SKIN TUMORS

KeratinocyteKeratinocyte Seborrheic keratSeborrheic kerat Actinic keratosisActinic keratosis

Bowen diseaseBowen disease

BCC & SQCCBCC & SQCC

MelanocyteMelanocyte Nevocell. nevusNevocell. nevus MelanomaMelanoma

Merkel cellMerkel cell -------- Merkel cell Ca.Merkel cell Ca.

SKIN TUMORS

MesenchymalMesenchymal HemangiomaHemangioma

DermatofibromaDermatofibroma

NeurofibromaNeurofibroma

AngiosarcomaAngiosarcoma

Kaposi sarcomaKaposi sarcoma

Dermatofib.sarc.Dermatofib.sarc.

Neurofibrosarc.Neurofibrosarc.

LymphocyteLymphocyte -------- Mycosis fung(T)Mycosis fung(T)

Lymphoma(B)Lymphoma(B)

Mast cellMast cell Urticaria pigm.Urticaria pigm. Syst. mastocytosSyst. mastocytos

Dermal adnexaDermal adnexa AdenomaAdenoma CarcinomaCarcinoma

SKIN TUMORS

EPIDERMAL TUMORS. EPIDERMAL TUMORS. A. BENIGN. A. BENIGN. 1. SEBORRHEIC KERATOSIS. 1. SEBORRHEIC KERATOSIS. -It is a benign neoplasm most -It is a benign neoplasm most commonly seen in elderly, having an appearance of a commonly seen in elderly, having an appearance of a raised, flat, soft, well demarcated brown lesion. raised, flat, soft, well demarcated brown lesion. -Is located -Is located mostly on the trunk, limbs & head. mostly on the trunk, limbs & head. -Micro: proliferation -Micro: proliferation of squamous epithelium + cysts filled with keratinof squamous epithelium + cysts filled with keratin

SKIN TUMORS

BENIGN...(cont.) 2. BENIGN...(cont.) 2. KERATOACANTHOMA. KERATOACANTHOMA. -Are keratotic papules that grow rapidly(3-6 wks.) -Are keratotic papules that grow rapidly(3-6 wks.) on skin exposed to sunlight, with characteristic on skin exposed to sunlight, with characteristic volcano-like lesion(umbilicated) resembling a volcano-like lesion(umbilicated) resembling a squamous cell carcinoma. squamous cell carcinoma. -Frequent spontaneous regression without Tx in 6- -Frequent spontaneous regression without Tx in 6-12 mo.12 mo.scar -scar -Micro: endophytic papillary proliferation of Micro: endophytic papillary proliferation of keratinocytes with some atypias that may be keratinocytes with some atypias that may be confused with squamous cell Ca. confused with squamous cell Ca.

SKIN TUMORS

BENIGN...(cont.) BENIGN...(cont.) 3. MULTIPLE KERATOACANTHOMAS. 3. MULTIPLE KERATOACANTHOMAS. There are some rare conditions in which There are some rare conditions in which multiple keratoacanthomas may appear: multiple keratoacanthomas may appear: -Ferguson-Smith familial keratoacanthomas -Ferguson-Smith familial keratoacanthomas More common in men, with large and More common in men, with large and some times self-healing lesions. some times self-healing lesions. -Grzybowski -Grzybowski eruptive keratoacanthomas, with multiple itchy eruptive keratoacanthomas, with multiple itchy lesions that may appear in the skin and mucosal lesions that may appear in the skin and mucosal surfaces that can result w/deformitysurfaces that can result w/deformity

SKIN TUMORS

BENIGN...(cont.) BENIGN...(cont.) 4. EPIDERMOID CYST. 4. EPIDERMOID CYST. -Formerly and incorrectly named -Formerly and incorrectly named “sebace ous”(sebaceous “sebace ous”(sebaceous gland NOT involved), is lined by stratified gland NOT involved), is lined by stratified squamous epithelium filled with keratin. squamous epithelium filled with keratin. -It is a typical -It is a typical nodular lesion with a soft-gray material as nodular lesion with a soft-gray material as contentcontent

