Types of basal cell skin cancer and treatment methods. Course of squamous cell skin cancer
Skin cancer usually includes the following types of malignant skin tumors:
basal cell carcinoma (basal cell carcinoma that develops from the basal cells of the skin epithelium)
squamous cell carcinoma (squamous cell carcinoma)
melanomaMelanoma is often excluded from the list of diseases identified with skin cancer.
Symptoms
Depending on its form, skin cancer may appear as a superficial erosion, plaque, or nodule. It is often asymptomatic, but ulceration, bleeding and pain may occur.
Source health.mail.ru
Causes
Almost anyone can develop skin cancer. But the following groups of people are most susceptible to this disease:
With fair skin, who are genetically programmed to have less melanin in their skin structure;
Old age;
Genetically predisposed to the development of tumors;Having a disease that is classified as a precancerous condition:
Bowen's disease;
Keir's erythroplasia;
Xeroderma pigmentosum;
Senile keratoma;
Cutaneous horn;
Melanoma-dangerous pigmented nevi;
Other chronic inflammatory skin diseases;
Exposed to prolonged exposure to ultraviolet radiation;
Smoking;In addition, the reasons that caused the development of skin cancer may be the following:
Exposure of the skin to certain chemicals that have a dangerous carcinogenic effect. Such substances include tar, components of tobacco products, lubricants, arsenic and its compounds;
Improper, poor nutrition, large amounts of consumed harmful substances that have carcinogenic properties to varying degrees. These can be products containing nitrates, nitrites, as well as smoked, canned, pickled and high-fat products;
Exposure of skin to radioactive radiation;
Exposure of the skin to thermal radiation and thermal factors;
Mechanical damage (trauma, cut) to a mole;
Traumatic damage to scarred tissue on the skin;
As a complication after radiation dermatitis;
The appearance of cancer at the burn site.
Source lechimsya-prosto.ru
First signs
The first signs of skin cancer are changes that appear on the surface of the skin. A growth may form that does not heal for a long time. Often the tumor does not cause pain.
Source pro-medvital.ru
Signs
Basal carcinoma is a cancer of the basal cells in the lower part of the epidermis. This is a very common type of cancer and accounts for more than 75% of all skin cancers. Most basal cells grow very slowly and almost never spread to other parts of the body. The main signs of skin cancer are the appearance of small, red, shiny spots or nodules that may sometimes bleed. In many cases, in the early stages of basal cell carcinoma, the top layer of skin may remain intact for many months. But eventually, ulcers appear that do not heal. If basal cell carcinoma is detected at an early stage, there is a chance of completely curing it. However, some basal cell carcinoma cells are aggressive, and if their growth is not stopped, they can spread into the deeper layers of the skin and sometimes reach the bones, making treatment difficult.
Squamous cell skin cancer is a cancer of the keratinocyte cells that are found in the top layer of the skin (epidermis). One in five skin cancers (20%) are of this type. Squamous cell carcinoma usually grows slowly and can only spread to other parts of the body if left untreated for a very long time. Sometimes, cancer cells can behave more aggressively and spread throughout the body at a relatively early stage. Most people are completely cured with relatively gentle treatments.
Malignant melanoma develops from basal cell and squamous cell carcinoma. The first signs of skin cancer, namely melanoma: a change in any existing mole or freckle, or the appearance of a new mole or freckle. The risk of developing melanoma increases with age. Melanomas develop from specialized skin cells called melanocytes, which produce melanin, the pigment that causes skin to darken when exposed to the sun. They are found in the epidermis, part of the outer layer of the skin. Melanomas occur when melanocytes divide uncontrollably and form a mass of cancer cells. This is caused by excessive exposure to ultraviolet radiation. Most melanomas can be cured if detected early. Therefore, it is very important to consult a doctor if you notice any change in a mole or freckle. If left untreated, melanoma can spread to the deeper layers of the skin and spread throughout the body through the lymphatic system and blood.
Source myfamilydoctor.ru
Stages
Currently, skin tumors are classified according to histology and depending on the stage of the tumor process (TNM classification). Malignant skin tumors include the following histological types: squamous cell tumors, basal cell tumors, skin appendage tumors and other tumors (Paget's disease).
The TNM classification is used for skin cancers excluding vulva, penis, eyelid, and cutaneous melanoma. Where T reflects the size of the primary tumor, N – the presence of metastatic lesions of regional lymph nodes, M – the presence of distant metastases.
Stage I includes skin tumors up to 2 cm in greatest dimension.
By stage II – tumors larger than 2 cm, but not growing into deeper tissues (muscles, bones).
Stage III includes tumors that grow into deeper tissues or tumors of any size in the presence of damage to regional lymph nodes.
Stage IV includes skin tumors with established distant metastases.
Source onkobolezni.ru
Diagnostics
Patients with suspected skin cancer should be consulted by a dermato-oncologist. The doctor examines the formation and other areas of the skin, palpates regional lymph nodes, and dermatoscopy. Determination of the depth of tumor germination and the extent of the process can be done using ultrasound. For pigmented formations, siascopy is additionally indicated.
Only cytological and histological examination can definitively confirm or refute the diagnosis of skin cancer. Cytological examination is carried out by microscopy of specially stained smears made from the surface of cancerous ulcers or erosions. Histological diagnosis of skin cancer is carried out on material obtained after removal of a tumor or by skin biopsy. If the integrity of the skin over the tumor node is not compromised, then the biopsy material is taken using the puncture method. According to indications, a lymph node biopsy is performed. Histology reveals the presence of atypical cells, establishes their origin (flat, basal, melanocytes, glandular) and the degree of differentiation.
When diagnosing skin cancer, in some cases it is necessary to exclude its secondary nature, that is, the presence of a primary tumor of internal organs. This is especially true for skin adenocarcinomas. For this purpose, ultrasound of the abdominal organs, X-ray of the lungs, CT of the kidneys, contrast urography, scintigraphy of the skeleton, MRI and CT of the brain, etc. are performed. The same examinations are necessary in the diagnosis of distant metastases or cases of deep germination of skin cancer.
Source krasotaimedicina.ru
Treatment
The following methods are used for treatment:
ray;
surgical;
drug;
cryodestruction;
laser coagulation.
Source diagnos.ru
Treatment of skin cancer is most often achieved with radiation therapy: close-focus radiotherapy, in more common forms combined with external gamma therapy. Other options for combined irradiation are also used - close-focus X-ray therapy with the subsequent introduction of radioactive needles.
As a result of irradiation, carried out on average for 3-4 weeks, the cancerous tissue dies, and after the radiation reaction disappears, scarring occurs on the skin. Surgical treatment is resorted to either in cases of very widespread lesions, or in such forms of cancer that turn out to be low-sensitive to radiation therapy. Then, after a course of preoperative irradiation, a wide excision of the tumor is undertaken, extending far beyond its periphery and depth. The extensive wound defects resulting from such operations are closed by skin grafting. It is also possible to use tumor cryodestruction.
Special preparation of the patient for these operations is not required; it is only important that no traces of a radiation reaction remain on the surrounding skin. Usually it is lubricated with indifferent oils (peach or sea buckthorn). It is advisable not to apply bandages for better aeration of the skin. For large ulcers, dressings are formed with a cotton-gauze roll (“steering wheel”) so as not to injure the tumor tissue.
Chemotherapy for skin cancer is rarely used, although there are isolated observations of successful treatment of early forms with ointments with cytostatic drugs.
In very common, inoperable forms, external irradiation is performed for palliative purposes, sometimes combining it with intra-arterial chemotherapy.
The course of skin cancer is relatively favorable, although in advanced stages it is not always possible to radically cure the patient. Sometimes it is necessary to resort to very extensive, mutilating operations in the form of wide excision of facial tissue with resection of the underlying bones or amputation for skin cancer of the extremities. Like all malignant tumors, skin cancer is prone to recurrence, especially after improperly administered radiation or insufficiently wide excision.
Treatment of skin appendage cancer is only surgical; other methods are ineffective.
Source www.cancer.ic.ck.ua
Squamous
Depending on the stage of the disease, there are several standard treatment regimens for skin cancer.
The principle of treatment for all types of skin cancer is the same and includes the following methods:
ray;
surgical;
drug;
cryodestruction;
laser coagulation.The choice of treatment method depends on the histological structure of the tumor, stage of the disease, clinical form and location of the tumor.
Source diagnos.ru
Squamous cell skin cancer can occur against the background of actinic keratosis, post-burn scar tissue, in places of constant mechanical damage, chronic inflammatory dermatosis such as the hypertrophic form of lichen planus, tuberculous lupus, x-ray dermatitis, pigmented xeroderma, etc. Squamous cell carcinoma developing on sun-damaged skin , in particular, in areas of actinic keratosis, metastasizes rarely (0.5%), while the frequency of metastasis of squamous cell carcinoma arising on scars is more than 30%, and in areas of late X-ray dermatitis - approximately 20%.
Source ilive.com.ua
Basal cell
Signs of basal cell skin cancer
Localization is typical on the eyelids, more often on the lower
Starts as a small growth
Classically looks like a nodule, indistinguishable in color from surrounding healthy skin, with a depression in the center
The edges of the tumor may appear pearlescent
Doesn't bother you at all, but can cause ectropion or inversion of the eyelid at an advanced stage
If the tumor is not treated, it gradually grows into the underlying tissue. Fortunately, basal cell skin cancer is one of those rare types of malignant neoplasms that do not metastasize to other organs.
The tumor can be removed either surgically or with radiation. As with all types of cancer, timely detection of the disease and initiation of treatment is important.
Prevention
People at increased risk of developing basal cell skin cancer, especially those with white skin and blond hair, are advised to avoid prolonged exposure to the sun. Use sunglasses to protect the delicate skin of your eyelids from ultraviolet light. Protective headgear, awnings, etc. also important when spending time outdoors.
Source websight.ru
Basal
Diagnostics
To evaluate patients with suspected basal cancer, the following studies are performed:
examination and palpation of the area of the neoplasm - allows the specialist to suspect basal cancer based on the clinical picture;
biopsy – the purpose of this study is to collect material for histological examination. In the case of an incisional biopsy, the procedure is performed using a thin needle, which is loaded into the tumor tissue and captures part of it. When performing an excisional biopsy, a piece of the tumor is removed using a scalpel. All manipulations are carried out under local anesthesia and do not cause pain to the patient;
histological examination - carried out in the laboratory, where the material obtained during the biopsy is examined under a microscope. At the same time, changes characteristic of a particular type of cancer are revealed in samples of tumor tissue.
After identifying basal cancer, a treatment program is drawn up that takes into account all the features of a specific clinical case. If a tumor is detected early and appropriate measures are taken, most patients with this diagnosis will have a favorable prognosis.
Radiation therapy is used to detect basal cancer in the early stages of development. In this case, the tumor area is irradiated with short-focus X-ray radiation. This way it is possible to slow down the growth rate of the tumor and achieve its regression. During treatment, the patient receives a radiation dose of approximately 50-75 Gray.
Surgical treatment consists of excision of the tumor. Surgical tactics become the leading one in the presence of small basal cell carcinomas, after removal of which a large tissue defect will not form. The procedure is performed under local or general anesthesia and involves excision of the pathological formation. It is important to achieve clean wound edges that are free of atypical cells. To do this, a certain amount of healthy tissue is excised along with the tumor. In addition, during surgery it is possible to perform histological, cytological, and microscopic examination of the wound edges.
Chemotherapy consists of prescribing local or systemic treatment with cytostatics. In the first case, antitumor drugs are administered intravenously or orally, in the second case they are applied to the surface of the tumor. Long-term use of small doses of cytostatics can achieve regression of some types of basal cell tumors.
Cryodestruction is based on the possibility of destroying a tumor using liquid nitrogen treatment. This drug causes a local decrease in the temperature of the tumor tissue to low numbers, due to which the intracellular fluid freezes and the death of atypical cells develops.
Laser therapy involves the use of a directed beam of laser beams. Within a few seconds of such exposure, water evaporates from the tumor tissue and its destruction is observed.
