Exenteration. Introduction. The skin. Epidermal malignancies 8/3/2017. Neglected basal cell carcinoma
|
|
- Wendy Mitchell
- 5 years ago
- Views:
Transcription
1 Jeremiah Tao, MD, FACS Director, Oculoplastic and Orbital Surgery Associate Professor, UC Irvine Neglected basal cell carcinoma Exenteration Introduction Chief question with any eyelid lesion: Suspicious or not? Other good reasons to remove a lesion: Irritation Eyelid malposition Cosmesis Jeremiah Tao, MD FACS The skin Eyelid skin is the thinnest skin in the body Made up of 2 layers Epidermis Dermis Epidermal malignancies Most common skin malignancy, basal cell carcinoma, arises from the basal layer (undifferentiated cells) Squamous cell carcinoma arises from more superficial epidermal skin cells these squamous cells produce keratin 1
2 Pigment cells Melanocytes, the pigment producing cells, are found in the basal layer of the epidermis Melanin is the pigment produced in melanosomes within the melanocytes Pigment cell malignancy = melanoma Dermis Deep layer of skin Contains skin appendages or adnexa: hair follicles sebaceous glands sweat glands Dermis The most common adnexal malignancy is sebaceous cell carcinoma Skin cancer Most common cancer in US Aging population Longer lifespan Increased outdoor activities Environmental changes Easier to treat when small in size Outline and objectives Suspicious or not, history & pattern recognition Basal cell, squamous cell, melanoma, & Merkel cell Management Malignant or not? History age & history of significant sun exposure are suggestive Lesion growth or change including bleeding Examination Pattern recognition Clinical intuition 2
3 Characteristics of malignancy Diagnosis starts with suspicion Treatment rests on complete surgical excision The most common skin malignancy is basal cell carcinoma (BCCa) >90% of malignant lid lesions Characteristics of malignancy Ulceration Lack of tenderness Induration Irregularity Telangiectasia Pearly borders Loss of lid margin architecture Ulceration Malignant cells grow rapidly outgrow blood supply central ulceration Benign lesions usually do not ulcerate Central ulceration in basal cell carcinoma Characteristics of malignancy Ulceration Lack of tenderness Induration Irregularity Telangiectasia Pearly borders Loss of lid margin architecture Lack of tenderness Despite ulceration, often with bleeding, malignant lesions tend not to be painful Pain develops when the tumor causes secondary problems (e.g. necrosis then eyelid malposition and corneal exposure) 3
4 Characteristics of malignancy Ulceration Lack of tenderness Induration Irregularity Telangiectasia Pearly borders Loss of lid margin architecture Induration Malignancies tend to be firm Benign lesions feel more like the surrounding normal skin Palpate the lesion Characteristics of malignancy Ulceration Lack of tenderness Induration Irregularity Telangiectasia Pearly borders Loss of lid margin architecture Irregularity Malignant tumors are made up of cell populations growing at different rates Differing growth patterns create irregular margins & asymmetric shapes Benign lesions tend to have smooth borders Irregularity (asymmetry) Contrast with benign milia 4
5 Contrast with benign syringomas Benign intradermal nevus * Classic patient = young, healthy female Irregularity in BCC Characteristics of malignancy Ulceration Lack of tenderness Induration Irregularity Telangiectasia Pearly borders Loss of lid margin architecture Telangiectasia Dilated & irregular vessels Pathognomonic for basal cell carcinoma Telangiectasia in basal cell carcinoma 5
6 Differential: benign papilloma Characteristics of malignancy Ulceration Lack of tenderness Induration Irregularity Telangiectasia Pearly borders Loss of lid margin architecture Pearly Nodular basal cell carcinoma Rolled translucent margins that are whitish and shiny in appearance Translucent appearance allegedly from proliferating cells in the basal layer of the epidermis Nodular basal cell carcinoma Pearly and nodular basal cell carcinoma 6
7 Differential: amelanotic nevus (benign) Amelanotic nevus (benign) Differential for nodular: epidermal cyst (benign) Fluid filled nodule = benign hidrocystoma Fluid filled nodule = benign hidrocystoma Characteristics of malignancy Ulceration Lack of tenderness Induration Irregularity Telangiectasia Pearly borders Loss of lid margin architecture 7
8 Notching & madarosis due to BCC Loss of eyelid margin architecture Lash loss, a.k.a., madarosis Eyelid margin destruction May be due to tumor outgrowing its blood supply Morpheaform BCC Madarosis & eyelid margin architecture change due to basal cell carcinoma Characteristics of malignancy Not all the characteristics of malignancy need to be present for the lesion to be malignant Recurrence should also raise suspicion Basal cell carcinoma (BCC) The most common skin malignancy 90% of eyelid malignancies 20% of eyelid tumors in general Related to ultraviolet or actinic damage More common in fair-skinned individuals (tend to burn rather than tan) Lower lid and medial canthus are most common locations (receive more sun than upper eyelid?) 8
9 Basal cell carcinoma Neglected basal cell carcinomas Low risk for metastasis May invade locally Mortality 3% Morbidity & mortality most common with: medial canthal lesions h/o treatment with radiation clinically neglected tumors Basal cell carcinoma subtypes Nodular most common Morpheaform or sclerosing Superficial least common on eyelids Nodular basal cell carcinoma Firm, raised, pearly nodule Telangiectasia common Central ulceration may be present rodent ulcer Nodular basal cell carcinoma Nodular basal cell carcinoma 9
