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Soutor 1e- Clinical Dermatology- Lecture 6- Benign and Malignant Tumors
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Soutor 1e- Clinical Dermatology- Lecture 6- Benign and Malignant Tumors
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Transcript:
Language: EN.
Segment:0 .
Segment:1 1. Benign and Malignant Tumors.
DR.LEE: I'm Dr. Peter Lee, Associate Professor of Dermatology in the Department of Dermatology at the University of Minnesota.
Segment:2 2. Learning Objectives.
DR.LEE: In this presentation, I will cover common benign tumors, such as seborrheic keratosis, dermatofibromas, cyst, and vascular lesions. We'll also cover nonmelanoma skin cancers such as basal cell carcinomas and squamous cell carcinomas. In addition, we will cover melanocytic tumors such as benign and atypical nevi as well as melanoma.
Segment:3 3. Benign Tumors.
DR.LEE: In the first part of this presentation, I will cover the following benign tumors. They include seborrheic keratosis, dermatofibroma, skin tag or acrochordon, sebaceous gland hyperplasia, lipoma, milia, epidermal and pilar cysts, digital mucous cyst, and acquired and congenital vascular lesions.
Segment:4 4. Seborrheic Keratosis.
DR.LEE: Seborrheic keratosis are seen in up to 50% of adults.
DR.LEE: They present as a hyperpigmented papule or plaque with a waxy hyperkeratotic surface as seen in this patient. They typically occur on the trunk but can be found in any location in the body.
Segment:5 5. Dermatofibroma.
DR.LEE: Deramtofibroma presents as a firm three to ten millimeter papule, usually hyperpigmented and often with a slightly hypopigmented center as seen in this figure.
DR.LEE: They're very common in the extremities especially in the lower extremities in women. A dimple sign may be present when you squeeze the dermatofibroma from the side.
Segment:6 6. Skin Tag (Acrochordon).
DR.LEE: Skin tags or acrochordon are commonly found in people after age 45. They present as skin-colored papules with a thin stalk as seen in this patient. They are typically located on the neck, axillae and groin where there are skin folds.
Segment:7 7. Sebaceous Gland Hyperplasia.
DR.LEE: Sebaceous gland hyperplasia present as two to four millimeter yellow to skin-colored papules, often with a central depression as seen on the forehead of this patient. They're usually found on the forehead and central face in patients.
Segment:8 8. Lipoma.
DR.LEE: A lipoma presents as a nodule with rubbery consistency as seen on the back of this patient.
DR.LEE: They may be single or multiple, and may occur in any body area.
Segment:9 9. Epidermal (Epidermoid) Cyst.
DR.LEE: Epidermal or epidermoid cysts, often called sebaceous cysts in lay terms, arise in infundibular region of the hair follicle. They present as a firm skin colored nodule with a central punctum as seen in this picture. The keratin within the cyst has a soft, cheesy consistency. Pilar cysts have a similar appearance but usually occur on the scalp without the central punctum.
Segment:10 10. Milia.
DR.LEE: Milia present as one to two millimeter white papules usually found around eyes and upper face as seen below the eye in this patient. They arise from the infundibular region of the hair follicle and are similar to epidermal cysts.
Segment:11 11. Digital Mucous Cyst.
DR.LEE: A digital mucous cyst is a pseudocyst formed by extrusion of local joint content. It presents as a translucent skin colored cyst near or at area of proximal nail matrix as seen in this patient.
Segment:12 12. Cherry Angioma.
DR.LEE: Cherry angioma presents as a small bright red or purple papules. They are commonly seen in females after age 30 and are typically present on the trunk. They occur more commonly in pregnancies.
Segment:13 13. Pyogenic Granuloma.
DR.LEE: Pyogenic granuloma is typically seen in children and young adults. They present with a rapidly growing exophytic papule, which bleeds easily as seen on the fingertip of this patient.
DR.LEE: They're most commonly seen on the face, neck and distal extremities. They're also commonly seen in pregnant women.
Segment:14 14. Vascular Congenital Malformations (Port Wine Stain, Stork Bite).