SKIN TUMORS

BENIGN...(cont.) 5. BENIGN...(cont.) 5. ACTINIC KERATOSIS. -ACTINIC KERATOSIS. -Provoked by an excessive and chronic exp Provoked by an excessive and chronic exp osure to sunlight, is considered as “premalignant” osure to sunlight, is considered as “premalignant” -It is typically seen as hyperkeratotic, scaly pla -It is typically seen as hyperkeratotic, scaly pla ques on the face, neck, limbs ques on the face, neck, limbs and trunk. -Affects most and trunk. -Affects most commonly to old patients -commonly to old patients -Micro; stratum corneum w/parakeratosis & Micro; stratum corneum w/parakeratosis & atypic keratinocytes that may evolve to Ca. in situ atypic keratinocytes that may evolve to Ca. in situ invasive squamous cell carcinoma.invasive squamous cell carcinoma.

SKIN TUMORS

BENIGN...(cont.) 6. BENIGN...(cont.) 6. MELANOCYTIC TUMORS. MELANOCYTIC TUMORS. NEVOCELLULAR NEVUS(MOLE). -Is NEVOCELLULAR NEVUS(MOLE). -Is originated in the deep layers of the skin originated in the deep layers of the skin (nevus cells) and is clearly related to sun ex (nevus cells) and is clearly related to sun ex posure. posure. -There are several types: junctional, compound -There are several types: junctional, compound and intradermal. and intradermal. -Gross: uniform tan/brown color w/sharp delineati -Gross: uniform tan/brown color w/sharp delineati on and tendency to be stable in size on and tendency to be stable in size and shape. -Malignant and shape. -Malignant transformation is uncommontransformation is uncommon

SKIN TUMORS

BENIGN...(cont.) BENIGN...(cont.) 7. MESENCHYMAL TUMORS. 7. MESENCHYMAL TUMORS. ACHROCORDON(SOFT ACHROCORDON(SOFT FIBROMA). -Also known as FIBROMA). -Also known as “cutaneous tags” occur in two types: as “cutaneous tags” occur in two types: as multiple filiform, smooth or fu multiple filiform, smooth or fu rrowed soft papules, especially on the rrowed soft papules, especially on the neck and in the axillae, and as a solitary soft, neck and in the axillae, and as a solitary soft, bag-like, pedunculated growths on the trunk or bag-like, pedunculated growths on the trunk or limbs.limbs.

SKIN TUMORS

BENIGN...(cont.) BENIGN...(cont.) MESENCHYMAL... MESENCHYMAL... DERMATOFIBROMA. DERMATOFIBROMA. -Occur in the skin as a firm, -Occur in the skin as a firm, indolent, single or multiple nodules. Usually the indolent, single or multiple nodules. Usually the nodules arise in adults, mostly on the limbs. nodules arise in adults, mostly on the limbs. -It may have from few mm. in -It may have from few mm. in diameter to 2-3 cm in size. Gross: lesions w/reddish diameter to 2-3 cm in size. Gross: lesions w/reddish color or reddish-brown because of color or reddish-brown because of hyperpigmentation of the over hyperpigmentation of the over laying skin. laying skin.

SKIN TUMORS

BENIGN...(cont.) BENIGN...(cont.) MESENCHYMAL... MESENCHYMAL... HEMANGIOMAS(Capillary, Cavernous) HEMANGIOMAS(Capillary, Cavernous) -Capillary or -Capillary or “strawberry”hemangiomas con “strawberry”hemangiomas con sist of one or several bright-red, soft, lobula sist of one or several bright-red, soft, lobula ted tumors that first appear between 3rd- ted tumors that first appear between 3rd-5th week of life, increase in size for several months 5th week of life, increase in size for several months and then regressand then regressinvolution. involution.

