SKIN TUMOURS

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SKIN TUMOURS

• DR IMRANA ZULFIKAR
• ASSITANT PROFESSOR SURGERY

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CLASSIFICATION OF SKIN TUMOURS

• BENIGN TUMOURS
• MALIGNANT TUMOURS

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BENIGN TUMOURS

• BASAL CELL PAPILLOMAS
• PAPILLARY WART
• FRECKLE
• LENTIGO
• NAEVI/MOLES
• HALO NAVUS
• CAFÉ AU LAIT SPOTS

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• BASAL CELL PAPILLOMA
• SOFT WARTY LESIONS,PIGMENTED AND
  HYPERKERATOTIC IN BASAL LAYER
• PAPILLARY WART
• BENIGN SKIN TUMOURS HPV
• FRECKLE
• NORMAL NUMBER OF MELANOCYTES WITH INCREASE
  PRODUCTION

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• LENTIGO
• SHARPLY CIRCOMSCRIBED PIGMENTED MACULES
• MAY AT TIMES ASSOCIATED WITH PEUTZ JEGHERS
  SYNDROME
• MOLES/NAEVUS
• MOLES/NAEVUS ARE LAYERED OR AGGREGATES OF
  MELONICYTES IN EPIDERMIS

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BASAL CELL PAPILLOMAS
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PAPILLARY WART
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FRECKLE
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LENTIGO
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NAEVIMOLES
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HALO NAVUS
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CAFÉ AU LAIT SPOTS
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• PREMALIGNANT LESIONS
• ACTINIC KERTOSES
• CUTANEOUS HORN
• KERATOACANTHAOMA
• BOWENS DISEASE
• EXTRA MAMMARY PAGETS DISEASE
• GIANT HAIRY NAEVUS
• DYSPLASTIC NAEVUS

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• ACTINIC KERATOSES
• DYSKERATOSIS WITH CELLULAR ATYPIA
• 20 SCC
• CUTANEOUS HORN
• CUTANEOUS ACCUMULATION (HEIGHT GREATER THAN BASE)
• 10 SCC
• KERATOACANTHOMA
• CUP SHAPED GROWTH PLUG OF KERATIN
• MgtF,50-70 YR ,ON FACE.
• PAPPILLOMA VIRUS,SMOKING ,CHEMICAL CARCINOGENIC
• SURGICAL EXCISION

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ACTINIC KERATOSES
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CUTANEOUS HORN
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KERATOACANTHOMA
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• BOWENS DISEASE
• SCC IN SITU
• CHRONIC SOLAR DAMAGE,ARSENIC EXPOSURE ,HPV 16
• SLOW ENLARGINGERYTHMATOUS PATCH OR PLAGUE
• TOPICAL THERAPY 5 FLUOROURACIL
• SURGICAL EXCISION 4MM
• MOHS MICROSCOPIC SURGERY
• EXTRAMMARY PAGETS DISEASE
• INTRA DERMAL ADENOCARCINOMA
• GENITAL OR PERIANAL REGIONSOR AXILLA
• SURGICAL EXCISION

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BOWENS DISEASE
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EXTRAMMARY PAGETS DISEASE
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• GIANT CONGINATAL PIGMENTED NAEVUS
• GCPNSPRECURSORS FOR MM
• MORE LIKELY WITH AXIAL LESIONS
• RETROPERITONEAL OR INTRACRANIAL LESIONS
• MULTIDICSIPILANARY MANAGEMENT
• PERINATAL CURETTAGE,DERMAABRASION,LASER
  RESURFACING, SURGICAL EXCISION WITH SKIN GRAFTS
• DYSPLASTIC NAEVUS
• IRREGULAR PROLIFERATIONS ATYPICAL MELANOCYTES
• AT BASAL LAYER OF EPIDERMIS

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GIANT CONGINATAL PIGMENTED NAEVUS
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DYSPLASTIC NAEVUS
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MALIGNANT LESION

• BASAL CELL CARCINOMA
• SUAMOUS CELL CARCINOMA
• MALIGNANT MELANOMA

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ACTINIC SOLAR KREATOSIS 20 S CC
CUTANEOUS HORN 10 SCC
KERATOACHANTHOMA SCC
BOWENS DISEASE 3-11 SCC
EXTRA MAMMARY PAGETS GIANT CONGENITAL PIMEMENTD NAEVUS 25 SCC 3-5 MM
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BASAL CELL CARCINOMA

• EPIDEMIOLOGY
• SLOW GROWING LOCALLY INVASIVE MALIGNANT TUMOUR
• PLURIPOTENT EPITHELIAL CELLS
• UVR IS STRONGEST PREDISPOSING FACTOR
• OTHERS MAY BEARSENICAL COMPOUNDS,COAL
  TAR,AROMATIC HYDROCARBONS
• 90LESION ON FACE ABOVE ALINE FROM THE LOBE OF
  THE EAR TO THE CORNER OF MOUTH
• WHITE SKIN 40-80 YRS MgtF
• PATHOGENESIS
• SLOW GROWING PROPOTIANTE TO DOSE OF CARCINOGEN
• RARLY METASTISE
• HARD TO CULTURE
• MACROSCOPIC APPEARANCE
• NODULAR
• NODULOCYSTIC
• CYSTIC
• MICROSCOPIOC APPEAREANCE

