Published in IVIS with the permission of the editor
Canine and feline
skin tumors
James Warland,
MA, VetMB, MRCVS
Queen's Veterinary School
Hospital, Cambridge, UK
Dr. Warland graduated from Cambridge
Veterinary School in 2009 and worked
in mixed general practice before
moving back to the University of
Cambridge in 2011 to become Junior Clinical Veterin-
arian in Oncology. His main interests include canine mast
cell tumors, infectious cancers and maximizing quality
of life in veterinary cancer patients.
Introduction
Due to its complex structure a large variety of
tumors may arise in the skin (Table 1), as can
secondary (metastatic) tumors. Approximately
2/3 of all canine cutaneous tumors are solitary,
benign lesions originating from the epithelium or
from adnexal structures, whilst in the cat malignant
tumors are more common than benign ones. The
etiology of most skin tumors is still unknown, but
roles of UVB light exposure, hormonal and viral
etiologies are demonstrated in some tumors. This
article provides an overview of the more common
skin tumors affecting dogs and cats but excludes
soft tissue sarcomas.
A presumptive diagnosis of a solitary skin tumor
may be made on clinical examination, but multi-
focal lesions may be harder to distinguish from
KEY POINTS
The skin is the most common site for neoplasia in
dogs and cats.
A huge number of different tumors may arise in the
skin, and the prognosis can vary from excellent to
hopeless depending on the tumor type.
Accurate identification of the tumor is essential to
allow for informed treatment options to be
considered.
34 / Veterinary Focus / Vol 21 No 3 / 2011
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Jane Dobson,
MA BVetMed, DVetMed
Dipl. ECVIM-CA & Onc
MRCVS
Queen's Veterinary School
Hospital, Cambridge, UK
Dr. Dobson is a graduate of the Royal
Veterinary College, London, where
she worked as houseman/registrar after qualifying. She is
currently Reader in Veterinary Oncology. A founding
Diplomate in the subspecialty of Oncology in ECVIM and
a RCVS recognized specialist in Veterinary Oncology, her
main interests are in anti-cancer chemotherapy, radio-
therapy and research into breed associated tumors in dogs.
other dermatological conditions. Fine needle
aspiration (FNA) is a quick, minimally invasive and
useful technique for assessing any mass within
the skin. In some cases (e.g. mast cell tumors,
cutaneous lymphoma) cytology may provide a
diagnosis, although histological examination of
the tumor is still required to grade the lesion.
Fine needle aspiration of local lymph nodes is also
useful to assess metastatic spread. Skin punch,
needle or incisional biopsies are required for a
definitive histological diagnosis. Collection of a
representative sample of tissue is important and
is discussed elsewhere in this issue. Excisional
biopsy (local resection of the whole mass) should
only be performed after careful consideration; it
can have disastrous consequences if used inappro-
priately and the opportunity for curative treatment
may be lost forever. Excisional biopsy is appropriate
in cases where prior knowledge of tumor histology/
grade would not alter the surgical approach.
Specific cutaneous tumors
Squamous cell carcinoma
Squamous cell carcinoma (SCC) is one of the
more common malignant cutaneous tumors in
the dog and the most common in the cat, usually
affecting animals > 10 years with no breed pre-
disposition. SCC can occur anywhere in the skin in
the dog, whereas lesions are more common on the
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CANINE AND FELINE SKIN TUMORS

Table 1.
Classification of the more common cutaneous and subcutaneous tumors by cell of origin.
Origin Benign Malignant
Epithelial tumors
Papilloma - Trichoblastoma (basal cell
Epidermis Basal cell carcinoma
tumor) - Infundibular keratinizing acanthoma
Squamous cell carcinoma
(intracutaneous cornifying epithelioma)

Sebaceous gland adenoma

Sebaceous gland Sebaceous gland adenocarcinoma
Sebaceous epithelioma
Perianal gland/hepatoid gland
Perianal glands Perianal gland/hepatoid gland adenoma carcinoma
Apocrine glands Adenoma/cystadenoma Adenocarcinoma
Hair follicles Pilomatricoma - Trichoepithelioma

