SKIN

CANCER
PATHOLOGY Presentation
By Shahid Bashir and Nawaira Salahuddin
 WHAT IS SKIN CANCER?
Skin Cancer can be defined as abnormal growth of Skin cells.

Exposure to solar radiation (Mild range wavelength Ultra violet B) causes

most skin cancers.

Squamous cell carcinoma and basal cell carcinoma are the most
common skin cancers.

The melanoma rate is rising more rapidly in population younger than

40 years of age. It is in 2nd number to breast cancer in females.
 TYPES OF SKIN CANCER
In this chapter, cancer has been described by three steps.

1. Benign
2. Pre Malignant
3. Malignant

Malignant lesion of the skin are described either as melanoma

or non-melanoma
TYPES OF SKIN CANCER
 BENIGN TUMOR
Seborrheic Keratosis
This is a hereditary benign proliferation of basal cells occurring most
frequently after the middle ages.

It appears as multiple lesions on the chest, back, and face.

The lesions also often appear following hormonal therapy or inflammatory

dermatomes.

These tumors are usually left untreated unless they itch, otherwise,
cryotherapy with liquid nitrogen is an effective treatment.
BENIGN TUNMOR
 NEVI (MOLES)
Aggregation of Melanocytes in skin are called Nevi.

They vary in size and can be of brown, black or flesh colored and can
appear on any part of skin.

Nevi seldom undergo transition to malignant melanoma but when it

does occur it often arises from pre-exiting mole.

The chances of cancerous transformation are increased as a result of

constant irritation.
 PRE-CANCEROUS CONDITION

They are two common pre malignant skin lesion.

1. Actinice Keratosis.
2. Bowen Diseases.
 ACTINICE KERATOSIS
Actinic Keratosis is a skin disease resulting from many years of exposure to
the Sun UV rays.

It results in abnormal cell growth, causing a well-defined crusty patch to

appears on the sun-exposed areas of the body.

These crusts are horny, dry, rough, and are recognized by touch.

Almost half of these estimated five million current cases of skin cancer
begin as Actinic Keratosis.

Not all Keratosis needs to be removed.

 TREATMENT OF ACTINICE KERATOSIS
Actinic Keratosis may be treated by:

1. 5 -Fluorouracil (Efudex).
2. Cryosurgery using liquid nitrogen
3. Electrotherapy.

Patients are advised to avoid Sun exposure and use

Sunscreens of high potency.
 BOWEN DISEASE
Bowen Diseases can occur anywhere on the skin
and on the mucus membrane.

It present as a brown to reddish-brown, scaly

plaque with well-defined margins.

Often, the person has a history of arsenic

exposure in youth.

Treatment is with surgical excision and topical

f 5-Fluorouracil
 MALIGNANT NEOPLASM
Basal cell carcinoma

Definition:
It is an epithelial skin tumor originating from undifferentiated basal cells
contained in the epidermis.
This cancer does not metastasize beyond the skin and does not invade the
blood or lymph vessels.

Etiology:
Prolonged and intermediate skin exposure are the most common causes of
basal carcinoma. Individuals who are HIV positive are most likely to develop
basal cell carcinoma.
BASAL CARCINOMA CLOSE VIEW
INSPECTION
 BASAL CELLS CARCINOMA
Pathogenesis:

The pathogenesis of basal cells tumor remain uncertain.

Basal cells carcinoma are very seldom seen in animal and are not found in
laboratory at all.
One theory suggest that these tumors arise as a result of a defect that prevent
the cells from being shed by the normal keratinization process. Another theory
suggest that undifferentiated basal cells become carcinomatous.

Clinical Manifestation:

It has pearly appearances, have roll edges and is slightly elevated above the
skin area. It is mainly found on Head and Neck region.
 SQUAMOUS CELL CARCINOMA
Definition:
It is a tumor of the epidermal keratinocytes and is the second most common skin
cancer in white/light-skinned individuals.

Squamous cell tumors may be of two types

1. In situ (confined to site of origin)
2. Invasive (Infiltrate surrounding tissues)

Etiology:
Cumulative Overexposure to UV radiation is the main cause of Squamous Cell Carcinoma.
Presence of pre-malignant lesions, radiation therapy, chronic skin irritation and
inflammation may also be responsible.
 SQUAMOUS CELL CARCINOMA
Pathogenesis: UV radiation continues to be one of the most important causes of skin
cancer.

