Oncology has many varieties. One of them is skin cancer. Unfortunately, at the present time there is a progression of pathology, expressed in the growth of cases of its occurrence. And if in 1997 the number of patients on the planet with this type of cancer was 30 people out of 100 thousand, then a decade later the average figure was already 40 people.
The highest incidence occurs in hot countries located in the tropical climate zone. There are especially many patients with this diagnosis in New Zealand and Australia. The median age of onset is 57 years. At the same time, a greater number of patients are people with white, and not with black skin.
What is this pathology?
Skin cancer is a malignant disease arising from the transformation of squamous stratified epithelial cells with a high degree of polymorphism. This pathology is another confirmation of the fact thatthe main defining moment in the development of oncological ailments in humans is nothing more than the aggressive impact of external factors.
Human skin serves as a kind of "suit" for him. It protects the body from the uncomfortable effects of the environment, while mitigating the occurrence of negative effects with the help of sclerotic and inflammatory processes. After the depletion of compensatory mechanisms in a certain area of the skin, the unrestrained and uncontrolled growth of immature tumor cells from previously normal tissue begins. At the same time, there is a tendency to destroy surrounding organs.
It is noted that the average person has a higher risk of skin cancer than the appearance of tumors with localization in the internal organs. The proof of this is that more than 50% of people who lived to be 70 years old have one of the varieties of just such a pathology. All this is explained by multiple sources of malignant tumor formation, which will be discussed below.
Classification of pathology
When considering the structure of the skin, the epidermis and its appendages are distinguished in its structure. So, the top layer of our "suit" is a flat stratified keratinized epithelium, which is located above the basement membrane. The latter is a kind of border between the epidermis and the underlying tissues.
Our "external suit" also has a kind of "buffer-shock absorber". This is subcutaneous fat. It is not part of the skin, despite the fact that it is located directly underepidermis. Such a layer is located between the internal organs and the outer integument.
Microscopic studies allowed scientists to identify the following layers of the epithelium:
- lower, or basal;
- Malpighian, or prickly;
- grainy;
- external or horny.
In the lowest layer of the epidermis - the basal layer, there is melanin. This component is responsible for skin color. In the immediate vicinity of the basement membrane, on its two sides, melanocytes are located. They are the source of melanin production. Appendages of the skin are also located near the membrane. These include sebaceous and sweat glands, as well as hair follicles.
Based on tissue affiliation, there are three types of malignant tumors. Among them:
- basalioma;
- squamous cell pathology;
- melanoma.
Basalioma skin cancer originates from the cells of the basal layer. The tumor in this case increases at a slow pace, without metastasizing for a long period of time. As a rule, the pathology is found on the face and looks like a regular plaque. Over time, the basalioma grows into the surrounding tissues and causes their destruction.
Squamous cell carcinoma affects exposed areas of the body. In addition, its formation occurs in the areas of scars and in those places where the current chronic dermatitis is localized. This type of tumor metastasizes through the lymphatic system.
Melanoma is the most aggressive form of skin cancer. The development of this type of pathologycomes from cells that contain the pigment melanin. Most often, the disease occurs from a pigmented nevus or from a mole. The risk of this disease increases significantly with prolonged exposure to the sun's rays.
In addition to the three main clinical forms of skin cancer, there are also:
- Adenocarcinomas. They are tumors that develop from the secreting epithelium of the sebaceous and sweat glands.
- Mixed tumors. Manifested in several tissue sources.
- Metastatic tumors. Such malignant neoplasms are the result of cancer of the internal organs.
Earlier, the classification of tumors included some of its varieties, which were found in soft tissues. These are skin dermatosarcoma, leiomyosarcoma, angiosarcoma and some other pathologies.
Reasons
It should be borne in mind that doctors do not consider skin cancer to be the most common oncological diseases. It accounts for approximately 5% of all cancer diagnoses. But at the same time, this form of pathology does not have gender differences. Skin cancer in a woman and a man can develop with the same probability, affecting people, as a rule, who have reached the age of 50. Moreover, the reasons that cause its appearance are divided into external and internal. Let's take a closer look at them.
External causes
Among the main risk factors for skin cancer are:
- UV exposure (exposure to sunlight). This explains why the development of skin cancer usually occurs in exposed areas.areas of the body, namely on the forehead, on the nose, on the ears, in the corners of the eyes and other parts of the head. After all, the areas of their location are most exposed to the rays of the sun. On the skin of the legs, arms and torso, malignant neoplasms are quite rare. Their probability relative to all cases of detection of the disease does not exceed 10%. Provoke the development of cancer can not only long-term, but also a single, but intense exposure to UV rays. Especially often this is the cause of the development of melanoma. Often, this form of skin cancer affects those people who are irregularly exposed to the scorching sun, but only occasionally. An example of this is when an office worker spends his holidays on the beach. Recently, the influence of this factor has become the main one. This is affected by the increase in the destruction of the ozone layer, which is the protection of our planet from ultraviolet rays. Often, skin cancer also affects lovers of bronze tanning who visit solariums.
