15 Skinandsofttissue1 100207194637 Phpapp01

8/10/2019 15 Skinandsofttissue1 100207194637 Phpapp01

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SKIN and SOFT TISSUESKIN and SOFT TISSUE

Celso M. Fidel, MD,FPSGS,FPCSCelso M. Fidel, MD,FPSGS,FPCS

Diplomate Philippine Board o S!r"er#Diplomate Philippine Board o S!r"er#


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Introd!$tionIntrod!$tion

SKINSKINConsidered as a sin"le anatomi$Considered as a sin"le anatomi$

ph#siolo"i$ph#siolo"i$

!nit!nit % to %.& s'. m in area% to %.& s'. m in area

Prote$ts the (od# (earin" the (r!nt oProte$ts the (od# (earin" the (r!nt o

in)!rio!s e*e$ts o e+ternalin)!rio!s e*e$ts o e+ternalenironmentenironment

SOFT TISSUESOFT TISSUE

Com rises a(o!t &- o the total (odComprises a(o!t &- o the total (od#


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SKIN INCISIONSSKIN INCISIONSChoice of known skin lines of relaxed tensionChoice of known skin lines of relaxed tension

Applying principles of effective concealmentApplying principles of effective concealment

and camouflageand camouflage

Considers dynamic muscle action and effect ofConsiders dynamic muscle action and effect of

gravity on skin and subcutaneous tissuegravity on skin and subcutaneous tissue Junctions of body planesJunctions of body planes

Lines of elevations of facial featuresLines of elevations of facial features

Lines of LangersLines of LangersContour Lines of junctions of body planesContour Lines of junctions of body planes

Lines of DependencyLines of Dependency

lective Lines that show when patient smileslective Lines that show when patient smiles


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!kin!kin


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S/inS/in

"revent fluid loss"revent fluid loss

#emperature control#emperature control

lasticity and supportlasticity and support


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1ESIONS OF SKIN 0ND SOFT TISSUE1ESIONS OF SKIN 0ND SOFT TISSUE

C$%&%'#ALC$%&%'#AL

#(A)*A#'C#(A)*A#'C

'%+LA**A#$(,'%+LA**A#$(,

%$"LA!#'C%$"LA!#'C

-%'&%-%'&%

*AL'&%A%#*AL'&%A%#

$#.( L!'$%!$#.( L!'$%! *#A!#A#'C !/'% L!'$%*#A!#A#'C !/'% L!'$%

+$('C% -$D, &(A%)L$*A+$('C% -$D, &(A%)L$*A


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CONGENIT01CONGENIT01

0. Dermoid C#st0. Dermoid C#st

Ori"inate rom tiss!e entrapped d!rin"Ori"inate rom tiss!e entrapped d!rin"

!sion o em(r#oni$ pro$esses!sion o em(r#oni$ pro$esses

1ined (# s'!amo!s $ells and ma#1ined (# s'!amo!s $ells and ma#$ontain$ontain

Stra2 $olored Fl!idStra2 $olored Fl!id

Chees# materialChees# material 1an!"o 3air1an!"o 3air

Generall# $#st in the head is operatedGenerall# $#st in the head is operated

at O4at O4


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DermoidDermoid

+re0uently occurs in the+re0uently occurs in the

midline over the 1midline over the 1

$cciput$cciput %asal dorsum%asal dorsum

*id2frontal region of scalp*id2frontal region of scalp

!acral area!acral area Abdominal areasAbdominal areas


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DermoidDermoid


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DermoidDermoid


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C$%&%'#ALC$%&%'#AL

C3 -ranchiogenic sinusesC3 -ranchiogenic sinuses Are located anterior to medial edge ofAre located anterior to medial edge of

sternocleidomastoid musclesternocleidomastoid muscle

Arise from either 'st45Arise from either 'st45ndndor 6or 6rdrd branchialbranchial

archarch

Located anterior to ear if coming from 'stLocated anterior to ear if coming from 'st

#(A)*A#'C#(A)*A#'C

A3 7oundsA3 7ounds AbrasionsAbrasions Lacerated woundsLacerated wounds

"unctured wounds"unctured wounds 'ncised wounds'ncised wounds

AvulsionAvulsion


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AvulsionAvulsion


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'ncised 7ounds'ncised 7ounds