The p53 tumor suppressor gene is often damaged by UV irradiation, so faulty cells are not
removed from the skin.

Melanocytes, the cell that give rise to melanoma, is seen as highly resistant to cell destruction.
Among them, the most damaged by the UV ray undergo Apoptosis while the rest repair
themselves, thus minimizing the chances of potential Squamous Cell Carcinoma.

Clinical Manifestation: More than 80% of SCC occur in the head and neck region.

MARJOLIN ULCER is used for aggressive epidermoid tumors.

 MEDICAL MANAGEMENT

An excisional biopsy provides

definitive diagnosis and
staging of SCC.

A deeply invasive tumor may

require a combination of
techniques. As with all benign, pre
malignant or malignant skin
lesions, sun protection is vitally
important.
 Malignant Melanoma
Neoplasm of skin that originates from
melanocytes.
Melanocytes are mostly found on the
skin but can also be found in the oral
cavity, esophagus, meninges, or within
the eyes.
 Malignant Melanoma
Cutaneous Melanoma can be divided into
Four types:

Superficial Spreading Melanoma

Nodular Melanoma
Lentigo Malign Melanoma
Acral lentiginous Melanoma
 1. Superficial Spreading Melanoma

Most common Melanoma, accounts for 70%

of the cutaneous melanoma.
Occurs in the area of chronic irritation,
like legs of female between knees and
ankle or trunk in both genders.
Usually occurs in people of 20 to 60 years
of age.
Mostly asymptomatic as it arise in pre
existing mole
 2. Nodular Melanoma

Most aggressive form of melanoma, can

be found on any part of the body.
Most common in men of age 60 and
above compared to women.
Small, suddenly appears, quickly enlarges,
dark pigment that invades the dermis.
Accounts for 15% of the cutaneous
melanoma.
 3. Lentigo Malign Melanoma
Mostly occurs on sun-exposed areas, eg,
head, neck, dorsa of hands.
Occurs in people older than 50 and
accounts for 10% of cutaneous
melanoma.
3-6 cm flat freckles with an irregular
border with a pigment of brown, black,
blue-black, red or white.
 4. Acral lentiginous Melanoma
Least common, accounts for only 5% of
cutaneous melanoma
It is the most common form of melanoma in
dark skinned people.
Lesions usually have flat, dark brown
portions with raised bumpy areas.
Most common areas include low pigment
sides where hair is absent, palms of hands,
soles of feet, nail bed etc.
 Incidence
Malignant melanoma accounts for only 5% of overall
Skin Cancer.
Ratio is 1 in every 36 men and 1 in every 55 Women.
The rate is increasing rapidly as in 1930, its ratio was 1
in 1500 individuals.
Peak incidence is among 40-60 years of old people.
 Etiology and Risk Factors

Most people who develope melanoma have blonde hairs (light

brown), fair skin and blue eyes.
These risks factors are considered to be linked with variations in
MCIR that assists in producing melanin (as it helps to protect
skin from UV-rays)
UVA (320-400nm) more prone to cause melanoma then UVB
(280-320nm).
Risk of Melanoma increases to 70% when use taning devices
before 30 years of age.
 Etiology and Risk Factors
Common in families with dysplastic Nevus
syndrome, also called atypical male syndrome.

Occurs when there is intense exposure to UV rays

and when immune system is suppressed im
chemotherapy.
 Pathogenesis

Depends on the intensity more than the

duration of radiation exposure.

Mostly Common in people that work indoors

but are exposed to extreem sun on weekends, eg
sunbathing.
 Kaposi Sarcoma

Malignancy of vascular
tissues that presents as a
skin disorder.
It forms in the lining of
blood vessels and lymph
vessels.
 Etiologic Factors and Incidence
Some researchs indicated that herpes virus can
cause kaposi sarcoma.
AIDS (sexually transmitd but not the one
transmitted through blood transfusion) is also
know to cause it.
Less than 10% chances among HIV infected women,
people with haemophilia and injection drug users
 Pathogenesis
Kaposi sarcoma is an
angioproliferative tumor.
It is suspected that androgenous
substances produced by HIV
infected cells and viral induced
tumorigenesis may promote
angiogenesis and growth of kaposi
sarcoma.
Thankyou for your attention.