Squamous cell Carcinoma

Malignant melanoma
Squamous cell carcinoma
 Squamous cell carcinoma
• MC type of skin cancer
• Other sites - head & neck, cervix, anal canal & vagina
• 5th-6th decades
• M>F
• C/F: small –large nodules, ulcerative growth, bleeding
•ETIOLOGY and RISK FACTORS:
UV LIGHT
IMMUNOSUPPRESSION
TOBACCO
ALCOHOL
BETEL LEAF
ACTINIC KERATOSIS
HPV
ULCERATION
 PATHOGENESIS
• 70% of SCC in oropharynx are associated with HPV

• Most common mutations in SCC involve p53 pathway

as well p63 and NOTCH1(squamous differentiation)

• HPV associated SCC, common mutation is p16

overexpression along with oncoprotein E6 and E7
expression and inactivation of p53 and RB pathways
 Morphology

• Grossly:
Early stage- firm, pearly plaques or irregular
roughened or veruccous areas of mucosal thickening.

As the lesions enlarge- ulcerated and protruding

masses with irregular and indurated borders are seen
SQUAMOUS CELL CARCINOMA GROSS
(2 points)

• Hemimandibulectomy specimen showing a ulcero

proliferative growth with irregular border
• Growth shows areas of necrosis and hemorrhage
 Morphology
• Histology:
Early disease - range from dysplastic
epithelial lesions to full thickness lesions (carcinoma in
situ)
SCC - nests or sheets of neoplastic
squamous cells with pleomorphic vesicular nuclei,
prominent nucleoli and moderate cytoplasm invading
into the underlying stroma.
Well differentiated keratinizing neoplasms to anaplastic
sarcomatoid tumors.
Keratin
pearl
 SQUAMOUS CELL CARCINOMA
Microscopy( 2 points)
• Nests of malignant cells seen with vesicular nuclei,

prominent nucleoli and scant cytoplasm along with keratin

pearls

• Surrounding stroma showing mixed inflammatory infiltrate

of lymphocytes and neutrophils

MALIGNANT MELANOMA

14
• Most deadly of all skin cancers

• Sites: Skin, oro and ano-genital mucosal surfaces,

esophagus, meninges, uvea of eye
 Pathogenesis
Inherited as an autosomal dominant trait(10-15%)

Majority occur sporadically

• Single most important cause is UV radiation exposure.

• Decreasing amounts of melanin in fair skinned individual

also attributed.
• Driver mutations in melanoma:

1. CDKN2A

2. RAS and PI3K

3. TERT
 MORPHOLOGY
Melanomas can show different variation in color with irregular
and often notched borders
Growth patterns
1. Radial Growth- within epidermis
• Types- Lentigo Maligna- indolent lesion on face
Superficial Spreading- MC type; on sun exposed skin
Acral/ lentiginous- unrelated to sun exposure
2. Vertical Growth- Appearance of nodule
Metastatic potential

Breslow Thickness
 MELANOMA Gross (2 points)
• Specimen of foot showing a blackish exophytic lesion
arising from the skin of the heel.

• Cut section shows a blackish growth arising from the

skin and infiltrating the deeper structures.
 MORPHOLOGY

HISTOLOGY:

• Individual melanoma cells are larger than

melanocytes
• Large nuclei with irregular borders, peripheral
clumped chromatin and eosinophilic nucleoli
MELANOMA Microscopy (2 points)
• Section shows squamous epithelium overlying a malignant tumor
composed of nests and sheets.

• Large cells with moderate cytoplasm, pleomorphic nuclei, prominent

eosinophilic nucleoli and abundant melanin pigment.
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