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Diseases of the feline nasal planum
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Skin lesions on a cat’s nose can be challenging in terms of differential diagnosis and treatment; Christina Gentry shows how to approach them in a logical fashion.
Christina Gentry
DVM, Dip. ACVD
Dr. Gentry undertook both her undergraduate study and Doctor of Veterinary Medicine at Texas A&M University and went on to complete a small animal rotating internship at the University of Georgia before doing her dermatology residency at the Veterinary Referral Center of Colorado. She achieved her dermatology diplomate status in 2016 and currently works in a private referral practice in Texas. She has a special interest in feline dermatology, otitis, and immune-mediated skin diseases.
Key points
- Nasal planum lesions in the cat may present alone or with other skin lesions.
- The presence or absence of other lesions can help narrow the differential list.
- Superficial impression cytology and biopsy are the most frequently used diagnostics.
- Immune-mediated, infectious and paraneoplastic disorders may also have systemic signs; these can include malaise and decreased appetite.
Introduction
Diseases of the nose and the bridge of the nose are uncommon to rare in feline patients. Some conditions will affect both the non-haired area (nasal planum and nasal philtrum) and the haired bridge of the nose, while others will affect only the nasal planum. A variety of conditions may lead to lesions on the nose, including neoplastic, parasitic, immune-mediated, infectious, genetic, environmental and idiopathic causes. Diseases affecting the nasal planum may also involve both the surrounding skin and distant sites. The goal of this article is to briefly review the pathogenesis, diagnostics, treatment options and prognosis for conditions that the practitioner is likely to encounter, based on the underlying etiology.
Neoplastic and paraneoplastic
Squamous cell carcinoma
Squamous cell carcinomas (SCC) are a common occurrence in the cat, accounting for around 15% of all feline cutaneous neoplasms (1). Most cutaneous SCC are found on the face, especially the minimally haired tips of the ears, bridge of the nose, eyelids, and non-haired nasal planum (Figure 1). The pathogenesis involves chronic exposure to UV radiation, with white or light-colored cats being at an increased risk due to the higher amount of UVB light reaching the skin surface (2). The initial lesions that develop – which may at first resemble a non-healing scratch or other trauma (3) – are actinic keratosis (pre-cancerous lesions of chronic sun exposure), then squamous cell carcinoma in situ, followed by squamous cell carcinoma. A combination of lesions may be present at the same time, but typically they are inflamed with crusts overlying erythematous, alopecic, and eroded skin (3), varying in size from a few millimeters to a few centimeters in diameter. Affected areas may be depressed and the crusts can be hemorrhagic, with papillary or fungiform masses sometimes present in more advanced cases.
Diagnosis is typically made by biopsy or excision. A punch biopsy method (see Box 1) can be used for the nasal planum, while a margin/shave biopsy may be more useful on the ear tips. Since the lesions affect the epidermis, a fine-needle aspirate may not be as helpful for diagnosis for smaller lesions. The histopathology of a well-differentiated SCC will have trabeculae and islands of epidermal cells that dive into the dermis. These lesions have more basal-appearing keratinocytes on the periphery, with gradual differentiation to keratinized epidermal cells in the center of the lesions. These epidermal cells form keratin "pearls" that can found in the center of the neoplastic epidermal islands (3). [...]
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