Basalioma on the arm. Possible recurrence after removal. Basalioma of the skin - external signs

In recent years, cancer has often become the main cause of high mortality among the population. Cancer cells can affect absolutely any tissue in the human body, causing various pathological processes. Let us consider in detail what is basal cell skin cancer, what are its causes and whether it is possible to recover from this disease.

What is this type of cancer?

This type of cancer is also called basalioma. It most often develops on the face, neck, or nose. It prefers to infect the male population over 40 years of age. It has been noted that representatives of the Mongoloid race and the Negroid race are not susceptible to this type of cancer.

The name "basalioma" comes from the fact that oncological cells begin their development from the basal layer of the skin, which is located deepest.

Causes of Skin Cancer

At present, the question of histogenesis (a set of processes leading to the formation) of this disease has not yet been fully resolved. Many are of the opinion that basal cell skin cancer develops from pluripotent epithelial cells. Differentiation can occur in different directions. We list some of the reasons that, according to most experts, can provoke the development of this pathology:

• genetic predisposition.
• Disorders in the work of the immune system.
• External influences of unfavorable factors.
• Development against the background of radiodermatitis, tuberculous lupus, psoriasis.

Basal cell skin cancer (the photo shows this) occurs most often in the epidermis and hair follicles. It grows slowly and rarely metastasizes. Some doctors consider basalioma not as a cancer or a benign formation, but as a tumor with locally destructive growth.

Quite often under the influence of strong carcinogens, for example x-rays, basal cell skin cancer turns into carcinoma.

Provocateurs of basalioma

There are many risk factors for this disease:

1. The most serious provocateur is ultraviolet radiation.
2. To belong to male gender. It is noted that its representatives are much more likely to be exposed to such a disease.
3. Having light skin. It has been found that people with dark skin practically do not suffer from this pathology.
4. The tendency of the skin to get sunburn.
5. Work under the open sun for a long time. As you get closer to the equator, the frequency of this disease increases. Most often develops basal cell or neck.
6. A high concentration of arsenic in drinking water. Those who are forced to work with this substance are at risk.
7. Polycyclic aromatic resins can also cause the development of this disease. They can be contained in coal tar, shale, soot.
8. Long-term use of immunosuppressants.
9. Some hereditary disorders, such as albinism or
10. Chronic ulcers.
11. Thermal burns.
12. Ionizing radiation.

It has also been found that excessive insolation (irradiation sunlight) in childhood can subsequently lead to the development of cellular cancer.

Basalioma classification

If we consider histology, then this pathology is classified as undifferentiated and differentiated cancer. The first category includes:

• solid basalioma;
• pigment;
• morphea-like;
• superficial.

Differentiated is divided into:

• keratotic basalioma;
• cystic;
• adenoid.

According to the international classification, the following variants of skin cancer are distinguished:

1. Solid basal cell carcinoma. This form is the most common and represents strands and cells that are arranged compactly. At the same time, basaloid cells do not have clear boundaries; in the center they can be with degenerative changes and cystic cavities.
2. Pigmented basal cell skin cancer (you can see a photo of it in the article) is characterized by diffuse pigmentation due to melanin content.
3. The superficial type of cancer often forms multiple foci. Relapse can occur after therapy along the borders of the scar.
4. Scleroderma-like is characterized strong development connective tissue, in which, as it were, strands of basal epithelial cells are embedded. They can penetrate deep inside, up to the subcutaneous tissue.
5. A malignant tumor with glandular differentiation is also called adenoid. It differs not only in the presence of large areas, but also in narrow epithelial strands, which consist of several rows of cells that form an alveolar or tubular structure.
6. Basal cell skin cancer right cheek with cyloidal differentiation. It is distinguished by the presence of foci with keratinized areas, which are surrounded by cells similar to prickly.
7. Cancer with sebaceous differentiation is quite rare.
8. Fibroepithelial type is a very rare type of basalioma. It usually spreads to the lumbar and sacral regions. Clinically, it may resemble fibropapilloma.

Types of basalioma by type of manifestation

There is a classification of this pathology and the type of manifestation. There are the following types:

1. Nodular-ulcerative basalioma. Consider this basal cell skin cancer. The initial stage (the photo confirms this) is characterized by the appearance of a nodule on the eyelids, in the corners of the mouth. The skin around the pink or reddish color with a matte or shiny surface. After some time, the nodule turns into an ulcer with a greasy coating. After some time, a vascular network appears on the surface, the ulcer becomes covered with a crust, and seals form along the edges. Gradually, the ulcer begins to bleed and grow into the deeper layers of the skin, but metastases do not form.
2. If the ulcer heals in the center, and growth continues along the edges, then we are talking about cicatricial-atrophic basalioma.
3. Perforating basalioma develops most often in those places that are often injured. Very similar to the nodular-ulcerative form, but develops at a much higher rate.
4. Warty form of cancer in its own way appearance resembles a head of cauliflower.
5. The nodular appearance is a single nodule that develops upward and protrudes above the surface of the skin.

Only after the form and type of the disease is determined, the doctor determines how to treat the basalioma. About any self-treatment, of course, there can be no question.

Symptoms of the disease

Quite often, if there is basal cell skin cancer, the initial stage (photo confirmation of this) proceeds completely without symptoms. In rare cases, slight bleeding is possible.

Patients may complain that a small ulcer has appeared on the skin, which slowly increases in size, but it is absolutely painless, sometimes itching appears.

Clinical manifestations of basalioma depend on the form of the tumor and its localization. The most common is nodular basalioma. It is a hemispherical knot with a smooth pink surface, in the center of which there is a small depression. The knot grows slowly and resembles a pearl.

With a superficial form of cancer, a plaque appears with clear boundaries, raised and having waxy-shiny edges. Its diameter can be from 1 to 30 mm. Grows very slowly.

If the basal cell carcinoma of the skin is of a cicatricial form, then it looks like a flat scar of a grayish-pink color, slightly pressed into the skin. The edges are raised and have a pearly tint. At the border of the formation, erosion occurs, covered with a pink-brown crust. During this form of cancer, there are periods when scars predominate, and erosion is very slight or absent.

The ulcerative form of basalioma is characterized by the destruction of soft tissues and bones that are located next to the tumor. Ulcers are irregular in shape, their bottom is covered with a gray-black crust, it is usually bumpy, and the edges are raised.

By the way, there is also basal cell skin cancer in cats (multiple primary). At the same time, many basaliomas can be seen on the body of the animal, in addition, mental disorders are observed, which are manifested by inadequate behavior, in addition, skeletal pathology develops. This type of malignant tumor is characterized by slow growth, the depth of the lesion and the risk of recurrence will depend on its size, location, cellular features state of immunity.

A person has great danger represents basal cell skin cancer. Treatment in this case is quite difficult. Pathology, as a rule, is localized on the face, skin around the eyes and nose.

The sclera-like form of basalioma also poses a great danger to humans. But pigmented basal cell skin cancer has a favorable prognosis. This form of treatment responds well.

How can the disease be diagnosed?

In order to make an accurate diagnosis, sometimes it is enough for an experienced specialist to look at the patient. The clinical manifestations of this type of cancer are quite characteristic, and there are no diagnostic difficulties. On the surface, most often the doctor finds single or multiple foci of microerosion, which are covered with easily detachable crusts from above.

Patients most often turn to a dermatologist when problems are detected, but in this case, an oncologist should deal with therapy. If we analyze a smear-scarificat from erosive areas, then in almost 100% of cases this allows us to confirm the diagnosis.

If cytological and histological studies raise any doubts, then the patient is given a biopsy of the lymph nodes.

It is important to distinguish basalioma from lupus, melanoma, keratosis, or psoriasis when making a diagnosis. After all examinations, if the diagnosis is confirmed, the doctor selects the method of therapy strictly individually. This disease does not have the same approach to the treatment of all patients.

Pathology therapy

Once a diagnosis of basal cell skin cancer is confirmed, treatment should begin immediately. Most often used following methods fight against this pathology.

• electrocoagulation and curettage;
• cryodestruction;
• radiation therapy;
• the Mohs method, which consists in excising the tumor with intraoperative microscopy of frozen horizontal sections, so that the extent of the upcoming operation can be determined.