10 Nodular basal cell carcinoma Nodular basal cell carcinoma Nodular BCC histology Lobules of small basophilic cells with high mitotic activity Peripheral palisading common Morpheaform basal cell carcinoma More invasive & worse prognosis Margins and invasiveness difficult to discern Firm lesions Ulceration common May mimic surgical scar Morpheaform BCC Morpheaform BCC 10
11 Morpheaform BCC Morpheaform BCC Morpheaform BCC Morpheaform BCC Morpheaform BCC Morpheaform BCC histology Basophilic, malignant basal cells arranged in cords that radiate peripherally No peripheral palisading Surrounding stroma develops fibrosis 11
12 Superficial BCC Superficial BCC Relatively rare on the face Slightly elevated, erythematous, scaling patches Superficial BCC Superficial BCC Squamous cell carcinoma (SCC) Much less common than BCC 5-10% of lid malignancies BCC:SCC ratio 40:1 Arises in sun-damaged skin (de novo or from actinic keratosis) Can appear as nodule or an indurated plaque Squamous cell carcinoma Hyperkeratosis scaly skin falls off easily SCC or its precursor, actinic keratosis (AK) ulceration, telangiectasia, & pearly borders 12
13 Squamous cell carcinoma Usually more aggressive than BCC 0.5% metastatic risk if arising de novo 20-40% if arising in area of previously damaged skin Pay attention to pathology report Invasive High atypia Margins may be diffuse often a large area of subclinical tumor involvement Squamous cell carcinoma Can be clinically indistinguishable from BCC May have increased keratin and debris Squamous cell carcinoma Squamous cell carcinoma Residual tumor after previous excision Advanced SCC SCC histology Field of squamous epithelial cells Invasion past basal lamina Keratinization and intercellular bridges present 13
14 Spread of SCC Direct extension by narrow cellular strands Perineural invasion Lymphatic spread Hematogenous Baso-squamous cell carcinoma Intermediate histology Behavior and treatment are same as SCC Keratoacanthoma Low-grade squamous cell carcinoma Characteristic large lesion with central crater filled with keratin May come on suddenly (weeks-months) May resolve spontaneously over 6 months SCC differential: actinic keratosis Premalignant skin lesion may become squamous cell carcinoma Looks/feels like rough patches (hyperkeratosis) May have surrounding erythema Usually multiple Actinic keratosis (benign) SCC differential: seborrheic keratosis (benign) Age & sun-related Color varies from flesh color to tan Appear greasy & stuck-on Treatment: shave excision 14
15 Seborrheic keratosis Seborrheic keratosis Keratoacanthoma Crater on histology Molluscum contagiosum also has crater on histology Molluscum bodies Sebaceous cell carcinoma Rare (1 to 5% of eyelid cancers) Arises within sebaceous glands of the skin (adnexal malignancy) BCC, SCC, and sebaceous cell carcinoma comprise >95% of eyelid malignancies 15
16 Sebaceous cell carcinoma Sebaceous glands in the periocular region: Meibomian glands glands of Zeis associated with lash follicles in the periocular skin in the caruncle eyebrow follicles Sebaceous cell carcinoma is more common in the periocular area than anywhere else due to so many sebaceous glands Sebaceous cell carcinoma No characteristic appearance masquerader May present as unilateral blepharoconjunctivitis or a chronic/recurrent chalazion Yellowish material within any suspicious lesion should suggest sebaceous cell carcinoma More common on upper lid more meibomian glands in the superior tarsus Sebaceous cell carcinoma Sebaceous cell carcinoma Sebaceous cell carcinoma Sebaceous cell CA 16
17 Sebaceous cell carcinoma Chalazion that won t go away Chalazion Chalazion Chalazion Sebaceous cell carcinoma Usually need a full-thickness specimen to make diagnosis Oil red-o stain on fresh tissue stains sebaceous material Foamy cytoplasm seen in dysplastic sebaceous cells diagnostic 17
18 Sebaceous cell carcinoma Two unusual growth patterns make complete excision difficult 1. Pagetoid spread superficially over large areas; margins not clinically visible 2. Multifocal, noncontiguous tumor origins with skip areas between Sebaceous cell carcinoma Map (blind) biopsy low yield Biopsy any abnormal area Now Later Sebaceous cell carcinoma Exenteration Map biopsies assess for peripheral pagetoid spread Take generous margins on full-thickness eyelid biopsy Frozen sections can be unreliable Jeremiah Tao, MD FACS Sebaceous cell carcinoma Why spend so much time on a rare tumor? it can be lethal Regional lymph node metastasis possible The longer the duration of symptoms before treatment, the poorer the prognosis for survival 18
19 Usually pre auricular from eyelids Melanoma Melanoma Eyelid melanomas are rare (<1%) Clinical features new onset or change in existing lesion Asymmetric shape (cannot fold on itself) Borders irregular (uncontrolled growth) Color change or multiple colors within lesion Diameter >6mm in diameter (large lesion) Melanoma May metastasize Risk of metastasis increases with increasing depth of lesion Sentinel node biopsy is usually indicated (unless just melanoma in-situ, or confined to epidermis) Differential for pigmented lesion: nevus (benign) 19
20 Differential for pigmented lesion: nevus (benign) Lid margin nevus Kissing nevi Differential for pigmented lesion: lentigo (benign) Lentigo senilis Ephelides 20
