This document discusses cancers of the skin, focusing on nonmelanoma skin cancers (NMSC) including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). It covers risk factors, clinical presentation, diagnosis, staging, prognosis and management options for BCC and SCC. Management typically involves surgical excision or destruction, with Mohs micrographic surgery (MMS) and radiation therapy (RT) used for higher risk cases. Topical therapies like imiquimod and 5-FU are also discussed.
This document summarizes risk factors, staging, and management recommendations for carcinoma of the penis. It discusses that chronic inflammation, phimosis, smoking, HPV infection, and multiple sexual partners increase risk. Staging involves physical exam, MRI, CT, and PET imaging. Early stage disease is treated with surgery or radiation, while advanced disease may receive neoadjuvant chemotherapy followed by surgery or radiation. Lymph node involvement is managed with lymph node dissection or surveillance. Recurrence is treated with chemotherapy, which has shown response rates of 30-50% in trials combining agents like cisplatin and taxanes. Targeted therapies like cetuximab may also have efficacy in advanced disease.
This document provides information on the management of carcinoma penis, including:
1. Details on staging, diagnosis, and treatment options for primary penile lesions and regional lymph nodes.
2. Recommendations for surveillance versus lymphadenectomy in patients with non-palpable nodes based on risk level.
3. Treatment guidelines for palpable positive nodes including bilateral radical inguinal lymphadenectomy.
4. Follow-up guidelines based on treatment provided for the primary tumor and regional nodes.
The document discusses carcinoma penis, including its epidemiology, risk factors, pathology, staging, investigations, and treatment options. Premalignant lesions like erythroplasia of Queyrat and balanitis xerotica obliterans are described. Treatment depends on the stage and includes circumcision for small tumors, local excision, glansectomy, Mohs micrographic surgery, and laser surgery to preserve the organ while wide local excision or penectomy may be needed for more advanced cases.
This document provides information on pediatric malignant solid tumors, including Wilms tumor (nephroblastoma), neuroblastoma, and rhabdomyosarcoma. It discusses the epidemiology, histology, clinical presentation, risk classification, diagnostic workup, and standard treatment approaches for each of these tumor types. Pediatric cancer is the second leading cause of death in children, though survival rates have improved to over 70% with modern multimodal therapy.
This document summarizes the basics of penile cancer, including:
- Risk factors include lack of circumcision, HPV infection, smoking, and phimosis.
- It most commonly presents as lesions on the glans or prepuce and can spread to lymph nodes or distant organs if untreated.
- Diagnosis involves biopsy to determine depth of invasion and grade. Prognosis depends on stage, grade, growth pattern, and presence of lymphovascular invasion.
This document discusses the case of a 65-year-old man who presented with a growth on his penis. Examination found a ulcerated growth. Investigations confirmed moderately differentiated squamous cell carcinoma. He underwent partial penectomy and bilateral inguinal lymph node dissection, which found no cancer in the nodes. His post-operative recovery was uneventful. The tumor board discussion covered epidemiology, risk factors, staging, investigations, treatment options and follow-up guidelines for penile cancer.
Here are the key organ-preserving treatment options for penile cancer:
- Circumcision for very small, prepuce-confined tumors
- Local wedge excision or partial penectomy for small T1 tumors
- Glansectomy for selected T1 tumors not involving corpora cavernosa
All local options have significant recurrence risks of 40-50%. Close follow-up is required.
This document summarizes risk factors, staging, and management recommendations for carcinoma of the penis. It discusses that chronic inflammation, phimosis, smoking, HPV infection, and multiple sexual partners increase risk. Staging involves physical exam, MRI, CT, and PET imaging. Early stage disease is treated with surgery or radiation, while advanced disease may receive neoadjuvant chemotherapy followed by surgery or radiation. Lymph node involvement is managed with lymph node dissection or surveillance. Recurrence is treated with chemotherapy, which has shown response rates of 30-50% in trials combining agents like cisplatin and taxanes. Targeted therapies like cetuximab may also have efficacy in advanced disease.
This document provides information on the management of carcinoma penis, including:
1. Details on staging, diagnosis, and treatment options for primary penile lesions and regional lymph nodes.
2. Recommendations for surveillance versus lymphadenectomy in patients with non-palpable nodes based on risk level.
3. Treatment guidelines for palpable positive nodes including bilateral radical inguinal lymphadenectomy.
4. Follow-up guidelines based on treatment provided for the primary tumor and regional nodes.
The document discusses carcinoma penis, including its epidemiology, risk factors, pathology, staging, investigations, and treatment options. Premalignant lesions like erythroplasia of Queyrat and balanitis xerotica obliterans are described. Treatment depends on the stage and includes circumcision for small tumors, local excision, glansectomy, Mohs micrographic surgery, and laser surgery to preserve the organ while wide local excision or penectomy may be needed for more advanced cases.
This document provides information on pediatric malignant solid tumors, including Wilms tumor (nephroblastoma), neuroblastoma, and rhabdomyosarcoma. It discusses the epidemiology, histology, clinical presentation, risk classification, diagnostic workup, and standard treatment approaches for each of these tumor types. Pediatric cancer is the second leading cause of death in children, though survival rates have improved to over 70% with modern multimodal therapy.
This document summarizes the basics of penile cancer, including:
- Risk factors include lack of circumcision, HPV infection, smoking, and phimosis.
- It most commonly presents as lesions on the glans or prepuce and can spread to lymph nodes or distant organs if untreated.
- Diagnosis involves biopsy to determine depth of invasion and grade. Prognosis depends on stage, grade, growth pattern, and presence of lymphovascular invasion.
This document discusses the case of a 65-year-old man who presented with a growth on his penis. Examination found a ulcerated growth. Investigations confirmed moderately differentiated squamous cell carcinoma. He underwent partial penectomy and bilateral inguinal lymph node dissection, which found no cancer in the nodes. His post-operative recovery was uneventful. The tumor board discussion covered epidemiology, risk factors, staging, investigations, treatment options and follow-up guidelines for penile cancer.
Here are the key organ-preserving treatment options for penile cancer:
- Circumcision for very small, prepuce-confined tumors
- Local wedge excision or partial penectomy for small T1 tumors
- Glansectomy for selected T1 tumors not involving corpora cavernosa
All local options have significant recurrence risks of 40-50%. Close follow-up is required.
This document provides information about soft tissue tumors. It discusses the epidemiology, classification, etiology, diagnosis and treatment of both benign and malignant soft tissue tumors. Some key points include:
- Benign soft tissue tumors are more common than sarcomas. Common benign tumors include lipomas, schwannomas and giant cell tumors of the tendon sheath.
- Risk factors for soft tissue sarcoma include exposure to herbicides/pesticides, radiation exposure, genetic conditions and viral infections.
- MRI is usually the best imaging modality for evaluating soft tissue tumors. Biopsy is needed for diagnosis.