The choice of the method of therapy depends entirely on the localization of the tumor, its size, the characteristics of the course and the state of the patient's body. Dermatologists usually prefer to use electrocoagulation at the very beginning of therapy. But it must be remembered that this method of treatment is effective if there are small tumors and they are located in non-dangerous places.

If histological examination is required, then the excision method is used. It is most often used in the presence of tumors with a malignant course and located in dangerous places, such as on the face or head. With its help, it is possible to obtain a good cosmetic result.

Radiation therapy in the presence of basalioma is rarely used, but if surgical intervention impossible, then it is simply irreplaceable. Doctors admit that it is quite effective. Irradiation is indispensable even with a high degree of malignancy of the tumor. At the same time, one should be careful about radiation therapy in young patients, since the risk of developing radiation dermatitis and induced malignancies is high.

If we consider the Mohs method, then it allows you to preserve healthy tissues as much as possible. This method is effective for recurrent tumors, large sizes and dangerous localization. If there is an excision on the eyelid, then they also resort to that method of therapy.

If a cancerous tumor on the skin has formed quite recently, then it is preferable to use close-focus X-ray therapy. And in advanced cases combined with surgery.

The method of cryodestruction of a tumor is widespread, that is, its removal with the help of liquid nitrogen. This procedure takes little time and is absolutely painless for the patient. There is, however, one drawback: a positive result can only be obtained if the neoplasm is located superficially and does not affect the deeper layers of the skin.

When located, they often resort to its removal with a laser. It is safe and painless, after the intervention, as a rule, a short rehabilitation period and an excellent cosmetic effect.

If there is a basal cell carcinoma of the superficial type, then topical treatment with Fluorouracil cream is prescribed. Recently, studies have been conducted on the effectiveness of injections of this drug into lesions. If skin cancer appears for the first time and has a small localization, then interferon injections are used.

Surgical treatment of basalioma

Surgical removal of basalioma is effective in the first stage of treatment. And also if a relapse occurs, or a tumor develops at the site of the scar. During the operation, the tumor is removed, but this method of therapy is undesirable if there are lesions on the face.

The operation is performed under local anesthesia, the tumor is removed to the border with healthy cells, for reliability, even slightly affecting them.

Consequences of basal cell skin cancer

There are several types of skin cancer, and depending on this, the course and prognosis of pathologies can also be different. If we talk about the consequences of basalioma, then it must be borne in mind that this tumor most often has a compact location, quite rarely penetrates inside and affects the lymph nodes.

But if an advanced form of cancer is located on the head and neck, then the process of destruction of the tissues of these parts of the body begins. It can even reach the bones, muscles and tendons.

Of all the types of skin cancer, this one is the most cosmetically unpleasant and the slowest to develop. But he, including thermal stages, can be amenable to surgical treatment. Therefore, if your doctor recommends surgery, do not be afraid, you must agree. Despite all its ugliness, the described skin gives patients a chance to recover even in the most advanced cases.

Preventive actions

Those who have already encountered basal cell skin cancer once should take special care to prevent recurrence. After treatment of basalioma, all doctor's recommendations should be followed:

• During the period of solar activity, that is, in summer, it is necessary to limit your stay on the street from 11 am to 5 pm. At this time, ultraviolet radiation is most aggressive, so its exposure should be avoided. If there is a need to go outside, then it is worth applying a special protective cream to the skin and using hats and glasses.
• Without proper nutrition it is impossible to maintain your immune system at the proper level. It is necessary to limit the amount of animal proteins, they can be replaced with vegetable proteins, such as nuts, legumes.
• The diet should have more vegetables and fruits.
• If there are old scars on the skin, then measures must be taken to prevent injury.
• All sores and wounds on the skin should be treated in a timely manner. If they tend to heal poorly, then a doctor should be consulted.
• If your work involves contact with petroleum products, then you should be especially careful, always use protective equipment.

Cancer of any shape or type is dangerous disease. It is better not to allow its development, but this is not always in our power. If this has already happened, then you should not give up and prepare for the worst. At present, medicine has stepped far forward, and sometimes miracles happen in the most neglected cases.

Take good care of your health and everything will be fine.

Basalioma (basal cell epithelioma, basal cell skin cancer, basal cell carcinoma) is a malignant tumor that is one of the most common tumors of epithelial nature and is in third place (after lung and stomach cancer) among all diseases of a tumor nature. Among all epithelial non-melanoma skin lesions of a malignant nature, its frequency ranges from 75 to 96%.

General characteristics of the neoplasm

In accordance with the definition of the Committee of the World Health Organization, a basalioma is a locally infiltrating (germinating) formation that is formed from epidermal cells or hair follicles and is characterized by slow growth, very rare metastasis and non-aggressive properties. It is also characterized by frequent recurrence after removal. Its peripheral cells histologically resemble those of the basal layer of the epidermis, which is how it got its name.

This skin disease occurs mainly in open areas of the skin, most exposed to sunlight. These are, first of all, the skin on the head, mainly in the frontal-temporal zone, and the neck. Basalioma of the skin of the face is especially often localized on the nose, in the area of ​​the nasolabial folds and on the eyelids. On average, in 96% of patients it is single, in 2.6% it is multiple (2-7 or more foci).

The main risk factors for the development of basal cell epithelioma:

1. Chronic and intense nature of the influence of ultraviolet radiation. At the same time, in contrast to, it is the chronic effect that is much more important. Therefore, melanoma often occurs on areas of the body protected from the sun by clothing, even several years after sunburn, and basalioma - on the open. This fact is confirmed by the different geographical frequency of the disease (in the southern climatic zones it occurs much more often than in the northern ones) and is a response to frequently asked question"Is it possible to sunbathe?".
2. age factor. The incidence is much higher in the elderly, and it increases with increasing age. Over 90% of cases basal cell carcinoma skin has been reported among people over 60 years of age.
3. Gender identity. Men suffer from basalioma twice as often as women. However, this indicator is not very convincing, as it may be associated with different character labor activity. In connection with the change in lifestyle and fashion in recent decades, there has been an increase in the incidence among women. Some authors write about the same incidence among both sexes.
4. Tendency to develop freckles in childhood and very light and fair skin types (types I and II). People with darker skin get sick much less often.
5. Various genetic diseases associated with hypersensitivity to ultraviolet rays.
6. The presence of basalioma in other family members.
7. Chronic inflammatory skin diseases, burns and the presence of trophic changes.
8. Constant chemical exposure to carcinogens (petroleum products, arsenic compounds, resins) and frequent mechanical damage to the same skin areas.
9. Influence of X-ray and radioactive types of radiation, previous radiation therapy.
10. Decreased immune defense of the body with: HIV infection, taking cystostatic drugs due to blood diseases or organ transplantation.

How dangerous is basalioma and should it be removed?

In the process of long-term growth, it gradually penetrates into the deeper layers, destroying soft, cartilaginous and bone tissues. The predisposition of tumor cells to spread along the nerve trunks and nerves, along the periosteum and between tissue layers was noted. If it is not removed in a timely manner, then tissue destruction will lead not only to cosmetic defects.

Basal cell carcinoma leads to the destruction of the cartilage and bones of the nose and auricle, to deformation and disfigurement of the nose and ear, to a constantly festering wound due to the addition of a secondary infection. The tumor is able to move from the wings of the nose to the mucous membranes of the nose, oral cavity, destroy the bones of the skull, including those forming the orbit, to visual impairment and hearing loss, damage eyeball. But what is especially dangerous about it is spreading into the cranial cavity (intracranially) through natural cavities and openings in it with brain damage and death. In addition, although extremely rare, basalioma still metastasizes (about 200 cases have been described).

Clinical signs and stages

Given the extremely rare metastasis of basal cell carcinoma, its classification by stages is based on the area of ​​spread and the depth of penetration into the underlying tissues with their destruction (destruction) without taking into account the involvement of the lymph nodes. Depending on this, 4 stages of development of the neoplasm are distinguished, which may look like a tumor or an ulcer:

1. I st. - size no more than 2 cm, localization within the dermis itself without spreading to surrounding tissues.
2. II Art. - sizes exceed 2 cm, germination of all layers of the skin without transition to the subcutaneous fat layer.
3. III Art. - significant dimensions - 3 cm or more, or any size, but extending to all underlying soft tissues (up to bone).
4. IV Art. - growth of the tumor bone tissue and/or cartilage.