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#(A)*A#'C#(A)*A#'C

-3 "neumatic tire injury-3 "neumatic tire injury

!pecial type of laceration!pecial type of laceration

(otating tire 8chews up9 soft tissue and tears it off from(otating tire 8chews up9 soft tissue and tears it off from

underlying deep fascia transecting the investing bloodunderlying deep fascia transecting the investing bloodvessels3vessels3

Common error ofCommon error of merely suturing the woundmerely suturing the woundandand failing tofailing to

recogni:erecogni:emassive avulsion of skin and subcutaneousmassive avulsion of skin and subcutaneoustissue would result in more extensive necrosis3tissue would result in more extensive necrosis3


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#(A)*A#'C#(A)*A#'C

-3-3 "neumatic tire injury"neumatic tire injury

*anagement*anagement Damage area cleanedDamage area cleaned

Divitali:ed tissue debridedDivitali:ed tissue debrided

xtremity splintedxtremity splinted

(aw area skin2grafted(aw area skin2grafted


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#(A)*A#'C#(A)*A#'C

C3 -urnsC3 -urns

#hermal#hermal $pen flame$pen flame

-oiling water-oiling water

!moke inhalation injuries!moke inhalation injuries

ChemicalChemical

lectricallectrical


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"artial #hickness -urns"artial #hickness -urns


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$cclusive Dressing w; Duoderm$cclusive Dressing w; Duoderm


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OT3E4 1ESIONSOT3E4 1ESIONS

/L$'D!/L$'D! Accepted form of treatmentAccepted form of treatment

!urgery with post


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OT3E4 1ESIONSOT3E4 1ESIONS

3ematoma3ematomaD!e to r!pt!re o a (lood esselD!e to r!pt!re o a (lood essel

Bl!ish or p!rplish s2ellin" o s/in andBl!ish or p!rplish s2ellin" o s/in ands!($!taneo!s tiss!es!($!taneo!s tiss!e

Ma# o$$!r as postoperatie $ompli$ationMa# o$$!r as postoperatie $ompli$ation

Treated $onseratiel#Treated $onseratiel#

S!r"i$al ea$!ation li"ate (leedersS!r"i$al ea$!ation li"ate (leeders


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INF10MM0TO4: CONDITIONSINF10MM0TO4: CONDITIONS

--

>irulent or massive>irulent or massive infectioninfectiontogether with lowtogether with lowpatient resistancepatient resistance4 results in skin and soft4 results in skin and softtissue losstissue loss

!kin grafting!kin graftingindicated once infection isindicated once infection iscontrolled and granulation tissue hascontrolled and granulation tissue has

developeddeveloped

#issue loss often seen in#issue loss often seen in malnourishedmalnourishedinfantsinfantsand children where ordinary pyogenicand children where ordinary pyogenic

infection produces massive skin necrosisinfection produces massive skin necrosis


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CellulitisCellulitis

CC ll liti


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+uruncle+uruncle


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+uruncle+uruncle


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CarbuncleCarbuncle


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NEOP10STIC CONDITIONSNEOP10STIC CONDITIONS

-enign conditions-enign conditionsA3 Common 7artsA3 Common 7arts

>errucae >ulgaris2>errucae >ulgaris2

$ccurs in 5$ccurs in 5ndnd decade of lifedecade of life

*aybe transmitted by direct or indirect contact*aybe transmitted by direct or indirect contact

Caused by a member of the papovavirusCaused by a member of the papovavirus

'nvades stratum spinosum epidermidis causing'nvades stratum spinosum epidermidis causing

papillomatosispapillomatosis

Located in hands and feetLocated in hands and feet

(ough4 grayish papillomatous nodular or(ough4 grayish papillomatous nodular or

elevated pla0ueselevated pla0ues


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>erruca >ulgaris>erruca >ulgaris


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-enign conditions-enign conditionsA3Common 7artA3Common 7art

>errucae >ulgaris2>errucae >ulgaris2

Can become tenderCan become tender 7ill resolve spontaneously7ill resolve spontaneously

"roblematic lesions can be treated"roblematic lesions can be treated

by1by1Curettage and electrodessicationCurettage and electrodessication

+ree:ing with li0uid nitrogen+ree:ing with li0uid nitrogen Chemotherapy with caustic agentChemotherapy with caustic agent



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Beni"n $onditionsBeni"n $onditions

B. C#st9B. C#st9are ;!id 6lled $aities inare ;!id 6lled $aities ins!($!taneo!s tiss!e 2hi$h ma#s!($!taneo!s tiss!e 2hi$h ma#resem(le solid t!morresem(le solid t!mor

