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Skin tumors

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  • 1. SKIN TUMORS www.freelivedoctor.com Keratinocyte Seborrheic kerat Actinic keratosis Bowen disease BCC & SQCC Melanocyte Nevocell. nevus Melanoma Merkel cell ---- Merkel cell Ca.
  • 2. SKIN TUMORS www.freelivedoctor.com Mesenchymal Hemangioma Dermatofibroma Neurofibroma Angiosarcoma Kaposi sarcoma Dermatofib.sarc. Neurofibrosarc. Lymphocyte ---- Mycosis fung(T) Lymphoma(B) Mast cell Urticaria pigm. Syst. mastocytos Dermal adnexa Adenoma Carcinoma
  • 3. SKIN TUMORS
    • EPIDERMAL TUMORS. A. BENIGN. 1. SEBORRHEIC KERATOSIS. -It is a benign neoplasm most commonly seen in elderly, having an appearance of a raised, flat, soft, well demarcated brown lesion. -Is located mostly on the trunk, limbs & head. -Micro: proliferation of squamous epithelium + cysts filled with keratin
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    • BENIGN...(cont.) 2. KERATOACANTHOMA. -Are keratotic papules that grow rapidly(3-6 wks.) on skin exposed to sunlight, with characteristic volcano-like lesion(umbilicated) resembling a squamous cell carcinoma. -Frequent spontaneous regression without Tx in 6-12 mo.  scar -Micro: endophytic papillary proliferation of keratinocytes with some atypias that may be confused with squamous cell Ca.
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  • 7. SKIN TUMORS
    • BENIGN...(cont.) 3. MULTIPLE KERATOACANTHOMAS. There are some rare conditions in which multiple keratoacanthomas may appear: -Ferguson-Smith familial keratoacanthomas More common in men, with large and some times self-healing lesions. -Grzybowski eruptive keratoacanthomas, with multiple itchy lesions that may appear in the skin and mucosal surfaces that can result w/deformity
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  • 14. SKIN TUMORS
    • BENIGN...(cont.) 4. EPIDERMOID CYST. -Formerly and incorrectly named “sebace ous”(sebaceous gland NOT involved), is lined by stratified squamous epithelium filled with keratin. -It is a typical nodular lesion with a soft-gray material as content
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  • 18. SKIN TUMORS
    • BENIGN...(cont.) 5. ACTINIC KERATOSIS. -Provoked by an excessive and chronic exp osure to sunlight, is considered as “premalignant” -It is typically seen as hyperkeratotic, scaly pla ques on the face, neck, limbs and trunk. -Affects most commonly to old patients -Micro; stratum corneum w/parakeratosis & atypic keratinocytes that may evolve to Ca. in situ  invasive squamous cell carcinoma.
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  • 21. SKIN TUMORS
    • BENIGN...(cont.) 6. MELANOCYTIC TUMORS. NEVOCELLULAR NEVUS(MOLE). -Is originated in the deep layers of the skin (nevus cells) and is clearly related to sun ex posure. -There are several types: junctional, compound and intradermal. -Gross: uniform tan/brown color w/sharp delineati on and tendency to be stable in size and shape. -Malignant transformation is uncommon
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  • 24. SKIN TUMORS
    • BENIGN...(cont.) 7. MESENCHYMAL TUMORS. ACHROCORDON(SOFT FIBROMA). -Also known as “cutaneous tags” occur in two types: as multiple filiform, smooth or fu rrowed soft papules, especially on the neck and in the axillae, and as a solitary soft, bag-like, pedunculated growths on the trunk or limbs.
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  • 27. SKIN TUMORS
    • BENIGN...(cont.) MESENCHYMAL... DERMATOFIBROMA. -Occur in the skin as a firm, indolent, single or multiple nodules. Usually the nodules arise in adults, mostly on the limbs. -It may have from few mm. in diameter to 2-3 cm in size. Gross: lesions w/reddish color or reddish-brown because of hyperpigmentation of the over laying skin.
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  • 30. SKIN TUMORS
    • BENIGN...(cont.) MESENCHYMAL... HEMANGIOMAS(Capillary, Cavernous) -Capillary or “strawberry”hemangiomas con sist of one or several bright-red, soft, lobula ted tumors that first appear between 3rd-5th week of life, increase in size for several months and then regress  involution.
