The course of squamous cell skin cancer. Differential diagnosis in squamous cell skin cancer. Oncology: the problem has a solution

IN AND. Volgin, T.V. Sokolova, M.S. Kolbina, A.A. Sokolovskaya

The problem of interdisciplinary interaction in the diagnosis and choice of treatment for basal cell disease (BCCC) is currently very relevant. Most forms of BCC go beyond narrow clinical specialties to some extent and are at the intersection of two or more disciplines. This problem is of great interest to dermatologists, oncologists and surgeons. This is due, firstly, to the absolute increase in the number of patients with various forms of BCC, and secondly, the emergence of new diagnostic and treatment methods that allow for a quick diagnosis and effective removal of tumor foci.

Epidemiology

The growth of oncological pathology is due not only to the aging of the population, the deterioration of the environmental situation, but also to the improvement in the detection of malignant neoplasms. The incidence rate of skin cancer (excluding melanoma) increased by 34.3% between 1996 and 2006. The largest increase in the incidence of malignant neoplasms of the skin from 1995 to 2005 was registered in the Far East (31.6%), Siberian (27.5%) and Urals (19.2%) federal districts. Among malignant neoplasms of the skin, BCC is the most common, accounting for 267.8 per 100,000 population in Russia.

BCC ranks second in frequency among all malignant neoplasms after lung cancer, accounting for 11-12%. Among malignant epithelial neoplasms of the skin, BCC is in the lead, its share ranges from 75 to 97% and continues to increase steadily. According to the Moscow Cancer Registry for 2000-2003, BCC accounted for 91.5% of all non-melanoma malignant skin tumors. The annual increase in the number of patients with BCC in different countries of the world, according to data for 1980-1999, ranged from 40 to 65%. More than 40,000 new cases of BCC are registered annually in the United States, and the increase in the number of newly registered patients reaches 65% and ranges from 500,000 to 700,000 new cases. In the UK, between 1970 and 1992, the incidence of BCC increased 3-fold. In Australia, the incidence reaches 1000-2000 cases per 100,000 population. In Switzerland, between 1976 and 1990, a constant increase in the incidence of 2.6% was recorded.

BCC most often develops over the age of 50 years. However, cases of the onset of the disease are often described in more early age starting from the age of 20. The average statistical age averages 64.4 ± 3.3 years. The share of elderly and senile people accounts for 72-78%. The likelihood of developing BCC in people older than 55 years is 4-8 times higher than in people younger than 20 years. in the Siberian federal district the age of patients with BCC in almost half of the cases exceeded 60 years. Cases of BCC have been described in girls aged 15 and 17 years.

Some aspects of the etiology and pathogenesis of BCC

Among them, the leading ones are hereditary predisposition to carcinogenesis, ultraviolet radiation (UVR), exposure to ionizing radiation, chemical carcinogens, mechanical damage to the skin, viral infections, and dysfunction of the immune and endocrine systems. However, specific mechanisms for the development of BCC under the influence of these factors are unknown in most cases. Features of the course of basaliomas are also determined by the age of the patients.

Genetic factors play a significant role in the pathogenesis of tumors. In patients with BCC (), a hereditary predisposition (family cases) to the development of tumors was established in 28% of cases. Of these, in more than 3/4 cases, oncological pathology was detected among relatives of the 1st degree of kinship and in the rest (21.4%) - of the 2nd degree. In recent years, much attention has been paid to the study of the association of genetic markers with various diseases. Genetic markers can be blood groups, Rh factor, HLA histocompatibility antigens, etc. In chromosome 9q22.3 of the human genome, the PTCH gene was found, mutations of which lead to the development of BCC. The genes that code for blood types are also on chromosome 9q, which undergoes changes that are found in many types of cancer. In other words, cancer genes are controlled by blood group antigen genes. According to HLA-typing data of patients with BCC, it was found that multiple formations are significantly associated with HLAB14 and HLADrl antigens.

On the big clinical material it was shown that in patients with BCRC, compared with healthy donors, the occurrence of I (0) and III (0B) blood groups significantly differed. Without taking into account the Rh factor, BCC developed 1.4 times more often in patients with I (0) blood group and 1.8 times less often in patients with III (0B) group. Multivariate analysis of the distribution of patients with BCC and voluntary donors, taking into account two factors (ABO blood type and Rh factor), showed that in the presence of blood group III (0B) with Rh-BCC was observed 11 times more often than in the same blood group and Rh+. In patients with group I (0) and Rh+, tumors occurred significantly 1.3 times more often than in Rh-.

Physical damage to the skin UVI stimulates the development of carcinogenesis through a direct effect on the DNA of cells. It has been proven that exposure to the skin of ultraviolet rays is accompanied by immune deficiency. Destruction of lymphocyte-activating la-antigens on the surface of lymphoid cells, impaired immune response, induction of suppressor lymphocytes, disappearance of functionally active Langerhans cells from the epidermis occur. UVR activates keratinocytes, enhances the production of certain cytokines and growth factors. In skin exposed to chronic insolation, a tendency to an increase in mast cells in the dermis was revealed. Any skin cells can undergo malignant transformation, but basal cell and squamous cell carcinomas develop more often.

UV-B rays have the greatest damaging effect, but at the cellular level, various chromophores are also able to adsorb UV-A energy and generate free radicals. They act on membrane lipids and proteins by destroying DNA. Damage to biologically important macromolecules occurs not due to the direct absorption of light quanta by them, but as a result of the photodynamic action of substances. Low doses of UV-A, or even sub-erythemal doses, are also capable of forming pyrimidine diamers and causing DNA damage, leading to cell mutation. Skin sensitivity to sunlight depends on its type. There are 6 skin phototypes. BCC occurs under the influence of the radiant energy of the sun, mainly in people with skin photosensitivity types I and II.

The role of UVR in the pathogenesis of BCC is indicated by the high incidence of BCC in the southern regions, the overwhelming number of patients belonging to the white race, the predominant localization of foci in open areas skin, where the ulcerative form predominates (83%). In persons with insufficient skin pigmentation, rays with a wavelength of 290-320 nm are the main cause of the disease. Skin cancer can occur not only under the influence of natural UV radiation, but also as a result of UV exposure from industrial sources. Increased skin sensitivity to solar insolation can be caused by drugs (tetracyclines, sulfonamides, phenothiazines, thiazides, greseofulvin, etc.) and some herbs, especially if they contain coumarins.

It has been shown that mutations in chromosome 9q22.3 of the human genome can occur under the influence of UV radiation. This is confirmed by the high risk of developing skin cancer in patients with rare hereditary diseases exacerbated by photosensitivity - albinism, xeroderma pigmentosum, nevoid basal cell carcinoma syndrome.

Chemical carcinogens, under the influence of which BCC can develop, can be hydrocarbons of oil, coal, mineral oils, resins, arsenic compounds, insecticides, herbicides, petroleum products, etc. The use of photoactive agents (coal tar, 8-methoxypsoralens) in the treatment of certain diseases , hematoporphyrins) in combination with UV-A skin exposure also leads to an increased risk of skin cancer. Experimentally identified mediators involved in carcinogenesis caused by chemical products. They are represented by a group of pro-inflammatory cytokines, often similar to those under UV exposure.

The role of chemical carcinogens in the pathogenesis of skin cancer is indicated by 25-year epidemiological studies in families where parents were in contact with potential carcinogens in production conditions. The risk of developing a tumor process in children was quite high. In foreign studies, the main focus is on fathers, since in developed countries women are much less likely to be employed in production with harmful working conditions. Studies conducted in Russia, where the share of women in industrial production is up to 46%, revealed a pronounced negative effect of harmful professional factors on parents, which affected the health of children, including the risk of developing cancer.

Radiation radiation in approximately 80% of cases comes from natural sources, including cosmic radiation, UV light and natural radionuclides, especially radon gas. The remaining 20% ​​arise from various man-made sources of radio and microwave radiation, nuclear power plants, etc. The pathological effect of high doses of radiation has been proven, but the total effect of low doses can be harmful to humans. X-ray, gamma and cosmic radiation are referred to as ionizing radiation. There is radiation of elementary particles - electrons, neutrons, mesons and deuterinos. X-ray and gamma radiation at a frequency of 1018-1022 Hz contribute to the emergence of malignant neoplasms of the skin, and ionizing radiation, in addition, - leukemia, osteogenic sarcomas and lung cancer. Diseases often develop 10-20 years after exposure.

The mechanism responsible for late carcinogenesis is not yet well understood. The long latent period between exposure to radiation and the development of cancer is explained by some scientists as the occurrence of the so-called induced genetic instability. Pathological genes can be passed on in a population of cells for several generations.

Anthropogenic contamination of the environment with radionuclides as a result of experimental nuclear explosions, intensive development nuclear power, the use of ionizing radiation sources in industry, transport, agriculture, science, as well as the expanding scope of X-ray and radioisotope research methods in medicine have led to an increase in external and internal human exposure.

Exposure doses from these sources in developed countries are already several times higher than levels of natural background exposure. The latent period for solid tumors depends on the dose of radiation and the age of the person and averages 20-30 years. On the example of the population living around the Semipalatinsk test site, the highest incidence of BCC and melanoma is shown.

An analysis of the history data of 300 patients with BCRC made it possible to study the frequency of exposure to various carcinogens (radiation, microwave radiation, fuels and lubricants, insolation, etc.) on their bodies. More than half (57.7%) of patients with BCC were exposed to carcinogens. Among them, 61.7% had a fairly long contact with fuel and lubricants. More than half (57.3%) were exposed to insolation both at work and at home. Contact with microwave radiation occurred in 31% of patients, exposure to radiation was noted by 28.3%. These factors often overlap. In almost 2/3 of cases, BCRC patients were exposed to 2 or more carcinogens. More often they were 2 (40.7%), less often - 3 (12.8%) and 4 (7.8%). It was shown that the adverse effect of carcinogens (fuel, lubricants, radiation and microwave radiation) most often occurred in hot climates. In 72.5% of patients with BCC, who lived in the southern regions, a combined effect of these factors and insolation was found.

A similar situation was revealed for patients living in different regions with a predominance of the southern (66.4%). The fact of a delayed effect of the action of a carcinogen has been established. Tumors in 68.6% of cases occurred during the retirement period or 12.6 ± 9.3 years after the end of the carcinogen.

The study of the association of skin cancer and antigens of blood groups of the AB0 system, taking into account the impact of factors contributing to carcinogenesis, revealed interesting patterns. It was found that the frequency of BCRC formation, the intensity of growth and size of tumors depended on the conjugation of endo- and exogenous factors. Under the influence of carcinogens, BCC developed 1.7 times more often in patients with II (AO) blood group and 2 times more often in patients with IV (AB). The occurrence of BCC in the majority (82%) of cases occurred in patients exposed to carcinogens for 5 years or more. Statistical processing of the material using the Spearman correlation coefficient showed that certain carcinogens in patients with BCC with different blood groups were associated with the size of tumors. If there was a history of exposure to radiation, large tumors were registered in patients with III and IV blood groups, insolation - in patients with group I, DBS - with II and III blood groups.

Virus-induced carcinogenesis is of particular importance in the pathogenesis of oncological diseases. This is due to the prevalence of viruses and the peculiarity of their life cycle.

Of particular interest in connection with the pronounced oncogenic potential is the human papillomavirus (HPV). The widespread introduction of molecular biological research methods has made it possible to discover more than 200 genes. HPV types. HPV infects basal epithelial cells, and different types of the virus differ in their tropism for different tissues: some are associated with damage to the skin (skin of the hands, feet and face), others infect the mucous membranes of the oral cavity, pharynx, respiratory tract and anogenital region or conjunctiva of the eyes.

There are high and low oncogenic risk HPV. The group of viruses of high oncogenic risk also includes types of the virus that are rarely detected in cancer, but are most often associated with the development of dysplasia of varying degrees. This made it possible to separate them into a separate group - "HPV of medium oncogenic risk".

The products of early HPV genes - E6 and E7, and to a lesser extent E5 have a transforming and carcinogenic potential. The products of these genes interact with the cellular tumor growth suppressor genes p53 and Rb, which leads to their inactivation and uncontrolled growth of infected cells with the accumulation of genomic mutations in them. The affinity of E6 and E7 proteins for p53 and Rb differs in high and low oncogenic HPV types. The presence of HPV DNA in the tissues of benign epithelial tumors and BCRC. In patients with BCC, immunosuppression is determined, affecting the cellular link of immunity, phagocytic activity, the production of endogenous interferons, immunogbulins of classes A, M, G. The most pronounced immunodeficiency was detected in ulcerative, especially recurrent forms of BCC, which make up 64% of all basaliomas.

A decrease in the number of epidermal Langerhans cells in the skin and a violation of their function lead to a decrease in the protective mechanisms of antitumor growth. Of great importance in the differentiation and proliferation of tumor cells are cytokines that regulate apoptosis and other mechanisms of cytotoxicity in malignant neoplasms.

In patients with Gorlin-Goltz syndrome, a decrease in the activity of normal killers to 3% was revealed (at a rate of 50.4%). This leads to a marked deficit cellular immunity in the link responsible for antitumor activity, which is a prerequisite for the development in these patients multiple foci lesions and pathologies of internal organs. Autoimmune disorders also occur in carcinogenesis.

Classifications of basal cell skin cancer

Undifferentiated or poorly differentiated basaliomas:

A) undifferentiated basalioma of predominantly solid structure (sometimes with subtle glandular or piloid differentiation);
b) pigmented basalioma;
c) superficial multicentric basalioma.
Differentiated basaliomas:
a) with glandular differentiation (adenoid basalioma);
b) with piloid differentiation (trichobasalioma); ,
c) with sebaceous differentiation;
d) with squamous epithelial (epidermoid) differentiation;
e) complex structure(with the presence of various types of differentiation).
Special forms of basalioma:
a) scleroderma-like;
b) basalioma of the type of fibroepithelial tumor of Pinkus;
c) basalioma, arising in the wall of the epidermal cyst.