Source hospital-israel.ru
Basal cell carcinoma (syn.: basal cell carcinoma, basal cell epithelioma, ulcus rodens, epithelioma basocellulare) is a common skin tumor with pronounced destructive growth, a tendency to recur, as a rule, does not metastasize, and therefore is more accepted in the domestic literature the term "basal cell carcinoma".
ICD-10 code
C44.3 Malignant neoplasm of the skin of other and unspecified parts of the face
Causes of skin basal cell carcinoma
The issue of histogenesis has not been resolved; most researchers adhere to the dysontogenetic theory of origin, according to which basal cell carcinoma develops from pluripotent epithelial cells. They can differentiate in different directions. In the development of cancer, importance is attached to genetic factors, immune disorders, and adverse external influences (intense insolation, contact with carcinogenic substances). It can develop on clinically unchanged skin, as well as against the background of various skin pathologies (senile keratosis, radiodermatitis, tuberculous lupus, nevi, psoriasis, etc.).
Basal cell carcinoma is a slow-growing and rarely metastasizing basal cell carcinoma that arises in the epidermis or hair follicles, the cells of which are similar to the basal cells of the epidermis. It is considered not as cancer or a benign neoplasm, but as a special kind of tumor with locally destructive growth. Sometimes, under the influence of strong carcinogens, primarily X-rays, basal cell carcinoma develops into basal cell carcinoma. The question of histogenesis has not yet been resolved. Some believe that basaliomas develop from the primary epithelial rudiment, others - from all epithelial structures of the skin, including from embryonic rudiments and malformations.
Risk factors
Provoking factors are insolation, UV, X-rays, burns, and arsenic intake. Therefore, basal cell carcinoma often occurs in people with skin types I and II and albinos who are exposed to intense sun exposure for a long time. It has been established that excessive sun exposure in childhood can lead to the development of a tumor many years later.
Pathogenesis
The epidermis is slightly atrophic, sometimes ulcerated, and there is a proliferation of tumor basophilic cells similar to the cells of the basal layer. Anaplasia is mild, mitoses are few. Basalioma rarely metastasizes, since tumor cells that enter the bloodstream are not capable of proliferation due to the lack of growth factor produced by the tumor stroma.
Pathomorphology of skin basalioma
Histologically, basal cell carcinoma is divided into undifferentiated and differentiated. The undifferentiated group includes solid, pigmented, morphea-like and superficial basal cell carcinomas, the differentiated group includes keratotic (with piloid differentiation), cystic and adenoid (with glandular differentiation) and with sebaceous differentiation.
The WHO international classification (1996) identifies the following morphological variants of basal cell carcinoma: superficial multicentric, codular (solid, adenoid cystic), infiltrating, non-sclerosing, sclerosing (desmoplastic, morphea-like), fibro-epithelial; with adnexal differentiation - follicular, eccrine, metatypical (basosquamous), keratotic. However, the morphological boundary of all varieties is unclear. Thus, in an immature tumor there may be adenoid structures and, on the contrary, with its organoid structure, foci of immature cells are often found. Also, there is no complete correspondence between the clinical and histological pictures. Usually there is correspondence only for such forms as superficial, fibroepithelial, scleroderma-like and pigmented.
For all types of basal cell carcinomas, the main histological criterion is the presence of typical complexes of epithelial cells with dark-colored oval nuclei in the central part and palisade-like complexes located along the periphery. In appearance, these cells resemble basal epithelial cells, but differ from the latter in the absence of intercellular bridges. Their nuclei are usually monomorphic and not subject to anaplasia. The connective tissue stroma proliferates together with the cellular component of the tumor, located in the form of bundles among cellular cords, dividing them into lobules. The stroma is rich in glycosaminoglycans, staining metachromatically with toluidine blue. It contains many tissue basophils. Retraction gaps are often detected between the parenchyma and stroma, which many authors regard as a fixation artifact, although the possibility of exposure to excessive secretion of hyaluronidase is not denied.
Solid basal cell carcinoma among undifferentiated forms it occurs most often. Histologically, it consists of various shapes and sizes of strands and cells of compactly located basaloid cells with unclear boundaries, resembling a syncytium. Such complexes of basal epithelial cells are surrounded at the periphery by elongated elements, forming a characteristic “picket fence”. Cells in the center of the complexes can undergo dystrophic changes with the formation of cystic cavities. Thus, along with solid structures, cystic ones can exist, forming a solid-cystic variant. Sometimes destructive masses in the form of cellular detritus are encrusted with calcium salts.
Pigmented basal cell carcinoma Histologically it is characterized by diffuse pigmentation and is associated with the presence of melanin in its cells. The tumor stroma contains a large number of melanophages with a high content of melanin granules.
An increased amount of pigment is usually detected in the cystic variant, less often in the solid and superficial multicentric. Basaliomas with pronounced pigmentation contain a lot of melanin in the epithelial cells above the tumor, throughout its entire thickness up to the stratum corneum.
Superficial basal cell carcinoma often multiple. Histologically, it consists of small, multiple solid complexes associated with the epidermis, as if “suspended” from it, occupying only the upper part of the dermis to the reticular layer. Lymphohistiocytic infiltrates are often found in the stroma. The multiplicity of foci indicates the multicentric genesis of this tumor. Superficial basal cell carcinoma often recurs after treatment along the periphery of the scar.
Scleroderma-like basal cell carcinoma, or the “morphea” type, is distinguished by the abundant development of scleroderma-like connective tissue, in which narrow cords of basal epithelial cells are “embedded”, extending deep into the dermis down to the subcutaneous tissue. Polygarden-like structures can be seen only in large cords and cells. Reactive infiltration around tumor complexes located among the massive connective tissue stroma, as a rule, it is scanty and more pronounced in the zone of active growth on the periphery. Further progression of destructive changes leads to the formation of small (cribrosoform) and larger cystic cavities. Sometimes destructive masses in the form of cellular detritus are encrusted with salts calcium.
Basal cell carcinoma with glandular differentiation, or adenoid type, is characterized by the presence, in addition to solid areas, of narrow epithelial strands consisting of several, and sometimes 1-2 rows of cells forming tubular or alveolar structures. The peripheral epithelial cells of the latter have a cubic shape, as a result of which the polysad-like character is absent or less clearly expressed. The internal cells are larger, sometimes with a pronounced cuticle; the cavities of the tubes or alveolar structures are filled with epithelial mucin. The reaction with carcinoembryonic antigen produces positive staining for extracellular mucin on the surface of cells lining the duct-like structures.
Basal cell carcinoma with cyloid differentiation characterized by the presence of keratinization foci in complexes of basal epithelial cells, surrounded by cells similar to spinous ones. In these cases, keratinization occurs bypassing the keratohyaline stage, which resembles the keratogenic zone of the isthmus of normal hair follicles and may have tricho-like differentiation. Sometimes there are immature milked follicles with initial signs of the formation of hair shafts. In some cases, structures are formed that resemble embryonic hair buds, as well as epithelial cells containing glycogen, corresponding to the cells of the outer layer of the hair follicle. Sometimes there may be difficulty in differentiating from follicular basaloid hamartoma.
Basal cell carcinoma with sebaceous differentiation It is rare and is characterized by the appearance of foci or individual cells typical of the sebaceous glands among the basal epithelial cells. Some of them are large, signet-shaped, with light cytoplasm and eccentrically located nuclei. When stained with Sudan III, fat is revealed in them. Lipocytes are much less differentiated than in a normal sebaceous gland; transitional forms are observed between them and the surrounding basal epithelial cells. This indicates that this type of cancer is histogenetically associated with the sebaceous glands.
Fibroepithelial type(syn.: Pincus fibroepithelioma) is a rare type of basal cell carcinoma that occurs mostly in the lumbosacral region and can be combined with seborrheic keratosis and superficial basal cell carcinoma. Clinically it may look like fibropapilloma. Cases of multiple lesions have been described.
Histologically, narrow and long cords of basal epithelial cells are found in the dermis, extending from the epidermis, surrounded by a hyperplastic, often edematous, mucoid-altered stroma with a large number of fibroblasts. The stroma is rich in capillaries and tissue basophils. Epithelial strands anastomose with each other and consist of small dark cells with a small amount of cytoplasm and round or oval, intensely stained nuclei. Sometimes in such cords there are small cysts filled with homogeneous eosinophilic contents or horny masses.
Nevobasocellular syndrome(syn. Gordin-Goltz syndrome) is a polyorganotropic, autosomal dominant syndrome related to phakomatoses. It is based on a complex of hyper- or neoplastic changes due to disorders of embryonic development. The cardinal symptom is the appearance in the early period of life of multiple basal cell carcinomas, accompanied by odontoten cysts of the jaws and anomalies of the ribs. There could be cataracts and changes in the central nervous system. It is also characterized by frequent changes in the palms and soles in the form of “indentations”, in which basaloid structures are also found histologically. After the early nevoid-basaliomatous phase, several years later, usually during puberty, ulcerative and locally destructive forms appear in these areas as an indicator of the onset of the oncological phase.
Histological changes in this syndrome are practically no different from the types of basal cell carcinomas listed above. In the area of the palmoplantar “indentations” there are defects in the stratum corneum of the epidermis with thinning of its remaining layers and the appearance of additional epithelial processes from small typical basaloid cells. Large basal cell carcinomas rarely develop in these places. Individual basal cell lesions of a linear nature include all types of organoid basal cell carcinomas.
Histogenesis of skin basalioma
Basalioma can develop both from epithelial cells and from the epithelium of the pilosebaceous complex. Using serial sections, M. Hundeiker and N. Berger (1968) showed that in 90% of cases the tumor develops from the epidermis. Histochemical examination of various types of cancer shows that in most cells glycogen and glycosaminoglycans are found in the tumor stroma, especially in adamantinoid and cylindromatous patterns. Glycoproteins are constantly detected in basement membranes.
Electron microscopy revealed that most cells of tumor complexes contain a standard set of organelles: small mitochondria with a dark matrix and free polyribosomes. There are no intercellular bridges at the contact sites, but finger-like projections and a small number of desmosome-like contacts are found. In areas of keratinization, layers of cells with intact intercellular bridges and a large number of tonofilaments in the cytoplasm are noted. Occasionally, zones of cells containing cellular membrane complexes are found, which can be interpreted as a manifestation of glandular differentiation. The presence of melanosomes in some cells indicates pigment differentiation. In basal epithelial cells, organelles characteristic of mature epithelial cells are absent, which indicates their immaturity.
It is currently believed that this tumor develops from pluripotent germinal epithelial cells under the influence of various types of external stimuli. Histologically and histochemically, the connection of basal cell carcinoma with the anagen stage of hair growth has been proven and the similarity with proliferating embryonic hair buds has been emphasized. R. Holunar (1975) and M. Kumakiri (1978) believe that this tumor develops in the germinal layer of the ectoderm, where immature basal epithelial cells with the potential for differentiation are formed.
Symptoms of skin basal cell carcinoma
Skin basal cell carcinoma has the appearance of a single formation, hemispherical in shape, often round in outline, slightly elevated above the skin level, pink or grayish-red in color with a pearlescent tint, but may not differ from normal skin. The surface of the tumor is smooth; in its center there is usually a small recess, covered with a thin, loosely adjacent squamous crust, upon removal of which erosion is usually detected. The edge of the ulcerated element is thickened like a roller, consists of small whitish nodules, usually designated as “pearls” and having diagnostic value. In this state, the tumor can exist for years, slowly growing.
Basaliomas can be multiple. Primary plural form, according to K.V. Daniel-Beck and A.A. Kolobyakova (1979), occurs in 10% of cases, the number of tumor foci can reach several dozen or more, which may be a manifestation of non-basocellular Gorlin-Goltz syndrome.
All symptoms of skin basalioma, including Gorlin-Goltz syndrome, allow us to distinguish the following forms: nodular-ulcerative (ulcus rodens), superficial, scleroderma-like (morphea type), pigmentary and fibroepithelial. With multiple lesions, these clinical types can be observed in various combinations.