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  • 31. SKIN TUMORS
    • BENIGN...(cont.) MESENCHYMAL... HEMANGIOMAS... -Cavernous hemangiomas consists of large, predominantly subcutaneous mass that may cause deformity. It can be seen in associa - tion w/ some other congenital conditions: Mafucci syndrome ( dyschondroplasia, fragility of bones + osteochondromas) and Blue Rubber-bleb nevus(large bluish tumors on skin + subcutaneous hemangiomas + intestinal and visceral lesions)
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    • BENIGN...(cont.) NEUROFIBROMAS. -It may occur as solitary cutaneous lesions, in which case one finds no café-au-lait spots and no family history of the disease. -Multiple cutaneous lesions w/café-au-lait spots, dominantly inherited, referred as neurofibromatosis or von Recklinghausen´s disease that starts to be manifested since childhood
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  • 36. SKIN TUMORS
    • B. PREMALIGNANT 1. LENTIGO MALIGNA(HUTCHINSON) -Appears in sun-damaged skin of elderly -It is a large pigmented macule, usually in white patients. 2. DYSPLASTIC NEVI(BK MOLES). -Are lesions that can have >5 mm in diameter and may occur as hundreds of moles in some individuals on both, sun-exposed and non sun-exposed areas of the skin, and have been seen in members of families(heritable melanoma syndrome)
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    • C. MALIGNANT. 1. BOWEN´S DISEASE. -It can be seen in non-sun exposed areas like oral mucosa, vulva, etc. and is frequen tly associated to a visceral malignancy. -Clinically appears like an erythematous plaque with indolent growth. -Micro: a typical Ca. in situ
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  • 44. SKIN TUMORS
    • MALIGNANT ...(cont.) 2. BASAL CELL CARCINOMA. -Is the most common malignant tumor due to sun exposure in patients over 40´s with pale skin. -It appears mainly in the face and can be destructive(erosion of the nose  sinuses) but almost never metastasize -Gross: pearly papule, rodent ulcer, superficial ca., scar-like, pigmented lesion -Micro: nests of epith.cells that resemble epidermal basal cells forming palisades + whorls of fibroblasts.
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  • 47. SKIN TUMORS
    • MALIGNANT...(cont.) 3. SQUAMOUS CELL CARCINOMA. -Less common than BCC and often seconda ry to AK, develops in sun-exposed skin of fair patients w/light hair & freckles -It has an increased tendency to metastasize locally -It may also appears in chronic scarring processes (osteomyelitis tracts)  more invasive -Clinical: may arise in dorsal surface of hands,face lips, ears w/small lesion initially  ulceration later
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  • 54. SKIN TUMORS
    • MALIGNANT...(cont.) 4. MALIGNANT MELANOMA. -Sunlight seems to have an important role in the development of this tumor in the skin: appears most frequently on the upper back (males/women) or on the legs(women). -Also, lightly pigmented individuals have higher risk to get a melanoma than those darkly pigmen ted. In addition, the presence of a pre-existing lesion (dysplastic nevus), hereditary factors or exposure to certain carcinogens  melanoma
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    • MALIGNANT...(cont.) MELANOMA... -Superficial malignant melanoma is the MOST common type, but after 1-2 yrs  nodular melanoma -Acral(distal) lentiginous melanoma affects mostly fingers and toes(nails) and is the most type in colored patients
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    • MALIGNANT...(cont.) MELANOMA... -Clinical Dx. A. Asymetry of shape B. Border is irregular C. Color is uneven
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    • MALIGNANT...(cont.) 5. MYCOSIS FUNGOIDES(T-cell lymphoma) -In fact it represents a stage in the wide spec trum of lymphoproliferative disorders that affects the skin. -There are 2 different clinical types: a chronic proliferative disorder and a nodular eruptive presentation. Also, it can be seen a more agressive form of adult T-cell leukemia/lymphoma
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    • KAPOSI SARCOMA. -There are four types of the disease: chronic (European KS), lymphadenopathic(African or endemic KS), transplant-associated (immunosuppresion-associated) and AIDS- associated(most common form in US) present in approximately 1/3 of AIDS patients, particularly male homosexuals. -The morphology of KS is similar in different types, w/relatively indolent evolution in old men as well as in non-AIDS presentation of the disease.
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