The initial stage of basalioma (stages I and II) is a small, pale pink or flesh-colored tubercle ranging in size from a few millimeters to 1 cm and with gentle edges. Often it looks like a bubble or a pearl. There may be several such tubercles, and they gradually merge, resulting in a plaque with a lobed surface. Often, vascular "asterisks" (telangiectasias) form on the surface of the tumor.

Subsequently, a roller of bubbles forms around it, and then a closed dense roller (a characteristic symptom), which is clearly visible when the skin is stretched, and a reddish “ring”, which is a constant inflammatory process.

Due to tissue breakdown, an ulcer or a small erosive surface is formed at the top of the tubercle, which are at the level of the surface of the surrounding healthy skin and covered with a skin-colored crust. When the latter is removed, an uneven bottom of erosion or crater-shaped edges of the ulcer open, which soon become crusted again.

The ulcerative or erosive surface may undergo partial scarring, but its size gradually increases. In places of ulceration, the color of the neoplasm changes over time. In addition, with any form of tumor, chaotically distributed pigmentation may appear on its surface, which does not indicate anything.

Basalioma slowly increases in size without causing any pain or discomfort. However, over time, severe pain and a violation of sensitivity may appear, associated with tissue compression and destruction of nerve branches and trunks.

The larger the affected area, the deeper the tumor has spread. It is its slow growth, on average up to 0.5 cm per 1 year, that makes it possible to detect the disease in 80% within 1-2 years from the onset of the first symptoms. Timely diagnosis in the early stages makes the prognosis for basalioma favorable. In 95-98% of cases of the disease, it is possible to carry out a radical excision with a fairly good cosmetic result and achieve a stable cure.

In the late stages (III and IV), all treated patients have significant cosmetic defects that are difficult to correct, and on average, half of the patients (46-50%) have a tumor recurrence after removal. The main reasons for the development of "neglected" stages:

• old age, in which many people have indifference to their appearance;
• mental, intellectual and personality disorders;
• lack of attention of close relatives;
• living in rural areas away from medical facilities;
• medical diagnostic errors and lack of adequate treatment.

The main forms of basal cell carcinoma

Solid basalioma (large nodular, nodular)

The form of skin cancer, which grows predominantly not in the depth of tissues, but outwards, has the form of a single hemisphere-type node ranging in size from millimeters to 3 cm with an easily bleeding surface. The skin over the mass is light pink or yellowish with telangiectasias. This form accounts for 75% of all basal cell epitheliomas. The most characteristic localization (in 90%) is the upper areas of the face and neck. The infiltration spread in depth is insignificant, due to which the surgical removal of the basalioma is effective even with its size of 2 cm.

Nodular or nodular-ulcerative form

Considered as further development nodular shape. In the center of the tumor, tissue destruction occurs, as a result of which an ulcer is formed with edges in the form of a roller and a bottom covered with purulent necrotic crusts. The most favorite localization of this form of basalioma is the skin of the nasolabial folds, eyelids and inner corners of the eyes. The size of the ulcer can be from millimeters to a significant size with deep germination and damage to surrounding tissues, which threatens the life of the patient.

Superficial basalioma

It accounts for about 70% of all initially diagnosed forms of this disease. It begins with the appearance of a pink spot up to 4 cm in diameter with "pearl" or waxy edges, slightly raised above the surface of healthy skin. It is characterized by localization on the chest and limbs (60%), less often on the face. Foci are often multiple. Infiltrative growth is not expressed. The increase occurs mainly due to the superficial expansion of the tumor area, which is benign in nature with a long (tens of years) course.

Flat basalioma

It occurs in 6% of all cases and is a formation in the form of a flesh-colored plaque. Its edges are raised in the form of a roller with a mother-of-pearl sheen. Localization in 95% - skin head and neck. This form rarely bleeds and almost never produces ulcers. Characteristic is a relatively aggressive course with spread deep into the subcutaneous adipose tissue and muscle tissue.

warty form

It is characterized by the external growth of small numerous hemispherical dense nodules that rise above the surface of the skin and are similar to cauliflower. Their color is lighter than the surrounding skin, vascular "asterisks" are absent.

The signs of recurrence of the disease are the same, but they are significantly more aggressive, more rapid development and often the appearance of tumors in other areas of the body. Relapses are most likely in cases of localization of the disease on the face.

Diagnostics

It is based on clinical signs, histological and cytological examination of the material taken by scraping or smear from the ulcerative or erosive surface or biopsy from the tumor area. Has high information content. She is effective methodology, especially in cases where differential diagnosis of basalioma and melanoma is necessary, since the former may contain melanin pigment, and the latter may be a non-pigmented variant. For pigmented basal cell carcinoma, specific dermoscopic morphological features that distinguish it from melanoma are the presence of:

• multiple clusters of gray-blue color (in 55%);
• large ovoid gray-blue nests (in 27%);
• "spoke wheels" - radial brownish or gray-brown stripes (in 17%);
• leaf-shaped zones (in 10%).

In superficial forms of basalioma, these structures are determined in a smaller percentage of cases.

The main signs of non-pigmented basal cell carcinoma during dermatoscopy are uniform brightly colored white or / and red zones, ulcerations, thin telangiectasias, tree-like branching of short and thin capillary branches. The above dark-colored structures may also be contained, but in much smaller quantities, and leaf-shaped structures more often are beige or brown.

For melanomas, the most typical and main feature is the pigmented "mesh", which is extremely rare in basaliomas and has an asymmetric character. In addition, pigmentless and low-pigmentation melanomas are characterized by vessels that are jagged lines, needles, and red dots.

Of great importance in the diagnosis is ultrasound procedure, which allows to more accurately determine the boundaries, volume and depth of tumor spread, which is important for deciding on the choice of treatment method and volume surgical intervention to reduce the likelihood of relapse.

Treatment methods for basalioma

The choice of treatment tactics is based on determining the location, extent of the tumor process, its form, stage and morphological structure.

1. Surgical method consists in excising the tumor with adjacent tissues to a width of 1-2 cm from the borders of the lesion. When bones and cartilages are involved in the process, they are also resected. This method is more suitable for tumors in the trunk or extremities, due to the complexity of subsequent plastic surgeries on the face. Contraindications for the surgical method - the lack of the possibility of radical removal of basalioma in case of localization on the nose, auricle, in the eye area, as well as old age, severe concomitant diseases, the presence of contraindications to anesthesia.
2. Removal of basalioma with liquid nitrogen (cryolysis), which is the destruction of the tissues of the formation by cooling to 90-150 ° C by the application or contact method. In this case, freezing and thawing of tissues is carried out repeatedly in several cycles. The method is used in the localization of neoplasms with a diameter of 20 mm or less, mainly on the extremities. Contraindications - significant size, deep infiltration, localization on the face.
3. Treatment of basalioma with radiation therapy- one of the most commonly used methods, both alone and in combination with other types of exposure. Radiation therapy used in the initial stages of the disease in the presence of a superficial focus, the diameter of which is not more than 5 cm, as well as localization in the periorbital zone, on the nose or auricle and for the treatment of elderly patients.

   In addition, it is also used in patients with advanced forms, sometimes in combination with chemotherapeutic agents, for palliative purposes. However, in recent years, radiation therapy has been used less and less due to the fact that radiation itself is a risk factor in the occurrence of basaliomas.

4. Laser removal of basalioma carried out using a neodymium or carbon dioxide laser. Efficiency averages around 85.5%
5. Photodynamic therapy, based on the effect of laser radiation on the tumor after the patient has taken a special photosensitizer, which selectively accumulates in the tissues of the pathological formation. Under the influence of a laser in the presence of a sensitizer, a photochemical reaction develops with photodynamic damage to the tumor tissue in the form of its necrosis and apoptosis of cancer cells without damage to collagen fibers. According to many authors, this method is most effective for both primary and recurrent skin cancer, and is especially suitable in cases of its localization on the face.

The treatment of basalioma is a serious practical problem, due to the difficulty of determining its clear boundaries before surgery, the difficulty of achieving excision boundaries, especially on the face and neck, and also due to the difficulty of restoring a significant postoperative defect. These factors carry a high degree of risk of recurrence of the disease with intracranial spread of the tumor.