Round cell tumors

Mast cells Mast cell tumors

Lymphocytes Cutaneous lymphoma - Epitheliotrophic T-cell lymphoma

Plasma cells Plasmacytoma

Epidermal dendritic cells Canine cutaneous histiocytoma

(Langerhans cells) Cutaneous histiocytosis

Interstitial and Localized and disseminated

interdigitating dendritic cells histiocytic sarcoma
Mesenchymal tumors

Collagenous hamartoma - Acrochordon (skin Fibrosarcoma

Fibroblasts
tag, fibroepithelial polyp) - Fibroma - Myxoma Myxosarcoma

Adipocytes Lipoma Liposarcoma

Blood vessel endothelium Hemangioma Hemangiosarcoma

Leiomyoma - Hemangiopericytoma -
Blood vessel wall Leiomyosarcoma
Myopericytoma - Angioleiomyoma -
Angioleiomyosarcoma
Angiofibroma
Peripheral nerve sheath tumor (PNST)
Peripheral nerve Schwannoma Malignant PNST

Melanocytes Melanoma Malignant melanoma

Anaplastic sarcoma with giant cells
Unknown origin (aka: malignant fibrous histiocytoma, giant cell tumor of soft parts)

head of the cat, affecting the nasal planum (Figures
1,2), pinnae, eyelids and lips. SCC may be product-
ive, forming a friable, papillary growth, or erosive,
forming an ulcerated lesion, and must be distin-
guished from inflammatory or infective lesions.
Etiology
Prolonged exposure to UVB light is recognized to
be an important factor of actinic solar dermatitis,
carcinoma in situ and eventually invasive SCC,
but some may be caused by papilloma viruses,
thermal injury or chronic inflammation.
Behavior, treatment and prognosis
Actinic keratosis is a pre-invasive lesion which may
develop to pre-malignant carcinoma and then SCC.
These are locally invasive tumors that infiltrate
the underlying dermal and subcutaneous tissue.
They are usually differentiated and metastasis
(usually slow) tends to be via the lymphatic route,
but the incidence is variable at other sites, e.g. in
the nail-bed of the digit (Figure 3) it can behave
much more aggressively. Canine tumors of the
nasal planum are locally aggressive and frequently
metastasize to the draining lymph nodes.

