BASAL CELLCARCINOMA. MELANOMA AND MESENCHYMAL BY S.

SRINATH , first year pg TUMOURS

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DEPT.OF PERIODONTICS
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BASAL CELL CARCINOMA (RODENT ULCER)

Typically, the basal cell carcinoma is a

locally invasive, slow growing tumour of middle aged that rarely metastasises.
It occurs exclusively on hairy skin, the

most common location(90%) being the face usually above a line from the lobe of the ear to the corner5/1/12the of

Basal cell carcinoma is seen more

frequently in white skinned people and in those who have prolonged exposure to strong sunlight

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Macroscopically, the most common

pattern is a nodulo-ulcerative basal cell carcinoma in which a slow growing small nodule undergoes central ulceration with pearly rolled margins.
The tumour enlarges in size by

burrowing and by destroying the tissues locally like a rodent and hence the name rodent ulcer

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Histologically, the most characteristic

feature is the proliferation of basaloid cells (resembling basal layer of epidermis)

A variety of patterns of these cells

may be seen :solid masses, masses of pigmented cells, keratotic masses , cystic change with sebaceous differentiation and adenoid pattern with apocrine or eccrine differentiation.
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The most common pattern is solid basal

cell carcinoma in which the dermis contains irregular masses of basaloid cells having characteristic peripheral palisaded appearance of the nuclei.

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MALIGNANT MELANOMA
Malignant melanoma or

melanocarcinoma arising from melanocytes is one of the most rapidly spreading malignant tumour of the skin that can occur at all age but is rare before puberty.
The tumour spreads locally as well as

to distant sites by lymphatics and by blood.

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The etiology is unknown but there is

role of excessive exposure of white skin to sunlight.

Other predisposing factors are the

presence of preexisting naevous(especially dysplastic naevous), heredity and local host immune response.
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Besides the skin, melanomas may

occur at various other sites such as oral and anogenital mucosa, oesophagus, conjunctiva, orbit and leptomeninges.
The common sites on the skin are the

trunk, legs and face, soles , palms and nail-beds

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Clinically, melanocarcinoma often

appears as a flat or slightly elevated naevous which has variegated pigmentation, irregular borders and of late has undergone secondary changes or ulceration, bleeding and increase in size.

Many of the malignant melanomas

however arise de novo rather than from a preexisting naevus.

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HISTOLOGICALLY
The following characteristics are

observed ORIGIN
The malignant melanoma whether

arising from a preexisting naevous or starting de novo has marked junctional activity at the epidermodermal junction and grows downward into the dermis
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. TUMOUR CELLS
The malignant melanoma cells are

usually larger than the naevous cells.

They may be epitheloid or spindle

shaped the former being more common.

The tumour cells have amphophilic

cytoplasm and large , pleomorphic nuclei with conspicuous nucleoli. 5/1/12

MELANIN
Melanin pigment may be present or

absent without any prognostic influence.

The pigment, if present tends to be in

the form of uniform fine granules.

At times, there may be no evidence

of melanin in H & E stained sections but the fontanna-masson stain or 5/1/12

INFLAMMATORY INFILTRATE
Some amount of inflammatory

infiltrate is present in the invasive melanomas

Infrequently partial spontaneous

regression of the tumour occurs due to destructive effect of dense inflammatory infiltrate.

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The prognosis for patients with

malignant melanoma is related to the depth of invasion of the tumour in the dermis.

Depending upon the depth of

invasion below the granular cell layer in millimeters, clark has described in 5 levels:

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Level I : malignant melanoma cells

confined to the epidermis and its appendages

Level II: extension into the papillary

dermis
Level III: extension of tumour cells up

to the interface between papillary and recticular dermis.

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Metastatic spread of malignant

melanoma is very common and takes place via lymphatics to the regional lymph nodes and through blood to distant sites like lungs, liver, brain, spinal cord and adrenals.

Rarely the primary lesion may regress

spontaneously but metastases are present widely distributed.

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MESENCHYMAL TUMOURS
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ETIOLOGY AND CLASSIFICATION OF MESENCHYMAL TUMOURS

TISSUE OF ORIGIN BENIGN Adipose tissue Adult fibrous tissue Lipoma Fibroma Myxoma MALIGNANT Lipo sarcoma Fibro sarcoma Myxo sarcoma Chondrosarcoma Osteo sarcoma Synovial sarcoma
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Embryonic fibrous tissue Chondroma Cartilage Bone Osteoma Benign synovioma

Mesothelium Blood vessels Lymph vessels Glomus Meninges

nil Haemangioma Lymphangioma Glomus tumour Meningioma

Mesothelioma Angiosarcoma Lymphangiosarco ma Nil Invasive meningioma Leukaemias Malignant lymphomas Neurogenic 5/1/12

Haemopoietic cells Nil Lymphoid tissue Nerve sheath Nerve cells Nil Neurilemmoma Neurofibroma Ganglioneuroma

DIAGNOSIS
Diagnosis is based on the

histogenesis and can be made by the following plan Cell patterns :

1. Smooth muscle tumours: interlacing

fascicles of pink staining tumour cells

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3.Herringbone pattern seen in case of fibrosarcoma

4.Palisaded arrangement seen in schwannomas

5.Biphasic pattern: combination arrangement of two types eg., synovial 5/1/12 sarcoma

Based on cell types 1.Spindle cells: seen in sarcomas.however there are subtle difference in different types of spindle cells eg.,
a) Fibrogenic tumours have spindle cells

with light pink cytoplasm and tapering ended nuclei.

a) Neurogenic tumours have tumour

cells similar to fibrogenic cells but

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C) leiomyomatous tumours have spindle cells with blunt ended (cigar shaped) nuclei and more intense eosinophilic cytoplasm and D)skeletal muscle tumours have spindle cells similar to leiomyomatous cells but in addition have cytoplasmic syriations. 2.small round cells:these are found in A)rhabdomyosarcoma
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 Epitheloid cells:found in epitheloid

sarcoma or in synovial sarcoma.

3.Immunohisochemistry:Based on the

differential diagnosis made on routine morphology,the panal of antibody stains is chosen for applying on parafin sections for staining.some common e.g., are
Smooth muscle actin[SMA] forsmooth

muscle tumours.
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Desmin for skeletal muscles S-100 for nerve fibres Factor VIII antigen for vascular

endothelium
LCA for lymphocytes.

4.Electron microscopy
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Thank u

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