SKIN TUMORS

BENIGN...(cont.) BENIGN...(cont.) MESENCHYMAL... MESENCHYMAL... HEMANGIOMAS... HEMANGIOMAS... -Cavernous hemangiomas consists of large, -Cavernous hemangiomas consists of large, predominantly subcutaneous mass that may predominantly subcutaneous mass that may cause deformity. It can be seen in associa - cause deformity. It can be seen in associa - tion w/ some other congenital conditions: tion w/ some other congenital conditions: Mafucci syndrome Mafucci syndrome ( dyschondroplasia, fragility of bones + ( dyschondroplasia, fragility of bones + osteochondromas) and Blue Rubber-bleb nevus(large osteochondromas) and Blue Rubber-bleb nevus(large bluish tumors on skin + subcutaneous hemangiomas + bluish tumors on skin + subcutaneous hemangiomas + intestinal and visceral lesions)intestinal and visceral lesions)

SKIN TUMORS

BENIGN...(cont.) BENIGN...(cont.) NEUROFIBROMAS. NEUROFIBROMAS. -It may occur as solitary cutaneous -It may occur as solitary cutaneous lesions, in which case one finds no café-au-lait spots lesions, in which case one finds no café-au-lait spots and no family history of the disease. and no family history of the disease. -Multiple cutaneous lesions w/café-au-lait -Multiple cutaneous lesions w/café-au-lait spots, dominantly inherited, referred as spots, dominantly inherited, referred as neurofibromatosis or von Recklinghausen´s disease neurofibromatosis or von Recklinghausen´s disease that starts to be manifested since childhoodthat starts to be manifested since childhood

SKIN TUMORS

B. PREMALIGNANT B. PREMALIGNANT 1. LENTIGO MALIGNA(HUTCHINSON) 1. LENTIGO MALIGNA(HUTCHINSON) -Appears in sun-damaged skin of elderly -Appears in sun-damaged skin of elderly -It is a large pigmented macule, usually -It is a large pigmented macule, usually in white patients. in white patients. 2. DYSPLASTIC NEVI(BK MOLES). 2. DYSPLASTIC NEVI(BK MOLES). -Are lesions that can have >5 mm in diameter -Are lesions that can have >5 mm in diameter and may occur as hundreds of moles and may occur as hundreds of moles in some individuals on both, sun-exposed and non in some individuals on both, sun-exposed and non sun-exposed areas of the skin, and have been seen in sun-exposed areas of the skin, and have been seen in members of families(heritable melanoma syndrome)members of families(heritable melanoma syndrome)

SKIN TUMORS

C. MALIGNANT. C. MALIGNANT. 1. BOWEN´S DISEASE. 1. BOWEN´S DISEASE. -It can be seen in non-sun -It can be seen in non-sun exposed areas like oral mucosa, vulva, etc. and exposed areas like oral mucosa, vulva, etc. and is frequen tly associated to a is frequen tly associated to a visceral malignancy. -visceral malignancy. -Clinically appears like an erythematous plaque Clinically appears like an erythematous plaque with indolent growth. with indolent growth. -Micro: a typical Ca. in situ -Micro: a typical Ca. in situ

SKIN TUMORS

MALIGNANT ...(cont.) MALIGNANT ...(cont.) 2. BASAL CELL CARCINOMA. -Is 2. BASAL CELL CARCINOMA. -Is the most common malignant tumor due to sun exposure the most common malignant tumor due to sun exposure in patients over 40´s with pale skin. in patients over 40´s with pale skin. -It appears mainly in the face and -It appears mainly in the face and can be destructive(erosion of the nosecan be destructive(erosion of the nosesinuses) but sinuses) but almost never metastasize -almost never metastasize -Gross: pearly papule, rodent ulcer, superficial ca., Gross: pearly papule, rodent ulcer, superficial ca., scar-like, pigmented lesion scar-like, pigmented lesion -Micro: nests of epith.cells that resemble -Micro: nests of epith.cells that resemble epidermal basal cells forming palisades + whorls of epidermal basal cells forming palisades + whorls of fibroblasts.fibroblasts.

