1. BENIGN TUMORS OF THE SKIN AND SUBCUTANEOUS TISSUE

2. Cysts( Epidermal Dermoid, Trichilemmal)
Cutaneous cysts are categorized as either epidermal, dermoid, or trichilemmal. Eepidermal cysts are the most common type of cutaneous cyst, and may present as a single, firm nodule any'where on the body. Dermoid cysts are congenital lesions that result when epithelium is trapped during fetal midline closure. eyebrow is the most frequent site of presentation, dermoid cysts are common anywhere from the nasal tip to the forehead

3. Epidermal cyst
Epidermal cyst

4. Dermoid cyst
Dermoid cyst

5. Dermoid cyst
Dermoid cyst

6. Terichilemmal (pilar) cysts,the second most common cutaneous cyst, occur more often on the scalp of females.

7. Pilar cyst
Pilar cyst

8. Keratoses(Seborrheic;Solar)
Seborrheic keratoses arise in sun-exposed
areas of the body such as the face,forearms,and back of the
hands.
Histologically, these lesions
contain atypical-appearing keratinocytes and evidence of
Dermal solar damage.
Although malignancies that do develop, rarely
metastasize, lesion destruction is the treatment of choice.
Treatments often include application of topical 5-fluorouracil,
surgical excision,electrodesiccation ,and dermabrasion.

9. Keratosis seb.
Kertatosis seb.

10. Keratosis seb.
Keratosis seb.

11. Nevi( Acquired and Congenital)
Junctional
Compound
Dermal

12. Simple nevi
Simple nevi

13. Simple nevi
Simple nevi

14. Congenital
Nevi are relatively rare, and may be'found in less than 1% of neonates.
Lesions are larger and often contain hair.
Histologically, congenital and acquired nevi appear similar.
Giant congenital lesions (giant hairy nevi) most often occur in a trunk
distribution, chest, or back .
Not only are these lesions cosmetically unpleasant, but congenital nevi may
develop into malignant melanoma in 1 to 5%o of cases‘
Total excision is the treatment of choice; however, the lesion
is often so large that inadequate tissue for wound closure precludes
complete resection.
Instead, serial excisions with local tissue expansionl advancement
are frequently required over several years‘.

15. Congenital
congenital

16. congenital
congenital

17. Vascular Tumors of the Skin and Subcutaneou Tissue
Hemangiomas are benign vascular neoplasms that present soon after birth . They initially undergo rapid cellular proliferation over the first year of life, then undergo slow Involution throughout childhood. Histologically, hemangiomas are composed of mitotically active endothelial cells surroundings several‘ confluent blood-filied space.

18. hemangioma
hemangioma

19. hemangioma
hemangioma

20. In the first year of life, approximately 90o/o involute over time
In the first year of life, approximately 90o/o involute over time. Acute treatment is limited to hemangioma that interfere with function, such as airway, vision, And feeding. In addition, lesions resulting in systemic problems, such As thrombo_ cytopenia or high-output cardiac failure, should prompt resection. The growth of rapidly enlarging lesions also can be halted with systemic prednisone or interferon alpha-2a treatment use.

21. In the absence of acute surgical indications or significant patient/ parent concern,many lesions are allowed to spontaneously in volute. However, hemangiomata that remain into adolescence o r involute to leave an unsightly telangiectasia typically require surgical excision for optimal resolution. In contrast to neoplasms vascular malformations are a result of Structural abnormalities formed during fetal development. like hemangiomas, vascular malformations grow in proportion to the body and never involute. Histologically, they contain enlarged Vascular spaces lined by nonproliferating endothelium.

22. Complication of A.V.M Such as pain, hemorrhage, ulceration,cardiac effects Or local tissue destruction, should prompt attempts at lesion destruction. Therapy consistsn of surgical resection.Even when complete lesion resection is not possible, significant debulking may greatly diminish symptomatology. In addition, angiography With selective embolization just before surgery greatly facilitates operative removal.

23. The capillary malformation, or port-wine stain, is
aflat, dull-red
lesion often located on the trigeminal (cranial nerve V)
distribution
on the face,trunk, or extremities
presentation within the V1 or V2 facial
regionsshould prompt concern of a possible link
to more systemic syndromes such as Sturge-Weber
Syndrome (leptomeningeal angiomatosis ,epilepsy,and glaucoma)

24. Port vein
Port vein

25. Port vein
Port vein

26. Glomus tumor is an uncommon, benign neoplasm of the extremity.
Representing less than l.5 o/o of all benign, soft-tissue extremity
tumors, these lesions arise from dermal neuromyoarterial aPParatus
(glomus bodies)
Glomus tumor more commonly affects the hand, and presentation within the
subungual region of the toe is rare‘.
Diagnosis of these lesions is traditionally delayed, and atypical presentation
on the foot or toes often leads to even greater diagnostic
Challenges In addition to the severe pain, point tenderness and cold
sensitivity are associated with these lesions and subungual glomus
tumors typically appear as blue, subungual discolorations of 1 to 2 mm
mm.
Tumor excision is the treatment of choice.

