1. Skin Cancer
Group A 4th year
Surgery Department
Chiangrai Prachanukroh Hospital

3. Physiologic Function
• Squamous epithelial cells
(keratinocytes)
• Melanocytes
• Dendritic cells & Langerhans cells
• Neural end organs
• Adnexal components

4. Malignant Tumors of the Skin
• frequently subject to epidermal tumors
• arising from cells of the dermis or adnexal
structures are relatively uncommon
• UV radiation, albino individuals of dark
skinned races is associated with an
increased development of skin cancer

5. Type of Skin Cancer
• Non – Melanomas
– Basal Cell Carcinoma
– Squarmous cell Carcinoma
• Melanomas
• Others
– Merkel Cell Carcinoma
– Kaposi's Sarcoma
– Extramammary Paget's Disease
– Angiosarcoma
– Dermatofibrosarcoma Protuberans
– Fibrosarcoma
– Liposarcoma

6. Basal Cell Carcinoma
• most common type of skin cancer
• slow growing, and Locally invasive
• Most commonly develop on sun-exposed
areas (e.g., nose, lip)
• Mutations : PTCH, p53.
• several subtypes

7. Basal Cell Carcinoma
• Nodulocystic Subtype
– Found on 70% of BCC
– pearly papules often containing prominent,
dilated subepidermal blood vessels
– Rodent Ulcer
(Rat Tooth)

8. Basal Cell Carcinoma
• Superficial subtype
– commonly occur on the trunk
– Flat red, scaling lesion (Bowenoid Lesion)
• Pigmented subtype
– tan to black in color must DDx with early
Malignant Melanomas
• Others : morpheaform, micronodular,
infiltrative

9. Superficial subtype
Pigmented Subtype
Morpheaform subtype

11. Treatment
• Surgical
– Excision (Margin 2 – 4 mm)
– Moh’s surgery
• Destructive
– Electrodessication/curretage
– Cryosurgery
– Laser phototherapy
• Medical
– Radiotherapy

12. Squarmous Cell Carcinama
• Seccond most common
of skin cancer
• Arise from Epidermal
Keratinocytes
• More invasiveness and
tendency to metastasize
than BCC
• Sun-exposed sites
in older people

13. Squarmous Cell Carcinama
• Dysorganized Keratin
• Keratin Horns on fleshy tumorous base
• Surface tends to ulcerate

14. Squarmous Cell Carcinama
• Tumor Thickness
• Local of Lesion (Metastasize Early)
– burn scars (Marjolin's ulcer)
– areas of chronic osteomyelitis
– areas of previous injury

16. Treatment
• Surgical
– Excision (Margin 1 mm)
• lymph node (LN) dissection remains topic of debate
– Moh’s surgery
• Destructive
– Electrodessication/curretage
– Cryosurgery
– Laser phototherapy
• Medical
– Radiotherapy

17. Malignant Melanoma
• Pathogenesis of melanoma is complex and
remains poorly understood to date
• Over 90% found on skin
about 10% anogenital mucosal surfaces,
esophagus, meninges, and the eye
• 5 to 10% of Melanomas are Nonpigmented
• The most consistent clinical signs are
changes in the color, size, or shape of a
pigmented lesion needs biopsy

18. Malignant Melanoma
– A (Asymmetry) one portion of the mole does
not match the other
• Radial : Grows horizontally; not associated with
metastases.
• Vertical : Grows downward into the dermis; is
associated with metastases.
– B (Border & Bleeding) edges are irregular,
notched, or blurred
– C (Color) different shades of black or brown,
patchy colors
– D (Diameter) spot is 6 millimeters across, or
growing larger

19. Malignant Melanoma
• The four types of melanoma
– superficial spreading (most common type)
• Found in anywhere except hand and feet
• prolonged radial growth phase
– Nodular (most aggressive type)
• vertical growth phase
– lentigo maligna
• the best prognosis
• indolent lesion on the face of older men
– acral lentiginous
• Unrelated to sun exposure (soles,palms, subungal)
• Hutchinson's sign

24. Additional Skin Malignancies
• Merkel Cell Carcinoma
• Kaposi's Sarcoma
• Extramammary Paget's Disease
• Angiosarcoma
• Dermatofibrosarcoma Protuberans
• Fibrosarcoma
• Liposarcoma

25. Tumors of Skin Migrants
• Mycosis Fungoides (Cutaneous T-Cell
Lymphomas)
• Mastocytosis

26. Syndromic Skin Malignancies
• Basal Cell Nevus (Gorlin's syndrome )
• Nevus Sebaceus of Jadassohn
• Epidermodysplasia verruciformis
• Epidermolysis Bullosus and Lupus
Erythematosus
• Xeroderma pigmentosum
• Familial dysplastic nevus syndrome

27. Preventions
• “Slip! Slop! Slap! Wrap!”
– Slip on a Shirt
– Slop on SPF 15+ Sunscreen
– Slap on Hat
– Wrap on Sunglasses

28. Reference