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Skin Tumours- Squamous Cell Carcinoma Presentation
The document outlines various types of skin tumors, including benign and malignant forms such as squamous cell carcinoma (SCC) and its risk factors, etiology, and characteristics. It discusses the prognosis based on depth, size, histological grade, and other factors influencing metastasis and treatment options including surgical excision, radiation therapy, and chemotherapy. Additionally, it highlights the importance of Moh's microsurgery for critical cosmetic sites and poorly differentiated tumors.
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Skin Tumours- Squamous Cell Carcinoma Presentation
- 1. Dr. M. Anusha.,M.S Assistant Professor Deptof General Surgery
- 2. BENIGN- Papilloma, SeborrhiecKeratosis MALIGNANT- Squamous Cell Carcinoma Basal Cell Carcinoma EPIDERMAL SKIN TUMOURS BENIGN - Naevi MALIGNANT- Malignant Melanoma MELANOCYTE S BENIGN- Syringoma, Hidradenoma, Trichifolliculoma, Trichilemmoma, Adenoma Sebaceum. MALIGNANT- Hidradenocarcinoma, Sebaceous Carcinoma. SKIN ADNEXA Neurofibroma Dermatofibroma Dermatofibroma protuberans DERMAL TUMOURS
- 3. • Cumulative SunExposure and Damage • Exposure to UV-B rays • Fair skinned individuals • Males more commonly affected. • Tobacco Use. • Infection with Human Papiloma Virus strains 5 and 6. • Chronic Inflammation -- Chronic sinus tracts, Osteomyelitis, Pre- Existing Scars, Burns • Immunosuppression. • Chemical Carcinogens - Arsenic, Dyes. RISK FACTORS PRE MALIGNANT CONDITIONS • Bowen's disease • Paget's disease(Extra Mammary) • Leukoplakia • Chronic scars • Chemically induced chronic irritation • Radiodermatitis • Senile/ Actinic Keratosis, E.g: Kangri cancer in Kashmir Chimney scrotal cancer Kang cancer of Tibetans. SQUAMOUS CELL CARCINOMA • SCC is a malignant tumour of keratinising cells of the epidermis or its appendages. • It arises from the stratum basalis of the epidermis and expresses cytokeratins 1 and 10. (Immunohistochemistry) ETIOLOGY
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- 12. • The appearanceof SCC may vary from smooth nodular, verrucous, papillomatous to ulcerating lesions. All ulcerate eventually, as they grow. • The ulcers have a characteristic everted edge and are surrounded by inflammed, indurated skin. • Bloody Discharge can be present GROSS MORPHOLOGY everted edges inflammed indurated skin
- 13. HISTOPATHOLOGY Numerous large areasof keratinization Polygonal cells arranged in orderly lobules Highly anaplastic cells that exhibit only abortive, single-cell keratinization (dyskeratosis).
- 14. Grade I: Welldifferentiated: 75% or more keratin pearls Grade II: Moderately differentiated: 50- 75% keratin pearls Grade Ill: Poorly differentiated: 25-50% keratin pearls Grade IV: Undifferentiated/anaplastic: <25% keratin pearls. BRODER’S GRADING PROGNOSTIC FACTORS • Depth: the deeper the lesion, the worse the prognosis.For SCC <2 mm, Metastasis is highly unlikely. • Surface size: lesions >2 cm have a worse prognosis than smaller ones. • Histological grade: the higher the Broder’s grade, the worse the prognosis. • Microscopic invasion of lympho-vascular spaces or nerve tissue carries a high risk of metastatic disease. • Site: SCCs on the lips and ears have higher local recurrence rates than lesions elsewhere. • Aetiology: SCCs that arise in burn scars, osteomyelitis, skin sinuses, chronic ulcers and areas of skin that have been irradiated have a higher metastatic potential. • Immunosuppression: SCCs will invade further in those with impaired immune response.
- 15. • Regional lymphnodes are commonly involved, which are hard, nodular, initially mobile but eventually fixed to underlying structures. • Blood spread does not occur. • The overall rate of metastasis is 2% for SCC (usually to regional nodes) with a local recurrence rate of 20%. SPREAD DIFERENTIAL DIAGNOSIS • BCC • Melanoma • Keratoacanthoma • Skin adnexal tumours Actinic keratosis Pyogenic granuloma
- 16. • Marjolin's ulcerwhich occurs in chronic scar is a type of squamous cell carcinoma without lymph node spread. VARIANTS • Verrucous carcinoma is a squamous cell carcinoma, commonly occurring in mucous membrane or mucocutaneous junction without lymph node spread. It is dry, exophytic, warty, indurated growth. It has good prognosis. It is a curable malignancy.
- 17. INVESTIGATION S MANAGEMENT • Wedge Biopsyfrom the edge of the ulcer. • FNAC of the Lymph node • MRI of the affected part to know the extent of the lesion. • Cautery and Ablation, • Cryotherapy • Drug therapy including Imiquimod. • Moh’s microsurgery, and radiation therapy. • Surgical excision,
- 18. • Surgical excisionis the treatment of choice, when feasible. • For lesions less than 2 cm in diameter, wide excision with a 4-mm margin for low-grade lesions and a 6-mm margin for high-grade lesions is sufficient. • Factors rendering tumors high risk are size >2 cm in diameter and involvement of subcutaneous tissue. • Reconstruction is usually done by primary split skin grafting (SSG/Thiersch) . Delayed skin grafting also can be done once wound granulates well. • Amputation of joint one level above can be done depending on the extent. • For lymph nodes, block dissection of the regional lymph nodes is done. • Curative radiotherapy , as tumour is radiosensitive. A dose of 6000 cGy units over 6 weeks; 200 units/day is used. • In advanced cases with fixed lymph nodes, palliative external radiotherapy is given to palliate pain, fungation and bleeding. • Chemotherapy is given using methotrexate, vincristine, bleomycin, cisplatin, carboplatin. • Field therapy using cryo probe or topical fluorouracil or electrodessication.
- 19. Moh’s microsurgery (Microscopically OrientedHistographic Surgery) • Moh’s microsurgery is indicated for lesions at sites • where cosmesis or function preservation is critical, for poorly • differentiated tumors, for invasive lesions, and for verrucous • carcinomas. • is indicated for lesions • Sites where cosmesis or function preservation is critical. • For poorly differentiated tumors • For invasive lesions • For verrucous carcinomas.