Presentation on theme: "DERMAL AND SUB DERMAL LESIONS"— Presentation transcript:
1DERMAL AND SUB DERMAL LESIONS Dr M Kanagavel DNB Surgery MRCS EdinFaculty and ConsultantDepartment of General, GI and Minimal Access Surgery(Accredited by The National Board of Examinations)St Isabel HospitalChennai –
2This Presentation: Overview of Dermal and Subdermal Lesions Define the LesionTypes:Benign Nodular LesionsPapules and PlaquesPigmented LesionsSubepidermal LesionsBenign DermatosesMalignant LesionsSurgical Treatment and BiopsySurveillance and Follow-up
4Gross morphologic terms Blister - Nonspecific term for fluid-filled lesion (see vesicle or bulla)Bulla - Fluid-filled lesion >5 mm in greatest dimensionErosion* - Loss of epidermisExcoriation - Lesion of traumatic nature with epidermal loss in a generally linear shapeLichenification * - Grossly thickened, leathery, hyperpigmented skin with hyperkeratosis and deep,
5Gross morphologic terms Macule - Flat circumscribed area demarcated by color from surrounding tissueNodule - Solid raised discrete lesion >5 mm in both diameter and depthOnycholysis – Separation of the nail from the nailbedPapule - Solid raised discrete lesion ≤5 mmPedunculated - Attached to its base by a stalk-like structurePlaque - Flat but elevated area, usually >5 mm
6Gross morphologic terms Pustule - Small pus-filled elevated area of the skin with discrete bordersUlceration* - Loss of epidermis with partial-to-complete loss of dermisSeborrheic - Related to excessive secretion of sebumSebum - Thick, greasy substance secreted by sebaceous glands that consists of fat and cellular debrisSessile - Attached directly to the skin by a broad base; not pedunculatedVesicle - Fluid-filled lesion ≤5 mm
8Histologic definitions Acantholysis - Dissolution of intercellular integrity with fragmentation of epidermisAcanthosis - Hyperplasia of epidermal layerDyskeratosis - Abnormal keratinization occurring prematurely in cells below the stratum granulosumErosion* - Loss of epidermisExocytosis - Infiltration of epidermis by inflammatory cells
9Histologic Definitions Hyperkeratosis (keratosis) - Thickening of the stratum corneum (the outermost layer of the epidermis) with excess abnormal keratinLichenification * - Hyperplasia of all compartments of the epidermis with acantholysis and papillomatosis
10Histologic Definitions Papillomatosis - Hyperplasia of the papillary dermis and lengthening and/or widening of the dermal papillaeParakeratosis - Persistence of the nuclei within the cells of the stratum corneum of the epidermis as seen in psoriasisSpongiosis - Edema limited to the epidermisUlceration* - Loss of epidermis with variable partial-to-complete loss of dermis
11DefinitionsAcral - Related to the extremities and the more distal parts of the bodyActinic – Relating to biochemical changes in the skin produced by sunlight energy from both the visible and ultraviolet rays
12History Duration Mode of Onset Associated Symptoms Pain Progression NatureSiteTime of OnsetProgressionExact Site
13History Systemic Symptoms Presence of Other lumps Secondary Changes Impairment of FunctionRecurrenceBody WeightPersonal Hsitory
14Physical Characteristics Characteristics outside of the lesionPhysical characteristics of the lesionHistologic characteristics of the lesion
15Physical Examination - Inspection SiteSizeShape and ExtentSurfaceEdgeNumberPulsationPeristalsisSurrounding Structures
16Examination - Palpation Signs of InflammationSiteSizeShape and ExtentSurfaceEdgeConsistencyNumberPulsation / fluctuationFluid ThrillTranslucencyCough ImpulseReducibilityCompressibilityFixity to Overlying SkinRelation to Surrounding StructuresPressure EffectExamination of nearby joints
20Acrochordon Soft, common, benign, usually pedunculated neoplasm It is usually skin colored or hyperpigmented,surface nodules or papillomas2-5 mm in diameter, although larger measure up to 5 cmNeck and the axillae, but any skin fold, including the groin, may be affected.
