Skin Tumors Important Question and Answers

Skin Tumors

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

Answer. It is the most common malignant skin tumor.

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

Basal Cell Carcinoma Common Sites

• 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 face.
• Cystic/Nodulocystic
• Ulcerative
• Multiple: Associated with syndromes and other malignancies.
• Pigmented basal cell carcinoma: It mimics melanoma
• Geographical or forest fie 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 for its development.
• Fair skin is vulnerable for development of it.
• Prolonged administration of arsenic in the form of arsenical ointments.

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 face, i.e. above the line drawn between angle of mouth and ear lobe.
• It can also present as a painless, fim, nodule.
• It is pigmented with fie blood vessels on its surface.
• The ulcer has 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 ulcer”.

Basal Cell Carcinoma Treatment

• It is radiosensitive. lf lesion is away from 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 suturing or flp (Z plasty, rhomboid flp, rotation flp) is the procedure of choice.
• Laser surgery, photodymamic therapy, 5-florouracil 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 eyes, nose or ear, to preserve more tissues.
  • MOHS is becoming popular in basal cell carcinoma. Procedure is done by dermatological surgeon along with a histotechnician/histologist.
  • Under local anesthesia, a saucerized excision of the primary tumour is done and quadrants of the specimen are mapped with diffrent colors.
  • Specimen is sectioned by histotechnician from margin and depth and it is stained using eosin and hematoxylin. lt is studied by MOHS surgeon or histologist.
  • Residual tumor from relevant mapped area is excised and procedure is repeated until clear margin and clear depth are achieved.
  • Clearance must be complete and proper in basal cell carcinoma.

 

Question.2. Write short note on epithelioma.

Answer. It is also called “squamous cell carcinoma”.

• It is the second common malignant tumor of skin after basal cell carcinoma.
• It arises from prickle cell layer of the skin.
• It usually affcts elderly males.

Epithelioma Clinical Features

• It is an ulcerative or cauliflwer-like lesion.
• Edges are *everted and *indurated.
• Base is indurated and it may be subcutaneous tissue,muscle or bone.
• Floor contains cancerous tissue, which look like granulation tissue.
• It is pale, *friable, bleed easily on touch.
• Surrounding area is also indurated
• Mobility is usually restricted.

Epithelioma Investigations

• Wedge biopsy from edge.
• FNAC from lymph node
• USG/CT scan to identify the nodal disease
• MRI to identify local extension.

Epithelioma Treatment

• Radiotherapy using radiation needles, moulds, etc. is given.
• Wide excision, 2 cm clearance followed by skin grafting or flps.
• Wide excision should show clearance both at margin as well as in the depth.
  • If muscle, fascia, cartilage are involved, it should be cleared.
  • Reconstruction is usually done by primary split skin grafting. Delayed skin grafting can also be done once wound granulates well.
  • Often flops of different type are needed depending on the site of lesion.
• Amputation with one joint above.
• For lymph nodes, block dissection of the regional lymph nodes is done.
• Curative radiotherapy is also useful in tumors which are not adherent to deeper planes or cartilage as squamous cell carcinoma is radiosensitive.
  • It is also useful in recurrent squamous cell carcinoma and in patients who are not fi for surgery.
  • A dose of 6000 cGy units over 6 weeks; 200 units/day is used. Recurrence after radiotherapy is treated by surgical-wide excision.
• In advanced cases with fied lymph nodes, palliative external radiotherapy is given to palliate pain, function and bleeding.
• Chemotherapy is given using methotrexate, vincristine, bleomycin.
• Field therapy using cryoprobe or topical florouracil or electrodesiccation.

 

Question.3. Write short note on neurofibroma.

Answer. Neurofibroma is a benign tumor arising from connective tissue of a nerve containing ectodermal neural and mesodermal connective tissue components.

Types of Neurofiroma

Nodular:

• Single, smooth, fim, tender swelling which moves horizontally or perpendicular to direction of nerve.

Plexiform:

• Occurs along distribution of trigeminal nerve in skin of face.
• Attain enormous size with thickening of skin which hang downwards.

Von-Recklinghausen’s Disease:

• Inherited disease with multiple neurofiromas in body.
• It can be cranial, spinal or peripheral
• Associated with pigmented spots on skin, i.e. Caféau-lait spots.

Elephantiasis:

• Origin is congenital and involve limbs.
• Skin of limb is thickened, dry and coarse.

Cutaneous:

• Small, multiple, firm/hard nodules arising from terminal ends of dermal nerves
• It can be pedunculated or sessile.

Neurofibroma Clinical Features

• Mild pain or painless swellings seen in subcutaneous and cutaneous plane with tingling, numbness and paresthesia.
• Most commonly affected sites are trunk, face and extremities
• Sessile or pedunculated elevated small nodules of various sizes
• Majority ofpatients have asymmetric areas ofpigmentation known as Café-au-lait spots. They are smooth-edge dark brown macules.
• Lisch nodules are present which are translucent brown pigmentation on iris.
• Crowe’s sign is present, i.e. axillary freckling, brown spot on skin.

Neurofibroma Complications

• Cystic degeneration is present.
• Spinal and cranial neurofiromas can cause neurological defiits.
• Spine dumb-bell tumor lead to compression of spinal cord and paralysis of limb.
• Hemorrhage in tissues.

Neurofibroma Treatment

Excision is done.

 

Question.4. Describe features of mole turning into melanocarcinoma.

Answer.

Following are the Features of mole turning into Melanocarcinoma.

• Lesion show superfiial radial growth pattrn.
• Lesion becomes ulcerated and growing day by day in size.
• Fungating growth is present associated with the bleeding.
• It leads to destruction of the underlying bone
• Lesion is fim on palpation
• Borders of lesion are erythematous.

 

Question.5. Write difference between squamous cell carcinoma and basal cell carcinoma.

Answer. Following are the differences between squamous cell carcinoma and basal cell carcinoma: