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SKIN TUMOURS. DR IMRANA ZULFIKAR ASSITANT 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 - PowerPoint PPT Presentation
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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