Fifty horses presented to the equine department of the university clinic, displaying no skin or mucous membrane lesions or severe signs of other diseases, were sampled. Methods: Cytobrush samples ...
Expression of p53, Ki67, EcPV2- and EcPV3 DNA, and viral genes in relation to metastasis and outcome in equine penile and preputial squamous cell carcinoma.
Equine veterinary journal    May 4, 2014   Volume 47, Issue 2 188-195 doi: 10.1111/evj.12245
van den Top JG, Harkema L, Lange C, Ensink JM, van de Lest CH, Barneveld A, van Weeren PR, Gröne A, Martens A.Equine penile and preputial squamous cell carcinoma (SCC) is a potentially lethal disease of which little is known regarding the relationship between tumour characteristics and prognosis. Objective: To assess the relationship between tumour differentiation grade (tumour subtype), presence of papillomaviruses, expression of viral genes (E2, E6, L1), nuclear proteins p53 and Ki67 and metastasis in equine penile and preputial SCC and to assess the relationship of tumour subtype, presence of papillomavirus type 2, p53 and Ki67 with survival. Methods: Retrospective case-control study using archived...
Detection of papillomavirus in equine periocular and penile squamous cell carcinoma. Newkirk KM, Hendrix DV, Anis EA, Rohrbach BW, Ehrhart EJ, Lyons JA, Kania SA.Squamous cell carcinoma (SCC) is the most common tumor arising in the periocular and penile areas of horses. Both ultraviolet radiation and papillomaviruses have been implicated in the pathogenesis of SCC in various species, including the horse. This retrospective study used polymerase chain reaction (PCR) to detect papillomavirus DNA in archival biopsy samples from equine periocular and penile SCC from 3 different geographic areas (northeast, southeast, and central United States). Forty-two periocular SCCs were tested; none contained papillomavirus DNA. Twenty-two penile SCCs were tested, and...
Expression of cyclo-oxygenases-1 and -2, and microsomal prostaglandin E synthase-1 in penile and preputial papillomas and squamous cell carcinomas in the horse.
Equine veterinary journal    December 5, 2013   Volume 46, Issue 5 618-624 doi: 10.1111/evj.12144
van den Top JG, Harkema L, Ensink JM, Barneveld A, Martens A, van de Lest CH, van Weeren PR, Gröne A.Penile and preputial papilloma and squamous cell carcinoma (SCC) are commonly diagnosed in horses. Papillomas have the potential to progress to potentially lethal SCC. Knowledge of pathogenetic mechanisms may help in prevention and definition of treatment targets. Methods: Retrospective study using archived material. Objective: To determine the expression of cyclo-oxygenase 1 (COX-1), cyclo-oxygenase 2 (COX-2) and microsomal prostaglandin E synthase-1 (mPGES-1) in penile and preputial normal tissue, papilloma and SCC in horses, and whether expression of these enzymes is influenced by degree of...
Verrucous hemangioma with pseudoepitheliomatous epidermal hyperplasia in an adult horse.
Veterinary pathology    November 27, 2013   Volume 51, Issue 5 992-995 doi: 10.1177/0300985813513039
Pérez-Écija A, Estepa JC, Barranco I, Rodríguez-Gómez IM, Mendoza FJ, Gómez-Laguna J.Verrucous hemangiomas are a rare specific variant of equine skin tumors not well described in the literature. An 8-year-old gelding presented a unilateral lesion on the pastern. Macroscopically, the mass showed a warty and verrucous surface with focal ulcerations. The histology showed a dermal proliferation of endothelial-layered capillaries and venules separated by a delicate stroma of scant fibroblasts and collagen deposition, with pseudoepitheliomatous hyperplasia (exuberant reactive irregular epithelial hyperplasia with tongue-like projections extending into the dermis, mimicking downgrowt...
Papillomavirus-associated diseases.