- Treatment depends on whether the tumor is benign or malignant. Benign tumors may
This document contains medical information about a 55-year-old male patient presenting with a 1-year history of an ulcer on his penis, as well as swelling and pain in his groin region and scrotum over the past 8-6 months. Physical examination revealed the penile and groin ulcers, as well as swollen lymph nodes and scrotal enlargement. Biopsy of the penile ulcer showed well-differentiated squamous cell carcinoma. Imaging and tests identified secondary infection with Pseudomonas bacteria and scrotal elephantiasis. The patient was diagnosed with advanced penile cancer complicated by infection and elephantiasis, requiring total penectomy and lymph node dissection for treatment.
1) Carcinoma of the penis has a higher incidence in South America, East Africa, and South East Asia. Risk factors include HPV infection, phimosis, smoking, and lack of circumcision.
2) Early stage lesions include erythroplasia of Queyrat, Bowen's disease, balanitis xerotica obliterans, and giant condyloma acuminatum. Advanced lesions are staged using the TNM system.
3) Treatment depends on the stage but may include local excision, circumcision, partial or total penectomy. Sentinel lymph node biopsy helps determine if inguinal lymphadenectomy is needed.
This document discusses neuroblastoma and nephroblastoma (Wilms tumor). Neuroblastoma is the most common extracranial solid tumor in children, arising from the sympathetic nervous system. It presents heterogeneously from spontaneous regression to aggressive forms. The causes are largely unknown. Nephroblastoma (Wilms tumor) is the most common malignant renal tumor of childhood. Both tumors are diagnosed through imaging and urine/blood tests. Prognosis and treatment varies depending on tumor histology and staging. Aggressive forms of neuroblastoma and anaplastic Wilms tumor remain difficult to treat.
This document outlines pre-malignant conditions and management algorithms for cancer of the penis. It discusses various premalignant lesions like Bowen's disease, erythroplasia of Queyrat, lichen sclerosis, and their treatment options including topical therapies, ablation, excision and Mohs micrographic surgery. It also discusses staging and treatment options for primary penile cancer including organ-sparing surgeries and algorithms for managing inguinal lymph nodes depending on tumor characteristics and pathological findings. Radiation therapy has a role for small early-stage lesions or in patients who cannot undergo surgery. The goal of management is eradication of disease while preserving organ function.
Soft tissue sarcomas are rare malignant tumors that can arise in any soft tissue of the body. They are characterized by their genetic alterations and histological grade. Diagnosis is made through biopsy and imaging is used to stage the tumor. Treatment typically involves complete surgical resection with negative margins, along with possible adjuvant radiation and chemotherapy depending on tumor grade and size. Prognosis depends on factors like tumor size, grade, depth, and completeness of resection. Recurrence rates remain high, especially for retroperitoneal and visceral soft tissue sarcomas.
1. Benign renal tumors are the majority of renal masses found, often incidentally. They include renal cysts, angiomyolipomas, oncocytomas, and papillary adenomas.
2. Renal cell carcinoma (RCC) accounts for 2-3% of adult cancers. Risk factors include tobacco, obesity, hypertension, and family history. The most common subtypes are clear cell and papillary RCC.
3. Certain hereditary syndromes increase RCC risk, like von Hippel-Lindau disease, hereditary papillary RCC, and Birt-Hogg-Dubé syndrome. Genetic mutations contribute to tumor development in these conditions.
1) Cancers of the penis are rare but devastating, accounting for 0.4-0.6% of cancers in men in the US and Europe but up to 10% in some other regions.
2) Risk factors include poor hygiene, phimosis, HPV infection, and lack of circumcision. Over 95% are squamous cell carcinoma.
3) Staging involves physical exam, biopsy, and imaging of lymph nodes and distant organs. Treatment may include organ-sparing surgery or penile amputation depending on size, grade, and extent of invasion.
It is a complete presentation on carcinoma penis, covering all aspects starting from premalignant lesions to details of squamous cell carcinoma penis including recent NCCN guidelines and steps of penectomy and lymph node dissection
Neuroblastoma is a form of childhood cancer that attacks the sympathetic nervous system. It most commonly occurs in children under two years old and forms in nerve tissue of the adrenal gland, neck, chest, or spinal cord. Common signs include bone pain, lumps in the abdomen or neck, dark circles around the eyes, trouble breathing, and swollen stomach. Tests like physical exams, urine tests, imaging scans, and biopsies are used to determine the stage of cancer, which ranges from localized to widespread. Treatments may include surgery, radiation, chemotherapy, and stem cell transplants.
This seminar discusses carcinoma penis. Dr. A.I. Mazumder is the moderator and Dr. Biswajit Deka is the presenter. Carcinoma penis is uncommon but psychologically devastating when diagnosed. It is important to differentiate between benign, premalignant, and malignant conditions. Metastasis often occurs if diagnosis or treatment is delayed and can be lethal. The cancer typically spreads slowly at first and may not cause symptoms, allowing it to progress before being found.
บรรยายในการประชุมวิชาการ Korat Hand and Reconstructive Surgery Day ครั้งที่ 3 "Update for Musculoskeletal Problems in Upper Extremities"
วันศุกร์ที่ 16 ธันวาคม 2559 ณ ห้องประชุมหลวงพ่อพุธ ฐานิโย อาคารเฉลิมพระเกีบรติ โรงพยาบาลมหาราชนครราชสีมา
Neuroblastoma is the most common extracranial solid tumor in children. It arises from neural crest cells that form the adrenal medulla and sympathetic ganglia. Over half of children present with metastatic disease. Risk factors include genetic predispositions and exposure to chemicals during pregnancy. Clinical features vary depending on tumor location but may include abdominal mass, bone pain, or eye symptoms. Treatment involves surgery, chemotherapy, and sometimes radiation. Prognosis depends on age, stage, and biological features of the tumor.
1. Premalignant penile lesions can be divided into non-HPV related (inflammatory) and virus related categories. Non-HPV related lesions include cutaneous horn, pseudoepitheliomatous micaceous and keratotic balanitis, and male lichen sclerosus.
2. Virus related lesions include condyloma acuminata caused by HPV, Bowenoid papulosis which is associated with HPV 16, and Kaposi sarcoma caused by HHV8.
3. These premalignant lesions require treatment such as surgical excision or laser ablation to prevent progression to squamous cell carcinoma, which over 40% of penile cancer patients have a history
Neuroblastoma is the third most common childhood cancer and arises from sympathetic nervous system. Staging involves evaluating tumor size, spread and biomarkers. Treatment ranges from observation to intensive chemotherapy and stem cell transplant depending on risk factors like age, stage, genetics and response to initial treatment. Targeted therapies are being studied in recurrent and high risk disease.
A 24-year-old man presented with an enlarging growth in his right eye that had been progressively growing larger over 8 months since being kicked in the eye. Examination found a growth in the right eye with full vision and eye movement. Biopsy of the growth found characteristics of mucosa-associated lymphoid tissue (MALT) lymphoma. MALT lymphoma can occur in the conjunctiva and has a generally favorable prognosis when treated locally. Further testing will be done to evaluate if the cancer is localized or has spread systemically.
Carcinoid tumors are slow-growing neuroendocrine tumors that commonly arise in the gastrointestinal tract and lungs. The document discusses carcinoid tumors in depth, including their definition, sites of origin, histology, staging, clinical features, diagnostic testing, and management approaches. Treatment involves surgical resection when possible, with additional therapies for advanced or metastatic disease aimed at controlling hormone secretion and tumor growth.
