SKIN TUMOURS

DR IMRANA ZULFIKARASSITANT PROFESSOR

SURGERY

CLASSIFICATION OF SKIN TUMOURS

BENIGN TUMOURS

MALIGNANT TUMOURS

BENIGN TUMOURS

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

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

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

BASAL CELL PAPILLOMAS

PAPILLARY WART

FRECKLE

LENTIGO

NAEVIMOLES

HALO NAVUS

CAFÉ AU LAIT SPOTS

PREMALIGNANT LESIONS

• ACTINIC KERTOSES• CUTANEOUS HORN• KERATOACANTHAOMA• BOWENS DISEASE• EXTRA MAMMARY PAGETS DISEASE• GIANT HAIRY NAEVUS• DYSPLASTIC NAEVUS

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• M>F,50-70 YR ,ON FACE.• PAPPILLOMA VIRUS,SMOKING ,CHEMICAL CARCINOGENIC• SURGICAL EXCISION

ACTINIC KERATOSES

CUTANEOUS HORN

KERATOACANTHOMA

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

BOWENS DISEASE

EXTRAMMARY PAGETS DISEASE

GIANT CONGINATAL PIGMENTED NAEVUSGCPNSPRECURSORS FOR MMMORE LIKELY WITH AXIAL LESIONSRETROPERITONEAL OR INTRACRANIAL LESIONSMULTIDICSIPILANARY MANAGEMENTPERINATAL CURETTAGE,DERMAABRASION,LASER RESURFACING,

SURGICAL EXCISION WITH SKIN GRAFTS

DYSPLASTIC NAEVUSIRREGULAR PROLIFERATIONS ATYPICAL MELANOCYTESAT BASAL LAYER OF EPIDERMIS

GIANT CONGINATAL PIGMENTED NAEVUS

DYSPLASTIC NAEVUS

MALIGNANT LESION

• BASAL CELL CARCINOMA

• SUAMOUS CELL CARCINOMA

• MALIGNANT MELANOMA

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

BASAL CELL CARCINOMAEPIDEMIOLOGY• SLOW GROWING LOCALLY INVASIVE MALIGNANT TUMOUR• PLURIPOTENT EPITHELIAL CELLS• UVR IS STRONGEST PREDISPOSING FACTOR• OTHERS MAY BEARSENICAL COMPOUNDS,COAL TAR,AROMATIC HYDROCARBONS• 90%LESION ON FACE ABOVE ALINE FROM THE LOBE OF THE EAR TO THE CORNER OF

MOUTH• WHITE SKIN 40-80 YRS M>F

PATHOGENESIS• SLOW GROWING PROPOTIANTE TO DOSE OF CARCINOGEN• RARLY METASTISE• HARD TO CULTURE

MACROSCOPIC APPEARANCE• NODULAR• NODULOCYSTIC • CYSTIC

MICROSCOPIOC APPEAREANCE• OVOID CELLS IN NEST WITH SINGLE OUTER PALISADING LAYER

BASAL CELL CARCINOMA

Nodular BCC• Chronic lesion

• Easy bleeding

• Pearly border

• Surface telangiectasias

• Head and neck, trunk, and extremities

PROGNOSIS HIGH RISK GROUPS

• >2CM• NEAR EAR NOSE OR EYE• ILL DEFIND MARGINS• RECURRENT TUMOURS • IMMUNOCOMPROMISED

MANAGEMENT

SURGICAL EXCISION MOHS MICROSCOPIC SURGERYNON SURGICALRADIOTHERAPYTOPICAL 5-FLUROURASIL

SQUAMOUS CELL CARCINOMA

EPIDEMIOLOGYMALIGNANT TUMOUR OF KERATINISING CELLS OF EPIDERMIS OR ITS APPENDAGESSECOND MOST COMMON TUMOUR WHITE SKIN ELDERLY MEN WITH CUMULATIVE SUN EXPOSURE ALSO ASSOCIATED CHRONIC INFLAMMATION(SINUS TRACTS , PREEXISTING

SCARS ,OSTEOMYLETIS,BURNS,IMMUNOSUPPRESION,MARJOLINS )2% METASTASIS20% 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

SQUAMOUS CELL CARCINOMA

PROGNOSIS INVASION>6CM HISTOLOGICAL GRADE HIGHER THE BRODER GRADE SITE LIPS AND EARS HAVE HIGH LEVEL OF

RECURRENCE AEITOLOGY IMMUNOSUPPRESION

MANAGEMENT

• DEFINTE TREATMENT SURGICAL LOUPE EXCISION(4MM CLEARANCE MARGIN IF <2 AND 1CM MARGIN >2CM LESIONS )

• IN TRANSIT METSTASIS• LYMPHATIC METSTASIS

MALIGNANT MALENOMA• EPIDEMIOLOGY• MM IS CANCER MELNOCYTES• MM ACCOUNTS FOR 5% OF SKIN

MALIGNANCY• INCREASES UVR EXPOSURE• 3%OF ALL MALIGNANCYS • 75% OF ALL DEATHS• 7%OCCULT METASTASIS

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

Clinical types- MM

Superficial spreading melanoma

Lentigo maligna melanoma

Acral lentiginous melanoma Nodular melanoma

MALIGNANT MELANOMA

ABCD of Melanoma

• Asymmetry

• Border irregularity

• Color variegation

• Diameter >6mm

BRESLOWS THICKNESS GRADE

• AJC STAGING

Prognostic features- MM• Good prognosis

– Breslow < 1mm

• Intermediate prognosis– Breslow 1-4mm

• Bad prognosis– Breslow >4mm

• Good prognosis– Breslow < 1mm

• Intermediate prognosis– Breslow 1-4mm

• Bad prognosis– Breslow >4mm

MANAGEMENT

• HISTORY /CLINICAL EXMINATION• SKIN BIOPSY

• SENTINEL LYMPH NODE BIOPSY

• LOCAL TREAMENT• REGIONAL LYMPH NODES

• PROGNOSIS• TUMOUR THICKNESS• LYMPH NODES• DISTANT METSTASIS

VASCULAR LESIONS• CONGENITAL: HEAMANGIOMAS VASCULAR MALFORMATIONS• ACCUIRED: SIDER NAEVICAMPBELL DE MORGAN SPOTS PYOGENIC GRANULOMAS ANGISARCOMASKAPOSIS SARCOMA