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SKIN TUMOURS DR IMRANA ZULFIKAR ASSITANT PROFESSOR SURGERY.

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Presentation on theme: "SKIN TUMOURS DR IMRANA ZULFIKAR ASSITANT PROFESSOR SURGERY."— Presentation transcript:

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 ACTINIC SOLAR KREATOSIS 20% S CC CUTANEOUS HORN10”% SCC KERATOACHANTHOM A SCC BOWENS DISEASE3-11% SCC EXTRA MAMMARY PAGETS GIANT CONGENITAL PIMEMENTD NAEVUS 25% SCC 3-5% MM

26 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 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

27 BASAL CELL CARCINOMA

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

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

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

31 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

32 SQUAMOUS CELL CARCINOMA

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

34 MANAGEMENT DEFINTE TREATMENT SURGICAL LOUPE EXCISION(4MM CLEARANCE MARGIN IF 2CM LESIONS ) IN TRANSIT METSTASIS LYMPHATIC METSTASIS

35 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

36 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

37 Clinical types- MM Superficial spreading melanoma Lentigo maligna melanoma Acral lentiginous melanomaNodular melanoma

38 MALIGNANT MELANOMA

39 ABCD of Melanoma A symmetry B order irregularity C olor variegation D iameter >6mm

40 BRESLOWS THICKNESS GRADE AJC STAGING

41 Prognostic features- MM Good prognosis –Breslow < 1mm Intermediate prognosis –Breslow 1-4mm Bad prognosis –Breslow >4mm

42 Good prognosis –Breslow < 1mm Intermediate prognosis –Breslow 1-4mm Bad prognosis –Breslow >4mm

43 MANAGEMENT HISTORY /CLINICAL EXMINATION SKIN BIOPSY SENTINEL LYMPH NODE BIOPSY LOCAL TREAMENT REGIONAL LYMPH NODES

44 PROGNOSIS TUMOUR THICKNESS LYMPH NODES DISTANT METSTASIS

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


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