Skin Neoplasms
Epidermal Tumors – Benign
Seborrheic Keratosis
- “stuck-on” flat topped papules or plaques
- exceedingly common on the trunks of individuals over the age of 40
- keratosis = presence of hyperkeratosis (thickened stratum corneum)
- Seborrheic = lesions more common in areas with numerous sebaceous glands
- Cream to brown colored (more white on distal extremities)
- MICRO: linear base; sharply demarcated
Nevus Sebaceus
- congenital hamartoma of sebaceous glands, apocrine glands, & papillomatous epidermis
- linear verrucous yellowish hairless plaque
- scalp, head, and neck
- enlarge at puberty due to hormonal stimulation
- basal cell CA-10%
- Treatment: surgical excision
Keratoacanthoma
- volcano with hyperkeratotic plug
- rapid growth over weeks
- may resolve spontaneously
- most common in sun-exposed areas
- resembles squamous cell CA
- Treatment: surgical excision because of similarity to SSCa
Epidermoid Cysts
- grow slowly and accumulate keratin
- tend to get Staph Aureus infections
- cyst can be located anywhere in the dermis or subQ fat
- any age
- contain white, cheesy material consisting mostly of hydrated keratin (produced by the squamous epithelial lining)
- Treatment: surgical excision if the patient desires
Epidermal Tumors – Premalignant
Actinic Keratosis (also called Solar Keratosis)
- hyperkeratotic white papule due to sun exposure in older patients
- erythema frequent
- poor demarcation
- Sun-exposed areas
- Premalignant
- Dysplasia of the epidermis
- “Chicken-fried” connective tissue
- HISTO: atypical keratinocytes in the dermis that have not yet invaded the dermis
- May become SC or BC CA’s if not treated
- Treatment – liquid nitrogen, topical FU, surgical excision
Premalignant Leukoplakia
- Leukoplakia = non-specific term for any white plaque in the mouth
- Premalignant Leukoplakia = subset of leukoplakia where there are premalignant changes (atypia, pleomorphism, hyperchromatism)in the mucosa that may change into squamous cell CA
- Treatment: Surgery
Bowen’s Disease (squamous cell CA in situ)
- full thickness atypical changes in the epidermis
- more advanced than actinic keratosis
- may change into a invasive squamous cell CA
- Clinical: usually several plaques several
centimeters in diameter that may resemble
inflammatory papulosquamous lesions
- Treatment: surgical excision
Epidermal Tumors – MALIGNANT
Basal Cell Carcinoma
- by far, the most common neoplasm in humans
- 1 in 6 Americans
- 99% cure rate
- almost NEVER metastasizes
- slow growing
- sun exposed skin
- pearly & translucent papular nodule with a rolled edge and an ulcerated or atrophic center
- HISTO: cells with small bule nuclei resembling the basal cells of the epidermis; peripheral palisading of nuclei and stromal retraction
- Treatment: radiation therapy or surgery
Squamous Cell CA
- 2nd most common skin cancer
- Nodule; scaling or hyperkeratosis, often with ulceration
- 99% cure rate
- 0.5% metastasizes
- Non-sun-exposed areas with SCC and SCC’s
of the lip have a higher incidence of Mets
- HISTO: keratin pearls; proliferation of squamous
epithelium with varying amounts of atypia
Dermal Tumors – Benign
Neurofibroma
- SOFT, skin colored nodules that occur
anywhere at almost any age
- Neurofibromatosis (von Recklinghausen’s
disease – autosomal dominant) – multiple
lesions
- HISTO: tumor made up of neural tissue
- Treatment: surgery if desired
Dermatofibroma
- HARD (indurated) brownish nodules
- Occur most commonly on the legs
- HISTO: proliferation of fibroblasts
and collagen in the dermis
- Proliferating cell is the fibroblase
- Treatment: surgery if desired
Acrochordon – (Skin Tag)
- common tags of redundant skin found in the armpits, neck, or groin
- often pedunculated
- more common in obese people
- snip them off with scissors
Hemangiomas
- usually red
- HISTO: blood vessel proliferation (usu capillaries)
- Types
1) Cavernous – deeper and consist of larger vessels
2) Cherry – small red papules on the trunks of patients over 30
3) Strawberry – present at or soon after birth
Ø often regress spontaneously
Ø will leave scar tissue
Spider Angioma
- can be associated with liver disease or estrogen therapy
- small blood vessel growths with a central feeding vessel surrounded by spider like legs
- Common in normal females
- Treatment: electrosurgery or laser
Pyogenic Granuloma
- eroding, weeping, red, juicy nodule that grows rapidly
- common on fingers and the mouth
- common in pregnancy
- HISTO: proliferation of blood vessels in a
pale stroma with polymorphous inflitration by
neutrophils and lymphocytes; epidermis thin or eroded
- Treatment: surgery
Lipoma
- very common
- nodule is in the subQ tissue
- proliferation of mature adipose cells