Forms
Surface view begins with the appearance of a limited scaly patch of pink color. Then the spot acquires clear contours, oval, round or irregular shape. Dense small shiny nodules appear along the edge of the lesion, which merge with each other and form a roll-like edge raised above the skin level. The center of the hearth sinks slightly. The color of the lesion becomes dark pink, brown. Lesions may be solitary or multiple. Among the superficial forms, self-scarring or pagetoid basalioma is distinguished with a zone of atrophy (or scarring) in the center and a chain of small, dense, opalescent, tumor-like elements along the periphery. The lesions reach a significant size. Usually has a multiple nature and a persistent course. Growth is very slow. Its clinical features may resemble Bowen's disease.
At pigmented form the color of the lesion is bluish, purple or dark brown. This type is very similar to melanoma, especially nodular, but has a denser consistency. Dermoscopic examination can provide significant assistance in such cases.
Tumor type is characterized by the appearance of a nodule, which gradually increases in size, reaching 1.5-3 cm or more in diameter, acquires a rounded appearance, and a stagnant pink color. The surface of the tumor is smooth with pronounced telangiectasias, sometimes covered with grayish scales. Sometimes its central part ulcerates and becomes covered with dense crusts. Rarely, the tumor protrudes above the skin level and has a stalk (fibroepithelial type). Depending on the size they distinguish small and large nodular forms.
Ulcerative appearance occurs as a primary variant or as a result of ulceration of the superficial or tumor form of the neoplasm. A characteristic feature of the ulcerative form is a funnel-shaped ulceration, which has a massive infiltrate (tumor infiltration) fused with the underlying tissues with unclear boundaries. The size of the infiltrate is much larger than the ulcer itself (ulcus rodens). There is a tendency to deep ulcerations and destruction of underlying tissues. Sometimes the ulcerative form is accompanied by papillomatous, warty growths.
Scleroderma-like, or scar-atrophic, appearance It is a small, clearly demarcated lesion with a thickening at the base, almost not rising above the level of the skin, yellowish-whitish in color. Atrophic changes and dyschromia may be detected in the center. Periodically, along the periphery of the element, foci of erosion of various sizes may appear, covered with an easily removable crust, which is very important for cytological diagnosis.
Pincus fibroepithelial tumor classified as a type of basal cell carcinoma, although its course is more favorable. Clinically, it manifests itself in the form of a skin-colored nodule or plaque, of dense elastic consistency, and practically does not undergo erosion.
Basalioma (squamous cell carcinoma, basal cell epithelioma) is a type of skin cancer. The tumor develops in the basal layer of epithelial tissue from atypical cells of the epidermis and follicular epithelium and does not metastasize. The neoplasm looks like a nodule and is capable of destroying bone and cartilage tissue.
Photo
Symptoms of basal cell carcinoma
Immunotherapy
To treat basal cell carcinoma of the face, the method of immunotherapy is used, which involves the use of a special ointment - imiquod. The drug stimulates the patient’s body to produce interferon, which helps in the fight against atypical cells. As a rule, nasal basal cell carcinoma is treated with cream, since this method of therapy does not leave scars. Imicvod is often used before starting chemotherapy.
Drug treatment
In the initial stages and in superficial forms, if there are contraindications or it is impossible to use radiation treatment, they resort to drug therapy. For this, omain ointment is used in the form of daily applications. Antitumor antibiotics are also prescribed - bleomycin, which are administered intravenously at 15 mg 2-3 times a week. Total dose 300-400 mg.
Photodynamic treatment
Treatment consists of introducing special substances (photosensitizers) under the skin that highlight clear boundaries of the tumor, which is then irradiated with light waves. For facial basal cell carcinoma, the photodynamic method is a priority treatment option, since it does not lead to cosmetic defects.
Cryogenic destruction
Destroying the tumor by freezing. This method of treatment in some cases surpasses the results of treatment by other methods. Using special equipment (cryoprobes), the tumor is frozen using liquid nitrogen. Advantages of cryotherapy:
Wound healing after cryodestruction is characterized by the absence of cosmetic defects, which eliminates the need for additional plastic surgery. This is important when the tumor is located on the face.
The method is used if the patient’s condition or the location of the basal cell carcinoma does not allow surgical removal. Radiation therapy is done using short-focus gamma radiation. The results of radiation therapy are aesthetically better than with surgical removal of basal cell carcinoma. The only drawback of the method is the duration of treatment (on average 20-25 sessions).
Surgical removal of basal cell carcinoma
The surgery is performed on an outpatient basis, under local anesthesia.
The tumor is excised widely - to be on the safe side, doctors take another five millimeters around the basal cell carcinoma to minimize the risk of relapse after recovery. Since this method of solving a problem on the face is difficult due to a cosmetic defect after surgery, doctors use other methods in open areas, and perform operations only on the body.
In some cases, in addition to surgical or destructive methods of treatment, cytostatic drugs (prospidin and bleomycin) are prescribed. Folk remedies are used to boost immunity.
Basalioma
Basalioma
Basalioma(basal cell carcinoma) is a malignant skin tumor. developing from epidermal cells. It gets its name due to the similarity of tumor cells to cells in the basal layer of the skin. Basalioma has the main signs of a malignant neoplasm: it grows into neighboring tissues and destroys them, and recurs even after proper treatment. But unlike other malignant tumors, basal cell carcinoma practically does not metastasize.
Causes of basal cell carcinoma
Basalioma occurs mainly in people over 40 years of age. Factors contributing to its development include frequent and prolonged exposure to direct sunlight. Therefore, residents of southern countries and people who work in the sun are more susceptible to basal cell carcinoma. People with fair skin get sick more often than dark-skinned people. Contact with toxic substances and carcinogens (petroleum products, arsenic, etc.), constant injury to a certain area of the skin, scars. burns. Ionizing radiation are also factors that increase the risk of basal cell carcinoma. Risk factors include decreased immunity due to therapy with immunosuppressants or a long-term disease.
The occurrence of basal cell carcinoma in a child or adolescent is unlikely. However, there is a congenital form of basal cell carcinoma - Gorlin-Goltz syndrome (neobasocellular syndrome), which combines a flat surface form of the tumor, mandibular bone cysts, rib malformations and other anomalies.
Classification of basalioma
The following clinical forms of basalioma are distinguished:
Symptoms of basal cell carcinomas
Most often, basalioma is located on the face or neck. The development of a tumor begins with the appearance on the skin of a small nodule of pale pink, reddish or flesh-colored. At the beginning of the disease, the nodule may resemble a regular pimple. It grows slowly without causing any pain. A grayish crust appears in its center. After its removal, a small depression remains on the skin, which soon becomes covered with a crust again. A characteristic feature of basal cell carcinoma is the presence of a dense ridge around the tumor, clearly visible when the skin is stretched. The small granular formations that make up the roller look like pearls.
Further growth of basal cell carcinoma in some cases leads to the formation of new nodules, which over time begin to merge with each other. Dilatation of superficial vessels leads to the appearance of “spider veins” in the tumor area. In the center of the tumor, ulceration may occur with a gradual increase in the size of the ulcer and its partial scarring. Increasing in size, basal cell carcinoma can grow into surrounding tissues, including cartilage and bones, causing severe pain.
Nodular-ulcerative basalioma is characterized by the appearance of a compaction protruding above the skin, which has a rounded shape and resembles a nodule. Over time, the compaction enlarges and ulcerates, its outline taking on an irregular shape. A characteristic “pearl” belt is formed around the nodule. In most cases, nodular-ulcerative basalioma is located on the eyelid, in the nasolabial fold or in the inner corner of the eye.
The perforating form of basalioma occurs mainly in those places where the skin is constantly injured. It is distinguished from the nodular-ulcerative form of the tumor by rapid growth and pronounced destruction of surrounding tissues. Warty (papillary, exophytic) basalioma resembles cauliflower in its appearance. It consists of dense hemispherical nodes that grow on the surface of the skin. A feature of the warty form of basalioma is the absence of destruction and germination into surrounding healthy tissue.
Nodular (large nodular) basalioma is a single node protruding above the skin, on the surface of which “spider veins” are visible. The node does not grow deep into the tissue, like nodular-ulcerative basalioma, but outward. The pigmented form of basalioma has a characteristic appearance - a nodule with a “pearl” ridge surrounding it. But the dark pigmentation of the center or edges of the tumor makes it look like melanoma. Sclerodermiform basalioma is distinguished by the fact that the characteristic pale nodule, as it grows, turns into a flat and dense plaque, the edges of which have a clear outline. The surface of the plaque is rough and may ulcerate over time.
The cicatricial-atrophic form of basalioma also begins with the formation of a nodule. As the tumor grows, destruction occurs in its center with the formation of an ulcer. Gradually, the ulcer grows and approaches the edge of the tumor, while scarring occurs in the center of the ulcer. The tumor takes on a specific appearance with a scar in the center and an ulcerated edge, in the area of which tumor growth continues.
Flat superficial basalioma (pagetoid epithelioma) is multiple neoplasms up to 4 cm in size that do not grow deep into the skin and do not rise above its surface. The formations vary in color from pale pinkish to red and have raised, “pearly” edges. This type of basal cell carcinoma develops over several decades and has a benign course.
Spiegler's tumor ("turban" tumor, cylindroma) is a multiple tumor consisting of pink-violet nodes covered with telangiectasia ranging in size from 1 to 10 cm. Spiegler's basal cell carcinoma is localized on the scalp and has a long-term benign course.
Complications of basal cell carcinoma
Although basal cell carcinoma is a type of skin cancer. it has a relatively benign course, since it does not metastasize. The main complications of basal cell carcinoma are related to the fact that it can spread to surrounding tissues, causing their destruction. Severe complications, including death, occur when the process affects the bones, ears, eyes, membranes of the brain, etc.
Diagnosis is carried out by cytological and histological examination of a scraping or impression smear taken from the surface of the tumor. During the examination, strands or nest-like clusters of round, spindle-shaped or oval-shaped cells are detected under a microscope. The cells are surrounded along the edge by a thin rim of cytoplasm.
However, the histological picture of basalioma can be as varied as its clinical forms. Therefore, its clinical and cytological differential diagnosis with other skin diseases plays an important role. Flat superficial basalioma is differentiated from lupus erythematosus. lichen planus. seborrheic keratosis and Bowen's disease. Sclerodermiform basalioma is differentiated from scleroderma and psoriasis. pigmented form - from melanoma. If necessary, additional laboratory tests are carried out aimed at excluding diseases similar to basal cell carcinoma.
Treatment of basal cell carcinoma
The method of treating basal cell carcinoma is selected individually depending on the size of the tumor, its location, clinical form and morphological appearance, and the degree of invasion into adjacent tissues. What matters is the primary occurrence of the tumor or relapse. The results of previous treatment, age and concomitant diseases of the patient are taken into account.
Surgical removal of basal cell carcinoma is an effective and most common method of treatment. The operation is performed for limited tumors located in areas that are relatively safe for surgical intervention. Resistance of basal cell carcinoma to radiation therapy or its recurrence is also an indication for surgical removal. In case of sclerodermiform basal cell carcinoma or recurrent tumor, excision is performed using a surgical microscope.
Cryodestruction of basal cell carcinoma with liquid nitrogen is a quick and painless procedure, however, it is effective only in cases of superficial tumor location and does not exclude the occurrence of relapse. Radiation therapy for basal cell carcinoma with a small stage I-II process is carried out by close-focus radiotherapy of the affected area. In case of extensive damage, the latter is combined with remote gamma therapy. In difficult cases (frequent relapses, large tumor size or deep invasion), radiotherapy can be combined with surgical treatment.
Laser removal of basal cell carcinoma is well suited for older people for whom surgical treatment can cause complications. It is also used in cases where basal cell carcinoma is localized on the face, as it gives a good cosmetic effect. Local chemotherapy for basal cell carcinoma is carried out by applying applications of cytostatics (fluorouracil, metatrexate, etc.) to the affected areas of the skin.
Basalioma prognosis
In general, due to the absence of metastasis, the prognosis of the disease is favorable. But in advanced stages and in the absence of adequate treatment, the prognosis of basal cell carcinoma can be very serious.