Somewhat later, W. Lever and G. Shaumburg - Lever proposed their own classification of BCC, depending on the type of cells and the direction of their differentiation. The division into three groups was preserved (differentiated, undifferentiated and special forms), poorly differentiated forms were excluded, the distribution of BCC variants related to one form or another was different, new tumor variants were added. In the group of differentiated tumors, the authors included cystic, adenoid, keratotic, granular, and adamantinoma-like variants; in the group of undifferentiated - solid, pigmented, scleroderma-like (morphea) and superficial.
E.S. Snarskaya proposes to keep the division of BCC into differentiated forms (basaliomas with elements of differentiation towards sweat, sebaceous glands or with elements of piloid differentiation) and undifferentiated (superficial, solid, morpheal-like, adenoid) and take into account the possibility of the presence of transitional forms.

A.N. Khlebnikova, on the basis of immunohistochemical methods of research, identified histological types of BCC, depending on the form of cell growth, their function and direction of differentiation without combining them into groups. These include superficial, multicentric, solid, adenoid (adenocystic), solid-adenoid, pigmented, scleroderma-like BCC, with sebaceous differentiation, with piloid differentiation (trichobasalioma), with squamous epithelial (epidermoid) differentiation, and a tumor of complex structure (with the presence of different types of differentiation ).

Using the same method for diagnosing BCC, T. Wade and A. Ackerman proposed their own classification, which already includes 26 independent histological variants of basaliomas, without combining them into groups.
In accordance with the WHO clinical and morphological classification (Lyon, 2006), the following forms of BCRC are distinguished: superficial, nodular, (solid), micronodular, infiltrative, fibroepithelial, BCRC with adnexal differentiation, basal squamous cell (metatypic) cancer, keratotic, cystic , adenoid, morphea-like, infundibulocystic, pigmented and other rare variants.

However, in everyday practice, it is often necessary to confine ourselves to the clinical classification of BCC. According to T. Fitzpatrick, there are five clinical forms: tumor, ulcerative, scleroderma-like, superficial and pigmented. T.P. Pisklakova proposes to distinguish several more clinical forms of BCC: tumor with three varieties (exophytic, papillary and nodular), ulcerative, superficial, pigmented, sclerodermiform (self-scarring) and cystic. R. Raichev and V. Andreev identified two varieties of the surface form of BCRC - pagetoid and erythematous. Currently, the most commonly used classification is B.A. Berenbein, A.M. Vavilov and V.V. Dubensky, allocating superficial, tumor, ulcerative, pigmented and scleroderma-like forms of basalioma.

Features of the course of basal cell skin cancer

According to the literature, the recurrence rate ranges from 10 to 29.2%. The most common (89%) recurrence occurred 5 years after completion of therapy. It is essential that relapses can be single (82%) and repeated (28%). Relapses should be distinguished from the appearance of new foci of proliferative growth in areas of healthy skin, which was observed in 10-20% of patients.

There are differences in the course of primary and recurrent BCC. Observation data of 429 patients with BCC of the eyelids in the ophthalmo-oncological center of the Chelyabinsk Regional Oncological Dispensary (1999-2005) indicate the predominance (2.9 times) of single relapses over multiple ones. In recurrent BCC compared with the primary process, multiple tumors were observed significantly 2.7 times more often (24.5% vs. 9%), 1.6 times more often they were recorded in patients with T2N0M0 stage (36.9% vs. 27.7 %) and 2.2 times more often with T3-4N0M0 (24.6% versus 11%). The dependence of the frequency of relapses on the localization of the tumor was revealed. When it was located on the skin of the lower eyelid with the involvement of the intermarginal space, relapses were observed 1.9 times more often (27.7% versus 15%) than with isolated localization only on the eyelid; 2.2 times more often (24.6% versus 12%) - with a widespread process involving two or more anatomical zones.

In the ulcerative form of BCC, relapses were recorded in 57% of cases, with aggressively growing growth - in 46.7% and mixed growth - in 26.6%.
The number of tumor foci in BCC can be single and multiple. The appearance of neoplasms, according to the definition of primary multiple tumors, can be recorded synchronously (simultaneously), metachronously (successively) and combined.

The incidence of multiple foci of BCC varies widely - from 1 to 21.4%. Differences in the frequency of development of multiple basaliomas can be explained from several positions. First of all, it is necessary to take into account the regional features of the ecological environment where patients with BCC live, and technogenically caused contact with various carcinogens. Secondly, the volume of material analyzed by various researchers. The longer the period of time covered by statistical analysis, the greater the likelihood of registering patients with multiple BCC. Thirdly, the presence of oncological alertness in patients, which is associated with propaganda among them healthy lifestyle life. The earlier the patient turns to a specialist, the less likely it is to have multiple tumors.

Patients with solitary tumors predominated (85.6%) with a disease duration of up to a year. With a duration of the process of more than 12 years, the number of patients with single tumors decreased by 1.9 times (85.6% versus 45.2%), and with multiple tumors it increased by 3.8 times (14.4% versus 54.8% ). It was noted that with multiple basaliomas, superficial forms of BCC are more often recorded. At the same time, the frequency of their registration decreases as the duration of the disease increases.

It was revealed that the superficial form was much less common with the duration of the disease from a year to 12 years and more than 12 years compared with a prescription of up to a year. The incidence of the ulcerative form, on the contrary, increased by 2.6 times (from 1 year to 12 years) and 1.8 times (more than 12 years) compared with the incidence with a prescription of up to a year. Pigmented and scleroderma-like forms were detected in patients only when the duration of the process was from 1 to 6 years. The solid form prevailed in patients with different duration of the process and ranged from 59.6% with the manifestation of the disease more than 12 years ago to 78.4% with the existence of the tumor for a year or less. It is significant that with an increase in the prescription of the disease, the number of patients with a combination of various forms of tumors increased by 5.7 times, from 4.6% (up to a year) to 26.2% (more than 12 years). The superficial form was more common with prescription up to a year and in patients with multiple lesions. Ulceration of the tumor occurred a year after its occurrence. Pigmented and scleroderma-like forms of BCC were formed when the duration of the disease was from 1 to 6 years.

Multiple basaliomas may be manifestations of genetic syndromes, in particular Gorlin-Goltz syndrome and xeroderma pigmentosa. In these cases, BCC may first occur in childhood and adolescence.

Gorlin-Goltz syndrome (basal cell carcinoma syndrome, nevoid basal cell carcinoma syndrome) is a genetically determined disease, the main symptom of which is the multiple nature of BCC in combination with malformations of the nervous, endocrine systems, skeleton, eyes and other organs and tissues. In this syndrome, the presence of mutations in the PTCH gene located at the chromosomal locus 9q 22.3 q31 has been proven. In patients with Gorlin-Goltz syndrome, various malformations are revealed - palmoplantar depressions, odontogenic cysts, bone cysts, hypertelorism, keeled chest, rib splitting, congenital blindness, cataracts, etc. The frequency of the syndrome in the population is estimated as 1:56 000 and accounts for 0.5% of cases of all basapiomas, and 6.7% in the structure of multiple basapiomas.

At the same time, it should be remembered that multiple basaliomas do not always indicate the presence of Gorlin-Goltz syndrome. In addition to the absence of malformations of the nervous, endocrine systems, skeleton, eyes and other organs and tissues, there are other clinical criteria. The average age of patients with Gorlin-Goltz syndrome is 46.7 years, the average number of foci of proliferative growth is 25.1, which are localized in equal proportion on open and closed areas of the skin. The appearance of multiple basaliomas is the priority of patients with an average age of 63.9 years, the average number of foci is 3.7 with their predominant localization in open areas.
Multiple BCC may be a manifestation of a rare genetic syndrome, xeroderma pigmentosum. It occurs when each parent passes on to the child a recessive mutant gene responsible for reparative DNA synthesis. Pigmentary xeroderma is characterized by increased sensitivity of the skin to ultraviolet rays and ionizing radiation. The frequency of the disease among representatives of the European population is 1:250,000. Early symptoms that occur in the first three years of life are photodermatitis, photophobia, conjunctivitis. After 10-15 years, BCC develops, which can be multiple.

BCRC can be combined with malignant tumors of the skin and other organs. The frequency of such a clinical picture is almost the same in different regions of the Russian Federation: 7% - Chelyabinsk region, 10.7% - Middle Urals, 8% - Moscow region. More often, BCC precedes the development of and/or is combined with tumors of the colon.

BCC is localized mainly in open areas of the skin. Almost in 3/4 (72.7%) of patients, BCC occurs on the scalp, in a small part of patients (8.7%) on the skin of the trunk and in single observations on the lower extremities (2.3%), neck (1.7 %) and upper limbs (1%). In 13.6% of cases, tumors were located in two or more anatomical regions.

Quantitative assessment of tumor localizations was carried out. To do this, they were completely counted in 300 patients with BCC, taking into account the topics of the process. The association between the frequency of development and the average number of tumors in different parts of the skin, including different anatomical areas of the head, was revealed. The highest rates were registered in the head area (83.3% and 1.4, respectively). Both indicators were significantly lower in the localization of tumors in both open and closed areas of the skin of the trunk and extremities. At the same time, on the skin of the trunk (21.3% and 0.42) and lower extremities(6.3% and 0.07) the scores were higher than in the assessment of the skin of the neck (3.7% and 0.04) and upper extremities (3.3% and 0.11). The data obtained indicate that insolation does not always play a leading role in the pathogenesis of the disease.

When analyzing the localization of BCC on the head, the rates of development and the average number of tumors were the highest in the nose (21.7% and 0.27), in the periorbital region (19.7% and 0.21), on the skin of the cheeks (15% and 0.22), auricle and external auditory canal (15.4% and 0.17), as well as the forehead (13.7% and 0.19). The indicators were slightly lower when assessing the skin of the scalp (11.7% and 0.16) and temples (10.7% and 0.12) and minimal when calculating the incidence and average number of tumors on the skin of the lips (2.7% and 0.03) and nasolabial folds (1.7% and 0.02).

Conclusion

Basalioma (squamous cell carcinoma, basal cell epithelioma) is a type of skin cancer. The tumor develops in the basal layer of epithelial tissues from atypical cells of the epidermis and follicular epithelium, does not metastasize. The neoplasm looks like a nodule and is capable of destroying bone and cartilage tissue.

Photo

Symptoms of basalioma

Immunotherapy

For the treatment of basalioma of the skin of the face, the method of immunotherapy is used, which involves the use of a special ointment - imiquod. The tool stimulates the body's production of a sick interferon, which helps in the fight against atypical cells. As a rule, basalioma of the nose is treated with a cream, since this method of therapy does not leave scars. Imiquod is often used before starting chemotherapy.

Medical treatment

In the initial stages and with superficial forms, with contraindications or inability to apply radiation treatment resort to drug therapy. For this, omain ointment is used in the form of daily applications. Antitumor antibiotics are also prescribed - bleomycins, which are administered intravenously at 15 mg 2-3 times a week. The total dose is 300-400 mg.

Photodynamic treatment

The treatment consists in the introduction of special substances (photosensitizers) under the skin that highlight the clear boundaries of the tumor, which is then irradiated with light waves. With facial basalioma, the photodynamic method is a priority therapy option, since it does not lead to cosmetic defects.

cryogenic destruction

Destruction of the tumor by freezing. This method of treatment in some cases is superior to the results of treatment by other methods. With the help of special equipment (cryoprobes) the tumor is frozen using a liquid nitrogen. Advantages of cryotherapy:

Wound healing after cryodestruction is characterized by the absence of cosmetic defects, which eliminates the need for additional plastic surgery. This is important when the tumor is located on the face.

The method is used if the patient's condition or the location of the basalioma does not allow for surgical removal. Radiation therapy is done by irradiation with short-focus gamma radiation. The results of radiation therapy are aesthetically better than surgical removal of the basalioma. The only drawback of the method is the duration of treatment (on average 20-25 sessions).

Surgical removal of a basalioma

Surgery is performed on an outpatient basis, under local anesthesia.

The tumor is excised widely - for “reinsurance”, doctors capture another five millimeters around the basalioma in order to minimize the risk of relapse after recovery. Since this method of solving a problem on the face is difficult due to a cosmetic defect after the operation, doctors in open areas use other methods, and operations are performed only on the body.

In some cases, in addition to surgical or destructive methods of treatment, cytostatic drugs (prospidin and bleomycin) are prescribed. In order to raise immunity, folk remedies are used.

Basalioma

Basalioma

Basalioma(basal cell carcinoma) is a malignant tumor of the skin. develops from epidermal cells. It got its name because of the similarity of tumor cells with the cells of the basal layer of the skin. Basalioma has the main signs of a malignant neoplasm: it grows into neighboring tissues and destroys them, recurs even after the correct treatment has been performed. But unlike other malignant tumors, basalioma practically does not metastasize.

Causes of basalioma

Basalioma occurs mainly in people over 40 years of age. Factors contributing to its development include frequent and prolonged exposure to direct sunlight. Therefore, residents of southern countries and people working in the sun are more susceptible to basalioma. Light-skinned people get sick more often than dark-skinned people. Contact with toxic substances and carcinogens (petroleum products, arsenic, etc.), permanent injury to a certain area of ​​the skin, scars. burns. ionizing radiation are also factors that increase the risk of basalioma. Risk factors include a decrease in immunity against the background of immunosuppressant therapy or a long-term illness.