- Treatment: surgery if desired
Dermal Tumors – Malignant
Kaposi’s Sarcoma
- commonly occurs in AIDS patients
- HHV-8
- Purpilish nodules, often oval,
- HISTO: proliferation of spindle-shaped endothelial cells and vascular slit-like spaces
- Blood Vessel tumor
- Can regress spontaneously
Melanocytic Tumors – Benign
Melanocytic Nevus
- commonly called Moles
- Nevus has two definitions
1) used to mean congenital
2) and sometimes used for any hamartoma of the skin
- Three Major types
1) Junctional Nevi
Ø Limited to the dermal/epidermal junction
Ø usually macular & brown
2) Intradermal Nevi
Ø limited to the dermis
Ø usually raised papules or nodules that are skin-colored
3) Compound Nevi
Ø nests in the dermis and the DEJ
Ø usually raised brown nodules or papules
- very rarely (1 in 10000) evolves into a malignant melanoma
Ephelis (freckles)
fair skin individuals
normal # of melanocytes that are producing too much melanin
darken more readily after sun exposure as compared to lentigines
Lentigo Simplex
clinically indistinguishable from junctional nevi
arise in childhood or young adulthood
NOT in old age due to sun exposure as do the other two type of lentigo
HISTO: all lentigines are made up of a proliferation of melanocytes
Solar Lentigo (Senile Lentigo)
- brown macules due to sun exposure
- Treatment: not needed
Café-au-Lait Spot
- “coffee with milk”
- brown macules
- common in normal individuals
- If more than 6 lesions, each > 1.5 cm in diameter, stong liklihood of neurofibromatosis exists.
Nevus Spilus
- flat tan patch with tiny dark specks in it
- onset in shildhood
- may mistake it for a melanoma; treatment not needed
Blue Nevus
- blue papule or nodule
- HISTO: spindled melanocytes in the dermis
- Treatment: unnecessary
Mongolian Spot
- huge blue macule
- present at birth or soon after
- resolves by age 3 years
- most common in babies of dark races in the sacral area
- HISTO: same as a blue nevus
Spitz Nevus
- pink nodule found in children or young adults
- HISTO: looks like malignant melanoma but behaves like a benign tumor
- Treatment: excision (because of similarity to malignant melanoma)
Halo Nevus
- nevus that is being destroyed immunologically
- common in children and adults
- white halo with a residual nevus in the center
- HISTO: nevus cells with invasion by lymphocytes
- Treatment: not needed unless melanoma is suspected
Melanocytic Tumors – Premalignant
Lentigo Maligna
- melanoma in situ of sunexposed skin
- often remain in situ for years or decades before becoming invasive
- usually appears in badly sundamaged areas or older individuals
- dark brown to black macule with a notched border
- HISTO: increased melanocytes at the basal layer (same as in the other 2 lentigines) + epidermal atrophy and atypical melanocytes
- Treatment: surgical excision
Dysplastic Nevus
- unusual nevi that are variegated in color (red, blue, black, and white)
- irregular or ill-defined borders
- often familial history of unusual “moles” or melanoma
- HISTO: proliferations of melanocytes with some atypia and unusual features
- New name—”nevus with architectural disorder”
- Treatment: excision of suspicious lesions; close follow-up
Lentigo Maligna Melanoma
- arises from lentigo maligna
- best prognosis because of minimal invasion
Superficial Spreading Malignant Melanoma
- most common type
- usually occurs in NON-SUN-EXPOSED AREAS -
- intermediate prognosis
Nodular Melanoma
- one solid nodule with NO macular component
- WORST PROGNOSIS
Acral Lentiginous Melanoma
- Acral = distal
- Can occur on the fingers, toes, or often near the nails
- Most common melanoma in blacks
- Prognosis same as for SSMM
General Notes on Malignant Melanomas
3rd most common skin cancer (behind BCCa and SCCa)
5 year survival – 80%
can occur in non-sun-exposed areas
Black lesion with ABCD criteria
Metastasizes to local nodes then to anywhere
Fastest increasing incidence of any cancer – ozone depletion?
Treatment: wide excision, with or without lymph node dissection
What to look for.
irregular notched borders
variegated colors (black, blue, red, and white)
history of color chancge or growth
remember that 1/3 arise from previous nevi and 2/3 de novo
intermittent burning
ABCD Criteria For Dermatologic Malignancies
A Asymmetry
B Borders irregular
C Color variegated
(red, white, blue, black)
D diameter > 6mm
Tags: Acrochordon, Actinic keratosis, Basal Cell Carcinoma, Bowen's Disease, Café-au-Lait Spot, Dermatofibroma, Epidermoid Cysts, Hemangiomas, Kaposi's sarcoma, keratin pearls, Keratoacanthoma, Lipoma, Melanocytic Nevus, Neurofibroma, Nevus Sebaceus, Premalignant Leukoplakia, Pyogenic Granuloma, Seborrheic keratosis, Senile Lentigo, Solar Keratosis, Spider Angioma, Squamous Cell
