Malignant Skin Tumors
Juraj Hegyi
LF MU

Nonmelanoma skin cancer (NMSC)
●

Basal cell carcinoma

●

Squamous cell carcinoma

●

Actinic keratosis

●

Angiosarcoma

●

Dermatofibrosarcoma protuberans

●

Merkel cell carcinoma

●

Sebaceus gland carcinoma

●

Skin metastasis

●

T and B cell lymphoma
2

Basal cell carcinoma (BCC)
●

First mentioned by Jacobsom in 1824

●

More common than melanoma

●

Yearly increase in incidence worldwide

●

Incidence doubles every 25 years

●

19 x more common in caucasians

●

26 distinct sub types...

3

Basal cell carcinoma (BCC)
●

●

●

●

Originates from pluripotent cells of the basal
layer of the epidermis and the terminal hair
follicle
A slow-growing tumor with virtually no potential
to establish metastases
Grows locally destructively
Nodular, superficial, with pigment,
sclerodermiform, infiltrative, fibroepithelial
(Pinkus), metatypical
4

Basal cell carcinoma (BCC)
risk factors
●

UV radiation, mainly UVB, less UVA
(melanoma)
–

The probability of occurrence increases in direct
proportion to the cumulative dose of UV radiation

–

The latency period from radiation to clinical
manifestation is about 20-30 years

–

Exterior workers ↑ risk

–

Frequent occurrence in the H line

5

Basal cell carcinoma (BCC)
risk factors
●

Phototype of the skin, geographical location.

●

Immunosuppression

●

Mainly transplanted patients

●

●

Genetic factors (Gorlin sy., Xeroderma
pigmentosum)
Carcinogens (arsenic)

6

Xeroderma pigmentosum

7

Nodular BCC
●

The most common form (60%)

●

Location mainly neck and head

●

Shiny, rigid papule, or knot with telangiectasias

●

Gradually central depression with bulging
edges (painless), ulcus rodens

8

Nodular BCC

9

Superficial BCC
●

Makes up about 15 - 30%

●

Location mainly torso and limbs

●

Easily infiltrated, sharply demarcated bearings

●

Sometimes desquamation and hemorrhagic
crust formation

10

Superficial BCC

11

Pigmented BCC
●

The structure most often resembles nBCC

●

Pigmented areas

●

Diff. dg. Malignant melanoma should be
considered

12

Pigmented BCC

13

Therapy
●

Invasive methods

●

Surgical excision

●

Mohs surgery

●

Cryotherapy

●

Curettage

●

Non-invasive methods

●

PDT

●

5% imiquimod (Aldara), 5% fluorouracil (Effudix)

●

Brachytherapy

14

Squamous cell carcinoma
(SCC)
●

The second most common skin cancer (approx.
20%)

●

Epithelial tumor with intraepithelial growth

●

It is relatively invasive

●

In places of solar damage, or burns or chronic
extensive scarring

●

70% head and neck

●

It metastasizes via lymphatic system
15

SCC risk factors
●

Age over 50 and male

●

Low phototype

●

UV exposure

●

Chronic skin changes

●

HPV

●

Chemical carcinogens

●

Ionizing radiation
16

SCC
●

Several clinical forms

●

M. Bowen

●

Erythroplasia de Queyrat

●

Ulcerative SCC

●

Periungual SCC

●

Marjolin ulcer

●

AK
17

Therapy
●

Radical surgical excision with a protective rim

●

Radiotherapy

●

Chemotherapy

●

Always USG of the lymph nodes

18

SCC

19

SCC

20

SCC

21

SCC

22

Actinic keratosis (AK)
●

Very common epidermal dysplasia

●

Sites of chronic solar damage

●

6 to 8 decades most often

●

About 10% progresses to SCC

●

●

Extremely common in immunosuppressed
individuals
Academic discussion: Ca in situ vs. Precanc.

23

AK

24

AK
●

Characteristic for AK is area carcinogenic
spread, the so-called “Field cancerization”

●

Presence of 6+ AK in a sun-exposed area

●

Risk factors as with other NMSCs

25

Therapy
●

Prevention, Prevention, Prevention (SPF, etc.)

●

May lead to spontaneous regression of AK

●

Cryosurgery / curettage

●

PDT

●

CO2 laser, ER: YAG laser

●

5% imiquimod (Aldara)

●

Ingenol mebutate (Picato)
26

AK

27

PDT AK

28

Merkel cell carcinoma
●

Rare neuroendocrine carcinoma of the skin

●

Fast growing, pink to bluish papule

●

●

Based on Merkel cells (associated with
receptors for sensory perception)
Rapid metastasis (in transit metastasis)

29

Merkel cell carcinoma

30

Dermatofibrosarcoma protuberans
●

●

Very rare mesenchymal skin tumor
Appearance of scar or protuberation with
palpable subcutaneous infiltrate beyond
exophytic growth

●

0.8 - 4.5 / 1,000,000

●

More common in blacks

●

Local recurrences are common

31

Dermatofibrosarcoma protuberans

32