10 Questions
What safety margin is recommended when the tumor thickness is less than 1 mm?
1 cm
What is the recommended safety margin when the tumor thickness is between 1-4 mm?
2 cm
What is the treatment option for metastases in malignant skin tumors?
Chemotherapy
When is a radical block dissection performed?
When the lymph nodes are enlarged and firm
What type of biopsy is performed if the lymph nodes are not clinically malignant?
Sentinel lymph node biopsy
Which prophylactic procedure is no longer performed in the treatment of malignant skin tumors?
Prophylactic block dissection
What is the origin of Kaposi's sarcoma?
Endothelium of lymphatic and blood vessels
In which geographical location is the endemic variety of Kaposi's sarcoma primarily found?
Africa
For which tumor thickness is a safety margin of 3 cm recommended?
Greater than 4 mm
Which virus is associated with the endemic variety of Kaposi's sarcoma?
Cytomegalovirus
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
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.
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