The course of squamous cell skin cancer. Differential diagnosis in squamous cell skin cancer. Histology of skin basalioma

Basalioma (synonymous with basal cell carcinoma) is the most common malignant epithelial neoplasm of the skin (80%), arising from the epidermis or hair follicle, consisting of basaloid cells and characterized by locally destructive growth; metastasizes extremely rarely.

Usually develops after 40 years due to prolonged insolation, exposure to chemical carcinogens or ionizing radiation. More common in men. In 80% of cases, it is localized on the skin of the head and neck, in 20% it is multiple.

Clinically, the following forms of basalioma are distinguished:

superficial- characterized by a scaly pink spot, round or oval in shape with a filiform edge, consisting of small shiny nodules of pearl, murky pink;

O puffy begins with a dome-shaped nodule, reaching a diameter of 1.5–3.0 cm within a few years,

ulcerative develops primarily or by ulceration of other forms; a basalioma with a funnel-shaped ulceration of a relatively small size is called ulcus rodeus (“corrosive”), and extending deep into (up to the fascia and bone) and along the periphery - ulcus terebrans (“penetrating”);

scleroderma-like basalioma has the appearance of a dense whitish plaque with a raised edge and telangiectasias on the surface.

Histologically, the most common (50–70%) type of structure, consisting of various shapes and sizes of strands and cells of compactly located basaloid cells resembling syncytium. They have rounded or oval hyperchromic nuclei and scanty basophilic cytoplasm, along the periphery of the strands there is a "palisade" of prismatic cells with oval or slightly elongated nuclei - a characteristic sign of basalioma. Often there are mitoses, the cellular fibrous connective tissue stroma forms bundle structures, contains a mucoid substance and an infiltrate of lymphocytes and plasma cells.

The course of basaliomas is long. Relapses occur after inadequate treatment, more often with a tumor diameter of more than 5 cm, with poorly differentiated and invasive basaliomas.

The diagnosis is established on the basis of clinical and laboratory (cytological, histological) data.

Treatment of solitary basaliomas is surgical, as well as with the help of a carbon dioxide laser, cryodestruction; with a tumor diameter of less than 2 cm, intralesional administration of intron A is effective (1,500,000 IU every other day No. 9, the course consists of two cycles). With multiple basaliomas, cryodestruction, photodynamic therapy, chemotherapy (prospidin 0.1 g intramuscularly or intravenously daily, per course of 3.0 g) are performed. X-ray therapy (more often close-focus) is used in the treatment of tumors located near natural openings, as well as in cases where other methods are ineffective.

squamous cell cancer

Squamous cell skin cancer (syn.: spinocellular cancer, squamous epithelioma) is a malignant epithelial tumor of the skin with squamous differentiation.

It mainly affects the elderly. It can develop on any part of the skin, but more often in open places (upper face, nose, lower lip, back of the hand) or on the mucous membranes of the mouth (tongue, penis, etc.). As a rule, it develops against the background of precancer of the skin. It metastasizes lymphogenously with a frequency of 0.5% for malignant solar keratosis to 60–70% for squamous cell carcinoma of the tongue (average 16%). Foci of squamous cell skin cancer are solitary or primary multiple.

Clinically isolated tumor and ulcerative types of skin cancer.

tumor type, initially characterized by a dense papule surrounded by a corolla of hyperemia, which turns over several months into a dense (cartilaginous consistency) inactive node (or plaque) soldered with subcutaneous adipose tissue, of a red-pink color with a diameter of 2 cm or more with scales or warty growths on the surface (warty variety), bleeding easily at the slightest touch, necrotizing and ulcerating; its papillomatous variety is characterized by more rapid growth, separate spongy elements on a wide base, which sometimes have the shape of a cauliflower or tomato. It ulcerates on the 3-4th month of the existence of the tumor.