Early treatment of basal cell carcinoma is of great importance for recovery. Due to the tendency of basal cell carcinoma to frequently recur, a tumor larger than 20 mm is already considered advanced. If treatment is carried out before the tumor reaches such a size and begins to grow into the subcutaneous tissue, then a permanent cure is observed in 95-98%. When basal cell carcinoma spreads to the underlying tissue after treatment, significant cosmetic defects remain.
Basalioma(basal cell carcinoma or basal epithelioma) is a special skin neoplasm that develops in the upper (basal) layer of the skin or hair follicles, which can grow for years, but rarely metastasizes. It mainly develops in men and women with fair skin who have reached 45-50 years of age, and practically does not occur in children and adolescents. In most cases, if basal cell carcinoma is identified and removed within 2 years from the moment of its occurrence, the patient recovers completely.
Basal cell carcinoma, classified as skin cancer according to the ICD classification, can develop on healthy epidermis as a result of burns, under the influence of carcinogenic substances, or excess sunlight or X-rays. Of no small importance is the genetic predisposition to the disease and various immune disorders that have arisen in the patient’s body. There are theories indicating a connection between basal cell carcinoma and a number of mutations in the genome, leading to weakening of control over the development and differentiation of skin cells.
In addition, a direct relationship has been identified between the occurrence of basal cell carcinoma and a person’s age, as well as the color of his skin. In particular, white skin is a significant factor provoking the appearance of basal cell carcinoma.
The disease often occurs against the background of various skin pathologies, such as psoriasis, actinic keratosis, tuberculous lupus, radiodermatitis, various nevi etc. Another important reason for the occurrence of basal cell carcinoma is decreased immunity. caused by long-term use of corticosteroid drugs.
Symptoms of skin basal cell carcinoma
Basalioma has the appearance of a small single plaque, rising above the skin level and consisting of numerous small nodules. The color of the tumor may be pink or pinkish-red, but may not differ from the shade of healthy human skin. Usually, a small depression forms in its center, covered with a thin crust, under which bleeding erosion is found. Along the edges of the ulcer there are ridge-like thickenings of numerous nodules - “pearls”, which have a characteristic pearlescent tint.
The initial stage of development of basal cell carcinoma practically does not give any clinical symptoms. Mostly, patients complain of the appearance of a constantly growing tumor on the skin of the face, lips and nose, which does not hurt, only sometimes causing mild itching.
Depending on the size and degree of local spread of basal cell carcinoma, there are four clinical stages of the disease:
I. The size of the basal cell carcinoma does not exceed 2 cm and is surrounded by healthy dermis.
II. The tumor has a diameter of over 2 cm, grows throughout the entire depth of the skin, but does not involve the subcutaneous fat layer.
III. An ulcer or plaque reaches any size, involving all the soft tissues underlying it.
IV. The tumor-like neoplasm affects nearby soft tissues, including cartilage and bones.
In approximately 10% of cases, a multiple form of basal cell carcinoma occurs, when the number of plaques reaches several tens or more, being a manifestation of non-basocellular Gorlin-Goltz syndrome .
The disease is diagnosed through clinical and laboratory tests, including:
1. Examination of the scalp, skin and visible mucous membranes of the patient, including visual examination of the area where the basal cell carcinoma is located using a magnifying glass. In this case, the shape, color and presence of shining “pearl” nodules along the edges of the tumor are necessarily noted.
2. Palpation of regional and distant lymph nodes for their enlargement.
70% of all tumor skin diseases are various basal cell carcinomas.
45-50% of people over the age of 65 suffer from skin basal cell carcinoma.
In 85% of cases, basal cell carcinoma occurs in exposed areas of the scalp.
Dark-skinned people practically do not get skin basal cell carcinoma.
Basal cell carcinoma is more common in rural residents, who are more exposed to intense solar radiation than in city dwellers.
3. Collection of histological material using various methods: scraping, smear or puncture biopsy. The method is selected depending on the type and condition of the tumor; its surface is first cleared of dry crusts. If the basal cell carcinoma is an ulcer, a smear-imprint is taken from it by applying a glass slide to the ulcerated surface. A puncture is taken only from fairly large tumors that have an intact surface. Scraping of the skin lesion is performed with a scalpel, the resulting material is immediately applied and distributed on a glass slide.
4. Carrying out an ultrasound examination to determine the true size of the basal cell carcinoma and the depth of the inflamed tissue.
The final diagnosis is established based on the clinical presentation and histology results.
Taking into account the main symptoms of basal cell carcinoma, the following forms can be distinguished:
nodular-ulcerative ;
fibroepithelial ;
pigmented ;
superficial ;
scleroderma-like according to the morphea type.
Usually, superficial basal cell carcinoma begins with the appearance of a pale pink spot, no more than 5 mm in diameter, which constantly peels off and gradually acquires clear round, oval or irregular outlines. After some time, the edges of the focal inflammation thicken, numerous shiny nodules appear, forming a thin ridge. Its center begins to sink slightly and acquires a dark pink or brown tint. Gradually, the tumor slowly grows and reaches significant sizes, resembling Bowen's disease. At the same time, it begins to destroy local tissues or grows on the surface of the skin, practically without destroying the deep layers of subcutaneous tissue.
Pigmented basal cell carcinoma. relating to varieties of superficial basal cell carcinoma, it differs in the color of the tumor, which has a characteristic dark brown, bluish or purple color. This shade occurs due to diffuse pigmentation, resulting from the formation of a large number of colored cells with an increased content of melanin granules, both in the tumor and throughout the entire thickness of the epidermis. Pigmented basal cell carcinoma is often confused with other dangerous skin cancers. In particular, nodular melanoma has similar symptoms, however, basal cell carcinoma has a denser structure in its consistency.
Nodal or nodular basal cell carcinoma often begins with a hemispherical nodule, colored pale pink, through the walls of which small blood vessels are visible. After several years, it acquires a flat shape, reaching large sizes - more than 2 cm. Quite often, an ulcer appears in the central part of the basal cell carcinoma, penetrating deep into the skin, surrounded by a strip of inflamed tissue up to 1 cm wide. The favorite location for such a tumor is the forehead, chin or base of the nose.
Solid basalioma is considered a large-nodular form and is most often found in patients. It is characterized by a single nodule that rises above the epidermis and grows not deep into the skin, but above its surface.
Tumor basalioma develops from a single nodule, gradually increasing in size and acquiring a rounded shape. Its surface is mostly smooth, sometimes covered with small grayish scales. In some cases, the tumor acquires a pink color and reaches a diameter of over 3 cm. A small ulcer, covered with dense scales, forms in its center. Depending on the size of the tumor, large and small nodular tumor basalioma are distinguished.
Ulcerative basal cell carcinoma It is distinguished by a funnel-shaped ulcer, around which it is easy to notice a massive compaction of tissue with unclear boundaries. The infiltrate can be several times larger than the size of the ulcer, cause pain when pressed, and gradually increase in size, affecting neighboring areas. Sometimes the development of an ulcerative lesion is accompanied by growths in the form of warts and papillomas.
In 98% of cases, if treatment for basal cell carcinoma is started in the early stages, complete recovery occurs. In the last stages of the tumor, recurrence occurs in 50% of cases after excision.
Scleroderma-like or cicatricial atrophic basalioma characterized by a small lesion that has a yellowish-whitish color and is almost invisible on the skin. Periodically, erosions of various sizes appear along the edges of the formation, covered with a thin crust, which is easily separated and reveals reddish inflammation underneath. This type of basalioma is characterized by a large proliferation of scleroderma-like connective tissue, spreading deep into the skin down to the subcutaneous tissue. Subsequently, destructive changes lead to the formation of small and larger cystic cavities, sometimes accumulating crystals of calcium salts.
Fibroepithelial basalioma or Pincus tumor– a rare type of basal cell carcinoma that appears as a plaque or nodule that does not differ in color from healthy skin. Basically, the tumor occurs in the lumbosacral region of the back, has a dense consistency and, in extremely rare cases, undergoes erosion. The disease is often combined with seborrhea and may look like fibropapilloma.
Nevobasocellular Gordin-Goltz syndrome, which occurs against the background of disorders of the embryonic development of the fetus, is a hereditary disease that combines pathology of the skin, eyes, internal organs and nervous system. Basically, its main symptom is the formation of multiple basal cell carcinomas, accompanied by anomalies of the ribs and jaw cysts. Quite often, tumors arise against the background of changes in the skin of the soles and palms, on which peculiar “indentations” are formed - thinned layers of the epidermis with additional small processes. Large basal cell carcinomas practically do not form in these areas. Much less often, the syndrome develops together with cataracts and diseases of the central nervous system.
Treatment of skin basal cell carcinoma
When treating basal cell carcinoma, various conservative and radical methods are used, the choice of which depends on the type, nature and number of tumors, the age and gender of the patient, and the presence of concomitant diseases:
1. Surgical removal is used for non-aggressive basal cell carcinomas located in the patient’s back or chest. The tumor is excised with a scalpel with an indentation of 2 cm into healthy tissue, the wound is closed with a skin flap or skin stretched from the sides of the incision. In order to prevent relapse and more serious consequences, single radiation therapy of up to 3 Gy is performed.
2. If the tumor has grown deep into the tissue and cannot be removed surgically, radiation is performed, the total dose of which can be 50-75 Gy.
3. Small tumors with a diameter of up to 0.7 mm are removed by diathermocoagulation and curettage, having previously anesthetized the surgical site.
4. Cryodestruction – nitrogen freezing of small superficial basal cell carcinomas, not exceeding 3 cm in diameter, localized on the nose or forehead. It is not used to treat tumors located in the corner of the eye, on the nose or part of the ear.
5. Laser destruction is especially effective if a relapse occurs at the site of the removed tumor.
6. Photodynamic therapy (PDT) is used for basal cell carcinoma located in hard-to-reach places, for example, on the skin of the eyelid, or with multiple nodular formations. PDT provides a good cosmetic effect and almost completely eliminates the risk of complications.
7. When treating solitary basal cell carcinomas with a diameter of less than 2 cm, a carbon dioxide laser or intron A is used, which is injected directly into the lesion.
8. X-ray therapy is rarely used, usually to treat tumors located near natural orifices or when surgery or other treatments for basal cell carcinoma have failed.
9. Local therapy with various drugs: omain, prospedine or fluorouracil ointment.
In addition, the patient should be observed by an oncologist-dermatologist and take preventive measures to protect the skin from aggressive chemical compounds, ionizing radiation and excessive insolation.
There are folk remedies used in the treatment of basal cell carcinoma. In particular, the juice of celandine or burdock is popular, which is used to treat the site of tumor formation. However, it is worth understanding that such serious oncology as stages 3 and 4 of basal cell carcinoma requires modern treatment methods with the participation of an experienced and professional doctor.
Basal cell carcinoma - photo classification, types.
Features of photo classification of basal cell carcinoma.
The presented photos show basal cell carcinoma in each of its main variants. Attempts have been made to classify basal cell carcinomas based on growth pattern or differentiation patterns, but such methods have not achieved universal acceptance.
Most often, basal cell carcinoma comes in one of three subtypes: nodular, superficial, or ulcerative.
Nodular basalioma in the photo.
This is the most common type of basal cell carcinoma, accounting for about 60% of all primary cases. It looks like a raised, translucent papule or nodule with dilated vessels on the surface (telangiectasia). Such a nodule may ulcerate and have pigment inclusions. Most often, nodular basal cell carcinoma appears on the head and neck, you will notice this in the photo. Over time, the borders become roll-shaped and pearly, while the central part ulcerates - a so-called corrosive ulcer is formed. Without treatment, the nodular version of basal cell carcinoma reaches large sizes and spreads deeply, destroying the eyelids, nose or ears. In large lesions, tissue destruction and ulceration often dominate the picture, so that it is not always easy to recognize the true nature of the disease.
Skin cancer
Skin cancer
Among the total number of malignant tumors, skin cancer accounts for about 10%. Currently, dermatology notes an increasing trend in incidence with an average annual increase of 4.4%. Most often, skin cancer develops in older people, regardless of their gender. Those most predisposed to the disease are fair-skinned people, people living in conditions of increased insolation (hot countries, highlands) and those who spend long periods of time outdoors.