%. Epidermal in$l!sion C#st%. Epidermal in$l!sion C#st Epidermal $ells are trapped inEpidermal $ells are trapped in

s!($!taneo!ss!($!taneo!s

tiss!e. Des'!amation leads to thetiss!e. Des'!amation leads to the$reation$reation

o a $ait#o a $ait#


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Se(a$eo!s C#stsSe(a$eo!s C#sts


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0ppli$ation o 0nesthesia0ppli$ation o 0nesthesia


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Start o E+$isionStart o E+$ision


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The 6nal o!t$omeThe 6nal o!t$ome


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Se(a$eo!s $#st in e#elidsSe(a$eo!s $#st in e#elids


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!tellate !uturing of &anglion!tellate !uturing of &anglion

CystCyst


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!tellate !uturing of &anglion!tellate !uturing of &anglion

CystCyst


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Lines of LangersLines of Langers

O S C CO O SNEOP10STIC CONDITIONS


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-enign conditions-enign conditionsC3 >ascular #umorsC3 >ascular #umors?3?3 Capillary HemangiomasCapillary Hemangiomas

@"ort wine2 !tain@"ort wine2 !tain

found in thefound in the

face4face4

chest4chest4

extremitiesextremities



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-enign conditions-enign conditions

C3 >ascular #umorsC3 >ascular #umors

53'mmature .emangioma53'mmature .emangioma

+ound in the head4 neck4 chest and+ound in the head4 neck4 chest and

extremities of infantsextremities of infants

levated4 red4 soft4 compressible tumorsBlevated4 red4 soft4 compressible tumorsB

fre0uently enlarges during ?st year of lifefre0uently enlarges during ?st year of life

)ndergoes spontaneous regression during)ndergoes spontaneous regression during

the next 52 yearsthe next 52 years



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NEOP10STIC CONDITIONSNEOP10STIC CONDITIONS-enign conditions-enign conditions

C3 >ascular #umorsC3 >ascular #umors6363 Cavernous .emangiomasCavernous .emangiomas

Compressible shows a wide channelCompressible shows a wide channel

w; loose connective tissue septaew; loose connective tissue septae

lined by embryonal endotheliumlined by embryonal endothelium

Lesions maybe nodular4 lobular or polypoidLesions maybe nodular4 lobular or polypoid

!urgery is the treatment of choice!urgery is the treatment of choice



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NEOP10STIC CONDITIONSNEOP10STIC CONDITIONS-enign conditions-enign conditions

C3 >ascular #umorsC3 >ascular #umorsE3 !pider %evi @ #elangiectasiaE3 !pider %evi @ #elangiectasia

occur in all age groups commonoccur in all age groups common

in the face4 chest extremitiesin the face4 chest extremities

Arise during pregnancy in cirrhosisArise during pregnancy in cirrhosis

Central arteriole with vesselCentral arteriole with vessel

resembling venules radiating fromresembling venules radiating from

the centerthe center



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-enign conditions-enign conditionsD3 LipomaD3 Lipoma

-enign encapsulated subcutaneous-enign encapsulated subcutaneous

lesion4 single but maybe multiplelesion4 single but maybe multiple Are most common on the neck4Are most common on the neck4

shoulder4 back4 thighshoulder4 back4 thigh

$ccasionally fluctuates under the$ccasionally fluctuates under the

palpating fingerpalpating finger

>isible lobulation upon stretching the>isible lobulation upon stretching the

skinskin

Li


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LipomaLipoma

A ill *


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Axillary *assAxillary *ass

* %


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*ass %ape*ass %ape

A th >iA th >i


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Another >iewAnother >iew

( d f !( d f !


