Premalginant highly suspected lesion to turn to malginant so

they should diagnosied or treated very early.reason of all skin

tumor prolonged exposure of skin to sunlight.other reason
chronic irriation chemical irriation
From the shape of the ulcer we can make clinical diagnosis of the type of skin tumor. There are five types of ulcers

Sloping ulcers healing traumatic and in the phase of healing . Epithilized and growing into the center

Punched out(cut off) ischemic ulcer (no evidence of healing)

Undermind ulcers: tuberculosis and pressure sore from inside it much larger than outside
Rodent ulcers some source of healing

Everted ulcers very aggressive tumor growth over the healing process that is what make them everted
Both rodent and everted ulcers are charactistic for skin tumor
Mycosis fungoides it is not fungal infection it is localized lymphoma in the skin

BCC very rare distal mets if left without treatment tissue destriction happen
Charactisic locally invasive
enil riah. 3 enob laitpecco. 2 htuom fo elgnA . 1Area of face that is exposed to sun
Light skin people very senstive to skin light because no adequative melanocyte to produce melanin
 Rodent ulcer very ugly very destrictive to deep tissue very aggressive tumor

Great amount of melanocyte produce melanin that look as black melanotic appearance
 )pearl appearance) ‫ بكون على شكل لؤلؤ‬vessel ‫نشوف‬
Necrosis of center heep up expanding to surounding tissue

Recurent BCC more agressive than primary tumor

 Anatomy and histology

Hairy skin
Glabrous skin
reticular ‫ و‬papillary ‫ عبارة عن‬Dermis
Epidermis :lucidum usually in the sole and palm
Transformation to malignant cell happen after basal lyer
year old )30 _20s ulcers aggressive usually develop from chronic burn or scar for longstanding burn or ulcers (’ Marjolin
More aggressive than common SCC
Charactistic feature everted edges
There is a picture of groin although it is not exposed area a squamous carcinoma can happen in it due to old scar
burning or chronic irriation or painting

cure100% TIS non invading basement membrane very early stage if exicise it
criteria)7High risk features (
invasion of facial bone3 T
long bones extremities4 T
)2with N3 or T2 or T1 or ((T3 or N4 t ro stem tnatsid:4 Stage
 Keratoacanthoma very early squamous or we consider it premalignant or malignant from begining
Duration of growth and physical features uses for differential diagnosis when similiar clinical appearance happens
Cardinal symptoms suggesting malignant transformation

Irregural preexiting pigmented mole

Vargiated mean different stages of color because of disappear of color or darken
 Irregural preexiting pigmented mole
Vargiated mean different stages of color because of disappear of color or darken
 A melanotic M no excessive melanin comes from melanocytes
Lentigo malignant melanoma premalignant that develops pigmented nodule after that it turns to malignant
Acral lengtiginous melanoma in the palm or sole or under the nail bed (subungle)there is no melanin so any new
pigment lesion presented should consider MM until prove otherwise
These pictures present exicision of pigmented lesion in the medial arch (not well bearing area) it was planned to use flap
reconstriction to cover the area but they could proximated the skin to colse it directly without flap reconstriction

Sentineal lymph node it uses to determine if there are regional lymph node mets it is the first lymph node to be affected
We injuct some radioactve subs and follow by x ray
The sentineal lymph node is the first lymph node to filtered by carcinomatic cell of MM
The following picture is for satellite nodules

T depends on depth not size

Macrometastitic the lymph node is hard you can feel it durated look like there is filteration of carcinomatic cell otherwise
prove of histopathology( we can not find that is affected by clinical examination)
M1a single nodular mets
 Surgical Teatment for cutaneous MM according to depth of tumor

Magin it can be lateral or deep

Lymph node clearance if the lymph node where in lower limb we go to groin if it is in the upper limb we go to axillia
Typical level of amputation we take adequate margin .we exicise involving distal interpharangeal joint.we use flap to
close it posteriourly.we have to do bone shortage to have good cover the stump underneath it

The following topic is mycosis fungoides

We can diagnosis only by taking part of it and send it to histopathology

Kaposi’s sarcoma

Rare type of skin cancer caused by the virus human herbesvirus 8

Kaposi’s sarcoma associated heresvirus (KSHV)
Speard during sex through blood or saliva ,from mother to her baby during birth
Four main types:
HIV related kaposi’s sarcoma aggressive
Classical kaposi’s sarcoma most benign tumor
Transplant kaposi’s sarcoma immunocomprimise to accept organ
Endemic or african kaposi’s sarcoma