In the overall structure of skin cancer, 11-25% are squamous cell cancer and about 60-75% are basal cell cancer. Since the development of squamous cell and basal cell skin cancer occurs from epidermal cells, these diseases are also classified as malignant epitheliomas.
Causes of skin cancer
Among the causes of malignant degeneration of skin cells, excessive ultraviolet radiation ranks first. This is proven by the fact that almost 90% of skin cancer cases develop in exposed areas of the body (face, neck), which are most often exposed to radiation. Moreover, for people with fair skin, exposure to UV rays is the most dangerous.
The occurrence of skin cancer can be triggered by exposure to various chemicals that have a carcinogenic effect: tar, lubricants, arsenic, tobacco smoke particles. Radioactive and thermal factors acting on the skin can lead to cancer. Thus, skin cancer can develop at the site of a burn or as a complication of radiation dermatitis. Frequent traumatization of scars or moles can cause their malignant transformation with the occurrence of skin cancer.
Hereditary characteristics of the body may predispose to the appearance of skin cancer, which causes familial cases of the disease. In addition, some skin diseases have the ability to undergo malignant transformation into skin cancer over time. Such diseases are classified as precancerous conditions. Their list includes Keir's erythroplasia. Bowen's disease. xeroderma pigmentosum. leukoplakia. senile keratoma. cutaneous horn, Dubreuil melanosis. melanoma-dangerous nevi (complex pigmented nevus, blue nevus, giant nevus, nevus of Ota) and chronic inflammatory skin lesions (trophic ulcers, tuberculosis, syphilis, SLE, etc.).
Skin cancer classification
The following forms of skin cancer are distinguished:
- Squamous cell skin cancer(squamous cell carcinoma) - develops from flat cells of the superficial layer of the epidermis.
- Basal cell skin cancer(basal cell carcinoma) - occurs with atypical degeneration of the basal cells of the epidermis, which have a rounded shape and are located under a layer of flat cells.
- Skin adenocarcinoma- a rare malignant tumor that develops from the sebaceous or sweat glands.
- Melanoma- skin cancer arising from its pigment cells - melanocytes. Considering a number of features of melanoma. Many modern authors identify the concept of “skin cancer” only with non-melanoma cancer.
- TX - it is impossible to evaluate the tumor due to lack of data
- TO - the tumor is not detected.
- Tis - cancer in situ (pre-invasive carcinoma).
- TI - tumor size up to 2 cm.
- T2 - tumor size up to 5 cm.
- TZ - tumor size more than 5 cm.
- T4 - skin cancer grows into underlying deep tissues: muscle, cartilage or bone.
To assess the prevalence and stage of the process in non-melanoma skin cancer, the international TNM classification is used.
T - extent of primary tumor
N - state of lymph nodes
- NX - it is impossible to assess the condition of regional lymph nodes due to lack of data.
- N0 - no signs of metastases to regional lymph nodes were detected.
- N1 - there is metastatic damage to regional lymph nodes.
- MX - lack of data regarding the presence of distant metastases.
- MO - no signs of distant metastases were detected.
- M1 - the presence of distant metastases of skin cancer.
M - presence of metastasis
The degree of differentiation of tumor cells is assessed within the histopathological classification of skin cancer.
Skin Cancer Symptoms
Squamous cell skin cancer is characterized by rapid growth and spread both over the surface of the skin and in depth. The growth of a tumor into tissues located under the skin (muscle, bone, cartilage) or the addition of inflammation is accompanied by the appearance of pain. Squamous cell skin cancer may appear as an ulcer, plaque, or nodule.
The ulcerative version of squamous cell skin cancer has the appearance of a crater-shaped ulcer, surrounded, like a roller, by dense, raised and abruptly breaking edges. The ulcer has an uneven bottom, covered with crusts of dried serous-bloody exudate. It gives off a rather unpleasant smell.
A plaque of squamous cell skin cancer is distinguished by its bright red color, dense consistency and lumpy surface. It often bleeds and quickly increases in size.
The coarsely lumpy surface of the node in squamous cell skin cancer makes it look like a cauliflower or mushroom. Characterized by high density, bright red or brown color of the tumor node. Its surface may become eroded or ulcerated.
Basal cell skin cancer is more benign and slower than squamous cell cancer. Only in advanced cases does it grow into the underlying tissue and cause pain. Metastasis is usually absent. Basal cell skin cancer is highly polymorphic. It can be represented by nodular-ulcerative, warty, perforating, cicatricial-atrophic, pigmented, nodular, sclerodermiform, flat surface and “turban” forms. The onset of most clinical variants of basal cell carcinoma occurs with the formation of a single small nodule on the skin. In some cases, neoplasms may be multiple.
Skin adenocarcinoma most often occurs in areas rich in sweat and sebaceous glands. These are the armpits, groin area, folds under the mammary glands, etc. Adenocarcinoma begins with the formation of an isolated node or small papule. This rare type of skin cancer is characterized by slow growth. Only in some cases can adenocarcinoma reach large sizes (about 8 cm in diameter) and invade muscles and fascia.
Melanoma in most cases is a pigmented tumor that is black, brown or gray in color. However, there are also cases of depigmented melanomas. During the growth process of melanoma skin cancer, there are horizontal and vertical phases. Its clinical variants are represented by lentigo melanoma. superficial spreading melanoma and nodular melanoma.
Complications of skin cancer
Skin cancer, spreading deep into the tissues, causes their destruction. Considering the frequent localization of skin cancer on the face, the process can affect the ears, eyes, paranasal sinuses, and brain, which leads to loss of hearing and vision, the development of sinusitis and meningitis of malignant origin, damage to vital structures of the brain, and even death.
Metastasis of skin cancer occurs primarily through the lymphatic vessels with the development of malignant lesions of regional lymph nodes (cervical, axillary, inguinal). This reveals compaction and enlargement of the affected lymph nodes, their painlessness and mobility when palpated. Over time, the lymph node becomes fused with the surrounding tissues, as a result of which it loses its mobility. Soreness appears. Then the lymph node disintegrates with the formation of an ulcerative defect in the skin located above it.
Diagnosis of skin cancer
Patients with suspected skin cancer should be consulted by a dermato-oncologist. The doctor examines the formation and other areas of the skin, palpates regional lymph nodes, and dermatoscopy. Determination of the depth of tumor germination and the extent of the process can be done using ultrasound. For pigmented formations, siascopy is additionally indicated.
Only cytological and histological examination can definitively confirm or refute the diagnosis of skin cancer. Cytological examination is carried out by microscopy of specially stained smears made from the surface of cancerous ulcers or erosions. Histological diagnosis of skin cancer is carried out on material obtained after removal of a tumor or by skin biopsy. If the integrity of the skin over the tumor node is not compromised, then the biopsy material is taken using the puncture method. According to indications, a lymph node biopsy is performed. Histology reveals the presence of atypical cells, establishes their origin (flat, basal, melanocytes, glandular) and the degree of differentiation.
When diagnosing skin cancer, in some cases it is necessary to exclude its secondary nature, that is, the presence of a primary tumor of internal organs. This is especially true for skin adenocarcinomas. For this purpose, an ultrasound of the abdominal organs is performed. X-ray of the lungs. Kidney CT. contrast urography. skeletal scintigraphy. MRI and CT of the brain, etc. The same examinations are necessary in the diagnosis of distant metastases or cases of deep germination of skin cancer.
Skin cancer treatment
The choice of treatment for skin cancer is determined in accordance with its type, the extent of the process, and the degree of differentiation of cancer cells. The location of the skin cancer and the patient's age are also taken into account.
The main task in the treatment of skin cancer is its radical removal. Most often it is carried out by surgical excision of pathologically changed tissues. The operation is carried out with the capture of apparently healthy tissue by 1-2 cm. A microscopic intraoperative examination of the marginal zone of the removed formation allows the operation to be carried out with minimal capture of healthy tissue with the most complete removal of all skin cancer tumor cells. Excision of skin cancer can be performed using a neodymium or carbon dioxide laser, which reduces bleeding during surgery and gives a good cosmetic result.
For small tumors (up to 1-2 cm) with slight germination of skin cancer into surrounding tissues, electrocoagulation can be used. curettage or laser removal. When performing electrocoagulation, the recommended capture of healthy tissue is 5-10 mm. Superficial highly differentiated and minimally invasive forms of skin cancer can be subjected to cryodestruction with the capture of healthy tissue by 2-2.5 cm. Since cryodestruction does not leave the opportunity for a histological study of the removed material, it can be carried out only after a preliminary biopsy confirming the small spread and high differentiation of the tumor .
Skin cancer that covers a small area can be effectively treated with close-focus X-ray therapy. Electron beam irradiation is used to treat superficial but large skin cancers. Radiation therapy after tumor removal is indicated for patients with a high risk of metastasis and in cases of recurrent skin cancer. Radiation therapy is also used to suppress metastases and as a palliative method in cases of inoperable skin cancer.
It is possible to use photodynamic therapy for skin cancer, in which irradiation is carried out against the background of the introduction of photosensitizers. For basal cell carcinoma, local chemotherapy with cytostatics has a positive effect.
Preventing skin cancer
Preventive measures aimed at preventing skin cancer consist of protecting the skin from exposure to adverse chemical, radiation, ultraviolet, traumatic, thermal and other influences. Avoid exposure to open sunlight, especially during periods of maximum solar activity, and use various sunscreens. Workers in the chemical industry and those associated with radioactive radiation must follow safety rules and use protective equipment.
Monitoring patients with precancerous skin diseases is important. Regular examinations by a dermatologist or dermato-oncologist in such cases are aimed at timely detection of signs of the disease degenerating into skin cancer. Preventing the transformation of melanoma-dangerous nevi into skin cancer lies in the correct choice of treatment tactics and method of their removal.
Skin cancer prognosis
Mortality rates for skin cancer are among the lowest compared to other cancers. The prognosis largely depends on the type of skin cancer and the degree of differentiation of tumor cells. Basal cell skin cancer has a more benign course without metastasis. With adequate and timely treatment of squamous cell skin cancer, the 5-year survival rate of patients is 95%. The most unfavorable prognosis is for patients with melanoma, in which the 5-year survival rate is only 50%.
Skin basalioma
Skin basalioma or cancer in the form of a neoplasm that develops from a cell of the skin basal layer is characterized by slow growth and the absence of metastases. To what extent the neoplasm is benign or malignant in medicine there is still no consensus. Many consider it an intermediate stage between benign and malignant tumors.
Basalioma– skin cancer occurs in 70-75% of all cases of malignant skin tumors. Per 100 thousand population, 26 men and 21 women may develop basal cell carcinoma. This skin disease is more common in the south of Russia, in the Rostov and Astrakhan regions, Stavropol and Krasnodar territories.
Those at risk for the disease are light-skinned people and those who work outdoors for a long time: fishermen, builders, agricultural workers and workers repairing roads.
Skin basal cell carcinoma, what is it?
Despite the absence of metastases, basal cell carcinoma is like any malignant neoplasm. can germinate and destroy neighboring tissues, and recur after proper treatment. It is selected individually in each case in accordance with the characteristics of the tumor.
Basal cell skin cancer
Not knowing what basal cell carcinoma looks like or what it is, many, when they find one or several fused nodules on the skin, rising above the skin, do not pay attention to them, because they do not experience pain in these places in the early stages.
After some time, the nodule takes the form of a yellow or off-white plaque with a surface covered with scales. Usually people try to tear off the crust, under which bleeding from the capillary may occur. When they notice that the formation begins to ulcerate, patients understand that they need to consult a dermatologist. Experienced specialists immediately refer patients to an oncologist, since one type of tumor can suggest basal cell carcinoma.
Forms of basal cell carcinoma - classification
Most often, a tumor forms (basal cell carcinoma) on the head:
The classification includes the following forms or types of basal cell carcinoma:
Clinical classification:
Designations and their explanation:
Stages of basal cell carcinoma
Since basal cell carcinoma in the initial stage (stage T0) looks like an unformed tumor or pre-invasive carcinoma (carcinoma in situ - Tis), it is difficult to determine despite the appearance of cancer cells.