Basal cell carcinoma of the skin is a basal cell carcinoma of the skin that affects people over the age of forty. A dangerous tumor develops in the basal layers of the epidermis, and in the initial stages is a nodular formation. The growth of basalioma is not characterized as intensive, and is not accompanied by the formation of metastases. How is basal cell carcinoma of the skin treated, and should we be afraid of nodular formations on the skin in the future?

Basalioma is a type of skin cancer

The root cause of the occurrence of basalioma

Basalioma of the skin is a "mature" disease that rarely occurs in young people. Finding the root cause will determine the most effective treatment in the shortest possible time, which will lead to a speedy recovery. Basalioma manifests itself in open areas of the skin, therefore, along with complex symptoms, moral discomfort arises. The main causes of the appearance of a tumor in the lower layers of the epidermis:

• constant exposure to ultraviolet rays;
• frequent dermatitis and skin diseases;
• skin injuries;
• bad habits (especially smoking);
• influence of carcinogens;
• burns, skin damage;
• old scars;
• chronic diseases of the skin.

Signs of basalioma will allow you to restore the overall picture of the disease and make a comprehensive, effective treatment at any stage of tumor development.

Basalioma: external manifestations

What does a basalioma look like at an early stage? A nodular formation, similar to a slight inflammation, is accompanied by strong painful sensations. Basal cell skin cancer spreads to different parts of the body, forming whole agglomerates consisting of tumors. In no case should you start the disease, because the more the surface of the skin is damaged, the longer rehabilitation waiting for a person. The surface of the skin of the back, face, and any other areas of the sensitive epidermis is prone to the appearance of nodular formations. By itself, a basalioma of any type does not go away, and the course of the disease only worsens.

Basalioma in the initial stage looks like a nodule

A type of basalioma of the skin

What is a basalioma? A nodular formation that can pretend to be a common pimple. For ease of classification, basaliomas are divided into several distinctive types, which depend on the location of the tumor, its size, and concomitant infection of healthy skin. Neoplasms of the lower layers of the epidermis that threaten human health:

• nodular-ulcerative;
• cicatricial-atrophic;
• nodular;
• warty;
• papilloma.

staging accurate diagnosis, will provide timely help, because diseases similar in type and external manifestation can affect different parts of the skin and affect healthy parts of the body in an atypical way.

Risk groups and forms of the disease

Basalioma is a disease that affects older people more often.

Nodular-ulcerative

For eyelids and sensitive skin The mucosa is characterized by a nodular-ulcerative disease. At the initial stage, a barely noticeable nodule appears, surrounded by a small reddened edema. Inflammation turns red, in extreme cases burgundy color. The surface of such a tumor most often shines like an old crust. Without proper therapy, nodular-ulcerative basalioma develops into an ulcer, subject to permanent injuries (wounds, cracks). Secondary infection of neoplasms with foreign infections is a common phenomenon that entails serious consequences.

Under the dry, compacted crust, a capillary network stands out, through which pathogenic bacteria and harmful microorganisms. Metastases in cases of nodular-ulcerative basalioma are not observed.

warty

Often the center of the formed ulcer heals, and then the tumor grows on healthy areas of the skin. A similar formation occurs on the injured epidermis (wounds or cuts), and develops quite quickly. Basalioma of the warty type in appearance resembles a cauliflower. The structure of the tumor consists of numerous nodular formations that can protrude above the surface of the skin, not go inside. A characteristic feature of a warty basalioma is the growth of a dangerous tumor outward, and not under the skin.

Warty basalioma grows in the center and spreads to the sides

Scleroderma-like

Scleroderma-like basalioma differs from similar forms of the disease by sharp, clear edges of the nodule and neighboring inflamed tissues. The roller (skin surrounding the formation) has a dark red tint, which, when pressed, begins to hurt a lot. A rare form of the disease affects the skin of the face and neck, less often - the back and collarbones. Only an experienced specialist can determine the exact diagnosis.

Pigmentary

Pigmentary basalioma is outwardly similar to melanoma, manifested by a massive nodule under the skin and a pearly roller around the tumor. This type of formation is often confused with others, especially for a person who has not previously encountered the complex features of skin cancer. Outwardly, formations, tumors, nodules in the lower layers of the epidermis are identical.

flat

A flat superficial basalioma indicates the development of a pedzhitoe disease. Such formation can go unnoticed for a long time. Basal cancer of this type develops inward, which creates all the necessary prerequisites for deterioration general condition person. Superficial basalioma is one of the most dangerous forms of skin disease (cancer).

Cylindrical

Spiegler's tumor. Cylinders are several tumors that form a single infected surface. This type of tumor is characterized by the location under the hair on the scalp. The benign nature of the disease requires urgent treatment before the disease develops into a malignant disease.

carcinomic

Carcinoma can develop on the human mucosa in cases where reduced immunity is unable to resist internal inflammatory processes. Basalioma of this type refers to dangerous malignant skin tumors that require urgent surgical intervention.

A complex skin disease is not transmitted through touch (close body contact). A nodular tumor is not contagious, so you should not be afraid of accidental infection from a sick person.

Basal cell skin cancer poses a direct threat only to a person in whose body pathological changes occur. A cancer cell can grow rapidly or take years to manifest.

Carcinoma is extremely dangerous

Diagnosis of skin cancer

Diagnosis of a complex disease begins with a primary examination of the formation on the upper layers of the skin. Basalioma is easy to identify, but for a more accurate diagnosis, you will need to carry out:

• cytological research;
• histological testing;
• general blood analysis;
• external examination of the skin condition.

Based on the results of all tests, an experienced specialist determines the exact diagnosis, on the basis of which the most effective treatment is prescribed. Therapy aimed at destroying the tumor will only help with integrated approach to the problem that has arisen.

In diagnostics, the edges of the formation and the composition of the cells (exclusively under a microscope) can be considered. Nested accumulation of cells is of only three types:

• round;
• oval;
• spindle-shaped.

The clinical manifestation often differs from histological studies, so self-treatment based on an external examination is ineffective. Basal cell skin cancer is mistaken for lupus, lichen (red or flat), Bowen's disease. Psoriasis is also a similar dermatitis, with which they rarely go to the doctor for qualified help. If it is difficult to make a general picture of the disease, then scraping of the tumor (biopsy) can be re-examined and reviewed.

Basalioma diagnostics which covers the examination of the whole organism will reveal hidden diseases that caused the development of the tumor.

Removed basalioma must be examined under a microscope

Basalioma treatment

A malignant tumor-basalioma is treated quite quickly if a person seeks qualified help in a timely manner. After the diagnosis is clarified, the patient is prescribed complex therapy. In cases where the tumor has managed to grow and grow, the only available option for getting rid of the formation is surgical intervention. The study of the edge of the nodule in the lower layer of the epidermis allows you to remove only potentially dangerous areas of the skin. Similar procedure takes place under general anesthesia, so the person does not feel severe pain or discomfort.

AT postoperative period an unpleasant scar is formed at the site of the tumor. Healing ointments and cosmetic plastic can remove this defect (an inevitable consequence of surgical intervention).

Alternative Method

To undergo the main course of treatment using other methods of getting rid of basalioma is an alternative available to the patient. Basal cell skin cancer is amenable to the following mandatory procedures:

• gradual cryodestruction;
• photodynamic therapy;
• drug treatment of the tumor.

A disease that cannot be transmitted by airborne droplets or by contact, requires a strong impact on cancer cells, but freezing with nitrogen or radiation therapy is determined by the attending physician. Skin cancer basalioma in the early stages lends itself to fast treatment followed by rehabilitation. Tumors that have grown on healthy areas of the skin are removed gradually to reduce stress for the body. The moral well-being of a person plays an important role in the effectiveness of therapeutic therapy.

Photodynamic therapy is one of the methods of treatment of basalioma

Complication of advanced basalioma

Problem affecting people middle age, is not aggressive. A nodular formation and an inflamed roller do not pose a direct threat to human health in the early stages of the disease. It is necessary to undergo complex treatment at the first symptoms of the disease - discomfort and pain in the area of ​​​​the neoplasm. Even advanced forms of the disease (basalioma tumor) do not metastasize, but this does not mean at all that such a malignant formation is urgent.

