1. DR IMRANA ZULFIKAR ASSITANT PROFESSOR SURGERY
SKIN TUMOURS
DR IMRANA ZULFIKAR
ASSITANT PROFESSOR SURGERY

2. CLASSIFICATION OF SKIN TUMOURS
BENIGN TUMOURS
MALIGNANT TUMOURS

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

4. BASAL CELL PAPILLOMA PAPILLARY WART FRECKLE
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 MOLES/NAEVUS 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. FRECKLE

9. LENTIGO

10. NAEVIMOLES

11. HALO NAVUS

12. CAFÉ AU LAIT SPOTS

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

14. 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

15. ACTINIC KERATOSES

16. CUTANEOUS HORN

17. KERATOACANTHOMA

18. EXTRAMMARY PAGETS DISEASE
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

19. BOWENS DISEASE

20. EXTRAMMARY PAGETS DISEASE

21. GIANT CONGINATAL PIGMENTED NAEVUS
GCPNSPRECURSORS 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

22. GIANT CONGINATAL PIGMENTED NAEVUS

23. DYSPLASTIC NAEVUS

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

25. 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

26. 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 ALINE 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

27. BASAL CELL CARCINOMA

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

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

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

31. 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

32. SQUAMOUS CELL CARCINOMA

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

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

35. 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

36. MACROSCOPIC APPEANRANCE
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

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

38. MALIGNANT MELANOMA

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

40. BRESLOWS THICKNESS GRADE
AJC STAGING

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

42. Intermediate prognosis
Good prognosis
Breslow < 1mm
Intermediate prognosis
Breslow 1-4mm
Bad prognosis
Breslow >4mm

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

44. PROGNOSIS
TUMOUR THICKNESS
LYMPH NODES
DISTANT METSTASIS

45. VASCULAR LESIONS CONGENITAL: HEAMANGIOMAS VASCULAR MALFORMATIONS
ACCUIRED:
SIDER NAEVI
CAMPBELL DE MORGAN SPOTS
PYOGENIC GRANULOMAS
ANGISARCOMAS
KAPOSIS SARCOMA