Lec 9&10 covered soft tissue tumors. Lipomas are benign fatty tumors that are usually solitary, well-encapsulated masses of mature adipocytes. Liposarcomas are malignant adipocyte tumors that typically present as large, infiltrative masses with necrosis and hemorrhage. They have variable histology from well-differentiated to poorly differentiated subtypes. Nodular fasciitis is a self-limited reactive lesion, while fibromatoses are locally aggressive fibroblastic proliferations. Fibrosarcomas are highly malignant fibroblastic tumors. Leiomyomas are benign smooth muscle tumors often seen in the uterus, while leiomyosarcomas are malignant variants that commonly arise de
This document provides information about soft tissue tumors. It discusses the epidemiology, classification, etiology, diagnosis and treatment of both benign and malignant soft tissue tumors. Some key points include:
- Benign soft tissue tumors are more common than sarcomas. Common benign tumors include lipomas, schwannomas and giant cell tumors of the tendon sheath.
- Risk factors for soft tissue sarcoma include exposure to herbicides/pesticides, radiation exposure, genetic conditions and viral infections.
- MRI is usually the best imaging modality for evaluating soft tissue tumors. Biopsy is needed for diagnosis.
- Treatment depends on whether the tumor is benign or malignant. Benign tumors may
This document contains medical information about a 55-year-old male patient presenting with a 1-year history of an ulcer on his penis, as well as swelling and pain in his groin region and scrotum over the past 8-6 months. Physical examination revealed the penile and groin ulcers, as well as swollen lymph nodes and scrotal enlargement. Biopsy of the penile ulcer showed well-differentiated squamous cell carcinoma. Imaging and tests identified secondary infection with Pseudomonas bacteria and scrotal elephantiasis. The patient was diagnosed with advanced penile cancer complicated by infection and elephantiasis, requiring total penectomy and lymph node dissection for treatment.
1) Carcinoma of the penis has a higher incidence in South America, East Africa, and South East Asia. Risk factors include HPV infection, phimosis, smoking, and lack of circumcision.
2) Early stage lesions include erythroplasia of Queyrat, Bowen's disease, balanitis xerotica obliterans, and giant condyloma acuminatum. Advanced lesions are staged using the TNM system.
3) Treatment depends on the stage but may include local excision, circumcision, partial or total penectomy. Sentinel lymph node biopsy helps determine if inguinal lymphadenectomy is needed.
This document discusses neuroblastoma and nephroblastoma (Wilms tumor). Neuroblastoma is the most common extracranial solid tumor in children, arising from the sympathetic nervous system. It presents heterogeneously from spontaneous regression to aggressive forms. The causes are largely unknown. Nephroblastoma (Wilms tumor) is the most common malignant renal tumor of childhood. Both tumors are diagnosed through imaging and urine/blood tests. Prognosis and treatment varies depending on tumor histology and staging. Aggressive forms of neuroblastoma and anaplastic Wilms tumor remain difficult to treat.
This document outlines pre-malignant conditions and management algorithms for cancer of the penis. It discusses various premalignant lesions like Bowen's disease, erythroplasia of Queyrat, lichen sclerosis, and their treatment options including topical therapies, ablation, excision and Mohs micrographic surgery. It also discusses staging and treatment options for primary penile cancer including organ-sparing surgeries and algorithms for managing inguinal lymph nodes depending on tumor characteristics and pathological findings. Radiation therapy has a role for small early-stage lesions or in patients who cannot undergo surgery. The goal of management is eradication of disease while preserving organ function.
Soft tissue sarcomas are rare malignant tumors that can arise in any soft tissue of the body. They are characterized by their genetic alterations and histological grade. Diagnosis is made through biopsy and imaging is used to stage the tumor. Treatment typically involves complete surgical resection with negative margins, along with possible adjuvant radiation and chemotherapy depending on tumor grade and size. Prognosis depends on factors like tumor size, grade, depth, and completeness of resection. Recurrence rates remain high, especially for retroperitoneal and visceral soft tissue sarcomas.
1. Benign renal tumors are the majority of renal masses found, often incidentally. They include renal cysts, angiomyolipomas, oncocytomas, and papillary adenomas.
2. Renal cell carcinoma (RCC) accounts for 2-3% of adult cancers. Risk factors include tobacco, obesity, hypertension, and family history. The most common subtypes are clear cell and papillary RCC.
3. Certain hereditary syndromes increase RCC risk, like von Hippel-Lindau disease, hereditary papillary RCC, and Birt-Hogg-Dubé syndrome. Genetic mutations contribute to tumor development in these conditions.
1) Cancers of the penis are rare but devastating, accounting for 0.4-0.6% of cancers in men in the US and Europe but up to 10% in some other regions.
2) Risk factors include poor hygiene, phimosis, HPV infection, and lack of circumcision. Over 95% are squamous cell carcinoma.
3) Staging involves physical exam, biopsy, and imaging of lymph nodes and distant organs. Treatment may include organ-sparing surgery or penile amputation depending on size, grade, and extent of invasion.
It is a complete presentation on carcinoma penis, covering all aspects starting from premalignant lesions to details of squamous cell carcinoma penis including recent NCCN guidelines and steps of penectomy and lymph node dissection
Neuroblastoma is a form of childhood cancer that attacks the sympathetic nervous system. It most commonly occurs in children under two years old and forms in nerve tissue of the adrenal gland, neck, chest, or spinal cord. Common signs include bone pain, lumps in the abdomen or neck, dark circles around the eyes, trouble breathing, and swollen stomach. Tests like physical exams, urine tests, imaging scans, and biopsies are used to determine the stage of cancer, which ranges from localized to widespread. Treatments may include surgery, radiation, chemotherapy, and stem cell transplants.
This seminar discusses carcinoma penis. Dr. A.I. Mazumder is the moderator and Dr. Biswajit Deka is the presenter. Carcinoma penis is uncommon but psychologically devastating when diagnosed. It is important to differentiate between benign, premalignant, and malignant conditions. Metastasis often occurs if diagnosis or treatment is delayed and can be lethal. The cancer typically spreads slowly at first and may not cause symptoms, allowing it to progress before being found.
บรรยายในการประชุมวิชาการ Korat Hand and Reconstructive Surgery Day ครั้งที่ 3 "Update for Musculoskeletal Problems in Upper Extremities"
วันศุกร์ที่ 16 ธันวาคม 2559 ณ ห้องประชุมหลวงพ่อพุธ ฐานิโย อาคารเฉลิมพระเกีบรติ โรงพยาบาลมหาราชนครราชสีมา
Neuroblastoma is the most common extracranial solid tumor in children. It arises from neural crest cells that form the adrenal medulla and sympathetic ganglia. Over half of children present with metastatic disease. Risk factors include genetic predispositions and exposure to chemicals during pregnancy. Clinical features vary depending on tumor location but may include abdominal mass, bone pain, or eye symptoms. Treatment involves surgery, chemotherapy, and sometimes radiation. Prognosis depends on age, stage, and biological features of the tumor.
1. Premalignant penile lesions can be divided into non-HPV related (inflammatory) and virus related categories. Non-HPV related lesions include cutaneous horn, pseudoepitheliomatous micaceous and keratotic balanitis, and male lichen sclerosus.