DR.LEE: Vascular congenital malformations are present at birth. The most common forms called stork bite and angel kiss present as macular erythema on posterior neck or mid-forehead and fade within first year of life. Port-wine stains do not resolve and may become thicker as seen in this cheek of this child.
DR.LEE: Port-wine stains may also be associated with syndromes, such as Sturge-Weber syndrome.
Segment:15 15. Infantile Hemangioma.
DR.LEE: Infantile hemangioma occur in 2% of all infants, and up to one third of all premature infants. They are more common in females. They are usually not present at birth, but grow rapidly in the first year. They present as red to purple, soft plaque or nodule as seen in the arm of this child.
DR.LEE: The lesions involute very slowly in early childhood.
Segment:16 16. Actinic Keratosis and Nonmelanoma Skin Cancer.
DR.LEE: Next, we will cover precancerous lesion actinic keratosis and skin cancers basal cell carcinoma and squamous cell carcinoma.
Segment:17 17. Actinic Keratosis (AK).
DR.LEE: Actinic keratosis are common precancerous lesions of keratinocytes. They're typically present in elderly Caucasians on chronically sun-unexposed areas. They present as solitary or multiple rough papules or plaques as seen on the scalp of this patient.
DR.LEE: Approximately 10% of untreated actinic keratosis may become squamous cell carcinomas.
Segment:18 18. Basal Cell Carcinoma (BCC).
DR.LEE: Basal cell carcinomas are the most common skin cancer in the human body. They are usually found in elderly Caucasians. They are rarely metastatic. Nodular basal cell carcinoma is the most common subtype. It typically presents as a translucent, pearly papule with erythema, telangiectasia and rolled border, usually occurring on the head and neck region.
DR.LEE: This patient presents with a typical lesion on the nasal ala of the nose.
Segment:19 19. Pigmented, Superficial, and Sclerotic Basal Cell Carcinomas (BCCs).
DR.LEE: There are three other common types of basal cell carcinomas. Superficial basal cell carcinomas have a rash-like appearance as seen in this Figure 15. Sclerotic basal cell carcinomas are the most aggressive basal cell carcinomas and have a scar-like appearance as seen above the right eyebrow in this patient in Figure 16.
DR.LEE: Nodular basal cell carcinomas may be pigmented mimicking a melanoma as seen in Figure 17.
Segment:20 20. Squamous Cell Carcinoma (SCC).
DR.LEE: Squamous cell carcinoma is the second most common skin cancer. It has some potential for local or distant metastasis. Associated risk factors include ultraviolet light exposure, solid organ transplantation, and immunosuppression and chronic inflammation. It is commonly found on face such as the balding scalp, dorsal hands, forearms, lower legs in women.
Segment:21 21. Squamous Cell Carcinoma In Situ.
DR.LEE: Squamous cell carcinoma in situ is limited to the epidermis with no dermal invasion. It presents as a rough erythematous, keratotic plaque or papule which is more indurated and/or tender than an actinic keratosis as seen on the helix of the ear on this patient.
Segment:22 22. Other Types of Squamous Cell in In-Situ: Bowen’s Disease Erythroplasia of Queyrat.
DR.LEE: There are two types of squamous cell carcinoma in situs, Bowen's disease and Erythroplasia of Queyrat.
DR.LEE: Both types are often misdiagnosed as a rash. Bowen's disease presents as an erythematous plaque typically found on lower legs of women, as seen in this Figure 19. Erythroplasia of Queyrat typically occurs on the penile shaft, or the glands of uncircumcised men as seen in Figure 20.
Segment:23 23. Invasive Squamous Cell Carcinoma (SCC).
DR.LEE: Invasive squamous cell carcinoma extends into the dermis. It presents as a hyperkeratotic pink papule or nodule, as seen on the dorsum of the hand in this patient.
Segment:24 24. Keratoacanthoma.
DR.LEE: Keratoacanthoma is another subtype of squamous cell carcinoma that grows rapidly. They present as a nodule with a central hyperkeratotic core.
Segment:25 25. Melanocytic Tumors.
