1. SKIN NEOPLASM (OVERVIEW)
M. RUSTOM
Plastic Surgeon

2. CATEGORIES OF SKIN TUMOURS
BENIGN TUMOURS
PRE MALIGNANT
MALIGNANT TUMOURS

3. BENIGN TUMOURS ( LESIONS )
BASAL CELL PAPILLOMAS
PAPILLARY WART
FRECKLE
LENTIGO
NAEVI/MOLES
HALO NAVUS
CAFÉ AU LAIT SPOTS

4. 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

5. 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

6. BASAL CELL PAPILLOMAS

7. PAPILLARY WART

8. LENTIGO

9. NAEVIMOLES

10. HALO NAVUS

11. CAFÉ AU LAIT SPOTS
-Autosomal dominant
-phyoChromocytoma

12. PREMALIGNANT LESIONS ACTINIC KERTOSES CUTANEOUS HORN KERATOACANTHAOMA
BOWENS DISEASE
EXTRA MAMMARY PAGETS DISEASE
GIANT HAIRY NAEVUS
DYSPLASTIC NAEVUS

13. ACTINIC KERATOSES CUTANEOUS HORN KERATOACANTHOMA
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

14. ACTINIC KERATOSES

15. KERATOACANTHOMA

16. BOWENS DISEASE
SCC IN SITU
CHRONIC SOLAR DAMAGE,ARSENIC EXPOSURE ,HPV 16
SLOW ENLARGINGERYTHMATOUS PATCH OR PLAGUE
TOPICAL THERAPY 5 –FLUOROURACIL
SURGICAL EXCISION (4MM MARGINS )
MOHS MICROSCOPIC SURGERY
EXTRAMMARY PAGETS DISEASE
INTRA DERMAL ADENOCARCINOMA
GENITAL OR PERIANAL REGIONS OR AXILLA
SURGICAL EXCISION

17. BOWENS DISEASE

18. EXTRAMMARY PAGETS DISEASE

19. GIANT CONGINATAL PIGMENTED NAEVUS GCPNS PRECURSORS 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

20. GIANT CONGINATAL PIGMENTED NAEVUS

21. DYSPLASTIC NAEVUS

22. MALIGNANT LESION BASAL CELL CARCINOMA SUAMOUS CELL CARCINOMA
MALIGNANT MELANOMA

23. 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

24. BASAL CELL CARCINOMA EPIDEMIOLOGY PATHOGENESIS MACROSCOPIC APPEARANCE
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 A LINE FROM THE LOBE OF THE EAR TO THE CORNER OF MOUTH
WHITE SKIN 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

25. BASAL CELL CARCINOMA

26. Nodular BCC Chronic lesion Easy bleeding Pearly border
Surface telangiectasias
Head and neck, trunk, and extremities

27. PROGNOSIS HIGH RISK GROUPS
>2CM
NEAR EAR NOSE OR EYE
ILL DEFIND MARGINS
RECURRENT TUMOURS
IMMUNOCOMPROMISED

28. MANAGEMENT SURGICAL EXCISION MOHS MICROSCOPIC SURGERY NON SURGICAL
RADIOTHERAPY
TOPICAL 5-FLUROURASIL

29. MANAGEMENT SURGICAL EXCISION MOHS MICROSCOPIC SURGERY NON SURGICAL
RADIOTHERAPY
TOPICAL 5-FLUROURASIL

30. 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
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

31. SQUAMOUS CELL CARCINOMA

32. PROGNOSIS INVASION>6CM HISTOLOGICAL GRADE HIGHER THE BRODER GRADE
SITE LIPS AND EARS HAVE HIGH LEVEL OF RECURRENCE
AEITOLOGY
IMMUNOSUPPRESION

33. MANAGEMENT
DEFINTE TREATMENT SURGICAL LOUPE EXCISION(4MM CLEARANCE MARGIN IF <2 AND 1CM MARGIN >2CM LESIONS )
DISTAL METSTASIS
LYMPHATIC METSTASIS

34. MALIGNANT MALENOMA EPIDEMIOLOGY MM IS CANCER MELNOCYTES
MM ACCOUNTS FOR 5% OF SKIN MALIGNANCY
INCREASES UVR EXPOSURE
3%OF ALL MALIGNANCYS
7%OCCULT METASTASIS

35. 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

36. Clinical types- MM Superficial spreading melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma
Nodular melanoma

37. MALIGNANT MELANOMA

38. ABCD of Melanoma Asymmetry Border irregularity Color variegation
Diameter >6mm

39. STAGING OF MM :
AJC STAGING
BRESLOWS THICKNESS GRADE

40. Prognostic features- MM
Good prognosis
Breslow < 1mm
Intermediate prognosis
Breslow 1-4mm
Bad prognosis
Breslow >4mm

41. MANAGEMENT HISTORY /CLINICAL EXMINATION SKIN BIOPSY
SENTINEL LYMPH NODE BIOPSY
LOCAL TREAMENT
REGIONAL LYMPH NODES

42. PROGNOSIS :
TUMOUR THICKNESS
LYMPH NODES
DISTANT METSTASIS