INTEGUMENTARY SYSTEM

DR UZMA NAZ
 SKIN CANCERS
• SQUAMOUS CELL CARCINOMA.
• BASAL CELL CARCINOMA.
• MALIGNANT MELANOMA.
• MERKEL CELL CARCINOMA.
 SQUAMOUS CELL CARCINOMA
• Common Malignant Skin Tumour.
• It is the second most common form of skin
cancer.
• Lower part of face.
 MORPHOLOGY
• Scaling, Indurated and ulcerated nodule.
• red, poorly defined base with adherent
yellow or white scale
• ulcerated center
• Invasion of Dermis by sheets and islands
of neoplastic epidermal cells, KERATIN
‘’PEARLS’’.
RISK FACTORS:
• Squamous cell carcinoma is most common in fair-skinned, light-eyed, and light-
haired people.
• It affects more males than females.
• Incidence is highest in Australia and in the southern and southwestern United
States.
• Excessive exposure to sunlight
• Association with chemical carcinogens(Arsenic).
• Radiation or radiological exposure.
• Pre-existing actinic keratosis.

PREVENTION
sun avoidance
sunscreen use
PREVENTION
• Locally Invasive.
• 5% metastasis.
• Excision is usually curative.
• if treated timely, very excellent prognosis
 BASAL CELL CARCINOMA
• Most Common.
• Sun-exposed areas.
• Head and Neck, upper part of face.
• The infiltrative growth BCC has a scaly
surface, a pink to reddish color and an
irregular, ill-defined margin
• Darkly staining basaloid cells.
• Palisade arrangement of the nuclei.
• Locally aggressive, ulcerate and bleed.
• Never metastasizes.
• Curable.
Presentation
• It often appears as a painless raised area of skin, which may be shiny
with small blood vessels running over it;
• Which carcinoma rarely becomes metastatic?
Basal
• Which carcinoma can slowly progress and become metastatic?
Squamous
• Which carcinoma is the most common skin tumor overall?
Basal
MALIGNANT MELANOMA
• Common in Fair-skinned persons.
• Arises from melanocytes.
• Excessive exposure to sunlight.
• Important is tumour thickness.
GROWTH PHASES:
Radial(initial phase): Growth occur in all directions but
predominantly within epidermis and papillary zone of the dermis.
Lymphocytic response is predominant. Do not metastasis and cure
frequently.
Vertical(later phase): Growth extends into the reticular dermis or
beyond. Prognosis varies with depth. Lymphatics or hematogenous
metastasis.
CLINICAL VARIANTS:
Lentigo maligna melanoma: Sun exposed skin. Predominate is
radial growth phase. Develops from pre-existing lentigo maligna,
(brown flat spot with an irregular shape that slowly gets bigger,
due to excessive sun exposure).
Superficial spreading melanoma: Most common. Irregular
borders. Trunk and extremities. Radial growth predominates.
Nodular melanoma: Vertical growth phase. Poor prognosis.
Acral-lentiginous melanoma: Hand and feet of Dark skin
persons.
• The most dangerous form of skin cancer, a malignancy of the
melanocyte, the cell that produces pigment in the skin. Melanoma is
most common in people with fair skin
• Most melanomas present as a dark, mole-like spot
• Melanoma is a common but serious skin cancer which, if not removed
early while it is thin, spreads internally and is usually fatal.
MERKEL CELL CARCINOMA
• Also called neuroendocrine malignancy
of skin.
• Arises on Head and neck.
• Elderly people.
• Immunostaining for neuroendocrine
markers.
• Perinuclear ‘’DOT-LIKE’’ staining
with cytokeratin 20.
PRESENTATION
• The first sign of Merkel cell carcinoma is usually a fast-growing,
painless nodule.
• The nodule may be skin-colored or may appear in shades of red, blue
or purple
• Merkel cell carcinoma begins in the Merkel cells. Merkel cells are
found at the base of the epidermis. Merkel cells are connected to the
nerve endings in the skin that are responsible for the sense of touch.
• TREATMENT
• Even with treatment, Merkel cell carcinoma commonly spreads
(metastasizes) beyond the skin. Merkel cell carcinoma tends to travel
first to nearby lymph nodes.
• Cancer that has metastasized is more difficult to treat and can be
fatal.
 THERMAL INJURIES
• Burn is a Tissue injury (coagulative necrosis).
• Internal or External body surfaces.

CAUSES
• Flames, hot sources, electricity,
chemicals and radiations.
• Amount of tissue destruction is based on temperature (>40˚C) and
time of exposure.
DIAGNOSIS AND PROGNOSIS:
1.Burn size: % of total body surface area (TBSA)burned.
2.Age: burns at the extremes of age carry a greater morbidity and
mortality
3.Depth: difficult to assess initially, History of etiologic agent and
time of exposure helpful.
Classification:
1.First degree: erythema but no skin breaks.
2.Second degree: blisters, red and painful
(a)Superficial partial-thickness involves epidermis and upper dermis
(b)Deep partial-thickness involves deeper dermis.
3. Third degree: full-thickness, charred.
4. Fourth degree: muscle, bone.
Location: face and neck, hands, feet and perineum may cause
special problems and warrant careful attention; often necessitate
hospitalization/burn centre .

Inhalation injury: beware of closed quarters burn, burned nasal

hair, carbon particles in pharynx, hoarseness, conjunctivitis.

Prognosis: best determined by burn size (TBSA) and age of patient,

inhalation injury.
Treatment plan:
1.History and physical exam.
2.Relieve respiratory distress — escharotomy and/or intubation.
3.Prevent and/or treat burn shock — IV — large bore needle.
4.Monitor resuscitation — Foley catheter and hourly urine output.
5.Treat ileus and nausea — N.G.tube if > 20% burn.
6.Tetanus prophylaxis.
7.Baseline laboratory studies i.e. Hct., glucose, BUN, chest x-ray, electrolytes,
cross-match, arterial blood gases and carboxyhaemoglobin.
8.Cleanse,debride,and treat the burn wound.
 MISCELLANEOUS SKIN DISORDERS
Acrochordon (skin tag, fibroepithelial
polyp):
Common Lesion.
Face near the eyelids, neck, trunk or axilla.
Central connective tissue core
covered by stratified squamous epithelium.
Dermatofibroma:
Benign neoplasm.
Firm nodule sometimes with pigmented acanthosis.
Intertwining bundles of collagen and fibroblasts.
Seborrheic keratosis:
Benign neoplasm.
Older person.
Also called senile keratosis.
Sharply demarcated raised papules or
plaques.
Head, trunk and extremities.
Actinic keratosis:
Premalignant epidermal lesion.
Chronic excessive exposure to sunlight.
Roughness, Scaling, Poorly demarcated
plaques on face, neck, upper trunk or
extremities.