21 Merkel cell carcinoma Merkel cell carcinoma Neuroendocrine skin tumor Rare but may be increasing Highly malignant, potentially lethal Rapidly growing, nontender, red or violaceous nodule with intact skin Infiltrating pattern of growth Metastatic Merkel cell carcinoma Differential: hemangioma Differential: hemangioma Differential: hemangioma Hemangioma Merkel cell carcinoma 21
22 Malignant eyelid lesions Final diagnosis rests with pathologist Treatment Gold standard = wide local resection with histologic confirmation (3-5+ mm margins), then reconstruction, sentinel nodes for sebaceous cell, melanoma, invasive SCC Other options/adjuncts: Cryo destruction, chemotherapy Chemo or immune therapy for eyelid carcinoma Local Imiquimod Systemic Melanoma - Immune check point inhibitors targeting programmed cell death (Pembrolizumab and Nivolumab) BCC - Hedgehog inhibitors (Vismodegib) Biopsy Techniques Parallel & vertical cuts through tarsus Pentagonal wedge excision: general rules Primary repair for up to 1/3 lid extent Add procedures when >1/3 defect Dog ear deformity at base/apex of pentagon 22
23 Lazy pentagonal wedge excision For margin lesions, can hide wedge under skin/muscle flaps Upper lid use crease Lower lid subciliary Wedge under lid crease incision Jeremiah Tao, MD, FACS Jeremiah Tao, MD, FACS Jeremiah Tao, MD, FACS 23
24 Jeremiah Tao, MD, FACS Jeremiah Tao, MD, FACS Dailey R, Chavez M. Upper Eyelid Margin Mass Excision Technique: Supraciliary Approach. Ophthal Plast Reconstr Surg Jan/Feb;27(1): Jeremiah Tao, MD, FACS Jeremiah Tao, MD, FACS Incisional vs. excisional biopsy Dailey R, Chavez M. Upper Eyelid Margin Mass Excision Technique: Supraciliary Approach. Ophthal Plast Reconstr Surg Jan/Feb;27(1): Incisional Biopsy Only a portion of the lesion is removed to allow for pathologic diagnosis Best place to get specimen is at periphery of lesion to include some normal tissue Excisional Biopsy The entire gross lesion is removed Jeremiah Tao, MD, FACS 24
25 Mohs excision Mohs Excision Mohs surgery is a form of excisional biopsy performed by specially-trained dermatologists Entire lesion is removed and narrow margins of surrounding tissues are examined with frozen sections In theory, minimal normal tissue is removed Pre op Squamous cell carcinoma Mohs defect Mohs defect often still require wedge due to remnant tarsus Mohs defect Post-op Principals of eyelid reconstruction Reconstitute BOTH eyelid lamella Anterior lamella: skin/orbicularis oculi Posterior lamella: conjunctiva/retractor band/tarsus Reconstitute canthal attachments Reconstitute lacrimal drainage system Pre op Primary closure Mohs defect 25
26 BCC BCC Mohs Defect Closure with forehead and cheek rotation flaps Mohs' defect Final result Basal cell carcinoma Basal cell carcinoma Pre op Mohs defect Intra op Intra op Mustarde flap Mustarde flap Basal cell carcinoma Pre op Mohs defect 26
27 Post op Lateral rotational flap Post op Mohs defect Lateral rotational flap Post op Basal cell pre-op Intra-op after frozen sections Immediate post op Thank You!! 27
Technicians & Nurses Program
ASCRS ASOA Symposium & Congress Technicians & Nurses Program May 6-10, 2016 New Orleans Evaluation and Treatment of Eyelid Malignancies Richard C. Allen MD PhD FACS Professor Section of Ophthalmology Dept.
More informationPeriocular Malignancies
Periocular Malignancies Andrew Gurwood, O.D., F.A.A.O., Dipl. Marc Myers, O.D., F.A.A.O. Drs. Myers and Gurwood have no financial interests to disclose. Course Description Discussion of the most common
More informationBenign versus Cancerous Lesions How to tell the difference FMF 2014 Christie Freeman MD, CCFP, DipPDerm, MSc
1 Benign versus Cancerous Lesions How to tell the difference FMF 2014 Christie Freeman MD, CCFP, DipPDerm, MSc Benign lesions Seborrheic Keratoses: Warty, stuck-on Genetics and birthdays Can start in late
More informationAnatomic Divisions. Ocular Surface. Intraocular. Orbital. Lacrimal. Eyelid
Anatomic Divisions Ocular Surface Intraocular Orbital Lacrimal Eyelid Ocular Surface Melanocytic Squamous Neoplasia Lymphoid Melanocytic Nevi PAM (Primary Acquired Melanosis) Ocular Melanocytosis Melanoma
More informationLid Lesions: Relax or Refer
Lid Lesions: Relax or Refer Blair Lonsberry, MS, OD, MEd., FAAO Professor of Optometry Pacific University College of Optometry blonsberry@pacificu.edu Agenda Benign vs. Malignant lesions Benign Eyelid
More informationClinical characteristics
Skin Cancer Fernando Vega, MD Seattle Healing Arts Clinical characteristics Precancerous lesions Common skin cancers ACTINIC KERATOSIS Precancerous skin lesions Actinic keratoses Dysplastic melanocytic
More informationDermatopathology: The tumor is composed of keratinocytes which show atypia, increase mitoses and abnormal mitoses.
Squamous cell carcinoma (SCC): A common malignant tumor of keratinocytes arising in the epidermis, usually from a precancerous condition: 1- UV induced actinic keratosis, usually of low grade malignancy.
More informationDoctors of Optometry Course Notes
Doctors of Optometry Course Notes OD19 1CE COPE: 43871-AS Eyelid Lumps and Bumps Sunday, February 26, 2017 2:40 pm 3:30 pm Regency C 3 rd Floor Presenter: Blair Lonsberry, OD, FAAO Dr. Lonsberry is a Full
More informationOnly the Mohs Knows: Management of Periocular Skin Cancers
Only the Mohs Knows: Management of Periocular Skin Cancers Andrew R. Harrison, M.D. Director, Oculoplastic and Orbital Surgery University of Minnesota Overview Common Eyelid Skin Cancers Management Options
More informationCutaneous Malignancies: A Primer COPYRIGHT. Marissa Heller, M.D.
