Skin carcinoma is a type of cancerous malignant tumor that develops from cells of the epithelial tissue of various organs (mucous membranes, skin and various internal organs).
Skin cancer is a skin tumor formation of a malignant nature, which occurs as a result of atypical transformation of its cells, is characterized by strong polymorphism. There are four main types of such cancer, basal cell, squamous cell, melanoma and adenocarcinoma, each of which has its own clinical forms.
Skin tumor
In the total number of malignant tumors, skin carcinoma is about ten percent. Dermatologists are currently talking about an upward trend in incidence with an average increase of 4.4% per year. This cancer most often develops in older people, regardless of their gender. Light-skinned people are especially predisposed to the appearance of the disease, as well as persons wholive in conditions of strong insolation (highlands and hot countries) and are outdoors for a long time.
Among the total number of phenomena of such oncology, 11 to 25% of its squamous form and 60 to 75% - basal cell cancer. Since the development of basal cell and squamous cell skin cancer is carried out from epidermal cells, such diseases are also referred to as malignant epitheliomas.
Causes of occurrence
Among the reasons that cause malignant transformation of skin cells, the first place is occupied by excessive exposure to ultraviolet radiation. This proves the fact that about 90% of cases of skin tumors occur in open areas of the body (neck, face), which are most often exposed to radiation. For people with fair skin, the effect of ultraviolet rays becomes the most dangerous.
The appearance of skin carcinoma can be caused by exposure to certain chemicals that have a carcinogenic effect: lubricants, tar, particles of tobacco smoke and arsenic. Thermal and radioactive factors that act on the skin can also lead to cancer. For example, skin cancer can become a complication of radiation dermatitis or develop in the burn area. Frequent trauma to moles or scars can lead to their malignant transformation with the appearance of skin cancer.
Genetics
The genetic characteristics of the organism may predispose to the occurrence of skin carcinoma,which causes familial cases of the disease. In addition, a number of skin diseases have the ability to undergo malignant transformation into skin cancer over time. Such pathologies are precancerous conditions. Their list includes Bowen's disease, erythroplasia, leukoplakia, xeroderma pigmentosum, cutaneous horn, senile keratoma, melanoma-dangerous nevi (nevus of Ota, giant nevus, blue nevus, complex pigmented nevus), Dubreuil's melanosis, chronic inflammatory skin lesions (SLE, syphilis, tuberculosis, trophic ulcers, etc.).
Classification
There are the following forms of this type of cancer:
- Squamous cell verrucous carcinoma of the skin, or squamous cell tumor, which develops from squamous cells of the epidermal surface layer.
- Skin adenocarcinoma is a rare malignant tumor that develops from the sweat or sebaceous glands.
- Basal cell carcinoma of the skin, or basalioma, - appears with atypical transformation of epidermal basal cells located under flat cells and having rounded outlines. The classic, most common variety is the nodular (micronodular) form, which accounts for up to 75% of cases. It is characterized by the formation of primary tumor elements - dense nodules up to 2-5 millimeters in diameter, which, as a result of a long period of existence, are interconnected. Thus, they form a tumor focus with a diameter of up to two centimeters. Micronodular basal cell carcinoma of the skin may be pigmented or ulcerative.
- Melanoma is a skin tumor that arises from its melanocytes, that is, pigment cells. Taking into account a number of signs of melanoma, modern authors often equate the term "skin cancer" with non-melanoma cancer.
Symptoms of skin carcinoma
Squamous cell skin cancer is characterized by rapid spread and growth both in depth and on the surface of the epidermis. The germination of a tumor in the tissues under the skin (cartilaginous, bone, muscle), or the addition of an inflammatory process, is accompanied by the onset of pain syndrome. Squamous cell skin cancer appears as a nodule, plaque, or ulcer.
The ulcerative form of squamous cell skin cancer looks like a crater-shaped ulcer, which is surrounded, like a roller, by tight raised and abruptly breaking edges. The ulcer has an uneven bottom, it is covered with crusts of dry bloody-serous exudate. She smells pretty bad. The plaque of squamous cell skin cancer has a bright red tint, a bumpy surface and a dense texture. It often bleeds and grows rapidly.
In squamous cell carcinoma of the skin of the face of the skin, the large bumpy surface of the node makes its shape look like a mushroom or cauliflower. Characterized by brown or bright red color, high density of the tumor node. Its surface may ulcerate or erode.