21KeratoacanthomaThey are hemispheric shaped with a keratin-filled crater and overhanging edges
22Pyogenic Granulomais a rapidly proliferating solitary lesion of mostly disorganized vascular growth known for its bleeding tendencies.Also known as a cutaneous ectasia,it is commonly associated with minor previous trauma to the area
23Sebaceous Horn – Cornu cutaneum is a skin lesion made of compacted keratin that forms an exophytic conical projectionActinic keratoses, Seborrheic keratoses, benign verrucae, inverted follicular keratoses, and sqaumous cell carcinoma
24Keloidfibrotic, papular lesions that usually occur as an aberrant healing response to cutaneous injuries, such as acne, trauma, surgery, and piercingearlobes, chest, lower legs, upper back, and jaw line.unlike hypertrophic scars, grow beyond the borders of the original scar.pruritus, pain, and, occasionally, a burning sensation.
25Seborrhiec keratosisgreasy appearance and prevalence in regions of the body with a high concentration of sebaceous glands (ie, face, shoulder, chest, back).
43Bowen’s Disease Velvetty, flat lesions Clear margin Premalignant Ca in situ
44Vascular Lesions Hemangiomas, Kaposiform hemangioendothelioma (KHE), Tufted angiomas (TA),Pyogenic granulomas,Hemangiopericytomas, and other rare lesions.
45Vascular Tumor/Infantile HemangiomaVascular Malformations Proliferative30% visible at birth70% become apparent during first few weeks of lifeFemale to male ratio 3:1Rapid postnatal growth followed by slow involutionEndothelial cell proliferationIncreased mast cellsNo coagulation abnormalitiesHigh percentage respond dramatically to corticosteroid treatment in 2 to 3 weeksImmunopositive for biologic markers (including GLUT1)
47Vascular Malformations Congenital malformations of capillaries, veins, lymphatic vessels, or arteries.They may also exist as a combination of different types of vessels (eg, the arteriovenous malformation).
48Classification These malformations may further be High-flow Low-flow lesions based on the vessel type.
49Lymphatic Classification The lymphatic lesions may be further divided into macrocystic and microcystic based on the size of the cystic components within the lesion.
50Vascular Malformations Vascular malformations are congenital, meaning that they are present at birth.Most are diagnosed during infancy, although some are noticed later in childhood.In the case of a lymphatic malformation that presents after viral upper respiratory infection.
51Vascular Malformation Congenital abnormality with proportional growthNo gender predilectionMay expand secondary to sepsis, trauma, or hormonal changesNormal endothelial cell turnoverNormal mast cell countDo not involuteLocalized consumptive coagulopathy possibleLow-flow: phleboliths, ectatic channelsHigh-flow: enlarged, tortuous vessels with arteriovenous shuntingNo response to corticosteroids or antiangiogenic agentsImmunonegative for hemangioma biologic markers
52Venous MalformationsComposed of ectatic, poorly organized venous channels that have normal endothelium and lack the normal smooth muscle architecture that usually surrounds veins.Malformations are low-flow lesions.
53Lymphatic Malformations Present at birth and lined by nonproliferating endothelium.They may occur anywhere in the body, although the head and neck region is most commonly affected.Lymphatic malformations are low-flow lesions and may exist as combinations of lymphatic and venous vessels, in which case they are termed venous-lymphatic malformations
54Arteriovenous malformations Arteriovenous malformations (AVMs) are high-flow lesions that allow shunting of blood from the arterial system directly into the venous system.It is thought that they are residual from failure of primitive vascular communications to obliterate.In addition, these lesions share the ability with other vascular malformations to expand rapidly with infection, trauma, or hormonal disturbance.
55Investigations General Specific FNA Exfoliative Cytology Skin Testing UltrasoundCTBiopsyDrill / PunchIncisionalExcisionalPunch