cutaneous lump

• a bump, mess, swelling beneath skin. Either benign or malignant. Could be from various reason.

• common causes : cyst, infection, tumour, lymph nodes.

Caucasian male

• person who is white or pale skin, live in the European origin.

• prone to get skin cancer, because of less melanin.

66 year old caucasian male

• old age - low immunity

• caucasian - relate to genetics

former gardener

• lifestyle as a gardener

• occupational hazard - involvement with skin cancer, ozone layer related.

• exposure to UV light

• UV related skin malignancy

• exposed to parasites (insects, etc)

• exposure to hazardous chemicals (eg rafflesia)

• geographical disease

• fungal infection - contaminated water, plant related fungal infection

• bacterial infection - sawah padi ( watery environment, dangerous bacteria)

• 
  

one year history of cutaneous Lump

• long duration - chronic inflammation

• no pain - benign tumour( no discomfort, only irritated growing)

• human papilloma virus - warts

at the back of neck

• due to gardening, fungal easily enters

• exposed more to the sun, compared to other parts of the body during gardening

• sweating at the neck area - high sebaceous gland activity, that leads to sebaceous cyst

• bite of parasites - insect exposure at the back of the neck, when insect attach, in invade the skin.

• lymph nodes - swell, inflammation or malignancy,

• enlargement of lymph nodes due to infection.

• swelling - lymphocytes and macrophages accumulation at the sites.

• size, texture is not described - for further determination of disease

• trauma - experience trauma that lead to swelling

former gardener

• attire during gardener - exposed clothes may lead to more risk

• duration of his work during gardening

family history

• skin cancer - ask if any family member has skin cancer

• geographical disease he is exposed to

• hereditary skin cancer - cancer associated skin condition

cutaneous lump

• physical exam on lump - the size, texture, to know type of infection, to declare if its lump

• acne or mole

• ask is it painful, itchy, ulcerated

past medical history

• allergies

• cancer history - radiation exposed dues to chemotherapy, lead to formation of lump

• past injury on the back of the neck

social history

• lifestyle - alcohol drinking, smoking

• travel history - may infected during his travels

• sharing of clothes - scabies, infections, hygiene

• drugs - pharmaceutical ( allergies to the drugs, due to previous diseases )or non pharmaceutical drugs

• food intake - excessive fatty acid

Immunosuppressants

-organ rejection

- medications that suppress immune sysmptoms (during transplant of tissue)

Corneal graft

- surgical procedure tht replace a damaged/diseased cornea w a healthy dorner cornea

• replacing cornea w a healthy cornea

• Graft - donor tissue used

• Initiate a immune response - rapid cell in graft exposed to T lymphocytes (immune response doesnt recognjse th antigen on donor organ)

Keratoplasty

- procedure of transplanting healthy cornea

• Replace of cornea

• Replace or repair

• risk n complication - graft rejection, infection, glaucoma, corneal graft failure

Hereditary skin condition

- passed down from older to younger gen

• Genetic disease related to skin cond.

• Affects hair,skin, nail

Rapidly growing

- significant increase in population size in short period time

• Capable bcoz cell may get complete nutrient

• Malignant tumour (rapid)

• Possible malignancies - carcinoma, melanoma, cutaneous metastistis(cancer in various areas)

  
  

rapidly growing  lump

• Cause - growth hormone, during child too much growth hormone

• Aggresive/malignant growth, suggests other malignancies

• Genetic - inherit from parent

• sign of cancer (lymphoma)

• Abnormal mass of tissue in diff parts of organ

• Benign (cyst, fibroma, fibroids) -> malignant (rapid growth,skin cancer)

size within three months, neglected for much longer

• Lump reached the max size within 3 mnths (no medical attention sought)

• Active growth or slow growth (quite diff to classify)

• ignored for a long period

patient moved from the UK to Australia at the age of 20.