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(eady for !urgery(eady for !urgery



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3 %erve #umors3 %erve #umors

?3 %eurilemomas?3 %eurilemomas

$riginates from !chwanns cells of$riginates from !chwanns cells of

peripheral nerve sheaths and mayperipheral nerve sheaths and may

not adhere to nervenot adhere to nerve

#reatment is by excision#reatment is by excision



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3 %erve #umors3 %erve #umors

53 %eurofibroma153 %eurofibroma1

*ay occur as single or multiple as in*ay occur as single or multiple as in

>on (ecklinghausens disease>on (ecklinghausens disease

+ibromas of the dermis+ibromas of the dermis

%eurofibromas @multiple%eurofibromas @multiple 7idespread skin pigmentation at7idespread skin pigmentation at

back@coffee2 colored spotsback@coffee2 colored spots

atho nomonicatho nomonic

% +ib% +ib


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%euro +ibroma%euro +ibroma

P4EM01IGN0NT SKIN 1ESIONP4EM01IGN0NT SKIN 1ESION


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?3 Actinic /eratosis?3 Actinic /eratosis

(ough4 scaly epidermal lesion in areas of the(ough4 scaly epidermal lesion in areas of the

body subjected to chronic sun exposurebody subjected to chronic sun exposure

66rdrdand Eand Eththdecade and ?FG to 5FG willdecade and ?FG to 5FG will

undergo malignant transformationundergo malignant transformation

'f benign4 excision or cryotherapy'f benign4 excision or cryotherapy H2fluorouracil for patients with manyH2fluorouracil for patients with many

keratosiskeratosis

A ti i / t i


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Actinic /eratosisActinic /eratosis



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5353 -owens Disease-owens Disease 'ntraepidermal s0uamous cell carcinoma or'ntraepidermal s0uamous cell carcinoma or

Carcinoma in situ of the skinCarcinoma in situ of the skin

7ell defined erythematous pla0ue covered7ell defined erythematous pla0ue covered

by an adherent scaly yellow crustby an adherent scaly yellow crust

%o lymphatics in the layer affected4 no%o lymphatics in the layer affected4 no

potential for metastasispotential for metastasis

EEththto Ito Iththdecade of lifedecade of life

Arsenic ingestion and viruses implicated asArsenic ingestion and viruses implicated as

etiologic agentsetiologic agents

#reatment#reatmentsame as actinic keratosissame as actinic keratosis

- Di- Di


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-owens Disease-owens Disease



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3.3. KeratoacanthomaKeratoacanthoma

Locally destructive skin lesion found inLocally destructive skin lesion found in

the head, neck, & upper extremitiesthe head, neck, & upper extremities

Fast groing ith!Fast groing ith!

smooth rounded "orders & keratiticsmooth rounded "orders & keratitic

center plugcenter plug

#t may regress ithin six months#t may regress ithin six months

$xcision is treatment of choice$xcision is treatment of choice

%uamous cell cancer is found in ' of%uamous cell cancer is found in ' of

the lesions "iopsiedthe lesions "iopsied


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NE>I 5MO1ES?NE>I 5MO1ES?


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NE>I 5MO1ES?NE>I 5MO1ES? "igmented lesions of skin that fre0uently"igmented lesions of skin that fre0uently

concern the patient because of the fearconcern the patient because of the fearof malignancyof malignancy

Average white male has ?H to 5F nevi so totalAverage white male has ?H to 5F nevi so totalexcision is unreasonableexcision is unreasonable

Clinical diagnosis is of prime importanceClinical diagnosis is of prime importance

because malignant transformation can occurbecause malignant transformation can occur

7ell circumscribed lesions with uniform color7ell circumscribed lesions with uniform color

rarely progress to malignancyrarely progress to malignancy


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pidermal %evuspidermal %evus


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.alo %evus.alo %evus

BENIGN PIGMENTED 1ESIONSBENIGN PIGMENTED 1ESIONS


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?3 Junctional %evi?3 Junctional %evi

Dark4 flat4 smooth4 lesions about ?mmDark4 flat4 smooth4 lesions about ?mm

to 5cm diameterto 5cm diameter

$ccasionally hairy and develop from$ccasionally hairy and develop from

the basal layer of epidermisthe basal layer of epidermis

%evi that are located in the palms and%evi that are located in the palms and

soles are usually junctionalsoles are usually junctional

Can develop into malignant melanomaCan develop into malignant melanoma

but this rarely occurs before pubertybut this rarely occurs before puberty



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553 Compound %evi3 Compound %evi

-rown to black4 well circumscribed-rown to black4 well circumscribed

lesionslesions

)sually less than ? cm in diameter)sually less than ? cm in diameter

*aybe elevated and are fre0uently*aybe elevated and are fre0uently

hairy arising from epidermal2hairy arising from epidermal2dermal interface and within thedermal interface and within the

dermisdermis

*alignant transformation is rare*alignant transformation is rare



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63 'ntradermal %evi63 'ntradermal %evi