The main danger advanced disease is a weakening of the body against the background of a protracted illness. Tumors covered with a crust are subject to constant traumatism, and wounds and ulcers formed are ways for secondary infections and dangerous bacteria to enter. Basalioma disease, even though it refers to oncological diseases, but the threat arises only in extremely neglected forms. To allow the development, an increase in the number of tumors is undesirable.

Prognosis of treatment of basalioma

The prognosis worries every patient. An external skin defect affects not only physical, but also moral well-being. The overall prognosis due to the absence of metastases is favorable and positive. It comes to fatal cases only in the absence of treatment and neglect of one's own health. After transferring a one-time treatment (getting rid of the tumor), the patient is prescribed rehabilitation and subsequent prevention. Relapses of the disease are common and can only be avoided by persistent, positive people.

If the size of the tumor has not reached twenty millimeters in diameter, then the prognosis Get well soon is over 90%. Simple therapy, diligent implementation of the recommendations of doctors and faith in a cloudless future are the key to quick effective treatment.

Basalioma can be confused with any dermatitis that occurs as a natural reaction to internal diseases or an external unfavorable environment. Tumors in the form of nodules under the skin from the very beginning do not disturb a person, but soon a potentially dangerous formation begins to grow and infect neighboring healthy areas of the skin. How quickly should you respond to a tumor? Basal cell skin cancer leaves scars, scars, but surgical (standard) intervention saves a person's life. It is impossible to remove the tumor on your own, and deliberate damage to the nodules will only increase the inflammatory process. Every person who takes care of their own health is able to defeat a malignant tumor, and being able means having incredible power.

Family physicians are regularly faced with the identification, treatment and counseling of patients with epithelial neoplasms, the most common of which is basal cell carcinoma. Unfortunately, even surgical excision primary focus does not always produce the expected effect, and occurs recurrence of basalioma. Despite the fact that they are usually slow growing, with minimal metastatic potential, exposure to predisposing factors contributes to the aggressive development of this type of tumor.

Why is the disease returning?

A neoplasm that affects the epidermis tends to slowly but steadily grow into the thickness of the tissue, so therapeutic intervention is aimed at the complete destruction of all malignant cells. However, it has been established that this is the result of inadequate therapy. The recurrence rate of basal cell carcinoma is predetermined by the type of surgery used to treat skin cancer.

Complete eradication is especially important because, when returning, the tumor becomes larger in size and much more aggressive than the primary cancerous lesion.

Most basaliomas are detected even at the stage when their diameter is less than 1 cm. As a rule, primary tumors are up to 1 cm in size, located on the face and no more than 2 cm. Those that are localized on the body have a low probability of re-growth.

Tumors of the parotid canal are of particular concern because the structure is expanded inside the skull, which provides access to these tumors to the brain (aggressive type of therapy is justified in this case).

Recurrent tumors are more difficult to treat and require more aggressive therapies than primary ones.

The first signs of relapse

Most recurring lesions develop within the first two years after treatment. Signs are classified into local and general.

1. Basal cell carcinoma most often appears as slightly translucent, although it can take on other forms. A neoplasm forms on those areas of the skin that are exposed to the sun - more often it is the head and neck. A superficial cancerous lesion is quite often localized on the trunk and limbs, manifesting itself as a scaly plaque, resembling eczema or psoriasis in appearance. It has a pearly hue and is painful, the patient experiences a feeling of tightness of the skin around the focus.
2. On the background pathological changes the patient has general weakness, insomnia, increasing pain syndrome.

Simultaneously with these clinical manifestations, laboratory indicators anemia is on the rise.

Necessary tests and examinations

A basic examination is carried out as standard: the patient is prescribed to take a blood test for clinical and biochemical analysis. Spend visual inspection the affected area of ​​the skin, helper methods an ultrasound examination of the localization of the alleged recurrence of the tumor is also prescribed.

In the diagnostic process, the role of histological examination is indispensable, because the statement correct diagnosis impossible without determining the exact morphological parameters.

Adequate biopsy is also critical in tumor evaluation. The pattern of tumor growth is important information that cannot be determined by superficial examination or laboratory studies - this can only be established by submitting a piece of cancer tissue for examination.

For a better microscopic assessment of the tumor tissue and identifying the type of its growth (aggressive or sluggish), special histochemical diagnostic methods are prescribed.

Treatment of recurrence of basalioma

Exists wide range treatment approaches, including standard excision, and from destructive alternatives - curettage, photodynamic and radiation therapy. Which method will be applicable in each specific case - the doctor prescribes, based on many indicators of the state of the patient's body. The decision as to which therapy to use is best made by the oncologist based on four factors:

• tumor size;
• location;
• histological data;
• features of the course of primary basal cell neoplasm.

Many therapeutic alternatives are available for the treatment of recurrent basalioma, but total surgical excision is still considered the "gold standard". Almost all tumors of this type are curable if diagnosed and treated as soon as possible.

Micrographic surgery allows you to remove the lesion without affecting healthy tissue. The process involves progressive radial sectioning and inspection of the edges of the defect in real time. The method is preferred due to the fact that it is able to preserve the sensitivity of the scalp and neck.

Prevention of the recurrence of the disease

After elimination of the primary form of this epithelial tumor, patients should be observed clinically and regularly examined. Only 50% of recurrences occur within the first 2 years after surgical treatment of basalioma, 66% after 3 years and 18% after 5 years.

After undergoing therapeutic intervention, it must be remembered that damaged skin remains susceptible to sunlight, so it is absolutely impossible to expose yourself to ultraviolet radiation.

Prognosis and how long do such patients live?

If a recurrence of basalioma did not bypass, and metastases involved in the tumor process regional lymph nodes, bones, lungs and liver, life expectancy, unfortunately, cannot be long. Therefore, having a history of this type of neoplasm, it is important to visit a doctor regularly.

Basalioma is a malignant tumor that grows from the deepest basal layer of the epidermis. In most countries of the world, it is the most common type skin cancer and approximately three quarters of all skin tumors. Males are predominantly affected. Basalioma can develop at any age, but about a third of reported cases are in patients over 40 years of age. An increase in the frequency of basaliomas is observed in countries with a hot climate and a high average annual rate ultraviolet radiation. It is characterized by slow growth and lack of metastasis. The most common localization of these tumors are exposed parts of the body, however, these tumors are predominantly located on the chest, neck and head. Due to the slow imperceptible growth, this neoplasm can go unnoticed by both the patient and the doctor for a long time and can be detected only in advanced stages.

Although this tumor does not metastasize, it can lead to serious consequences. Its localization in the region of the eye sockets, nose, mouth and auricles is especially dangerous, since during germination it significantly deforms the cartilaginous and even bone basis of these organs and leads to a pronounced violation of their function. Besides natural holes These organs provide a pathway through which basaliomas can enter the skull and even affect the brain. Thus, this tumor, which has a non-aggressive behavior in comparison with other malignant tumors, under certain circumstances can even lead to death.

Diagnosis and treatment, as a rule, does not cause difficulties. Most forms of this cancer respond successfully to both radiation and surgical treatment. Medical treatment is also applicable, but due to the predominantly local nature of this tumor, it is rarely used. The probability of tumor recurrence depends on its size, penetration depth and the chosen method of treatment, however, there are other factors that can affect this process. Given the slow growth, lack of hematogenous metastasis, and high rates complete cure the prognosis of this disease is generally considered favorable.

Causes of basalioma

Mandatory causes of basaliomas

• pigment xeroderma;
• Bowen's disease;
• Paget's disease;
• erythroplasia of Queyra.

Bowen's disease
A precancerous skin disease that develops in both men and women more often on exposed parts of the body. The reason for its development is prolonged traumatization of the skin by ultraviolet radiation, aggressive chemicals, as well as human papillomavirus. Clinically, the disease is manifested by the formation of a spot with uneven outlines, which eventually transforms into a slowly growing plaque. The plaque can be either smooth and velvety, bright red in the initial stages, or dense, rough, copper-colored, covered with scales, sores and cracks in the subsequent stages.