Ulcerative type, characterized by a superficial ulcer of irregular shape with clear edges, spreading not in depth, but along the periphery, covered with a brownish crust (superficial variety); the deep variety (spreading along the periphery and into the underlying tissues) is an ulcer with a yellowish-red color (“greasy”) base, steep edges and a bumpy bottom with a yellow-white coating. Metastases to regional lymph nodes occur on the 3rd-4th month of the existence of the tumor.

Histologically, squamous cell skin cancer is characterized by proliferating into the dermis strands of cells of the spinous layer of the epidermis. Tumor masses contain normal and atypical elements (polymorphic and anaplastic). Atypia is manifested by cells of various sizes and shapes, hyperplasia and hyperchromatosis of their nuclei, and the absence of intercellular bridges. There are many pathological mitoses. Distinguish between keratinizing and non-keratinizing squamous cell carcinoma. Highly differentiated tumors demonstrate pronounced keratinization with the appearance of "horny pearls" and individual keratinized cells. Poorly differentiated tumors do not have pronounced signs of keratinization; strands of sharply polymorphic epithelial cells are found in them, the boundaries of which are difficult to determine. Cells have various shapes and sizes, small hyperchromic nuclei, pale nuclei-shadows and nuclei in a state of decay are found, pathological mitoses are often detected. Lymphoplasmacytic infiltration of the stroma is a manifestation of the severity of the antitumor immune response.

The course is steadily progressive, with germination in the underlying tissues, pain, dysfunction of the corresponding organ.

The diagnosis is established on the basis of the clinical picture, as well as the results of cytological and histological studies. Differential diagnosis is carried out with basalioma, keratoacanthoma, solar keratosis, Bowen's disease, skin horn, etc.

Treatment is carried out by surgical removal of the tumor within healthy tissues (sometimes in combination with X-ray or radiotherapy), chemosurgical treatment, cryodestruction, photodynamic therapy, etc. are also used. The choice of treatment method depends on the stage, localization, prevalence of the process, the nature of the histological picture, the presence of metastases, the age and general condition of the patient. So, with the localization of the tumor in the area of the nose, eyelids, lips, as well as elderly people who are unable to endure surgical treatment, radiotherapy is more often performed. The success of treatment largely depends on early diagnosis. Prevention of squamous cell skin cancer lies primarily in the timely and active treatment of precancerous dermatoses. The role of sanitary propaganda among the population of knowledge about the clinical manifestations of squamous cell skin cancer is important so that patients consult a doctor as early as possible when it occurs. It is necessary to warn the public about the harmful effects of excessive insolation, especially for fair-skinned blonds. It is also important to comply with safety regulations at work where carcinogenic substances are present. Workers employed in such industries should be subjected to systematic professional examinations.

20.04.2018

There is a huge amount of material on the Web about skin cancer. Unfortunately, information that is not presented in the form of scientific articles and not on the websites of dermato-oncologists does not stand up to scrutiny.

In this article, I will answer many burning questions: “how to recognize skin cancer in yourself?”, “is skin cancer dangerous?”, “what are the treatment options for skin cancer?” and others.

Types of skin cancer

There are 3 types of common skin cancers. They differ both in the incidence rate (i.e., the chance of getting sick) and in the degree of danger to life - basalioma, squamous cell carcinoma and melanoma.

Melanoma- one of the rare and dangerous skin tumors. It accounts for only 4% of the total number of malignant skin lesions, but is the cause of almost 80% of deaths in this localization. Read more about melanoma.

Basal cell skin cancer

Basalioma- the most common, but at the same time the safest type of skin cancer. Death from basalioma is possible only in very advanced cases or with aggressive forms (basal squamous) tumors. The favorable course of basalioma is due to the fact that it almost never metastasizes (only 0.5% of cases).

Symptoms and signs

Most often, basalioma occurs on the skin of the nose, a little less often on the face, and much less often on other parts of the body.

The peak incidence occurs at the age of over 40 years. The youngest patient who was diagnosed with basalioma by histology was 39 years old.

