#Skin malignancy is the most common malignancy in fair-skinned populations. #Skin malignancies are either non-melanoma or melanoma. #A persistent skin lesion that does not heal is highly suspicious for malignancy and should be examined by a health care provider. # Early detection and treatment can often lead to a highly favourable prognosis.

1. WELCOME
DEPARTMENT OF DERMATOLOGY &
VENEREOLOGY
(DR.SIRAJUL ISLAM MEDICAL COLLEGE & HOSPITAL)

2. WELCOME
TO THE SESSION
PRESENTED BY
DR. MD. ASIFUR RAHAMAN
INTERN DOCTOR
DR.SIRAJUL ISLAM MEDICAL COLLEGE &
HOSPITAL

3. SKIN MALIGNANCY

4. SKIN
MALIGNANCY
• Skin malignancy is the most common malignancy in
fair-skinned populations.
• Skin malignancies are either non-melanoma or
melanoma.
• A persistent skin lesion that does not heal is highly
suspicious for malignancy and should be examined by a
health care provider.
• Early detection and treatment can often lead to a highly

5. Continued…
• The visibility of the skin lesions increases the likelihood
of early detection and diagnosis.

7. RISK FACTORS FOR SKIN
MALIGNANCY
• Fair-skinned and fair-haired people due to insufficient
skin pigmentation.
• Prolonged exposure to sun light.
• Exposure to chemical pollutants(arsenic, nitrates, coal,
tar and pitch, oils and paraffins).
• Scars from severe burns.
• Chronic skin irritations.

8. Continued….
• Immunosuppression
• Genetic factors
• Ionizing radiation & radiotherapy
• Chronic inflammation

9. TYPES OF SKIN MALIGNANCY
• The most common types of skin malignancy are
:
1. Basal Cell Carcinoma (BCC)
2. Squamous Cell Carcinoma(SCC)
3. Malignant Melanoma.

11. 1. BASAL CELL CARCINOMA (BCC)
• Basal Cell Carcinoma is the most common type of Skin
Malignancy.
• It generally appears on sun-exposed areas of the body
and is more prevalent in regions where the population is
subjected to intense and extensive exposure to the sun.
• The incidence is proportional to the age of the patient
and the total amount of sun exposure, and it is inversely
proportional to the amount of melanin in the skin.

12. Continued….
• Basal Cell Carcinoma (BCC) is a locally invasive
malignancy arising from epidermal basal cells. It is the
most common type.

15. CLINICAL MANIFESTATIONS
• Basal cell carcinoma usually begins as a small, pale,
translucent papules or nodules, pearly borders,
telangiectatic vessels may be present.
• As it grows, it undergoes central ulceration and
sometimes crusting.
• Superficial basal cell carcinoma presents as a red/brown
plaque or patch with a raised, thread like edge.
• The tumors appear most frequently on the face.

16. Continued…
• Basal cell carcinoma is characterized by invasion and
erosion of adjoining tissues.
• It rarely metastasizes, but recurrence is common.

17. INVESTIGATION
• The diagnosis is often obvious clinically
• A diagnostic confirmatory- Skin biopsy for
histopathology may be required prior to definitive
treatment.

18. MANAGEMENT
• Surgical excision results in the lowest recurrence rates
• Moh‘s micrographic surgery is effective for high risk Basal
Cell Carcinoma
• Cryotherapy and topical 5-fluorouracil can be used for
superficial Basal Cell Carcinoma
• Medical treatments are often appropriate for low risk
superficial tumours in patients with comorbidities
• Topical photodynamic therapy & topical imiquimod are both
effective in superficial Basal Cell Carcinoma

19. Continued…
• Basal Cell Carcinoma in patients with Gorlin’s Syndrome
should not be treated with radiotherapy
• Hedgehog pathway inhibitors can induce clinical
response in patients with advanced inoperable Basal Cell
Carcinoma

20. 2. SQUAMOUS CELL CARCINOMA (SCC)
• Squamous Cell Carcinoma (SCC) is a malignant
neoplasm of keratinizing epidermal cells, occurring most
frequently in elderly males & smokers.
• It frequently occurs on sun-exposed skin or at the base
of skin lesion.
• Squamous Cell Carcinoma is less common than Basal
Cell Carcinoma .
• Squamous Cell Carcinoma can be highly aggressive, has
the potential to metastasize, and may lead to death if not

22. CLINICAL MANIFESTATIONS
• The lesions may be primary, arising on the skin and
mucous membranes, or they may develop from a
precancerous condition, such as scarred or ulcerated
lesions.
• Squamous Cell Carcinoma appears as a rough,
thickened, scaly tumor that may be asymptomatic or may
involve bleeding.
• The border of an Squamous Cell Carcinoma lesion may
be wider, more infiltrated & more inflammatory than that

23. Continued…
• Usually occur on chronically sun-exposed areas,
especially of the bald scalp, tops of ears, face & back of
hands are common sites

