1. Skin Tumors and Their Treatments: Arif Turkmen, MD.FRCS, FRCS(Plast), EBOPRAS, European Hand Diploma İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi Plastik, Rekonstrüktif ve Estetik Cerrahi Anabilim Dalı

2. epidermis dermis Bazal hücre tabakası deri altı yağ tabakası

3. deri ektoderm / mezoderm Epithelial Structures: epidermis Sebaceous galnds Apocrine glands Eccrine glandsi Hair Follicles Other structures: Langerhans cells Merkel Cells Vessels Lymphatic Fat Cells Mast Cells Neuroectoderm : Melanocyte, Nerve

4. BENING TUMORS; 1- Tumor originated form Skin Appendages 2- Cysts 3- Soft Tissue Tumor 4-Lesions comes from the Epidermis 5- Pigmented Lesions 1- DERİNİN SELİM TÜMÖRLERİ 2- DERİNİN HABİS TÜMÖRLERİ MALIGNANT TUMOURS: 1- BCC 2- SCC 3- M M 4-Others

5. 1- Originated form Skin Appendages Differentiation of Hair Follicles : Tripitelioma, Trikofolküloma, Trikolemmoma, Pilomatrisoma Differentiation of Sebaceous Glands: Sebase nevüs, Sebase Hiperplazi Sebase epiteliom Differentiation of Eccrine Silindroma, Syringoma, Ekrin Poroma,Ekrin Spiradenoma Differentiation of Apocrine glands Apokrin kistadenom 2- Cysts 3- Soft Tissue Tumor 4-Lesions comes from the Epidermis 5- Pigmented Lesions 1- DERİNİN SELİM TÜMÖRLERİ

6. 2-Cysts: Sebaceous Cysts Dermoid Cysts 3- Soft Tissue Tumor 4-Lesions comes from the Epidermis 5- Pigmented Lesions 1- DERİNİN SELİM TÜMÖRLERİ 1

7. 3- Soft Tissue Tumor Xantom Lipom Haemangiom Nörofibrom Leiomyom Tumor form connective tissue, fat tissue, vessels nerve and muscle.) 4-Lesions comes from the Epidermis 5- Pigmented Lesions Dermatofibrom Papillom 1- DERİNİN SELİM TÜMÖRLERİ

8. 4- Lesions originated from Epidermis: Seborrheic Keratosis Actinic Keratosis Bowen hastalığı 5- Pigmented lesions 1- DERİNİN SELİM TÜMÖRLERİ

9. 5- Pigmented Lesions : - Naevi (compount,, Junctional, dermal)) - Solar Lentigo 1- DERİNİN SELİM TÜMÖRLERİ

10. premalignant lesions 1- Keratosis Actinic KeratosisRadiation Keratosis Solar KeratosisSkin horn 3- Chemically inductive Keratosis 3- Epithelial tumors KeratoacanthomaTrycoepithelioma Fibro-epitheliomaSebaseous Nevus Cylindroma 4- Inheridet Conditions Xeroderma pigmentosum Epidermolisis Bullosa

11. 5- Trauma and Scars Chronic wounds Chronic Fistulas Unstable burn scarsLupus Vulgaris 6- Mucosal lesions Leukoplakia 7- Others Liken Planus premalignant lesions

12. Actinic keratosis (senile keratosis) must be distinguished from the seborrheic keratosis because it represents dysplastic epithelium and is a premalignant lesion. The actinic keratosis is found primarily on exposed surfaces as discrete, flat, or slightly elevated lesions with hard, dry adherent hyperkeratosis and underlying erythema. These lesions are often numerous in elderly people with weather-beaten skin

13. Keratoacanthoma It is a rapidly growing papule that enlarges to 1 cm to 2 cm within a period of several weeks The round, smooth, pink nodule encircles a massive keratinous plug. Histologically, the keratoacanthoma may be difficult to distinguish from a squamous cell carcinoma,

14. Xeroderma Pigmentosum Xeroderma pigmentosum is a relatively rare systemic disease Transmitted through an incomplete sex-linked recessive gene. The disease, which has its onset during early childhood, is characterized by extreme sensitivity to sunlight. Initially, diffuse lentigos are noted, with progressive drying and thinning of the skin.

15. Xeroderma Pigmentosum The primary deficiency is that of the enzyme endonuclease, which is needed to repair sunlight-damaged DNA. Malignant degeneration into is noted during early adult life, with death due to metastatic disease. Prolongation of life is possible by absolute protection from sun exposure and continual aggressive treatment of all developing tumors. The prognosis is dismal.

16. Malignant Tumours of The Skin Basal Cell Carsinoma(BCC) Squamous Cell Carsinoma (SCC) Malignant Melanoma (MM)

17. Basal Cell Carcinoma Basal cell carcinoma is the most common malignancy of whites, arising from cells of the basal layer of the epithelium or from the external root sheath of the hair follicle

18. SKIN CANCER : aetiology and stimulators exposure to ultraviolet radiation (UV) ionising radiation chemical carcinogens viral carcinogens Chronic wounds, fistulas and unstable burn scars repeated irritating microtraumas inherited conditions such as xeroderma pigmentosum premalignant lesion

19. Fitzpatrick Deri Tipleri Derinin fototip’i derinin içindeki melanin miktarına göre belirlenir

20. UVB Damages to DNA UVA causes wrinkles on the skin

21. Basal Cell Carcinoma most common above the line “tragus-comissura” It is directly related to sun exposure, the etiologic factor being UV radiation. Basal cell carcinomas occur most often at sites with the greatest concentration of pilosebaceous follicles. most often in white skined people Radiosensitive it almost never metastasises (if diameter less than 10 cm)

22. Signs of the Skin Cancer: The wound does not heal with in an appropriate time Bleeds The lesion grows slowly Change of the character of the lesion a lesion presented with Lymphadenopathy Tüm yaşamda deri kanseri riski 1/5 1980 yılından bu yana %65 artış

23. –Sun protective cream:

24. COMISSURA - TRAGUS LINE

25. Classification of BCC(ACKERMAN): A- LOCALIZED 1- Nodular 2- Nodulocystic 3-Pigmented B- SUPERFICIAL 1-Superficial spreading 2-Multifocal C-INFILTRATIVE 1- Mopheic

26. Diagnosis: History Etyoloji Premalign lezyolar Yaş / cinsiyet Lokalizasyon Biopsy Küretaj Yüzeyel tıraşlama Punch biyopsi Eksizyonel biyopsi

27. Deri kanserleri M.M. en sık rastlanan 8. kanser M.M.hayat boyunca rastlanma sıklığı 1/200 M.M. diğer kanserlere göre en hızlı artış gösteren BCC / SCCA : 4 / 1 Çocuklukta güneş ışını alımı, sık sık olması Çocuklukta b ül oluşturan güneş yanığı olması

28. Histopathologic confirmation is obtained with a biopsy Curettage Shave biopsy Punch biopsy Excisional biopsy

29. Basal Cell Carsinoma TREATMENT Cryotherapy Electrocoagulation Surgical excision ( 2 - 5 mm ) Radiotherapy Local chemotherapeutic drug Curettage Superficial shaving Laser

30. Squamous Cell Carcinoma Squamous cell carcinoma originating from the keratinizing or malpighian (spindle) cell layer of the epithelium, is seen primarily in older patients, mostly men

32. Squamous Cell Carcinoma most common below the line “tragus-comissura” the primary etiological factor is solar radiation. chronic ulcers including chronic lesions, burn wound, osteomyelitis, cytotoxic drugs, immunosuppressant drug treatment, a wide variety of dermatoses, discoid lupus erythematosus, and hidradenitis suppurativa play a significant role in the development of the relatively small number of these skin cancers. Seen most often in black skined people Radioresistance Five percent to 10% of squamous cancers metastasize

33. Tissue transplantation: –Risk of skin cancer is% 35 - 70 over 20 years –The risk of skin cancer: (SCC: 65-100 times higher than normal population BCC: 10 times higher MM: 4 times higher

34. Squamous Cell Carsinoma TREATMENT Surgical excision (1 cm) Radiotherapy

37. Last slide