Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Dermatology PPT 20 Naevi Tumors Lecture Notes
NAEVI AND TUMORS
Nevus
? Circumscribed, non-neoplastic skin or mucosal lesion,
? usually present at or soon after birth.
? Term should always be qualified according to the cell or tissue of
origin, for example "connective tissue nevus" or "vascular nevus".
? Nevi generally represent clones of genetically altered cells arising
from mosaicism.
Benign tumor
? A localized proliferation of cells of one type,
? which has some degree of autonomous control of growth,
? but a normal differentiation.
In situ tumor
? A localized collection of morphologically malignant epidermal cells,
? which have still not invaded the basement membrane
? so it essentially applies to epidermal tumors.
Malignant tumor
? A collection of morphologically malignant cells
? with full capacity to metastasize to lymph nodes and other organs.
? Others:
? Underlying skin diseases
? oculocutaneous albinism
? Xeroderma pigmentosum
? Epidermodysplasia verruciformis
? Chronic venous ulcers
EPIDERMAL TUMORS AND NEVI
? SEBORRHEIC KERATOSIS
? Benign epidermal tumor,
? seen after age of 50.
? Morphology: Multiple, well-defined, hyperpigmented papules with a
"stuck on" appearance, a greasy surface, and keratinous plugs.
? Sites: Face, trunk, and upper extremities.
? Treatment: Can be left alone, remove if cosmetically disfiguring.
Biopsy if diagnosis is in doubt (to rule out malignant melanoma).
? Biopsy- horn pseudocysts
? small black papules, limited to
the upper part of face.
?
Skin Tags
? Familial
? Associated with obesity.
? Acanthosis nigricans.
? Diabetes.
? Soft, skin-colored or pigmented, pedunculated papules
? Neck, axillae, and groins.
? radiofrequency
Melanocytic Nevus
Congenital melanocytic nevi
? Derived from epidermal melanocytes and nevus cel s have a predilection
for deeper penetration.
? Present at birth.
? single,multiple.
? Color varies from brown to black
? lesions darken and enlarge as the child grows.
? With age, the lesions also become raised and develop rugosities
(cerebriform appearance).
? Coarse hair develops in 90% of lesions
?
? Giant lesions are usually seen on the trunk and because they may
cover large areas of the trunk, are called "bathing trunk nevi".
? Complications: potential for malignant transformation is definitely
more in giant congenital melanocytic nevi (bathing trunk nevi).
? Meningeal involvement and spina bifida, seen in lesions located over
vertebral column.
ACQUIRED MELANOCYTIC NEVI
JUNCTIONAL MELANOCYTIC NEVUS
COMPOUND MELANOCYTIC NEVUS
INTRADERMAL MELANOCYTIC NEVUS
OTHERS
? MONGOLION SPOTS
? Bluish ill-defined macules
? Lumbosacral region.
? Regress by age of 4 years
?
? NEVUS OF OTA
? Present at birth.
? Or appears in infancy.
? Macular pigmentation, which has two components: More prominent
slate grey hyperpigmentation due to dermal melanocytes. Brownish
epidermal pigmentation.
? Distribution along the maxillary division of the trigeminal nerve.
? Pigmentation of sclera (slate gray) and conjunctiva (brown) often
present
?
? Halo nevus or Sutton's nevus:
? Melanocytic nevus which develops a halo of depigmentation
? over period of many years, the nevus involutes and
? the depigmented halo repigments.
COMPLICATIONS
? INFLAMMATION
? MALIGNANT CHANGE-
? The following changes in a melanocytic nevus are suspect and
warrant a biopsy:
? Change in size and pigmentation.
? Change in shape and contour.
? Itching, inflammation, ulceration, and bleeding.
?
Verrucous Epidermal Nevus ? localised/
generalised
Variants
? ILVEN
? NEVUS COMEDONICUS
? NEVUS SEBACEOUS
?
Becker's Nevus
? Common condition.
? More frequent in men.
? Begins shortly before, at or after puberty.
? Appears as a hyperpigmented (light-dark brown) patch, which has a
characteristic splashed appearance.
? Over period of time, coarse dark hairs appear on the lesion
? Chest and shoulders.
Epidermoid and Trichelemmal Cysts
? freely mobile over underlying
structures
? tethered to the skin.