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BASAL CELL CARCINOMA
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Nodular BCC

• Chronic lesion
• Easy bleeding
• Pearly border
• Surface telangiectasias
• Head and neck, trunk, and extremities

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• PROGNOSIS HIGH RISK GROUPS
• gt2CM
• NEAR EAR NOSE OR EYE
• ILL DEFIND MARGINS
• RECURRENT TUMOURS
• IMMUNOCOMPROMISED

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• MANAGEMENT
• SURGICAL
• EXCISION
• MOHS MICROSCOPIC SURGERY
• NON SURGICAL
• RADIOTHERAPY
• TOPICAL 5-FLUROURASIL

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SQUAMOUS CELL CARCINOMA

• EPIDEMIOLOGY
• MALIGNANT TUMOUR OF KERATINISING CELLS OF
  EPIDERMIS OR ITS APPENDAGES
• SECOND MOST COMMON TUMOUR
• WHITE SKIN ELDERLY MEN WITH CUMULATIVE SUN
  EXPOSURE
• ALSO ASSOCIATED CHRONIC INFLAMMATION(SINUS TRACTS
  , PREEXISTING SCARS ,OSTEOMYLETIS,BURNS,IMMUNOSUPP
  RESION,MARJOLINS )2 METASTASIS
• 20 RECURRENCE
• MACROSCOPIC
• EVERTED EDGES WITH INFLAMMED SKIN
• SMOOTH NODULAR,VERROCOUS
• PAPILLOMATOUS
• ULCERATING
• MICROSCOPIC
• IRREGULAR MASSES OF SQUAMOUS EPITHELIUM
• CELLULAR MORPHOLOGY,BRODERS GRADE ,DEPTH OF
  INVASIONPERINEURAL OR VASCULAR INVASION

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SQUAMOUS CELL CARCINOMA
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• PROGNOSIS
• INVASIONgt6CM
• HISTOLOGICAL GRADE
• HIGHER THE BRODER GRADE
• SITE LIPS AND EARS HAVE HIGH LEVEL OF
  RECURRENCE
• AEITOLOGY
• IMMUNOSUPPRESION

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• MANAGEMENT
• DEFINTE TREATMENT SURGICAL LOUPE EXCISION(4MM
  CLEARANCE MARGIN IF lt2 AND 1CM MARGIN gt2CM
  LESIONS )
• IN TRANSIT METSTASIS
• LYMPHATIC METSTASIS

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MALIGNANT MALENOMA

• EPIDEMIOLOGY
• MM IS CANCER MELNOCYTES
• MM ACCOUNTS FOR 5 OF SKIN MALIGNANCY
• INCREASES UVR EXPOSURE
• 3OF ALL MALIGNANCYS
• 75 OF ALL DEATHS
• 7OCCULT METASTASIS

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• RISK FACTORS
• XERODERMAPIGMENTOSUM
• PAST MEDICAL OR FAMILY HISTORY
• HIGH NUMBER OF NAEVI
• TENDENCY TO FRECKLE
• GCPN
• DYSPLASTIC NAEVUS
• IMMUNOCOMPROMISED
• MACROSCOPIC APPEANRANCE
• SUPERFICIAL SPREADING MELANOMA75
• NODULAR MELANOMA 15
• LENTIGO MALIGNA MELANOMA5-10
• ACRAL LENTIGIOUS MELANOMA2-8
• FEATURES IN NAEVI SUGGESTING MM
• CHANGE IN SIZE ,SHAPE COLOUR ,ITCHING,SATELLITE
  LESIONS
• BLOOD SUPPLY

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Clinical types- MM
Superficial spreading melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma
Nodular melanoma
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MALIGNANT MELANOMA
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ABCD of Melanoma

• Asymmetry
• Border irregularity
• Color variegation
• Diameter gt6mm

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• BRESLOWS THICKNESS GRADE
• AJC STAGING

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Prognostic features- MM

• Good prognosis
• Breslow lt 1mm
• Intermediate prognosis
• Breslow 1-4mm
• Bad prognosis
• Breslow gt4mm

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• Good prognosis
• Breslow lt 1mm
• Intermediate prognosis
• Breslow 1-4mm
• Bad prognosis
• Breslow gt4mm

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• MANAGEMENT
• HISTORY /CLINICAL EXMINATION
• SKIN BIOPSY
• SENTINEL LYMPH NODE BIOPSY
• LOCAL TREAMENT
• REGIONAL LYMPH NODES

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• PROGNOSIS
• TUMOUR THICKNESS
• LYMPH NODES
• DISTANT METSTASIS

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VASCULAR LESIONS

• CONGENITAL
• HEAMANGIOMAS
• VASCULAR MALFORMATIONS
• ACCUIRED
• SIDER NAEVI
• CAMPBELL DE MORGAN SPOTS
• PYOGENIC GRANULOMAS
• ANGISARCOMAS
• KAPOSIS SARCOMA