Are light colored well circumscribedAre light colored well circumscribedlesion less than ? cm in diameterlesion less than ? cm in diameter

.airs are usually present and the cell.airs are usually present and the celldistribution is in the dermisdistribution is in the dermis

*alignant transformation is rare*alignant transformation is rare

E3 -lue %eviE3 -lue %evi

!mooth4 hairless lesion about ? cm!mooth4 hairless lesion about ? cm

Arise from the dermisArise from the dermis

*ali nant de eneration is rare



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5.5. &iant "igmented %evi&iant "igmented %evi

-rown to black4 hairy lesions with an-rown to black4 hairy lesions with an

irregular nodular surfaceirregular nodular surface

+re0uently involve more than ? s03 inch+re0uently involve more than ? s03 inch

foot of body surface and arise from thefoot of body surface and arise from the

dermis and junctional areasdermis and junctional areas

+re0uently described in terms of distribution+re0uently described in terms of distribution

as bathing trunk 8vest49 sleeve oras bathing trunk 8vest49 sleeve orstockingstocking

*alignant degeneration is ?FG*alignant degeneration is ?FG

xcision with margin of normal tissuexcision with margin of normal tissue


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#(A#*%##(A#*%#

-3 'ndications for excision of any-3 'ndications for excision of anypigmented lesion include1pigmented lesion include1

?3?3 Changes in color4 si:e4 shapeChanges in color4 si:e4 shape4 or4 or consistencyconsistency

53 "ain53 "ain 63 !atellite nodules63 !atellite nodules

E3 (egional adenopathyE3 (egional adenopathy

C3 xcisional biopsy w; normal marginsC3 xcisional biopsy w; normal margins

D3 +or large lesions4 a full thicknessD3 +or large lesions4 a full thickness

wedge biopsy including a small areawedge biopsy including a small area

of normal skin should be takenof normal skin should be taken

M01IGN0NT 1ESIONSM01IGN0NT 1ESIONS


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M01IGN0NT 1ESIONSM01IGN0NT 1ESIONS*alignant *elanoma*alignant *elanoma

A3 pidemiologyA3 pidemiology ?3 incidence is ?6 new cases;?3 incidence is ?6 new cases; ?FF4FFF?FF4FFF;year;year

representing an increase of HFGrepresenting an increase of HFG

53 occurs in H53 occurs in Hththdecade4 rare in childrendecade4 rare in children

63 some 5FG to 6FG arise in head 63 some 5FG to 6FG arise in head

neckneck

E3 incidence is e0ual in males and inE3 incidence is e0ual in males and in

femalesfemales



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xposure to sunlight3 +air skinnedxposure to sunlight3 +air skinnedwhites with fre0uent directwhites with fre0uent direct

exposure to the sun often affectedexposure to the sun often affected

'n men chest4 back4 upper extremities'n men chest4 back4 upper extremities

'n women affects back upper and'n women affects back upper and

lower extremitieslower extremities

Detection of melanoma is determinedDetection of melanoma is determined

by changes in the color4 si:e andby changes in the color4 si:e and

sha e of a nevusshape of a nevus



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*alignant *elanoma*alignant *elanoma

C3 Classification based on &ross andC3 Classification based on &ross and .istologic appearance.istologic appearance

?3 !uperficial !preading *elanoma?3 !uperficial !preading *elanoma

Accounts for FG of all melanomaAccounts for FG of all melanoma

Can be present on any part of theCan be present on any part of the

body but more at the back legsbody but more at the back legs

HHththdecade of lifedecade of life

'rregular borders4 varied color'rregular borders4 varied color

))pperpperdermis w; lateraldermis w; lateraljunctional spreadjunctional spread

&enerally prognosis is good&enerally prognosis is good


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53 %odular *elanoma53 %odular *elanoma

Accounts for ?HG of all melanomaAccounts for ?HG of all melanoma

IIthth

decade of lifedecade of life -lue black lesion on any part-lue black lesion on any part

of bodyof body

>ertical spread rapid dermal>ertical spread rapid dermal

invasioninvasion

"rognosis is poor"rognosis is poor

%odular *elanoma%odular *elanoma


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%odular *elanoma%odular *elanoma


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M01IGN0NT 1ESIONSG S O S


E3 Lentigo *aligna @ *elanotic freckle ofE3 Lentigo *aligna @ *elanotic freckle of