The occurrence of basalioma in a child or adolescent is unlikely. However, there is a congenital form of basalioma - Gorlin-Goltz syndrome (neobazocellular syndrome), which combines a flat superficial form of the tumor, mandibular bone cysts, malformations of the ribs and other anomalies.

Basalioma classification

The following clinical forms of basalioma are distinguished:

Symptoms of basalioma

Most often, basalioma is located on the face or neck. The development of the tumor begins with the appearance on the skin of a small nodule of pale pink, reddish or flesh-colored. At the beginning of the disease, the nodule may resemble a common pimple. It grows slowly without causing any pain. A grayish crust appears in its center. After its removal, a small depression remains on the skin, which soon becomes covered with a crust again. Characteristic of basalioma is the presence of a dense roller around the tumor, which is clearly visible when the skin is stretched. The small granular formations that make up the roller look like pearls.

Further growth of the basalioma in some cases leads to the formation of new nodules, which eventually begin to merge with each other. Expansion of superficial vessels leads to the appearance of "spider veins" in the tumor area. Ulceration may occur in the center of the tumor with gradual increase the size of the ulcer and its partial scarring. Increasing in size, the basalioma can grow into the surrounding tissues, including cartilage and bones, causing severe pain.

Nodular-ulcerative basalioma is characterized by the appearance of a seal protruding above the skin, which has a rounded shape and looks like a nodule. Over time, the seal increases and ulcerates, its outlines acquire an irregular shape. A characteristic "pearl" belt is formed around the nodule. In most cases, nodular-ulcerative basalioma is located on the eyelid, in the region of the nasolabial fold, or in the inner corner of the eye.

The perforating form of basalioma occurs mainly in those places where the skin is constantly injured. From the nodular-ulcerative form of the tumor, it is distinguished by rapid growth and pronounced destruction of surrounding tissues. Warty (papillary, exophytic) basalioma resembles cauliflower in its appearance. It is a dense hemispherical nodules growing on the surface of the skin. A feature of the warty form of basalioma is the absence of destruction and germination in the surrounding healthy tissues.

A nodular (large-nodular) basalioma is a single nodule protruding above the skin, on the surface of which "spider veins" are visible. The node does not grow deep into the tissues, like a nodular-ulcerative basalioma, but outward. The pigmented form of basalioma has a characteristic appearance - a nodule with a "pearl" roller surrounding it. But dark pigmentation of the center or edges of the tumor makes it look like melanoma. Sclerodermiform basalioma differs in that the characteristic nodule of pale color, as it grows, turns into a flat and dense plaque, the edges of which have a clear contour. The surface of the plaque is rough and may ulcerate over time.

The cicatricial-atrophic form of basalioma also begins with the formation of a nodule. As the tumor grows in its center, destruction occurs with the formation of an ulcer. Gradually, the ulcer increases and approaches the edge of the tumor, while scarring occurs in the center of the ulcer. The tumor acquires specific kind with a scar in the center and an ulcerated edge, in the area of ​​which tumor growth continues.

Flat superficial basalioma (pagetoid epithelioma) is a multiple neoplasm up to 4 cm in size, which do not grow into the depth of the skin and do not rise above its surface. The formations have a different color from pale pinkish to red and raised "pearl" edges. Such a basalioma develops over several decades and has a benign course.

Spiegler's tumor ("turban" tumor, cylindroma) is a multiple tumor consisting of pink-violet nodes covered with telangiectasias ranging in size from 1 to 10 cm. Spiegler's basalioma is localized on the scalp, has a long benign course.

Complications of basalioma

Although basalioma is a type of skin cancer. it has a relatively benign course, since it does not metastasize. The main complications of basalioma are related to the fact that it can spread to surrounding tissues, causing their destruction. Severe complications up to death occur when the process affects the bones, ears, eyes, membranes of the brain, etc.

Diagnosis is carried out by cytological and histological examination of a scraping or smear-imprint taken from the surface of the tumor. During the study under a microscope, strands or nest-like clusters of cells of a round, spindle-shaped or oval shape are found. On the edge of the cell is surrounded by a thin rim of the cytoplasm.

However, the histological picture of basalioma is as diverse as its clinical forms. Therefore, its clinical and cytological differential diagnosis with other skin diseases plays an important role. Flat superficial basalioma is differentiated from lupus erythematosus. lichen planus. seborrheic keratosis and Bowen's disease. Sclerodermiform basalioma is differentiated from scleroderma and psoriasis. pigmented form - from melanoma. If necessary, additional laboratory tests are carried out to exclude diseases similar to basalioma.

Basalioma treatment

The method of treatment of basalioma is selected individually depending on the size of the tumor, its location, clinical form and morphological appearance, the degree of germination in neighboring tissues. Primary is the occurrence of a tumor or recurrence. The results of previous treatment, age and concomitant diseases of the patient are taken into account.

Surgical removal of a basalioma is the most effective and most common way to treat it. The operation is performed with limited tumors located in relatively safe for surgical intervention places. The resistance of the basalioma to radiation therapy or its recurrence is also an indication for surgical removal. In case of sclerodermiform basalioma or tumor recurrence, excision is performed using a surgical microscope.

Cryodestruction of basalioma with liquid nitrogen - fast and painless procedure, however, it is effective only in cases of superficial location of the tumor and does not exclude the occurrence of relapse. Radiation therapy of basalioma with a small size of the stage I-II process is carried out by close-focus X-ray therapy of the affected area. In the case of an extensive lesion, the latter is combined with remote gamma therapy. In difficult cases (frequent recurrences, large tumor size or deep germination), radiotherapy can be combined with surgical treatment.

Laser removal of basal cell carcinoma is well suited for older people in whom surgical treatment can cause complications. It is also used in the case of localization of basalioma on the face, as it gives a good cosmetic effect. Local chemotherapy of basalioma is carried out by applying applications of cytostatics (fluorouracil, metatrexate, etc.) to the affected areas of the skin.

Basalioma prognosis

In general, due to the absence of metastasis, the prognosis of the disease is favorable. But in advanced stages and in the absence adequate treatment the prognosis of a basalioma can be very serious.

Early treatment of basalioma is of great importance for recovery. Due to the tendency of basalioma to recur frequently, a tumor larger than 20 mm is already considered advanced. If the treatment is carried out until the tumor has reached such a size and has not begun to grow into the subcutaneous tissue, then in 95-98% there is a stable cure. When the basalioma spreads to the underlying tissues, significant cosmetic defects remain after treatment.

Basalioma(basal cell carcinoma or basal epithelioma) is a special skin neoplasm that develops in the upper (basal) layer of the skin or hair follicles, which can grow for years, but rarely metastasizes. It mainly develops in men and women with fair skin who have reached the age of 45-50, and practically does not occur in children and adolescents. In most cases, if the basalioma is determined and removed within 2 years from the moment of its occurrence, the patient recovers completely.

Basalioma, classified according to the ICD classification as skin cancer, can develop on a healthy epidermis as a result of burns, under the action of carcinogens, excess sunlight or X-rays. Of no small importance is the genetic predisposition to the disease and various immune disorders that have arisen in the patient's body. There are theories pointing to the connection of basalioma and a number of mutations in the genome, leading to a weakening of control over the development and differentiation of skin cells.

In addition, a direct relationship was found between the occurrence of basalioma and the age of a person, as well as the color of his skin. In particular, white skin is a significant factor that provokes the appearance of basal cell carcinoma.

The disease often occurs against the background of various skin pathologies, such as, psoriasis, senile keratosis, tuberculous lupus, radiodermatitis, various nevi and others. Another important cause of basal cell carcinoma is decreased immunity. caused by long-term use of corticosteroid drugs.

Symptoms of basalioma of the skin

Basalioma has the appearance of a small single plaque, rising above the level of the skin and consisting of numerous small nodules. The color of the tumor may be pink or pinkish red, but may not differ from the shade of healthy human skin. Usually, a small depression forms in its center, covered with a thin crust, under which bleeding erosion is found. Along the edges of the sore there are valo-shaped thickenings of numerous nodules - "pearls" that have a characteristic mother-of-pearl hue.

The initial stage of development of basal cell carcinoma practically does not give any clinical symptoms. Basically, patients complain about the appearance of a constantly growing tumor on the skin of the face, lips and nose, which does not hurt, only sometimes causes slight itching.

Depending on the size and degree of local spread of the basalioma, there are four clinical stages of the development of the disease:

I. The size of the basalioma of the formation does not exceed 2 cm and is surrounded by a healthy dermis.

II. The tumor has a diameter of more than 2 cm, grows through the entire depth of the skin, but does not capture the subcutaneous fat layer.

III. Ulcer or plaque reaches any size, capturing everything soft tissues lying underneath.

IV. A tumor-like neoplasm affects nearby soft tissues, including cartilage and bones.

In about 10% of cases, a multiple form of basalioma occurs, when the number of plaques reaches several tens or more, being a manifestation of non-basal cellular Gorlin-Goltz syndrome .

The disease is diagnosed by conducting clinical and laboratory studies, including:

1. Examination of the scalp, skin and visible mucous membranes of the patient, including visual examination of the location of the basalioma with a magnifying glass. In this case, the shape, color and presence of gleaming "pearl" nodules along the edges of the tumor are necessarily noted.

2. Palpation of regional and distant lymph nodes for their enlargement.

70% of all neoplastic diseases skin - a variety of basaliomas.

45-50% of people over the age of 65 suffer from skin basalioma.

In 85% of cases, basal cell carcinoma occurs in exposed areas of the scalp.

Black people practically do not get sick with basalioma of the skin.

Basalioma is more common in rural residents, who are more exposed to intense solar radiation than in urban residents.

3. Collection of histological material by various methods: scraping, smear or puncture biopsy. The method is selected depending on the type and condition of the tumor, its surface is previously cleaned of dry crusts. If the basalioma is an ulcer, an imprint smear is taken from it by applying a glass slide to the ulcerated surface. A puncture is taken only from sufficiently large tumors with an intact surface. Scraping from the skin formation is performed with a scalpel, the resulting material is immediately applied and distributed on a glass slide.

4. Carrying out an ultrasound examination to determine the true size of the basalioma and the depth of the inflamed tissues.

The final diagnosis is established on the basis of the clinic and the results of histology.

Taking into account the main symptoms of basalioma, the following forms can be distinguished:

nodular-ulcerative ;

fibroepithelial ;

pigmented ;

superficial ;

scleroderma-like morphea type.

Usually, superficial basalioma starts with the appearance pale pink spots with a diameter of not more than 5 mm, which is constantly peeling and gradually acquires clear rounded, oval or irregular outlines. After some time, the edges of focal inflammation thicken, numerous shiny nodules appear, forming a thin roller. Its center begins to sink slightly and acquires a dark pink or brown hue. Gradually, the tumor grows slowly and reaches significant values, resembling Bowen's disease. At the same time, it begins to destroy local tissues or grows on the surface of the skin, practically without destroying the deep layers of subcutaneous tissue.

Pigmentary basalioma. belonging to the varieties of superficial basalioma, it differs in the color of the tumor, which has a characteristic dark brown, bluish or purple color. This shade occurs due to diffuse pigmentation resulting from the formation of a large number of colored cells with high content melanin granules, both in the tumor and throughout the entire thickness of the epidermis. Pigmentary basalioma is often confused with other dangerous skin cancers. In particular, nodular melanoma has similar features, however, in terms of its consistency, basal cell carcinoma has a denser structure.

nodal or nodular basalioma often begins with a hemispherical nodule, painted in a pale pink color, through the walls of which small blood vessels shine through. After several years, it acquires a flat shape, reaching a large size - more than 2 cm. Quite often, an ulcer occurs in the central part of the basalioma, penetrating deep into the skin, surrounded by a strip of inflamed tissue up to 1 cm wide. A favorite localization site for such a tumor is the forehead, chin or base of the nose.

Solid basalioma is considered to be a large-nodular form and is most common in patients. It is characterized by a single nodule, rising above the epidermis, and growing not deep into the skin, but above its surface.

Tumor basalioma develops from a single nodule, gradually increasing in size and acquiring a rounded shape. Its surface is mostly smooth, sometimes covered with small grayish scales. In some cases, the tumor acquires a pink color and reaches a diameter of more than 3 cm. A small sanious sore, covered with dense scales, forms in its center. Depending on the size of the neoplasm, large- and small-nodular tumor basalioma are distinguished.

Ulcerative basalioma is distinguished by a funnel-shaped sore, around which it is easy to notice a massive compaction of tissues with fuzzy boundaries. The infiltrate can be several times the size of the ulcer, cause pain when pressed and gradually increase in size, capturing neighboring areas. Sometimes the development of an ulcer focus is accompanied by growths in the form of warts and papillomas.

In 98% of cases, if the treatment of basalioma is started on early stages, full recovery occurs. In the last stages of the tumor after excision, recurrence occurs in 50% of cases.

Scleroderma-like or cicatricial atrophic basalioma characterized by a small lesion that has a yellowish-whitish color and is almost invisible on the skin. Periodically, erosion occurs along the edges of the formation. different sizes covered with a thin crust, which is easily separated and reveals a reddish inflammation underneath. This type of basalioma is characterized by a large proliferation of scleroderma-like connective tissue, extending deep into the skin up to the subcutaneous tissue. In the future, destructive changes lead to the formation of small and larger cystic cavities, sometimes accumulating crystals of calcium salts.

Fibroepithelial basalioma or pinkus tumor- a rare type of basalioma, manifested in the form of a plaque or nodule that does not differ in color from healthy skin. Basically, the tumor occurs in the lumbosacral region of the back, has a dense texture and, in extremely rare cases, is eroded. The disease is often combined with seborrhea, it may look like fibropapilloma.