The Veterinary clinics of North America. Equine practice    October 1, 2013   Volume 29, Issue 3 643-655 doi: 10.1016/j.cveq.2013.08.003
Torres SM, Koch SN.This article reviews various aspects of 3 clinical disorders associated with papillomavirus in horses commonly known as classical viral papillomatosis, genital papillomas/papillomatosis, and aural plaques. Classical papillomatosis is usually asymptomatic and spontaneously resolves within 1 to 9 months; therefore, treatment is often not required. Genital papillomas/papillomatosis have not been reported to spontaneously resolve, and there is increasing evidence that genital papillomas may evolve to in situ or invasive squamous cell carcinomas. Horses with aural plaques may be asymptomatic or may...
Surgical Management of Penile and Preputial Neoplasms in Equine with Special Reference to Partial Phallectomy.
Journal of veterinary medicine    September 8, 2013   Volume 2013 891413 doi: 10.1155/2013/891413
Rizk A, Mosbah E, Karrouf G, Abou Alsoud M.Penile and preputial neoplasia in horses occurs infrequently and represents diagnostic and therapeutic challenges. The present study was carried out on a total number of 21 equids (14 stallions and 7 donkeys) suffered from different penile and preputial neoplasia. Diagnosis of neoplasms was based up on history of the case, clinical examination as well as histopathological evaluation. Animals with penile and preputial neoplasms were underwent local excision and partial phallectomy with a slightly modified version of the techniques described by William's. The diagnosed neoplasms were penile and ...
Comparison of the levels of Equus caballus papillomavirus type 2 (EcPV-2) DNA in equine squamous cell carcinomas and non-cancerous tissues using quantitative PCR.
Veterinary microbiology    June 20, 2013   Volume 166, Issue 1-2 257-262 doi: 10.1016/j.vetmic.2013.06.004
Knight CG, Dunowska M, Munday JS, Peters-Kennedy J, Rosa BV.Equus caballus papillomavirus type 2 (EcPV-2) infection has been associated with equine genital squamous cell carcinomas (SCCs). However, quantitative PCR (qPCR) has not been performed to determine viral copy numbers within these lesions. Additionally, the frequency with which EcPV-2 can be detected in other common sites of equine SCC development remains uncertain. The aim of this study was to develop a qPCR assay to estimate the viral load in a variety of equine tissue samples. These included 40 SCC lesions, 19 penile non-SCC or precursor disease lesions, and 222 tissues without observable le...
Cutaneous neoplastic lesions of equids in the central United States and Canada: 3,351 biopsy specimens from 3,272 equids (2000-2010).
Journal of the American Veterinary Medical Association    December 14, 2012   Volume 242, Issue 1 99-104 doi: 10.2460/javma.242.1.99
Schaffer PA, Wobeser B, Martin LE, Dennis MM, Duncan CG.To identify epidemiological trends in cutaneous neoplasms affecting equids in central North America and compare them with previously reported trends. Methods: Retrospective case series. Methods: 3,351 cutaneous biopsy specimens from 3,272 equids with a neoplastic diagnosis. Methods: Diagnostic reports from 2 diagnostic laboratories (Colorado State University and Prairie Diagnostic Services Inc) were reviewed for frequency of specific lesions and epidemiological trends. Variables included in analyses (if known) were age, sex, breed, geographic location, date of diagnosis, location of neoplasm o...
EcPV2 DNA in equine papillomas and in situ and invasive squamous cell carcinomas supports papillomavirus etiology.
Veterinary pathology    October 11, 2012   Volume 50, Issue 4 686-692 doi: 10.1177/0300985812463403
Lange CE, Tobler K, Lehner A, Grest P, Welle MM, Schwarzwald CC, Favrot C.Equine penile papillomas, in situ carcinomas, and invasive carcinomas are hypothesized to belong to a continuum of papillomavirus-induced diseases. The former ones clinically present as small grey papules, while the latter 2 lesions are more hyperplasic or alternatively ulcerated. To test the hypothesis that these lesions are papillomavirus-induced, samples of 24 horses with characteristic clinical and histologic findings of penile papillomas or in situ or invasive squamous cell carcinomas were collected. As controls, 11 horses with various lesions--namely, Balanoposthitis (6 cases), melanoma ...
[Diagnostic assessment of peritoneal fluid cytology in horses with abdominal neoplasia].
