SKIN TUMOURS
DR IMRANA ZULFIKAR
ASSITANT PROFESSOR
SURGERY
CLASSIFICATION OF
SKIN TUMOURS
 BENIGN TUMOURS
 MALIGNANT TUMOURS
BENIGN TUMOURS
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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
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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
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SURGICAL EXCISION
ACTINIC KERATOSES
CUTANEOUS HORN
KERATOACANTHOMA
BOWENS DISEASE
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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 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
GIANT CONGINATAL
PIGMENTED NAEVUS
DYSPLASTIC NAEVUS
MALIGNANT LESION
• BASAL CELL CARCINOMA
• SUAMOUS CELL CARCINOMA
• MALIGNANT MELANOMA
ACTINIC SOLAR
KREATOSIS
CUTANEOUS HORN
KERATOACHANTHOM
A
BOWENS DISEASE
20% S CC
10”% SCC
SCC
3-11% SCC
EXTRA MAMMARY
PAGETS
25% SCC
GIANT CONGENITAL
PIMEMENTD NAEVUS
3-5% MM
BASAL CELL CARCINOMA
EPIDEMIOLOGY
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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
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SLOW GROWING PROPOTIANTE TO DOSE OF CARCINOGEN
RARLY METASTISE
HARD TO CULTURE
MACROSCOPIC APPEARANCE
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NODULAR
NODULOCYSTIC
CYSTIC
MICROSCOPIOC APPEAREANCE
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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,
PROGNOSIS HIGH RISK GROUPS
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>2CM
NEAR EAR NOSE OR EYE
ILL DEFIND MARGINS
RECURRENT TUMOURS
IMMUNOCOMPROMISED
MANAGEMENT
SURGICAL
EXCISION
MOHS MICROSCOPIC SURGERY
NON SURGICAL
RADIOTHERAPY
TOPICAL 5-FLUROURASIL
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,IMMUNOSUPPRESION,MARJOLINS )2% METASTASIS
20% RECURRENCE
MACROSCOPIC
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EVERTED EDGES WITH INFLAMMED SKIN
SMOOTH NODULAR,VERROCOUS
PAPILLOMATOUS
ULCERATING
MICROSCOPIC
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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:
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XERODERMAPIGMENTOSUM
PAST MEDICAL OR FAMILY HISTORY
HIGH NUMBER OF NAEVI
TENDENCY TO FRECKLE
GCPN
DYSPLASTIC NAEVUS
IMMUNOCOMPROMISED
MACROSCOPIC APPEANRANCE
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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
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PROGNOSIS
TUMOUR THICKNESS
LYMPH NODES
DISTANT METSTASIS
VASCULAR LESIONS
• CONGENITAL:
HEAMANGIOMAS
VASCULAR MALFORMATIONS
• ACCUIRED:
SIDER NAEVI
CAMPBELL DE MORGAN SPOTS
PYOGENIC GRANULOMAS
ANGISARCOMAS
KAPOSIS SARCOMA