Different types of skin tumours and their management

Different types of skin tumours and their management

1. Dr. P. ANISH MS

2. Classification 1. Keratinocytic /epidermal tumors squamous cell carcinoma
basal cell carcinoma
Merkel cell carcinoma
carcinoma precursors and benign simulants of carcinoma:
actinic keratosis
verruca
seborrheic keratosis 2. Melanocytic tumors tumors occurring in intermittently sun-exposed skin:
melanocytic tumors in intermittently sun-exposed skin
low-cumulative sun damage (CSD) melanoma (superficial spreading melanoma)
simple lentigo and lentiginous melanocytic nevus

3. 3.Tumors occurring in chronic sun exposure: lentigo maligna melanoma
desmoplastic melanoma
Spitz tumors , including benign (Spitz nevus) and malignant (Spitz melanoma) acral melanoma, acral nevus ocular tumors : uveal melanoma
conjunctival melanoma
conjunctival nevus
other malignant melanoma types: nodular melanoma, nevoid melanoma, metastatic melanoma

4. 3. Appendageal tumors apocrine and eccrine differentiation​
malignant (e.g. Porocarcinoma , digital papillary adenocarcinoma)
benign (e.g. Poroma , cylindroma )
follicular differentiation
malignant (e.g. Pilomatrical carcinoma)
benign (e.g. Pilomatrixoma )
sebaceous differentiation ( Sebaceoma , Sebaceous adenoma, carcinoma) other special sites: mammary Paget disease extramammary Paget disease hidradenoma papilliferum

5. 4. Hematolymphoid tumors mycosis fungoides Sezary syndrome Erdheim –Chester disease 5 5. Soft tissue tumors lipoma hemangioma neurofibroma Ewing sarcoma

6. 6. Inherited tumor syndromes associated with skin malignancies familial melanoma xeroderma pigmentosum naevoid basal cell carcinoma syndrome ( Gorlin syndrome)
Carney complex
BAP1 tumor predisposition syndrome
Muir–Torre syndrome.

7. Etiology UVR, mostly of the UVB spectrum (290-320 nm) that induces mutations in suppressor genes. The propensity for multiple BCC may be inherited. Associated with mutations in the PTCH gene in many cases. Age of Onset : Older than 40 years. Sex : Males > females. Race: Rare in brown- and black-skinned persons Basal cell carcinoma

8. Predisposing Factors Skin phototypes I and Il and albinos are highly susceptible to develop BCC with prolonged sun exposure. Also a history of heavy sun exposure in youth predisposes the skin to the development of BCC later in life. Previous therapy with x-rays for facial acne greatly increases the risk of BCC Superficial multicentric BCC occurs 30-40 years after ingestion of arsenic but also without apparent cause.

9. Clinical Manifestation Slowly evolving, usually asymptomatic. Erosion or bleeding with minimal trauma may be first symptom. Skin Lesions: There are five clinical types: 1- Nodular 2- Ulcerating 3-Sclerosing (Cicatricial), 4- Superficial; 5- Pigmented

10. 1-Nodular BCC: Papule or nodule, translucent or "pearly." Skin-colored or reddish, smooth surface with telangiectasia, well defined, firm. Portions of nodular BCC may have erosions or stipples of melanin pigmentation.

11. Basal cell carcinoma; nodular type A. A glistening, smooth plaque on the lower eyelid with multiple telangiectasias . B. An oval, pearly nodule on the nose close to the inner c anthus .

12. A smooth, pearly tumor with telangiectasia below the lower eyelid. Tumor feels hard, is well defined, and is asymptomatic. A large, firm reddish glistening nodule with small ulcerations on the nose.

13. C. Rodent ulcer in the preauricular region. A rolled pearly border surrounds an ulcer with yellow necroses and a tiny black crust. D. A deep ulcer with a surrounding rolled border, smooth, glisteningand partly covered with crusts in the mandibular region. All these lesions are hard upon palpation.

14. 3-Sclerosing BCC: Appears as a small patch of morphea or a superficial scar, often illdefined , skin-colored , whitish but also with peppery pigmentation

15. 3-Sclerosing BCC: cont.. Sclerosing BCC can progress to nodular or ulcerating BCC Basal cell carcinoma, sclerosing , nodular, and ulcerating A large lesion,which looks like morphea and is whitish and firm upon palpation but within the level of the skin, is found on the temple and in the supraciliar region.

16. 4-Superficial multicentric BCCs: Appear as thin plaques

17. Superficial basal cell carcinoma, invasive. There are two irregular red areas with rolled borders and central telangiectasia. In the larger lesion the BCC is elevated with an irregular surface and assumes the morphology and growth behavior of a nodular BCC, the lesion is erosive and will progress to an ulcer.

18. 5-Pigmented BCC: May be brown to blue or black

19. Distribution : Isolated single lesion; multiple lesions are not infrequent; > 90% occur in the face. Search carefully for "danger sites": Medial and lateral canthi , nasolabial fold, behind the ears . Superficial multicentric BCCS occur on the trunk. BCC usually arises only from epidermis that has a capacity to develop (hair) follicles.

