skin and soft tissue tumors
DESCRIPTION
Skin and Soft Tissue Tumors. Dr. Jamaleldin Hassainan. Arise from any histological structures that make up skin. Epidermis Connective tissue Glands Muscle Nerves. CLASSIFICATION. Benign Premalignant Malignant. Common Benign Tumors. Heamangiomas : Involuting Non- involuting. - PowerPoint PPT PresentationTRANSCRIPT
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Skin and Soft Tissue Tumors
Dr. Jamaleldin Hassainan
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Arise from any histological structures that make up skinEpidermisConnective tissueGlandsMuscleNerves
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CLASSIFICATION
BenignPremalignantMalignant
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Common Benign Tumors
Heamangiomas :
InvolutingNon- involuting
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Involuting Heamangiomas
Heamangiomas of childhood 95% of all heamangiomas Not a true neoplasm Neoplasm of endothelial cells Undergo complete spontaneous
involution
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Involuting Heamangiomas (cont.) Present at birth or appears 2-3 weeks
after birth Grows rapidly 4-6 months Spontaneous involution complete 5-7 yrs
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Classification Involuting
SuperficialCombinedDeep
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Superficial Involuting
Strawberry nevus Nevus vasculosa Capillary heamangioma
Appearance : Sharp demarcated red Slightly raised lesion & irregular surface
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COMBINED
Strawberry Capillary & CavernousAppearance : A firm bluish tumor , may extend deeply
into sub cutaneous surface
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Deep Involuting
Cavernous Appearance :
Blue tumor covered by normal skin Treatment :
Requires no treatment involving vital organ eg. lid
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Non Involuting Heamangiomas
Usually present at birth No rapid growth Growth is proportion to growth of child Persists into adulthood Causes severe aesthetic problems May cause arterio venous fistula , eventually
lead to cardiac failure. Treatment :
Not satisfactory
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Port Wine Stain
May involve any portion of the body When present in face as a flat patch
correlating to sensory branch of 5th nerve Microscopic appearance : Thin walled capillaries distributed
throughout the dermis lined by thin mature endothelial cells
Treatment :Unsatisfactory - Tattooing - Laser -Radiotherapy
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Malignant Tumors
Basal cell carcinomaSquamous cell carcinomaMalignant Melanoma
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Basal Cell Carcinoma (Rodent ulcer) Most common malignant carcinoma Predisposing factors : Age >40 yrs Ultraviolet light exposure Fair skin , blond hair & blue eyes living in
tropical climate i.e. westerners living in Saudi Arabia .
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Predisposing Factors (cont.)
Growth is slow , steady & insidious. Several years may pass before patient becomes concerned.
Invade adjacent tissue , massive ulcerations .
Rarely metastases & death may occur by invading deeper extension into intracranial or major blood vessels.
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APPEARANCE
Small , translucent skin elevated nodule Rolled pearly edges Telangiactic vessels occur commonly on
surface
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Sclerosing Morphia
Less common Elongated strands of basal that infiltrate
the dermis . Flat & whitish or waxy appearance and
firm palpation
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Erythromateous Basal Cell Carcinoma
Body basal occurs most frequently on the trunks.
Appears reddish plaques with atrophic center
Smooth slightly raised borders.
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Pigment Basal
Sometimes mistaken for melanoma
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Treatment
Radio therapy : Good in treatment of structures that are
difficult to reconstruct . Should not be used in pt. under 40 y , or in pt. who failed to respond to radiation therapy
Treatment : 4-6 weeks
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Treatment
Curettage & Electro desiccation : Excise 2-3 mm margin
Surgical excision : small moderate size lesion down to subcutaneous tissue
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Squamous Cell Carcinoma
1st most cancer in dark skinned people 2nd most cancer in light skinned group Causative agents same as basal cell
carcinoma . Most common sites are the ears ,
cheeks , lower lip & back of the hands.
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Squamous cell (cont.)
Other causative agents are chronic contact with tars hydrocarbons & exposure to ionizing radiation .
Also chronic ulcers , thermal burns healed with fibrosis ( Marjolins ulcer )
These are aggressive tumors , does not usually metastasize , as fibrosis & initial burns has already destroyed lymphatic
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Presentation
Locally invasive without metastasizing from premalignant tumors eg. Bowens disease , chronic radiation dermatitis.
