Malignant Skin Tumors-Presentation,Clinical features,Management

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 MALIGNANT SKIN TUMORS 

1)INTRODUCTION:

  • Skin is outermost coat of human body 
  • Skin act as a protective cover against various insulting agents such as ultraviolet radiation of sunlight
  • 3 malignant skin tumour :

  1. Squamous cell carcinoma
  2. Basal cell carcinoma
  3. Malignant melanoma




2)PRESENTATION :

A)SQUAMOUS CELL CARCINOMA:

  • Carcinoma of cell of epidermis ,starts from prickle cell layer and migrate towards the outer surface.
  • May occur in pre-existing lesion of skin:
  1. Marjolin ulcer
  2. Venous ulcer
  3. Leukoplakia
Site:
  • Junction of skin and mucous membrane eg(lip,eyelid)
  • It is also seen in mucous membrane lined by stratified squamous epithelium (eg)tongue,mouth
Predisposing factors:
  • Scar,ulcer
  • Exposure to sunlight or irradiation
  • Bowen's disease
Types:
  1. Proliferative
  2. Ulcerative 

B)BASAL CELL CARCINOMA (RODENT ULCER)

  • Common malignant skin tumors 
  • Slow growing neoplasm
Location:
  • Majority of lesion found on face above a line from lobule of ear to angle of mouth
Common Site :
  • Eyelid
  • Bridge of the nose
  • Around nasolabial fold
  • Inner,outer canthus of eye 
Types:
  1. Nodular
  2. Pigmented
  3. Superficial
  4. Cystic
  5. Infiltrative
Precipitating Factors:
  • Ultraviolet rays :common in australia,new zealand
  • Fair skin is vulnerable for development of basal cell carcinoma
  • Arsenic in ointment






C)MALIGNANT MELANOMA (MELANOCARCINOMA)

  • Malignant tumour arising from pigment -forming cells (melanoblast)
  • Melanoblast-derived from neural crest 
Common Sites :
  • Head and Neck
  • Lower Extremity
  • Trunk
Predisposing Factors :
  • Ultraviolet 
  • Trauma
Pre-Existing Mole
  • Enlargement 
  • Ulceration
  • Itching 
  • Bleeding
Microscopic Picture:
  • Anaplastic
  • All melanoma show radial growth
  • Nodular melanoma-vertical growth phase 




3)CLINICAL FEATURE:

A)SQUAMOUS CELL CARCINOMA:

  • Ulcerative ,cauliflower like lesion
  • Edge is everted and indurated
Floor :
  • Cancerous tissue ,look like granulation tissue 
Base-
  • Indurated ,may be subcutaneous tissue ,muscle,bone
  • Mobility -restricted
Early Case -
  • Ulcer moved along with skin over underlying structure
  • When squamous cell carcinoma affect lower limb/abdominal wall
  • Regional lymph node,inguinal,lymph node 
  • Enlarged 
Spread:
  • Local spread
  • Lymphatic -chief method
  • Blood -rare,late 



B)BASAL CELL CARCINOMA:

  • Ulcer that never heals
  • Sometimes ,healing takes place 
  1. Scabbing
  2. Breaks down
  3. Ulcer again 
Note:Usually scabbing is seen in benign ,only malignant tumour which show scabbing)
base :
  • Subcutaneous fat (or) deeper structure like muscle,bone 
  • Painless
  • Firm nodule
  • Pigmented with fine blood vessel on its surface
Field fire rodent ulcer:
  • Rapidly growing
  • Disfigurement of facial skin
Spread:
  • Local invasion
  • Slowly penetrate :bone,cartilage 
  • Blood spread-rare
  • No lymphatic spread 



C)MALIGNANT MELANOMA

  • Painless ulcer
  • Floor -irregular
  • Bleeds on touch 
  • Lesion-firm in consistency ,induration-absent 
  • Halo may be present surrounding the ulcer
  • Edges-irregular
  • Lesion moves with the skin ,usually not fixed to underlying structure satellite nodules (within 2 cm of primary )may be found surrounding the lesion
Spread :
1)Local Spread:
  • Occur by continuity and contiguity
2)Lymphatic Spread:
  • Principle mode of spread
  • Spread occur both by permeation and embolisation
3)Blood Spread :
  • Occur early ,cause secondaries in liver 




4)MANAGEMENT :

A)SQUAMOUS CELL CARCINOMA 

1)Primary treatment :

  • Surgery 
  • Radiotherapy 
2)Secondaries 
  • Once primary is treated or controlled along with antibiotics
  • FNAC -to confirm diagnosis 
B)BASAL CELL CARCINOMA:
  • Surgical excision
  • Radiation-elderly patients 
  • Wide excision 
  • Primary suturing -defect if lesion is small
  • Skin grafting -defect as big as in neck or dorsum of hand
c)Malignant Melanoma:
  • Excision biopsy -wide excision 

AIM OF THIS POST :

vanakkam,today we started with a short introduction about malignant skin tumors ,presentation of squamous cell carcinoma,basal cell carcinoma,malignant melanoma its clinical features and finally treatment of these skin tumours ,hope this post helped you learn ,if it helped you do let me know in the comment section below as it would motivate me to post more such content .

Contact Details:
Email:Stencildent@gmail.com
Instagram :Stencildent 

                                          Thank You 

 

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