? Characteristically, have a central
punctum through which cheesy
material can be expressed
? Sites
? Complications
? Epidermoid cyst: Face, upper
? Secondary infection.
back, and retroauricular region
? Rupture in the dermis and
induce a foreign body reaction.
? Trichilemmal cyst : Most
? Dystrophic calcification
frequent on the scalp.
? MILIA:
? small subepidermal keratin cysts.
? small, firm, white papules,
which are less than 2 mm in
diameter.
? De novo on the face
? At sites of healed subepidermal
blisters e.g., bullous pemphigoid
Premalignant Lesions
? cutaneous horn
? keratoacanthoma
? Bowen's disease
? actinic keratoses
? arsenical keratoses
cutaneous horn
?Cutaneous horn (cornu cutaneum)
? A conical hypertrophic protuberance emanating from a skin-
colored to erythematous papular base
? Height at least one-half of the largest diameter
? Thirty-eight percent to 40 percent of all cutaneous horns
represent AKs
? Is a morphological diagnosis.
? Occurs secondary to:
? Epidermal nevus.
? Warts.
? Seborrheic keratoses.
? Rarely, underlying squamous cell carcinoma.
keratoacanthoma
? Rapidly growing, skin-colored
nodule, which develops a central
horny plug ; the plug falls off to
leave a crater.
? Most lesions resolve
spontaneously, leaving a
depressed (cosmetically
unacceptable) scar.
? Few (very few!!) transform into
squamous cell carcinoma.
Keratoacanthoma
? Solitary or multiple
? rapid growth
? 1 to 2.5 cm
? ulcer with keratinous material
? spontaneous resolution
Bowen's Disease
? Carcinoma in situ
? erythematous plaque
? irregular borders
? enlarging psoriasiform plaque
? indentations (reniform margin)
BOWEN'S DISEASE
? A: psoriasiform plaque, showing
irregular indentations.
? B: infiltration of the lesion
indicates development of
squamous cell carcinoma
? Treatment
? Excision,
? cryotherapy, or
? topical 5-fluorouracil (5-FU).
? Actinic keratoses: pink irregular
macules and papules with dry
adherent scales.
? middle aged and elderly.
? Face, scalp, and dorsae of hand.
? Suspect transformation into
squamous cell carcinoma (a rare
occurrence), if the lesion
enlarges rapidly, ulcerates or
bleeds.
? arsenic keratoses: multiple corn-
like papules.
? rain drop pigmentation
MALIGNANT EPIDERMAL TUMORS
? BASAL CELL CARCINOMA
? SQUAMOUS CELL CARCINOMA
? MALIGNANT MELANOMA
1. BASAL CELL CARCINOMA
? The most common cancer
affecting humans
? Slow growing
? At least 75% first tumours are on
the face
? Relatively `benign' in most cases
? but if left untreated can be
disfiguring and life threatening
Basal Cell Carcinoma
? Raised, with pearly border
? prominent vasculature
? ulceration
? nodular most common
TYPES OF BCC
NODULAR
? Usually begin as a small
pink `pearly' papule
? Develop a depression in
the centre
? Rolled edge
? Overlying telangiectasia
Superficial Basal Cell
? Scaly patches
? irregular borders
? extremities, less common in head
and neck
MORPHOEIC
? White or waxy
? Always on face
? Presents as a spontaneous `scar'
? Margins are usually much wider than
what is clinically visible
Pigmented BCC
? Basal Cell Carcinoma----
histopathology is diagnostic
? Cells resemble those of stratum
basale
? peripheral palisading
? stromal retraction
? Course
? Slowly progressive,
? locally invasive (especially noduloulcerative variant) neoplasm,
? eating into underlying structures like cartilage or bone, if left
untreated.
? Lymphadenopathy and distant metastasis do not occur.
? Surgical excision is treatment of choice in most cases.
? All variants of BCC except the morphoeic variant are excised with a
0.5 cm of skin margin.
? Morphoeic variant is excised with wider margin (up to 2 cm) because
the lateral extent is often indistinct.
Squamous cell carcinoma
? Etiology:
? Damaged skin (photodamaged/scarred/ulcerated skin/leucoplakia/
erythroplasia),
? topical and systemic carcinogens- Pitch tar, mineral oils, and inorganic
arsenic
? human papilloma virus
? immunosuppression - HIV
? Certain rare genetic disorders, with defective DNA repair
mechanisms, such as xeroderma pigmentosum
? A: raised ulcer with indurated
base and everted margin
(cauliflower-like) on the lower lip.