Vol 21 No 3 / 2011 / Veterinary Focus / 35

Published in IVIS with the permission of the editor
Dr. Jane Dobson.
Figure 1.
An early squamous cell carcinoma on the nasal planum of a cat.
Dr. Jane Dobson.
Figure 2.
Invasive squamous cell carcinoma of the nasal planum.
Dr. Jane Dobson.
Figure 3.
Squamous cell carcinoma of the digit.
Wide local surgical excision is the treatment of
choice and if achieved, the prognosis is favorable.
SCC is moderately radiosensitive and radiotherapy
may be indicated as an alternative or adjunctive
treatment in cases where adequate surgical resect-
ion is not possible. Locally applied Strontium 90
has been reported for treatment of superficial
lesions (1). Photodynamic therapy (PDT) has been
used successfully for treatment of early, superficial
lesions of the nasal planum in cats and provides a
good alternative to surgery and radiotherapy (2).
36 / Veterinary Focus / Vol 21 No 3 / 2011
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A multicentric SCC in situ has been described in
cats (3). Biologically this is a premalignant lesion
which is histologically similar to Bowens disease
in humans (sometimes referred to as Bowenoid
carcinoma). This tends to affect middle aged to
older mixed breed cats with lesions developing in
haired, pigmented regions of the skin. A papilloma
virus may be implicated in the etiology, and the
lesion can progress to invasive SCC.
SCC of the nail-bed region of the canine digit is
an aggressive tumor and invasion and destruct-
ion of the distal phalanx is common. Amputation
of the affected digit(s) is the treatment of choice
but these tumors may metastasize to the local
and regional lymph nodes and distantly; the pro-
gnosis is guarded. A phenomenon of SCC affecting
several digits has been reported in large breed,
black dogs e.g. standard poodles, giant schnauzers
(4). These tumors appear to have a lesser tend-
ency for metastasis but may affect multiple digits
on different feet.
Melanoma
Melanocytic tumors are relatively uncommon. In
dogs, cutaneous melanoma principally affects
older animals and is most common in breeds with
heavily pigmented skin, e.g. the Scottish terrier.
Older cats are also affected but there is no sex or
breed predisposition. Grossly, tumors may appear
as flat, plaque-like to domed masses, up to 2 cm
in diameter, sited within the dermis. They are
usually dark brown to black and quite well defined.
Malignant tumors may attain larger size, contain
less pigment and frequently ulcerate. In the cat
cutaneous melanoma must be distinguished
from the more common pigmented basal cell
tumor.
Behavior, treatment and prognosis
Tumor site seems to be an important factor govern-
ing the behavior of cutaneous melanoma. Most
melanocytic tumors of the canine skin are slow-
growing and benign. Tumors arising on the digits
and at mucocutaneous junctions (e.g. eyelids and
lips) are more aggressive with a higher incidence
of metastasis to local lymph nodes, the lungs and
other organs.
Wide surgical excision is the treatment of choice
for benign dermal melanoma and the prognosis
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CANINE AND FELINE SKIN TUMORS

following complete surgical excision is good.

Surgical excision is also indicated for local
control of malignant tumors but the prognosis in
such cases is guarded to poor because of the risk
of metastasis. There is no proven role for chemo-
therapeutics in the control of malignant melanoma.
Investigations into the canine melanoma vaccine,
using human tyrosinase, are still ongoing (5).

Mast cell tumors

Dr. Jane Dobson.

The presentation and behavior of mast cell tumors
(MCT) differs between the cat and dog.
Figure 4.
Canine MCT Subcutaneous mast cell tumor of the forelimb.
These are one of the most common cutaneous
neoplasms, representing up to 20% of all canine
skin tumors (6). They tend to affect older animals
(mean age 8 years) but may occur at any age.
Several breeds of dog including the boxer, Stafford-
shire bull terrier, and possibly the Labrador and
golden retriever appear to be predisposed. The
tumors show tremendous diversity in gross appear-
ance, clinical behavior, rate of metastasis and
response to treatment, as a result of which they

Dr. Jane Dobson.

present considerable prognostic and therapeutic
problems. The following is a short review; readers
are advised to refer to the extensive literature
Figure 5.
available.
Ulcerated mast cell tumor.

Presentation/clinical signs
The gross appearance can mimic any other
cutaneous tumor (Figures 4,5). Low grade, well-
differentiated tumors usually present as a solitary
slowly growing, dermal nodule. Some tumors
Dr. Jane Dobson.

ulcerate through the skin and in some cases local

release of histamine from tumor cells may cause
the lesion to fluctuate in size and become red
and angry looking. More aggressive MCTs may
present as large, ill-defined soft tissue masses and
some may be surrounded by satellite nodules as
the tumor spreads through surrounding cutaneous
lymphatic vessels (Figure 6).
Behavior
MCTs can vary in behavior, from slowly growing,
low grade tumors which follow a benign course
to rapidly growing, invasive, highly malignant
tumors. Histological grading based upon the
degree of cellular differentiation, the mitotic
index and invasion of adjacent tissue has been
shown to be of prognostic value (7-9). Behavior,
Figure 6.
Aggressive inguinal mast cell tumor showing ulceration and
satellite nodules.
suggested treatments and prognosis of MCTs are
discussed in Table 2.
Malignant MCTs may metastasize either by the
lymphatic route or via the blood. In most cases the
first sign of metastasis is enlargement of the local
lymph node. Discrete pulmonary metastases are
rare; disseminated MCTs more commonly metasta-
size to the spleen, liver, kidneys and the skin.