27. Glu. tumor
Glu.tumor

28. MALIGNANT TU MORS OF THE SKIN
Although malignancies arising from cells of the dermis or adnexal structures are relatively uncommon, the skin is frequently subject to epidermal tumors, such as basal cell carcinoma (BCC), SCC, and melanoma.

29. to UV radiation is associated with an increased development of
Perhaps of greatest significance is that increased exposure
to UV radiation is associated with an increased development of
all skin cancer.Clinical studies reveal that persons with outdoor
occupations are at greater risk, as are those with fair complexions
and people living in regions receiving higher per capita sunlight' In
addition, albino individuals of dark-skinned races are Prone to
develop cutaneous neoplasms that are typically rare in nonalbino
membirs of the same group. This observation suggests that
Melanin and its ability to limit UV radiation tissue penetration.

30. Chronically irritated or nonhealing areas such as burn scars, sites of repeated bullous skin sloughing, and Decubitus ulcers present an elevated risk of developing SCC. Systemic immunologic dysfunction is also related to an increase in cutaneous malignancies‘ Immunosuppressed patients receiving chemotherapy, those with advanced HIV/AIDS, and immunosuppressed transplant recipients have an increased incidence of BCC, SCC, and melanoma.

31. Basal Cell Carcinoma BCC is the most common type of skin
cancer.Based on gross and histologic
morphology, BCC has been divided into several
subtypes:
nodular, superfitial spreading, micronodular,
infiltrative, pigmented, and morfeaform.

32. bcc
bcc

33. bcc
bcc

34. bcc
bcc

35. Treatment option Curettage,Electrodesication ,Laser therapy
(for less than 2mm tumors)
For large one 0.5 to 1 cm resection

36. Squamous Cell Carcinoma
SCCs arise from epidermal keratinocytes While less
Common than BCC, SCC is more devastating and
tendency to metastasize.
Before local invasion' in situ SCC lesions are termed
Bowen's disease.
In situ SCC tumors specific to the penis are referred
t o as erythroplasia of Queyrat‘.
Following tissue invasion, tumor thickness correlates
well with malignant behavior.

37. Developed in 1936, Mohs' technique uses serial excision in small increments coupled with immediate microscopic analysis to ensure tumor removal. One distinct advantage of Mohs' technique is that all specimen margins are evaluated. In contrast, traditional histologic examination surveys selected Portions on surgical margin.The major benefit of Mohs'techniquei s the ability to remove a tumor with minimal sacrifice of uninvolved tissue.A lthough this procedure is of particular value when managing tumors of the eyelid, nose, or cheek, one major drawback is procedure length. Recurrence and metastases rates are comparable to those of wide local excision

38. scc
scc

39. scc
scc

40. scc
scc

41. scc
scc

42. Malignant Melanoma
The pathogenesis of melanoma is complex and remains poorly understood to date. Melanoma may arise from transformed melanocytes where that these cells have migrated during normal Embryogenesis Although nevi (freckles) are benign melanocytic neoplasms found on the skin of many people,dysplastic nevi contain a histologically identifiable focus of atypical melanocytes. These lesions are thought to represent an intermediate stage between benign nevus and true malignant melanoma .

43. Dysplastic nev.
Dysplastic nev.

44. Up to l4% of malignant melanomas occur in a Familial pattern
Up to l4% of malignant melanomas occur in a Familial pattern. Once the melanocyte has transformed into the malignant phenotype, tumor growth occurs radially in the epidermal plane.even though microinvasion of the dermis may have occurred, metastases do not occur until these melanocytes form dermal nests.

45. Although the eye and anus are notable sites,over 90% of melanomas are found on the skin .In addition,4% of tumors are discovered as metastases without any identifiable primary site. Suspicious features suggestive of melanoma include any pigmented lesion with an irregular border, Darkening coloration,ulceration,and raised surface.

46. In order of decreasing frequency, the four types of melanoma are; superficial spreading, nodular, lentigo maligna, and acral lentiginous. The most common type,superficiasl preading accounts for up to 70o/o of melanomas. These lesions occur anywhere on the skin except the hands and feet. They are typically flat and measure I to 2 cm in diameter at diagnosis.

47. melanoma
melanoma

48. melanoma
melanoma

49. melanoma
melanoma

50. melanoma
melanoma

51. Staging system
clark
breslow

52. Regardless of tumor depth or extension‘ surgical excision is the management of choice. Lesions I mm or less in Thickness can be treated with a l-cm marqin. For lesions I mm to 4 mm thick, a 2-cm margin is recomended. Lesions of greater than 4 mm may be treated with 3-cm margins, The surrounding tissue should be removed down to the fascia to Remove all lymphatic channels. If the deep fascia is not involved by the tumor, removing it does not affect recurrence or survival rates, so the fascia is left intact.