Precancerous diseases of the skin and soft tissues are two different groups that must be considered separately. Their common characteristic is that this complex of diseases is characterized by the occurrence of malignant tumors. It is divided into two subgroups: obligate (high degree of malignancy) and facultative (with optional malignancy).
Description of this pathology
Precancerous skin diseases are characterized by single or multiple nodules, growths, foci of hyperkeratosis, papules, age spots or foci of irritation of different colors, shapes and sizes. The diagnosis is established on the basis of examination and the results of histological studies. Treatment - surgical removal, chemotherapy, cryotherapy, interferon therapy.
Precancerous skin diseases are neoplasms of epithelial origin of benign nature andpathological conditions of the skin of a non-tumor nature, with a tendency to transform into a malignant tumor. The risk of rebirth can vary greatly. A photo of a precancerous skin disease is presented just above.
Main cause of malignancy
The main cause of malignancy is external non-specific irritations (insolation, mechanical friction, temperature effects), lack of timely treatment and various endogenous factors. Such pathologies mainly affect the elderly and middle-aged people. There are also some congenital ailments of this kind, which mainly affect adolescents and children. Diagnosis of precancerous skin diseases and therapy is carried out by doctors in the field of dermatology and oncology.
Pathologies of the mucous membrane of the mouth and facial tissues
Diseases of these obligate type areas include Manganotti cheilitis, localized hyperkeratosis, warty precancer. The facultative type of precancerous diseases of the skin of the face and the red border of the lips include keratoacanthoma, skin horn, papilloma.
Also include papillomatosis of the palate, hyperkeratotic and erosive-ulcerative forms of lichen planus and lupus erythematosus, erosive-ulcerative and verrucous forms of leukoplakia.
Classification of precancerous diseases of the skin of the face and oral mucosa includes:
- The skin horn is a limited area of hyperplasia with severe hyperkeratosis, which has the shape of a horn protrusion. Similar hearthlimited, brown-gray in color and up to 1 cm in diameter.
- Keratoacanthoma is a benign epidermal tumor in the form of a painless hemispherical node with a dense texture. In its central section there is a funnel-shaped impression of a small size, filled with horny dense masses of a white hue. The tumor is mobile, not associated with the underlying tissues. This neoplasm is similar to squamous cell carcinoma of the skin and often transforms into cancer.
- Papilloma of the red border of the lips is limited from the surrounding tissues. Its surface is rough or villous, sometimes covered with horny structures. Pathology is characterized by exophytic and endophytic growth, which, according to many scientists, brings it closer to cancer.
In case of chronic injuries of papillomatosis areas of the oral mucosa, ulceration, inflammation, and foci of necrosis develop. The seal formed at the base of the papilloma is one of the symptoms of malignancy.
Background pathologies include dermatitis, actinic, meteorological and post-radiation cheilitis, chronic cracks and ulcers of the red border of the lips and oral mucosa, flat leukoplakia.
Patients with obligate precancerous diseases of the skin and mucous membranes, as a rule, are subject to surgical treatment (excision is performed with a conventional scalpel or by laser excision, surgical diathermy, laser coagulation, cryogenic exposure).
Surgical intervention allows for not only radical therapy, but alsomorphological verification of tissues that were removed during its process.
Patients with facultative precancerous pathologies - such as cutaneous horn, papilloma, keratoacanthoma, papillomatosis, erosive-ulcerative and verrucous forms of leukoplakia - also undergo surgery. Patients with leukoplakia in some cases can be treated conservatively (according to indications). Patients with lupus erythematosus, lichen planus, background pathologies of the oral mucosa are subject to the same therapy.
Classification of precancerous skin diseases
As noted above, there are two categories of precancerous lesions: obligate and facultative. It should be noted that such a division is rather arbitrary. There are known diseases that some physicians refer to as obligate precancerous conditions, and others as optional. Thus, the category of skin pathologies of the first type includes Paget's disease, Bowen's disease and Queyre's erythroplasia, which are specific forms of skin cancer - cancers in situ, local oncological processes that do not extend beyond the skin. In addition, xeroderma pigmentosum is considered obligate precancer.
Facultative precancerous skin diseases are senile keratosis and other non-specific lesions. The probability of malignant transformation of the degeneration of senile keratosis is approximately 10%. Radiation dermatitis of chronic forms, arsenic hyperkeratosis, tuberculous and syphiliticskin lesions are malignant in about 6% of cases. Fistulas in osteomyelitis, trophic ulcers (long-term) and extensive scars after burns become malignant in 5-6% of patients. Skin lesions in lupus erythematosus turn into cancerous tumors in about 2-4% of cases.
Let's take a closer look at precancerous diseases of the skin of the face and oral mucosa.
Bowen's disease
This is a rather rare pathology, described in 1912. It can occur at the age of 20-80 years, it is diagnosed equally often in men and women. The main factors predisposing to the development of this disease are human papillomas, virus infection, ultraviolet radiation and contact with toxic substances (tar, tar, arsenic). Precancerous pathology can appear on any area of the skin, but the genital area and trunk are most often affected.