What basal cell skin cancer looks like depends on the form:

Nodal shape (synonymous with nodular). The tumor is presented in the form of a nodule. It can be distinguished from other skin formations by an increased number of vessels on the surface, a waxy sheen and small gray-blue inclusions. All these signs are visible in the photo.

In addition, on the surface of the nodular basalioma there may be another characteristic sign - ulceration.

surface form basalioma in most cases is presented in the form of an area of redness on the skin. Peeling elements and the waxy sheen already mentioned above are also possible.

Scleroderma-like form basalioma is very rare and often presents difficulties in diagnosis. It is characterized by a lighter and firmer seal compared to the surrounding skin.

pigment form basaliomas constitute a very small proportion of the total number of these tumors. It is distinguished by a large amount of pigment. In this regard, basalioma is often mistaken for melanoma when viewed without a dermatoscope.

can reach very large sizes and in advanced cases is practically not amenable to treatment.

Photo in the initial stage

Unfortunately, basal cell skin cancer is extremely difficult to diagnose in the early stages, i.e. with minimal size. Here are some photos:

Diagnosis of basalioma in the early stages, with a small tumor size, can present significant difficulties. Only a combination of a comprehensive examination of the entire skin, a thorough clarification of the history of the formation and dermatoscopy will help in establishing the diagnosis of basalioma at an early stage.

Basaliomas with high and low risk of recurrence (NCCN, 2018)

Notes

Localization regardless of size can be a sign of high risk
Histological forms of low risk: nodular (nodular), superficial, keratotic, piloid, with differentiation towards skin appendages, Pinkus fibroepithelioma
Area H means high risk regardless of size
Morpheus-like, basosquamous (metatypic), sclerosing, mixed infiltrative, micronodular in any part of the tumor

Only one of the factors from the right or left column is sufficient to assign a tumor the status of "high risk of recurrence".

Basalioma treatment

The main goal of the treatment of basal cell carcinoma is the complete removal of the tumor with the maximum preservation of the cosmetic properties and functions of those parts of the body where this neoplasm has developed.

Usually the best result is obtained surgical methods. However, the desire to preserve functionality and cosmetic properties may lead to the choice radiotherapy as the main method of treatment.

Depending on the risk of recurrence (see above), the approach to treating basalioma may vary.

In patients with superficial basalioma and low risk of recurrence, when surgery or radiation therapy is contraindicated or not applicable, the following treatments may be used:

5-fluorouracil ointment;
ointment "Imiquimod" ("Aldara", "Keravort");
photodynamic therapy;
cryodestruction.

Micrographic surgery according to Mohs may be recommended for patients at high risk of relapse.

Chemotherapy for basalioma, it includes hedgehog signaling pathway inhibitors vismodegib (Erivedge) and sonidegib (Odomzo). These drugs can help when surgical methods, like radiation therapy, are inappropriate or contraindicated.

What you need to know about basalioma?

In the vast majority of cases, basalioma not poses a threat to life.
If the answer is basal cell carcinoma during a histological examination of a distant formation, there is nothing to worry about. It is important to make sure that education is removed fully- be sure to consult with an oncologist.
If after removal of the basalioma in the histological examination there is the phrase “tumor cells in the resection margin” or something similar, it is necessary further treatment to completely remove the tumor.
Strongly not I recommend removing the basalioma without histological examination, since even a very typical looking formation may not be what it seems at first glance.
Basaliom needs treat. Observation is a bad option for such a diagnosis. Treatment of advanced forms (see photo of the ulcerative form) is extremely difficult and expensive.
If you have already had a basalioma removed, you need to regularly undergo an examination of the entire skin by an oncologist in order to possibly identify another such tumor.
Probability of metastasis in the metatypical (basosquamous) histological type it is higher than in other species.

Squamous cell carcinoma

It is less common than basalioma, the second most common type of skin cancer and has a slightly less favorable prognosis. However, it should be noted that the course of the disease much less malignant than melanoma.

Metastases occur relatively rarely - an average of 16% of cases. In patients with squamous cell skin cancer less than 2 cm in size, the 5-year survival rate is about 90%, with large sizes and tumor invasion into the underlying tissues - less than 50%.