2. Virus related lesions include condyloma acuminata caused by HPV, Bowenoid papulosis which is associated with HPV 16, and Kaposi sarcoma caused by HHV8.
3. These premalignant lesions require treatment such as surgical excision or laser ablation to prevent progression to squamous cell carcinoma, which over 40% of penile cancer patients have a history
Neuroblastoma is the third most common childhood cancer and arises from sympathetic nervous system. Staging involves evaluating tumor size, spread and biomarkers. Treatment ranges from observation to intensive chemotherapy and stem cell transplant depending on risk factors like age, stage, genetics and response to initial treatment. Targeted therapies are being studied in recurrent and high risk disease.
A 24-year-old man presented with an enlarging growth in his right eye that had been progressively growing larger over 8 months since being kicked in the eye. Examination found a growth in the right eye with full vision and eye movement. Biopsy of the growth found characteristics of mucosa-associated lymphoid tissue (MALT) lymphoma. MALT lymphoma can occur in the conjunctiva and has a generally favorable prognosis when treated locally. Further testing will be done to evaluate if the cancer is localized or has spread systemically.
Carcinoid tumors are slow-growing neuroendocrine tumors that commonly arise in the gastrointestinal tract and lungs. The document discusses carcinoid tumors in depth, including their definition, sites of origin, histology, staging, clinical features, diagnostic testing, and management approaches. Treatment involves surgical resection when possible, with additional therapies for advanced or metastatic disease aimed at controlling hormone secretion and tumor growth.
Lec 9&10 covered soft tissue tumors. Lipomas are benign fatty tumors that are usually solitary, well-encapsulated masses of mature adipocytes. Liposarcomas are malignant adipocyte tumors that typically present as large, infiltrative masses with necrosis and hemorrhage. They have variable histology from well-differentiated to poorly differentiated subtypes. Nodular fasciitis is a self-limited reactive lesion, while fibromatoses are locally aggressive fibroblastic proliferations. Fibrosarcomas are highly malignant fibroblastic tumors. Leiomyomas are benign smooth muscle tumors often seen in the uterus, while leiomyosarcomas are malignant variants that commonly arise de
Basal cell carcinoma and squamous cell carcinoma are the two most common types of skin cancer. Basal cell carcinoma is the most common human cancer, making up 25% of all cancers. It rarely metastasizes but can cause extensive damage locally. Risk factors include sun exposure, lighter skin, older age, immunosuppression, and genetic conditions. Treatment options include curettage and electrodesiccation, surgical excision with margin assessment, Mohs surgery, radiation therapy, and topical therapies like imiquimod for superficial lesions. Mohs surgery achieves the highest cure rates of over 99% for basal cell carcinoma.
This document provides information about skin malignancies and skin cancers. It begins with an introduction to skin anatomy and then covers the embryology, types of skin tumors including basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. For each type of skin cancer, it discusses epidemiology, risk factors, clinical features, pathogenesis, subtypes, investigations, and management. The key types of skin cancers covered are basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. It provides detailed information about each type's characteristics, presentation and treatment.
This document discusses various benign, premalignant, and malignant lesions of the penis. It covers the etiology, risk factors, diagnosis, staging, and management options for penile cancer including surgery, radiotherapy, and chemotherapy. The main types of penile cancer are squamous cell carcinoma (>95%) and mesenchymal tumors (<3%). Surgical options range from circumcision to partial or total penectomy. Radiotherapy can be delivered via brachytherapy or external beam radiation. Management depends on tumor stage, size, histology, and patient preferences regarding organ preservation.
This document summarizes various benign, premalignant, and malignant lesions of the penis. It discusses the etiology, diagnosis, staging, and management of penile carcinoma. The main types of penile carcinoma are squamous cell carcinoma (>95%) and mesenchymal tumors (<3%). Risk factors include phimosis, number of sexual partners, and HPV infection. Diagnosis involves physical exam, imaging, and histology. Treatment options depend on the location, size, stage, and grade of the tumor, and may include surgery, radiation therapy, chemotherapy, or a combination. Surgery ranges from circumcision to penectomy, while radiation includes brachytherapy and external beam radiation therapy. Prognosis depends on
This document summarizes information about different types of skin cancer that commonly occur on the head and neck region. It discusses basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. BCC is the most common type, usually slow-growing but can become invasive. SCC often arises from sun exposure and pre-cancerous lesions on sun-exposed sites in elderly males. Melanoma accounts for fewer cases but causes most skin cancer deaths. Risk factors, diagnosis, staging, and management are described for each type. Wide excision and reconstruction are used for early stages while advanced cases may require neck dissection and adjuvant therapy.
Cutaneous malignancies and related disorders.pptxAjilAntony10
The document discusses cutaneous malignancies like basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma. It covers their etiology, risk factors, clinical features, histopathological classification, staging and treatment options. The key points are: BCC is the most common type and arises from UV exposure. SCC usually occurs on sun-exposed skin and risk is higher with tanning bed use. Malignant melanoma is the most deadly but can be cured if detected early, using the ABCDE criteria to monitor moles. Wide local excision is the main treatment for all, with Mohs surgery preferred for certain types/locations.
Retinoblastoma is a rare cancer that affects the retina. It is caused by mutations in the RB1 gene. There are two main types - hereditary retinoblastoma, which requires only one mutation, and sporadic retinoblastoma, which requires two mutations. Symptoms include leukocoria. Diagnosis involves ophthalmoscopy, imaging like ultrasound and MRI, and sometimes biopsy. Treatment depends on factors like tumor size and location, and may include focal therapies like cryotherapy, chemotherapy, external beam radiation, plaque brachytherapy, or enucleation of the eye. Prognosis depends on extent of disease and risk of metastasis.
Squamous cell carcinoma and basal cell carcinoma are the two most common types of non-melanoma skin cancer. Squamous cell carcinoma occurs more often in sun-exposed areas and affects men more than women. Larger lesions, deeper invasion and higher grades are associated with greater recurrence risk. Treatment options include excision, cryotherapy and radiation therapy. Basal cell carcinoma is more common and occurs predominantly in light-skinned individuals on sun-exposed areas. The nodular type is most common. Treatment involves wide local excision, Mohs surgery, or radiation therapy depending on size and location.
1) The document discusses various malignant eyelid tumours including basal cell carcinoma, squamous cell carcinoma, sebaceous gland carcinoma, melanoma, and rare tumours.
2) It describes the clinical features, risk factors, histology, signs and symptoms, and treatment options for each tumour type.
3) Reconstruction after tumour excision depends on the extent of tissue removed and may involve techniques such as direct closure, flaps, or free grafts to reconstruct the posterior or anterior lamellae as needed.
This document discusses tumours of the ear, including both benign and malignant types. It provides details on the epidemiology, risk factors, pathology, diagnosis and treatment of various tumours such as basal cell carcinoma, squamous cell carcinoma, melanoma, and others. Treatment options discussed include surgical excision with various techniques depending on tumour size and location, Mohs surgery, radiation therapy, and reconstruction after tumour removal. Staging criteria and classifications of temporal bone tumours are also presented.