Degree of prevalence of basal cell carcinoma
We explain how to identify basal cell carcinoma using a simpler classification. It includes basalioma:
The initial stage includes T0 and T1 of precise classification. Basaliomas look like small nodules with a diameter of less than 2 cm. There are no ulcerations.
The advanced stage includes T2 and T3. The tumor will be large, up to 5 cm or more, with primary ulcerations and soft tissue lesions.
Terminal stage includes T4 precise classification. The tumor grows up to 10 centimeters or more and invades the underlying tissues and organs. In this case, multiple complications may develop due to the destruction of organs.
Risk factors for basal cell carcinoma
Children and adolescents rarely get this type of cancer. Basal cell carcinoma appears more often on the face of men and women after 50 years of age. The tumor also affects other exposed areas of the skin.
Due to excessive exposure to direct sunlight and smoking, basal cell carcinoma of the nasal skin may occur. For chronic diseases of the facial skin - basal cell carcinoma of the eyelid. If there are carcinogenic substances in the production environment, for example, basal cell carcinoma of the auricle and hands. with old scars from periodic and frequent burns - appears on the skin of the torso and limbs, on the neck.
If basal cell carcinoma appears, the causes may be related to the following factors:
You can't mistake a lump for acne. It needs to be treated because it can destroy even the bones of the skull, lead to thrombosis of the meninges and death.
How does the disease manifest itself?
Manifestation of basal cell carcinoma
Anatomically, the formation looks like a flat plaque, nodule, superficial ulcer or extensive deep ulceration with a dark red bottom.
Signs of basal cell carcinoma at the microscopic level are characterized by emerging strands and complexes consisting of intensely colored small cells. They are limited on the periphery by prismatic cells with the presence of nuclei located basally. The nuclei have long axes located at right angles to the border of the complex or cord. In this case, the grouping of cells will be parallel.
Inside the cells there is a small amount of cytoplasm with dark round, oval or elongated nuclei. Small cells differ from basal epithelial skin cells in the absence of intercellular bridges. The cells inside the complexes and cords are even smaller in size and their arrangement is random and more loose.
Clinical symptoms of basal cell carcinoma first appear as a dense, pinkish, pinkish-yellowish or matte white micro-nodule in the form of a pearl. It protrudes above the skin and tends to merge with a group of similar nodules, forming a plaque with telangiectasias (meshes or asterisks) - persistent dilatation of capillaries, venules or arterioles, the nature of which is not associated with inflammation.
In the center of the plaque, spontaneous disappearance of individual nodules or their ulceration may occur with the formation of a ridge consisting of dull whitish nodules along the periphery. In the future, the disease can manifest itself in two tumor states:
Nodular-ulcerative basalioma Irregularly shaped, it manifests itself with all clinical symptoms and is most often formed in the area of the eyelid, the inner corner of the eye and the nasolabial fold.
Perforating tumor may appear in the same places due to frequent trauma to the skin. But it grows faster and destroys surrounding tissue more actively than nodular-ulcerative tissue.
Nodular large nodular or solid tumor in the form of a single node above the skin, it is covered with spider veins - solid cords and complexes with scalloped outlines, tending to merge into massive formations. It grows outward and is surrounded by a “pearl” cushion. Due to the dark pigmentation in the center or along the edges, it is mistaken for melanoma of the skin.
Adenoid formation (cystic) consists of cyst-like structures and glandular tissue, giving it a lace-like appearance. The cells here are bordered in regular rows by small cysts with basophilic contents.
Symptoms of superficial multicentric (pagetoid) basal cell carcinoma manifest as a round or oval plaque with a border of nodules along the periphery and a slightly sunken center covered with dry scales. Under them, telangiectasias are visible in the thinned skin. At the cellular level, it consists of many small lesions with small dark cells in the superficial layers of the dermis.
Warty (papillary, exophytic) tumor can be mistaken for a cauliflower wart due to the dense hemispherical nodes growing on the skin. It is characterized by the absence of destruction and does not grow into healthy tissues.
Pigmented neoplasm or pagetoid epithelioma comes in a variety of colors: bluish-brown, brownish-black, pale pinkish and red with raised pearl-like edges. With a long, torpid and benign course, it reaches 4 cm.
At cicatricial-atrophic (flat) form of the tumor a nodule is formed, in the center of which an ulcer (erosion) forms, which spontaneously scars. The nodules continue to grow on the periphery with the formation of new erosions (ulcers).
During ulceration, an infection occurs and the tumor becomes inflamed. With the growth of primary and recurrent basalioma, the underlying tissues (bones, cartilage) are destroyed. It can move into nearby cavities, for example, from the wings of the nose - into its cavity, from the earlobe - into the cartilage of the shell, destroying them.
For sclerodermiform tumor characterized by a transition from a pale nodule as it grows into a plaque of a dense and flat shape with a clear contour of the edges. Over time, ulcers appear on the rough surface.
For Spiegler's tumors (cylindromas) Characterized by the appearance of multiple benign nodes of pink-violet color, covered with telangiectasia. When localized under the hair on the head, it lasts for a long time.
Diagnosis of basal cell carcinoma
If, after a visual examination, a doctor suspects a basal cell carcinoma in a patient, the diagnosis is confirmed by cytological and histological examination of fingerprint smears or scrapings from the surface of the tumor. In the presence of strands or nest-like clusters of spindle-shaped, round or oval cells with thin rims of cytoplasm around them, the diagnosis is confirmed. Tests for skin cancer (smear impression) are taken from the bottom of the ulcer and the cellular composition is determined.
If, for example, the tumor marker CA-125 is used to diagnose ovarian cancer, then there are no specific oncological blood markers to determine the malignancy of basal cell carcinoma. They could accurately confirm the development of cancer in her. Other laboratory tests can reveal leukocytosis, increased erythrocyte sedimentation rate, positive thymol test, and increased C-reactive protein. These indicators are consistent with other inflammatory diseases. There is some confusion in the diagnosis, so they are rarely used to confirm the diagnosis of neoplasms.
However, due to the varied histological picture of basal cell carcinoma, as well as its clinical forms, differential diagnosis is carried out to exclude (or confirm) other skin diseases. For example, lupus erythematosus, lichen planus, seborrheic keratosis, Bowen's disease should be differentiated from flat superficial basal cell carcinoma. Melanoma (cancer of a mole) - from the pigmented form, scleroderma and psoriasis - from the sclerodermiform tumor.
Informative video: biopsy and CO2 laser removal of basal cell carcinoma of the skin of the dorsum of the nose
Treatment methods for basal cell carcinoma. Removal of basal cell carcinoma
When cellular skin cancer is confirmed, treatment methods are selected depending on the type and how much the tumor has grown and grown into neighboring tissues. Many people want to know how dangerous basal cell carcinoma is and how to treat it so that there are no relapses. The most proven method of treating small tumors is surgical removal of basal cell carcinoma using local anesthesia: lidocaine or ultracaine.
When the tumor grows deep inside and into other tissues, surgical treatment of basal cell carcinoma is used after irradiation, i.e. combined method. In this case, the cancerous tissue is completely removed to the border (edge), but if necessary, they enter the nearest healthy areas of the skin, retreating 1-2 cm from it. With a large incision, a cosmetic suture is carefully applied and removed after 4-6 days. The sooner the formation is removed, the higher the effect and the lower the risk of relapse.
Treatment is also carried out using the following effective methods:
Radiation therapy
Radiation therapy is well tolerated by patients and is used for small tumors. The treatment is long-term, at least 30 days, and has side effects, since the rays affect not only the tumor, but also healthy skin cells. Erythema or dry epidermitis appears on the skin.
Mild skin reactions go away on their own; persistent ones require local therapy. Radiation therapy in 18% of cases is accompanied by various complications in the form of trophic ulcers, cataracts, conjunctivitis, headaches, etc. Therefore, symptomatic treatment is carried out or with the use of hemostimulating agents. Treatment of the sclerosing form of basalioma with radiation therapy is not carried out due to its extremely low effectiveness.
Laser therapy
Once the diagnosis of basal cell skin cancer or basal cell carcinoma is confirmed, laser treatment has almost completely replaced other methods of tumor removal. During one session it is possible to get rid of the disease with a carbon dioxide laser. The tumor is exposed to CO2 and is evaporated layer by layer from the skin surface. The laser does not touch the skin and only affects the affected area with temperature, without touching healthy areas.
Patients do not feel pain, since during the procedure there is anesthesia while being protected by cold. There is no bleeding at the removal site, a dry crust appears, which will disappear on its own within 1-2 weeks. You should not peel it off yourself with your nails to avoid infection.
Laser removal of basal cell carcinoma
This method is suitable for patients of all ages, especially the elderly. If basal cell carcinoma or basal cell carcinoma is detected, laser treatment will be preferable due to the following advantages of this method:
Cryodestruction
What is basalioma and how to treat it if there are many formations on the face or head, there are large, neglected ones and growing into the bones of the skull? This is a cell from the basal layer of the skin that, by dividing, has grown into a large tumor. In this case, cryodestruction will help, especially for those patients who develop rough (keloid) scars after operations, who have pacemakers and receive anticoagulants, including Warfarin.
Cryodestruction
Information! According to the results of the study, relapses occur in 7.5% after cryodestruction, in 10.1% after surgery, and in 8.7% of all cases after radiation therapy.
The list of advantages of cryodestruction includes:
Information! Cryodestruction, unlike radiation therapy, does not destroy the DNA of the cells surrounding the basalioma. It promotes the release of substances that enhance immunity against the tumor and prevents the formation of new basal cell carcinomas at the site of removal and in other areas of the skin.
After a biopsy confirming the diagnosis, to prevent discomfort and pain during cryodestruction, local anesthetics are used (Lidocaine - 2%) and/or Ketanol (100 mg) is given to the patient an hour before the procedure for pain relief.
If liquid nitrogen is used as a spray, then there is a risk of nitrogen spreading. Cryodestruction can be carried out more accurately and deeper using a metal applicator, which is cooled with liquid nitrogen.
It is important to know! You cannot independently freeze squamous cell carcinoma or basal cell carcinoma with tampons with Wartner Cryo or Cryopharm (it makes no sense), since freezing occurs only to a depth of 2-3 mm. It is impossible to completely destroy basal cell carcinoma cells using these means. The tumor is covered with a scar on top, and oncogenic cells remain in the depths, which is fraught with relapse.
Photodynamic therapy
Photodynamic therapy for basal cell carcinoma is aimed at selective destruction of tumor cells with substances called photosensitizers when exposed to light. At the beginning of the procedure, a medicine, such as Photoditazine, is injected into the patient's vein to accumulate in the tumor. This stage is called photosensitization.
When a photosensitizer accumulates in cancer cells, basalioma is examined under ultraviolet light to mark its border on the skin, since it will glow pink and fluorescence occurs, which is called video fluorescent marking.
Next, the tumor is illuminated with a red laser with a wavelength corresponding to the maximum absorption of the photosensitizer (for example, 660-670 nm for Photoditazine). The laser density should not heat living tissue above 38? C (100 MW/cm?). The time is set depending on the size of the tumor. If the tumor is the size of 10 kopecks, then the irradiation time is 10-15 minutes. This stage is called photo exposure.
When oxygen enters chemical reactions, the tumor dies without damaging healthy tissue. In this case, cells of the immune system: macrophages and lymphocytes absorb the cells of the dead tumor, which is called photoinduction of immunity. Relapses do not occur at the site of the original basal cell carcinoma. Photodynamic therapy is increasingly replacing surgical and radiation treatment.
Drug therapy
If research confirms basal cell carcinoma, treatment with ointment is prescribed in courses of 2-3 weeks. Ointments for occlusive dressings are used locally:
The ointment should be applied, covering the surrounding skin by 0.5 cm. To protect healthy tissues, they are lubricated with zinc or zinc salicylic paste.
If chemotherapy is carried out, then Lidaza and Wobe-mugos E are used. Multiple basal cell carcinomas are treated with intravenous or intramuscular infusion of Prospidin before cryodestruction of the lesions.
For tumors up to 2 cm, if they are localized in the corners of the eyes and on the eyelids, interferons are used inside the auricle, since laser, chemotherapy or cryodestruction, as well as surgical excision cannot be used.