Cutaneous Malignancies: A Primer Marissa Heller, M.D. Associate Director of Dermatologic Surgery Department of Dermatology Beth Israel Deaconess Medical Center December 10, 2016 Skin Cancer Non-melanoma
More informationLagophthalmos. Lagophthalmos: signs. Lagophthalmos: clinical tips. Lagophthalmos: treatment plan. Madarosis
Lagophthalmos Def: incomplete closure of the eyelid SX: FBS, irritation, red, burn, dry, chronic morning corneal irritation Lagophthalmos: signs 2-5 mm lid separation with slit lamp during blink can force
More informationLUMPS AND BUMPS: AN ORGANIZED APPROACH TO DIAGNOSIS AND MANAGEMENT
LUMPS AND BUMPS: AN ORGANIZED APPROACH TO DIAGNOSIS AND MANAGEMENT Tammy P. Than, M.S., O.D., F.A.A.O. The University of Alabama at Birmingham / School of Optometry 1716 University Blvd. Birmingham, AL
More informationBenign and malignant epithelial lesions: Seborrheic keratosis: A common benign pigmented epidermal tumor occur in middle-aged or older persons more
Benign and malignant epithelial lesions: Seborrheic keratosis: A common benign pigmented epidermal tumor occur in middle-aged or older persons more common on the trunk; but extremities, head and neck are
More informationLumps and Bumps: The Dermatology of Lid Lesions
Lumps and Bumps: The Dermatology of Lid Lesions Thomas J. Joly, MD, PhD Assistant Professor of Ophthalmology Eastern Virginia Medical School Ophthalmic Plastic Surgery Service Virginia Eye Consultants
More informationIdentifying Skin Cancer. Mary S. Stone MD Professor of Dermatology and Pathology University of Iowa Carver College of Medicine March, 2018
Identifying Skin Cancer Mary S. Stone MD Professor of Dermatology and Pathology University of Iowa Carver College of Medicine March, 2018 American Cancer Society web site Skin Cancer Melanoma Non-Melanoma
More informationSkin Malignancies Non - Melanoma & Melanoma Marilyn Ng, MD Dept. of Surgery M&M Conference Downstate Medical Center July 19, 2012
Skin Malignancies Non - Melanoma & Melanoma Marilyn Ng, MD Dept. of Surgery M&M Conference Downstate Medical Center July 19, 2012 Case Presentation 57 yo man with 3 month hx of a nonhealing < 1 cm right
More informationIT S FUNDAMENTAL MY DEAR WATSON! A SHERLOCKIAN APPROACH TO DERMATOLOGY
IT S FUNDAMENTAL MY DEAR WATSON! A SHERLOCKIAN APPROACH TO DERMATOLOGY Skin, Bones, and other Private Parts Symposium Dermatology Lectures by Debra Shelby, PhD, DNP, FNP-BC, FADNP, FAANP Debra Shelby,
More informationDermoscopy: Recognizing Top Five Common In- Office Diagnoses
Dermoscopy: Recognizing Top Five Common In- Office Diagnoses Vu A. Ngo, DO Department of Family Medicine and Dermatology Choctaw Nation Health Services Authority Learning Objectives Introduction to dermoscopy
More informationPathology of the skin. 2nd Department of Pathology, Semmelweis University
Pathology of the skin 2nd Department of Pathology, Semmelweis University Histology of the skin Epidermis: Stratum corneum Stratum granulosum Stratum spinosum Stratum basale Dermis: papillary and reticular
More information29/06/1439 بسم ا هلل ا لرحمن ا لر حيم
بسم ا هلل ا لرحمن ا لر حيم 1 LID RECONSTRUCTION by Ali M ISMAIL professor of ophthalmology @SOHAG U H Occuloplastic fellow @NNUH Occuloplastic fellow @Cambridge UH Honor fellow @ Mooorfield eye Hospital
More informationSkin Cancer 101: Diagnosis and Management of the Most Common Cancer
Skin Cancer 101: Diagnosis and Management of the Most Common Cancer Sarah Patton, PA-C, MSHS Skin Surgery Center www.skinsurgerycenter.com Seattle/Bellevue, WA Skin cancer Skin cancer is by far the most
More informationKnow who is at risk: LOOK! for ABCDs, rapidly changing lesions, do a biopsy when indicated
Lindy P. Fox, MD Assistant Professor Director, Hospital Consultation Service Department of Dermatology University of California, San Francisco Applies to adults without history of malignancy or premalignant
More informationLiving Beyond Cancer Skin Cancer Detection and Prevention
Living Beyond Cancer Skin Cancer Detection and Prevention Cutaneous Skin Cancers Identification Diagnosis Treatment options Prevention What is the most common cancer in people? What is the most common
More informationMECHANISMS OF HUMAN DISEASE: LABORATORY SESSION PATHOLOGY OF THE SKIN LAB. Friday, February 12, :30 am 11:00 am
MECHANISMS OF HUMAN DISEASE: LABORATORY SESSION PATHOLOGY OF THE SKIN LAB Friday, February 12, 2012 9:30 am 11:00 am FACULTY COPY GOALS: Describe the basic clinical and morphologic features of various
More informationKnow who is at risk: LOOK! for ABCDs, rapidly changing lesions, do a biopsy when indicated
Lindy P. Fox, MD Associate Professor Director, Hospital Consultation Service Department of Dermatology University of California, San Francisco Applies to adults without history of malignancy or premalignant
More informationBasal cell carcinoma 5/28/2011
Goal of this Presentation A practical approach to the diagnosis of cutaneous carcinomas and their mimics Thaddeus Mully, MD University of California San Francisco To review common non-melanoma skin cancers
More informationGlenn D. Goldman, MD. University of Vermont Medical Center. University of Vermont College of Medicine