Basal cell carcinoma (BCC) is the most common type of skin cancer. It typically appears as a slowly growing tumor on sun-exposed skin, particularly the face. BCC arises from basal cells in the lower epidermis and is caused by cumulative sun exposure and genetic factors. Microscopically, BCC shows proliferating basaloid cells forming nodular lesions or superficial growth patterns. While locally invasive, BCC rarely metastasizes and can usually be cured with surgery.
Primary cutaneous lymphoma is a type of non-Hodgkin lymphoma that presents in the skin without evidence of extracutaneous disease. Mycosis fungoides is the most common type of cutaneous T-cell lymphoma, presenting as patches and plaques on the skin that can progress to tumors. Treatment depends on the stage of disease and includes skin-directed therapies like radiation and phototherapy for early stages and systemic therapies for advanced disease. Prognosis is generally good for early stage mycosis fungoides but worsens with increasing stage and extracutaneous spread.
This document provides an outline for a presentation on skin malignancies including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM). It covers the epidemiology, etiology, risk factors, pathology, classification, diagnosis, treatment and prevention of these three skin cancers. Diagnosis involves history, examination, and investigations. Treatment involves surgical options like excision and Mohs surgery as well as non-surgical options. Prevention focuses on sun protection and early detection through follow up visits.
This document discusses squamous cell carcinoma (SCC), a type of non-melanoma skin cancer. It notes that SCC comprises about 20% of non-melanoma skin cancers. Risk factors for SCC include cumulative sun exposure, fair skin, genetic conditions, immunosuppression, arsenic exposure, and other skin damage or diseases. Actinic keratosis is a precancerous lesion that can progress to SCC. Diagnosis involves biopsy and imaging if needed to assess spread. Treatment depends on risk factors and location but commonly includes surgery, Mohs surgery, radiation, or a combination for more advanced cases.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
3. NONMELANOMA skin cancer (NMSC)
• 1/5 Americans will develop NMSC during his or her lifetime
• The most common human cancer
• Higher than the incidence of lung, breast, prostate and colon cancer
combined
• Risk factors: solar radiation, UV exposure, age
27-Feb-20 3
4. Diagnosis of Nonmelanoma Skin Cancer
• Clinical findings:
• Nodularity
• Tissue friability
• Erythema
• Definitive diagnosis can be established only by tissue biopsy
• A: Shave biopsy : raised lesions such as nodular
basal cell carcinoma
• B: Punch biopsy : lesions with a deeper dermal
or subcutaneous extension such as
dermatofibrosarcoma protuberans (DFSP)
27-Feb-20 4
- clean (nonsterile) conditions - local anesthesia
DeVita, Hellman, and Rosenberg's Cancer Principles & Practice of Oncology
5. NMSC Surgical Excision
• C: excisional biopsy : under sterile conditions
• Excisional surgery involves the removal of the cancer and a margin of clinically
uninvolved skin
• Procedure types:
• In office : effective and cost efficient, poor pathological assessment
• MMS : potential for irregular subclinical extension, better pathological
assessment
27-Feb-20 5
6. NMSC Surgical Excision.. cont.…
• Mohs Micrographic Surgery:
• staged excision with intraoperative
microscopic analysis that facilitates
optimal margin control
• Immediately processed frozen
sections for microscopic examination
• cure rate of >97% to 99% for primary
BCC and SCC
27-Feb-20 6
DeVita, Hellman, and Rosenberg's Cancer Principles & Practice of Oncology
7. NMSC Surgical Excision.. cont.…
• Surgical Destruction:
• curettage and cautery or electrodessication C&D:
Curettage of Visible tumor with 2 to 4 mm margins, then cautery or electrodesiccation to
destroy another 1 mm at the lateral and deep margins
• Cryotherapy:
using liquid nitrogen
Requires −50°C to −60°C at the deep and lateral margins of the tumor
Complications: delayed wound healing, hypertrophic scarring, hypo- and
hyperpigmentation, paresthesia if superficial nerves are injured
Limitation: inability to evaluate treatment margins
27-Feb-20 7
8. Radiation Therapy
• Can be used to treat : BCC and SCC, Merkel cell carcinoma (MCC),
angiosarcoma (AS), cutaneous lymphomas, some adnexal carcinomas, and
other primary and metastatic cutaneous neoplasms.
• Primary modality for:
• overall health status precludes surgery
• unwilling or unable to undergo surgery
• Size and extent of the tumour precludes surgical extirpation
• Adjuvant treatment:
• Positive surgical margins
• Perineural invasion (PNI)
• Local regional nodal metastasis
• Limitation: assess and control the tumor margins, postradiation dermatitis
and future skin cancers
27-Feb-20 8
9. Radiation Therapy.. Cont..
• Radiation type:
• Electron external beam: superficial tumors
• Photons beam (x-rays) : for deeper tumors
• Radiation dose:
• 2- to 2.5-Gy fractions to a total of 50 to 66 Gy
• Acceptable local control and late toxicity
• Accelerated / hypo-fractionated treatment protocols provide excellent local
control but have an increased risk of fibrosis, atrophy, telangiectasias, and
poor cosmesis
• Local control : BCC, 90% to 95% at 5 years; SCC, 80% to 95% at 5 years
27-Feb-20 9
10. Topical Therapy
• Imiquimod, functions as a topical immune-response modifier :
• Activates intracellular toll-like receptors 7 and 8
• Induction of cytokines : IFN-α and IFN-γ and interleukin (IL)-6, IL-8
• A T-helper type 1–dominant inflammatory response driven by CD4 T cells
• Inferior outcome compared to surgery or RT
• A.E.: site reactions, fatigue, myalgias, fever and chills or flu-like symptoms,
headache, diarrhea, nausea, and tender lymphadenopathy
• 5-FU:
• Chemotherapeutic agent that interferes with DNA synthesis by inhibiting
thymidylate synthetase
• Outcome and adverse event same as imiquimod.
27-Feb-20 10
11. BASAL CELL CARCINOMA
• Slow-growing neoplasm
• Originating from the basal cell layer of the epidermis
• The most common human cancer
• Half of all human cancers and 75% of skin malignancies
• Sun-exposed areas of lighter skinned individuals
• locally invasive
• The incidence continues to increase, doubling of the number of cases every 10
years
• More common in older individuals
• Increasing incidence in each decade of life that peaks after age 80 years
• Men are affected more often than women (3/2)