20. Distribution : •Scalp in bald people Basal cell carcinoma: predilection sites Dots indicate superficial multicentric BCCs.

21. Laboratory Examination Dermatopathology : Solid tumor consisting of proliferating atypical basal cells, large, oval cells deep-blue staining on H&E, but with little anaplasia and infrequent mitoses; Palisading arrangement at periphery; variable amounts of mucinous stroma .

22. Treatment Excision with primary closure, skin flaps, or grafts. Cryosurgery and electrosurgery are options, but only for very small lesions and not in the danger sites or on the scalp

23. Squamous cell carcinoma Sun exposure, chronic inflammation, and immunosuppression Premalignant lesions: actinic keratosis, keratoacanthoma , bowens disease, erythroblastosis of queyrat . Macroscopy: Smooth, nodular, verrucous lesions with exerted edges. Microscopy: keratin pearls

24. Premalignant lesions

25. Squamous cell carcinoma is defined as malignant epithelial neoplasm exhibiting squamous differentiation as characterised by the formation of keratin and/or the presence of intercellular bridges. Pathogenesis : Molecular basis of Cancer It is characterized by a progression of changes on cellular and genetic level that ultimately reprogram a cell to undergo uncontrolled cell division, thus forming a malignant mass. Squamous cell carcinoma

26. RISK FACTORS 1.Smoking of cigarettes, cigars, and pipes 2. Use of smokeless tobacco: snuff and chewing tobacco 3. Drinking of 3 ounces or more of ethanol per day 4. Smoking and ethanol (highest risk) 5. Betel nut 6. Age over 40 years 7. High accumulation of irradiation over the years 8.Previous history of oral cancer 9. Infection with human immunodeficiency virus and other immunosuppression conditions 10. Ethnic or family history 11. Syphillis 12. Chronic mechanical irritation 13. Poor oral hygiene 14. Candidal infection

27. ROLE OF CONSTITUENTS OF TOBACCO • Polycyclic aromatic hydrocarbons- carcinogenesis • Nicotine - carcinogenesis • Nitrosamine- carcinogenesis • Phenol - tumour promotion& irritation • Benzopyrene- carcinogenesis • Carbon monoxide - impaired oxygen transport Formaldehyde & oxides of N - toxicity

28. MANIFESTATIONS Rapid proliferation / growth of long standing, innoculous lesion. • Unexplained colour change. • Growth / ulceration of pigmented area. • Ulceration / erosion in otherwise. • Homogenous white/red lesions. • Longstanding ulcers with areas of sharp tooth or appliances insult. Induration in / around ulcer. Unexplained mobility, exfoliation of teeth. Unexplained paresthesia . • Unexplained dysphagia, hoarseness of voice. • Unexplained restriction of tongue movements. • Pain in ear. Rapid enlargement of lymph nodes

29. Tnm staging TUMOUR SIZE TX - Primary tumor cannot be assessed TO - No evidence of primary tumor Tis - Carcinoma in situ T1 - Tumor 2 cm or less in greatest dimension T2 - Tumor more than 2 cm but not more than 4 cm in greatest dimension T3 - Tumor more than 4 cm in greatest dimension

30. T4 a - Lip tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin of face (ie, chin or nose)* oral cavity tumor invades through cortical bone, into deep [extrinsic] muscle of tongue ( genioglossus , hyoglossus , palatoglossus , and styloglossus ), maxillary sinus, or skin of face. T4b - Tumor involves masticator space, pterygoid plates, or skull base and/or encases internal carotid artery Tnm staging

31. NODAL METASTASIS • Nx - Regional lymph nodes cannot be assessed • NO - No regional lymph node metastasis N1 - Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension • N2 - Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension; or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension; or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest d imension . Tnm staging

32. N2a- Metastasis in a single ipsilateral lymph node more than 3 cm but not more than 6 cm in greatest dimension. N2b- Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension N2c -Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension. N3 metastasis in a lymph >6cm in greatest dimension. M: DISTANT METASTASIS Mx Distant metastasis cannot be assessed. MO No distant metastasis. M1 Distant metastasis.

33. Treatment Freezing: This involves removing cancerous cells by freezing them with liquid nitrogen. Laser therapy: An intense beam of light v aporizes growths, usually with little damage to surrounding tissue and with a reduced risk of bleeding, swelling and scarring. Lasers are often used to treat superficial carcinomas on the lips.

34. Treatment Wide local excision <2cm – 4mm clearance >2cm – 1cm clearance Mohs surgery: This is often considered the most effective treatment for squamous cell carcinomas. During the procedure, removal of the tumor layer by layer. This allows the entire growth to be removed without taking an excessive amount of surrounding healthy skin.

35. Radiation therapy: This may be an option for treating large cancers on the eyelids, lips and ears- areas that are difficult to treat surgically - or for tumors too deep for resection Chemotherapy : For very superficial cancers, creams or lotions containing anti-cancer agents may be applied directly to the skin. Some of these medications can cause severe inflammation and scarring. Treatment

36. Thank you..’