Non-basocellular Gordin-Goltz syndrome, which occurs against the background of violations of the embryonic development of the fetus, refers to hereditary diseases that combine the pathology of the skin, eyes, internal organs and the nervous system. Basically, its main symptom is the formation of multiple basaliomas, accompanied by an anomaly of the ribs, jaw cysts. Quite often, tumors occur against the background of changes in the skin of the soles and palms, on which peculiar “indentations” are formed - thinned layers of the epidermis with additional small processes. Large basaliomas in these areas are practically not formed. Much less often, the syndrome develops along with cataracts and diseases of the central nervous system.

Treatment of skin basalioma

In the treatment of basalioma, various conservative and radical methods are used, the choice of which depends on the type, nature and number of tumors, the age and sex of the patient, and the presence of concomitant diseases:

1. Surgical removal is used for non-aggressive basaliomas located in the back or chest of the patient. The tumor is excised with a scalpel with an indent of 2 cm on healthy tissues, the wound is closed skin flap or skin stretched from the sides of the incision. In order to prevent relapse and more serious consequences one-time radiation therapy up to 3 Gy is carried out.

2. If the tumor has grown deep into the tissue and cannot be removed surgically, irradiation is performed, the total dose of which can be 50-75 Gy.

3. Diathermocoagulation and curettage remove small tumors, with a diameter of up to 0.7 mm, after anesthetizing the operation site.

4. Cryodestruction - nitrogen freezing of small superficial basaliomas, not exceeding 3 cm in diameter, localized on the nose or forehead. It is not used in the treatment of tumors located in the corner of the eye, on the nose, or on part of the ear.

5. Laser destruction is especially effective if a relapse occurs at the site of the removed tumor.

6. Photodynamic therapy (PDT) is used for basal cell carcinoma located in hard-to-reach places, for example, on the skin of the eyelid, or having multiple nodular formations. PDT provides a good cosmetic effect, almost completely eliminates the risk of complications.

7. In the treatment of solitary basaliomas with a diameter of less than 2 cm, a carbon dioxide laser or intron A is used, which is injected directly into the lesion.

8. X-ray therapy is rarely used, as a rule, in the treatment of tumors located next to natural openings or when surgery or other treatments for basal cell carcinoma have not worked as expected.

9. Local therapy with various drugs: omain, prospedin or fluorouracil ointment.

In addition, the patient should be observed by an oncologist-dermatologist, take preventive measures to protect the skin from aggressive chemical compounds, ionizing radiation and excessive insolation.

There are folk remedies used in the treatment of basalioma. In particular, celandine or burdock juice is popular, which is used to treat the site of tumor formation. However, it should be understood that such a serious oncology as stages 3 and 4 of basal cell carcinoma require modern methods of treatment with the participation of an experienced and professional doctor.

Basalioma - photo classification, varieties.

Features of photo-classification of basalioma.

In the presented photos, the basalioma in each of its main options. Attempts have been made to classify basal cell carcinomas based on growth patterns or differentiation patterns, but such methods have not gained general acceptance.

Most often, basal cell carcinoma has one of three subtypes: nodular, superficial, or ulcerative.

Nodular basalioma in the photo.

This is the most common type of basalioma, accounting for about 60% of all primary cases. It has the appearance of a raised, translucent papule or nodule with vasodilatation on the surface (telangiectasia). Such a nodule may ulcerate, have pigment inclusions. Most often, nodular basalioma appears on the head and neck, you will notice this in the photo. Over time, the borders become roller-shaped and pearly, while the central part ulcerates - a so-called corroding ulcer is formed. The nodular variant of basalioma without treatment grows large and spreads deep, destroying the eyelids, nose or ears. In large lesions, tissue destruction and ulceration often dominate the picture, so that it is not always easy to recognize the true nature of the disease.

Skin cancer

Skin cancer

Among the total number of malignant tumors, skin cancer is about 10%. Currently, dermatology notes an upward trend in incidence with an average annual increase of 4.4%. Most often, skin cancer develops in older people, regardless of their gender. The most predisposed to the occurrence of the disease are fair-skinned people, people living in conditions of increased insolation (hot countries, highlands) and staying for a long time on outdoors.

In the general structure of skin cancer, 11-25% is squamous cell carcinoma and about 60-75% is basal cell carcinoma. Since the development of squamous cell and basal cell skin cancer originates from the cells of the epidermis, these diseases are also referred to as malignant epitheliomas.

Causes of Skin Cancer

Among the causes of malignant degeneration of skin cells, in the first place is excessive ultraviolet radiation. This is proved by the fact that almost 90% of skin cancer cases develop in open areas of the body (face, neck), which are most often exposed to radiation. Moreover, for people with fair skin, exposure to UV rays is the most dangerous.

The occurrence of skin cancer can be triggered by exposure to various chemicals that have a carcinogenic effect: tar, lubricants, arsenic, tobacco smoke particles. Radioactive and thermal factors acting on the skin can lead to the appearance of cancer. So, skin cancer can develop at the site of a burn or as a complication of radiation dermatitis. Frequent traumatization of scars or moles can cause their malignant transformation with the onset of skin cancer.

Predisposing to the appearance of skin cancer may be hereditary characteristics of the body, which causes family cases of the disease. In addition, some skin diseases have the ability to undergo malignant degeneration into skin cancer over time. Such diseases are classified as precancerous conditions. Their list includes erythroplasia of Queyra. Bowen's disease. xeroderma pigmentosum. leukoplakia. senile keratoma. skin horn, Dubreuil's melanosis. melanoma dangerous nevi (complex pigmented nevus, blue nevus, giant nevus, nevus Ota) and chronic inflammatory skin lesions (trophic ulcers, tuberculosis, syphilis, SLE, etc.).

Skin cancer classification

The following forms of skin cancer are distinguished:

1. Squamous cell skin cancer(squamous cell carcinoma) - develops from flat cells of the surface layer of the epidermis.
2. Basal cell skin cancer(basalioma) - occurs during atypical degeneration of the basal cells of the epidermis, which have a rounded shape and are located under a layer of flat cells.
3. Skin adenocarcinoma- a rare malignant tumor that develops from the sebaceous or sweat glands.
4. Melanoma- skin cancer arising from its pigment cells - melanocytes. Considering a number of features of melanoma. many modern authors identify the concept of "skin cancer" only with non-melanoma cancer.

To assess the prevalence and stage of the process in non-melanoma skin cancer, the international TNM classification is used.

T - the prevalence of the primary tumor

5. TX - unable to assess the tumor due to lack of data
6. TO - the tumor is not determined.
7. Tis - cancer in situ (preinvasive carcinoma).
8. TI - tumor size up to 2 cm.
9. T2 - tumor size up to 5 cm.
10. TZ - the size of the tumor is more than 5 cm.
11. T4 - skin cancer grows into the underlying deep tissues: muscles, cartilage or bones.

N - condition of the lymph nodes

• NX - it is impossible to assess the state of regional lymph nodes due to lack of data.
• N0 - signs of metastases in regional lymph nodes were not detected.
• N1 - there is a metastatic lesion of regional lymph nodes.

M - the presence of metastasis

• MX - lack of data regarding the presence of distant metastases.
• MO - signs of distant metastases were not detected.
• M1 - the presence of distant metastases of skin cancer.

Assessment of the degree of differentiation of tumor cells is made within the histopathological classification of skin cancer.

Skin Cancer Symptoms

Squamous cell skin cancer is characterized by rapid growth and spread both over the surface of the skin and in depth. The germination of the tumor in the tissues located under the skin (muscle, bone, cartilage) or the attachment of inflammation is accompanied by the appearance of pain. Squamous cell skin cancer may present as an ulcer, plaque, or nodule.

The ulcerative variant of squamous cell skin cancer has the appearance of a crater-shaped ulcer, surrounded, like a roller, by dense raised and abruptly breaking edges. The ulcer has an uneven bottom, covered with crusts of dried serous-bloody exudate. It gives off a rather unpleasant smell.

The plaque of squamous cell carcinoma of the skin is characterized by a bright red color, a dense texture and a bumpy surface. It often bleeds and quickly increases in size.

The lumpy surface of the nodule in squamous cell skin cancer makes it look like a cauliflower or mushroom. High density, bright red or brown color of the tumor node is characteristic. Its surface may erode or ulcerate.

Basal cell skin cancer is more benign and slower than squamous cell carcinoma. Only in advanced cases does it grow into the underlying tissues and cause pain. Metastasis is usually absent. Basal cell skin cancer is highly polymorphic. It can be represented by nodular-ulcerative, warty, perforating, cicatricial-atrophic, pigmented, nodular, sclerodermiform, flat superficial and "turban" forms. The onset of most clinical variants of basalioma occurs with the formation of a single small nodule on the skin. In some cases, neoplasms may be multiple.

Skin adenocarcinoma most often occurs in areas rich in sweat and sebaceous glands. These are armpits, inguinal region, folds under the mammary glands, etc. Adenocarcinoma begins with the formation of an isolated node or small papule. This rare type of skin cancer is characterized by slow growth. Only in some cases, adenocarcinoma can reach large sizes (about 8 cm in diameter) and grow into muscles and fascia.

Melanoma in most cases is a pigmented tumor that is black, brown or gray in color. However, there are cases of depigmented melanomas. During the growth of melanoma skin cancer, a horizontal and a vertical phase are distinguished. Its clinical variants are represented by lentigo melanoma. superficial spreading melanoma and nodular melanoma.

Complications of skin cancer

Skin cancer, spreading deep into the tissues, causes their destruction. Given the frequent localization of skin cancer on the face, the process can affect the ears, eyes, paranasal sinuses, and the brain, which leads to loss of hearing and vision, the development of sinusitis and meningitis of malignant origin, and damage to vital brain structures, even death.

Metastasis of skin cancer occurs primarily through the lymphatic vessels with the development of malignant lesions of regional lymph nodes (cervical, axillary, inguinal). In this case, compaction and an increase in the affected lymph nodes, their painlessness and mobility during probing are revealed. Over time, the lymph node becomes soldered to the tissues surrounding it, as a result of which it loses mobility. Soreness appears. Then the lymph node disintegrates with the formation of an ulcerative defect of the skin located above it.

Diagnosis of skin cancer

Patients with suspected skin cancer should be consulted by a dermato-oncologist. The doctor conducts an examination of the formation and other areas of the skin, palpation of regional lymph nodes, dermatoscopy. Determination of the depth of tumor germination and the prevalence of the process can be done using ultrasound. For pigmented formations, siascopy is additionally indicated.

Only a cytological and histological examination can finally confirm or refute the diagnosis of skin cancer. A cytological examination is performed by microscopy of specially stained smears-imprints made from the surface of cancerous ulcers or erosions. Histological diagnosis of skin cancer is carried out on the material obtained after removal of the neoplasm or by skin biopsy. If the integrity of the skin over the tumor node is not broken, then the biopsy material is taken using the puncture method. According to indications, a biopsy of the lymph node is performed. Histology reveals the presence of atypical cells, establishes their origin (flat, basal, melanocytes, glandular) and the degree of differentiation.

When diagnosing skin cancer, in some cases it is necessary to exclude its secondary nature, that is, the presence of a primary tumor of the internal organs. This is especially true for adenocarcinomas of the skin. For this purpose, ultrasound of the organs abdominal cavity. lung radiography. CT of the kidneys. contrast urography. skeletal scintigraphy. MRI and CT of the brain, etc. The same examinations are necessary in the diagnosis of distant metastases or cases of deep germination of skin cancer.

Skin Cancer Treatment

The choice of a method for treating skin cancer is determined in accordance with its type, the prevalence of the process, and the degree of differentiation of cancer cells. The localization of skin cancer and the age of the patient are also taken into account.

The main task in the treatment of skin cancer is its radical removal. Most often, it is carried out by surgical excision of pathologically altered tissues. The operation is performed with the capture of apparently healthy tissues by 1-2 cm. Perform the operation with a minimum capture of healthy tissues at the maximum complete removal of all tumor cells of skin cancer allows microscopic intraoperative examination of the marginal zone of the removed formation. Excision of skin cancer can be performed using a neodymium or carbon dioxide laser, which reduces bleeding during surgery and gives a good cosmetic result.

For small tumors (up to 1-2 cm), with a slight germination of skin cancer in the surrounding tissues, electrocoagulation can be used. curettage or laser removal. When conducting electrocoagulation, the recommended capture of healthy tissues is 5-10 mm. Superficial highly differentiated and minimally invasive forms of skin cancer can be subjected to cryodestruction with the capture of healthy tissues by 2-2.5 cm. .

Skin cancer that affects a small area can be effectively treated with close-focus X-ray therapy. Electron beam irradiation is used to treat superficial but large skin cancers. Radiation therapy after tumor removal is indicated for patients with a high risk of metastasis and in case of recurrence of skin cancer. Radiation therapy is also used to suppress metastases and as a palliative treatment for inoperable skin cancer.

It is possible to use photodynamic therapy for skin cancer, in which irradiation is carried out against the background of the introduction of photosensitizers. With basalioma, local chemotherapy with cytostatics gives a positive effect.

Prevention of skin cancer

Preventive measures aimed at preventing skin cancer consist in protecting the skin from the effects of adverse chemical, radiation, ultraviolet, traumatic, thermal, and other effects. Avoid open sunlight, especially during the period of greatest solar activity, use various sun protection. Workers in the chemical industry and those involved in radiation exposure must follow safety rules and use protective equipment.

Monitoring of patients with precancerous skin diseases is important. Regular examinations by a dermatologist or dermato-oncologist in such cases are aimed at timely detection signs of degeneration of the disease into skin cancer. Prevention of the transformation of melanoma-dangerous nevi into skin cancer lies in the correct choice of treatment tactics and the method of their removal.