27-Feb-20 11
12. BCC .. CONT. ..
• Primary carcinogen is UVR:
• sun exposure
• Indoor tanning (NOT “safer”)
• Other carcinogens:
• Ionizing radiation
• Chemicals (e.g., arsenic, polyaromatic hydrocarbons)
• Psoralen plus UVA (PUVA) therapy
• Genetic syndromes with inherited mutations in tumor suppressor genes (TSG)
• Alterations in immune surveillance (i.e., organ transplantation, underlying
hematologic malignancy, immunosuppressive medications, or HIV infection)
27-Feb-20 12
13. BCC Genomic analysis
• BCC is associated with mutations in the PTCH1 regulatory gene, which
maps to chromosome 9q22.3
• Loss of heterozygosity at this site is seen in both sporadic and hereditary
BCC
• The PTCH1 protein is part of a receptor complex that regulates the
hedgehog signaling pathway, a key regulator of embryonic development
and cellular proliferation
• Loss-of-function mutations in PTCH1 thus permit unopposed Smoothened
activity and cellular proliferation
• This understanding of the molecular pathogenesis of BCC has led to the
development of targeted medical therapy for BCC with small-molecule
inhibitors of Smoothened
27-Feb-20 13
14. BCC Clinical and Pathologic Features
• slowly growing solitary lesion on sun-exposed skin
• Typically asymptomatic
• May bleed or ulcerate
• Half of BCCs occur on the face and ears, 30% on the nose
• Subtypes: nodular, superficial, and infiltrative
27-Feb-20 14
15. BCC NODULAR subtype
• most common BCC subtype
• >60% of all tumors
• Clinically, it presents as a raised, translucent,
pearly, skin-toned to pink papule or nodule
with prominent telangiectasias
• easy bleeding and/or crusting
• sun-exposed areas of the face in individuals
over the age of 60 years
27-Feb-20 15
16. BCC Superficial subtype
• second most common subtype of BCC
• up to 15% of all BCCs
• younger patients at a mean age of 57 years
• well-defined, pink to erythematous, scaly or
eroded macule or plaque commonly with a thin
pearly border
• predominately on the trunk
• Histologically, superficial BCC may be a broad
lesion characterized by basophilic buds extending
from an atrophic epidermis into the papillary
dermis
• limited to the upper dermis
27-Feb-20 16
17. BCC Infiltrative subtype
• 5% to 15% of all BCCs
• predominately in the head and neck region of older adults
• Clinically : flat or indurated, slightly firm lesion, without well-
demarcated borders, with a white to yellowish hue, and may be
difficult to differentiate from a scar
27-Feb-20 17
18. Staging, Prognosis, and Management
• overall prognosis is excellent
• mortality for BCC is far less than 1%, with less than 1,000 deaths per
year in the United States
• traditional tumor-node-metastasis (TNM) staging in not necessary
• High risk features: infiltrative and morpheaform subtypes of BCC;
recurrent BCC; anatomic location on the nose, ear, eyelid, or temple;
and increasing preoperative size
27-Feb-20 18
19. BCC Management
• Low-risk tumors: surgery or C&D
• high-risk tumors:
• MMS
• RT
• Combination MMS + RT for deep destructive tumors
• Topical 5-FU is twice-daily application for 3 to 6 weeks irrespective of tumor
size or location
27-Feb-20 19
20. BCC Management
• Very high risk, metastatic, multiple, not eligible for RT / MMS:
• Vismodegib:
• once-daily oral dosing of 150 mg
• adverse events:
• muscle spasms
• Alopecia
• dysgeusia leading to weight loss
• Fatigue
• diarrhea, and hyponatremia
• between 12% and 54% of patients discontinued therapy because of adverse effects
27-Feb-20 20
21. SQUAMOUS CELL CARCINOMA - SCC
• Risk factors:
• Age : 10-fold greater in people aged >70
• Chronic UVR: 5- to 10-fold greater in geographic regions of high environmental UVR
• fair skin complexion and light-colored hair and eyes
• Men are affected twofold more commonly than women
• UV light therapy
• chemical carcinogens (e.g., petroleum, coal tar)
• ionizing radiation
• HPV : anogenital and periungual regions
• Heritable conditions : xeroderma pigmentosum
• Drugs: Immunosuppressive therapy, photosensitizing drugs (voriconazole),
Vemurafenib,
27-Feb-20 21
22. SCC Clinical and Pathologic Features
• Invasive SCC may present as a slightly
raised papule plaque or nodule that is
skin-colored, pink, or red
• surface of the tumor may be smooth
, keratotic, or ulcerated
• Bleeding with minimal trauma is
common
• Verrucous carcinoma, a variant of SCC,
includes oral florid papillomatosis, giant
condyloma of Buschke-Lowenstein (on
the genitalia), and epithelioma
cuniculatum (on the plantar foot)
27-Feb-20 22
23. SCC histologically
• large cellular size, nuclear hyperchromatism, lack of
maturation, nuclear atypia, and the presence of
mitotic figures
• Well-differentiated SCC, cytoplasmic keratinization
is manifested by the presence of keratin pearls (horn
cysts)
• Poorly differentiated or undifferentiated SCC shows
decreased evidence of keratinization, higher degree
of cytologic atypia, and increased number of mitotic
figures.
27-Feb-20 23
24. SCC Staging and Prognosis
• Cutaneous SCCIS is a stage 0: indolent, enlarge slowly over years,
seldom progresse to invasive carcinoma
• Overall prognosis is good to excellent
• 2% to 4% of patients will develop nodal metastasis
• 1% to 2% of patients will die from disease (4,000 to 9,000 deaths per year in the United States)
• risk for local recurrence and metastasis: location, size, depth,
histologic differentiation, PNI, immunosuppression
• no universally accepted staging system
27-Feb-20 24
25. SCC Management
• destruction by C&D
• removal by excisional surgery or MMS
• RT
• Adjuvant postoperative RT:
• residual disease
• positive margins
• PNI (especially if symptomatic)
• multiple recurrences
• underlying tissue invasion
27-Feb-20 25
26. Management of Regional, Distant, or
Inoperable SCC
• Local RT : Definitive doses 60 to 66 Gy
• Lymph node dissection
• A combination of both (parotid nodes)
• Metastatic disease:
• Cetuximab: chimeric monoclonal antibody directed against the EGFR
• chemotherapy,
• Immunotherapy with nivolumab or pembrolizumab:
• monoclonal antibodies to the immune checkpoint receptor programmed death 1 (PD-1)
27-Feb-20 26
27. MERKEL CELL CARCINOMA
• Rare and aggressive tumor
• Neuroendocrine cell origin
• Frequent metastasis and poor overall prognosis
• Men twice that in women
• whites are more than 20 than blacks
• Risk factors:
• Immunosuppression
• UV
• Merkel cell polyomavirus (MCPyV)
27-Feb-20 27
28. Management of Merkel Cell Carcinoma
• MMS with 1- to 2-cm margins is generally recommended
• With surgery alone 25% recure within 2 years and 47% within 5 years
• Relapses pattern:
• local 9%
• Nodal 53%
• Distant metastasis 38%
• Adjuvant RT?
• Positive surgical margins (RT dose of 56 to 60 Gy)
• 60 to 66 Gy can be considered for primary RT
27-Feb-20 28
29. MCC Systemic therpay
• nodal, metastatic, and recurrent MCC
• Chemotherapy: cyclophosphamide, anthracyclines, and cisplatin
• 3-year survival rate was 17% in metastatic disease
• Immunotherapy:multicenter, phase II, noncontrolled study of
pembrolizumab (anti–PD-1) 2 mg/kg every 3 weeks(1)
• 25 patients evaluated objective response rate was 56%, and 4 patients (16%)
showed a complete response
• 2019 update: At 24 months, progression-free survival was 48.3% and overall
survival was 68.7%.