- Mechanical injury to the skin. They can cause a malignant tumor if the areas where birthmarks are located (pigmented nevi) are damaged.
- Irradiation with ionizing (gamma and x-ray) radiation. Such exposure contributes to the development of early or late radiation dermatitis.
- Irradiation with infrared rays. As a rule, this factor is present in the metallurgical and glass industries.
- Prolonged or regular contact with certain substances that can cause carcinogenicinfluence. These include petroleum products, coal, herbicides, insecticides and mineral oils. The development of pathology is also possible with frequent use of hair dye.
- Arsenic species intoxication.
- Thermal burns. They are especially dangerous when repeated.
Internal Causes
Such predisposing factors for the development of skin cancer include:
- Rasu. The greatest predisposition to the development of skin cancer are blondes and people of the Caucasian race. Among the representatives of the black race, patients with this disease are extremely rare.
- Weak immunity. It also predisposes to skin cancer. Some danger in this regard is the period of pregnancy, during which all conditions are created for the degeneration of moles or pigmented nevi.
- Heredity.
- Infection of a person with certain types of papillomavirus (HPV).
- Inflammatory processes of a chronic nature of various etiologies, which capture not only the skin, but also the underlying tissues. These include deep mycosis and fistulas, trophic ulcers and gummous form of syphilis, systemic lupus erythematosus and other types of similar pathologies.
Development of the disease
When exposed to UV radiation, as well as other causative factors, in most cases directly skin cells are damaged. In this case, DNA is affected. Destruction of the cell membranes is not detected. With partial destruction of nucleic acids, a mutation takes place, leading to a change in membrane lipids, as well as in key protein proteins.molecules. The lesion is noted in the epithelial basal cells.
However, HPV and various types of radiation are not only mutagenic. The body develops immune deficiency. A similar process is explained by the death of dermal cells, as well as the irreversibility of the process of destruction of certain membrane antigens necessary for the activation of lymphocytes. As a result, the cellular immune link malfunctions and antitumor defense mechanisms are suppressed.
General symptoms
How to recognize skin cancer? At the earliest stages, the volume of malignant tissue is still quite small. Changes affect the body at the cellular level. In the subsequent period, a solid intradermal and cutaneous formation appears. This process is due to a progressive increase in the number of tumor cells. In addition, pigmented spots or ulcers appear on the skin, having an infiltrated base. Symptoms of skin cancer (see pathology photo below) do not include itching at the site of the neoplasm.
In other words, whether the spot itches or not, it is not a diagnostic sign of skin cancer. Painful cider at the site of its localization can tell about the progression of the tumor.
How to recognize skin cancer? Among the possible symptoms of pathology are:
- the formation of a dense nodule in the thickness of the skin, which has a pearly white, reddish or dark color, which tends to increase and grow into adjacent tissues;
- the presence of spots of the wrongform, which is characterized by uneven peripheral growth;
- formation of a pigmented induration with a tendency to progressive central ulceration;
- detection of a bumpy, slightly protruding dense formation above the surface of the skin, which has a heterogeneous color and areas of erosion and peeling;
- warty formation of papillary type, prone to uneven softening, after which the formation of decay sites occurs;
- changing the size and color of nevi present on the body with the appearance of a red corolla around them;
- pain that disturbs in the area of scars and skin formations, indicating a deep lesion of the dermis.
Skin cancer (a photo of how the pathology looks like is given below), as a rule, manifests itself in open areas of the body and on the face, as well as in those places that are rubbed with clothes or are often injured for one reason or another.
In most cases, such neoplasms are single. However, cases of the appearance of several tumors at once are no exception.
Stages of disease
How to recognize skin cancer? At the initial stage of the pathology, only local symptoms appear. The size of the tumor in this case is within 2 mm, without going beyond the epidermis. This is a visible formation that can move with the movement of the skin. During the study, it turns out that the pathological process covers not only the upper, but also the lower layers.epidermis. The patient's condition does not cause any alarms. The prognosis for his recovery is quite favorable.