DR.LEE: Next I will cover melanocytic tumors.
Segment:26 26. Solar Lentigo.
DR.LEE: Solar lentigines are common, benign lesions seen in older adults on sun-exposed areas. They are characterized by increased number of melanocytes. They present with light tan to dark brown macules, typically on sun exposed areas such as the face, extensor arms and upper trunk and dorsal hands as seen in this patient.
Segment:27 27. Benign Melanocytic Nevus (Mole).
DR.LEE: Benign melanocytic nevi are more common in Caucasians with onset in early childhood. Benign nevi usually are less than one centimeter and have uniform colors and borders. Junctional nevi present as pink to black macules as seen in Figure 24. Intradermal nevi typically present as flesh-colored papules as seen in Figure 25. Compound nevi have junctional and intradermal components.
Segment:28 28. Atypical (Dysplastic) Nevus.
DR.LEE: Atypical or dysplastic nevi occur in up to 5% of Caucasians. Patients with atypical nevi may have an increased risk for melanoma. Atypical nevi have features that are different from other nevi on the body. They may have variable shapes, irregular borders and variegated colors ranging from pink to black, as seen on the back of this patient.
Segment:29 29. Congenital Melanocytic Nevus.
DR.LEE: Congenital melanocytic nevi are seen in 1% of Caucasian infants. They present as a brown to black plaque or nodule. They're often several centimeters in diameter as on the thigh of this patient, or may cover a whole body region. There is an increased risk for melanoma development, especially with the larger lesions.
Segment:30 30. Melanoma.
DR.LEE: The incidence of melanoma is on the rise with lifetime risk of 2.67% in males and 1.79% in females.
DR.LEE: The most common locations are the trunk in men, especially in the back, and also in the extremities in women. Thin melanomas with thickness of less than 0.75 millimeters have a five year survival rate of greater than 98%. While those greater than four millimeter thickness have a 20% survival rate. Early detection and treatment are very important.
Segment:31 31. ABCDE Rule for Melanoma Features.
DR.LEE: The ABCDE rule for melanoma features include A for asymmetry, B for border that's irregular, notched or blurred, C for color that's variable or irregularly distributed, D for diameter that is greater than six millimeters, and E for evolving or changing lesions or what's called exceptional nevus such as a very unusual appearing nevus.
DR.LEE: The melanoma in this slide demonstrates these features.
Segment:32 32. Types of Melanoma.
DR.LEE: Superficial spreading melanoma is the most common type of melanoma that accounts for 70% of all melanomas. It has a superficial radial growth phase before an invasive vertical growth phase. The lesion in Figure 29 is a superficial spreading melanoma. Lentigo maligna melanoma accounts for 10% to 30% of all melanomas.
DR.LEE: It presents as a large flat lesion typically on the head and neck of elderly patients as seen in this patient and Figure 30.
Segment:33 33. Nodular Melanoma.
DR.LEE: Nodular melanoma accounts for 10% to 15% of all melanomas. It has a vertical growth phase only and may be fairly deep with poor prognosis at the time of diagnosis. It typically presents with a dark brown to black papule as seen on the ear lobe of this patient in Figure 31.
DR.LEE: The amelanotic variant of melanoma may be red or pink as seen in Figure 32.
Segment:34 34. Acral Lentiginous Melanoma.
DR.LEE: Acral lentiginous melanoma accounts for 5% of melanomas. It is the most common presentation of melanoma in patients of color such as Asian and Black patients. It typically occurs on the palms and soles as seen in this patient.
Segment:35 35. Summary.
DR.LEE: In summary, the benign tumors covered in this presentation are commonly seen and can usually be diagnosed clinically.
DR.LEE: Basal cell and squamous cell carcinomas rarely become metastatic, but can cause significant problems with local invasion, especially if they're located on the central part of the face. The incidence of melanoma is rising and early detection is very important. Most skin cancers are caused by excess ultraviolet and sun exposure.
DR.LEE: Sunscreens and other measures to limit ultraviolet exposure are important in prevention of skin cancers.
Segment:36 36. Contributors.