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    April 25, 2012   Volume 40, Issue 2 85-93 
Recknagel S, Nicke M, Schusser GF.To evaluate the diagnostic value of peritoneal fluid (PF) cytology for clinical diagnosis of abdominal neoplasia in horses. Methods: Ten horses with histopathologically confirmed abdominal neoplasia, in which a PF analysis was performed, were included in this retrospective study. PF was analyzed for total protein concentration and a nucleated cell count was performed. Using cytological criteria of malignancy, the PF samples were evaluated regarding their probability of malignancy. Results: Cytologic classification of cells according to criteria of malignancy allowed a positive cytologic diagno...
EcPV-2 is transcriptionally active in equine SCC but only rarely detectable in swabs and semen from healthy horses.
Veterinary microbiology    February 14, 2012   Volume 158, Issue 1-2 194-198 doi: 10.1016/j.vetmic.2012.02.006
Sykora S, Samek L, Schönthaler K, Palm F, Borzacchiello G, Aurich C, Brandt S.Squamous cell carcinomas (SCC) are malignant tumours arising from keratinocytes. In horses, there is increasing evidence for Equus caballus papillomavirus type 2 (EcPV-2) being causally involved in SCC development. However, only little is known regarding intralesional transcription of the virus, and sparse information on the incidence of EcPV-2 infection in healthy equids is available so far. Using RT-PCR, total mRNA from 8 EcPV-2 DNA-positive and 1 EcPV-2 negative SCC/SCC precursor lesions was screened for the presence of EcPV-2 E6 and E1 transcripts. Using PCR, we tested 193 sample specimens...
EcPV2 DNA in equine genital squamous cell carcinomas and normal genital mucosa.
Veterinary microbiology    February 11, 2012   Volume 158, Issue 1-2 33-41 doi: 10.1016/j.vetmic.2012.02.005
Bogaert L, Willemsen A, Vanderstraeten E, Bracho MA, De Baere C, Bravo IG, Martens A.Squamous cell carcinoma (SCC) represents the most common genital malignant tumor in horses. Similar to humans, papillomaviruses (PVs) have been proposed as etiological agents and recently Equine papillomavirus type 2 (EcPV2) has been identified in a subset of genital SCCs. The goals of this study were (1) to determine the prevalence of EcPV2 DNA in tissue samples from equine genital SCCs, penile intraepithelial neoplasia (PIN) and penile papillomas, using EcPV2-specific PCR, (2) to examine the prevalence of latent EcPV2 infection in healthy genital mucosa and (3) to determine genetic variabili...
Case report: squamous cell carcinoma of the urinary bladder in a horse.
Compendium (Yardley, PA)    January 1, 2012   Volume 34, Issue 10 E1-E5 
Zantingh AJ, Gaughan EM, Bain FT.A 14-year-old Hanoverian gelding was evaluated after a 10-week history of occasional straining during urination and dark red urine production after exercise. Physical examination findings were within normal limits. After 2 weeks of clinical signs, ultrasonography had found no abnormalities in the kidneys or bladder. A freely voided urine sample revealed an elevated protein concentration (500 mg/dL; reference range: <100 mg/dL) and few red blood cells. Vitamin C supplementation was suggested to acidify the urine, as was provision of a salt block to encourage water intake.
Carbon dioxide laser photoablation adjunctive therapy following superficial lamellar keratectomy and bulbar conjunctivectomy for the treatment of corneolimbal squamous cell carcinoma in horses: a review of 24 cases.
Veterinary ophthalmology    December 13, 2011   Volume 15, Issue 4 245-253 doi: 10.1111/j.1463-5224.2011.00977.x
Michau TM, Davidson MG, Gilger BC.  To determine the complications and nonrecurrence rates following superficial lamellar keratectomy, bulbar conjunctivectomy, and adjunctive carbon dioxide (CO(2)) photoablation for corneolimbal squamous cell carcinoma (SCC) in the horse. Methods:   Retrospective study. Sample population  Twenty-four horses with corneolimbal SCC. Methods:   Medical records of horses diagnosed with corneolimbal SCC that was surgically excised and where CO(2) photoablation was used as an adjunctive therapy from 2000 to 2007 were reviewed. Signalment, prior therapy, tumor location and size, complications,...
