SKIN TUMOR

1. Benign Neoplasms & Hyperplasia:

- Disorder of melanocytes
- Vascular tumors
- Vascular malformations
- Miscellaneous cysts & pseudocysts
- Miscellaneous benign neoplasms &
hyperplasias
- Benign dermal & subcutaneous neoplasms &
hyperplasias
2. Precancerous Lesions & Cutaneous Carcinomas :
- Squamous cell carcinoma
- Basal cell carcinoma
3. Melanoma :
- Precursors of cutaneous melanoma
- Cutaneous melanoma

DISORDERS OF
MELANOCYTES
Congenital Melanocytic Nevus = giant
hairy nevus
Def :
Melanocytic nevus present at birth

Clinical features :
Most congenital melanocytic nevi are heavily
pigmented, have papillomatous surface and
contain hairs.
*At birth, may be less heavily pigmented
and not have prominent hairs

Histology :
always junctional and dermal component.
Diagnostic approach :
clinical examination, dermatoscopy
Prognosis :
large risk of malignant melanoma
Therapy :
Goals : avoid malignant melanoma & cosmetic
improvement
*patients should be followed yearly. Any new nodules
are highly suspicious and should be excised

Acquired Nevomelanocytic Nevi

(NMN)
Def : are small (<1cm),
circumscribed, acquired pigmented
macules, papules, or
nodules
composed of groups of melanocytic
nevus cells located in the
epidermis, dermis, and, rarely,
subcutaneous tissue.

Clasification :

1. Junctional melanocytic NMN

- arise at the dermal-epidermal
junction
- macule, or only very slightly raised,
never > 1cm, tan, brown,
dark brown, or even black, round or
oval with smooth, regular borders

2. Compound melanocytic NMN:

- nevus cell invade the papilary
dermis
- papules or small nodules, dark
brown, sometimes black, domeshape, smooth or cobblestone-like
surface

Dermal melanocytic NMN :

3. Dermal melanocytic NMN :

- nevus grows or remains intradermal
- sharply defined papule or nodule,
skin- colored, tan or fleck of brown, often
with teleangiectasis, round, dome-shaped,
smooth surface.

VASCULAR TUMOR

Hemangioma of infancy :
- localized proliferative process of
angioblastic mesenchyme
- soft, bright red deep purple,
compressible,
diascopy (+), spontaneous
regression white
gray area on central
surface

Pyogenic granuloma:
- rapidly developing vascular lesion usually
following minor trauma
- solitary nodule, bright red, dusky red, or
brown black, smooth surface
- Tx : surgical excision, electrodesiccation

VASCULAR MALFORMATIONS

Port-wine stain = nevus fammeus :

- an irregularly shape, red or
violaceous,
macular capilary
malformation of dermal blood
vessel, present at birth
and
never disappears spontaneously,
tends to increase in proportion to
the
size of child
- Tx: copper vapor laser

Miscellaneous cysts & pseudocysts

Epidermoid cyst := sebaceous cyst

=epidermal cyst
- derived from epidermis/hair follicle
epithelium.
- solitary/multiple nodule
keratinaceous
material creamcolored,pasty consistency
- loc: face, neck, upper trunk, scrotum

Milium
- 1-2mm, superficial, white to yellow,
keratin
containing epidermal cyst.
- loc : eyelids, cheeks, forehead

iscellaneous benign neoplasms & hyperplasias

Seborrheic keratosis :
- hereditary benign epithelial tu
- small 1-2mm, barely elevated
papulelarge plaque, warty surface,
brown, gray, black, skin-colored,
round/oval
- Tx : electrocautery

Keratoacantoma :
- isolated nodule, skin-colored/slightly
red, dome-shape with central keratotic
plug, ussually on the face, rapid growth
rate, spontaneous remission several
month
- surgical excision

nign dermal & subcutaneous neoplasms & hyperplasi

Lipoma :
- soft, rounded,/lobulated & movable,
single/multiple nodule, compous fat cell
- loc : neck, trunk & extremities

Hypertropic scars & keloid:

- exuberant fibrous repair tissues
after a cutaneous injury
- Tx: intralesional glucocorticoid
injection, silicone
gel/cream

Skin Tag = cutaneous papiloma, soft fibroma

- soft, skin-colored/tan/brown, round/oval,
pedunculated papiloma
- Tx : snipping, electrodesiccation,
cryosurgery

Syringoma
Def : benign tumor that resembles the ecrine dermal
duct
Clinical features :
multiple skin-colored to yellowish papules
location : peri orbital (the most common site),
genital region, umbilicus
DD : xanthelasma, wart (genital)
Therapy : electrocautery, laser ablation, dermabrasion
* Recurrences are the rule

Squamous cell carcinoma

- clasification : - in situ
- invasive
*In situ:
Def : solitary or multiple
macules/papules/plaques which may be
scaling/hyperkeratotic that commonly
arises in epithelial dysplastic lesions such
as solar keratosis or HPV-induced
squamous intraepithelial lesions.
Etiol : UVR, HPV, arsenic, tar, chronic heat
exposure

*Invasive :
- malignant tu of keratinocyte, UVR-induced
lesions
(majority), HPV, indurated papule/
plaque/ nodule, keratotic scale/
hyperkeratotic
- Dx :~dermatopathological
- DD : numular eczema, psoriasis,
seborrheic keratosis
- Tx : surgical excision, cryosurgery, 5fluorouracil
cream (in situ)

Basal Cell Carcinoma

(Basalioma)

Def : malignant tumor, locally

invasive, aggressive and destructive.
Age of onset : > 40 y
Predisposing factors : skin phototype
I&II, albinos, prolong skin exposure
Skin lesions ;
nodular/ulcerating/sclerosing,
superficial and pigmented

Skin lesions ; nodular/ulcerating/sclerosing,

superficial and pigmented
- nodular papule/nodule, translucent/pearly,
skin-colored/reddish, smooth surface, well
defined, firm
- ulcerating cover with crust, rolled
border(rodent ulcer)
- sclerosing (cicatrical) small patch
morfea/superficial scar, skin-colored
- pigmented brown-blue/black, smooth,
glistening surface, hard&firm, oval/round shape,
depressed center

Melanoma

Def : most malignant tumor of the

skin that arises from the malignant
transformation of melanocytes at the
dermal-epidermal junction or from
the nevomelanocytes of atypical
melanocytic nevi or congenital
nevomelanocytic nevi that become
invasive and metastasize after
various time intervals.

6 signs of malignant melanoma (ABCDE rule) :

A Asymetri in shape unlike other
B Border is irregular edges irregularly scallop,
notched, sharply defined
C Color is not uniform : mottled haphazard
display of colors
D Diameter is usually large greater than the
tip of
a pencil eraser (6.0 mm)
E Elevation is almost always present and
irregular surface distortion is assessed by
side-lighting
Enlargement history of increase in size of
lesion

Clinical :
Lentigo maligna melanoma:flat, macule
3cm or larger, well defined irregular
nodule vertical growth
Superficial spreading melanoma :
asymetry lesion, asymetry in
distribution of color
Nodular melanoma :blueberry-like
nodule/ ulcerated/ thick plaque