Skin Tumors Important Question And Answers

Skin Tumors Important Question And Answers

Skin Tumors

Question 1. Write a short note on basal cell carcinoma.

Answer. It is the most common malignant skin tumor.

• It is a slow-growing neoplasm.
• It arises from the basal cell of the pilosebaceous adnexa and occurs only on the skin.

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Basal Cell Carcinoma Common Sites

• The majority of lesions are found on the face.
• Inner canthus and outer canthus of eyes.
• Eyelids.
• Bridge of the nose.
• Around nasolabial fold.
• These sites are the area where the tears roll down; hence, it is also called ‘Tear cancer.’
• Nodular: Common on the face.
• Cystic/Nodulocystic
• Ulcerative
• Multiple: Associated with syndromes and other malignancies.
• Pigmented basal cell carcinoma: It mimics melanoma
• Geographical or forest fire basal cell carcinoma: Involve wide area with central scabbing and peripheral active proliferating edge.
• Basio-squamous: Behave-like squamous cell carcinoma and spread in lymph nodes

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Basal Cell Carcinoma Etiology

• Ultraviolet rays are the main factor in its development.
• Fair skin is vulnerable to development of it.
• Prolonged administration of arsenic in the form of arsenical ointments.

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Basal Cell Carcinoma Clinical Features

• It is common in males in middle-aged and elderly
• The most common clinical presentation is an ulcer that never heals.
• It is common on the region of the face, i.e., above the line drawn between the angle of the mouth and the ear lobe.
• It can also present as a painless, firm nodule.
• It is pigmented with fine blood vessels on its surface.
• The ulcer has a raised and *beaded edge; induration may be present and bleed on touch.

Basal Cell Carcinoma Spread

• It spread by local invasion.
• It slowly penetrates deep inside, destroying the underlying tissue like bone, cartilage, or even eyeball, hence the name “rodent ulc.”.

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Basal Cell Carcinoma Treatment

• It is radiosensitive. If the session is away from the vital structure, then curative radiotherapy can be given.
  Radiotherapy is not given once it erodes cartilage or bone.
• Surgery: Wide excision (l cm clearance) with skin grafting, primary suturig, or flip (Z plasty, rhomboid flap, rotation flap) is the procedure of choice.

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• Laser surgery, photodynamic therapy, 5-fluorouracil local application.
• Cryosurgery.
• Microscopically Oriented Histographic Surgery (MOHS):
  • It is useful to get a clearance margin and in conditions such as basal cell carcinoma close to the eyes, nose, or ear to preserve more tissues.
  • MOHS is becoming popular in basal cell carcinoma. The procedure is done by a dermatological surgeon along with a histotechnician/histologist.
  • Under local anesthesia, a scheduled excision of the primary tumor is done, and quadrants of the specimen are mapped with different. The specimen is sectioned by a histotechnician from margin and depth, and it is stained using eosin and hematoxylin. Lt is studied by an MOHS surgeon or histologist.
  • Residual tumor from the relevant mapped area is excised, and the procedure is repeated until a clear margin and clear depth are achieved.
  • Clearance must be complete and proper in basal cell carcinoma.