A retrospective comparison of surgical removal and subsequent CO2 laser ablation versus topical administration of mitomycin C as therapy for equine corneolimbal squamous cell carcinoma.
Veterinary ophthalmology    December 13, 2011   Volume 15, Issue 4 254-262 doi: 10.1111/j.1463-5224.2011.00982.x
Clode AB, Miller C, McMullen RJ, Gilger BC.  To compare the complications and nonrecurrence rate following topical mitomycin C (MMC) therapy vs. CO(2) laser ablation for treating equine corneolimbal squamous cell carcinoma (SCC). Methods:   Retrospective study. Methods:   Twenty-five horses with corneolimbal SCC. Methods:   Medical records of horses undergoing surgical tumor resection followed by either topical MMC therapy (0.04%) or CO(2) laser ablation between the years of 2004 and 2010 were reviewed. Recurrence and complications were compared between groups and within MMC subgroups defined by the time at which treatment was ...
Nictitating membrane resection in the horse: a comparison of long-term outcomes using local vs. general anaesthesia.
Equine veterinary journal. Supplement    December 7, 2011   Issue 40 42-45 doi: 10.1111/j.2042-3306.2011.00486.x
Labelle AL, Metzler AG, Wilkie DA.Neoplasia, for which surgical excision is a frequent treatment, is the most common disease of the equine nictitating membrane. There is little long-term follow-up information available to the practitioner regarding the long-term effects of nictitating membrane excision on ocular health. No information is available to compare recurrence of primary neoplasia of the nictitating membrane after excision with local or general anaesthesia. Objective: To evaluate the long-term complications of nictitating membrane resection in horses; recurrence of neoplasia of the nictitating membrane when nictitatin...
Heterobilharzia americana infection as a cause of hepatic parasitic granulomas in a horse.
Journal of the American Veterinary Medical Association    October 12, 2011   Volume 239, Issue 8 1117-1122 doi: 10.2460/javma.239.8.1117
Corapi WV, Birch SM, Carlson KL, Chaffin MK, Snowden KF.CASE DESCRIPTION-A 22-year-old American Paint Horse gelding from the Gulf Coast region of Texas was evaluated for regrowth of a perirectal squamous cell carcinoma that had been surgically removed 11 months previously. CLINICAL FINDINGS-A necrotic and ulcerated mass was present below the anus. The horse had paraphimosis and was having difficulty with urination. Histologic examination of the mass revealed that it was squamous cell carcinoma, and the horse was euthanized because of the unlikelihood that the mass could be adequately resected and its close proximity to the urethra. OUTCOME-At necro...
Bovine papillomavirus type 1 and Equus caballus papillomavirus 2 in equine squamous cell carcinoma of the head and neck in a Connemara mare.
Equine veterinary journal    June 13, 2011   Volume 44, Issue 1 112-115 doi: 10.1111/j.2042-3306.2010.00358.x
Kainzbauer C, Rushton J, Tober R, Scase T, Nell B, Sykora S, Brandt S.In January 2010, 18 months after excision of an ocular squamous cell carcinoma (SCC), a Connemara mare presented with anorexia and periorbital/parotideal lesions. Post mortem examination revealed these lesions as forming one entity, with 2 additional growths in the retropharyngeal region and the left jugular groove, respectively. The lesions were confirmed histopathologically as SCCs. Using PCR, peripheral blood mononuclear cells (PBMCs) from 2008 and 2010, tumour tissue, intact skin and vulval mucosa were screened for Equus caballus papillomavirus type 2 (EcPV-2) and bovine papillomavirus typ...
Persistent, widespread papilloma formation on the penis of a horse: a novel presentation of equine papillomavirus type 2 infection.