Paget's disease
This disease is synonymous with breast cancer. It often develops after 50 years in both female and male patients. The peak incidence in women is 62 years, and in men - 69 years. Its first manifestations are a slight reddening of the nipple or a certain area of ​​the areola with superficial peeling and increased tactile irritability. In the future, itching, burning and soreness occurs, serous-bloody discharge from the nipple appears. The classic symptoms are retraction of the nipple and the formation on the areola and the skin around it of an area that looks like an orange peel. Last symptom caused by swelling of the sebaceous and sweat glands over a deep-seated tumor that compresses the lymphatic ducts. On palpation of the armpits, an inflammatory reaction of the lymph nodes is often detected, manifested by their enlargement and soreness.

Erythroplasia of Queira
Inflammatory skin disease of the glans penis and foreskin, often leading to the development of squamous or basal cell skin cancer of this localization. It develops more often in men aged 40 to 70 years. Clinically, it is a scarlet shiny spot, plaque or their accumulation on the mucosa of the glans penis, often turning into foreskin. To the touch, the formation is painless and slightly protrudes above the surface of the skin. A disease similar in clinical manifestations that develops on the mucous membranes of the genital organs in women is described as Bowen's disease of genital localization.

Relative causes of basaliomas

• keratoacanthoma;
• trophic ulcers;
• solar keratosis;
• seborrheic acanthoma;
• radiation ulcers;
• keloid scars;
• skin horn;
• syphilitic gummas and granulomas;
• cold abscess in tuberculosis, etc.

Trophic ulcers
These pathological formations cannot be called diseases, since they are vascular or neurogenic complications of such metabolic diseases as diabetes mellitus, atherosclerosis obliterans, deep vein thrombosis of the lower extremities. In diabetes, ulcers occur more often on the feet. With arterial and venous insufficiency, ulcers develop on the legs near the ankles. Visually, trophic ulcers are round or oval, long-term non-healing skin defects. To the touch, they are often painless, since an element of polyneuropathy is also present in their formation. A transparent sticky substance is constantly or periodically released on their surface, causing the effect of wetting.

solar keratosis
The appearance of these formations is facilitated by a certain genetic predisposition and intense insolation. This type keratosis is numerous foci of skin peeling. Over time, these lesions thicken, rise above the surface of the skin and become pink-white due to the large number of small skin scales. Histologically, these foci are areas of altered tissue that develops in place of a healthy one, which in medicine is referred to as dysplasia and metaplasia. Metaplasia, in turn, is a direct harbinger of tumor degeneration.

Seborrheic acanthoma
A synonym for this disease is senile keratosis. According to the name, it develops mainly in the elderly, but it can rarely occur in young people. More often, this tumor-like formation is localized on closed parts of the body near places often irritated by friction ( bra straps, etc.). As a rule, this formation is a uniformly pigmented soft tumor covered with oily crusts. As the tumor grows, the crusts may crack and shed, being replaced by similar, deeper crusts. The growth of this volumetric education is extremely slow, sometimes reaching several decades. According to various sources, degeneration into basal cell carcinoma occurs no more often than in 5-7% of cases.

Radiation ulcers
Skin damage by ionizing radiation occurs in emergency situations during accidents at nuclear facilities or during the treatment of certain types malignant tumors by irradiating them with waves of the radioactive spectrum. Radiation ulcer develops in stages. Initially, redness forms in the zone of the most intense changes. After a few hours, against the background of redness, multiple small blisters appear, with a tendency to unite. After another 1-2 days, in the projection of the irradiated area of ​​the skin, there is a continuous large painful blister with a transparent yellowish liquid. Through certain time it opens on its own, exposing the bottom of the ulcer. A distinctive feature of these ulcers is their ability to recur. In other words, after their healing, the ulcer periodically reopens. Thus, late radiation ulcers are foci of increased mitotic activity and excessive formation of connective tissue, and, in fact, areas of metaplasia. Metaplasia of any epithelium, in turn, is a precancerous condition.

Keloid scars
This type of scar develops after wounds with a fuzzy comparison of boundaries or with a large tissue defect. In these cases, the resulting cavities are filled with an excess of detritus - the cellular basis, from which the connective tissue is subsequently formed. Such tissue has the character of a benign tumor, since it is well differentiated and capable of fairly progressive growth. Clinically, such a scar differs in color from healthy skin and is more dense. Interestingly, its growth does not always occur outward, where it immediately becomes noticeable. In most cases, the keloid scar grows inside the wound. Given that it does not have invasive growth, like a malignant tumor, its growth is accompanied by compression of the surrounding structures. Therefore, such a scar itself is a source of chronic inflammation and for this reason must be removed.

Skin horn
To this day, there are disputes regarding the cause of the development of this pathological formation. Some dermatologists consider the horn to be an independent skin disease, others - a manifestation of senile keratoacanthoma, and others - a variant of Bowen's disease. However, it has been proven that in about a quarter of cases this volumetric formation is capable of degenerating into a basalioma. In shape, it really resembles a horn with dimensions rarely exceeding 1–2 cm. The surface of the horn is rough, the consistency is often dense, but it can also be moderately elastic. When scraping, thin scales are separated. The base of the outgrowth may be enlarged and similar to normal skin with signs of inflammation. More often, however, the base of the horn does not differ from its structure.

Syphilitic gummas and granulomas
In addition to direct complications of syphilisassociated with its pathogenesis, there are also indirect complications of gums and granulomas. It must be admitted that such cases are rare in medical practice, but they should not be forgotten. In the case of a long chronic course of syphilis, skin changes can become so pronounced that they lead to the formation of foci of metaplasia, which are a precancerous condition. For the development of such a scenario, it is necessary that the body be weakened just enough so that the maximum intensity of the protective and regenerative processes is approximately equal to the aggressiveness of pale treponemas - the causative agents of syphilis. Under such conditions, the resulting gummas and granulomas do not heal for a long time, leading to a gradual change in the properties of the skin on which they developed. In the entire history of medicine, no more than 20 such cases have been registered ( according to information for 2013), so they are more scientific than clinical.

cold abscess
This type of abscess is otherwise called an abscess, which more clearly reflects its origin. In most cases, a cold abscess develops with secondary tuberculosis of the bones, skin, joints, or lymph nodes, as well as after improper BCG vaccination technique. Most often it is formed in the paravertebral space with caseous melting of one of the vertebrae, as well as on the shoulder. In this case, pus is released outside the main focus, encapsulated and forms an abscess. Such an abscess is called a cold abscess, because the skin over it is rarely changed and painful. When it is opened, a light curdled or crumbly pus is found, which stands out from the wound for a long time. Often, after such abscesses, long-term non-healing fistulas and ulcers remain, which are the substrate for the degeneration of local tissues into tumor ones.

In addition, there are a number of other factors that, according to statistics, increase the likelihood of basal cell skin cancer. These factors include mainly factors of the internal and external environment that have an aggressive effect on the skin. When these factors are combined with an existing relative precancerous disease, the incidence of tumor development increases by 2–5 times.

Factors in the development of basal cell skin cancer

• excessive skin tan;
• freckles;
• numerous moles;
• prolonged contact with arsenic and its derivatives;
• prolonged contact with oil products and tar;
• thermal injury to the skin hypothermia and burns);
• immunosuppression.

Excessive skin tan
Excessive ultraviolet radiation adversely affects the skin through at least two mechanisms. First of all, a strong tan leads to inflammation of the skin. Frequent inflammation, in turn, leads to a steady increase in the rate of reparative processes. At a certain point in time, the proliferation of connective tissue and basal epithelium can become uncontrolled, which is the substrate of the tumor process. Second mechanism negative impact ultraviolet radiation on the skin lies in its direct effect on the DNA of the cells of the basal layer of the skin. In this case, a mutation occurs, leading to the loss of tumor cells functional features and increase the rate of their division.

Freckles
The presence of freckles in a person indicates that there are areas in his skin that easily absorb ultraviolet radiation. It is for this reason that freckles stand out from the rest of the skin. Ultraviolet rays lead to the development of basalioma by mechanisms similar to those above.

Numerous moles
Moles are benign tumors melanogenic cells. According to statistics, their malignant degeneration often occurs in melanomas, which have an extremely aggressive course. However, in a certain proportion of cases, degeneration into basal cell carcinoma also occurs.

