Tumours of the skin

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Tumours of the skin By Dr. Sahar Ismail
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Skin Tags

• Flesh-colored to brown
• Polypoid papules attached by a stalk
• More common on neck, groin, body folds
• Hereditary predisposition, increased in obese
  patients
• Complications rare, can necrosis
• Can be treated with scissor excision. No
  treatment necessary

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Seborrheic Keratosis

• Benign epidermal stuck-on papules
• Rough, dry, crumbling surface
• No malignant potential
• Can become irritated

• Sudden appearance or increase in the number and
  size of SKs., may be a sign of internal
  malignancy .

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Treatments of SK
Liquid nitrogen Shave excision LASER Do nothing
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Pilar Cyst

• Smooth firm nodule found on the scalp, no central
  punctum
• Firm, thick cyst wall
• Treat with surgical excision, entire cyst wall
  must be removed

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Epidermoid Cyst

• Mobile nodule with central punctum
• Commonly located on neck, face, trunk
• Thin, fragile cell wall containing foul-smelling
  cheesy keratinous material
• Treat with surgical excision, whole cyst wall
  must be removed
• Gardners syndrome when associated with multiple
  GI polyps, fibromas, skull osteomas

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Epidermoid Cyst Note the central punctum
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Epidermoid cyst
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Dermatofibroma

• Flesh-colored to hyperpigmented macule or papule
• Dimple sign depresses when squeezed
• Most common on lower legs, extremities
• Occurs from fibrous reaction following trauma,
  inflamed follicle, insect bite
• Treat with cryotherapy, excision, or do nothing

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Dermatofibroma
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Keloid versus Hypertrophic Scar

• Keloids extend beyond wound margin
• More common in African Americans
• Re-excision can make the keloid worse
• Treated with topical steroids, cryotherapy or
  LASER

• Hypertrophic scars stay within wound margins
• Tend to regress with time
• Treatment is rarely needed or desired

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Keloid
Hypertrophic Scar
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Squamous cell carcinoma (SCC)

• Malignant tumor of epidermal keratinocytes with
  an average metastatic rate of 2-3 of all
  patients.

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• Second most common skin cancer
• Most common on sun-exposed skin
• More aggressive if at site of injury or scar,
  lip, ear, penis, scrotum, anus, or in
  immuno-suppressed patients

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Squamous cell carcinoma (SCC)
Etiology
I) Extrinsic factors

• Ultraviolet radiation the major factor for the
  development of non-melanoma skin cancer (NMSC).
• Exposure to carcinogenic sub. e.g. arsenic,
  tobacco.
• Ionizing radiations from X-rays.
• HPVs, e.g. HPV-16 (cervical penile SCCs),

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SCC Etiology (Contd)
II) Intrinsic factors

• Precancerous tumors, e.g. solar keratosis,
  Bowens dis., leukoplakia.
• Premalignant dermatoses, e.g. long-standing
  ulcers, burn scars other chronic granulomas.
• Immunosuppression 2ry to immunosuppressive
  drugs, HIV inf., lymphomas or organ transplants.

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SCC (Contd)
Clinically

• Solitary, firm, slowly enlarging nodule with
  indurate base.
• Shallow ulcer with raised everted edge, indurated
  base.
• Verrucous or fungoid lesions.
• Treatment
• Surgical excision. ( Mohs surgery).

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Basal cell carcinoma BCC

• BCC is the most common malignancy in humans.
• Although rarely metastatic, it is capable of
  significant local destruction disfigurement.

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BCC (Contd)
Predisposing factors

• UV light.
• Chronic intake of inorganic arsenic.
• Predisposing skin conditions dermatofibromas,
  nevus sebaceous of Jahadsson, burn scars.
• Immunsuppression X-ray irradiations.

However, BCC may arise without apparent cause.
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BCC (Contd)
Clinical features

• It occurs almost exclusively on hair-bearing
  skin, especially on the face. Most common on
  sun-exposed areas

Clinical types

• Nodulo-ulcerative.
• Pigmented.
• Superficial.
• Morphea-like.

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Clinical types

• Nodulo-ulcerative.
• Pigmented.
• Superficial.
• Morphea-like.

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Nodular BCC is the most common form waxy,
pearly, translucent papule with telangiectasia
and ulceration
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BCC (Contd)
Treatment

• Excision with safety margin ½ inch for small
  tumors.
• Radiotherapy.
• Curettage electro surgery.
• Cryosurgery.
• Mohs micrographic surgery (MMS).
• Cytotoxic agents

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MELANOMA

• Arises from malignant melanocytes in the skin.
• Risk factors
• Pigmented lesions dysplastic nevi large no. of
  benign nevi, congenital nevus
• White vs black race
• Family history
• Immuno-suppression
• Excessive sun exposure

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• Most common on the back
• Clinically suspect melanoma if
• New pigmented lesion asymmetry, border
  irregularity, variaing dark color, diameter gt 0.6
  cm.
• Change in preexisting nevus change in color
  size, shape or surface.
• Asymptomatic.
• Nodule or plaque that may ulcerate.

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• Treatment
• Surgery of the primary lesion
• Treatment of metastasis
• Adjuant therapy
• Chemotherapy
• Radiation