27-Feb-20 29
1- https://www.nejm.org/doi/full/10.1056/NEJMoa1603702
30. More to mention..
• DERMATOFIBROSARCOMA PROTUBERANS
• 1 in 4 million
• Locally aggressive – low grade
• MMS, chemotherapy, RT
• ANGIOSARCOMA(malignant hemangioendothelioma, hemangiosarcoma, and lymphangiosarcoma)
• 0.1 per million
• violaceous to red, ill-defined patch commonly on the face or forehead
• mortality rate of 50% at 15 months after diagnosis
• MICROCYSTIC ADNEXAL CARCINOMA (sweat gland carcinoma)
• smooth-surfaced, nonulcerated, flesh-colored to yellowish asymptomatic nodule, papule, or
plaque
• surgically remove the tumor
• SEBACEOUS CARCINOMA
• Sebaceous glands
27-Feb-20 30
32. Cutaneous Melanoma
• Malignant transformation of the melanocyte
• >70% of the deaths attributable to skin cancer each year
• 5.2% of new cancer diagnoses
• Incidence is rising 3% per year
• Is the fifth most common U.S. cancer diagnosis
• 1/28 men and 1/44 women will be diagnosed with melanoma of the skin during
their lifetime
• 91.2% of melanomas are cutaneous, 5.3% ocular, 1.3% mucosal, and 2.2%
metastases from unknown primary site
• More in whites
• For women aged 25 to 35 years, melanoma is the leading cause of cancer-related
death
27-Feb-20 32
34. Molecular Biology of Cutaneous
Melanoma
• THE RAS-RAF-MAPK PATHWAY ( Driver Mutations)
• RAF Kinases
• BRAF mutations are detected in 40% to 45% of cutaneous
melanoma
• MEK
• constitutive signaling leading to oncogenic cell
proliferation and escape from apoptosis
27-Feb-20 34
35. Cellular Changes in Melanocyte to
Melanoma Progression
Early cutaneous melanomas usually proceed
to grow radially, and this is called the radial
growth phase (RGP) of melanoma, which
may continue for years before progressing to
the vertical growth phase (VGP)
27-Feb-20 35
36. Melanoma ETIOLOGY AND RISK FACTORS
• Ultraviolet Light Exposure:
• Both UVA and UVB have immunosuppressive effects on the skin, which are implicated in melanoma induction, Thus, sun protection
should address both UVA and UVB rays
• Tanning bed (UVA)
• Physical Traits
• Blond or red hair
• Green or blue eyes
• Familial Predisposition
• Pregnancy and Estrogen Use
• Incidence of melanoma is higher in pregnant females
• They have a particularly bad outcome
27-Feb-20 36
37. Melanoma PREVENTION AND SCREENING
• Sun Protection
• clinical trial in Australia, March 1992 to August 1996 of 1,621 randomly
selected adults
• sun protection factor (SPF) 16 sunscreen every morning
• 10-year follow-up
• invasive melanoma decreased by 73% in the intervention
• Recommendations:
• The best protection from the sun is a building, the next best is protective
clothing, and the third best is sunscreen
• Avoiding midday sun from about 11 a.m. to 3 p.m.
27-Feb-20 37
38. Melanoma Screening for Early Diagnosis
• Self-examination
• decrease incidence and mortality
• It is more common for women to detect melanomas, for themselves or for
their partners
• ½ of melanomas are identified by the patient or family
• Patients with melanoma or at high risk should be seen regularly by a
dermatologist
27-Feb-20 38
39. DIAGNOSIS OF PRIMARY MELANOMA
• Characteristics
• ABCD :
• Asymmetry
• Border irregularity
• Color variation
• Diameter >6 mm
• High-risk patients low threshold for biopsy
• Symptoms:
• bleeding, itching, pain, and ulceration
• deep vertical growth and are hallmarks of a late diagnosis
27-Feb-20 39
40. DIAGNOSIS OF PRIMARY MELANOMA
• Biopsy:
• full-thickness biopsy of the entire lesion with 1-2 mm margins
• 35% of U.S. dermatologists favour shave biopsy, 12% favor scoop or
saucerization biopsy, and 11% favour punch biopsy
• with only 31% favouring the recommended excisional biopsy
27-Feb-20 40
41. Melanoma Subtypes: Histologic Growth
Patterns
• Superficial Spreading Melanoma
• 70% of primary cutaneous melanomas
• trunk and extremities
• associated with sun exposure
• Nodular Melanoma
• may be nonpigmented
• commonly are diagnosed when relatively thick
• carry the worst prognosis
• 20% of cutaneous melanomas
• Acral Lentiginous Melanoma
• <5% of melanomas
• acral sites (subungual, palmar, plantar)
• mucosal surfaces (anorectal, nasopharyngeal, female genital tract)
• independent of UV light exposure
27-Feb-20 41
• Lentigo Maligna Melanoma
• older individuals
• chronically sun-damaged skin – face
• 10% to 20% of melanomas
42. Prognostic Factors for Primary Melanomas
• Depth of Invasion
• Breslow thickness:
• T1 lesions are ≤1 mm thick
• T2 lesions are 1.1 to 2 mm thick
• T3 lesions are 2.1 to 4 mm thick
• T4 lesions are >4 mm thick
• Clark level : not used anymore
• Ulceration
• important negative prognostic feature
• T1a, T2a, T3a, and T4a melanomas are nonulcerated
• T1b, T2b, T3b, and T4b melanomas are ulcerated
• An ulcerated lesion is comparable to that of a nonulcerated lesion one T level higher
(e.g., T2b and T3a are both stage IIA)
27-Feb-20 42
43. Prognostic Factors for Primary Melanoma
• Patient Sex :
• prognosis is better for women than men
• Sex and Location:
• Women more on the extremities
• men more on the trunk and head and neck
• Location:
• clinical outcome for patients with melanomas on extremities is better than
that for patients with truncal or head and neck melanomas
• Mucosal melanoma is the worst location
27-Feb-20 43
44. Prognostic Factors for Primary Melanoma
• Patient Age
• Mortality risk increases with age
• Growth Pattern
• Nodular melanomas have the worst prognosis
• Lesser risk with superficial spreading melanoma
• Mitotic Rate
• Six or more mitoses per square millimetre worse prognosis
• 10-year survivals of 97%, 96%, 91%, 86%, and 77% for 0, 1, 2 to 3, 4 to 10, and
≥11 mitoses per
27-Feb-20 44
49. Melanoma In Situ (Clinical TISN0M0, Stage 0)
• Wide excision alone - curable in the vast majority of cases
• Margin of 5 to 10 mm
• No need to perform radiologic staging studies
• Follow up annually
27-Feb-20 49
50. Thin Primary Melanoma (Clinical T1A – T3A)
• <0.8 mm thick
• Excision with a appropriate margin (usually 1 to 2 cm) (including skin
and all underlying subcutaneous tissue to the deep muscle fascia)
• risk of metastasis for thin melanomas is in the 5% to 10% range
• Follow-up:
• Annually for many years
27-Feb-20 50
51. REGIONALLY METASTATIC MELANOMA (STAGE III):
LYMPH NODE METASTASIS, SATELLITE LESIONS,
AND IN-TRANSIT METASTASES
• Regional metastases are defined:
• Local recurrence is best defined as recurrence of melanoma in the scar from
the original excision or at the edge of the skin graft if that was used for
closure.