Prolonged contact with arsenic and its derivatives
As you know, arsenic is a poison for human body. Its feature is the ability to accumulate in the skin and its appendages ( nails, hair) and stay there for many years. With prolonged skin contact with this substance, poisoning does not occur because the required dose is not reached, at which it occurs. However, the accumulated arsenic leads to latent inflammation of the deep layers of the epithelium, leading to its dysplasia.

Prolonged contact with oil products and tar
It has been statistically observed that workers in oil wells, auto repair shops, coal mines and gas stations are more likely to get basal cell skin cancer than representatives of other professions. It is assumed that oil distillation products and tar have a toxic effect on the skin. More often, skin damage is limited to its dryness or eczema, however, in some cases, malignant tumors develop in the lungs, brain, and skin.

Thermal injury
Both burns and frostbite are characterized by damage to the deep layers of the skin and muscles. The cold itself does not have a negative effect on the skin, since it keeps the tissue structure unchanged. Thaw is more dangerous because it is accompanied by the formation of ice crystals that destroy skin cells and subcutaneous tissue from the inside. Frequent burns also lead to chronic inflammation. As a result of such lesions, the skin often and profusely regenerates. Active regeneration increases the chances of an error, manifested by a cellular mutation. In addition, frequent thermal injuries lead to the formation of a layer of scar tissue under the skin, which, like keloid scars, tends to become malignant.

Immunosuppression
Immunity in the usual sense not only protects the body from viruses and bacteria, but also prevents the formation of tumor cells. This type of immunity is called antitumor immunity. Its intensity depends on the severity of general immunity. When it is excessively increased, the risk of developing autoimmune diseases increases, and when it is weakened, it increases the risk of benign and malignant tumors.

The identification of these factors lasted more than a dozen years. Numerous studies have been carried out in many countries of the world, in which statistical data have been transformed into certain patterns. For example, basalioma most often develops in miners who have contact with aggressive substances suspended in dust. Engineers, by virtue of their profession, are forced to regularly come into contact with various petroleum products. Firefighters expose their skin to frequent burns, which cannot but affect it.

The highest risk of developing basal cell carcinoma is in fair-skinned people with small amounts of the skin pigment melanin. Freckles and red hair also increase the risk of this disease. The combination of the above factors confirms the reality - the residents of Scotland and Northern Ireland, who have red hair and many freckles, have the greatest predisposition to basalioma. We are talking about predisposition, because in reality these countries do not have the highest rate of basal cell carcinoma.

The frequency of this disease increases with an increase in the average annual amount of ultraviolet radiation. In other words, as we get closer to the equator, the average number of patients with this most common type of malignant skin tumor increases. However, it is necessary to make an amendment that these statistics are confirmed only in countries with a predominantly fair-skinned population. Black people almost never get skin cancer due to the high concentration of melanin in their skin. The Mongoloid race is also less prone to this disease, however, not to the same extent as Negroid. The greatest risk rightfully belongs to the Caucasian race.

Immunosuppression develops for many reasons, the most common of which are HIV/AIDS, immunosuppressive treatment, and tumor chemotherapy. Presumably, immunosuppression increases the likelihood of basal cell skin cancer, however, as well as other tumors, through a parallel decrease in the intensity of DNA repair processes. As a result, after a certain time, cells with modified DNA appear, which can provoke tumor growth.

Radiation radiation has a direct destructive effect on tissues. Strong radiation leads to burns, weak - to cell mutation. Long-term skin burns lead to an increase in the activity of connective tissue cells, which in some cases can lead to the development of basalioma. It is noteworthy that tumors that have developed as a result of radiation exposure or severe sunburn are multiple in nature and are each at its own stage of development.

Large moles and scars have a certain potential for growth, despite the fact that the former are initially benign tumors, and the latter are connective tissue that fills the wound defect. With growth, a gradual change in the composition of these tissues may occur, accompanied by a loss of their functional properties and the acquisition of a pronounced tendency to division.

The main pathogenetic link in the development of any tumor is a mutation in its genome and blocking of the process called cell apoptosis. Apoptosis is a natural defense mechanism, in which any cell of the body, ceasing to perform its direct functions, must independently destroy itself. Cells lacking this mechanism lose their specificity and multiply freely, producing millions of daughter cells with a similar DNA error. As a result, an area of ​​aggressively growing tissue appears, which does not perform any function, but heavily consumes the resources of the body, that is, a malignant tumor.

In the case of basalioma, its growth occurs infiltratively. In other words, the tumor grows into the surrounding tissues, destroying them along the way. It is for this reason that there is always an active zone of inflammation around the tumor, even if it is small.

Types of basalioma

Tumor growth is accompanied not only by an increase in its size, but also by a change in the contour of the boundaries. The more the contour of the tumor is changed, the more malignant it is, that is, the more pronounced cellular atypia. Despite the fact that basalioma is a slow-growing tumor, signs of inflammation caused by compression of surrounding tissues are almost always found along its periphery. On any form of tumors, pigment can appear. As a rule, it is randomly distributed over the surface of the tumor. Its appearance also says nothing, like the color of the tumor itself. The location of the tumor near vital organs, such as the eyes, nose, ears, can lead to severe deformation of the cartilaginous skeleton. In addition, the tumor tends to spread into the skull through natural openings and cavities. This, in turn, threatens to involve the brain with membranes in the tumor process, which threatens with a fatal outcome.

It is believed that the basalioma never metastasizes, but this is not entirely true. In the United States of America, several cases of basalioma growth in the lungs have been reported. At first glance, such an unusual localization of the tumor could be caused by the spread of tumor cells from the primary focus through the blood. However, upon closer examination, no metastases were found outside the lungs, which is not entirely characteristic of hematogenous dissemination. Another important feature of all cases was that they all developed in patients in whom the tumor had spread to the mucous membrane of the mouth or nose. The only explanation for this manifestation of the tumor was the entry of exfoliated cells into the lungs along with a sigh.

There are the following clinical forms basalioma:

• nodal;
• superficial;
• cicatricial;
• ulcerative.

Nodular form of basalioma

Superficial form of basalioma

Cicatricial form of basalioma

It is important to note that the cicatricial form of basalioma can be both with primary cancer and with relapses ( repeated manifestations) after treatment. The recurrence rate for this type is as high as 40% in some countries due to the deep growth trend of this tumor. When a tumor reaches a vessel or nerve, it often grows along these formations for a long distance. This fact explains the appearance of secondary tumors with an identical pathomorphological picture at a distance from the site of growth of the removed tumor. The growth of these tumors is also slow, so they have a favorable prognosis. Typical localization on the chest, neck and face.

Ulcerative form of basalioma

In addition to the clinical classification there is also a morphological one, which is used mainly by laboratory assistants and doctors and is difficult to understand for people who do not have a special medical education. According to this classification, tumors are divided into many histological variants according to the degree of cellular differentiation and similarity with various tissues of the body.

Diagnosis of basaliomas

Usually, focusing on the above clinical signs of the nodular form, it is enough to simply suspect basal cell carcinoma. However, in the initial stages of growth, when the size of the tumor does not exceed 3–5 mm, it is easy to confuse it with an ordinary mole ( especially if the tumor is pigmented), molluscum contagiosum, or senile seborrheic hyperplasia. Hair can grow from a mole, which does not happen with basalioma. A distinctive feature of molluscum contagiosum and senile seborrheic hyperplasia is a small island of keratin in the central part. When crusted, the tumor can be confused with wart, keratoacanthoma, squamous cell skin cancer, and molluscum contagiosum. In this case, the crusts must be gently exfoliated. With basal cell carcinoma, this is easiest to do. After the bottom of the wound is exposed, for greater certainty and scientific confirmation, it is necessary to make a smear-imprint from the bottom of the ulcer and determine its cellular composition.

Highly pigmented basaliomas are easily confused with malignant melanomas. To prevent this from happening, you need to know that the elevated edges of basal cell carcinoma almost never contain melanin. In addition, the staining of basalioma is often brown, and melanoma has a dark gray tint. The flat form of basal cell carcinoma can be confused with eczema, psoriatic plaques, and Bowen's disease, but when the scales are scraped off the edge of the tumor, the true picture of the disease is revealed.