• Aus has the highest rates of skin cancer

• UV radiation exposure for longer period

• Aus has environment quite hot (climate is warmer than UK)

• Aus has higher UV radiation exposure

• Consider he is Caucasian (low melanin)

received immunosuppressants to prevent corneal graft 

• Immunosuppressants contribute to skin cancer development

• Non melanoma n squamous cell carcinoma has quite aggresive cancer manifestation

• Our immune system looking for antigen/ cancer

• Tumour immunosurveillance - Lump cells escape (rapid growth)

mother died of cancer  associated with a hereditary skin condition

• family has associated w skin related problem

• basal cell carcinoma (common) - painless, shiny, small BV running along

• High risk of skin cancer

smoking about 20 cigarettes per day for the past 20

years

• increase risk of skin cancer

• Carcinogenic substance in cigarretes weakens immune system of thw body

• Oppurtunity to get skin cancer

• Premature skin aging

had no history of known medical illnesses, alcohol or drug  abuse.

• not the factors contributing to diagnosis

• Non-related to skin infection

Skin Cancer - hereditary from parents

Neglected the problem for longer period - cancer has manifested/developed/metastasizes

Radiation towards other parts of body (not specifically on the back of neck)

Characteristics of lump associated from other disease

Migration to Aus - UV radiation

Early UV damage can sustain in the body for longer

Smoking -> premature skin aging + caucasian = skin cancer, DNA damage (nicotine is carcinogenic)

Protruding - outward projection (clearly visible)

Ulcerated - having a sore / open wound

Foul-smelling - bad smell (rotting - necrotic)

Cauliflower-like firm mass - Large mass resembling cauliflower (collection of tissue)

Erythematous skin area - Red in colour (inflammation/UV radiation)

Vital signs: normal

• doesn't effect other systems

• normal temp - no fever

Protruding, Ulcerated, mostly necrotic, foul-smelling

• dead cells

• related to malignant tumor

cauliflower-like firm mass, 4 × 3 cm in size was observed

• no abcess (not infection)

• firmness >>> malignancy

• irregular >>> advanced squamous cell carcinoma (SCC)

• 4x3cm >>> bigger in size

large erythematous skin area

• Redness of skin (basal/squamous cell carcinoma)

• Increased blood flow (infection) >>> vasodilation/development of BV

• Possibilities of blister

• Large >>> spreading mass, invasion into deeper skin layer

Skin cancer has developed over large erythematous skin area

Enlarged mass- serious, possibilities of radiation

No past injury

Malignant tumor - determination of treatment (excision//radiotherapy)

Distant metastases - spread to other body parts

Computed tomography (CT) scan - medical imaging method which takes picture using xray

Subadjacent tissue - located underneath another tissue

General anasthaesia - state where patient is unconscious, doesn't feel any pain

Reepithelialisation - process of wound healing by replacing damaged epithelium

Histological Examination - study of the microscopic structure of tissue (biopsy specimen // surgical sample)

Lymphovascular / Perineural Invasion - presence of malignant cell in vascular //lymph vessels

Excision - surgical removal of tissue, growth, organ, bone

Full blood count and biochemistry were normal

• skin condition - doesn't effect the systemic parts

• early stage of development

  
  

Total body CT scan of including the patient’s neck: tumor had not infiltrated deep into the subjacent tissues

• early stage of development

• no widespread of tumor

  
  

No lymph node or distant metastases were noted

• early stage of development

• no widespread of tumor

• lymph node involvement - vital for staging cancer

  
  

tumour was totally excised with a 2 to 3 cm clear margin around it

• no cancer cells were found at the site

• completely excised - reduced risk of recurrance

• no additional surgery is needed

  
  

the surrounding skin was left to heal slowly with reepithelialisation

• positive indicator of recovery

• monitor any signs of infection

  
  

Keratinising (well-differentiated) squamous cell carcinoma (SCC)

• grows into keratin containing mass

• well-differentiated - tumor cells looks similar to normal skin cell

• poorly differentiated - anaplasia

Lymphovascular or perineural invasion was not a feature

• early stage of development

• no lymph node involvement

• well-differentiated

  
  

Excision appeared complete in the sections examined

• entire tumor is successfully removed

• no cancer cells detected

• reduce the recurrence of cancer

Smoking Hx - could contribute to recurrence

Less UV exposure - former gardener

Advise the patient

• negative effects of smoking / awareness

• usage sunscreen / sun block