SKIN TUMORS (except malignant melanoma) dory

Benign tumors Malignant tumors grow slowly do not invade surrounding tissue can have large dimension and produce „mass efect“ = compression of vital organs such as blood vessels do not metastasize grow fast invade surrounding tissue (regardless of size) can metastasize (spread to non-adjacent tissues)

Diagnosis Clinical findings Dermatoskopic examination (can increase accuracy by 20 – 80 %) Biopsy + histological examination (confirmation)

Therapy depends on a few factors: the type of tumor, the size, the site and whether the patient will be able to undergo an operation Surgical excision Liquid nitrogen Phototherapy - actinotherapy, photodynamic therapy Imiguimod (immune response modifier) Laserotherapy

Epidermal Tumors BENIGN Seborrheic Keratosis Clear Cell Acanthoma PREmalignant Actinic Keratosis Bowen Disease Paget Disease Erythroplasia of Queyrat Leukoplakie Lentigo Maligna MALIGNANT Basal Cell Carcinoma Squamous Cell Carcinoma Malignant Melanoma Carcinoma Cutis Carcinoides

Benign Epithelial Tumors (from keratinocytes) Seborrheic Keratosis (senile wart, seborrheic verruca) They appear in various colors, from light tan to black, are round or oval, slightly elevated with rough surface, and range in size from small to more than 2 cm across. It can sometimes imitates malignant melanoma. Diagnosis: clinical findings, dermatoskopy, histology (if needed) THERAPY (cosmetic reasons usually): exkochleation, excision or laserotherapy

Benign Epithelial Tumors (from keratinocytes) Clear Cell Acanthoma (Degos acanthoma, Pale cell acanthoma) It usually presents as a moist solitary firm, brown-red, well-circumscribed, 5 mm to 2 cm nodule, on the lower extremities of middle-aged to elderly individuals. It is characterized by slow growth, and may persist for years.

PREmalignant Epithelial Tumors Actinic Keratosis - scaly lesion on chronically sunlight-exposed skin, that usually appear in elderly persons and may evolve into spinalioma Bowen disease - squamous cell ca in situ is slowly growning psoriasiform plaque in older adult. Paget disease - dermatitis-like change involving nipple and adjacent skin of the brest as a manifestation of an underlying carcinoma of the breast.

PREmalignant Epithelial Tumors Erythroplasia of Queyrat is squamous cell ca in situ on mucosal or transitional surfaces, usually on genitals of elderly men. Leukoplakia is a solitary lesion on the oral mucosa, asymptomatic, white, hyperkeratotic spot.

Malignant Epithelial Tumors Basal Cell Carcinoma (Basalioma, Basal Cell Epithelioma) - very common usually on chronically sunlight-exposed skin, more in elderly people Superficial BCC (the most common) Nodular BBC Pigmented BBC Sclerosing BBC Ulcerated BBC (old term „ulcus rodens“ means „destructive“, old term „ulcus terebrans“ means boring through → it can destroy underlying structures)

Malignant Epithelial Tumors Squamous Cell Carcinoma - common tumor usually arises from actinic keratosis, carcinoma in situ, chronic ulcer … or can develops de novo it develops anywhere on skin, often on chronically sunlight-exposed skin, usually appear in older people (back, extremities, face, scalp…)

Malignant Epithelial Tumors Papillomatosis Cutis Carcinoides - unfrequent - unilateral or bilateral, large cauliflower-like vegetating masses develop over the shins or insteps, can reach a size of 15 cm, tumors slowly expand

Mesenchymal Tumors BENIGN Soft Fibroma Fibroma Durum Keloid MALIGNANT Lipoma Leiomyoma Neurofibroma fibroangioma, angiolipoma, lipofibroma… MALIGNANT Dermatofibrosarcoma Protuberans Malignant Fibrous Histiocytoma Fibrosarcoma (lipo-, leiomyo-…)

Benign Mesenchymal Tumors (fibrous tumors) Dermatofibroma (fibroma durum, histiocytoma…) - firm pigmented nodule usually on the legs. Soft Fibroma (Fibroma Molle, Skin Tag, Acrochordon) - harmless pedunculated outpouching of skin. Keloid - usually develops after injury or operation, but can develops spontaneously (belongs to tumors), - thick firm nodules extend beyond the boundaries of the original wound, the growths can be several cm thick, extremely hard, with smooth, mirror-like surface.

Benign Mesenchymal Tumors Tumors of Muscle Tissue Lipoma – from fat tissue, one of the most common tumors Leiomyoma - can arise from the smooth muscle of the hair (arrector pili), nipple, scrotum (dartos) and blood vessels Neurofibroma - cutaneous neural tumor from nerve sheath

Malignant Mesenchymal Tumors (fibrous tumors) Malignant Fibrous Histiocytoma is the most common soft tissue sarcoma in adult. Dermatofibrosarcoma Protuberans is an uncommon tumor, usually involving the shoulder girdle region of young to middle-aged adults.

Vascular Tumors BENIGN Hemangiomas Pyogenic Granuloma Lymphangioma MALIGNANT Sarcoma Kaposi Lymphangiosarcoma

Adnexal Tumors BENIGN Trichoepitelioma Pilomatricoma Trichoblastoma Keratoacanthoma Syringoma Cylindroma Sebaceous Hyperplasia MALIGNANT (uncommon) carcinomas (trichilemmal, sweat or sebaceous glands…)

Benign Adnexal Tumors (Hair Follicle Tumors) Keratoakanthoma - quickly growing tumor, mimics a squamous cell carcinoma but regresses spontaneously in most cases. Trichoepithelioma (superficial trichoblastoma) Tumor also containing hair germs, but often with multiple lesions . Trichoblastoma (giant trichoepithelioma) - uncommon tumor containing follicular germinative cells, any area of the body may be involved Pilomatricoma (pilomatrixoma, Malherbe tumor…) - tumor with features of follicle matrix, typically in childhood.

Benign Adnexal Tumors (from glands) Syringoma - from sweat glands, the most common adnexal tumor, they typically occur below the eyes of young women. Eccrine poroma – from sweat glands Sebaceous Hyperplasia – from sebaceous gland, very often, discrete skin-colored papule