SKIN TUMORS

MALIGNANT...(cont.) MALIGNANT...(cont.) 3. SQUAMOUS CELL CARCINOMA. 3. SQUAMOUS CELL CARCINOMA. -Less common than BCC and often seconda -Less common than BCC and often seconda ry to AK, develops in sun-exposed skin of fair ry to AK, develops in sun-exposed skin of fair patients w/light hair & freckles -It patients w/light hair & freckles -It has an increased tendency to metastasize locally has an increased tendency to metastasize locally -It may also -It may also appears in chronic scarring processes appears in chronic scarring processes (osteomyelitis tracts)(osteomyelitis tracts)more invasive more invasive -Clinical: may arise in dorsal surface of hands,face -Clinical: may arise in dorsal surface of hands,face lips, ears w/small lesion initially lips, ears w/small lesion initiallyulceration ulceration later later

SKIN TUMORS

MALIGNANT...(cont.) 4. MALIGNANT...(cont.) 4. MALIGNANT MELANOMA. -MALIGNANT MELANOMA. -Sunlight seems to have an important role in the Sunlight seems to have an important role in the development of this tumor in the skin: appears most development of this tumor in the skin: appears most frequently on the upper back (males/women) frequently on the upper back (males/women) or on the legs(women). -Also, lightly or on the legs(women). -Also, lightly pigmented individuals have higher risk to pigmented individuals have higher risk to get a melanoma than those darkly pigmen get a melanoma than those darkly pigmen ted. In ted. In addition, the presence of a pre-existing lesion addition, the presence of a pre-existing lesion (dysplastic nevus), hereditary factors or exposure to (dysplastic nevus), hereditary factors or exposure to certain carcinogenscertain carcinogensmelanomamelanoma

SKIN TUMORS

MALIGNANT...(cont.) MALIGNANT...(cont.) MELANOMA... MELANOMA... -Superficial malignant -Superficial malignant melanoma is the MOST common type, but melanoma is the MOST common type, but after 1-2 yrsafter 1-2 yrs nodular nodular melanoma melanoma -Acral(distal) lentiginous melanoma affects -Acral(distal) lentiginous melanoma affects mostly fingers and toes(nails) and is the most mostly fingers and toes(nails) and is the most type in colored patientstype in colored patients

SKIN TUMORS

MALIGNANT...(cont.) MALIGNANT...(cont.) MELANOMA... MELANOMA... -Clinical Dx. -Clinical Dx. A. A. Asymetry of shape Asymetry of shape B. Border is irregular B. Border is irregular C. Color is uneven C. Color is uneven

SKIN TUMORS

MALIGNANT...(cont.) 5. MALIGNANT...(cont.) 5. MYCOSIS FUNGOIDES(T-cell lymphoma) MYCOSIS FUNGOIDES(T-cell lymphoma) -In fact it represents a stage in the wide spec -In fact it represents a stage in the wide spec trum of lymphoproliferative disorders trum of lymphoproliferative disorders that affects the skin. that affects the skin. -There are 2 different clinical types: a chronic -There are 2 different clinical types: a chronic proliferative disorder and a nodular proliferative disorder and a nodular eruptive presentation. Also, it can eruptive presentation. Also, it can be seen a more agressive form of adult T-cell be seen a more agressive form of adult T-cell leukemia/lymphomaleukemia/lymphoma

SKIN TUMORS

KAPOSI SARCOMA. -KAPOSI SARCOMA. -There are four types of the disease: chronic There are four types of the disease: chronic (European KS), lymphadenopathic(African or (European KS), lymphadenopathic(African or endemic KS), transplant-associated endemic KS), transplant-associated (immunosuppresion-associated) and AIDS- (immunosuppresion-associated) and AIDS- associated(most common form in US) present associated(most common form in US) present in approximately 1/3 of AIDS patients, particularly in approximately 1/3 of AIDS patients, particularly male homosexuals. -male homosexuals. -The morphology of KS is similar in different types, The morphology of KS is similar in different types, w/relatively indolent evolution in old men as well as w/relatively indolent evolution in old men as well as in non-AIDS presentation of the disease.in non-AIDS presentation of the disease.