Transcript Skin Tumors and Their Treatments

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
epidermis
Bazal hücre tabakası
dermis
deri altı yağ tabakası
deri
ektoderm / mezoderm
Epithelial Structures: Other structures:
epidermis
Sebaceous galnds
Apocrine glands
Eccrine glandsi
Hair Follicles
Langerhans cells
Merkel Cells
Vessels
Lymphatic
Fat Cells
Mast Cells
Neuroectoderm : Melanocyte , Nerve
1- DERİNİN SELİM TÜMÖRLERİ
BENING TUMORS;
1- Tumor originated form Skin Appendages
2- Cysts
3- Soft Tissue Tumor
4-Lesions comes from the Epidermis
5- Pigmented Lesions
2- DERİNİN HABİS TÜMÖRLERİ
MALIGNANT TUMOURS:
1- BCC
2- SCC
3- M M
4-Others
DERİNİN form
SELİM
TÜMÖRLERİ
1-1-Originated
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
1-1-DERİNİN
SELİM
TÜMÖRLERİ
DERİNİN
SELİM
TÜMÖRLERİ
1
2-Cysts:
Sebaceous Cysts
Dermoid Cysts
3- Soft Tissue Tumor
4-Lesions comes from the Epidermis
5- Pigmented Lesions
1- DERİNİN SELİM TÜMÖRLERİ
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
4- Lesions originated from Epidermis:
Seborrheic Keratosis
Actinic Keratosis
Bowen hastalığı
5- Pigmented lesions
1- DERİNİN SELİM TÜMÖRLERİ
5- Pigmented Lesions :
Naevi
(compount,,
Junctional, dermal))
- Solar Lentigo
•
premalignant lesions
1- Keratosis
Actinic Keratosis
Solar Keratosis
Radiation Keratosis
Skin horn
3- Chemically inductive Keratosis
3- Epithelial tumors
Keratoacanthoma
Fibro-epithelioma
Cylindroma
Trycoepithelioma
Sebaseous Nevus
4- Inheridet Conditions
Xeroderma pigmentosum
Epidermolisis Bullosa
•
premalignant lesions
5- Trauma and Scars
Chronic wounds
Unstable burn scars
6- Mucosal lesions
Leukoplakia
7- Others
Liken Planus
Chronic Fistulas
Lupus Vulgaris
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
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,
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.
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.
Malignant Tumours of The Skin
• Basal Cell Carsinoma
• Squamous Cell Carsinoma
• Malignant Melanoma
(BCC)
(SCC)
(MM)
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
SKIN CANCER :
aetiology and stimulators
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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
Fitzpatrick Deri Tipleri
Derinin fototip’i derinin içindeki melanin miktarına göre belirlenir
UVB Damages to DNA
• UVA causes wrinkles on the skin
Basal Cell Carcinoma
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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)
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
– Sun protective cream:
COMISSURA - TRAGUS LINE
Classification of BCC(ACKERMAN):
A- LOCALIZED
1- Nodular
2- Nodulocystic
3-Pigmented
B- SUPERFICIAL
1-Superficial spreading
2-Multifocal
C-INFILTRATIVE
1- Mopheic
Diagnosis:
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History
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Etyoloji
Premalign lezyolar
Yaş / cinsiyet
Lokalizasyon
• Biopsy
• Küretaj
• Yüzeyel tıraşlama
• Punch biyopsi
• Eksizyonel biyopsi
Deri kanserleri
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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 bül oluşturan güneş yanığı olması
Histopathologic confirmation is
obtained with a biopsy
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Curettage
Shave biopsy
Punch biopsy
Excisional biopsy
TREATMENT
• Basal Cell Carsinoma
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Cryotherapy
Electrocoagulation
Surgical excision ( 2 - 5 mm )
Radiotherapy
Local chemotherapeutic drug
Curettage
Superficial shaving
Laser
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
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
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
TREATMENT
• Squamous Cell Carsinoma
• Surgical excision (1 cm)
• Radiotherapy
Last slide