Basal cell tumor
Basal cell tumor of the skin has moreslow and benign course compared to squamous. Only in advanced situations does it grow into the tissues underlying it, causing pain. As a rule, metastasis is absent. Basal cell carcinoma is characterized by greater polymorphism, which can be represented by turban, flat superficial, sclerodermiform, nodular, pigmented, cicatricial-atrophic, perforating, warty and nodular-ulcerative forms. Most of the clinical types of basalioma begin with the formation of a small single nodule on the skin. Neoplasms in some cases may be multiple.
Location location
Carcinoma of the skin of the face mainly appears on areas that are covered with sebaceous and sweat glands. These include the groin, armpits, folds under the mammary glands. Adenocarcinoma begins with the formation of a small papule or isolated nodule. This rare type of skin cancer is slow growing. Only in some cases can large dimensions (approximately eight centimeters in diameter) and infiltration into fascia and muscle be achieved.
Pigmented or depigmented
In most cases, melanoma is a pigmented tumor that is grey, brown or black in color. But cases of depigmented melanomas are known. In the process of growth of a skin melanoma tumor, a vertical and horizontal phase are distinguished. Its clinical variants are represented by nodular, superficialspreading and lentigo melanoma.
Diagnosis
People with suspected face and body skin carcinoma should consult a dermato-oncologist. The specialist examines the formation and other areas of the skin, performs dermatoscopy and palpation of regional lymph nodes.
Establishment of the depth of the tumor, as well as the prevalence of the pathogenic process is carried out by means of ultrasound. Additionally, siascopy is prescribed for pigmented formations.
Only histological and cytological studies can definitively refute or confirm the diagnosis of "skin tumor". A cytological examination is performed using microscopy of specially colored smears made from erosions or the surface of cancer ulcers.
Histological diagnosis
Histological diagnosis of a skin tumor is carried out on the material obtained after the elimination of the neoplasm or by skin biopsy. In the absence of violation of the integrity of the skin over the tumor node, the biopsy material is taken by the puncture method. If indicated, a lymph node biopsy is done. Histology determines the presence of atypical cells, their origin (glandular, melanocytes, basal, flat) and the level of differentiation.
In the process of diagnosing skin cancer, in some cases it is necessary to exclude its secondary origin, that is, the presence of a primary tumor in the internal organs. This is especially true for adenocarcinomas of the skin. To do this, ultrasound of the organs of the peritoneal cavity, pulmonary radiography, CT of the kidneys, scintigraphyof the skeleton, contrast urography, CT and MRI of the brain of the head, etc. The same examinations are required to diagnose situations of deep germination of a skin tumor or distant metastases.
How is skin cell carcinoma treated?
Features of treatment
The method of treatment is selected in accordance with the prevalence of the process, its type, the level of differentiation of cancer cells. The age of the patient and the location of the skin tumor are also taken into account.
The main goal in the treatment of skin carcinoma is radical removal. It is mainly performed surgically, with the help of excision of pathologically altered tissues. The intervention is carried out with the capture of 1-2 centimeters of he althy-looking tissues. To carry out the operation, minimally capturing he althy tissues and removing all the cells of a cancerous skin tumor as completely as possible, makes it possible to perform an intraoperative microscopic examination of the marginal zone of the area being eliminated. Skin cancer excision can be performed using a carbon dioxide or neodymium laser, which reduces bleeding during the intervention and gives an excellent cosmetic result.
Relatively small neoplasms (one to two centimeters), with a slight degree of tumor growth into the surrounding tissues, curettage, electrocoagulation or laser removal can be used. If electrocoagulation is performed, it is desirable to capture he althy tissues by 5-10 millimeters. Superficial, minimally invasive and well-differentiated forms of skin cancer may be subject to cryodestruction, when he althy tissues are captured2-2.5 centimeters. Since cryodestruction does not allow for a histological examination of the removed material, it can be performed only after a preliminary biopsy, when high differentiation and low prevalence of the neoplasm are confirmed.
Skin cancer that affects a small area can be treated effectively with close-focus X-ray therapy. To cure superficial and at the same time large neoplasms, irradiation with a beam of electricity is used. After the tumor has been eliminated, radiation therapy is given to people with an increased likelihood of metastasis and recurrence of skin cancer. It is also used to suppress metastases, as well as a palliative method for inoperable oncology.
The use of photodynamic treatment is permitted, in which irradiation is carried out with the introduction of a photosensitizer. A positive effect in basalioma allows you to get local chemotherapy with cytostatics.
Forecast
Skin cancer has one of the lowest mortality rates compared to other cancers. This largely depends on the degree of differentiation of tumor cells and the type of cancer.
What is the prognosis for basal cell carcinoma of the skin? This form of oncology has a more benign course, there is no metastasis. If squamous cell carcinoma is treated on time, the five-year survival rate is 95%. The most unfavorable prognosis in people with melanoma, this figure is only 50%.