.utchinson.utchinson

#he least commonB H#he least commonB Hththdecadedecade

-rown black w; elevated nodules w;in a-rown black w; elevated nodules w;in a

smooth frecklesmooth freckle

+re0uent in the head4 neck4 hand+re0uent in the head4 neck4 hand

!low growth in radial direction w; cells in!low growth in radial direction w; cells in

the upper dermisthe upper dermis

>ertical extension is fre0uent>ertical extension is fre0uent

"rognosis is excellent"rognosis is excellent

Lentigo *alignaLentigo *aligna


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CLA(/! CLA!!'+'CA#'$%CLA(/! CLA!!'+'CA#'$%

Level ? #umor confined to epidermisLevel ? #umor confined to epidermis

Level ??Level ?? #umor invades papillary#umor invades papillarydermdermisisLevel ???2#Level ???2#umorumorfills the papillaryfills the papillarydermdermisis bubutt

ddoes not invadeoes not invadereticureticularlardermdermisis

Level ?>2#uLevel ?>2#umor invades the reticularmor invades the reticulardermisdermis

Level > < #umor invades subcutaneousLevel > < #umor invades subcutaneous

tissue @ +at tissue @ +at



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M01IGN0NT 1ESIONSM01IGN0NT 1ESIONS*alignant *elanoma*alignant *elanoma -(!L$7 CLA!!'+'CA#'$%-(!L$7 CLA!!'+'CA#'$%

'nvolves measuring the deep invasion'nvolves measuring the deep invasion precisely in millimeterprecisely in millimeter

"atients with Clark level ?4 ??4 ???4"atients with Clark level ?4 ??4 ???4lesion w;a depth of invasion that islesion w;a depth of invasion that is

less than F3 are at low risk forless than F3 are at low risk for

metastasismetastasis

"atients w; level ?> or > and w; a"atients w; level ?> or > and w; a

depth of invasion greater than ?3H mmdepth of invasion greater than ?3H mm

are at high risk for distant metastasisare at high risk for distant metastasis



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'n order to complete the staging'n order to complete the staging #horough histological and physical#horough histological and physical

examination are necessaryexamination are necessary

'nclude ancillary work2up like'nclude ancillary work2up like complete blood countcomplete blood count

urinalysisurinalysis

chest x2raychest x2ray ?5 test se0uential multiple?5 test se0uential multiple

analysis @ !*A 2?5 analysis @ !*A 2?5



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*alignant *elanoma*alignant *elanoma #reatment#reatment11 A3 xcisionA3 xcision

-3 (esection-3 (esection

C3 Adjuvant #herapyC3 Adjuvant #herapy

(egional hyperthermic perfusion(egional hyperthermic perfusion

ChemotherapyChemotherapy 'mmunotherapy'mmunotherapy (adiotherapy(adiotherapy



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Mali"nant MelanomaMali"nant Melanoma

Pro"nosis@Pro"nosis@

Disease $on6ned at primar# site &Disease $on6ned at primar# site &

#ear#ear s!rial is A-9-s!rial is A-9-

I re"ional l#mph nodes are inoledI re"ional l#mph nodes are inoled

s!rial "oes do2n to =- to &-s!rial "oes do2n to =- to &-

Patients 2ho hae distant or is$eralPatients 2ho hae distant or is$eral

metastasis are !s!all# dead 2ithinmetastasis are !s!all# dead 2ithin

B0S01 CE11 C04CINOM0B0S01 CE11 C04CINOM0


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A malignant skin tumorA malignant skin tumorcharacteri:ed by slow growthcharacteri:ed by slow growth

and very rare distantand very rare distant

metastasismetastasis&enerally occurs in the head&enerally occurs in the head

and neckand neck+ound most commonly in+ound most commonly in

individuals of %orthernindividuals of %orthern

uro ean Descenturopean Descent

-asal Cell Carcinoma-asal Cell Carcinoma


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-asal Cell Carcinomaasa Ce Ca c o a



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Etiolo"#Etiolo"#

It has (een asso$iated 2ith@It has (een asso$iated 2ith@ eroderma pi"mentos!meroderma pi"mentos!m

Basal $ell ne!s s#ndromeBasal $ell ne!s s#ndrome

Ne!s se(a$eo!sNe!s se(a$eo!s Unsta(le (!rn s$arUnsta(le (!rn s$ar

Dermatitis s!()e$ted to radiation therap#Dermatitis s!()e$ted to radiation therap#

