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SKIN TUMOURS

SKIN TUMOURS. DR IMRANA ZULFIKAR ASSITANT PROFESSOR SURGERY. CLASSIFICATION OF SKIN TUMOURS. BENIGN TUMOURS MALIGNANT TUMOURS. BENIGN TUMOURS. BASAL CELL PAPILLOMAS PAPILLARY WART FRECKLE LENTIGO NAEVI/MOLES HALO NAVUS CAFÉ AU LAIT SPOTS. BASAL CELL PAPILLOMA

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SKIN TUMOURS

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  1. SKIN TUMOURS DR IMRANA ZULFIKAR ASSITANT PROFESSOR SURGERY

  2. CLASSIFICATION OF SKIN TUMOURS • BENIGN TUMOURS • MALIGNANT TUMOURS

  3. BENIGN TUMOURS • BASAL CELL PAPILLOMAS • PAPILLARY WART • FRECKLE • LENTIGO • NAEVI/MOLES • HALO NAVUS • CAFÉ AU LAIT SPOTS

  4. BASAL CELL PAPILLOMA SOFT WARTY LESIONS,PIGMENTED AND HYPERKERATOTIC IN BASAL LAYER PAPILLARY WART BENIGN SKIN TUMOURS HPV FRECKLE NORMAL NUMBER OF MELANOCYTES WITH INCREASE PRODUCTION

  5. LENTIGO • SHARPLY CIRCOMSCRIBED PIGMENTED MACULES • MAY AT TIMES ASSOCIATED WITH PEUTZ JEGHERS SYNDROME MOLES/NAEVUS • MOLES/NAEVUS ARE LAYERED OR AGGREGATES OF MELONICYTES IN EPIDERMIS

  6. BASAL CELL PAPILLOMAS

  7. PAPILLARY WART

  8. FRECKLE

  9. LENTIGO

  10. NAEVIMOLES

  11. HALO NAVUS

  12. CAFÉ AU LAIT SPOTS

  13. PREMALIGNANT LESIONS • ACTINIC KERTOSES • CUTANEOUS HORN • KERATOACANTHAOMA • BOWENS DISEASE • EXTRA MAMMARY PAGETS DISEASE • GIANT HAIRY NAEVUS • DYSPLASTIC NAEVUS

  14. ACTINIC KERATOSES • DYSKERATOSIS WITH CELLULAR ATYPIA • 20% SCC CUTANEOUS HORN • CUTANEOUS ACCUMULATION (HEIGHT GREATER THAN BASE) • 10% SCC • KERATOACANTHOMA • CUP SHAPED GROWTH PLUG OF KERATIN • M>F,50-70 YR ,ON FACE. • PAPPILLOMA VIRUS,SMOKING ,CHEMICAL CARCINOGENIC • SURGICAL EXCISION

  15. ACTINIC KERATOSES

  16. CUTANEOUS HORN

  17. KERATOACANTHOMA

  18. BOWENS DISEASE • SCC IN SITU • CHRONIC SOLAR DAMAGE,ARSENIC EXPOSURE ,HPV 16 • SLOW ENLARGINGERYTHMATOUS PATCH OR PLAGUE • TOPICAL THERAPY 5 –FLUOROURACIL • SURGICAL EXCISION 4MM • MOHS MICROSCOPIC SURGERY EXTRAMMARY PAGETS DISEASE • INTRA DERMAL ADENOCARCINOMA • GENITAL OR PERIANAL REGIONSOR AXILLA • SURGICAL EXCISION

  19. BOWENS DISEASE

  20. EXTRAMMARY PAGETS DISEASE

  21. GIANT CONGINATAL PIGMENTED NAEVUS GCPNSPRECURSORS FOR MM MORE LIKELY WITH AXIAL LESIONS RETROPERITONEAL OR INTRACRANIAL LESIONS MULTIDICSIPILANARY MANAGEMENT PERINATAL CURETTAGE,DERMAABRASION,LASER RESURFACING, SURGICAL EXCISION WITH SKIN GRAFTS DYSPLASTIC NAEVUS IRREGULAR PROLIFERATIONS ATYPICAL MELANOCYTES AT BASAL LAYER OF EPIDERMIS

  22. GIANT CONGINATAL PIGMENTED NAEVUS

  23. DYSPLASTIC NAEVUS

  24. MALIGNANT LESION • BASAL CELL CARCINOMA • SUAMOUS CELL CARCINOMA • MALIGNANT MELANOMA

  25. BASAL CELL CARCINOMA EPIDEMIOLOGY • SLOW GROWING LOCALLY INVASIVE MALIGNANT TUMOUR • PLURIPOTENT EPITHELIAL CELLS • UVR IS STRONGEST PREDISPOSING FACTOR • OTHERS MAY BEARSENICAL COMPOUNDS,COAL TAR,AROMATIC HYDROCARBONS • 90%LESION ON FACE ABOVE ALINE FROM THE LOBE OF THE EAR TO THE CORNER OF MOUTH • WHITE SKIN 40-80 YRS M>F PATHOGENESIS • SLOW GROWING PROPOTIANTE TO DOSE OF CARCINOGEN • RARLY METASTISE • HARD TO CULTURE MACROSCOPIC APPEARANCE • NODULAR • NODULOCYSTIC • CYSTIC MICROSCOPIOC APPEAREANCE • OVOID CELLS IN NEST WITH SINGLE OUTER PALISADING LAYER