Vol 21 No 3 / 2011 / Veterinary Focus / 37

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Table 2.

Prognosis and suggested treatments for canine MCT based on histopathological grade.

Mitotic index Metastatic

Origin Description (Mitoses/10hpf) potential Recommended treatment Prognosis

Grade I Well differentiated Low (< 10%) Surgical excision Good

Surgical excision +/-

Grade II < 5-7* Variable (< 20%) radiotherapy if complete Fair
Intermediate in resection not possible.
histological
appearance and Surgical excision +/-
behavior. Prognosis radiotherapy if complete
Grade II is harder to predict. > 5-7* Variable (< 50%) resection not possible. Guarded
Adjunctive chemotherapy
should be considered.

Chemotherapy (traditional or
Poorly differentiated tyrosine kinase inhibitors).
Grade III High (> 80%) Multimodal therapy including Poor
and rapidly growing.
surgery + radiotherapy
should be considered.

*The best cut-off has not been established for MI, with different authors favoring 5 or 7 mitoses/10 hpf.

Paraneoplastic Syndromes
Both solitary and metastatic MCTs can have local
or systemic effects via the release of histamine and
other vasoactive amines from the tumor cells.
This can cause local edema and erythema of the
adjacent tissues and distant gastro-duodenal
ulceration leading to anorexia, vomiting, melena,
anemia and, in some cases, perforation.
Diagnostic Investigations
Hematological assessment may indicate anemia
due to blood loss from a bleeding intestinal ulcer.
Circulating mast cells (mastocytosis) are rare but
eosinophilia may be present.
Mast cells can be readily identified by FNA cytology
and this simple technique should be performed
prior to surgical removal of any cutaneous lesion.
MCT cannot be graded accurately on cytology
alone, although some indication of the degree of
differentiation of the tumor cells may be possible.
Excisional samples should therefore be submitted
for histological grading and assessment of the
margins of excision.
Local and regional lymph nodes should always be
evaluated by palpation, radiography/ultrasound
(as appropriate) and cytology. Ultrasound evaluat-
ion of liver, spleen and kidneys is also valuable.
Pulmonary metastasis is rare but skin is a common
site for MCT metastasis and skin nodules should be
investigated by FNA or biopsy. Dogs presenting
with multiple low/intermediate grade MCT have
separate de novo tumor development rather than
metastatic disease, and each should be dealt with
as a separate tumor. Survival time in these anim-
als is not less than dogs with a single MCT (10).
Treatment
Surgical resection is undoubtedly the treatment
of choice for any well differentiated MCT. Wide
surgical resection is not as important as previously
thought and 2 cm margins should be adequate for
all grade I & II tumors < 5 cm diameter, but not
the most aggressive tumors (11). The most
common cause of treatment failure is poorly
executed or planned surgery, leading to inadequate
resection of the primary tumor and subsequent
local recurrence. The first surgical attempt stands
most chance of success and cure rates for sub-
sequent surgical excisions or adjunctive therapies
are low. It is vitally important to identify a MCT
(cytologically or histopathologically) prior to any
attempt at treatment so that appropriate surgical
margins can be planned and achieved at the first
attempt.
Radiotherapy may be beneficial as a post-surgical
treatment in cases of intermediate tumors where
complete surgical resection is not feasible (12)