These clinical signs are intended to guide the doctor towards the correct diagnosis, and its confirmation should be carried out only after a biopsy, cytology or morphological study tumors.

Examination by a doctor

At the appointment with these specialists, the patient may be asked the following questions:

• How long ago did education begin?
• How did it manifest itself, was there pain or itching?
• Are there similar formations anywhere else on the body? If yes, where?
• Is it the first time the patient encounters it or have there been similar formations before?
• What is the type of activity and the conditions in which the patient works?
• How much time, on average, does the patient spend outdoors?
• Does he apply the necessary protective measures in relation to solar radiation?
• Has the patient ever been exposed to excessive radiation exposure? If so, where and approximately what was the total dose?
• Does the patient have relatives with cancer?

In addition, the doctor may refer the patient to additional examinations, such as x-rays in two projections, ultrasound, computed tomography and magnetic resonance imaging. These paraclinical studies can provide valuable information about the size and depth of the tumor, its distribution in the cranial cavity, and proximity to vital structures.

Patients with treated basal cell carcinoma should be examined annually by a doctor not only to control tumor recurrence, but also to screen for new tumors. A patient, once treated for oncopathology, automatically falls into the risk category for other tumor diseases.

When is a biopsy and histological examination of a basalioma needed?

The biopsy is performed in a treatment room under aseptic conditions. For this manipulation, weak anesthesia with inhalation drugs is performed or not performed at all. Puncture is carried out in the following way. The tumor is fixed with the fingers of the left hand. Right hand an empty syringe with a hollow needle at the end is inserted to the middle of the tumor. The advancement of the needle from the edge of the tumor to the center should be accompanied by its rotation. Upon reaching the center of the tumor, the syringe plunger is retracted, after which the needle is removed. Then, with a sharp push, the contents of the needle are thrown onto the glass slide and spread through it with the help of another - a cover glass. With a sufficient amount of biopsy, several samples are made. The thinner the layer of the substance on the glass, the better the prepared samples and the more likely it is to establish the correct diagnosis.

Laboratory tests

Basalioma treatment

The following features reduce the likelihood of successful treatment of basalioma:

• tumor diameter more than 20 mm;
• localization of the tumor near the eyes, nose and lips;
• fuzzy and uneven borders of the tumor;
• low level patient immunity;
• accompanying illnesses;
• infiltrative, micronodular and basosquamous histological type of tumor;
• tumor growth near large blood vessels and nerves.

Is there an effective drug treatment for basalioma?

What are the signs of malignant tumor growth?

BUT– asymmetry ( asymmetry) - any mole that has a benign course in 95% of cases is always symmetrical. The exception is birthmarks, which can have intricate contours and still remain harmless.

B- the border ( border) - the edges of the mole, as a rule, are even and smooth. The appearance of notches, sores or scales on them indicates the beginning of malignancy.

C- color ( color) - a benign papilloma is always the same shade over its entire surface. The appearance of more or less pigmented islands on the surface of the tumor indicates its malignant transformation.

D– diameter ( diameter) - this parameter is the least accurate and most likely misleading many, however, it is believed that a tumor up to 6 mm in size is most likely benign, and in excess this indicator increases the possibility of its rebirth.

E– progression ( evolution) - rapid growth is a characteristic feature of malignant tumors. A benign tumor can normally increase by 1-2 mm per year.

When is surgery to remove a tumor needed?

However, small tumors ( T1 and T2) can be treated, including targeted radiation therapy or local chemotherapy drugs. Such tumors can be cured with only one type of therapy. Tumor sizes corresponding to stages T3 and T4 are an indication for the combined use of radiation and surgical treatment. The goal of surgical treatment is to excise and complete removal tumors.

The operation to remove the basalioma should be performed in the operating room under aseptic conditions. The type of anesthesia depends on the expected volume of surgery, the location of the tumor and the general condition of the patient. Local infiltrative and conduction anesthesia is performed in patients up to an average of 55-60 years old with a tumor located on the trunk and extremities. The size of the tumor should not exceed 10 mm. For larger tumors with presumed involvement of underlying structures, spinal anesthesia is performed. Localization of the tumor on the neck and back prescribes general anesthesia regardless of the age of the patient.

Due to its specificity, this tumor does not always have clear boundaries. Often the boundaries are not defined due to ulceration of the edges of the tumor with the transition to healthy tissues. In this case, the oncosurgeon must carefully examine the edges of the tumor before the operation using a special magnifying device or a simple magnifying glass. In the future, focusing on the edges of the tumor, its wedge-shaped resection is performed. Depending on the size of the tumor, a certain distance is retreated from it in order to minimize the likelihood of residual tumor cells in the wound and prevent recurrence. Russian and Western schools disagree on the amount of the required indent. The Russian school is more radical, as it recommends retreating from each edge of the tumor by 2 cm at T1 and T2 and 3 cm at T3. The Western school says that the amount of indentation should not exceed 3 - 5 mm. This is justified by statistical data, indicating that with a margin of 3 mm, the probability of recurrence is in the region of 15%, and with a margin of 4–5 mm, it does not exceed 5%.

Based on the foregoing, it follows that an increase in indentation reduces the likelihood of relapses, but leaves a more pronounced postoperative defect. However, it is important to note that even with the maximum indentation, the probability of tumor recurrence remains within 2–3%. This is due to the specificity of basal cell skin cancer, namely its ability to grow along blood vessels and nerves over considerable distances.

Surgical methods such as laser therapy and cryotherapy deserve special attention. They are mainly used for small tumors. Their advantage is atraumaticity and fast healing rates. However, there is a certain pattern here as well. The success of this method in skilled hands reaches 97% for small tumors, however, with an increase in the size of the tumor, the chance of recurrence also increases.

most perfect surgical method Removal of basaliomas is currently considered MOHS surgery. This method was proposed in the 30s of the last century and consists in layer-by-layer removal of the tumor and its parallel histological examination. In more detail, the operation is performed as follows. First, the tumor is classically removed, observing the necessary indents. The wound, meanwhile, is tamponed, but not sutured, and the patient is sent to a special ward where he can rest. The tumor itself is sent to the laboratory, where the laboratory assistant, using special equipment, divides it into many thin layers, each of which is examined under a microscope after appropriate staining. The tumor is considered completely removed if in all sections the pathological tissue is surrounded by healthy tissue on all sides. If at any level contact of the tumor tissue with the edge of the cut is detected, then the patient is called again, and an additional piece of tissue is exfoliated in the indicated area, which is also sent to the laboratory. Thus, in stages, the tumor is completely removed along with all the branches. The duration of such an operation takes an average of 8 hours, but there were cases when the operation, with all the interruptions, lasted 2-3 days. The duration of the method is justified by the highest rates of cure and the lowest percentage of recurrence, which in some advanced clinics reaches tenths of a percent.

Treatment of basal cell carcinoma depending on the stage of its development

Basalioma of the second stage
The same methods of treatment are used as in the first stage, however, in the form complex therapy. In most cases, treatment is carried out in 1 - 2 stages. With one-stage treatment, the course of treatment is carried out, as in the first stage, but adjusted for the larger size of the tumor. In two-stage treatment, it is performed first radical removal tumors, and then a control course of radiation therapy. With an increase in tumor size, the effectiveness of cryotherapy and laser removal decreases, so it is important to properly weigh all the pros and cons before choosing a treatment method. Chemotherapy drugs are rarely used from stage 2 basal cell carcinoma onwards.

Basalioma of the third stage
In this case, treatment is carried out in 2 - 3 stages. Two-stage treatment is carried out as in the second stage. Three-stage treatment involves an additional course of chemotherapy or ionizing radiation to reduce the size of the tumor before removing it. Cryotherapy and laser techniques are not used for tumors of this size.

Basalioma of the fourth stage
When the removal of the tumor brings more benefit than no treatment, surgery is performed. However, when the tumor spreads to vital structures, it is necessary to refrain from surgery. Radiation therapy of tumors of this size can lead to only a slight decrease in its size and very pronounced side effects. General chemotherapy treatment can also ensure a recurrence of the disease for a certain period of time, but this happens quite rarely. Under certain circumstances, it makes sense to perform a palliative operation in order to reduce compression of the structures surrounding the tumor and improve its sanitary condition.