Rapidly growing widely invasive with metastasizes especially squamous cell tumors arising from normal skin .
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Presentation (cont.)
Grows initially starts as a erythomatous plaque or nodule with indistinct margins.
Surface may be : - Flat - Verocous - Ulcerative
Histopathology : Malignant epithelium cell are seen extending down into the dermis like horn pearls .
Treatment : - Surgery -Radiation
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Types of Nevi
Junctional Nevi: Are small , circumscribed , light brown or
black , flat – slightly raised & rarely contained hair
Mainly lies between dermis & epidermis these may be found in mucous membrane ,genitalia , soles & palms
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Intradermal Nevi
Small spots , color range from blue to bluish black
Flat & dome shaped Compound found in both dermis and
epidermis
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Dysplastic Nevi (5-12 mm)
Pink base with indistinctive irregular edges
Family Hx important , suspicious lesions must be excised .
Congenital : Excess in 1% of newborn , most lesions are small
Considered to be pre cancerous
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Malignant Melanoma
Incidence over 300,000 new cases skin tumors every year in USA . 9000 are melanomas, that is 4.6 %
2/3 of all deaths of skin tumors are from melanomas.
Incidence of melanomas is increasing & 5 year survival also inc. from 41% - 67%
Men= Women White > Black
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MELANOMA (cont.)
Etiology - Ultra violet increase risk
-Familial Hx has been recognized Average person has 15-20 nevi 1/3 of all melanomas arise from pigment
nevi .
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Factors which suggest melanoma from mole
Color :focal shades with red blue or white . A darkening in colours
Size :recent rapid enlargement in dia. > 10mm Shape: irregular margins ,notchening and
indentations Surface: ulceration s bleeding or crusting
irregular elevation Symptoms: pruritis ,inflamation and pain Location : back lower extamities neck (BANS)
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Classification of Melanoma based on Histology Superficial spreading : most common
type especialy from pre-existing moleCommon in back & both sexes Nodular melanoma becomes large and
ulcerated before noticed Cartigo melanoma : most common occur
in old age
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CLARKS CLASSIFICATION
LEVEL %OF RM1 INSITU ABOVE 0
BASMENTMEMBRANE 2 INVASION OF PAPILLERY DERMIS 4%3 FILLING PAPILLARY AREA AND
EXTENDING TO THE JUNCTION OF 334 PAPILLARY AND RETICULAR AREA INTO
RETICULAR LEYER OFDERMIS615 SUBCUTANIOUS TISSUE 78
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HIGH RISK AREAS AND POOR SYRVIVAL RATE B : BACK A: POS. LAT OF ARM N POS LAT NECK S SCALP
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PROPHYLACTIC NODE DISSECTION LEVEL 1 AND 2 NO NODE
DISSECTION LEVEL3 ??? LEVEL 4 AND 5 PROPHYLACTIC
NODE DISSECTION
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NODE DISSECTION NOT ADVISED IN
LYPHATIC DRAINAGE MORE THAN ONE AREA
PATIENT AGE > 70 YEARSSERIOUS CONCURRENT DISEASEUNRESECTABLE DISTANT METASTISIS
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PROGNOSIS MOST IMPORTANT SIZE OF TUMOUR AND DEPTH OF INVASION LESS THAN 2CM DIAMETER ANDLESS
THAN 0.7MM DEPTH. CURABLE BY WIDE LOCAL EXCISION. NODULAR MELENOMAS WITH UNCERATION
POOR PROGNOSIS,LESSION IN EXTRAMITIES BETTER ,PROGNOSIS THAN TRUNK
WOMEN BETTER 5YRS SURVIVAL THAN MEN
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•NON SURGICAL TREATMENT (IMMUNOTHERAPY) TREATMENT SMALL METASTISIS BCG NOT
SUITABLE FOR LARGE LESSIONS MELANOMA RADIO RESISTANT RARELY
USED FOR DEFINITE TRAETMENT MAYBE USED FOR PALIATION
CHEMOTHARAPY WITH PHENYLIN & ALAMINE MUSTURED AND OTHER DRUGS
FOR SURVIVAL AND LIMB PRESERVATIONSLONG TERM PALIATION TT LARGE LEGION
SURGERY ,RADIO THERAPY AND CHEMOTHERAPY