Skin cancer prognosis

Mortality rates for skin cancer are among the lowest compared to other cancers. The prognosis largely depends on the type of skin cancer and the degree of differentiation of tumor cells. Basal cell skin cancer has a more benign course without metastasis. With adequately carried out timely treatment of squamous cell skin cancer, the 5-year survival rate of patients is 95%. The most unfavorable prognosis is in patients with melanoma, in which the 5-year survival rate is only 50%.

Basalioma of the skin

Skin basalioma or cancer in the form of a neoplasm that has developed from a cell of the skin basal layer is characterized by slow growth and the absence of metastases. Whether a neoplasm is benign or malignant in medicine there is still no consensus. Many consider it an intermediate stage between benign and malignant tumors.

Basalioma- skin cancer occurs in 70-75% of all cases of malignant neoplasms of the skin. 26 men and 21 women can get sick with basalioma per 100 thousand of the population. This skin disease is more common in the South of Russia, in the Rostov and Astrakhan regions, Stavropol and Krasnodar regions.

In the risk zone of the disease are fair-skinned people and those who work for a long time in the open air: fishermen, builders, agricultural workers and workers repairing roads.

Basalioma of the skin, what is it?

Despite the absence of metastases, basalioma, like any other malignant neoplasm. can germinate and destroy neighboring tissues, recur after a properly performed treatment. It is selected in each case individually in accordance with the characteristics of the tumor.

Basal cell skin cancer

Not knowing what a basalioma looks like, what it is, many, when one or more fused nodules rising above the skin are found on the skin, do not pay attention to them, because they do not experience pain in these places in the early stages.

After some time, the nodule takes the form of a yellow or off-white plaque with a surface covered with scales. Usually people tend to tear off the crust, under which bleeding from the capillary can occur. When they notice that the formation begins to ulcerate, patients understand that they need to contact a dermatologist. Experienced specialists immediately refer patients to an oncologist, since basalioma can be suspected by one type of tumor.

Forms of basalioma - classification

Most often, the tumor forms (basalioma) on the head:

The classification includes the following forms or types of basalioma:

Clinical classification:

Designations and their interpretation:

Stages of basalioma

Since a basalioma in its initial stage (stage T0) looks like an immature tumor or preinvasive carcinoma (carcinoma in situ - Tis), it is difficult to determine it despite the appearance of cancer cells.

The prevalence of basalioma

We explain how to determine the basalioma according to a simpler classification. It includes basalioma:

The initial stage includes T0 and T1 accurate classification. Basaliomas appear as small nodules less than 2 cm in diameter. There are no ulcerations.

The extended stage includes T2 and T3. The tumor will be large, up to 5 cm or more with primary ulceration and soft tissue lesions.

The terminal stage includes T4 accurate classification. The tumor grows up to 10 or more centimeters, grows into the underlying tissues and organs. In this case, multiple complications may develop due to the destruction of organs.

Risk Factors for Basalioma

Children and teenagers rarely get this type of cancer. Most often, basalioma appears on the face of male and female audiences after 50 years. The tumor also affects other open areas of the skin.

Due to excessive exposure to direct sunlight and smoking, basalioma of the skin of the nose can occur. In chronic diseases of the skin of the face - basalioma of the eyelid. In the presence of carcinogenic substances in the workplace, for example, basalioma of the auricle and hands. with chronic scars from periodic and frequent burns - appears on the skin of the trunk and limbs, on the neck.

If a basalioma has appeared, the causes of occurrence may be associated with factors:

Education should not be mistaken for acne. It must be treated, because it can even destroy the bones of the skull, lead to thrombosis of the meninges and death.

How the disease manifests itself

Manifestation of basal cell carcinoma

Anatomically, the formation looks like a flat plaque, nodule, superficial ulcer or extensive deep ulceration with a dark red bottom.

Signs of basalioma at the microscopic level are characterized by emerging strands and complexes consisting of intensely stained small cells. They are limited along the periphery to prismatic cells with nuclei located basally. The nuclei have long axes located at right angles to the boundary of the complex or strand. In this case, the grouping of cells will be parallel.

Inside the cells there is a small amount of cytoplasm with dark rounded, oval or elongated nuclei. Small cells differ from basal epithelial skin cells in the absence of intercellular bridges. Cells within complexes and strands are even smaller in size and their arrangement is disordered and looser.

The clinical symptoms of basalioma appear initially as a dense, pinkish, pinkish-yellowish or dull white micro-nodule in the form of a pearl. It protrudes above the skin and tends to merge with a group of the same nodules, forming a plaque with telangiectasias (networks or asterisks) - persistent expansion of capillaries, venules or arterioles, the nature of which is not associated with inflammation.

In the center of the plaque, spontaneous disappearance of individual nodules or their ulceration may occur with the formation of a roller along the periphery, consisting of nodules of a dull whitish color. In the future, the disease can manifest itself in two conditions of the tumor:

Nodular-ulcerative basalioma irregular shape is manifested by all clinical symptoms and is more often formed in the eyelid area, inner corner eyes and nasolabial folds.

perforating tumor can appear in the same places due to frequent injury to the skin. But it grows faster and more actively destroys surrounding tissues than nodular-ulcerative.

Nodular large nodular or solid tumor in the form of a single node above the skin, it is covered with vascular asterisks - continuous strands and complexes with scalloped outlines that tend to merge into massive formations. It grows outward and is surrounded by a "pearl" roller. Due to dark pigmentation in the center or along the edges, it is mistaken for skin melanoma.

Adenoid formation (cystic) It is composed of cyst-like structures and glandular tissue, giving it a lace-like appearance. The cells here are surrounded by regular rows of small cysts with basophilic contents.

Superficial symptoms multicentric (pagetoid) basalioma are manifested by a rounded or oval plaque, which has a border of nodules along the periphery and a slightly sunken center, covered with dry scales. Under them, telangiectasias are visible in the thinned skin. At the cellular level, it consists of many small foci with small dark cells in the superficial layers of the dermis.

Warty (papillary, exophytic) tumor can be mistaken for a cauliflower-shaped wart due to dense hemispherical nodes growing on the skin. It is characterized by the absence of destruction and does not grow into healthy tissues.

Pigmented neoplasm or pagetoid epithelioma it comes in a variety of colors: bluish-brown, brownish-black, pale pinkish and red with raised pearl-shaped edges. With a long, torpid and benign course, it reaches 4 cm.

At cicatricial-atrophic (flat) form of the tumor a nodule is formed, in the center of which an ulcer (erosion) is formed, which spontaneously scars. Nodules continue to grow on the periphery with the formation of new erosions (ulcers).

During ulceration, an infection joins and the tumor becomes inflamed. With the growth of primary and recurrent basalioma, the underlying tissues (bones, cartilage) are destroyed. It can pass into nearby cavities, for example, from the wings of the nose - into its cavity, from the earlobe - inside the cartilage shell, destroying them.

For sclerodermiform tumor characterized by a transition from a pale nodule with growth into a plaque of a dense and flat shape with a clear contour of the edges. On a rough surface, sores appear over time.

For Spiegler's tumors (cylindromas) the appearance of multiple benign nodes of pink-violet color, covered with telangiectasias, is characteristic. When localized under the hair on the head, it proceeds for a long time.

Diagnosis of basalioma

If after visual inspection the doctor suspects a basalioma in the patient, the diagnosis is confirmed by cytological and histological examination of smears-imprints or scrapings from the surface of the neoplasm. In the presence of strands or nest-like clusters of spindle-shaped, round or oval cells with thin rims of cytoplasm around them, the diagnosis is confirmed. Tests for skin cancer (imprint smear) are taken from the bottom of the ulcer and determine the cellular composition.

If, for example, the tumor marker CA-125 is used to diagnose ovarian cancer, then there are no specific oncological blood markers to determine the malignancy of basalioma. They could accurately confirm the development of cancer in her. In other laboratory tests, leukocytosis, an increased erythrocyte sedimentation rate, a positive thymol test, enlarged C-reactive protein. These figures are consistent with other inflammatory diseases. There is some confusion in the diagnosis, so they are rarely used to confirm the diagnosis of neoplasms.

However, due to the diverse histological picture of basalioma, as well as its clinical forms, differential diagnosis is carried out to exclude (or confirm) other skin diseases. For example, lupus erythematosus, lichen planus, seborrheic keratosis, Bowen's disease should be differentiated from flat superficial basalioma. Melanoma (mole cancer) - from a pigmented form, scleroderma and psoriasis - from a sclerodermiform tumor.

Informative video: biopsy and removal by CO2 laser of basalioma of the skin of the back of the nose

Methods of treatment of basalioma. Basalioma removal

When cellular skin cancer is confirmed, treatment methods are selected depending on the type and how much the tumor has grown and grown into neighboring tissues. Many people want to know how dangerous basalioma is, how to treat it so that there are no relapses. The most proven way to treat small neoplasms is the surgical removal of the basalioma using local anesthesia: lidocaine or ultracaine.

When the tumor grows deep inside and into other tissues, surgical treatment of basalioma after irradiation is used, i.e. combined method. At the same time, the cancerous tissue is completely removed to the border (edge), but if necessary, they go to the nearest healthy areas of the skin, retreating 1-2 cm from it. With a large incision, a cosmetic suture is carefully applied and removed after 4-6 days. The sooner the formation is removed, the higher the effect and the lower the risk of recurrence.

Treatment is also carried out with the following effective methods:

Radiation therapy

Radiation therapy is well tolerated by patients and is used for small neoplasms. The treatment is long, at least 30 days, and has side effects, since the rays affect not only the tumor, but also healthy skin cells. Erythema or dry epidermitis appears on the skin.

Lungs skin reactions pass on their own, "stubborn" require local therapy. Radiation therapy in 18% of cases is accompanied by a variety of complications in the form of trophic ulcers, cataracts, conjunctivitis, headaches, etc. Therefore, symptomatic treatment is carried out or with the use of hemostimulating agents. Treatment of the sclerosing form of basalioma with radiation therapy is not carried out due to its extremely low efficiency.

laser therapy

When confirming the diagnosis of "basal cell skin cancer or basal cell carcinoma", laser treatment almost completely replaced other methods of tumor removal. During one session, it is possible to get rid of the disease with a carbon dioxide laser. The tumor is affected by CO2 and is evaporated in layers from the skin surface. The laser does not touch the skin and affects the temperature only on the affected area, without touching healthy areas.

Patients do not feel pain, because during the procedure, anesthesia occurs while protecting with cold. There is no bleeding at the site of removal, a dry crust appears, which will fall off on its own within 1-2 weeks. You should not tear it off yourself with your nails, so as not to infect the infection.

Laser removal of basalioma

This method is suitable for patients of all ages, especially for the elderly. If basal cell carcinoma or basal cell carcinoma is found, laser treatment will be preferred due to the following advantages of this method:

cryodestruction

What is a basalioma and how to treat it if there are many formations on the face or head, there are large, neglected and growing into the bones of the skull? This is a cell from the basal layer of the skin, which, by dividing, has grown into a large tumor. In this case, cryodestruction will help, especially for those patients who form rough (keloid) scars after operations, who have pacemakers and receive anticoagulants, including Warfarin.

Cryodestruction

Information! According to the results of the study, after cryodestruction, relapses occur in 7.5%, after surgery - in 10.1%, after radiation therapy - in 8.7% of all cases.

The list of benefits of cryodestruction includes:

Information! Cryodestruction, unlike radiation therapy, does not destroy the DNA of the cells surrounding the basalioma. It promotes the release of substances that enhance immunity against the tumor, and prevents the formation of new basaliomas at the site of removal and in other areas of the skin.

After a biopsy confirming the diagnosis, to prevent discomfort and pain during cryodestruction, local anesthetics (Lidocaine - 2%) are used or / and Ketanol (100 mg) is given to the patient an hour before the procedure.

If liquid nitrogen is applied in the form of a spray, then there is a risk of nitrogen spreading. More precisely and deeper, cryodestruction can be carried out using a metal applicator that is cooled with liquid nitrogen.

It is important to know! It is impossible to freeze squamous cell carcinoma or basalioma with tampons with Wartner Cryo or Cryopharm (does not make sense), since freezing occurs only to a depth of 2-3 mm. It is impossible to completely destroy basalioma cells with these means. The tumor is covered with a scar from above, and oncogenic cells remain in depth, which is fraught with relapse.

Photodynamic therapy

Photodynamic therapy for basalioma is aimed at the selective destruction of tumor cells by substances - photosensitizers when exposed to light. At the beginning of the procedure, a drug, such as Photoditazine, is injected into the patient's vein to accumulate in the tumor. This stage is called photosensitization.

When a photosensitizer accumulates in cancer cells, the basalioma is viewed under ultraviolet light to mark its border on the skin, as it will glow pink, fluorescence occurs, which is called video fluorescent marking.

Next, the tumor is illuminated with a red laser with a wavelength corresponding to the maximum absorption of the photosensitizer (for example, 660-670 nm for Photoditazine). The laser density should not heat the living tissue above 38°C (100 MW/cm?). The time is set depending on the size of the tumor. If the tumor has a size of 10 kopecks, then the exposure time is 10-15 minutes. This stage is called photo exposure.

When oxygen enters chemical reactions the tumor dies off without damaging healthy tissue. At the same time, the cells immune system: macrophages and lymphocytes absorb dead tumor cells, which is called photoinduction of immunity. Relapses at the site of the original basalioma do not occur. Photodynamic therapy are increasingly replacing surgical and radiation treatments.

Drug therapy

If confirmed by studies of basalioma, treatment with ointment is prescribed in courses for 2-3 weeks. Ointments for occlusive dressings are used locally:

The ointment should be applied, capturing the surrounding skin by 0.5 cm. To protect healthy tissues, they are lubricated with zinc or zinc salicylic paste.

