MALIGNANT SKIN 2

SQUAMOUS CELL CARCINOMA (EPITHELIOMA)

These tumours can occur anywhere but usually occur on the exposed

parts  of the body (hand face).

 It also occurs in old burn scars, and sites of chronic irritation or irradiation.

 

CLINICAL FEATURES

The site of tumours formation starts as a hard nodule and develop

into an ulcer or cauliflower like growth.

Metastasis  occurs to the regional lymph nodes. These  are  hard

and soon get fixed to surrounding structure.

Histologic  examination  shows hyperchromatic  atypical  squamous

cells infiltrating the dermis forming "nests" or "pearls".

 

Treatment  is wide-excision with healthy margin or irradiation. 

The  involved lymph nodes need to be removed en block.

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SKIN TUMOURS MALIGNANT 1

6. MALIGNANT TUMOURS

6.1 Basal Cell Carcinoma (Rodent Ulcer  above left)

 

Clinical features:

Presents  as a hard pearly nodule on the face above the level  of

the  lips. It occurs most often in those above 40 years  of  age. 

The  nodule  shows small blood vessels and may  ulcerate  in  the

centre it grows slowly but does not metastasis.

 

On  histology shows a down growth of cells of the basal layer  of

the  epidermis.The nuclei of these cells show deep  staining  and

there may be extension of spread into the dermis.

 

TREATMENT

Can be with either with surgery (wide excision)or radiotherapy.

 

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SKN TUMOURS 2

4.4 BOWEN'S DISEASE

This is a slow enlarging red raised patch with irregular  outline

crusting is present.

   *  Histologic examination shows that the epidermis is

      thickened, cells are atypical and keratinisation is marked.

   *  Squamous cell carcinoma develops after many years.

   *  Treatment is wide excision.

 

5. TUMOURS OF THE DERMIS

5.1  The  tissue  of  the dermis can give  rise  to  LIPOMAS  and

NEUROFIBROMAS   the   latter  present  as  single   or   multiple

neurofibromas and can be inherited (von Recklinghausens Disease),

the epidermis moves free on these nodules and these nodules  move

free of the deep fascia and muscles. These are benign lesions and

rarely  undergo  malignant change.Malignant change  is  diagnosed

clinically on the basis of :

     a)  Rapid increase in size

     b)  Pain in the lesion

     c)  Fixity to skin or deeper structures

     d)  Metastasis

 

Treatment  of  any skin nodule should be  EXCISION  to  establish

histopathologic diagnosis

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SKIN TUMOURS 1

4. TUMOURS OF SKIN

4.1 Papilloma

Simple non-infective papillomas can occur at any site.

They  are usually pedunculated (Fig.) and the small  finger

like  processes on the surface can be seen with magnifying  lens. 

If  small they can be excised with an ellipse of skin to  include

the base.

 

4.2 KERATO-ACANTHOMA (Moluscum Sebaceum)

This  presents  as a rapidly increasing  hemisepherical  swelling

which soon ulcerates with crust formation (keratin),

It can also be cured by curreting Fig. .

 

4.3 CUTANEOUS NEUROFIBROMA

These  take origin from the sheath of nerves a nodule  can  occur

anywhere on the body and can be multiple.  They may be associated

with pigment of patches of skin.  One of these lesions should  be

removed and submitted for histology.

 

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DERMOID CYSTS

DERMOID CYSTS

These  are  cysts  situated  deep to the skin  and  there  is  no

punctum,thus the skin moves over the cysts.

 - They are either along lines of embryonic union (congenital) in

   the mid line and external angular dermoids

 - They can  also  occur on the palms of hands and  back  due  to

   puncture wounds and result  from  deep  implantation  of  skin

   elements (Implantation dermoid). 

Both varieties are filled with Sebum.

 

TREATMENT

Most dermoids cam be excised under local anaesthesia.The external

angular  dermoids  should  be preceded by  X-ray  to  exclude  an

intraceranial extension.

 

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KELOIDS AND SUBACEOU CYSTS

3.4 KELOID
Following an  injury or surgical incisions,sites of repair show enlarging overgrowth of vascular collagen in the healing wound
leading to ugly scars.

There is a constitutional factor responsible in affected individuals  

The hyperplastic scar as opposed to keloid usually stops  growing,and does not itch.

 

TREATMENT

Lesions  may  be  helped  by small dose  of  radiotherapy  or  local cortisone application.
Surgical excision in combination with other methods may
provide comparable results

 

3. CYSTS

3.1 Subaceous Cysts

This is a cyst in the skin usually in a hair bearing area and  is

believed to originate from a subaceous gland in a hair  follicle,

it is in fact a retnetion cyst due to obstruction of the mouth of

subaceous  gland.  The cyst is found on the scalp and  is  filled

with putty like subaceous material

The  punctum is visible on its summit and is the site  of  block. 

The cyst is attached to the skin on clinical examination.

 

TREATMENT

The uninfected cyst can be excised under local anaesthesia.  

If infected they require antibiotics and drainage

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SKIN CONDITIONS

2.1 Callosity

 

This  is  an acquired localised thickening of the  skin.   It  is

usually  seen in the hands of manual workers. 

 

The thickening  is as  a  result  of use of the hands in  response  to  the  persons

occupation  it  is  protective in nature  and  thus  requires  no

treatment.

 

2.2 Corns

 

These  are  also  callosities on the foot and  are  localised  to

points where the skin is over a joint and receives pressure  from

the joint within and the ill fitting footwear from outside.  They

can also be seen on the sole of the foot.  They can sometimes get

painfull .

 

A change to open foot wear can provide relief.  This can also  be

treated  with  painting with 10% Salicylic acid in  collodian  or

acetone.  The corn peels off.

 

2.3 WARTS

These  are  localised  areas of skin hyperplasia  and  look  like

papillomas and are caused by infection by filterable virus.  They

can  be multiple through cross infection and occur often  on  the

hands and face .

 

TREATMENT

Warts  may be removed by curettage, diathermy or  excision  under

local or general anaesthesia if multiple.

They also respond to treatment with 10% formalin, podophyllin  or

salicylic acid plaster (50%)

 

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