ROJoson PEP Talk: Skin and Soft Tissue Tumors - Part 2 - Management - Fundamentals and Generalities

1. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
SKIN and SOFT
TISSUE TUMORS–
Part 2.
Health Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of Skin and
Soft Tissue
Tumors – Part
2
March 12, 2022
1400H - 1500H
Via Zoom

2. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
SKIN and SOFT
TISSUE TUMORS–
Part 2.
Health Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of Skin and
Soft Tissue
Tumors – Part
2
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

3. There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.

4. From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.

5. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
SKIN and SOFT
TISSUE TUMORS–
Part 2.
Health Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of Skin and
Soft Tissue
Tumors – Part
2
My PEP TALK today
is entitled:
Fundamentals and
Generalities in
Medical
Management of
SKIN and SOFT
TISSUE TUMORS,
Part 2. This is part
of the Health
Disorder Course.

6. Contents:
• What is a skin tumor? A soft tissue tumor?
• What are the different types of skin and soft
tissue tumors?
• What are the causes of skin and soft tissue
tumors?
• How common are the skin and soft tissue
tumors?
PART 1
Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors

7. Contents:
• Clinical diagnosis of skin and soft tissue
tumors
• Paraclinical diagnostic procedures for skin and
soft tissue tumors
• Treatment for skin and soft tissue tumors
• Prognosis for skin and soft tissue tumors
PART 2
Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors

8. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Definition of Terms in Title AND Delimitation of
Coverage of Talk:
Fundamentals – simplest and essential facts and
theories which can serve as a basis or foundation
and support for advanced information
Generalities – general statements of info, not
covering specifics and details
Medical Management – diagnosis and treatment
by physicians

9. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Clinical diagnosis of skin and soft tissue
tumors
Clinical diagnosis means a conclusion or decision
made by a physician after examining a patient
and after evaluation of the data on symptoms and
signs.
Symptoms are what are felt and observed by the
patient or a person on the body.
Signs are findings of a physician after physical
examination of a patient.

10. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Clinical diagnosis of skin and soft tissue
tumors
Procedures in clinical diagnosis of skin and soft tissue
tumors:
Patient has symptoms.
• Physician evaluates the symptoms to look for cues for a
skin and soft tissue tumor and then cues or pattern for a
particular skin and soft tissue tumor.
• Physician does physical examination to look for sign-cues
of skin and soft tissue tumor and then cues or pattern
for a particular skin and soft tissue tumor.
• Physician processes symptoms and signs to determine 1)
whether a skin and soft tissue tumor is present and 2) if
present, what is the type (or clinical diagnosis).

11. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Clinical diagnosis of skin and soft tissue
tumors
Processes used in clinical diagnosis of skin
and soft tissue tumor:
• Pattern recognition
• Prevalence

12. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Clinical diagnosis of skin and soft tissue
tumors
Processes used in clinical diagnosis:
• Pattern recognition process means realization
that the patient’s presentation conforms to a
previously learned picture or pattern of
disease.
• Prevalence process means choice of a diagnosis
is based on the frequency of occurrence of the
disease in a certain locality, in a certain age and
sex group, and in the affected organ and
system.

13. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Clinical diagnosis of skin and soft tissue
tumors
Common symptoms that will lead to
suspected skin and soft tissue tumor
Presence of a tumor or mass or bukol
felt and /or seen on or over the skin.
Skin tumor?
Soft tissue tumor?
What type?

14. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
What is a skin tumor? A soft tissue tumor?
Based on location of
tumor
Skin tumor –
tumor in / on the
skin
Soft tissue tumor
– tumor in / on
the soft tissue
Bone tumor – tumor
in / on the bone

15. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
What is a skin tumor? Soft tissue tumor?
So,
a skin and soft tissue tumor is an unusual
and abnormal collection of tissues
occupying the skin and soft tissue and it is
NOT a …………………

16. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
What is a skin tumor? Soft tissue tumor?
So,
a skin and soft tissue tumor is an unusual
and abnormal collection of tissues
occupying the skin and soft tissue and it is
NOT a prominence, induration or swelling
or skin rashes or discoloration.

17. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
What is a skin tumor? Soft tissue tumor?
Note: An infection of the skin and soft tissue may
present as a tumor.
Usually, the tumor is an abscess (one that
contains pus).

18. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
What are the different types of skin and
soft tissue tumors?
Based on cells or tissues of origin
SOFT TISSUE TUMORS
Fat tissues
Muscular tissues
Connective tissues
Blood vessels
Nerves
SKIN TUMORS
Basal cells
Squamous cells
Melanocytes
Skin glands
Blood vessels
Nerves
Connective tissues

19. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
What are the different types of skin and
soft tissue tumors?
Based on cells or tissues of origin
SKIN TUMORS
Basal cells
Squamous cells
Melanocytes
Skin glands
Blood vessels
Nerves
Connective tissues
Basal cell carcinoma
Squamous cell carcinoma
Mole / Nevus
Melanoma
Seborrheic keratosis
Seborrheic adenoma
Hemangioma
Lymphangioma
Neurilemmoma
Fibroma
Epidermal cysts
warts

20. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
What are the different types of skin and
soft tissue tumors?
Based on cells or tissues of origin
SOFT TISSUE TUMORS
Fat tissues
Muscular tissues
Connective tissues
Blood vessels
Nerves
Fat tumor – lipoma / liposarcoma
Muscular tumor – rhabdomyoma / sarcoma
Connective tissue tumor – fibroma / sarcoma
Blood vessel tumor – hemangioma /
hemangiosarcoma
Nerve tumor – neurilemmoma /
neurosarcoma

21. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
How to diagnose skin tumors?
TIPS:
Learn and know the
• Pattern of the more common
skin tumors
• Cues for skin abscess
• Cues for skin cancers
LOOK AT and FEEL the SKIN TUMOR!
• Confined to the surface of the
skin?
• Beneath the skin (at the
epidermis and dermis level)?
• Appearance of skin tumor?

22. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
How to diagnose skin tumors?
TIPS:
Learn and know the
• Pattern of the more common
skin tumors
LOOK AT and FEEL the SKIN TUMOR!
• Confined to the surface of the
skin?
• Beneath the skin (at the
epidermis and dermis level)?
• Appearance of skin tumor?
Dark-brown to
black tumor on
the surface of the
skin
With no change in
appearance since
its first detection
MOLE

23. Superficial skin
tumor, firm,
raised, rough
surface and may
appear
cauliflower-like.
Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
How to diagnose skin tumors?
TIPS:
Learn and know the
• Pattern of the more common
skin tumors
LOOK AT and FEEL the SKIN TUMOR!
• Confined to the surface of the
skin?
• Beneath the skin (at the
epidermis and dermis level)?
• Appearance of skin tumor?
WART

24. Tumor
immediately
beneath the skin
with an “eye” or
punctum
Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
How to diagnose skin tumors?
TIPS:
Learn and know the
• Pattern of the more common
skin tumors
LOOK AT and FEEL the SKIN TUMOR!
• Confined to the surface of the
skin?
• Beneath the skin (at the
epidermis and dermis level)?
• Appearance of skin tumor?
EPIDERMAL
CYST

25. Tumor
immediately
beneath the skin,
with redness,
tender, fluctuant
with pus
Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
How to diagnose skin tumors?
TIPS:
Learn and know the
• Pattern of the more common
skin tumors
• Cues for skin abscess
LOOK AT and FEEL the SKIN TUMOR!
• Confined to the surface of the
skin?
• Beneath the skin (at the
epidermis and dermis level)?
• Appearance of skin tumor?
ABSCESS

26. Tumor on the skin
surface
- History of non-
healing sore with
raised borders
Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
How to diagnose skin tumors?
TIPS:
Learn and know the
• Pattern of the more common
skin tumors
• Cues for skin cancers
LOOK AT and FEEL the SKIN TUMOR!
• Confined to the surface of the
skin?
• Beneath the skin (at the
epidermis and dermis level)?
• Appearance of skin tumor?
CANCER

27. Tumor looks like
a mole but
increasing in size
and appearance
over time
Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
How to diagnose skin tumors?
TIPS:
Learn and know the
• Pattern of the more common
skin tumors
• Cues for skin cancers
LOOK AT and FEEL the SKIN TUMOR!
• Confined to the surface of the
skin?
• Beneath the skin (at the
epidermis and dermis level)?
• Appearance of skin tumor?
MELANOMA

28. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
How to diagnose soft tissue tumors?
TIPS:
Learn and know the
• Pattern of the more common
soft tissue tumors
• Cues for soft tissue abscess
• Cues for soft tissue cancers
LOOK AT and FEEL the SOFT TISSUE
TUMOR!
• Nature – whether solid or cystic
• Border – whether clear or not
• Consistency – hard or not
• Mobility – movable or not
• Tenderness – present or not
• Appearance on the skin surface
• Deep in the muscular layer
• Hard
• Fixed

29. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
How to diagnose soft tissue tumors?
TIPS:
Learn and know the
• Pattern of the more common
soft tissue tumors
LOOK AT and FEEL the SOFT TISSUE
TUMOR!
• Nature – whether solid or cystic
• Border – whether clear or not
• Consistency – hard or not
• Mobility – movable or not
• Tenderness – present or not
• Appearance on the skin surface
Pattern: Subcutaneous level;
solid; clear border; soft; movable;
non-tender; no skin changes

30. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
How to diagnose soft tissue tumors?
TIPS:
Learn and know the
• Pattern of the more common
soft tissue tumors
LOOK AT and FEEL the SOFT TISSUE
TUMOR!
• Nature – whether solid or cystic
• Border – whether clear or not
• Consistency – hard or not
• Mobility – movable or not
• Tenderness – present or not
• Appearance on the skin surface
Pattern:
Subcutaneous up to
skin level; soft; with
skin discoloration
(bluish to suggest
blood vessel tumor –
hemangioma)

31. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Paraclinical diagnostic procedures for skin
and soft tissue tumors
The foremost indication for a paraclinical
diagnostic procedure can be stated this
way:
if you are not certain on the primary
clinical diagnosis and you need to be
certain or be more certain before
treatment, then go for a paraclinical
diagnostic procedure.

32. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Paraclinical diagnostic procedures for skin
and soft tissue tumors
To decide on indication of the paraclinical
diagnostic procedure,
the physician uses two processes –
- degree of certainty on the primary
clinical diagnosis and
- comparison of the treatment plans for
the primary and secondary clinical
diagnoses.

33. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Paraclinical diagnostic procedures for skin
and soft tissue tumors
Procedures Benefit
(goal – to
be more
definite on
the
diagnosis)
Risk Cost Availability
Option1
Option2
Option3
If there is a need for a
paraclinical diagnostic
procedure, the
physician uses the B-
R-C-A processes.
B – stands for benefit;
R – risk; C – cost; A –
Availability.

34. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Paraclinical diagnostic procedures for skin
and soft tissue tumors
Procedures Benefit
(goal – to
be more
definite on
the
diagnosis)
Risk Cost Availability
Option1
Option2
Option3
The physician gives or
lists the various
options of paraclinical
diagnostic procedures
and then gives data
on the BRCA.
With the data given,
the patient is asked
what s/he prefers.

35. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Paraclinical diagnostic procedures for skin
and soft tissue tumors
Example of BRCA
comparative analysis
of paraclinical
diagnostic procedures
Procedures Benefit (goal – to be
more definite on the
diagnosis)
Risk Cost (PhP) Availability
Option1 accuracy 99% acceptable 4000 available
Option2 accuracy 90% acceptable 3000 available
Option3 accuracy 60% acceptable 1000 available

36. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Paraclinical diagnostic procedures for skin
and soft tissue tumors
Common instrumental and laboratory diagnostic
procedures that can be used after the clinical
diagnosis of skin and soft tissue tumors:
BIOPSY – obtaining and examining under the
microscope samples of body cells and tissues
• Closed biopsy (needle biopsy – fine needle;
core needle) – without cutting the skin
• Open biopsy – with skin cut (section; excision)
• Punch biopsy with a punch instrument
Pinch biopsy –
pinching a piece of
tissue from a skin
tumor that is
fungating like a
cauliflower.

37. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Paraclinical diagnostic procedures for skin
and soft tissue tumors
Competencies required of physicians managing
skin and soft tissue tumors:
• Know the uses and indications of all known
instrumental and laboratory diagnostic
procedures for skin and soft tissue tumors.
• Use as needed and indicated.
• Select the most cost-effective one.
• Know how to interpret the results.

38. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Paraclinical diagnostic procedures for skin
and soft tissue tumors
BIOPSY – for soft tissue tumors with intact skin
• Closed biopsy (needle biopsy – fine needle;
core needle) – without cutting the skin
• Open biopsy – with skin cut (section; excision)

39. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Paraclinical diagnostic procedures for skin
and soft tissue tumors
Procedures
BIOPSY
(for soft
tissue
tumor)
Benefit (goal –
to be more
definite on the
diagnosis)
Risk Cost Availability
Fine needle 90% yield Least
invasive
P √
Core needle 95% yield PP √
Open 99% yield Most
invasive
(with scar)
PPP √

40. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Treatment of skin and soft tissue tumors
Operation – main modality of treatment
• Excision – for non-cancer tumors
• Wide excision – for cancer tumors
Other treatment modality such as radiation or
chemotherapy may be added for cancer tumors
T

41. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Prognosis for skin and soft tissue tumors
Generally good if diagnosed and treated early.
For non-cancer tumors, majority (99%) will be
cured.
For cancer tumors, majority will be cured if
diagnosed and treated early.
Cancers with poor prognosis are the sarcomas
and melanomas.

42. Contents:
• Clinical diagnosis of skin and soft tissue
tumors
• Paraclinical diagnostic procedures for skin and
soft tissue tumors
• Treatment for skin and soft tissue tumors
• Prognosis for skin and soft tissue tumors
PART 2
Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Summary
Take Away

43. Fundamentals
and Generalities
in Medical
Management of
Skin and Soft
Tissue Tumors
Take Away in
relation to
Patient
Empowerment
Be always in touch with reliable medical
information on fundamentals and
generalities in medical management of
skin and soft tissue tumors.
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of skin and soft
tissue tumors.

44. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
SKIN and SOFT
TISSUE TUMORS–
Part 2.
Health Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of Skin and
Soft Tissue
Tumors – Part
2