If chemotherapy is performed, then Lidaza, Wobe-mugos E is used. Multiple basaliomas are treated with intravenous or intramuscular infusion of Prospidin until cryodestruction of the foci.

For tumors up to 2 cm, if they are localized in the corners of the eyes and on the eyelids, interferons are used inside the auricle, since laser, chemotherapy or cryodestruction, as well as surgical excision, cannot be used.

Treatment of basaliomas is also carried out with aromatic retinoids that can regulate the activity of the components of the cyclase system. If drug therapy is interrupted or there are tumors larger than 5 cm, undifferentiated and invasive basaliomas, then relapses may occur.

Folk therapy in the treatment of skin basalioma. Recipes for ointments and tinctures

Important! Before treating basalioma folk remedies, it is necessary to do an allergy test to all herbs that will be used so as not to aggravate the condition.

The most popular folk remedy is decoction based on celandine leaves. Fresh leaves (1 tsp) are placed in boiling water (1 tbsp.), Let stand until cool and take 1/3 tbsp. three times a day. You need to prepare fresh broth each time.

If there is a single or small basalioma on the face, treatment with folk remedies is carried out by lubrication:

Golden mustache juice used as a compress during the day, applying moisturized cotton swabs, fixing them with a bandage or plaster.

Ointment: powder from the leaves of burdock and celandine(according to? Art.) Stir well with melted pork fat and simmer for 2 hours in the oven. Lubricate the tumor 3 times / day.

Ointment: burdock root(100 g) boiled, cooled, kneaded and mixed with vegetable oil(100 ml). Continue to boil the composition for 1.5 hours. Can be applied to the nose, where it is inconvenient to use compresses and lotions.

Ointment: prepare the collection, mixing birch buds, spotted hemlock, red clover, large celandine, burdock root - 20 grams each. Finely chopped onion (1 tbsp) is fried in olive oil (150 ml), then it is collected from the pan and pine resin (resin - 10 g) is placed in oil, after a few minutes - the collection of herbs (3 tbsp.) , after 1-2 minutes, remove from heat, pour into a jar and tightly close the lid. Day insist in a warm place. Can be used for compresses and for lubricating tumors.

Remember! Treatment of basalioma with folk remedies serves as an addition to the main method of treatment.

Life expectancy and prognosis for skin basalioma

If a basalioma is found, the prognosis will be favorable, since metastases do not form. Early treatment of the tumor does not affect life expectancy. In advanced stages, the size of the tumor is more than 5 cm and frequent relapses the survival rate for 10 years is 90%.

As a preventive measure for basalioma, you should:

Conclusion! For the prevention and treatment of basalioma, complex methods should be used. When neoplasms appear on the skin, you should immediately consult a doctor for early treatment. This will save nervous system and prolong life.

This disease has many names. basalioma, basal cell epithelioma, ulcusrodens or epitheliomabasocellulare. It refers to diseases that are often found among patients. Basically, in our country, the term "basiloma" is more common in the specialized literature. Since the tumor on the skin has a clear destabilizing growth, regularly recurring. But metastasis does not occur with this cancer.

What causes skin basalioma?

Many experts believe that the reasons lie in the individual development of the organism. In this case, it begins its origin in pluripotent epithelial cells. And they continue their progress in any direction. In the production of cancer cells, a genetic factor plays an important role, as well as various disorders in the immune system.

Affect the development of the tumor strong radiation, or contact with harmful chemicals that can cause malignant neoplasms.

Basalioma is also able to form on the skin, which does not have any changes. And the skin that has various skin diseases (posriasis, senile keratosis, tuberculous lupus, radiodermatitis and many others) will be a good platform for the development of cancer.

In basal cell epithelioma, all processes proceed very slowly, so they do not turn into squamous cell carcinoma complicated by metastases. Often the disease starts in top layer skin, in hair follicles, as their cells are similar to the basal epidermis.

Doctors interpret this disease as a specific tumor formation with local destructive growth. And not as a malignant or benign tumor. There are cases when the patient was exposed, for example, to strong exposure to the harmful rays of the x-ray machine. Then the basalioma is able to develop into basal cell carcinoma.

Regarding histogenesis, when the development of tissues of a living organism is carried out, researchers still cannot say anything.

Some think that squamous cell carcinoma begins its origin in the primary skin germ. Some believe that the formation will come from all parts of the epithelium of the skin structure. Even from the germ of the embryo and malformations.

Disease Risk Factors

If a person often comes into contact with arsenic, gets burns, is irradiated with X-rays and ultraviolet radiation, then the risk of developing basalioma is very high. This type of cancer is often found in people with the first and second type of skin, as well as in albinos. Moreover, all of them experienced the effects of radiation exposure for a long time. If even in childhood a person was often exposed to insolation, then a tumor may appear decades later.

The origin and development of the disease

The outer layer of the skin in patients is slightly reduced in size, sometimes pronounced. Basophilic cells begin to grow, the tumor becomes a single layer. Anaplasia is almost invisible, ontogeny is slightly pronounced. There are no metastases in squamous cell carcinoma, because the cells of the neoplasms, entering the blood ducts, cannot multiply. Since they do not have growth factors, which the tumor stroma should produce.

VIDEO

Signs of cutaneous basalioma

Basal cell epithelioma of the skin is a solitary formation. The shape is similar to a half ball, the view is more rounded. The neoplasm may slightly protrude above the skin. The color is more pink or greyish-red, with a shade of mother-of-pearl. In some cases, basilioma is indistinguishable from normal skin at all.

To the touch, the tumor is smooth, in its middle there is a small depression, which is covered with a thin, slightly loose sanious crust. If you remove it, then under it you will find a small erosion. Along the edges of the neoplasm there is a thickening in the form of a roller, which consists of small whitish nodules. They look like pearls, according to which basilioma is determined. A person can have such a tumor for many years, only becoming a little larger.

Such neoplasms on the patient's body can be in large numbers. Back in 1979, scientists K.V. Daniel-Beck and A.A. Kolobyakov found that the primary multiple species can be found in 10% of patients. When there are dozens or more tumor foci. And this is then revealed in the non-basocellular Gorlin-Goltz syndrome.

All signs of such skin cancer, even Gorlin-Goltz syndrome, make it possible to divide it into the following forms:

• nodular ulcer (ulcusrodens);
• superficial;
• scleroderma-like (morphea type);
• pigment;
• fibroepithelial.

If a sick person has a large number of foci, then the forms can be of several types.

Types of basalioma

Superficial type manifests itself by the appearance on the skin pink spots, a little flaky. Over time, the spot becomes clearer, acquiring an oval or rounded shape. On its edges you can see small nodules slightly shiny. They then merge into a dense ring, similar to a roller. In the middle of the spot is a depression that becomes dark, almost brown. It can be single or multiple. And also over the entire surface of the hearth there is a rash of dense, small particles. Almost always, the nature of the rash is multiple, and basilioma flows constantly. Its growth is very slow. Clinical signs are strongly similar to Bowen's disease.

The pigmented type of basalioma resembles, but only the density is stronger. The affected areas have a blue-violet or dark brown tint. For an accurate diagnosis, dermoscopic examination of the spots is carried out.

The tumor type begins with the appearance of a small nodule. Then it gets bigger and bigger. Its diameter becomes about three centimeters. And it looks like a round speck of stagnant pink paint. On the smooth surface of the tumor, dilated small vessels are clearly visible, some are covered with a grayish coating. The central part of the affected area may have a dense crust. The growth does not protrude above the skin, and she has no legs. There are two forms of this type: with small and large nodules. It depends on the size of the tumors.

The ulcerative type appears as a variation of the primary variant. And also as a result of the manifestation of superficial or tumor basilioma. A typical sign of this form of the disease is an expression in the form of a funnel. It looks massive, its fabric seems to be glued to the lower layers, their borders are not clearly visible. The size of the accumulations is much larger than the ulcer. In this variant, there is a tendency to strong expressions, due to which the lower part of the tissue begins to collapse. There are times when ulcerative appearance is complicated by growths in the form.

The scleroderma-like or cicatricial-atrophic type has a small, clearly defined focus of infection, compacted at the base, but not protruding above the skin. The color shade is closer to yellowish-whitish. In the middle of the spot, atrophied transformations or dyschromia occur. Sometimes erosive foci of various sizes appear. They have a peel that is very easy to remove. This is a positive moment when conducting cytological studies.

Pinkus fibroepithelial tumor is a type of squamous cell carcinoma, but it is quite mild. Outwardly, it looks like a nodule or plaque in the color of a person's skin. The consistency of such a spot is dense and elastic, erosion is not observed on it.

Therapy for skin basalioma

Basal cell epithelioma is treated conservatively. Doctors surgically remove lesions along the border of healthy skin. Cryodestruction is also practiced. Such treatment is used if there may be a cosmetic defect after surgery. It is possible to smear spots with prospidin and colhamic ointments.

Basalioma (basalioma)

In the WHO International Histological Classification of Tumors (1980), basalioma is designated by the term "basal cell carcinoma". She represents slowly developing tumor, which has the ability to locally invasive and destructive growth, practically does not metastasize (or in very rare cases) and occurs in the epidermis or in the appendages of the skin.

Basalioma can occur in people of both sexes, at a young and old age, on any part of the skin. However, it most often develops in people over 40 years of age, and its predominant localization is the face (periorbital region, nose, nasolabial folds), as well as the temporal, parotid region, skull skin, neck. Basalioma can occur on intact skin or against the background of pathological processes that preceded it: late x-ray dermatitis, foci of cicatricial atrophy that developed with tuberculous and lupus erythematosus, as well as some connective tissue tumors (histiocytoma, etc.).

According to the clinical picture, there are superficial, tumor, ulcerative, pigmented and scleroderma-like forms of basalioma.

Superficial form of basalioma characterized by the appearance of an initially limited scaly patch of pink color. In the future, the spot gradually acquires clear contours, oval, round or irregular shape. On its periphery, small, dense nodules appear, gleaming in side lighting, merging with each other and forming a roller-like edge raised above the level of the skin with a slight depression in the center. The tumor acquires a dark pink, brownish, grayish, and with a pigmented form, a bluish, purple or dark brown color. Such lesions may be solitary or multiple. The multiple form of superficial basalioma often occurs in blondes living in a climate zone with increased insolation, and can be combined with freckles, nevus cell nevus, multiple foci of seborrheic keratosis, and Bowen's disease (Fig. 77). Among the superficial forms, self-scarring, or pagetoid, basalioma is distinguished, which is characterized by peripheral growth of the lesion, in the center of which an atrophy zone is formed, and along the periphery - chains of small, dense, opalescent nodules. Such plaques can reach a significant size (diameter up to 5-7 cm or more).

Tumor form basalioma is characterized by the appearance of a nodule, which gradually (over several years) increases in size, reaching 1.5-3 cm or more in diameter, acquires a rounded shape, pale pink or stagnant pink color. The surface of such a formed tumor can be smooth with pronounced telangiectasias, sometimes covered with grayish scales, or its central part ulcerates and becomes covered with dense bloody crusts (Fig. 78). Sometimes the tumor protrudes significantly above the level of the skin, may have a stalk (the so-called fibroepithelial type). Depending on the size of the tumor, small- and large-nodular forms of basalioma are distinguished. When the nodes merge, a tumor conglomerate (a conglomerated form of basalioma) can form.

Ulcerative form basalioma can be formed as a primary variant of the tumor or be the result of a superficial or tumor form of the neoplasm (Fig. 79). The characteristic clinical signs of the ulcerative form of basalioma as the primary variant of the tumor are a funnel-shaped ulceration of relatively small size and a massive infiltrate soldered to the underlying tissues (tumor proliferation) with fuzzy boundaries, which are much larger in size than the ulcer itself. This form of ulcerative basalioma is isolated under the name "ulcus rodens" (Fig. 79). In some cases, the tumor ulcerates especially intensively, destroys the underlying tissues, grows in depth and along the periphery (ulcus terebrans). Sometimes the ulcerative form of basalioma is accompanied by papillomatous, warty growths (ulcerative-papillary form), characterized by particularly intense endophytic and exophytic growth, and with “dangerous” localization (corner of the eye, eyelid, parotid, temporal region) can lead to death.

Scleroderma-like the form of basalioma is a rare clinical variety. In this case, the tumor looks like a dense whitish plaque with slightly raised edges. Typically, this form of basalioma develops very slowly, grows along the periphery, and there may be telangiectasias in its central part.

The histological features of basalioma are even more varied than its clinical features. The main pathomorphological criterion, common to all diverse forms of basalioma, is the presence of tumor cells that mimic the basal cells of the epidermis. This similarity is especially pronounced in the peripheral zone of tumor proliferates, where the cells are arranged like a palisade and differ from the usual basal cells of the epidermis by the absence of intercellular processes and large, intensely stained nuclei.

Many authors give various histological classifications of basalioma. General essence they are reduced to the isolation of solid, cystic, adenoid tumor types and varying degrees of differentiation of the histological picture of basalioma in the direction of the hair follicle (trichobasalioma), elements of the sebaceous glands, sweat glands, complex structure, etc. It should be emphasized that various clinical forms of the tumor practically do not differ from each other histologically. Allocate only superficial, multicentric, scleroderma-like and fibroepithelial histological types of basalioma with characteristic clinical features.

Differential diagnosis of basalioma should be carried out in relation to one or another clinical form of neoplasm: superficial, pigmented, scleroderma-like, tumor and ulcerative.

The superficial solitary form of basalioma should be differentiated from lichen planus, lupus erythematosus, Bowen's disease, seborrheic keratosis.