At the initial stage, the disease is an uneven spot, which subsequently transforms into a red plaque with a velvety moist surface. It reveals areas of hypo- and hyperpigmentation. Sometimes the surface of this spot is covered with uneven dry scales, as a result of which this formation strongly resembles a psoriatic plaque. Formations can be single and multiple, which merge with each other. Usually there is a long course of the pathological process, the plaque can persist for several years.
In the absence of therapy, this precancerous skin pathology turns into squamous cell carcinoma. The diagnosis is made on the basis of histologicalresearch. Therapy is surgical removal along with nearby he althy tissue. In addition, cryodestruction, electrocoagulation or laser coagulation are often used.
Erythroplasia of Queira
This is a subspecies of Bowen's disease that affects the skin of the penis. Men aged 40-70 suffer from pathology. The disease is a reddish smooth plaque with a velvety moist surface. Education slowly grows over several years, in the end its malignant degeneration is noted.
Paget's disease
This precancerous disease of the skin is usually localized in the areola. In about 20% of cases, this tumor can be located in other areas: on the back, face, thighs, perineum, buttocks, on the vulva. In some medical classifications, the disease is considered as one of the forms of breast cancer. It is diagnosed in both sexes at the age of 50-60. In men, this pathology develops less frequently, but is more malignant. At the initial stage, this precancerous disease looks like an eczema-like lesion, which is accompanied by itching, burning, tingling and pain.
In the future, the affected area increases, erosion, scales and ulcerations form on the surface of the formation. The retraction of the nipple is detected, the appearance of pathological discharge is possible. Such a precancerous disease progresses over several years and spreads to neighboring tissues. It is also notedmetastasis and local infiltrative growth. Diagnosis of precancerous skin diseases should be timely. Treatment is radical breast resection or mastectomy combined with hormonal therapy, radiotherapy and chemotherapy.
Pigmented xeroderma
This is a rare hereditary precancerous skin disease. Manifested in the form of increased sensitivity to ultraviolet radiation. The pathological process proceeds in 3 stages. The first occurs at the age of 2-3 years, most often in the summer, against the background of even slight insolation. Red, inflamed spots appear on exposed areas of the child's body. Subsequently, zones of uneven hyperpigmentation appear in their place. Each exposure to the sun is accompanied by the appearance of new lesions and increased signs of hyperpigmentation.
At the second stage, several years after the onset of the first symptoms of the disease, zones of atrophy and telangiectasia form on the affected areas. Due to spider veins, uneven areas of pigmentation, the skin becomes pronounced motley, cracks, crusts, sores and warty growths form on it. There are also pathological changes in the cartilaginous tissues, which are often noticeable in the form of nasal deformity. Eye lesions also occur: corneal opacity, keratoconjunctivitis, inflammation of the eyelids, lacrimation and photophobia.
The third stage occurs during puberty or post-puberty. On the affected areas of the skinthere are malignant and benign neoplasms: angiomas, fibromas, keratomas, basaliomas, melanomas, squamous cell carcinoma. Especially malignant are tumors that form in the area of warty growths. Approximately 60% of patients do not live up to 15 years. The main cause of death is distant metastasis and infiltrative local growth of tumors.
Solar keratosis
This precancerous skin disease is also called actinic keratosis, a pathology with a low risk of malignant degeneration. The disease is caused by excessive insolation. It most often affects blue-eyed fair-skinned blondes of elderly and middle age. In women, pathology is diagnosed less frequently. Open areas of the skin are affected, where a yellowish spot initially forms. In the future, it is covered with dense scales. Therapy - cryodestruction, laser removal, cytostatic ointments. It is not necessary that this pathology will degenerate into cancer. This will only happen if the problem is continually exacerbated by frequent sun exposure.
Clinical guidelines for these dangerous pathologies
Clinical recommendations for precancerous diseases of the skin, mucous membranes and soft tissues are to timely diagnose these pathologies, treat existing lesions and prevent the development of new foci of the pathological process.
In order to reduce the risk of transition of such phenomena into oncological tumors, it is necessary to limit or eliminatedamaging effects on the skin and mucous membranes of UV rays, electromagnetic radiation, ionizing radiation and chemical carcinogens.
In addition, the public and physicians should be aware of the potential dangers of using certain hormonal medications (exogenous estrogens).
Another direction is the identification and medical examination of persons with a congenital predisposition to cancer and dysplastic nevus syndrome.
Immunological direction is useful for identifying and treating people with various forms of immunosuppression, immunodeficiency, patients with transplanted organs.
Inspection of the skin in case of suspected precancerous condition is carried out in the examination room when visiting the first contact specialist. Examination by an oncologist is carried out in the first year of observation every 3 months, then, after successful therapy, less often. It is important to independently examine your body for the appearance of new moles or age spots.