Treatment of basal cell carcinomas is also carried out with aromatic retinoids, which can regulate the activity of the components of the cyclase system. If drug therapy is interrupted or there are tumors larger than 5 cm, undifferentiated and invasive basal cell carcinomas, relapses may occur.
Traditional therapy for the treatment of skin basal cell carcinoma. Recipes for ointments and tinctures
Important! Before treating basalioma with folk remedies, it is necessary to do an allergy test to all herbs that will be used so as not to aggravate the condition.
The most popular folk remedy is decoction based on celandine leaves. Fresh leaves (1 tsp) are placed in boiling water (1 tbsp), let stand until cool and take 1/3 tbsp. three times a day. You need to prepare a fresh decoction every time.
If there is a single or small basalioma on the face, treatment with folk remedies is carried out by lubricating:
Golden mustache juice use as a compress during the day, applying moistened cotton swabs, securing them with a bandage or plaster.
Ointment: powder from burdock and celandine leaves(according to? century) stir well with melted pork fat and simmer for 2 hours in the oven. Apply to the tumor 3 times a day.
Ointment: burdock root(100 g) boil, cool, knead and mix with vegetable oil (100 ml). Continue boiling the mixture for 1.5 hours. Can be applied to the nose, where it is inconvenient to use compresses and lotions.
Ointment: prepare a collection, mixing birch buds, spotted hemlock, meadow clover, greater celandine, burdock root - 20 grams each. Finely chopped onion (1 tbsp) is fried in olive oil (150 ml), then it is collected from the frying pan and pine resin (resin - 10 g) is placed in the oil, after a few minutes - a collection of herbs (3 tbsp) , after 1-2 minutes, remove from heat, pour into a jar and close tightly with a lid. Infuse for a day in a warm place. Can be used for compresses and to lubricate tumors.
Remember! Treatment of basal cell carcinoma with folk remedies serves as a complement to the main method of treatment.
Life expectancy and prognosis for skin basal cell carcinoma
If basal cell carcinoma is detected, the prognosis will be favorable, since metastases do not form. Early treatment of the tumor does not affect life expectancy. In advanced stages, tumor size more than 5 cm and frequent relapses, survival rate within 10 years is 90%.
As measures to prevent basal cell carcinoma, you should:
Conclusion! To prevent and treat basal cell carcinoma, comprehensive methods should be used. If new growths appear on the skin, you should immediately consult a doctor for early treatment. This will preserve the nervous system and prolong life.
Course of squamous cell skin cancer characterized by steady progression with infiltration of the underlying tissues, the occurrence of pain and dysfunction of the corresponding organ. Over time, the patient may develop anemia and general weakness; metastases to internal organs lead to the death of the patient.
Grade of malignancy of squamous cell skin cancer assessed by its invasiveness and ability to metastasize. Different forms of squamous cell skin cancer differ in their propensity to metastasize. The most aggressive is spindle cell cancer, as well as acantholytic and mucin-producing cancer. The frequency of metastasis of the acantholytic variety of squamous cell skin cancer varies from 2% to 14%; Moreover, a tumor diameter greater than 1.5 cm correlates with the risk of death. Verrucous cancer metastasizes extremely rarely; such cases have been described in cases of true squamous cell carcinoma of the oral mucosa, anogenital area or sole that developed against its background, and metastasis occurred in regional lymph nodes.
Usually the risk of metastasis increases with increasing thickness, tumor diameter, level of invasion, and decreasing degree of cell differentiation. In particular, well-differentiated tumors are less aggressive than anaplastic ones. The risk of metastasis also depends on the location of the tumor. For example, tumors on open areas of the skin are less aggressive, although tumors located on the ears, in the nasolabial folds, in the periorbital and parotid areas have a more aggressive course. Tumors localized in closed areas of the skin are much more aggressive, characterized by rapid growth, and have a more pronounced tendency to invasion, anaplasia and metastasis, compared to tumors in open areas of the skin.
Aggression and incidence of squamous cell carcinoma metastasis genitals and perianal area. The frequency of metastasis also depends on whether the neoplasm develops against the background of precancerous changes, scars, or normal epidermis. Thus, with the development of de novo squamous cell skin cancer, metastases are diagnosed in 2.7-17.3% of cases, while with squamous cell skin cancers arising against the background of solar keratosis, the frequency of metastasis is estimated at 0.5-3%, with squamous cell cancers , against the background of solar cheilitis - in 11%. The frequency of metastasis of squamous cell skin cancers that developed against the background of Bowen's disease and Keir's erythroplasia is 2 and 20%, respectively; squamous cell carcinomas formed against the background of burn and X-ray scars, ulcers, fistulas with osteomyelitis are observed with a frequency of up to 20%. The risk of metastasis increases significantly with genetically determined (xeroderma pigmentosum) or acquired immunological deficiencies (AIDS, lymphoproliferative processes, conditions after organ transplantation). The average rate of metastasis of squamous cell skin cancer is estimated at 16%. In 15% of cases, metastasis occurs in visceral organs and in 85% - in regional lymph nodes.
Diagnosis of squamous cell carcinoma is established on the basis of clinical and laboratory data, among which histological examination is of decisive importance. Histological diagnosis is most difficult in the earliest stages of the disease and in undifferentiated forms. In some cases, the pathologist cannot decide whether the process is precancerous or cancerous. In such cases, examination of the tumor using serial sections is required. When diagnosing verrucous cancer, a deep biopsy is necessary. Detection of squamous cell skin cancer is especially successful when there is close contact between the pathologist and the clinician. In order to develop the most rational treatment tactics, patients with squamous cell skin cancer should be carefully examined to detect metastases.
Differential diagnosis for squamous cell skin cancer carried out with solar keratosis, basal cell carcinoma, keratoacanthoma, pseudocarcinomatous hyperplasia of the epidermis, Bowen's disease, Queyre's erythroplasia, Paget's disease. cutaneous horn, sweat gland cancer. In typical cases, the differential diagnosis is not difficult, but sometimes difficulties may arise in its implementation. Although squamous cell carcinoma of the skin and solar keratosis present with atypia, dyskeratosis of individual cells and proliferation of the epidermis, only squamous cell carcinoma is accompanied by invasion of the reticular layer of the dermis. At the same time, there is no clear boundary separating both diseases, and sometimes when studying histological preparations of a solar keratosis lesion, serial sections reveal one or more areas of progression with transition to squamous cell carcinoma.
Distinguish squamous cell carcinoma from basal cell carcinoma in most cases it is not difficult, basalioma cells are basophilic, and in squamous cell carcinoma the cells, at least of a low degree of malignancy, have eosinophilic staining of the cytoplasm due to partial keratinization. Cells in high-grade squamous cell carcinoma may be basophilic due to the lack of keratinization, but they differ from basal cell carcinoma cells by greater nuclear atypia and mitotic figures. It is also important to take into account that keratinization is not the prerogative of squamous cell skin cancer and also occurs in basal cell carcinoma with piloid differentiation. However, keratinization in basaliomas is partial and leads to the formation of parakeratotic strands and funnels. Less commonly, it can be complete, with the formation of horny cysts, which differ from “horny pearls” in the completeness of keratinization. Only sometimes the differential diagnosis with basalioma can be difficult, especially when two types of cells are identified in the acanthotic cords: basaloid cells and atypical ones, such as cells of the spinous layer of the epidermis. Such intermediate forms are often regarded as metatypical cancer.
Since standard methods do not always help in the differential diagnosis of squamous cell skin cancer, special methods based on analysis of the antigenic structure of tumor cells can be used for this purpose. In particular, immunohistochemical methods can help to distinguish poorly differentiated squamous cell skin cancer from non-epithelial tumors of the skin and subcutaneous tissues, which are similar in clinical manifestations, but have a completely different course and prognosis. Thus, the identification of certain antigens that serve as histogenetic markers of epidermal differentiation, for example, keratin intermediate filaments, distinguishes elements of squamous cell carcinoma from elements of tumors originating from non-keratinized cells, such as melanoma. atypical fibroxanthoma, angiosarcoma, leiomyosarcoma or lymphoma. An important role in the differential diagnosis of squamous cell skin cancer is played by the detection of epithelial membrane antigen. Diffuse expression of this marker is observed even with severe anaplasia in late stages of tumors.
The difference between epithelial neoplasms is determined by studying the composition of cytokeratins. For example, basal cell carcinoma tumor cells express low molecular weight cytokeratins, and tumor keratinocinocytes of squamous cell carcinoma express high molecular weight cytokeratins. In the differential diagnosis of squamous cell skin cancer, detection of oncofetal antigens is also used. For example, unlike squamous cell carcinoma in situ, tumor cells in Paget's disease and extramammary Paget's disease stain when reacting to CEA.
Terminal differentiation marker expression keratinocytes- Ulex europeus antigen - is more expressed in well-differentiated squamous cell skin cancers, decreases in poorly differentiated squamous cell skin cancers and is absent in basal cell carcinoma. Expression of urokinase plasminogen activator correlates with low differentiation of squamous cell skin cancer.
Important in differential diagnosis of squamous cell skin cancer from keratoacanthoma has the detection of expression of free arachidic agglutinin, transferrin receptor and blood group isoantigens on the latter cells, while their expression in cells of squamous cell carcinoma in situ and squamous cell carcinoma of the skin is reduced or absent. In particular, partial or complete loss of blood group isoantigen expression (A. B or H) is an early manifestation of the transformation of keratoacanthoma into squamous cell carcinoma. RBTL on an aqueous tissue extract from keratoacanthoma and squamous cell skin cancer tissue, as well as flow cytometry data, can help in the differential diagnosis between squamous cell skin cancer and keratoacanthoma. A significant difference in peak DNA index and highest DNA content was described between keratoacanthoma and squamous cell skin cancer (85.7 and 100%, respectively). It has also been shown that most cells in squamous cell skin cancer are aneuploid.
Skin cancer, like most cancers, is considered a multi-etiological condition. And it is not always possible to reliably determine the main trigger for the appearance of malignant cells. At the same time, the pathogenetic role of a number of exo- and endogenous factors has been proven, and several precancerous diseases have been identified.
Skin cancer is a malignant neoplasm in the form of a tumor, which develops as a result of atypical transformation of cells under the influence of subjective and objective factors. The disease is very dangerous because it affects the largest and most important organ of the human body.
If cancer is detected in its early stages and treated correctly, it can be eliminated forever, preventing the disease from returning. In the case of the development of a severe, aggressive form, other organs of the human body are often affected, which leads to irreversible consequences, and sometimes even death.
It is extremely important to promptly detect any kind of changes in the skin and consult a doctor for examination and treatment.
Skin cancer is a fairly common form of a malignant type of tumor, in which both women and men are affected almost equally, their age is generally from 50 years or more, although the possibility of the disease developing in one or another variety of forms in more than young patients.
The affected area is, as a rule, areas of the skin that are open to one or another influence. The development of skin cancer is observed in 5% of the total number of cases of cancer as such.
Mechanism of disease development
Exposure to ultraviolet radiation and other causative factors leads in most cases to direct damage to skin cells. In this case, it is not the destruction of cell membranes that is pathogenetically important, but the effect on DNA.
Partial destruction of nucleic acids causes mutations, which leads to secondary changes in membrane lipids and key protein molecules. Predominantly basal epithelial cells are affected.
Various types of radiation and HPV have not only a mutagenic effect. They contribute to the appearance of relative immune deficiency.
This is explained by the disappearance of dermal Langerhans cells and the irreversible destruction of some membrane antigens that normally activate lymphocytes. As a result, the functioning of the cellular immune system is disrupted and protective antitumor mechanisms are suppressed.
Immunodeficiency is combined with increased production of certain cytokines, which only worsens the situation. After all, these substances are responsible for cell apoptosis and regulate the processes of differentiation and proliferation.
The pathogenesis of melanoma has its own characteristics. The malignant degeneration of melanocytes is promoted not only by exposure to ultraviolet radiation, but also by hormonal changes.
Clinically significant for disruption of melanogenesis processes are changes in the levels of estrogens, androgens and melanostimulating hormone. This is why melanomas are more common in women of reproductive age.