With lichen planus in contrast to the superficial solitary basalioma, one lesion almost never occurs, especially only on the face, where basalioma is most often observed. However, in cases of localization of the formed focus of the superficial form of basalioma on the neck or on the skin of the trunk, it may resemble the atrophic form of lichen planus. The latter differs from basalioma in short terms of development, dark brown, lilac opalescent color. On its periphery there is a brilliant roller, in which it is impossible to distinguish individual nodules (pearls), so characteristic of basalioma. The decisive diagnostic feature that testifies in favor of lichen planus is the presence of specific polygonal papules with an umbilical indentation in the center on other areas of the skin and often on the oral mucosa. IN doubtful cases a cytological study, and especially a histological one, makes it easy to distinguish lichen planus (degeneration of cells of the basal layer of the epidermis, washed out by cells of a strip-like infiltrate) from basalioma (tumor nests, as if suspended from the basal layer of the epidermis).

lupus erythematosus in the presence of a limited formed focus of small size with atrophy in the center, it may have an external resemblance to a superficial basalioma. Anamnestic data (relapses of lupus erythematosus in the spring-summer season), as well as clinical features of the lesion in lupus erythematosus, characterized by a peripheral zone of erythema, in the center of which, against the background of atrophy, may be observed remnants of follicular hyperkeratosis. In addition, with lupus erythematosus, only one small lesion is rarely observed. In most cases, there are similar lesions on the nose with a transition to the cheeks (in the form of a butterfly), on auricles, in the area of ​​the red border of the lips, which is uncharacteristic of basalioma. If basalioma is suspected, it is necessary to conduct a cytological or histological examination; which, in contrast to lupus erythematosus, in basal cell carcinoma allows to identify tumor cells.

Bowen's disease sometimes it is clinically difficult to distinguish from the superficial form of basalioma, especially in cases where the latter is represented by a large plaque, on the surface of which there are serous-cortical layers. In contrast to superficial basalioma, the lesion in Bowen's disease has uneven outlines and a mottled picture: areas of cicatricial atrophy are combined with severe hyperkeratosis and erosive and ulcerative changes. In addition, the peripheral zone of the plaque in Bowen's disease is, as it were, elevated above the surrounding skin, in contrast to the superficial basalioma, there are no nodular elements in the marginal zone that form a ridge-like edge. In differential diagnosis, the results of cytological (with basalioma, layers of small tumor basalioma-like cells, with Bowen's disease, elements with squamous differentiation) and histological (with basalioma, tumor proliferates in the form of nests suspended from the epidermis, with Bowen's disease, acanthosis with areas of cell discomplexation, nuclear polymorphism, dyskeratosis of individual cells, i.e., the histological picture of intraepidermal cancer) studies.

The superficial multiple form of basalioma should also be differentiated from disseminated form of lipoid necrobiosis and syndrome. Goltz-Gorlin.

Disseminated form of lipoid necrobiosis in contrast to superficial multiple basalioma, it is characterized by flat plaques of a round or oval shape, pinkish-yellowish in color with an erythema zone along the periphery and slight induration or atrophy in the center. Often such patients or their relatives are diagnosed with diabetes mellitus. The disease can occur in young and adulthood, while multiple superficial basalioma is more common in the elderly. The histological picture of lipoid necrobiosis, in contrast to superficial multiple basalioma, is characterized by granulomatous and necrobiotic processes in the dermis and the absence of changes (including atrophy) of the epidermis.

Goltz-Gorlin syndrome- a hereditary disease, in contrast to the superficial multiple form of basalioma, is characterized by multiple nevoid basaliomas that occur in young people or exist from birth. Such basaliomas are combined with various malformations - cystic formations in the bones of the jaws and ribs, as well as with pigmented vascular nevi. Thus, these two diseases can only be distinguished on the basis of anamnestic data and additional clinical symptoms characteristic of the Goltz-Gorlin syndrome, since the clinical and histological features of the lesions are identical.

The scleroderma-like form of basalioma should be differentiated from limited scleroderma, Pasini-Pierini atrophoderma, scleroatrophic lichen.

Limited scleroderma in contrast to scleroderma-like basalioma, it is characterized by large (sometimes 10 cm in diameter or more) lesions in the form of dense plaques of waxy or mauve color with regular outlines and a zone of congestive erythema along the periphery. In the case of complete resolution of scleroderma, atrophy with hyper- or depigmentation remains at the site of the former lesion. Scleroderma-like basalioma is characterized by a more superficially located focus of small size, whitish color, without a peripheral zone of erythema. In some cases, a barely raised ridge can be found in the tumor zone, which has never happened with plaque scleroderma. Histological studies make it possible to identify characteristic nests and strands of tumor cells surrounded by a cicatricial stroma (Marfea type) in scleroderma-like basalioma, while in limited scleroderma there is homogenization of collagen fibers and moderate atrophy of the epidermis.

Atrophoderma Pasini-Pierini in contrast to scleroderma-like basalioma, it is characterized by the appearance, more often in women, of spots of rounded or irregular outlines various sizes stagnant pink, cyanotic color with a lilac zone along the periphery. In the future, superficial cicatricial atrophy may develop in the central part of the spots. Histologically, Pasini-Pierini atrophoderma is easily distinguished from scleroderma-like basalioma based on the homogenization of collagen fibers, connective tissue edema, and epidermal atrophy.

Lichen sclerosus(syn.: Zumbusch white lichen) may bear some resemblance to scleroderma-like basalioma when considered as an isolated element. However, in most cases, unlike scleroderma-like basalioma, the lesions in this dermatosis are multiple, their surface sinks and has a whitish appearance of wrinkled tissue paper, which is uncharacteristic of basalioma.

The pigmented form of basalioma should be differentiated from precancerous melanosis Dubrey and malignant melanoma.

Precancerous melanosis of Dubrey differs from a pigmented basalioma in its clinical picture - an unevenly colored (from light brown to black) plaque with polycyclic outlines and histological features. The latter consist in the fact that the foci of precancerous melanosis are characterized by the accumulation of atypical melanocytes in the epidermis, while in pigmented basalioma, despite the accumulation of unchanged melanocytes between tumor cells and the content of a large amount of melanin, in the stroma, there are elongated prismatic cells typical of this neoplasm. , surrounding tumor proliferates like a palisade, which is not observed with Dubrey's melanosis.

malignant melanoma differs from pigmented basalioma in its clinical features, which consist in the development of a smooth domed or bumpy dark brown or black plaque, sometimes large, easily injured and bleeding. The tumor often develops from a precancerous Dubrey melanosis, a blue nevus, or a giant warty pigmented nevus that preceded it. In this regard, anamnesis plays an important role in the differential diagnosis of malignant melanoma and pigmented basalioma. The localization of lesions is also of some importance, since the foci of pigmented basalioma are located mainly on the face, and malignant melanoma - on any part of the skin. Of decisive importance in the differential diagnosis are sometimes the results of histological examination. It should be emphasized that if a malignant melanoma is suspected, a biopsy in order to obtain material for histological examination should be carried out only after a total, within a wide range, excision of the tumor or simultaneously with it. An approximate differential diagnostic criterion for malignant melanoma and pigmented basalioma is the use of the isotope method with radioactive phosphorus (34 R). Accumulation of the isotope in the lesion by more than 200% compared with the symmetrical area of ​​intact skin (in comparison with the clinical features of the pathological process and anamnestic data) testifies in favor of malignant melanoma.

The tumor solitary form of basal cell carcinoma should be differentiated from necrotizing (calcified) epithelioma of Malerba, eccrine spiradenoma, fibropapillomatous malformation, atheroma, adenoma of the sebaceous glands, keratinizing squamous cell carcinoma, lymphocytoma, eosinophilic granuloma, keratoacanthoma.

Necrotizing (calcified) epithelioma of Malherba differs from the tumor form of basalioma primarily in its stony density, large size (several centimeters in diameter), and also in that it occurs not only in adults, but also in children and young men. Histological examination allows us to establish that Malherbe's epithelioma, unlike the tumor form of basalioma, is located in the deep sections of the dermis or in the subcutaneous fatty tissue, surrounded by a capsule, not associated with the epidermis, but comes from the hair matrix. In addition, this tumor is characterized by the presence of shadow cells with degenerating, decaying nuclei and the deposition of calcium salts both in the cytoplasm of cells and in foci of necrosis.

Eccrine spiradenoma clinically differs from the tumor form of basalioma in that it develops in most cases in young people, is localized not only on the face, but often on the anterior surface of the body, has the appearance of a bulging, dense, painful node on palpation. At the same time, the epidermis above the tumor is not changed, its pattern is not smoothed. Unlike basalioma, eccrine spiradenoma may spontaneously resolve. Histologically, it differs from the tumor form of basalioma in that it is located in the deep parts of the dermis, is not associated with the epidermis, has a lobed structure, glandular and cystic structures, and it lacks palisade-shaped prismatic cells along the periphery of tumor proliferates, which are so characteristic of basalioma.

Fibropapillomatous malformation has some similarities with the fibroepithelial type of tumor solitary basalioma. Both tumors rise above the level of the skin, may be pedunculated, have a pinkish-matte color. The differences are that with basalioma the lesion is dense, the skin over it is tense, often riddled with telangiectasias, and the fibropapillomatous malformation of a soft doughy consistency, although it can be more dense, is mobile, the skin above it is thinned, can fold, and unlike basalioma, it occurs in childhood or adolescence. Histologically, fibropapillomatous malformation differs from the tumor form of basalioma in that it is based on connective tissue with fibrosis and hyalinosis, covered with thinned epidermis.

Atheroma in unlike the tumor form of a solitary basalioma, it has an elongated-rounded shape in the form of a bump and a dense consistency, soldered to the underlying tissues, can suppurate, and then its surface becomes soft, the epidermis becomes thinner, breaks through and the contents of the atheroma are evacuated. Histological atheroma differs from the tumor form of basalioma in that it is a cyst lined with epithelium, in which there are no tumor basaloid cells.

sebaceous adenoma, as well as the tumor form of basalioma, it is more often localized on the face, has a rounded, spherical shape, dense doughy consistency, yellowish-pink color, its diameter is 0.3-1 cm. Unlike the tumor form of basalioma, sebaceous adenoma occurs in young people and children, there are no telangiectisias on its surface and for a long time it practically does not change. Histologically, the adenoma of the sebaceous glands has a lobular structure, is located in the dermis, is not associated with the epidermis, which is not changed or thinned. On the periphery of the lobules of the sebaceous gland there are growths of basaloid cells, but they differ from tumor cells in basalioma, as they are prone to squamous differentiation. The histological picture of the tumor form of basalioma with sebaceous differentiation differs from the above histological picture of sebaceous gland adenoma in that among the tumor proliferates typical of basalioma, there are cells with light, foamy protoplasm, in which neutral fat is found

Keratinizing squamous cell carcinoma (exophytic form) may have a clinical similarity with the tumor form of basalioma in cases where its surface is ulcerated or covered with cortical layers. The difference between them lies in the fact that even with prolonged existence and ulceration, a basalioma retains a smooth peripheral zone in the center, while in squamous cell carcinoma, in the case of exophytic growth, there are papillary growths on the surface of the tumor, to which purulent discharge with an unpleasant odor is attached. The base of the plaque in squamous cell carcinoma often increases in size, and with the collapse of the central part and the formation of ulcerations along the periphery, it remains a dense epithelial roller. The tumor acquires uneven outlines, painful. Histologically, keratinizing squamous cell skin cancer differs from the tumor form of basalioma by the proliferation of cells of the spinous layer of the epidermis, resulting in the formation of layers of tumor cells with discomplexation, nuclear polymorphism, severe anaplasia and the formation of "pearls" - the result of keratinization of individual cells of the spiny layer of the epidermis. Along the periphery of tumor proliferate complexes there are small dark elements, but there is no palisade-like arrangement of high prismatic cells so characteristic of basalioma. Unlike the tumor form of basalioma, keratinizing squamous cell carcinoma metastasizes.

Lymphocytoma skin in the case of localization of a single focus on the face may have a clinical similarity with the solitary, tumor form of basalioma. In contrast, lymphocytoma is characterized by a rich pink or stagnant red color, its surface is not spherical, as in basalioma, but more flattened and there are no telangiectasias on it, often observed in tumor forms of basalioma. For the differential diagnosis of the tumors under consideration, anamnetic data are also important. Usually, basalioma develops gradually and exists for a long time (sometimes for many years), and lymphocytoma occurs suddenly. A cytological examination of a lymphocytoma fails to detect an accumulation of tumor basalioma-like cells, and a histological examination in the dermis reveals a diffuse (Jessner-Kanaf lymphocytic infiltration) or follicular (Spigler-Fendt lymphocytoma) infiltrate, consisting of lymphocytes and histiocytes.

Eosinophilic granuloma in those cases when it is not represented by flattened, infiltrated plaques, the most characteristic of this tumor, but by a limited tumor-like, nodular element, it can clinically resemble the tumor form of basalioma. However, eosinophilic granuloma is easily distinguished from it by its brownish-bluish coloration and the sudden onset of the lesion, often after trauma or a bite. In doubtful cases, a histological examination helps to establish the correct diagnosis: an eosinophilic granuloma is characterized by a polymorphic infiltrate in the dermis with the presence of eosinophils, separated from the unchanged epidermis by a zone of normal collagen, while in basalioma there is a proliferation of tumor cells emanating from the epidermis or skin appendages.

Tumor multiple form of basalioma should be differentiated from Brook's adendrial cystic epithelioma, cylindroma, trichoepithelioma.

Brook's adenoid cystic epithelioma unlike the tumor multiple form of basalioma, it is more common in young women and children. Foci, lesions are multiple, monomorphic, do not ulcerate, tend to cluster or are arranged symmetrically, which never happens with tumor multiple basalioma. Histologically, Brook's adenoid cystic epithelioma differs from basalioma in the presence of cysts with incompletely formed hair, strands of basaloid cells, and ducts of eccrine sweat glands.

