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Questions and Answers
What safety margin is recommended when the tumor thickness is less than 1 mm?
What safety margin is recommended when the tumor thickness is less than 1 mm?
What is the recommended safety margin when the tumor thickness is between 1-4 mm?
What is the recommended safety margin when the tumor thickness is between 1-4 mm?
What is the treatment option for metastases in malignant skin tumors?
What is the treatment option for metastases in malignant skin tumors?
When is a radical block dissection performed?
When is a radical block dissection performed?
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What type of biopsy is performed if the lymph nodes are not clinically malignant?
What type of biopsy is performed if the lymph nodes are not clinically malignant?
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Which prophylactic procedure is no longer performed in the treatment of malignant skin tumors?
Which prophylactic procedure is no longer performed in the treatment of malignant skin tumors?
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What is the origin of Kaposi's sarcoma?
What is the origin of Kaposi's sarcoma?
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In which geographical location is the endemic variety of Kaposi's sarcoma primarily found?
In which geographical location is the endemic variety of Kaposi's sarcoma primarily found?
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For which tumor thickness is a safety margin of 3 cm recommended?
For which tumor thickness is a safety margin of 3 cm recommended?
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Which virus is associated with the endemic variety of Kaposi's sarcoma?
Which virus is associated with the endemic variety of Kaposi's sarcoma?
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Study Notes
Malignant Neoplasms of the Skin
Basal Cell Carcinoma (Rodent Ulcer)
- A locally malignant lesion that arises from the basal cells of the epidermis
- More common in males above 40 years old
- Most common malignant lesion of the skin
- Predisposing factors:
- Prolonged exposure to UV rays
- Light-colored complexion
- Albinism and xeroderma pigmentosum
- Ionizing radiation
- Immunodeficiency
Gross Appearance
- Usually starts as a small nodule covered by thin epidermis
- Ulcerates, producing serous discharge and bleeding
- Edge of the ulcer is rolled-in and beaded
- Rate of growth is very slow
- Two types: excavating (deeply infiltrating) and superficial spreading (resembling psoriasis or eczema)
Microscopic Appearance
- Tumor cells arranged as nests or sheets
- Outer layer composed of low columnar cells with tall nuclei
- Inner layer composed of polyhedral cells with large basophilic nuclei
- No tendency to keratinization and mitotic figures are uncommon
Spread and Treatment
- Direct spread to surrounding and underlying structures
- No lymphatic or blood spread
- Treatment: radiotherapy or surgery, with a safety margin of 0.5cm
- Prognosis: excellent, with a 100% cure rate if excised completely
Squamous Cell Carcinoma (Epithelioma)
- More common in elderly males
- Predisposing factors:
- Prolonged exposure to UV rays
- Previous irradiation
- Albinism and xeroderma pigmentosum
- Long-standing skin irritation
- Immunosuppression
- Gross appearance: ulcerated mass with raised, everted edges
- Microscopic appearance: groups of carcinoma cells infiltrating underlying tissue, with keratinization and epithelial pearls
- Spread: rapid infiltration, lymphatic spread to regional nodes, and blood stream spread
- Treatment: surgery or radiotherapy, with a safety margin of at least 0.5cm
- Differential diagnosis: keratoacanthoma, basal cell carcinoma, and malignant melanoma
Melanoma
- Incidence: increasing in western countries, rare before puberty
- Aetiology:
- Prolonged exposure to UV rays
- Benign naevus
- Change in size, pigmentation, or bleeding
- Pathology and clinical types:
- Superficial spreading melanoma (SSM)
- Nodular melanoma (NMM)
- Lentigo maligna (Hutchinson's melanotic freckle)
- Acral-lentiginous melanoma
- Amelanotic melanoma
- Prognostic factors:
- Thickness of the lesion (Breslow classification)
- Depth of invasion (Clark's level of invasion)
- Spread: direct, lymphatic, and blood stream
- Treatment: surgical excision with an adequate safety margin, sentinel lymph node biopsy, and chemotherapy for metastases
- Prognosis: 100% five-year survival rate if excised completely
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Description
This quiz covers the characteristics, incidence, and aetiology of Basal Cell Carcinoma, a locally malignant skin lesion commonly found in males over 40 years old.
