Skin Tumors

DR.
ATA UR REHMAN
REGISTRAR,
DEPT. OF GENERAL SURGERY,
DR. ZIAUDDIN HOSPITAL,
KDLB CAMPUS.
SKIN:
 The skin is the largest organ of the body.
 Skin weighs about 6 pounds.
 Total area of about 20 square feet.
 Varies in thickness from site to site being

thickest on palm and soles.
ANATOMY:
 EPIDERMIS
 Stratum basale
 Stratum spinosum
 Stratum granulosum
 Stratum lucidum
 Stratum corneum
 DERMIS
 Paillary layer
 Reticular layer
FUNCTIONS:
 Barrier to the environment.
 Temperature and water homeostasis.
 Excretion
 Endocrine and metabolic function.
 Sensory organ for pain and pressure.

CONGINITAL/GENETIC SKIN
LESIONS:
 NEUROFIBROMATOSIS:
 Arise from Schwann cells.

 Two different type.
 70% type 1. ( autosomal dominant)
 Chromosome 17 mutation.
NEUROFIBROMATOSIS:
NEUROFIBROMATOSIS:
XERODERMA PIGMENTOSA:
 Autosomal recessive ( chromosome 9).
 Intolerance to Ultra-Voilet radiations.
 Erythema, pigmentation, photophobia.
 Mostly expire in early adulthood.

INFLAMATORY CONDITIONS:
 Hidradenitis Suppurativa:
 Chronic inflammatory disease.

 Involves apocrine glands of axilla or groin.
 Common in females (4X).
 Follicular occlusion------ folliculitis----- sec. infection.
 TREATMENT:
 Maintain hygiene.
 Topical / oral antibiotics.
 Anti-androgens.
 Surgical excision.
Hidradenitis Suppurativa
INFECTIONS:
 IMPETIGO:
 Superficial skin lesion. (staph and strepococcus)
 Blisture ---- rupture ----- honey colored crust.
 Washing, local and systemic antibiotics.
 CELLULITIS:
 Bacterial infection of skin and subcutaneous tissue.
 Erythematous, edematous, painful.
 Fever and raised TLC
 Broad spectrum antibiotic, limb elevation
IMPETIGO
IMPETIGO
CELLULITIS
CELLULITIS
 NECROTISING FASCIITIS:
 Polymicrobial synergistic infection involving deep

layers.
 80% have history of trauma or infection.
 Rapidly progress to septic shock
 Resuscitation, antibiotics, surgical debridement.

NECROTIZING FACITIS
EPIDERMAL CYST:
 Cysts lined by stratified squamous epithelium.
 Commonly known as sebaceous cyst.
 Hairy areas of the body.
 Fixed to skin, have a punctum.
 Treatment:
 Not inflamed ----- excision
 Inflamed ----- antibiotics then incision and drainage.
EPIDERMOID CYST
SKIN TUMOURS
BENIGN MALIGNANT
BENIGN LESIONS:
BASAL CELL PAPILLOMA:
(SEBORRHEOEIC
KERATOSIS)
BASAL CELL PAPILLOMA:
(SEBORRHEOEIC
KERATOSIS)
BENIGN LESIONS:
 BASAL CELL PAPILLOMA
(SEBORRHEOEIC KERATOSIS)
 Soft, pigmented and hyperkeratotic.

 Arise from basal layer of epidermis
 Contains melaonocytes.
 Most common benign skin tumour of old age.
BENIGN LESIONS:
CUTANEOUS PAPILLOMA
CUTANEOUS PAPILLOMA:
 Skin tag, cutaneous papilloma, soft fibroma
 Common, benign, flesh-colored papule
 Uncommon before age 30, very common

thereafter
 Found in 25% of adults, increase with age
 F>m, obesity, diabetes, pregnancy, intesinal

polyposis syndromes
http://www.visualdxhealth.com/adult/acrochordonSkinTag.htm
BENIGN LESIONS:
 MOLES/NAEVI:
 Migrated melanocyets from neural crest to

epidermis during embryogenesis.
 Epidermis----- mole
 Dermis ----- naevi

Syringomas  Sweat duct tumors
 More common in
females
 May first appear in

adolescence, but more
often in the third decade
 Found around eyelids

and are skin colored to
yellow in appearance
PREMALIGNANT LESIONS:
 SOLAR KERATOSIS:
 Area of dyskeratosis and cellular atypia.
 20% can transform into squamous cell carcinoma.