Veterinary dermatology    June 6, 2011   Volume 22, Issue 6 570-574 doi: 10.1111/j.1365-3164.2011.00987.x
Knight CG, Munday JS, Rosa BV, Kiupel M.A 9-year-old gelding presented with approximately 100 papillomas that covered about 75% of the distal penis. Biopsy was performed, and histology showed evidence of viral cytopathic change and koilocytosis. Polymerase chain reaction using DNA extracted from biopsied tissue amplified equine papillomavirus type 2 (EcPV-2) DNA sequences. Sixteen months later, the horse was re-examined and the appearance of the papillomas was unchanged. Equine papillomavirus type 2 DNA sequences were again amplified from both biopsied tissue and swabs of the penis. Papillomavirus was localized to the lesions by imm...
Pathology in practice. Squamous cell carcinoma of the penis with multifocal metastasis to the regional lymph nodes, lungs, and heart.
Journal of the American Veterinary Medical Association    March 2, 2011   Volume 238, Issue 5 581-583 doi: 10.2460/javma.238.5.581
Cramer SD, Breshears MA, Qualls HJ.No abstract available
Equine penile squamous cell carcinomas are associated with the presence of equine papillomavirus type 2 DNA sequences.
Veterinary pathology    January 31, 2011   Volume 48, Issue 6 1190-1194 doi: 10.1177/0300985810396516
Knight CG, Munday JS, Peters J, Dunowska M.Forty cases of equine penile disease were screened with polymerase chain reaction for the presence of papillomaviral DNA. Cases consisted of 20 squamous cell carcinomas (average age of horse, 23.9 years) and 20 non-squamous cell carcinoma diseases (average age of horse, 13.3 years). All horses but one originated from the Northeastern United States. Breeds were not recorded. As based on MY09/MY11 consensus primers, DNA sequences from equine papillomavirus type 2 were amplified from 9 of 20 horses (45%) with penile squamous cell carcinoma and only 1 of 20 horses (5%) with non-squamous cell carci...
Squamous cell carcinoma invading the right temporomandibular joint in a Belgian mare.
The Canadian veterinary journal = La revue veterinaire canadienne    November 3, 2010   Volume 51, Issue 8 885-887 
Perrier M, Schwarz T, Gonzalez O, Brounts S.This report describes a rare case of squamous cell carcinoma invading the right temporomandibular joint, right guttural pouch, and calvarium. Radiography, computed tomography, and histopathology were performed in the diagnostic workup. Computed tomography depicted more accurately than radiography the invasive nature, exact location, and extent of the lesion. Ce rapport décrit un rare cas de carcinomes squameux envahissant l’articulation temporomandibulaire droite, la poche gutturale et la calotte crânienne. Une radiographie, une tomodensitométrie et une histopathologie ont été réalisÃ...
Equus caballus papillomavirus-2 (EcPV-2): an infectious cause for equine genital cancer?
Equine veterinary journal    November 3, 2010   Volume 42, Issue 8 738-745 doi: 10.1111/j.2042-3306.2010.00311.x
Scase T, Brandt S, Kainzbauer C, Sykora S, Bijmholt S, Hughes K, Sharpe S, Foote A.The aetiology of genital squamous cell carcinoma (SCC) in horses remains unknown, but the similarity to the disease in man, for which papillomavirus infection has been shown to be a causal factor, requires to be investigated in horses. Objective: One or more novel papillomaviruses cause equine genital SCC and its associated premalignant lesions. Methods: DNA was extracted from samples of equine genital SCC and performed rolling circle amplification, in order to identify closed circular DNA viral genomes within the samples. The amplified DNA was subcloned and sequenced and the DNA sequence comp...
Penile and preputial tumours in the horse: literature review and proposal of a standardised approach.
Equine veterinary journal    November 3, 2010   Volume 42, Issue 8 746-757 doi: 10.1111/j.2042-3306.2010.00290.x
Van Den Top JG, Ensink JM, Gröne A, Klein WR, Barneveld A, Van Weeren PR.Penile and preputial tumours are not uncommon in the horse, but can cause discomfort and lead to serious complications. Several types of tumour of the male external genitalia have been described. The most common type is the squamous cell carcinoma (SCC), which is found mainly in older horses. Reports of a breed predilection for penile tumour formation are equivocal, but castration, coat colour, poor hygiene and various infectious agents have all been suggested to predispose to the development of some types of tumour (e.g. SCC, papilloma and melanoma). Careful assessment of the primary tumour i...