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I am giving you guys skin cancer

I am giving you guys skin cancer. RODENT ULCER MARJOLIN’S ULCER EPITHELIOMA. RODENT ULCER. What is it??. Usually a slow-growing , locally invasive malignant tumor of pleuripotent epithelial cells Arising from basal epidermis and hair follicles, hence affecting the pilosebaceous skin.

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I am giving you guys skin cancer

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  1. I am giving you guys skin cancer

  2. RODENT ULCERMARJOLIN’S ULCEREPITHELIOMA

  3. RODENT ULCER

  4. What is it?? • Usually a slow-growing, locally invasivemalignant tumor of pleuripotent epithelial cells • Arising from basal epidermis and hair follicles, hence affecting the pilosebaceous skin

  5. Predisposing Factors • Exposure to UVR • Exposure to Arsenic compounds, coal tar, aromatic compounds, IR, Coal Tar • Genetic Skin Cancers • White skinned people • Age 40-80 yrs

  6. PATHOGENESIS • No apparent precursor lesion • Proportional to initial dose of carcinogen but not duration. • Rarely metastise,Hard to culture,Resist transplantation • Mesodermal factors acting as intrinsic promoters coupled with an initiation step

  7. MACROSCOPIC GENERALISED • LOCALISED • Nodular • Nodulocystic • Cystic • Pigmented • Maevoid 90% • INFILTRATIVE • Ice pick • Morphoeic • Cicatrising • SUPERFICIAL • Multifocal • Superficial Spreading

  8. Variety of bcc

  9. MICROSCOPIC Ovoid cells in nests with single outer Palisading layer

  10. ORIGIN • Basal layer of epidermis. • Occasionally arises from basal cells of hair follicles and sweat glands. • Seen in scalp known as TURBAN TUMOR

  11. Why Rodent Ulcer?? • LOCAL INVASION • Gradually destroys tissues it comes in contact with!! • LYMPHATIC SPREAD not seen • Regional lymph nodes NOT enlarged. • Blood spread rare

  12. CLINICAL FEATURES • SYMPTOMS: • Persisting ulcer or nodule • Not painful / may itch • Grows slowly • SIGNS: • Site- 90% BCC seen on face above line joining angle of mouth to lobule of ear.

  13. SIGNS: Site- 90% BCC seen on face above line joining angle of mouth to lobule of ear.

  14. COMMON SITES • INNER CANTHUS OF EYE • OUTER CANTHUS OF EYE • NOSE • ON AND AROUND NASOLABIAL FOLD • ON THE FORE HEAD Tear Cancer

  15. LESION • Starts as Nodule • Gradually centre of nodule dies and ulcer results. • EDGE- Raised & Rounded.BEADED MARGIN • GROWTH SPREADS- Shape irregular. • FLOOR- Dried Serum, Epithelial cells. • BASE- Tissue & Tumor is eroding ie. Fat, Muscle, Bone!!

  16. PROGNOSIS LOW RISK • HIGH RISK • > 2cm • Eye, Nose , Ear • Ill defined margins • Recurrent ulcer

  17. MANAGEMENT • SURGICAL • Excision • Mohs Micrographic Surgery • Two stage surgery • NON SURGICAL • Curettage • Electrodessication • Laser Vaporization RADIOTHERAPY • No pathological specimen • No confirmation of diagnosis • Tumor margin not confirmed

  18. Mohs Micrographic Surgery

  19. Indications • POORLY DEMARCATED • RECURRENT • INCOMPLETELY EXCISED • AREA AROUND EYES NOSE EAR

  20. PROCEDURE • Performed under LOCAL ANESTHESIA • Initial SAUCERISING EXCISION of primary tumors visible extent. • Sample and the defect are then marked and oriented • Map of specimen drawn & characterised using different colored stains in different equators.

  21. Histotechnician receives tissue sample from the Mohs Surgeon. • Sample is sectioned and stained with H&E • Mohs surgeon examines slide for tumor residue and excises the relevant mapped parts.

  22. NON SURGICAL • Radiotherapy (scars badly) • Cryotherapy • Topical Chemo (5-fluorouracil, imiquimod)

  23. Follow Up • Gross Margin involvement: 67% recurrence • Microscopic involvement: 33% recurrence within 2 yrs. • Uncomplicated completely excised: Surveillance as in HIGH Risk groups! • GORLIN’s syndrome

  24. EPITHELIOMA(SCC)

  25. EPITHELIOMA

  26. What is it?? • SCC is a malignant tumor of keratinising cells of the epidermis or its appendages. • Arises from the stratum basale of the epidermis • 2nd most common skin tumor (4 times less than BCC & affects Elderly)

  27. PREDISPOSING FACTORS • WHITE SKINNED • TWICE AS COMMON IN MEN • SUN EXPOSURE • CLOSER TO EQUATOR

  28. Contd. • chronic inflammation (chronic sinus tracts, pre-existing scars, osteomyelitis, burns, vaccination points) • immunosuppression (organ-transplant recipients). • When a SCC appears in a scar it is known as a Marjolin’s ulcer.

  29. Contd • Radiation exposure • Smoking • HPV infection

  30. MACROSCOPIC • The early appearance of SCC may vary from smooth nodular to verrucous, papillomatous and ulcerating lesions. • Eventually all lesions ulcerate

  31. MICROSCOPIC • Solid column of epithelial cells that are seen growing down into dermis. • Expanding into bulb like masses. • KERATINISATION, CELL NEST/Epithelial pearl appearance.

  32. SPREAD • LOCAL SPREAD • LYMPHATIC SPREAD • BLOOD SPREAD- rarely

  33. HISTOPATHOLOGY • Pathological pattern (e.g. adenoid), • Cellular morphology (e.g. spindle) • Broder’s grade(grade 1 to 4) • Depth of invasion

  34. ORIGIN • a) skin denovo • b)pre existing condition like • Long standing ulcers • Senile keratosis • Leukoplakia • Skin exposed to radiation • lupus

  35. PREMALIGNANT LESIONS • Chronic Ulcer : MARJOLINS ulcer

  36. FEATURES • Painless!!! • Less malignant than typical SCC • Edge not always raised & everted • Slow growing malignant lesion • No lymphatic metastasis

  37. TREATMENT • Surgery : Wide excision of lesion with 1 cm margin.

  38. OTHER PREMALIGNANT COND. Xeroderma pigmentosum • Bowen disease Senile keratosis

  39. LUPUS VULGARIS

  40. Condition which cause chr irritation • 1)Leukoplakia • 2)Burn,scar,venous ulcer,OM, • 3)Continous heat by a charcoal burner ie.kangri – abdomen -KANGRI CANCER

  41. Tibetans - sleep over oven beds-KANG CANCER

  42. Prolonged exposure to chemicals as in soot – SCC of scrotum – CHIMNEY SWEEP CANCER

  43. SITES SKIN- anywhere

  44. MUCOUS MEMBRANE

  45. B/w SKIN & MUCOUS MEMBRANE

  46. COLUMNAR EPITHELIUM

  47. TRANSITIONAL EPITHELIUM

  48. CLINICAL FEATURES • History • Age > 40 yrs • Occupation -chimney sweepers • Duration- one or few months (variable cap growth) • Symptoms • Nodule/ Ulcer • Usually Painless • Enlarged Lymph node ( unlike BCC)

  49. LOCAL EXAMINATION • Site • Size and shape.- circular /oval • EDGE: Raised & Everted • FLOOR: Necrotic tissue, Serum, Blood. • BASE: Indurated. • MOBILITY: early cases can be moved later fixed • Regional Lymph nodes enlarged due to 2ndry infectn • Tenderness +

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