SOLAR KERATOSIS
 CUTEANOUS HORN:
 Excessive Keratin deposition.
 10% have underlying squamous call carcinama.

CUTEANOUS HORN
 KERATOACANTHOMA:
 Symmetrical cutaneous growth with central

keratin plug.
 Twice common in men
 Common site face
 50 to 70 yrs
 Excision is recommended.
 Bowen’s disease:
 Carcinoma in situ
 3-11% progress to SCC.
 Chemical irritant, solar radiation, HPaV.
 Surgical excision.
BOWEN’S DISEASE
BOWEN’S DISEASE
MALIGNANT LESION:
 BASAL CELL CARCINOMA:
 Slowly growing
 Locally invasive
 Arise from basal epidermis and hair follicles.
 Predisposing factor ---- UV radiations
 33% in body parts not exposed.
 Middle age or elderly
 90 % upper face.
 White colored people
 Common in men.
 Rarely metastasise.
 BASAL CELL CARCINOMA:
 > 2 cm are high risk.

 Treatment:
 Surgical excision with margins of 1.5 cm
 Mohs’ micrographic surgery.
BASAL CELL CARCINOMA
BASAL CELL CARCINOMA
MALIGNANT LESION:
 SQUAMOUS CELL CARCINOMA:
 Malignant tumor of keratinising cells.
 Arise from stratum germinosum.
 Second most common skin tumor. (4X less than BCC)
 Twice common in men, white skinned and smokers.
 Associated with chronic inflamation, sinus tracts,
burns.
 Metastasize.
 Treatment:
 Surgical excision ----- if < 2 cm ----clearance 4mm
if > 2 cm ----clearance 1cm.
SQUAMOUS CELL CARCINOMA
SQUAMOUS CELL CARCINOMA
MALIGNANT LESION:
 MALIGNANT MAELONOMA:
 Cancer of melanin producing cells.

 Largely by exposure to UV radiations.
 < 5% of all skin malagnacies
 Most common cancer of young age
 Most likely cause of cancer related deaths.
 Treatment:
 Surgical excision
MALIGNANT MAELONOMA
MALIGNANT MAELONOMA
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DR.

 Skin weighs about 6 pounds.

 Total area of about 20 square feet.

 Varies in thickness from site to site being

 Barrier to the environment.

 Temperature and water homeostasis.

 Endocrine and metabolic function.

 Sensory organ for pain and pressure.

 Arise from Schwann cells.

 Intolerance to Ultra-Voilet radiations.

 Erythema, pigmentation, photophobia.

 Mostly expire in early adulthood.

 Chronic inflammatory disease.

 Polymicrobial synergistic infection involving deep

 80% have history of trauma or infection.

 Rapidly progress to septic shock

 Resuscitation, antibiotics, surgical debridement.

 Soft, pigmented and hyperkeratotic.

 Common, benign, flesh-colored papule

 Uncommon before age 30, very common

 Found in 25% of adults, increase with age

 F>m, obesity, diabetes, pregnancy, intesinal

 Migrated melanocyets from neural crest to

 Dermis ----- naevi

 May first appear in

 Found around eyelids

 Area of dyskeratosis and cellular atypia.

 20% can transform into squamous cell carcinoma.

 Excessive Keratin deposition.

 10% have underlying squamous call carcinama.

 Symmetrical cutaneous growth with central

 > 2 cm are high risk.

 Cancer of melanin producing cells.

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