Professional Documents
Culture Documents
SKIN
PONGSAK MAHANUPAB,M.D.
Department of Pathology
Faculty of Medicine Integumentary System ( 330203) Sept.2
วัตถุประสงค์เชิงพฤติกรรม
เมื่อสิ้นสุดการเรียนการสอน นักศึกษาสามารถ
1. ทราบชนิดเนื้องอกของผิวหนังที่พบได้บ่อย
รวมทั้งซีสต์ของผิวหนัง
2. ทราบพยาธิกำาเนิดของเนือ้ งอกของผิวหนัง
3.
ทราบลักษณะที่เห็นด้วยตาเปล่าและลักษณะที่เห็นจากกล้อง
จุลทรรศน์ของเนื้องอกเหล่านัน้
Content
1. Tumors of epidermis
- Squamous cell carcinoma
- Basal cell carcinoma
- Actinic keratosis
Content
3. Tumors of melanocytes
- Nevus
- Malignant melanoma
4. Tumors of blood and lymphatic
vessels
- Hemangioma, lymphangioma
Content
5. Cysts of the skin
- Epidermal inclusion cyst
6. Tumor-like lesions of skin
- Seborrheic keratosis
- Keratoacanthoma
- Keloid/hypertrophic scar
Tumors of Epidermis
SQUAMOUS CELL
CARCINOMA
PROLIFERATI
ON OF
BASALOID
CELLS
ACTINIC KERATOSIS
- Premalignant lesion
( precancerous lesion )
- Result from chronic
exposure to sunlight
- High incidence in lightly
pigmented individual
- Ionizing radiation,
hydrocarbons, arsenicals
may induce
•Gross
- <1 cm. in diameter, tan
brown, red or skin colored,
scaly
- Rough, sandpaper-like
consistency
- Increase keratin similar
to cutaneous horn
- site of involvement :- sun
exposure area ( face, arm,
dorsum of hands ), lip
( actinic cheilitis )
•Erythematous scales -
somes are pigmented,
peripheral spreading
•Can develop into
squamous cell
carcinoma ( about 20
%),
Multiple lesions on areas exposed
to sun
Minimally elevated, slightly scaly,
flesh colored to pink
•Microscopic
- Cytologic atypia at the
lower most layers, may be
associated with
hyperplasia of basal cells
- Atrophy:- thinning of
epidermis
- Basal cells:- dyskeratosis
with pink or reddish
- Stratum corneum is
thickened with retained
nuclei ( parakeratosis )
- Presence of intercellular
bridge
- Dermis :- thickened,
blue-gray elastic fibers
(elastosis), a probable
result of abnormal dermal
elastic fiber synthesis by
sun-damaged fibroblasts
focal or confluent
parakeratosis
Cellular atypia and
mitotic figure in deep
epidermal layer, may
bud in to superficial
dermis
Normal
epidermis
HYPERKERAT
OSIS AND
PARAKERATO
SIS
Tumors of Skin
Appendages
SKIN APPENDAGE TUMORS
- Some have a
predisposition for
occurrence on specific
- Syringoma :- lesions of
eccrine differentiation ,
multiple small tan papules
in the vinicity of the lower
eyelid
Small papules, 1-2 mm., mainly at
lower eyelid
Epithelial strands of small
basophilic cells, characteristics
of cystic duct ( commalike or
tadpole ) lined by a double-
layer of flattened epithelial
cells containing colloid material
- Trichoepithelioma :-
follicular differentiation,
multiple , semitranslucent,
dome-shaped papules
- Face, scalp, neck, upper
trunk
SEBACEOUS CARCINOMA
JUNCTIONAL NEVUS
Compound nevus
- Junctional + intradermal
(dropping of)
- Three types of nevus
cells
A, B and C
N
COMPOUND NEVUS
Type A : upper dermis, “
epithelioid cell “ cuboid,
abundant cytoplasm,
varying amount of melanin
pigment
TYPE A NEVUS
CELL
Type B : middle,
smaller, less
cytoplasm,less melanin,
resemble lymphoid cells
Type C : lower, resemble
fibroblast or Schwann
cells, elongated, spindle-
shaped nuclei, strands,
rarely contain melanin
TYPE C NEVUS
CELL
Intradermal
nevus
- No junctional
activity
NEVUS CELL
MALIGNANT
MELANOMA
•Originate from
melanocytes
at DE - junction
•More than half, arise de
novo
•Cause : sunlight,
intermittent sunburn
• Presence of pre-existing
nevus
• Clinical warning signs
1. Enlargement of pre-existing
mole
2. Itching or pain in pre-existing
mole
3. Development of new pigmented
lesion during adult life
4. Irregularity of border of
•Classification
- Radial growth :
horizontally growth within
epidermis and superficial
dermis
- Vertical growth :
dermal layer as expansile
•Microscopic
- Melanoma cell - larger
than nevus cells, larger
nuclei, irregular contour,
prominent red nucleoli
- Poorly formed nests or
individual cells
- Pagetoid invasion of
epidermis
PROMINENT
NUCLEOLUS
Pagetoid skin
invasion
Tumors of Blood and
Lymphatic Vessels
HEMANGIOMA
- Extremely common,
particularly in infancy and
childhood about 7 % of all
benign tumors
- Most benign pediatric
hemangiomas are capillary
and cavernous
- Presence from birth and
expand along with the
growth of children
- Many regress
spontaneously at or before
puberty
Capillary Hemangioma
- Less common
- Gross:- red-blue, soft spongy ,
2 cm.
- Microscopic : sharply defined,
not encapsulated, large, cavernous
vascular spaces, intravascular
thrombosis with associated
dystrophic calcification
Lymphangioma
W
ALL
KERATIN
CAVITY
FOREIGN BODY
REACTION
Tumor-like Lesions
SEBORRHEIC
KERATOSIS
• Very common, often multiple
• Trunk, face,extremity
(except palm,and sole )
• Do not appear before middle
age
• Sharply demarcated, brown ,
slightly raised, stuck on the
- Stuck on
lesion
- Sharply
defined
- Softly
lobulated
papule or
plaque
- Warty
surface
•Histopathology
- Hyperkeratosis,
acanthosis
- Basaloid cells:
proliferation of small ,
uniform, relatively
large nuclei
- Horn cysts
ACANTHOSIS
Epidermal hyperplasia Proliferation of
basaloid cells
( acanthosis )
Horn
cyst
PROLIFERATION OF BASALOID CELLS WITH
MELANIN PIGMENT
HORN CYST
KERATOACANTHOMA
•Solitary or multiple
•Common, clinically and
histologically resemble
squamous cell carcinoma
•Elderly
•Firm,dome- shaped nodule
1 - 2.5 mm.
•Reach full size within 6
- 8 W,
involuted
spontaneously about
one year
•Increase incidence in
immunosuppressed
Raised smooth
edge and
umbilicated,
crusted center
lesion
•Histopathology
- Large center,
irregular shape
crater,keratin
- Lips or buttress
- Base : irregular
epidermal
LIP
CRATER
LIP
dome-or cup-
shaped
elevated wall
central keratin
mass
BASE
FIBROEPITHELIAL
POLYP
• Acochordon, squamous
papilloma, skin tag
• Common
• Middle age and old
• Neck, trunk, face,
intertriginous area
• Soft, flesh - colored, baglike,
•Histopathology
- Fibrovascular core
- Benign squamous
epithelium
KELOID / HYPERTROPHIC
SCAR