Glenn D. Goldman, MD University of Vermont Medical Center University of Vermont College of Medicine Recognize and identify the main types of skin cancer and their precursors Identify and understand new
More informationMECHANISMS OF HUMAN DISEASE: LABORATORY SESSION PATHOLOGY OF THE SKIN LAB. Friday, February 13, :30 am 11:00 am
MECHANISMS OF HUMAN DISEASE: LABORATORY SESSION PATHOLOGY OF THE SKIN LAB Friday, February 13, 2009 9:30 am 11:00 am FACULTY COPY GOALS: Describe the basic clinical and morphologic features of various
More informationGlenn D. Goldman, MD. Fletcher Allen Health Care. University of Vermont College of Medicine
Glenn D. Goldman, MD Fletcher Allen Health Care University of Vermont College of Medicine Recognize and identify the main types of skin cancer Understand how and why Mohs surgery is utilized for the treatment
More informationLearning Objectives. Tanning. The Skin. Classic Features. Sun Reactive Skin Type Classification. Skin Cancers: Preventing, Screening and Treating
Learning Objectives Skin Cancers: Preventing, Screening and Treating Robert A. Baldor, MD, FAAFP Professor, Family Medicine & Community Health University of Massachusetts Medical School Distinguish the
More informationVision Health: Conditions, Disorders & Treatments EYELID DISORDERS
Vision Health: Conditions, Disorders & Treatments EYELID DISORDERS There are a number of disorders that can affect the eyelid. Entropion Entropion is an inward turning of the eyelid and lashes toward the
More informationLumps and Bumps: An Organized Approach to Diagnosis and Management. Disclosure. Introduction. References. Structure of Skin.
Lumps and Bumps: An Organized Approach to Diagnosis and Management Nothing to disclose Disclosure Tammy Pifer Than, MS, OD, FAAO Carl Vinson VAMC tammythan@bellsouth.net References Fitzpatrick's Color
More informationHistopathology: skin pathology
Histopathology: skin pathology These presentations are to help you identify, and to test yourself on identifying, basic histopathological features. They do not contain the additional factual information
More informationSKIN CANCER. Most common cancer diagnosis 40% of all cancers
SKIN CANCER Most common cancer diagnosis 40% of all cancers OBJECTIVES Review common and uncommon cancers of the skin. Special emphasis on melanoma and dysplastic nevus Review pathology/tnm/staging, which
More informationI have a skin lump doc! What s next? 12 th August 2017 Dr. Sue-Ann Ho Ju Ee
I have a skin lump doc! What s next? 12 th August 2017 Dr. Sue-Ann Ho Ju Ee Some thoughts Is this skin cancer? How common is this? How likely is this in this patient? What happens next if it s something
More informationDesmoplastic Melanoma R/O BCC. Clinical Information. 74 y.o. man with lesion on left side of neck r/o BCC
R/O BCC Sabine Kohler, M.D. Professor of Pathology and Dermatology Dermatopathology Service Stanford University School of Medicine Clinical Information 74 y.o. man with lesion on left side of neck r/o
More informationCutaneous Melanoma: Epidemiology (USA) The Sentinel Node in Head and Neck Melanoma. Cutaneous Melanoma: Epidemiology (USA)
The Sentinel Node in Head and Neck Melanoma Cutaneous Melanoma: Epidemiology (USA) 6 th leading cause of cancer among men and women 68,720 new cases of invasive melanoma in 2009 8,650 deaths from melanoma
More informationSkin lesions The Good and the Bad. Dr Virginia Hubbard Ipswich Hospital NHS Trust Barts and the London School of Medicine and Dentistry
Skin lesions The Good and the Bad Dr Virginia Hubbard Ipswich Hospital NHS Trust Barts and the London School of Medicine and Dentistry Case 1 32 year old woman Australian Lesion on back New hair growing
More informationSkin Cancer. 5 Warning Signs. American Osteopathic College of Occupational and Preventive Medicine OMED 2012, San Diego, Monday, October 8, 2012 C-1
Skin Cancer AMERICAN OSTEOPATHIC COLLEGE OF OCCUPATIONAL & PREVENTIVE MEDICINE OMED 2012 October 8, 2012 E. Robert Wanat II, D.O., M.P.H. Learning Objectives: Identify the 3 Basic Types of Skin Cancer
More informationSkin Cancer of the Nose: Common and Uncommon
Skin Cancer of the Nose: Common and Uncommon Mark Russell, M.D. Associate Professor of Dermatology, Otolaryngology, and Pathology University of Virginia Objectives Review clinical presentations of select
More informationPeriocular skin cancer
Periocular skin cancer Information for patients Skin cancer involving the skin of the eyelid or around the eye is called a periocular skin cancer. Eyelid skin cancers occur most often on the lower eyelid,
More informationGeneral information about skin cancer
Skin Cancer General information about skin cancer Key points Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin. There are different types of cancer that start in
More informationDavid B. Troxel, MD. Common Medicolegal Situations: Misdiagnosis of Melanoma
Common Medicolegal Situations: Misdiagnosis of Melanoma David B. Troxel, MD Medical Director, The Doctors Company, Napa, California Clinical Professor Emeritus, University of California at Berkeley Past
More informationIdentifying Benign and Malignant Skin Lesions. No Disclosures. Common Benign Lesions. Benign Lesions 2/25/2018. Stucco Keratoses.
