1. Krisinda C. Dim-Jamora, MD, FPDS Section of Dermatology, The Medical City Department of Dermatology, Makati Medical Center Skin and Cancer Foundation, Inc

2.  I have no conflict of interest in this lecture.

3. 1. Describe the clinical features and pathology of the following benign & malignant skin tumors: A.Seborrheic Keratoses B.Acanthosis Nigricans C.Fibroepithelial Polyp D.Epidermal Inclusion Cyst E.Sebaceous Gland Hyperplasia F.Xanthomas G. Actinic Keratosis H.Keratoacanthoma I.Squamous Cell Cancer J.Basal Cell Cancer K.Dermatofibrosarcoma Protuberans

4.  Recognize  Diagnose  Manage  Follow-up

5.  Slow-growing  Well-defined  No change in color  No to minimal change in size  Painless  No bleeding  Quick growth  Irregular/ ill-defined  Variegated or sudden change in color  Painful  Bleeding  Crusting

7.  Solitary or multiple, oval, slightly raised, light brown to black, sharply demarcated papules of plaques  Face, chest, back, extremities  4 th -5 th decade  MOA: local arrest of maturation of keratinocytes  De novo or from lentigines  Patho: hyperplasia of epid & supporting papillary CT  Tx: EDC or LN2

8.  Small pseudohorn cysts from invagination of Stratum Corneum

9.  Brown, hyperpigmented, thickened skin on the nape and axillae  Pathology: Insulin-like growth factor deposition in tissue  Predisposing factor: obesity, internal malignancies  Tx: Weight loss, management of underlying malignancy

10. Papillomatosis, hyperkeratosis, hypergranulosis of the stratum corneum

12.  AKA Acrochordon  Location: Face, Neck, Trunk  Treatment: Scissors excision, EDC, LN2

14.  Location: anywhere in the body  Pathology: invagination of the keratinizing portion of the epidermis  Treatment: complete excision of cyst wall

16.  Location: Face  Pathology: enlargement of oil- bearing glands of the skin  Treatment: EDC

17.  Enlarged sebaceous glands

18.  Location: anywhere on the body depending on the clinical subtype  Pathogenesis: lipid-laden cells accumulate in the skin  Family hx of hypercholesterolemia  Dx’tics: lipid profile  Tx: Statins, desctructive methods

19.  Multiple nests of large, pale-staining, fat-laden histiocytes

20.  Precancerous skin condition  Epidermal proliferation of dysplastic keratinocytes  Chronic UV exposure  Head & Neck, Extremities, Back  Tx: Destructive modalities

22.  Considered a subtype of SCC  Self-healing in 20% of cases  Recurrent, persistent type needs aggressive treatment  Tx: excision, Mohs surgery

25.  Most common skin cancer  From non- keratinizing cells in the basal layer of the epidermis  Causes:  UV light  Radiation Exposure  Genodermatoses: Basal Cell Nevus Syndrome

26.  On the face and neck: do a punch biopsy or shave biopsy to determine the diagnosis  On the extremities/trunk: either do a preliminary biopsy or you can do a wide excision with a 5 millimeter margin

27. 1. Traditional excision with 5 mm margin 2. Mohs micrographic surgery 3. Cryosurgery 4. Electrodessication & currettage 5. Radiation therapy 6. 5% imiquimod

28.  NODULAR  SUPERFICIAL  INFILTRATIVE/MORPHEAFORM  MICRONODULAR

29.  Slow-growing tumor that invades locally  Rate of doubling: 6 months to 1 year  Physically deforming  Perineural invasion in less than 0.2%  Recurrent tumors in the preauricular and malar areas  Pain  Paresthesia  Paralysis

30. Primary OR Recurrent Location Histology Size Clinical Nature Mohs Surgery Recurrent High-Risk Aggressive growth >2 cm off face >0.5 cm on face Incomplete excision Ill-defined Multicentric RT Genetic syndrome Immunosuppressed Excision EDC Cryo RT Primary Low-risk Nodular, Superficial <2 cm off face <0.5 cm on face Well-defined borders

32.  2 nd most common  Male: Female 22:1  Causes: 1.Chronic exposure to UVR 2.Tar/Soot 3.Arsenic 4.Heat 5.Scar 6.PUVA 7.HPV 16 & 18 8.Genodermatoses: XP, Dyskeratosis Congenita

34. 1. Wide excision 2. Mohs surgery 3. Radiation therapy

35. Primary OR Recurrent Location Histology Size Clinical Nature Mohs Surgery Recurrent High-Risk Aggressive growth >2 cm off face >0.5 cm on face Incomplete excision Ill-defined Multicentric RT Genetic syndrome Immunosuppressed Excision EDC Cryo RT Primary Low-risk Nodular, Superficial <2 cm off face <0.5 cm on face Well-defined borders

36.  Local tissue destruction  Regional Lymph Node Metastasis: 1-3 years after initial Dx  0.5-6% Metastatic rate Lund HZ. How often does squamous cell carcinoma of the skin metastasize? Arch Dermatol. 1965. 92:635.

37. Rare, aggressive, malignant spindle cell tumor Pulmonary metastasis Usually affects young males May present as an innocuous skin lesion or bulky, fungating lesion in recurrent cases Tx: Surgical extirpation