38 / Veterinary Focus / Vol 21 No 3 / 2011

Published in IVIS with the permission of the editor
CANINE AND FELINE SKIN TUMORS
and, on occasions, may be used in conjunction
with chemotherapy for the treatment of tumors
which cannot be surgically excised due to their
site (13). There is no good evidence for the use of
radiotherapy as a sole treatment.
For grade II tumors with a high mitotic index and
grade III tumors chemotherapy is used to prevent
or slow metastatic spread (14). Short term respon-
ses have been achieved with protocols involving
vinblastine, chlorambucil and prednisone, or
lomustine (CCNU). Two tyrosine kinase inhibitors,
masitinib and toceranib, are licensed in some
countries for use in unresectable or recurrent
intermediate and high grade canine MCT; although
experience is lacking, they show promising
efficacy (15,16). It should be remembered that
surgery is still the treatment of choice and a
judgment of unresectable should be made by a
specialist surgeon.
Patients with systemic and/or gastrointestinal
signs must be treated appropriately with agents
such as H2 antagonists, cimetidine or ranitidine.
Sucralfate is also of benefit.
Feline MCT
In the cat MCTs are less common than in the dog
and also less of a diagnostic problem. Two forms
are recognized: cutaneous and visceral. Most
cutaneous MCTs are benign solitary cutaneous/
dermal nodules. Uncommonly, a cat may be affect-
ed by multiple skin nodules, or a solitary lesion
may be invasive. Histological grading of feline
cutaneous MCTs has not been shown to be clinically
useful. Surgical resection is the treatment of choice
and the prognosis is usually good (17). In cats with
multiple tumors corticosteroids may be of
palliative value. Invasive or incompletely excised
tumors may be treated with adjunctive radio-
therapy.
A variant of feline MCT has been reported mostly
affecting Siamese cats (18). This tumor, which may
be multicentric, is characterized histologically by
sheets of histiocyte-like mast cells with scattered
lymphoid aggregates and eosinophils. These tumors
may regress spontaneously without therapy.
Plasmacytoma
Plasmacytomas are common in dogs but rare in
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cats. They typically affect older dogs with no breed
predilection and usually present as a solitary skin
or mucocutaneous tumor; the oral cavity (includ-
ing gingiva), feet, trunk and ears are the most
common sites. The gross appearance is usually of
a raised red or ulcerated, quite well-defined mass,
rarely more than 2-5 cm in size. Plasma cells are
derived from -lymphocytes; histological diagnosis
can be difficult if the tumor cells are lacking clear
differentiation, and special staining techniques
may be required to differentiate plasmacytoma
from poorly differentiated sarcoma and other round
cell tumors. Potentially a plasmacytoma could
represent a metastasis from the systemic form of
plasma cell malignancy, multiple myeloma; this
has been reported in the cat but not the dog (19).
Both cutaneous and oral forms of plasmacytoma
are usually benign and are rarely associated with
systemic signs. Surgical resection is usually curative
and prognosis is good.
Histiocytic skin conditions
Several reactive and malignant neoplastic histio-
cytic diseases have been described. The most
common is canine cutaneous histiocytoma (CCH),
a benign cutaneous tumor unique to the skin of
the dog and representing up to 10% of all canine
cutaneous tumors. CCH is most common in young
dogs with 50% occurring in animals < 2 years old.
The tumor typically arises on the head, the limbs,
feet or trunk, and presents as a rapidly growing,
intradermal lesion. The surface may become alope-
cic and ulcerated. The boxer, dachshund and the
flat-coated retriever are reported to be predisposed
to CCH. Histological sections show infiltration of
the epidermis and dermis by neoplastic histiocytic
cells; numerous mitotic figures and an indistinct
boundary give this lesion the appearance of a highly
malignant neoplasm. However, CCH is a benign
tumor which usually regresses spontaneously.
Regression is associated with infiltration of the
tumor by cytotoxic T-cells and lymphocytic infiltrat-
ion is often described in histological reports. Surgi-
cal excision - if necessary - is usually curative and the
prognosis is good.
Multifocal/diffuse cutaneous
neoplasia
Although MCT and metastases from both carci-
nomas and sarcomas can present as multiple
nodular skin lesions, the tumors most commonly
