Transcript skin tumors - qums - دانشگاه علوم پزشکی قزوین

‫به نام خدا‬
‫دکتر سید امیر فرزام‬
‫عضو هیئت علمی دانشگاه‬
‫علوم پزشکی قزوین‬
SKIN TUMORS
Keratinocyte
Melanocyte
Merkel cell
Seborrheic kerat Actinic keratosis
Bowen disease
BCC & SQCC
Nevocell. nevus Melanoma
----
Merkel cell Ca.
SKIN TUMORS
Mesenchymal
Lymphocyte
Hemangioma
Angiosarcoma
Kaposi sarcoma
Dermatofibroma Dermatofib.sarc.
Neurofibroma
Neurofibrosarc.
----
Mycosis fung(T)
Lymphoma(B)
Mast cell
Urticaria pigm.
Syst. mastocytos
Dermal adnexa
Adenoma
Carcinoma
SKIN TUMORS
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EPIDERMAL TUMORS.
A. BENIGN.
1. SEBORRHEIC KERATOSIS.
-It is a benign neoplasm most commonly seen in
elderly, having an appearance of a raised, flat,
soft, well demarcated brown lesion.
-Is located mostly on the trunk, limbs & head.
-Micro: proliferation of squamous epithelium +
cysts filled with keratin
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SKIN TUMORS
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BENIGN...(cont.)
2. KERATOACANTHOMA.
-Are keratotic papules that grow rapidly(3-6 wks.)
on skin exposed to sunlight, with characteristic
volcano-like lesion(umbilicated) resembling a
squamous cell carcinoma.
-Frequent spontaneous regression without Tx in 612 mo.scar
-Micro: endophytic papillary proliferation of
keratinocytes with some atypias that may be
confused with squamous cell Ca.
SKIN TUMORS
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BENIGN...(cont.)
3. MULTIPLE KERATOACANTHOMAS.
There are some rare conditions in which multiple
keratoacanthomas may appear:
-Ferguson-Smith familial keratoacanthomas
More common in men, with large and some
times self-healing lesions.
-Grzybowski eruptive keratoacanthomas, with
multiple itchy lesions that may appear in the skin
and mucosal surfaces that can result w/deformity
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SKIN TUMORS
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BENIGN...(cont.)
4. EPIDERMOID CYST.
-Formerly and incorrectly named “sebace
ous”(sebaceous gland NOT involved), is
lined by stratified squamous epithelium
filled with keratin.
-It is a typical nodular lesion with a softgray material as content
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SKIN TUMORS
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BENIGN...(cont.)
5. ACTINIC KERATOSIS.
-Provoked by an excessive and chronic exp
osure to sunlight, is considered as “premalignant”
-It is typically seen as hyperkeratotic, scaly pla
ques on the face, neck, limbs and trunk.
-Affects most commonly to old patients
-Micro; stratum corneum w/parakeratosis &
atypic keratinocytes that may evolve to Ca. in situ
invasive squamous cell carcinoma.
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SKIN TUMORS
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BENIGN...(cont.)
6. MELANOCYTIC TUMORS.
NEVOCELLULAR NEVUS(MOLE).
-Is originated in the deep layers of the skin
(nevus cells) and is clearly related to sun ex
posure.
-There are several types: junctional, compound
and intradermal.
-Gross: uniform tan/brown color w/sharp delineati
on and tendency to be stable in size and shape.
-Malignant transformation is uncommon
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SKIN TUMORS
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BENIGN...(cont.)
7. MESENCHYMAL TUMORS.
ACHROCORDON(SOFT FIBROMA).
-Also known as “cutaneous tags” occur in
two types: as multiple filiform, smooth or fu
rrowed soft papules, especially on the neck
and in the axillae, and as a solitary soft,
bag-like, pedunculated growths on the trunk
or limbs.
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SKIN TUMORS
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BENIGN...(cont.)
MESENCHYMAL...
DERMATOFIBROMA.
-Occur in the skin as a firm, indolent, single or
multiple nodules. Usually the nodules arise in
adults, mostly on the limbs.
-It may have from few mm. in diameter to 2-3 cm
in size. Gross: lesions w/reddish color or reddishbrown because of hyperpigmentation of the over
laying skin.
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SKIN TUMORS
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BENIGN...(cont.)
MESENCHYMAL...
HEMANGIOMAS(Capillary, Cavernous)
-Capillary or “strawberry”hemangiomas con
sist of one or several bright-red, soft, lobula
ted tumors that first appear between 3rd-5th
week of life, increase in size for several
months and then regressinvolution.
