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This case series presents four varied clinical intersections and examines how the environmental exposome may contribute to overlapping neoplastic presentations. The first and fourth cases illustrate incidental findings during excisional biopsy, while the second emphasizes diagnostic uncertainty from concurrent neoplasms and the third highlights surgical complexity from intertwined tumor entities. Histopathology delineates tumor types, and the discussion evaluates ultraviolet radiation, air pollutants, chemical carcinogens, and smoking. The study underscores a potential exposome–collision tumor link to support interdisciplinary collaboration and holistic management.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/converging-neoplasms-and-the-environmental-exposome-four-distinct-encounters-with-collision-tumors-in-dermatology-open-access-case-report/329070/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/converging-neoplasms-and-the-environmental-exposome-four-distinct-encounters-with-collision-tumors-in-dermatology-open-access-case-report/329070.png","ImageObject",300,407,{"name":92,"@type":93},"Riley","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-23","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What are collision tumors and why are they clinically important?","Question",{"text":112,"@type":113},"Collision tumors contain two or more distinct cell types within a single lesion. They are uncommon and create diagnostic and therapeutic challenges due to overlapping tumor biology.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does the article relate environmental exposures to collision neoplasms?",{"text":117,"@type":113},"It explores the environmental exposome as a potential contributor to the emergence of neoplastic overlaps. Proposed factors include ultraviolet radiation, air pollutants, chemical carcinogens, and smoking.",{"name":119,"@type":110,"acceptedAnswer":120},"What diagnostic and treatment steps are highlighted for collision tumors?",{"text":121,"@type":113},"The article emphasizes dermatoscopic examination and full-lesion pathologic evaluation to avoid missing a secondary tumor. Treatment commonly involves excision with margins based on guidelines for the more aggressive tumor.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},329070,1790161651,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},1374391975076,"https://ap-avatar.wpscdn.com/avatar/14000253ca4ec9f6853?x-image-process=image/resize,m_fixed,w_180,h_180&k=1783305029341752051","Open Access Case Report  \nPublished via VCOM Clinical, Biomedical, and Educational Research  \nReceived 06/17/2024  \nReview began 07/23/2024  \nReview ended 08/13/2024  \nPublished 08/28/2024  \n© Copyright 2024  \nForbes Kaprive et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.68031  \nConverging Neoplasms and the Environmental Exposome: Four Distinct Encounters with Collision Tumors in Dermatology  \nJessica Forbes Kaprive 1, Stephanie Washburn 1 , Alexandra Loperfito 2, Craig Garofola 3  \n1. Dermatology, LewisGale Medical Center, Blacksburg, USA 2. Dermatology, Edward Via College of Osteopathic Medicine, Blacksburg, USA 3. Dermatology, River Ridge Dermatology, Blacksburg, USA  \nCorresponding author: Jessica Forbes Kaprive, [jessicafkaprive@gmail.com](jessicafkaprive@gmail.com)  \nAbstract  \nCollision tumors-characterized by two or more distinct cell types within a singular lesion-are uncommon yet intriguing dermatological phenomena, presenting diagnostic and therapeutic enigmas. Our case series details four diverse presentations of such tumor intersections in dermatology. Beyond the individual cases, we embark on an exploration into the potential environmental exposome 's role in the emergence of these neoplastic overlaps.  \nWhile the first and fourth cases underscore serendipitous discoveries during an excisional biopsy, the second revolves around diagnostic ambiguity arising from concurrent neoplasms. The third case delineates the challenges in surgical management due to intertwined tumor entities. Integral to our investigation, histopathological evaluations helped demarcate the distinct tumor types. We then delve into environmental factors-cumulative ultraviolet radiation, air pollutants, chemical carcinogens, and smoking-speculating their role in tandem neoplastic presentations.  \nCutaneous collision tumors are infrequently occurring neoplasms of unknown origin characterized by two or more distinct cell types within a singular lesion. This series highlights a potential connection between specific environmental exposome and the development of collision neoplasms. An appreciation of this potential relationship will hopefully incite interdisciplinary collaborations and holistic management strategies, improving patient outcomes in the face of these dermatological rarities.  \nCategories: Public Health, Dermatology, Oncology  \nKeywords: sunburn, tobacco, mustard gas, squamous cell carcinoma, basal cell carcinoma, environmental exposure, collision tumor  \nIntroduction  \nCollision tumors are characterized by two or more distinct cell types occurring within a singular lesion, with an estimated prevalence of around 69 per 40,000 cutaneous biopsies [1,2] . The most common combination observed occurs with basal cell carcinoma (BCC) and melanocytic nevus [1] . The pathogenesis for the development of collision remains unknown, though the most widely accepted hypothesis involves neoplastic heterogeneity [1] . Other proposed theories include the field cancerization theory and interaction theory, which suggest that recurrent skin damage increases the risk for the development of two neoplasms within one location and that the formation of one neoplasm produces epidermal or stromal changes inducing the formation of a second neoplasm, respectively [1] . Diagnosing these lesions requires a dermatoscopic exam and pathologic evaluation of the entire lesion to reduce the chance of overlooking a secondary tumor [1] .  \nTreatment often involves excision, with margins based on the NCI guidelines for the more aggressive tumor  \n[1] . The tumors involved often dictate prognosis, though the average disease-free interval for collision tumors is 22.7 months, suggesting they tend to be less aggressive than an individual neoplasm [1] .","cbCairdDm8ihhdAg","https://ap.wps.com/l/cbCairdDm8ihhdAg","pdf",9541357,"English","# Introduction\n## Collision tumor definition, prevalence, and hypothesized mechanisms\n## Diagnosis and treatment considerations\n# Case Presentation\n## Case one\n## Figure 1: Melanoma-in-situ, focal basal cell carcinoma, and incidental seborrheic keratosis\n## Figure 2: Histopathology of melanoma-in-situ, focal basal cell carcinoma, and incidental seborrheic keratosis","[{\"question\":\"What are collision tumors and why are they clinically important?\",\"answer\":\"Collision tumors contain two or more distinct cell types within a single lesion. They are uncommon and create diagnostic and therapeutic challenges due to overlapping tumor biology.\"},{\"question\":\"How does the article relate environmental exposures to collision neoplasms?\",\"answer\":\"It explores the environmental exposome as a potential contributor to the emergence of neoplastic overlaps. Proposed factors include ultraviolet radiation, air pollutants, chemical carcinogens, and smoking.\"},{\"question\":\"What diagnostic and treatment steps are highlighted for collision tumors?\",\"answer\":\"The article emphasizes dermatoscopic examination and full-lesion pathologic evaluation to avoid missing a secondary tumor. Treatment commonly involves excision with margins based on guidelines for the more aggressive tumor.\"}]","Converging Neoplasms and the Environmental Exposome: Four Distinct Encounters with Collision Tumors in Dermatology - Open Access Case Report | PDF",1789982301,25]