What does stage 2 skin cancer look like? The progression of the disease is indicated by an increase in the size of the tumor. It reaches 4 mm in diameter, while capturing the deep layers of the dermis. In this case, the patient complains of pain or itching. Sometimes one of the nearby lymph nodes is involved in the pathological process, or a secondary one appears on the periphery of the main focus. Metastases in the second stage of skin cancer are usually absent. However, in rare cases, one of them can still occur. If the pathology is detected in a timely manner, then the doctors give their patients a comforting prognosis. Based on statistics, 50% of patients live with proper treatment for 5 years.
What happens in the third stage of the development of the disease? With its further progression, malignant cells spread through the lymph flow. At the same time, they carry a package lesion of distant and regional lymph nodes. At this stage, the main symptoms of skin cancer (photo below) are scaly or bumpy painful growths.
Due to the fact that such foci of pathology grow to the subcutaneous tissues, they have restrictions on movement. Metastases spread through the lymphatic system without affecting the internal organs. The prognosis for patients at this stage is relatively good. Based on the available data, the survival rate is 30%.
On the last one,the fourth stage of the disease leads to multiple hematogenous and lymphogenous metastasis. What does skin cancer look like at this stage? New tumor-like formations appear on the body. And they are not only on the skin. Tumors are also located in various organs, leading to an increase in general exhaustion, which is called "cancerous cachexia". At this stage, patients complain of high pain. After all, the pathological process begins to capture cartilage and bone tissue. Often, the tumor bleeds, spreading pathological cells throughout the body and poisoning it. The prognosis at this stage is poor. Only less than 20% of all patients survive.
Basalioma
How to recognize skin cancer at an early stage? A photo of a basalioma when it occurs makes us understand that on the skin such a formation looks like a nodule or a flat plaque. At this point, it is rather difficult to determine the pathology, since the tumor has not yet fully formed.
At the first stage, the neoplasm reaches a diameter of 2 cm. It is limited to the dermis and does not pass into the tissues adjacent to the focus of pathology.
At the second stage of the disease, basilioma increases in diameter, reaching 5 cm. It covers the entire thickness of the skin, but does not extend to the layers of subcutaneous tissue.
At the third stage, the tumor becomes more than 5 cm in diameter. The lesion begins to be an ulcerated surface. Subcutaneous fatty tissue is destroyed, after which tendons, muscles and soft tissues are damaged.
The fourth stage of a basalioma is indicated by a tumor thatspread so much that, in addition to damage and ulceration of soft tissues, it managed to destroy bones and cartilage.
Symptoms and signs of this type of skin cancer can also be determined by a simplified classification. It implies the division of basalioma into the following stages:
- initial;
- expanded;
- terminal.
What does skin cancer look like at an early stage (photo below)? When a basalioma occurs, it can be identified by small nodules less than 2 cm in diameter, which do not ulcerate.
How to recognize advanced stage skin cancer? This is the period when the tumor becomes larger, growing in diameter up to 5 centimeters or more. In this case, primary ulcerations appear on the skin and soft tissue lesions occur.
How to recognize skin cancer at the thermal stage? Pathology is a tumor that has grown to 10 cm or more, which has grown into the underlying organs and tissues. In the thermal stage, the patient usually develops multiple complications due to organ destruction.
There are several varieties of basalioma, each of which has its own external signs:
- Nodal. With the development of this type of skin cancer, the initial stage of the pathology manifests itself in the form of the formation of a dense nodule, which has a mother-of-pearl pink color. It rises above the surface and has a recess in the center. When an injury occurs, such a nodule is easily damaged and begins to bleed.
- Surface. In this type of skin cancer, the initial stage is detectedwhen there are plaques of irregular or rounded shape, which have a red-brown color. Such neoplasms have waxy shiny edges slightly raised above the surrounding skin. Sometimes a patient develops several such foci at once, which grow quite slowly and only in rare cases go deep into the skin.
- Scar. How to recognize skin cancer? At an early stage of occurrence, cicatricial basalioma is a depression with raised waxy edges. At the bottom of this formation is a dense tissue. With the development of pathology on the periphery, ulcerations begin to appear periodically. Over time, they scar and merge with the primary focus.
Squamous cell carcinoma
Let's move on to the main features of this type of pathology. How to recognize skin cancer at an early stage in this case? The initial manifestations of the pathology have many options, each of which depends on the form of cancer, morphology, and localization of the focus of the malignant process.
In squamous cell oncology, changes can develop on different parts of the body. These are the soles of the feet, palms, perianal region, facial skin or scalp. This cancer has several forms. One of them is plaque. How to recognize skin cancer (photo can be seen below)? With this form of oncology, a colored area appears on a certain part of the body, over which a tubercle appears. To the touch, this pathological area is rough and dense.