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SKIN TUMORS
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BENIGN...(cont.)
MESENCHYMAL...
HEMANGIOMAS...
-Cavernous hemangiomas consists of large,
predominantly subcutaneous mass that may
cause deformity. It can be seen in associa tion w/ some other congenital conditions:
Mafucci syndrome ( dyschondroplasia, fragility of
bones + osteochondromas) and Blue Rubber-bleb
nevus(large bluish tumors on skin + subcutaneous
hemangiomas + intestinal and visceral lesions)
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SKIN TUMORS
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BENIGN...(cont.)
NEUROFIBROMAS.
-It may occur as solitary cutaneous lesions, in
which case one finds no café-au-lait spots and no
family history of the disease.
-Multiple cutaneous lesions w/café-au-lait spots,
dominantly inherited, referred as
neurofibromatosis or von Recklinghausen´s
disease that starts to be manifested since childhood
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SKIN TUMORS
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B. PREMALIGNANT
1. LENTIGO MALIGNA(HUTCHINSON)
-Appears in sun-damaged skin of elderly
-It is a large pigmented macule, usually in white
patients.
2. DYSPLASTIC NEVI(BK MOLES).
-Are lesions that can have >5 mm in diameter
and may occur as hundreds of moles in some
individuals on both, sun-exposed and non sunexposed areas of the skin, and have been seen in
members of families(heritable melanoma
syndrome)
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SKIN TUMORS
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C. MALIGNANT.
1. BOWEN´S DISEASE.
-It can be seen in non-sun exposed areas
like oral mucosa, vulva, etc. and is frequen
tly associated to a visceral malignancy.
-Clinically appears like an erythematous
plaque with indolent growth.
-Micro: a typical Ca. in situ
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SKIN TUMORS
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MALIGNANT ...(cont.)
2. BASAL CELL CARCINOMA.
-Is the most common malignant tumor due to sun
exposure in patients over 40´s with pale skin.
-It appears mainly in the face and can be
destructive(erosion of the nosesinuses) but
almost never metastasize
-Gross: pearly papule, rodent ulcer, superficial ca.,
scar-like, pigmented lesion
-Micro: nests of epith.cells that resemble
epidermal basal cells forming palisades + whorls
of fibroblasts.
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SKIN TUMORS
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MALIGNANT...(cont.)
3. SQUAMOUS CELL CARCINOMA.
-Less common than BCC and often seconda
ry to AK, develops in sun-exposed skin of fair
patients w/light hair & freckles
-It has an increased tendency to metastasize
locally
-It may also appears in chronic scarring processes
(osteomyelitis tracts)more invasive
-Clinical: may arise in dorsal surface of hands,face
lips, ears w/small lesion initiallyulceration later
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SKIN TUMORS
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MALIGNANT...(cont.)
4. MALIGNANT MELANOMA.
-Sunlight seems to have an important role in the
development of this tumor in the skin: appears
most frequently on the upper back
(males/women) or on the legs(women).
-Also, lightly pigmented individuals have higher
risk to get a melanoma than those darkly pigmen
ted.
In addition, the presence of a pre-existing lesion
(dysplastic nevus), hereditary factors or exposure
to certain carcinogensmelanoma
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SKIN TUMORS
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MALIGNANT...(cont.)
MELANOMA...
-Superficial malignant melanoma is the
MOST common type, but after 1-2 yrs
nodular melanoma
-Acral(distal) lentiginous melanoma affects
mostly fingers and toes(nails) and is the
most type in colored patients
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SKIN TUMORS
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MALIGNANT...(cont.)
5. MYCOSIS FUNGOIDES(T-cell lymphoma)
-In fact it represents a stage in the wide spec
trum of lymphoproliferative disorders that affects
the skin.
-There are 2 different clinical types: a chronic
proliferative disorder and a nodular eruptive
presentation. Also, it can be seen a more agressive
form of adult T-cell leukemia/lymphoma
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SKIN TUMORS
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KAPOSI SARCOMA.
-There are four types of the disease: chronic
(European KS), lymphadenopathic(African or
endemic KS), transplant-associated
(immunosuppresion-associated) and AIDSassociated(most common form in US) present in
approximately 1/3 of AIDS patients, particularly
male homosexuals.
-The morphology of KS is similar in different
types, w/relatively indolent evolution in old men
as well as in non-AIDS presentation of the
disease.
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