Dermatology in Primary Care Identifying Benign and Malignant Skin Lesions Christy Quire Baker, APRN, FNP-BC, DCNP Dermatology Certified Nurse Practitioner No Disclosures Common Benign Lesions Seborrheic
More informationDermatology for the PCP Deanna G. Brown, MD, FAAD Susong Dermatology Consulting Staff at CHI Memorial
Dermatology for the PCP Deanna G. Brown, MD, FAAD Susong Dermatology Consulting Staff at CHI Memorial Cutaneous Oncology for the PCP Deanna G. Brown, MD, FAAD Susong Dermatology Consulting Staff at CHI
More informationLarge majority caused by sun exposure Often sun exposure before age 20 Persons who burn easily and tan poorly are at greatest risk.
Basics of Skin Cancer Detection and Treatment of Non- Melanoma Skin Cancers Large majority caused by sun exposure Often sun exposure before age 20 Persons who burn easily and tan poorly are at greatest
More informationA PRACTICAL APPROACH TO ATYPICAL MELANOCYTIC LESIONS BIJAN HAGHIGHI M.D, DIRECTOR OF DERMATOPATHOLOGY, ST. JOSEPH HOSPITAL
A PRACTICAL APPROACH TO ATYPICAL MELANOCYTIC LESIONS BIJAN HAGHIGHI M.D, DIRECTOR OF DERMATOPATHOLOGY, ST. JOSEPH HOSPITAL OBJECTIVES Discuss current trends and changing concepts in our understanding of
More informationEpithelial Cancer- NMSC & Melanoma
Epithelial Cancer- NMSC & Melanoma David Chin MB, BCh, BAO, LRCP, LRCS (Ireland) MCh(MD), PhD (UQ), FRCS, FRACS (Plast) Plastic & Reconstructive Surgeon Visiting Scientist Melanoma Genomic Group & Drug
More informationSkin Malignancies. Presented by Dr. Douglas Paauw
Skin Malignancies Presented by Dr. Douglas Paauw Disclosure: Dr. Paauw has no significant financial interest in any of the products or manufacturers mentioned. How Common Is Skin Cancer? *½ of all White
More informationCommon Benign Lesions and Skin Cancers. 22nd May 2015 Dr Mark Foley
Common Benign Lesions and Skin Cancers 22nd May 2015 Dr Mark Foley Thank you for downloading this file. This intended to supplement the presentation given at the NZ Wound Care Conference, it is not intended
More informationMalignant Melanoma Early Stage. A guide for patients
This melanoma patient brochure is designed to help educate melanoma patients and their caregivers. It was developed under the guidance of Dr. Michael Smylie, Professor, Department of Oncology, University
More informationNasreen A. Syed, MD F.C. Blodi Eye Pathology Laboratory University of Iowa
Nasreen A. Syed, MD F.C. Blodi Eye Pathology Laboratory University of Iowa No financial disclosures No discussion of off-label use of medications or unapproved devices 67 year old male referred to Oculoplastics
More informationSEBACEOUS NEOPLASMS. Dr. Prachi Saraogi Clinical Fellow in Dermatology
SEBACEOUS NEOPLASMS Dr. Prachi Saraogi Clinical Fellow in Dermatology Sebaceous neoplasms Sebaceous adenoma (Benign) Sebaceous carcinoma (Malignant) SEBACEOUS ADENOMA Benign tumours composed of incompletely
More informationPathology. Skin Tumor. Bayan N. Mohammad 15/10/2015. Mohammad al-orjani. Page 0 of 23
#7 35 Pathology Skin Tumor Bayan N. Mohammad 15/10/2015 Mohammad al-orjani Page 0 of 23 بسم هللا الرحمن الرحيم GREETINGS This lecture is about skin tumors, all the slides are included and every slide will
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES OCULAR ONCOLOGY PERIOCULAR CUTANEOUS MALIGNANCY Site Group: Ocular Periocular Cutaneous Malignancies Prepared by: Harmeet S. Gill MD, FRCSC
More informationInteresting Case Series. Aggressive Tumor of the Midface
Interesting Case Series Aggressive Tumor of the Midface Adrian Frunza, MD, Dragos Slavescu, MD, and Ioan Lascar, MD, PhD Bucharest Emergency Clinical Hospital, Bucharest University School of Medicine,
More informationSkin Cancer - Non-Melanoma
Skin Cancer - Non-Melanoma Introduction Each year, millions of people find out that they have skin cancer. Skin cancer is almost 100% curable if found early and treated right away. It is possible to prevent
More informationSection 1. Lids and lacrimal COPYRIGHTED MATERIAL
Section Lids and lacrimal COPYRIGHTED MATERIAL Basal cell carcinoma Basal cell carcinoma (BCC) is a proliferation of the basal cells of the dermis in human skin. There are four recognised types of BCC:
More informationOcular Malignancies in the Elderly
Cancer Ocular Malignancies in the Elderly E. Rand Simpson, MD, Associate Professor of Ophthalmology, University of Toronto; Director, Ocular Oncology, Princess Margaret Hospital,Toronto, ON. Larry Ulanski
More informationPage 1 of 15 Title Authored By Course No Contact Hours 2 Skin Cancer the Real Picture for Early Detection and Treatment Cheryl Sommer RN, MSN, ARNP SC120604 Purpose The purpose of this course is to provide
More informationJournal of International Academy of Forensic Science & Pathology (JIAFP)
Journal of International Academy of Forensic Science & Pathology (JIAFP) ISSN 2395-0722 MICROCYSTIC ADNEXAL CARCINOMA-A CASE REPORT WITH REVIEW OF LITERATURE Case Report Sulakshana M S 1,Natarajan M 2
More informationNonmelanoma skin cancers
Skin cancer Philip Clarke Nonmelanoma skin cancers Treatment options Background Australia has one of the highest skin cancer rates in the world. Early detection and treatment of skin cancer is vital to
More informationCutaneous Adnexal Tumors
Cutaneous Adnexal Tumors Lesions with Predominant Follicular Differentiation Special Emphasis on Basal Cell Carcinoma 2014-04-01 Prof. Dr. med. Katharina Glatz Pathologie Cutaneous Adnexal Tumors Hair
More informationRegression 2/3/18. Histologically regression is characterized: melanosis fibrosis combination of both. Distribution: partial or focal!