  26. BASAL CELL CARCINOMA

  27. Nodular BCC Chronic lesion Easy bleeding Pearly border Surface telangiectasias Head and neck, trunk, and extremities

  28. PROGNOSIS HIGH RISK GROUPS • >2CM • NEAR EAR NOSE OR EYE • ILL DEFIND MARGINS • RECURRENT TUMOURS • IMMUNOCOMPROMISED

  29. MANAGEMENT SURGICAL EXCISION MOHS MICROSCOPIC SURGERY NON SURGICAL RADIOTHERAPY TOPICAL 5-FLUROURASIL

  30. SQUAMOUS CELL CARCINOMA EPIDEMIOLOGY MALIGNANT TUMOUR OF KERATINISING CELLS OF EPIDERMIS OR ITS APPENDAGES SECOND MOST COMMON TUMOUR WHITE SKIN ELDERLY MEN WITH CUMULATIVE SUN EXPOSURE ALSO ASSOCIATED CHRONIC INFLAMMATION(SINUS TRACTS , PREEXISTING SCARS ,OSTEOMYLETIS,BURNS,IMMUNOSUPPRESION,MARJOLINS )2% METASTASIS 20% RECURRENCE MACROSCOPIC • EVERTED EDGES WITH INFLAMMED SKIN • SMOOTH NODULAR,VERROCOUS • PAPILLOMATOUS • ULCERATING MICROSCOPIC • IRREGULAR MASSES OF SQUAMOUS EPITHELIUM • CELLULAR MORPHOLOGY,BRODERS GRADE ,DEPTH OF INVASIONPERINEURAL OR VASCULAR INVASION

  31. SQUAMOUS CELL CARCINOMA

  32. PROGNOSIS INVASION>6CM HISTOLOGICAL GRADE HIGHER THE BRODER GRADE SITE LIPS AND EARS HAVE HIGH LEVEL OF RECURRENCE AEITOLOGY IMMUNOSUPPRESION

  33. MANAGEMENT • DEFINTE TREATMENT SURGICAL LOUPE EXCISION(4MM CLEARANCE MARGIN IF <2 AND 1CM MARGIN >2CM LESIONS ) • IN TRANSIT METSTASIS • LYMPHATIC METSTASIS

  34. MALIGNANT MALENOMA • EPIDEMIOLOGY • MM IS CANCER MELNOCYTES • MM ACCOUNTS FOR 5% OF SKIN MALIGNANCY • INCREASES UVR EXPOSURE • 3%OF ALL MALIGNANCYS • 75% OF ALL DEATHS • 7%OCCULT METASTASIS

  35. RISK FACTORS: • XERODERMAPIGMENTOSUM • PAST MEDICAL OR FAMILY HISTORY • HIGH NUMBER OF NAEVI • TENDENCY TO FRECKLE • GCPN • DYSPLASTIC NAEVUS • IMMUNOCOMPROMISED MACROSCOPIC APPEANRANCE • SUPERFICIAL SPREADING MELANOMA75% • NODULAR MELANOMA 15% • LENTIGO MALIGNA MELANOMA5-10% • ACRAL LENTIGIOUS MELANOMA2-8% FEATURES IN NAEVI SUGGESTING MM • CHANGE IN SIZE ,SHAPE COLOUR ,ITCHING,SATELLITE LESIONS • BLOOD SUPPLY

  36. Clinical types- MM Superficial spreading melanoma Lentigo maligna melanoma Acral lentiginous melanoma Nodular melanoma

  37. MALIGNANT MELANOMA

  38. ABCD of Melanoma Asymmetry Border irregularity Color variegation Diameter >6mm

  39. BRESLOWS THICKNESS GRADE • AJC STAGING

  40. Prognostic features- MM Good prognosis Breslow < 1mm Intermediate prognosis Breslow 1-4mm Bad prognosis Breslow >4mm

  41. Good prognosis • Breslow < 1mm • Intermediate prognosis • Breslow 1-4mm • Bad prognosis • Breslow >4mm

  42. MANAGEMENT • HISTORY /CLINICAL EXMINATION • SKIN BIOPSY • SENTINEL LYMPH NODE BIOPSY • LOCAL TREAMENT • REGIONAL LYMPH NODES

  43. PROGNOSIS • TUMOUR THICKNESS • LYMPH NODES • DISTANT METSTASIS

  44. VASCULAR LESIONS • CONGENITAL: HEAMANGIOMAS VASCULAR MALFORMATIONS • ACCUIRED: SIDER NAEVI CAMPBELL DE MORGAN SPOTS PYOGENIC GRANULOMAS ANGISARCOMAS KAPOSIS SARCOMA

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