Vol 21 No 3 / 2011 / Veterinary Focus / 39
Published in IVIS with the permission of the editor
Fernando Constantino Casas.
Dr. Jane Dobson.
Figure 7.
Histological appearance of epitheliotrophic lymphoma, note the
tumor cell infiltrate is in the epidermis and surrounding adnexae.
associated with multifocal or diffuse skin lesions
are lymphoid neoplasms.
Cutaneous Lymphoma
Usually of T-cell origin, primary cutaneous lympho-
ma may be classified as either epitheliotrophic
(epidermal) or non-epitheliotrophic (dermal) on
histology.
Epitheliotrophic lymphoma (Mycosis fungoides)
is more common in dogs. Histological sections
show a diffuse infiltration of the epidermis by
neoplastic memory T-lymphocytes and other
inflammatory cells, Pautriers microabscesses
and a tropism for adnexal structures (Figure 7).
In the advanced stages of the disease the tumor
cells invade into deeper layers of the dermis,
heralding systemic dissemination.
In the early stage a dog may present with an erythe-
matous, exfoliative or seborrheic skin condition,
which is often very pruritic; lesions can heal in one
region and then erupt in another. This gradually
progresses with the development of plaques,
nodules and ulceration of the skin. At mucocuta-
neous junctions infiltration, depigmentation, and
ulceration are typical. Terminally there is rapid
progression, culminating in widespread dissemin-
ation to other organs. The mucous membranes of
the mouth, eyes and genitalia may be affected at
all stages (Figure 8).
Non-epitheliotrophic lymphoma is a very aggres-
sive tumor that usually presents with multiple
40 / Veterinary Focus / Vol 21 No 3 / 2011
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Figure 8.
Epitheliotrophic lymphoma. Note the focal lesions on the flanks
and around the ventrum, prepuce and nose.
cutaneous nodules, plaques or erythroderma.
Histologically there is an infiltration of the dermis
and subcutis with malignant lymphoid cells,
usually of T-cell origin. The disease usually has a
rapid course and quickly disseminates to involve
other organs such as the liver, spleen and bone
marrow. This form of cutaneous lymphoma is
more common (although still rare) in the cat.
The prognosis for non-epitheliotrophic lymphoma
is poor, with a rapid course and survival times
rarely exceeding 2-3 months. Epitheliotrophic
lymphoma carries a longer disease course and
treatment may be more successful. Response of
the lesions to systemic chemotherapy is variable
but some improvement can be achieved. Single
agent Lomustine (CCNU) has reportedly good
but often short-lived remission rates (80%)
whilst retinoids, L-asparaginase and Interferon
alpha, as well as radiotherapy, have been tried
and show some efficacy (20). Topical treatment
with nitrogen mustard is not recommended.
Secondary cutaneous lymphoma
Systemic lymphoma can disseminate to the skin.
This is more commonly of -cell origin, reflecting
the original tumor. Prognosis is poor as these
animals have frequently received extensive chemo-
therapy and have multi-drug resistance. Radio-
therapy may assist with treatment of problematic
lesions.
Metastatic cutaneous tumors
Cutaneous metastases may be seen with any
Published in IVIS with the permission of the editor
CANINE AND FELINE SKIN TUMORS
malignancy. Lesions can be very variable in appear-
ance, but usually the presence of a primary malign-
ancy will be known. Biopsy or FNA is usually
diagnostic and the prognosis is typically grave.
Worthy of particular mention is the lung-digit
syndrome seen in cats; this is characterized by
metastatic tumors of the digits attributable to a
primary lung tumor (SCC, bronchogenic carci-
noma, pulmonary carcinoma). Affected cats are
typically lame, with pain due to swelling and ulcer-
ation of one or more digits; the nail may be lost
(21). Prognosis is hopeless.
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Conclusion
Tumors of the skin are a daily occurrence in small
animal practice and whilst the majority of such
lesion in dogs are benign and carry a favorable
prognosis, it is important to be familiar with the
more common malignant tumors in order that they
be diagnosed and managed appropriately. This
article has sought to provide an overview of the
more common skin tumors of the cat and dog for
this purpose. The reader is referred to further litera-
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vast and complex issue to cover comprehensively.
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Vol 21 No 3 / 2011 / Veterinary Focus / 41