Regression Margaret Oliviero MSN, ARNP Harold S. Rabinovitz MD Histologically regression is characterized: melanosis fibrosis combination of both Distribution: partial or focal! Dermatoscopic terminology
More informationالمركب النموذج--- سبيتز وحمة = Type Spitz's Nevus, Compound SPITZ NEVUS 1 / 7
SPITZ NEVUS 1 / 7 Epidemiology An annual incidence rate of 1.4 cases of Spitz nevus per 100,000 individuals has been estimated in Australia, compared with 25.4 per 100,000 individuals for cutaneous melanoma
More informationVACAVILLE DERMATOLOGY
Connecting the Dots on those Spots NANDAN V. KAMATH, M.D. VACAVILLE DERMATOLOGY Sources All of the photos were taken with permission from the Dermnet NZ website - Dermnet New Zealand after communicating
More informationCourse # Lid Neoplasms and Procedures
Course # 103 Lid Neoplasms and Procedures Entropion Lid Neoplasms and Procedures MICHELLE WELCH, O.D. CHOCTAW NATION HEALTH SERVICES AUTHORITY Inward turn of eyelid usually lower lid For mild entropion,
More informationIn Office Optometric Lid Procedures
In Office Optometric Lid Procedures MICHELLE WELCH, O.D. CHOCTAW NATION HEALTH SERVICES AUTHORITY rmwelch@cnhsa.com 1 Entropion Inward turn of eyelid usually lower lid For mild entropion, repair by suture
More information5/20/2015. Mohs Surgery BCCA High risk anatomic locations. Mohs Surgery High risk anatomic locations. Mohs Surgery Histologically Aggressive BCCA
Mohs Surgery BCCA High risk anatomic locations High risk areas H zone nasal ala, nasal septum, nasal ala groove, periorbital region, periauricual region, region around and in ear canal, ear pinna and scalp
More informationSkin is a multilayered organ that covers and protects the body.
Section 1: Skin is a multilayered organ that covers and protects the body. K What I Know W What I Want to Find Out L What I Learned Essential Questions What are the four tissue types that are found in
More informationEyelid basal cell carcinoma Patient information
Eyelid basal cell carcinoma Patient information Your procedure relates to the face, eyelids, orbit or tear drainage system that together are treated by specialist surgeons in the field of oculoplastic
More informationGross Appearance & Histology of Skin Cancer. Kyle Mannion M.D. January 21, 2005
Gross Appearance & Histology of Skin Cancer Kyle Mannion M.D. January 21, 2005 Actinic Keratosis 5-20% will develop squamous/basal cell ca Almost solely from solar damage Usually develop during 4 th decade
More informationMalignant tumors of melanocytes: Part 1. Deba P Sarma, MD., Omaha
Malignant tumors of melanocytes: Part 1 Deba P Sarma, MD., Omaha The melanocytic tumor is one of the most difficult and confusing areas in Dematopathology. It is true that most (95%) of such lesions are
More informationProtocol applies to melanoma of cutaneous surfaces only.
Melanoma of the Skin Protocol applies to melanoma of cutaneous surfaces only. Procedures Biopsy (No Accompanying Checklist) Excision Re-excision Protocol revision date: January 2005 Based on AJCC/UICC
More informationDisclosure. Objectives. PAFP CME Conference Lou Mancano MD, FAAFP Reading Health System November 18, 2016
PAFP CME Conference Lou Mancano MD, FAAFP Reading Health System November 18, 2016 1 Disclosure The speaker has no conflict of interest, financial agreement, or working affiliation with any group or organization.
More informationCase Report Clear Cell Basal Cell Carcinoma
SAGE-Hindawi Access to Research Volume 2011, Article ID 386921, 4 pages doi:10.4061/2011/386921 Case Report Clear Cell Basal Cell Carcinoma Deba P. Sarma, 1 Daniel Olson, 1 Jennifer Olivella, 1 Tracey
More informationMerkel Cell Carcinoma Case # 2
DISCHARGE SUMMARY Admitted: 10/11/2010 Discharged: 10/13/2010 Merkel Cell Carcinoma Case # 2 Chief Compliant: A 79 year old lady status post tumor on the scalp excision and left neck likely dissection
More informationDisclosures. I have no conflicts of interest to disclose
Disclosures I have no conflicts of interest to disclose Lindy P. Fox, MD Associate Professor Director, Hospital Consultation Service Department of Dermatology University of California, San Francisco 2
More informationSkin Cancers Emerging Trends and Treatment Approaches
Skin Cancers Emerging Trends and Treatment Approaches Andrei Metelitsa, MD, FRCPC, FAAD Clinical Associate Professor, Dermatology, U of C Co-Director, Institute for Skin Advancement Copyright 2017 by Sea
More informationSKIN. 3. How is the skin structured around the finger joints to allow for flexible movement of the fingers?