Another form of squamous cell carcinoma isnodal. In this case, the initial stage of skin cancer (the photo is shown below) is the areas where there is an accumulation of different-sized nodules, which looks like a cauliflower. Such formations are brown in color and dense to the touch. In the early stages of this form of cancer, painful cracks appear in the skin. Gradually, nodules begin to form in them, which eventually grow and thicken.
The next form of squamous cell oncology is ulcerative. With this skin cancer, the initial stage (pictured below) is a pathological process in the form of the development of ulcers in the upper layer of the epidermis.
Tumor foci rise slightly above the skin, deepening in the center. The edges of such an ulcer have borders in the form of a roller. Another symptom of this form of skin cancer is a characteristic smell.
Squamous cell carcinoma is divided by its structure into keratinizing and non-keratinizing, as well as differentiated and undifferentiated. Consider these forms of pathology. So, keratinizing cancer develops from certain cell structures in which the process of keratinization has taken place. Doctors say that this form is the most benign due to the fact that it progresses rather slowly and gradually infiltrates into the layers of underlying tissues. This form of cancer is difficult to diagnose due to the lack of color in the malignant tumor. It is possible to suspect the development of oncology only when keratinization appears on the surfacevaricose ulcers and scars.
A large malignant process is the nonkeratinized form. Indeed, in this case, the foci of pathology are infiltrated at a high speed, reaching the lower layers of the skin. The main symptom of this form of oncology is fleshy granulations, which have a soft texture. The initial manifestations of this pathology are a formation that affects only the upper layer of the skin. When pressed, the patient does not feel pain. Over time, the formation begins to grow, its structure becomes denser, which leads to the appearance of a plaque that rises above the surface of the skin. The neoplasm continues to develop, and its color changes from a slight reddening to a variety of shades of brown. Further, during palpation, pain begins to occur, and blood or purulent exudate appears from the lesion. Following this, a dense crust appears on the upper part of the formation.
Melanoma
This malignant tumor is the most aggressive. And it affects not only the skin. Its negative impact sometimes extends to the spinal cord or brain, eyes and internal organs. At the same time, changes are not only in the lesion. Skin cancer metastases can be found in many other organs. It is important to know the main feature of melanoma. When metastases occur, the primary tumor, as a rule, stops growing and even goes through the stages of reverse development. The establishment of the diagnosis itself becomes possible only after the detection of damage to internal organs.
How it manifests itself at the elementarystages of melanoma? Skin cancer may be suspected:
- With tingling, burning and itching in the area of pigment formation. Such symptoms are due to the active process of cell division.
- In case of hair loss on the surface of the nevus. This process is due to the degeneration of melanocytes. They turn into tumor cells, which causes the destruction of the follicles.
- When areas of a darker color appear on the pigment formation or its overall color is enhanced. A similar process provokes the degeneration of the melanocyte into a tumor cell and the loss of its processes. The pigment, due to the inability to leave the cell, begins to accumulate.
- When pigment formation is clarified due to the loss of cells' ability to produce melanin. The color change is sometimes uneven. A pigmented formation can darken or lighten only from one edge, and sometimes in the middle.
- In case of size increase. A similar phenomenon indicates an active process of cell division, which occurs in the structure of the pigment formation.
- When there are cracks or ulcers, moisture or bleeding. Similar phenomena are caused by the process of destruction of normal skin cells by the tumor. The upper layer of the epidermis bursts, exposing its lower layers. That is why even the most insignificant injury is enough for the tumor to "explode" and its contents to spill out. In this case, cancer cells enter he althy areas of the skin and penetrate into their layers.
Treatment
What action will be taken to get rid ofskin cancer patient will directly depend on the stage, type, and prevalence of the processes.
- Surgical removal. This method involves the elimination of the tumor focus up to the limits of he althy tissues. It is used in the absence of infiltrative growth of education and screenings in the lymph nodes, that is, in the first stages of cancer. With a significant development of pathology, chemo- and radiation therapy is first performed. Surgical removal of the tumor focus is used at the final stage of treatment.
- Radiation therapy. This method is used both independently and to prevent the deterioration of the patient's condition after surgical treatment. Irradiate patients with small doses, conducting multiple procedures. Most often, this type of therapy is used when skin cancer is detected in women.
- Chemotherapy. This method is used in the case of metastatic and disseminated skin cancer, when there are multiple lesions in various parts of the body. Sometimes chemotherapy is combined with radiation, prescribing such procedures before removing tumor foci by surgery.
Prognosis for skin cancer is far from clear. The result of treatment will depend on the type of neoplasm and how soon after the onset of the development of the pathology, the patient went to the doctor. So, after skin cancer detected at an early stage, about 85-95% of patients recover. In advanced cases, the likelihood of treatment success is significantly reduced.