24. INVESTIGATION
• The diagnosis is made by Skin biopsy for histopathology

25. MANAGEMENT
• Complete surgical excision is the usual treatment of
choice.
• Most recurrence or metastases occur within 5 years
• Moh’s surgery is an option for Squamous Cell Carcinoma
• Occasionally, curettage & cautery may be appropriate for
small & low risk & either surgical excision is
contraindicated
• Radiotherapy may be indicated if surgical excision is not
feasible
• Such patients & those with metastatic disease require
management via a multidisciplinary team

26. 3. MALIGNANT MELANOMA
• A Malignant Melanoma is a cancerous neoplasm in which
abnormal melanocytes are present in the epidermis and
the dermis.
• Most lethal of all the skin cancers.
• Most melanomas arise from cutaneous epidermal
melanocytes

29. CLASSIFICATION OF CUTANEOUS MALIGNANT
MELANOMA
1. Melanoma without metastatic potential
• Melanoma in situ
• Lentigo maligna
2. Melanoma with metastatic potential
• Superficial spreading melanoma
• Nodular melanoma
• Acral lentiginous melanoma
• Subungual melanoma
• Lentigo maligna melanoma

31. RISK FACTORS
• The cause of Malignant Melanoma is unknown.
• Risk factors for Melanoma include fair skin, freckles, red
hair, number of naevi & sunlight exposure
• Ultraviolet rays are strongly suspected, based on indirect
evidence such as the increased incidence of melanoma.
• Family history of melanoma

32. CLINICAL MANIFESTATIONS
• Superficial spreading Melanoma occurs anywhere on the
body.
• It usually affects middle-aged people and occurs most
frequently on the trunk and lower extremities.
• Its presents as a slowly enlarging, macular, pigmented
lesion, with increasing irregularity in shape & pigment.

33. Continued…
• A nodular Malignant Melanoma arising de novo &
with breslow thickness of 3.5mm
• Sometimes a dull pink rose color can be seen in a
small area within the lesion.

34. INVESTIGATION
• The diagnosis is made by excision biopsy of a suspicious
lesion.

35. MANAGEMENT
• Surgical excision is the treatment of choice for small,
superficial lesions.
• Deeper lesions require wide local excision, after which
skin grafting may be needed.
• Regional lymph node dissection is commonly performed
to rule out metastasis.
• Immunotherapy with ipilimumab

36. Continued…
• Monoclonal antibodies directed at melanoma antigens.
• Autologous immunization against specific tumor cells.
• Chemotherapy may be used for metastatic melanoma

37. • The latter has precursor non-invasive states are-
1.Intra-epidermal carcinoma (Bowen’s disease)
2.Actinic keratosis

38. BOWEN’S DISEASE
• Bowen‘s disease is the name given to an intra-epidermal
carcinoma
• It presents as a slowly enlarging, erythematous, scaly
plaque on the lower legs of fair-skinned elderly women
• It can be confused with eczema or psoriasis & does not
respond to topical glucocorticoids
• It may also be hard to distinguish from superficial Basal
Cell Carcinoma.

40. INVESTIGATION
• Incisional biopsy is usually undertaken to confirm the
diagnosis
• This shows an intra-epidermal carcinoma with no
invasion through the basement membrane

41. MANAGEMENT
• For single / few lesions on good healing sites,
cryotherapy, curettage, photodynamic therapy, topical
imiquimod & 5-fluorouracil are options
• For multiple lesions and/or poor healing sites as the
lower leg, photodynamic therapy, where feasible, is the
treatment of choice, although topical 5-fluorouracil or
imiquimod is an alternative

42. ACTINIC KERATOSIS
• Actinic keratoses are scaly, erythematous lesions arising
on chronically sun-exposed sites
• They are common in fair-skinned people who have had
significant sun exposure
• Increase in size, ulceration, pain or tenderness can be
indicative of transformation into Squamous Cell
Carcinoma

44. INVESTIGATION
• Skin biopsy for histopathology
• The diagnosis of typical actinic keratosis is usually made
on clinical grounds

45. MANAGEMENT
• For single/few lesions on good healing sites,
cryotherapy, curettage, 5-fluorouracil/salicylic acid and
ingenol mebutate are options, especially if
hyperkeratotic
• For multiple lesions/field change, conventional or
daylight photodynamic therapy, topical 5-fluorouracil,
imiquimod or diclofenac in hyaluronic acid gel may be
effective

46. BENIGN SKIN LESIONS
• In practice, it is often difficult to distinguish between
skin cancer and a benign lesion on clinical grounds ; if
there is any doubt, biopsy & histology are required.
• Benign Melanocytic Naevi & Basal Cell Papillomas in
particular can often be mistaken for melanoma
• Keratoacanthoma while benign, is also commonly
considered to be invasive Squamous Cell Carcinoma on
clinical grounds

47. BENIGN SKIN LESIONS ARE:
1. Keratoacanthoma
2. Freckle
3. Lentigo
4. Hemangiomas
5. Basal cell papilloma
6. Melanocytic naevi
7. Blue naevi
8. Dermatofibroma
9. Acrochordon
10.Lipoma

48. THANK YOU