Clini$al Findin"sClini$al Findin"s 1esion has pearl# transl!$ent ed"es1esion has pearl# transl!$ent ed"es

Smooth eleation 2ith telan"ie$tati$Smooth eleation 2ith telan"ie$tati$

s!ra$es!ra$e



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#reatment#reatment

involves complete removal of the tumor toinvolves complete removal of the tumor to

achieve cure3 -'$"!, '! *A%DA#$(,achieve cure3 -'$"!, '! *A%DA#$(,

?3 Curettage and lectrodessication?3 Curettage and lectrodessication

HG cure rateHG cure rate

for lesions less than F35cmfor lesions less than F35cm

53 (adiation #herapy53 (adiation #herapy

FG cure rateBFG cure rateB

when tissue preservation is importantwhen tissue preservation is important

depigmentation and atrophy can occurdepigmentation and atrophy can occur



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#reatment#reatment63 xcision with primary Closure63 xcision with primary Closure A F3H cm margin from the grossly detectableA F3H cm margin from the grossly detectable

limit of the lesion ade0uate for curelimit of the lesion ade0uate for cure

HG cure rateHG cure rate

L% should be excised in continuityL% should be excised in continuity

if they are clinically positiveif they are clinically positive

(econstruction can be performed(econstruction can be performedin one settingin one setting

SU0MOUS CE11 C04CINOM0SU0MOUS CE11 C04CINOM0


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SU0MOUS CE11 C04CINOM0

't is more malignant in clinical behavior't is more malignant in clinical behaviorthan basal cell carcinomathan basal cell carcinoma

+ast growing and tends to metastasi:e to+ast growing and tends to metastasi:e to

regional L% plus wider local spreadregional L% plus wider local spreadtiologytiology

xposure to sunlightxposure to sunlight

+rom pre2malignant lesion+rom pre2malignant lesion

$ld burn scar$ld burn scar

xposure to arsenicals4 nitrates andxposure to arsenicals4 nitrates and

hydrocarbonshydrocarbons

!0uamous Cell Carcinoma!0uamous Cell Carcinoma


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00



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SU0MOUS CE11 C04CINOM0SU0MOUS CE11 C04CINOM0Clini$al ManiestationsClini$al Maniestations

Ma# appear as a satellite nod!le or a $entralMa# appear as a satellite nod!le or a $entralareaarea

o !l$eration that ma# (e$ome en$r!stedo !l$eration that ma# (e$ome en$r!sted

o(s$!rin"o(s$!rin"

deeper inasiondeeper inasion

Common in the lips, paranasal olds and a+illaCommon in the lips, paranasal olds and a+illa

Treatment@Treatment@

is (ased !pon e+amination o the (iops#is (ased !pon e+amination o the (iops#

spe$imenspe$imen

E+$ision Biops# or lesion less than %$mE+$ision Biops# or lesion less than %$m



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Treatment MethodsTreatment Methods

%. Ele$trodessi$ation%. Ele$trodessi$ation

For lesions less than %$m in diameterFor lesions less than %$m in diameter

For older indiid!alsFor older indiid!als

In patients 2ith re$!rren$e o t!morsIn patients 2ith re$!rren$e o t!mors



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=. 4adiation Therap#=. 4adiation Therap# Us!all# resered or adan$ed lesions inUs!all# resered or adan$ed lesions in

areasareas

2here s!r"i$al e+$ision leaes a2here s!r"i$al e+$ision leaes a$osmeti$all#$osmeti$all#

!na$$epta(le dee$t the nose, the e#elid,!na$$epta(le dee$t the nose, the e#elid,lipslips

Not !sed 2hen (one and $artila"e areNot !sed 2hen (one and $artila"e areinoledinoled

these re'!ire radi$al e+$isionthese re'!ire radi$al e+$ision

. MohHs S!r"er#. MohHs S!r"er#

99


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S2eat Gland T!morsS2eat Gland T!mors


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4are lesions arisin" rom the4are lesions arisin" rom thee$$rine ore$$rine or

apo$rine "landapo$rine "land

O$$!r in later lie as a sot tiss!eO$$!r in later lie as a sot tiss!emassmass

that has (een present or #earsthat has (een present or #ears

Metastasis toMetastasis to re"ional l#mphre"ional l#mphnodes arenodes are$ommon$ommon

$onsider disse$tion at time o initial$onsider disse$tion at time o initial

e+$isione+$ision


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