SKIN Objectives for Exam #1: 1. List various skin structures and describe their functions. 2. Describe skin responses to increases and decreases in body temperature. 3. Provide examples of various skin
More informationCase Scenario 1 Worksheet. Primary Site C44.4 Morphology 8743/3 Laterality 0 Stage/ Prognostic Factors
CASE SCENARIO 1 9/10/13 HISTORY: Patient is a 67-year-old white male and presents with lesion located 4-5cm above his right ear. The lesion has been present for years. No lymphadenopathy. 9/10/13 anterior
More informationIntegumentary System
Integumentary System The integumentary system is commonly known as the Skin Largest organ of human body 10% total body weight and would cover over 20 square feet Functions of Skin 1. Protection Barrier
More informationMOHS MICROGRAPHIC SURGERY: AN OVERVIEW
MOHS MICROGRAPHIC SURGERY: AN OVERVIEW SKIN CANCER: Skin cancer is far and away the most common malignant tumor found in humans. The most frequent types of skin cancer are basal cell carcinoma, squamous
More informationMalignant non-melanocytic lesions
Malignant non-melanocytic lesions Course C023: Fundamentals of Dermoscopy March 4, 2019, 11:20 AM - 11:50 PM Room: 146B Jason B. Lee, MD Professor & Vice Chair Director of Dermatopathology & Pigmented
More informationKidney Case 1 SURGICAL PATHOLOGY REPORT
Kidney Case 1 Surgical Pathology Report February 9, 2007 Clinical History: This 45 year old woman was found to have a left renal mass. CT urography with reconstruction revealed a 2 cm medial mass which
More informationBasal cell carcinoma diagnosed on Fine-Needle Aspiration Cytology A. Pathological Case Report
Basal cell carcinoma diagnosed on Fine-Needle Aspiration Cytology A Abstract Dr. Madhuri S.Kate 1, Dr. Preeti Jain 2, Dr. Shailesh S. Patne 3 Introduction: Basal cell carcinoma (BCC) is a locally invasive
More informationPanMidlands Ocular Cancer Pathway March 2008 Approved by The Midland Oculoplastic Surgery Society
PanMidlands Ocular Cancer Pathway March 2008 Approved by The Midland Oculoplastic Surgery Society Periocular Skin Pathway Referrals to Oculoplastics Strong Indication: Lesion within orbital rim Medial
More informationNodular Basal Cell Carcinoma PIGMENTED BASAL CELL. Squamous cell carcinoma
Malignant Tumors of the Eyelids Management of Eyelid Neoplasms Michelle Welch, O.D. NSU Oklahoma College of Optometry Pearls Most periocular tumors are derived from epidermis or adnexae Main goal rule
More informationMelanoma and Dermoscopy. Disclosure Statement: ABCDE's of melanoma. Co-President, Usatine Media
Melanoma and Dermoscopy Richard P. Usatine, MD, FAAFP Professor, Family and Community Medicine Professor, Dermatology and Cutaneous Surgery Medical Director, University Skin Clinic University of Texas
More informationSKIN SERVICES REVIEW Changes to Medicare Benefits Schedule for 1 November 2016
Attachment A SKIN SERVICES REVIEW Changes to Medicare Benefits Schedule for 1 November 2016 Deleted items 31200-31215, 31230-31240 31255-31335 Colour Coding for new / updated items: MUCOSAL BIOPSY AND
More informationAtlas of Eyelid and Conjunctival Tumors
Atlas of Eyelid and Conjunctival Tumors Jerry A. Shields, M.D. Director, Ocular Oncology Service Wills Eye Hospital Professor of Ophthalmology Thomas Jefferson University Philadelphia, Pennsylvania Carol
More informationMalignant Cutaneous Neoplasms
Malignant Cutaneous Neoplasms Kathleen Haycraft, DNP, FNP/PNP-BC, DCNP All slides Kathleen Haycraft Objectives: 1. Identify common cutaneous malignant neoplasms. 2. Identify the etiology, pathophysiology
More informationmonitored anesthesia care (MAC)
Entropion Entropion Entropion is an inward turning of the eyelid and lashes toward the eye, usually caused by relaxation of the eye muscles and tissue due to aging. Entropion usually affects the lower
More informationChapter 6 Squamous Cell Carcinoma: Variants and Challenges
Chapter 6 Squamous Cell Carcinoma: Variants and Challenges Michael B. Morgan EPIDEMIOLOGY: Second most common skin cancer, rare in the dark-skinned races. ETIOLOGY: Ultraviolet light, HPV infection. PATHOGENESIS:
More information04/09/2018. Squamous Cell Neoplasia and Precursor Lesions. Agenda. Squamous Dysplasia. Squamo-proliferative lesions. Architectural features
Squamous Cell Neoplasia and Precursor Lesions Jennifer L. Hunt, MD, MEd Aubrey J. Hough Jr, MD, Endowed Professor of Pathology Chair of Pathology and Laboratory Medicine University of Arkansas for Medical
More informationSkin and Body Membranes
4 Skin and Body Membranes PowerPoint Lecture Slide Presentation by Jerry L. Cook, Sam Houston University ESSENTIALS OF HUMAN ANATOMY & PHYSIOLOGY EIGHTH EDITION ELAINE N. MARIEB Skin and Body Membranes
More informationNEOPLASMS OF THE SURFACE EPITHELIUM (KERATINOCYTES)
NEOPLASMS OF THE SURFACE EPITHELIUM (KERATINOCYTES) Papillary Lesions Precancerous Lesions Keratinocyte Proliferations Carcinomas Melanotic Lesions Melanomas Normal Mucosa Keratin layer Spinous layer Basal
More informationNeoplasia 2018 Lecture 2. Dr Heyam Awad MD, FRCPath
Neoplasia 2018 Lecture 2 Dr Heyam Awad MD, FRCPath ILOS 1. List the differences between benign and malignant tumors. 2. Recognize the histological features of malignancy. 3. Define dysplasia and understand
More information