? B: raised ulcer with indurated
base and everted margin at site
of radiation dermatitis.
? Metastases
? Lymphadenopathy: Regional lymphadenopathy. Nodes hard and
sometimes fixed to underlying structures and tethered to skin.
? Visceral metastases: Infrequent.
? scc
? characteristic histology.
Malignant Melanoma
? Etiology:
Clinical variants :
? Multifactorial.
lentigo maligna melanoma,
? Actinic damage important.
superficial spreading melanoma
? Evidence of nevi in 25% of
(SSM),
patients with MM.
acral lentiginous melanoma, and
nodular malignant melanoma
(NMM).
SSM most frequent while NMM is
the most aggressive.
? Asymmetrical pigmented nodule,
? Border irregularity,
? Color variability,
? Diameter >0.5 cm,
? Elevation irregularity.
Subungual
Metastatic melanoma
melanoma
? histological grading using
Breslow's method.
? measures the vertical distance
(in mm) from granular cell layer
to the deepest part of tumor,
using a microscopic micrometer.
? prognostic predictor.
Benign Tumors of Skin Appendages
Malignant Tumors of Skin Appendages
Paget's Disease
? Paget's disease of breast:
? sharply marginated plaque with
a slightly raised edge and an
irregular outline.
? If the crusts are removed, a red,
glazed, moist surface is revealed.
? Note destruction of nipple.
Benign Tumors and Nevi of Dermis
? Port-wine stain: deeply
erythematous, telangiectatic
slightly bosselated lesion on the
face.
? Usually present at birth.
? Salmon patch
? Is a capil ary malformation
? Commonest vascular malformation
present at birth.
? salmon patch involutes by the age
of one.
? Presents as telangiectatic macules.
? Nape of neck, forehead, and
eyelids.
? Treatment None required.
? Venous malformation: a soft
compressible bluish swelling,
which increases in size when
dependent
? Lymphatic malformations
? Usually present at birth.
? Characterized by a cluster of
thin walled vesicles (resembling
frog spawn).
Infantile hamangioma
? Lesion appears within a few
weeks of birth and grows for a
few months.
? Spontaneous regression occurs
with minimal atrophy in most
patients.
? Soft, brightly red (strawberry
colored) nodule with pale
stippling indicating resolution
? Complications:
? Treatment
? Large swellings near orifices
? Small lesions: Resolve
(oral, nasal, anogenital)
spontaneously.
interfere with function.
? Large symptomatic lesions:
? Bleeding may follow trauma.
? Systemic steroids
? Ulceration especially in large
? Propranolol
lesions and in intertriginous area. ? Lasers: pulsed dye laser in
residual lesions.
Beningn acquired
hemangioma/ pyogenic
granuloma
Malignant Tumors of Dermis
Cutaneous T Cell Lymphoma (Mycosis Fungoides)
? Lymphoma of helper T cel s.
? Initial patch stage of wel -defined, bizarre
shaped, atrophic patches; poikiloderma
? later infiltrated plaque stage and then
? tumor stage with aggressive course.
? Characteristic histology with presence of
atypical cel s (Pautrier's microabscesses);
epidermotropism
? Treatment: Early stage: Topical steroids,
topical nitrogen mustard, PUVA, acitretin
and electron beam treatment.
? Tumor stage: Chemotherapy.
? Others:
? LCH
? Kaposi sarcoma
QUESTIONS (please answer in one word)
? 1. Horn pseudocysts are a feature of ?
? 2. Virus which is implicated in the pathogenesis of skin malignancies-
? 3. Bathing trunk nevus is a type of-
? 4. melanocytic nevus surrounded by a depigmented halo is
? 5.Name a premalignant lesion of skin
? 6.Pautrier microabscesses are seen in
? 7. What is the diagnosis in case of pigmented macules present over
left cheek distributed over maxillary division of trigeminal nerve-
? 8. Which of the malformation is most likely to involute
spontaneously?
? 9. Grouped open and closed comedones arranged linearly are seen in
? 10. . Breslow's method is used for histological staging of
This post was last modified on 07 April 2022