Other Skin Tumours

Merkel cell tumours: of neuroendocrine origin that occur in elderly patients, usually presenting as a rapidly growing nodule often in the head and neck area. They may present with skin involvement and lymph node spread. Prognosis in these tumours is poor. Secondary spread from small cell carcinoma of lung must be excluded.

Paget's disease of nipple: presents as an eczematous area on the nipple or areola. It is associated with underlying malignancy in the breast.

Extramammary Paget's disease: occurs at the vulva, perineum, scrotum, penis, anus and axilla. It presents as a red velvety area and on histological examination is an in situ carcinoma. It may or may not be associated with underlying carcinoma in the sweat glands of the skin or visceral malignancy in the gastrointestinal, urinary or gynaecological tracts.

Skin appendage tumours (benign and malignant): the hair follicle and sweat gland structures are capable of giving rise to a wide variety of skin appendage tumours. If multiple, they may be associated with clinical syndromes. Most of these lesions present as nodules in the skin and correct diagnosis is dependent on histological examination. The majority of lesions are benign, although a small number are malignant and may metastasise and cause death in the patient.

Benign epithelial tumours and tumour-like lesions: seborrhoeic keratosis is a benign epithelial tumour arising in the skin of middle-aged and elderly patients, presenting usually as a stuck-on, warty type of lesion. They are often pigmented and may be mistaken by the patient and clinician for a melanoma.

Viral warts: most viral warts are treated with topical agents and are not submitted for histo-logical diagnosis, unless the diagnosis is unclear.

Benign mesenchymal tumours: the mesenchymal tissue in the dermis and subcutis can give rise to various tumours. Most present as nodules in the skin and may be biopsied or excised by the clinician using curettage, shave, punch and elliptical excision.

Malignant mesenchymal tumours (sarcomas): rare. These lesions are often large and may have a history of growth or change. They may be biopsied to establish the diagnosis or have a wide surgical excision to remove the lesion.

Leukaemia and lymphoma: leukaemias and lymphomas may affect the skin in two main ways: (a) as an inflammatory skin rash as a consequence of the underlying malignancy and (b) as a lymphoma/leukaemia involving the skin, either as a primary skin lesion or spread to the skin as part of systemic disease. Lymphoma and leukaemia involvement of the skin may present as a skin rash, plaques or nodules of tumour. Usually, a small diagnostic biopsy is taken in such cases, either as a punch or an ellipse.

Secondary tumours: secondary tumours may involve the skin, either as directly from an underlying tumour or as metastatic spread. A small biopsy is usually used for diagnostic purposes. FNA also has a role to play (see below).

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