The ulcerative form of basalioma should be differentiated from squamous cell skin cancer, metatypical skin cancer, Bowen's disease.

Differential diagnosis with squamous cell carcinoma skin should be carried out taking into account its main clinical forms: exophytic-ulcerative, including papillary, and endophytic-ulcerative.

Exophytic-ulcerative form of squamous cell carcinoma, as well as its papillary form, are similar to the ulcerative-papillary form of basalioma. The differences are that the tumor in the exophytic-ulcerative form of squamous cell carcinoma can develop on any part of the skin, while the favorite localization of the basal cell carcinoma is the skin of the skull, eyelids in the corners of the eyes. Often, squamous cell carcinoma develops on scarred skin, while the papillary ulcerative form of basalioma often occurs on apparently unaltered skin. The growth of squamous cell carcinoma is much more active than that of basalioma. In the formed focus of the exophytic-ulcerative form of squamous cell carcinoma, the peripheral zone is well expressed in the form of an epithelial shaft, while the papillary-ulcerative form of basalioma is represented by diffuse papillary growths in the area of ​​the lesion without signs of a ridge-like marginal zone. In the exophytic-ulcerative form of squamous cell carcinoma, in some cases, metastases are found in regional lymph nodes, and in the ulcerative-papillary form of basalioma, regional lymph nodes can only be reactively changed in the event of a secondary infection.

In some cases, the clinical picture in these forms of neoplasms is so similar that it is possible to establish a final diagnosis only on the basis of the results of a histological examination. It allows to identify complexes of tumor proliferates in squamous cell carcinoma, consisting of spiny cells with the phenomenon of anaplasia, discomplexation and individual keratinization of individual cells (“pearls”). At the same time, in the ulcerative-papillary form of basalioma, regardless of the direction of differentiation of tumor cells, one can always find a palisade-like arrangement of high prismatic cells along the periphery of tumor complexes, typical for this tumor.

Endophytic-ulcerative form of squamous cell carcinoma must be differentiated from ulcus rodens and ulcus terebrans.

Ulcus rodens differs from the endophytic-ulcerative form of squamous cell carcinoma in its favorite localization of lesions in the chin, base of the nose, and corners of the eyes. A characteristic clinical feature of this type of ulcerative form of basalioma, in contrast to squamous cell carcinoma, is a pronounced infiltration of the tissue, far beyond the ulcer itself, and therefore the entire tumor conglomerate is, as it were, drawn into the underlying tissues, motionless. In this case, the ulcer itself can be small in size (diameter about 0.5-1 cm), irregularly cone-shaped, penetrates deep into the skin. With the endophyto-ulcerative form of squamous cell carcinoma, an elevation can always be found in the marginal zone - an epithelial ridge, the size of the ulcer often corresponds to the boundaries of the tumor, and discharge with a fetid odor is often observed, which is not present with ulcus rodens.

The difference between squamous cell carcinoma and ulcus terebrans is basically the same as from ulcus rodens. However, this type of ulcerative form of basalioma is characterized not only by invasive-destructive growth in the underlying tissues, but also by the spread of the tumor along the periphery, and therefore it often occupies vast spaces (temporal and ocular regions, forehead, skull, etc.). The tumor can destroy the underlying tissues, including bones, is characterized by intensive growth and, depending on the localization, can be fatal.

Histologically, it is especially important to distinguish the ulcerative form of basioma from poorly differentiated squamous cell carcinoma, the complexes of which may consist of small dark cells resembling basaloid ones. In this case, the main histological differential diagnostic criterion is a palisade-like arrangement of high prismatic cells around tumor nests in basalioma.

metatypical cancer differs from the ulcerative form of basalioma in the clinical picture. In metatypic cancer, a rather large plaque (diameter 3-5 cm or more) of irregular shape usually appears, along the periphery of which a typical basalioma roller, consisting of individual nodules (“pearls”), is often traced, and the surface of the tumor can be covered with dense serous-bloody crusts with areas of ulceration.

The localization of such lesions in metatypical cancer may be different, but more often they are located in the area of ​​the shoulder girdle, on the neck, in the behind-the-ear folds.

Histologically, the ulcerative form of basalioma differs from metatypical cancer in that, along with typical tumor nests consisting of small dark cells surrounded by prismatic cells characteristic of basal cell carcinoma, pronounced squamous differentiation is observed in metatypical cancer. As for such criteria for the differential diagnosis of metatypical cancer and ulcerative basalioma, such as mitotic activity, frequency and spectrum of pathological mitoses [Bogatyreva I.I. 1983], they cannot be considered absolutely reliable, since in different parts of the same lesion with metatypical cancer, these indicators may be different. In this regard, the most reliable method for the differential diagnosis of these neoplasms is the comparison of the clinical picture of the tumor with the result of a histological examination of serial sections from different areas of the neoplasm.

Bowen's disease differs from the ulcerative form of basalioma in that it is cancer in situ. Clinically, Bowen's disease is more often manifested by a solitary plaque with raised edges, the surface of which is eczema-like or has a hyperkeratotic character. Often, with Bowen's disease, a variegated surface of lesions is observed: areas of cicatricial atrophy are combined with superficial erosions and scaly-cortical layers. At the same time, plaques are not soldered to the underlying tissues and rarely turn into an ulcer, with the exception of cases when Bowen's disease transforms into squamous cell carcinoma. Histologically, Bowen's disease differs from the ulcerative form of basalioma in that it is an intraepidermal cancer and is characterized by acanthotic growths of the epidermis, within which discomplexation of cells of the spinous layer, nuclear polymorphism, and areas of dyskeratosis are expressed.

In contrast to Bowen's disease, the ulcerative form of basalioma is characterized by the proliferation of small tumor basaloid elements, the nests of which are surrounded by high prismatic cells.

Skin cancers originating from the epidermis and dermis include basaliomas, squamous cell carcinomas, and melanomas.

Basalioma

Basalioma (basal cell skin cancer, corrosive ulcer, etc.) is a tumor with a locally destructive effect that does not metastasize. Destructive tumor growth can lead to significant tissue destruction. At present, the prevailing point of view is that basalioma develops from a primary epithelial primordium, which can differentiate in the direction of various structures. In its development, certain importance belongs to genetic factors, immune processes, the influence of external factors (insolation, carcinogens, etc.). Basalioma can occur on intact skin, and may be the result of malignancy of various precancerous diseases. The predominant localization is the face, more often in persons of older age groups. The process is slow, often lasting for years.

clinical picture. Basalioma most often initially has the appearance of a translucent dense pearl-like nodule of the pearl type, pinkish-gray in color, sometimes such a nodule is covered with a tight-fitting crust. In other cases, a flat, slightly depressed, smooth red erosion occurs, the base of which is slightly compacted, and in appearance the element resembles a scratch. As the basalioma develops, the central part of the tumor (nodule) begins to get wet, a superficial ulceration appears, covered with a crust, which, when removed, exposes a superficial bleeding erosion or ulcer. Around the erosion or ulcer, you can usually see a thin, skin-colored dense roller. When the skin is stretched, it is clear that this roller consists of separate small “pearls”. In the future, the ulcer deepens, increases in size, its edges become ridge-like, and the entire ulcer becomes dense. Ulceration and ulcer enlargement occurs very slowly. With the spread of the process deep into the tumor loses its mobility. Can simultaneously occur scarring of the ulcer in the center or from one of its edges. Deepening of an ulcer is less often observed; in this case, its infiltrate destroys underlying tissues, including bone. Basalioma can have various clinical variations.

Of the varieties of basalioma, we indicate:

superficial , located mainly on the skin of the body and manifested by plaques slowly growing along the periphery with a characteristic thin dense rim, consisting of small pearl nodules; a scaly-crust is formed in the center, after rejection of which an atrophically altered erythematous surface is exposed;

flat cicatricial , located superficially, usually on the skin of the temple, characterized by serpiginous spread along the periphery with the formation of a roller-like edge and cicatricial-atrophic changes in the center;

scleroderma-like - dense plaques up to a small coin, ivory, usually located on the skin of the forehead;

knotty - dense, spherical nodules ranging in size from lentils to peas, covered with small crusts and scars, localized on the skin of the forehead, eyelids, scalp (uclus rodens). There is also a tendency to deep ulceration with dense crateriform edges and an uneven bottom (usual localization is the skin of the upper part of the face - uclus terebrans), characterized by a rapid progressive destructive process with necrosis of deep-lying tissues, the absence of a "pearl" roller, destruction of bone and cartilage tissue, strong bleeding and soreness, but without a tendency to metastasize (usual localization is the wings of the nose, earlobes, corners of the mouth, eyelids).

Histopathology. There are atypical growths of cells resembling the basal cells of the epidermis, in the form of anastomosing branched narrow strands that penetrate deep into the dermis. Cells do not tend to keratinize.

Treatment. Removal of the tumor within healthy tissue. Currently, cryodestruction, diathermocoagulation, surgical excision, prospidin or kolhamin ointment, etc. are usually used. Prospidin is used intramuscularly or intralesionally.

Squamous cell carcinoma (spinocellular carcinoma, squamous epithelioma) originates from the cells of the spinous layer of the epidermis. Squamous cell carcinoma occurs on the skin much less frequently than basalioma. It is mainly localized on the red border of the lower lip, in the perianal region, on the external genitalia. Squamous cell skin cancer, unlike basalioma, proceeds relatively quickly and severely, in general, no different from cancer of other localization, and metastasizes.

Squamous cell carcinoma can occur against the background of solar or senile keratosis, develop in scar tissue at the site of a burn, injury, chronic inflammation, x-ray dermatitis, xeroderma pigmentosa, etc.

In recent years, the importance of certain human papillomaviruses in the development of silt cell carcinoma has been established. The process of carcinogenesis occurs under the synergistic action of the virus with physical and chemical carcinogens and is due to genetically regulated immune mechanisms.

clinical picture. Squamous cell carcinoma is usually a solitary tumor in the form of a dense spherical formation in the thickness of the skin, initially the size of a pea. In the future, the tumor acquires an exo- or endophytic form. In the exophytic form, the tumor rises above the level of the skin, has a wide base, the surface of such cancer becomes uneven, warty. At the same time, the tumor grows in depth. Subsequently, she ulcerates. In the endophytic form, otherwise called ulcer-infiltrating, a dense small knot is formed in the thickness of the skin, which quickly ulcerates. The resulting ulcer is painful, especially on palpation, has an irregular shape, raised dense, everted and corroded edges, often it has a crater-like shape. The depth of the ulcer depends on the degree of infiltrating growth.

Tumor growth leads to significant destruction of the surrounding and underlying tissues, it becomes immobile. The bottom of the ulcer is uneven, bleeds easily, the tumor usually destroys blood vessels and even bones. Soon, lymph nodes (metastases) are involved in the process. General state patients are gradually deteriorating. Death occurs after 2-3 years from cachexia or bleeding caused by tumor decay and vascular damage.

Histopathology. An atypical growth (infiltrating growth) of the epithelium is detected due to the cells of the spiny layer in the form of intertwining strands that go deep into the thickness of the skin with the germination of the basement membrane. The cells themselves are mostly atypical and randomly arranged. There are keratinizing and non-keratinizing, more malignant, skin cancer. Atypia is characterized by a different size and shape of cells, hyperplasia and hyperchromatosis of the nuclei, the absence of intercellular bridges, and the presence of pathological mitoses. With keratinizing cancer, cells retain a tendency to keratinize, as a result, so-called horny "pearls" are found in the thickness of the epithelial layer. It should be noted that atypia is more pronounced in nonkeratinized cancer.

Diagnosis. The diagnosis should be confirmed by histological examination or cytological examination of a scraping from the surface of the ulcer, in which atypical cells are easily detected. It should be remembered about the possibility of metastasis of squamous cell carcinoma, primarily to regional lymph nodes.

Treatment. Performed by an oncologist. In this case, the tumor is usually surgically excised within healthy tissues, and regional lymph nodes are also removed; if necessary, additional chemotherapy is carried out, etc.

Melanoma (melanoblastoma, melanocarcinoma) is an extremely malignant tumor, primary focus which is most often found in the skin. Skin melanoma occurs mainly against the background of a pigmented nevus after injury, strong insolation, etc.

Pigmented nevus, which can transform into melanoma, can be congenital or acquired, that is, appearing after birth, while malignancy can occur quickly or after a considerable time. It all depends on the injury to the nevus in the broad sense of the word. Pigmented nevi, which are located on the sole, nail bed, perianal region, in places injured by clothing, etc., deserve special attention in relation to injury.

clinical picture. Schematically, the malignancy of a pigmented nevus can be represented as follows. Previously "calm" congenital or appeared during life, a flat pigmented nevus, which has the appearance of a spot or a flat papule slightly raised above the skin without hair, often round in shape, black, brown or gray, not increasing and not showing itself in any way, after a single or repeated mechanical injury or massive insolation begins to gradually increase along the plane of the skin or exophytically, sometimes changes color, becomes rough, begins to peel off.

As exophytic growth increases, the possibility of re-injury increases. As a result, the nevus becomes easily injured, bleeds after a slight touch of clothing, becomes infected, and gets wet for a long time. Each subsequent injury enhances exophytic growth. Gradually, a tumor forms at the site of the nevus in the form of a flat nodule that rises slightly above the skin with an uneven rough surface, usually repeating the shape of the former nevus, or in the form of a node on broad base, covered with easily removed dry and weeping, loose bloody crusts. On the surface of such a tumor, there may be brownish-pink papillomatous outgrowths.