• Satellites metastases may occur either simultaneously with the original
diagnosis or arise subsequent to original excision. Typically, recurrences that
are separate from the scar but within 2 to 5 cm of it are considered satellite
metastases (Fig. 92.10).
• Regional recurrences beyond 5 cm of the scar but proximal to regional nodes
are considered in-transit metastases (Fig. 92.11).
• Regional node metastases are typically in a draining nodal basin that is near
the lesion
27-Feb-20 51
53. • mortality in the range of 50% over 5 to 10 years – old data
• Initial workup:
• History and physical examination
• Serum LDH
• more aggressive: radiologic imaging as indicated by signs and symptoms
• Consider: CT scans of the chest, abdomen, and pelvis plus MRI of the head
• Wide excision with at least a 2-cm margin
• SNBx node negative:
• Chance of sentinel node positivity approximately 35% to 40% in STAGE II
• Palpable Metastatic Melanoma in Regional Nodes:
• Axillary Dissection
• Inguinal and Iliac Dissection
• Cervical Dissection + adjuvant RT
27-Feb-20 53
54. STAGE III Adjuvant treatment -
Immunotherapy
• High-Dose Interferon-α2B
• Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4) Blockade
• Ipilimumab (fully human immunoglobulin G1 monoclonal antibody
that blocks CTLA-4)
• improved OS in the treatment of metastatic melanoma in two randomized
clinical trials
• EORTC 18071 trail : ipilimumab vs placebo
• OS rate at 5 years was 65.4% in the ipilimumab group compared with 54.4% in
the placebo group (HR for death, 0.72; 95.1% CI, 0.58 to 0.88; P = .001)
27-Feb-20 54
55. STAGE III Adjuvant treatment -
Immunotherapy
• PD-1 Blockade In Adjuvant Therapy
• Checkmate-238 was a randomized, double-blind, phase III trial
• nivolumab VS ipilimumab
• RFS 70.5% in the nivolumab group and 60.8% in the ipilimumab group
• ONGOING:
• S1404 : HDI VS EPI NIVU
• Keynote-054: pembrolizumab VS placebo
27-Feb-20 55
56. STAGE III Adjuvant treatment - MAB
• COMBI-AD -Adjuvant Dabrafenib plus
trametinib for Resected Stage III BRAf V600–
Mutant melanoma
• Axel Hauschild et al, NEJM sep.2017,
• PRESENTED AT ESMO 2017-MADRID
• In phase 3 trials (COMBI-d and COMBI-v),
treatment with the BRAF inhibitor dabrafenib
plus the MEK inhibitor trametinib improved
survival in patients with unresectable or
metastatic BRAF V600E/K–mutant melanoma
27-Feb-20 56
pERK
Proliferation, Survival, Invasion, Metastasis
RAS
MEK
mutBRAF Dabrafenib
MAPK Pathway
Trametinib
57. Relapse-free survival
(primary endpoint)
27-Feb-20 Salman 57
438 413 405 392 382 373 355 336 325 299 282 276 263 257 233 202 194 147 116 110 66 52 42 19 7 2 0
432 387 322 280 263 243 219 203 198 185 178 175 168 166 158 141 138 106 87 86 50 33 30 9 3 0 0
Months From Randomization
Dabrafenib plus trametinib
Placebo
No. at Risk
0
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52
ProportionAliveandRelapseFree
1 y, 88%
2 y, 67%
3 y, 58%
1 y, 56%
2 y, 44%
3 y, 39%
NR, not reached.
Group
Events,
n (%)
Median
(95% CI), mo
HR
(95% CI)
Dabrafenib
plus
trametinib
166 (38)
NR
(44.5-NR) 0.47
(0.39-0.58);
P < .001
Placebo 248 (57)
16.6
(12.7-22.1)
P = .0000000000000153
58. Overall survival - (first interim analysis)
27-Feb-20 Salman 58
438 426 416 414 408 401 395 387 381 376 370 366 362 352 328 301 291 233 180 164 105 82 67 28 12 5 0
432 425 415 410 401 386 378 362 346 337 328 323 308 303 284 269 252 202 164 152 94 64 51 17 7 1 0
0
0
0
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54
ProportionAlive 1 y, 97%
2 y, 91%
3 y, 86%
1 y, 94%
2 y, 83%
3 y, 77%
a Prespecified significance boundary (P = .000019).
Months From Randomization
Group
Events,
n (%)
Median
(95% CI), mo
HR
(95% CI)
Dabrafenib
plus
trametinib
60 (14)
NR
(NR-NR) 0.57
(0.42-0.79);
P = .0006a
Placebo 93 (22)
NR
(NR-NR)
Dabrafenib plus trametinib
Placebo
No. at Risk
61. STAGE III MELANOMA Clinical Follow-up
• No studies have shown a clear benefit in terms of survival with closer
follow-up
• decreases psychological stress
27-Feb-20 61
63. STAGE IV MELANOMA
• Any patient with distant metastases is considered stage IV
• skin and subcutaneous tissue metastases M1a (better prognosis) - median
survival of 15months
• Lung metastases M1b - median survival of 12 months
• Other distant metastases M1c (poor prognosis) - survival of 6 to 9 months
• Timing of Distant Metastases:
• initially with stage IV disease is uncommon
• Often, within 2 to 3 years of diagnosis
• Can accrue after disease-free intervals of decades
• Patterns of Metastases:
• 60% to 80% of first metastases are at local or regional sites
• Most common first sites of visceral metastasis are lung and liver (about 10% each)
27-Feb-20 63
64. Clinical Evaluation of Melanoma (Stage IV)
• MRI scan of the brain
• total-body PET/CT scan (not in uveal melanoma)
• Bone scan, soft tissue MRI, ultrasound, or plain films may be
indicated to evaluate known areas of metastasis
27-Feb-20 64
65. Histologic or Cytologic Diagnosis
• Biopsy is better than FNA
• Immunohistochemical stains: S100, HMB45, tyrosinase, and MART-
1/MelanA
• Testing for BRAF:
• It is best to test a metastatic lesion
27-Feb-20 65
66. Surgery for Distant Metastases (Stage IV)
• Cases in Which the Benefit of Surgery Is Clear:
• Anemia due to occult bleeding from intestinal metastasis
• Bowel obstruction due to small bowel metastasis
• Cutaneous or subcutaneous metastasis with ulceration, pain, or impending ulceration
• Lymph node metastasis with neurologic symptoms
• Symptomatic brain metastasis
• Life-threatening hemorrhage from metastasis
• Cases in Which the Benefit of Surgery Is Likely, Especially if Patients Have
Progressed on Available Systemic Therapy:
• Solitary asymptomatic visceral metastasis resectable with minimal morbidity
• Bony metastasis with pain or joint involvement, unresponsive to radiation
• Solitary brain metastasis without symptoms
• Large, asymptomatic nodal metastasis with concurrent low-volume systemic disease
• Extensive skin and soft tissue metastases in the absence of visceral metastases
• Isolated growing metastasis in the setting of stable or regressing metastases after therapy
27-Feb-20 66