Moreover, hormone replacement therapy, taking contraceptive drugs and pregnancy can act as a provoking factor for them.
Another important factor in the appearance of melanomas is mechanical damage to existing nevi. For example, tissue malignancy often begins after the removal of a mole, accidental injury, and also in places where the skin is rubbed by the edges of clothing.
A malignant neoplasm begins with one or more pinkish spots that begin to peel off over time. This initial stage can last from one or two weeks to several years.
The main localization is the front part, the dorsal shoulder region and the chest. It is here that the skin is most delicate and susceptible to physiological changes in the body.
Skin cancer can form in the form of pigment spots that grow in size, become convex, and sharply darken to a dark brown color. Often occurs when moles degenerate into malignant neoplasms.
The tumor may also look like a simple wart.
CAUSES
Before the formation of a full-fledged malignant tumor, precancerous formations often appear, that is, precancerous diseases that have a high tendency to malignancy.
Precancers are divided into obligate and facultative. Obligate tumors degenerate into a malignant neoplasm in almost 100% of cases. This type of tumor includes:
- Bowen's disease;
- Erythroplakia of Keira;
- Xeroderma pigmentosum;
- Paget's disease.
The development of Bowen's disease is most common in older men. Precancer of this type is characterized by a violation of the integrity of the skin in any part of the body, however, it was noted that the surface of the body is more often affected.
When examining the skin, a solitary plaque is detected, growing up to 10 cm in diameter. The hue varies in color from pale pink to purple.
The boundaries of the tumor are clear, moderately rising above the surface of the skin. During development, the surface of the formation may become crusted and eroded.
Bowen's disease is characterized by slow growth and a 100% chance of degeneration into squamous cell carcinoma. There is an increased risk of a combination of skin lesions and internal organ cancer.
A peculiar variation of Bowen's disease is Keir's erythroplakia, the only difference is the predominant damage to the mucous membranes. Compared to other tumors, it is considered a rare disease.
Upon visual examination, it appears as a single plaque, having a scarlet tint with clear boundaries and edges rising above the surface of the skin. A significant sign indicating malignant degeneration is a change in the clarity of the boundaries, the appearance of erosion and ulceration.
In Keir's erythroplakia, the ulcer is covered with fibrin or a hemorrhagic crust.
Xeroderma pigmentosum is a disease that manifests itself in childhood. It is characterized by hereditary transmission in an autosomal recessive manner. Xeroderma pigmentosum manifests itself in the form of increased sensitivity to direct sunlight. Researchers have identified three main periods of the disease:
- Erythema and hyperpigmentation;
- Atrophic stage with the appearance of telangiectasia;
- Stage of neoplasms.
The exact reasons for the development of skin cancer cannot be established, but experts name a number of prerequisites that can provoke the disease:
- Exposure of the skin to carcinogenic chemical elements.
- Ionizing radiation.
- Frequent exposure of the skin to ultraviolet rays.
- Mechanical damage to tissues, scar formation, which in the future can cause the formation of cancer cells and the development of oncology.
- A burn or radiation dermatitis can trigger the development of cancer.
- Degeneration of moles into malignant tumors.
- Heredity.
- The presence of precancerous diseases: nevi, skin pigmentation, skin ulcers, syphilis, tuberculosis, melanosis, etc. In case of improper or untimely treatment of these diseases, oncology of the skin may develop.
Causes are a condition or situation that is fertile ground for the development of a particular disease.
The causes of skin cancer are:
- influence of direct ultraviolet and ionizing radiation;
- long-term exposure to chemical carcinogens on the skin surface, such as tobacco smoke;
- genetic predisposition of the body to cancer, in particular skin cancer;
- prolonged thermal effects on any area of the skin;
- occupational hazards, for example, many years of work associated with skin contact with arsenic and tar;
- various diseases of the skin related to precancerous conditions, for example, chronic dermatitis, keratoacanthoma, senile dyskeratosis, a large number of warts, atheromas and papillomas, which are often injured;
- scars left after illnesses, for example, lupus, syphilis, trophic ulcers or burns.
The causes of skin cancer can be divided into external and internal.
External reasons
There are many predisposing factors that can cause skin cancer.
- Excessive exposure to solar radiation and ultraviolet radiation. This factor is especially dangerous for fair-skinned and fair-haired people.
- Professions that involve prolonged exposure to the sun.
- Chemical carcinogens (fuel oil, arsenic, oil and others).
- Long-term thermal effects on specific areas of the skin. An example is “kangri cancer”, it is common among people in the mountainous regions of Nepal and India. This type of cancer develops on the skin of the abdomen, in those areas where pots of hot coal are placed to warm up.
- Precancerous skin diseases (Bowen's disease, Paget's disease, xeroderma pigmentosum, Queir's erythroplasia and benign neoplasms that are subject to constant trauma).
The following causes of skin cancer can also be identified:
- Smoking.
- Contact radiation and chemotherapy. These methods, which were used to treat cancer of other localizations, can also cause skin cancer.
- Reduced immunity due to the influence of various factors. These factors may be: AIDS, use of immunosuppressants and glucocorticoids after organ transplantation and in the treatment of autoimmune diseases.
- Genetic predisposition.
- Sexual characteristics. For example, melanomas, which occur mainly in women.
When considering the reasons that provoke the development of skin cancer, there are two main types of factors that are directly related to the process. In particular, these are exogenous factors, as well as endogenous factors; let’s consider them in a little more detail.
Otherwise, they can be defined as external factors. The most important of these factors is ultraviolet radiation and sunlight in particular.
What is noteworthy is that the development of squamous cell and basal cell cancer is ensured by chronic damage to the skin resulting from exposure to UV radiation, but the development of melanoma occurs primarily as a result of periodic intense exposure to sunlight.
Moreover, in the latter version, even a single exposure is sufficient for this.
There are several predisposing reasons contributing to the appearance of malignant skin tumors, namely:
- Long-term irradiation of the skin with UV rays. Proof of this can be the fact that residents of the southern regions suffer from skin cancer much more often than the northern ones.
- Exposure of skin to radiation.
- Long-term thermal effects on the skin.
- Chemical exposure. For example, contact with soot, various resins, tar, arsenic.
- Hereditary predisposition to skin cancer.
- Frequent use of medications that suppress the immune system (antitumor drugs, corticosteroids.
- Age over 50 years. At a younger age, malignant skin diseases appear less frequently, and skin cancer in children is diagnosed even less frequently (0.3% of all cancers).
- Mechanical injuries to nevi, birthmarks, scars.
Why does skin cancer appear?
In addition to the above causes of skin cancer, there are also a number of diseases considered precancerous. Precancerous diseases are divided into obligate and facultative precancer. Obligate precancer, as a rule, is a rare, slowly developing disease, which, however, completely turns into cancer. These include:
- xeroderma pigmentosum
- Paget's disease
- Bowen's disease
- Keir's erythroplasia
Facultative precancers include all kinds of chronic skin diseases: dermatitis, inflammatory and dystrophic processes. Slow-healing wounds and ulcers on the skin are also considered an optional precancer.
Skin cancer, symptoms and signs of different forms have significant differences
Signs of skin cancer to watch out for
- the presence of new moles or spots on the surface of the skin;
- dark red growths that rise above the surface of the skin;
- wound surfaces that do not heal for a long time;
- moles that have been present on the body for a long time began to change shape, color and size.
How does skin cancer manifest in each individual form?
CLASSIFICATION
There are several classifications according to which types of skin cancer can be distinguished. According to histological characteristics:
- Basal cell carcinoma or basal cell carcinoma is the most common type of skin malignancy. A more favorable type of cancer, because there is no tendency to infiltrative growth and metastasis;
- Squamous cell carcinoma is often formed against the background of existing precancerous skin diseases. The oncological process is prone to germination of the skin thickness and early elimination of metastases.
There is no classification by localization as such. Cancer can affect almost the entire skin, including the skin of the lips, external genitalia, scrotum, and anus.
The TNM classification includes four stages of skin cancer development, depending on the size of the tumor node, damage to regional nodes, and the presence of distant metastases.
Skin adenocarcinoma
Most often, skin cancer refers to all non-melanoma malignant neoplasms that originate from various layers of the dermis. Their classification is based on their histological structure. Melanoma (melanoblastoma) is often considered an almost independent form of carcinodermatosis, which is explained by the peculiarity of its origin and very high malignancy.
The main types of non-melanoma skin cancer are:
- Basal cell carcinoma (basal cell carcinoma) is a tumor whose cells originate from the basal layer of the skin. Can be differentiated or undifferentiated.
- Squamous cell carcinoma (epithelioma, spinalioma) - occurs from the more superficial layers of the epidermis. It is divided into keratinizing and non-keratinizing forms.
- Tumors originating from the skin appendages (adenocarcinoma of the sweat glands, adenocarcinoma of the sebaceous glands, carcinoma of the appendages and hair follicles).
- Sarcoma, whose cells are of connective tissue origin.
When diagnosing each type of cancer, the WHO-recommended TNM clinical classification is also used. It allows you to encode various characteristics of the tumor using digital and alphabetic notations: its size and degree of invasion into surrounding tissues, signs of damage to regional lymph nodes and the presence of distant metastases. All this determines the stages of skin cancer.
Each type of cancer has its own growth characteristics, which are additionally reflected when making the final diagnosis. For example, basalioma can be tumoral (large and small nodular), ulcerative (in the form of a perforating or corrosive ulcer) and superficial transitional.
Squamous cell carcinoma can also grow exophytically with the formation of papillary outgrowths or endophytically, that is, as an ulcerative-infiltrative tumor. Melanoma can be nodular or non-nodular (superficially widespread).
Other types of skin cancer are much less common and account for a fraction of a percent of all skin cancers. These can be tumors of the sweat and sebaceous glands (adenocarcinoma), tumors from the tissues that make up the follicles, metastases in the skin from other neoplasms.
The type of tumor in these cases can only be determined using diagnostic procedures - MRI, computed tomography and biopsy.
Adenocarcinoma
Adenocarcinoma is a fairly rare type of skin cancer. Develops from glandular cells (sweat and sebaceous glands), grows slowly. It looks like a dense blue-violet nodule or a papule rising above the skin; it forms in the armpit, groin, and under the mammary glands in women.
The node is characterized by slow growth, but in some cases it can reach large sizes (8-10 cm). Germination deeper beyond the skin tissue and metastasis are rare. After removal, the tumor may recur in the same place.
Verrucous carcinoma
Verrucous carcinoma is a rare type of skin cancer, a type of squamous cell carcinoma. It appears on the skin of the hands and resembles a wart in appearance, which makes correct diagnosis difficult in the early stages of the disease. However, these formations can bleed, which allows you to pay attention to them in time.
Since the skin is made up of cells that belong to a large number of tissues, there is significant variation in the tumors that affect them. Therefore, the concept of cancer in this case is very collective in nature and defines all pathologies of a malignant nature.
However, experts identify the most common types, which include basilomas, melanomas, squamous cell formations, lymphomas, carcinomas and Kaposi's sarcoma.
Squamous cell skin cancer
This type of pathological process on the skin has several synonyms; it can also be called squamous cell epithelioma or spinalioma. It occurs regardless of the area of the body and can be located anywhere.
But the exposed parts of the body, as well as the lower lip, are most susceptible to this damage. Sometimes doctors discover squamous cell carcinoma localized on the genitals.
This tumor is not gender-selective, but as for age, pensioners are more often affected. Experts point to scarring of tissue after burns or mechanical damage that is systematic in nature as the reasons that provoke its appearance.
Actinic keratosis, chronic dermatitis, lichen, tuberculous lupus and other diseases can also provoke the appearance of squamous cell carcinoma.
Basalioma or basal cell skin cancer.
It got its name from the place where it “grows” - the basal layer of the epidermis. This tumor lacks the ability to metastasize and recur. Its migration is directed mainly into the depths of tissues with their inevitable destruction.
About 8 out of 10 all cases of skin cancer are of this type.
This is the least dangerous of all types of skin tumors. The exception is those cases when basal cell carcinoma is located on the face or ears: in such circumstances it can reach impressive volumes, affecting the nose, eyes, and damaging the brain. Most often found in older people.