It can occur on any part of the body, including the genitals and mucous membranes, but most often in places exposed to sunlight.

Symptoms and signs

The appearance of squamous cell skin cancer depends largely on the clinical form of the disease.

keratinizing form- an elevation or a flat surface covered with horny scales that can grow and fall off. May bleed if damaged.

It must be remembered that under the mask skin horn it is the keratinizing form of squamous cell carcinoma that may be hiding. In this regard, such formations should always be removed only with a histological examination:

Nonkeratinizing endophytic form(growing in the direction of surrounding tissues). Most often it looks like a long-term non-healing wound or ulcer, which can deepen and expand over time.

Exophytic non-keratinizing form squamous cell skin cancer looks like a nodule that rises above the level of the skin. The surface of the node may be eroded or wet.

Photo in the initial stage

The initial stage of squamous cell carcinoma is understood as a condition when the malignant process is limited to the epidermis - the uppermost layer of the skin. Indicated in the diagnosis as in situ or intraepidermal squamous cell carcinoma. This disease is not life threatening if removed completely.

There are 2 forms of this phase of the disease:

Most often it is represented by single flat plaques, with clear boundaries, asymmetric shape, uneven edges. The size reaches 7–8 mm. Education can gradually increase, peeling or crusting is often noted on the surface.

The color is red or brown, located on any part of the body.

On my own behalf, I will add that in my practice, histologically confirmed Bowen's disease met only once. It looked like a small (3 x 4 x 3 mm) flesh-colored lump with a smooth surface on the skin of the shaft of the penis in a 43-year-old man.

The second form of skin cancer of the initial stage, which develops most often on the skin of the foreskin of the penis or head. Much less often, the disease affects the female external genitalia.

The most common appearance of Keyr's erythroplasia is a bright red spot with clear boundaries, a wet, shiny surface.

Treatment of squamous cell skin cancer (NCCN, 2018)

As in the case of basalioma, squamous cell carcinoma is divided into groups of high and low risk of recurrence and metastasis.

Area H: face mask (including eyelids, eyebrows, skin around the eyes, nose, lips [skin and red border of the lips], chin, lower jaw, skin/furrows in front of and behind the pinna, temples, ears), genitals, palms and feet .

Area M: cheeks, forehead, scalp, neck and shins

Region L: Trunk and limbs (excluding lower legs, palms, feet, nails and ankles)

Notes

The rim of hyperemia should be taken into account when measuring the size.
An excisional biopsy is preferred over an incisional one.
The modified Breslow thickness measurement should rule out parakeratosis and crusting and should be taken from the base of the ulcer, if any.
Localization, regardless of size, can be a sign of high risk.
Area H implies high risk regardless of size.

The basic principles and methods of treatment for squamous cell carcinoma are the same as for basalioma.

The main goal is to maintain functionality and cosmetic qualities. The most effective is considered surgical method– removal of the tumor with the capture of 4-6 mm of healthy tissue with a low risk of recurrence and metastasis. Recommended for high risk tumors micrographic surgery according to Mohs or excision in a wider range than at low risk.

Radiation therapy applicable in cases where other methods cannot be used. Platinum drugs (cisplatin, carboplatin), as well as EGFR inhibitors (cetuximab) can be used in chemotherapy for squamous cell carcinoma.

How not to get skin cancer? What to avoid?

Sunlight. The most proven cause of both types of skin cancer, however, like melanoma, is exposure to sunlight. If you like to visit hot countries, you have blond hair and skin, or your work is related to prolonged exposure to the sun, you should seriously take care of UV protection.

Precancerous skin diseases- the next factor that may precede the development of the squamous form: actinic (solar) keratosis and cheilitis, leukoplakia, papillomavirus infection of the mucous membranes and genitals. This type of tumor can also develop against the background of cicatricial changes after burns or radiation therapy.

Contact with carcinogens

Various chemicals can lead to the development of skin cancer: arsenic and petroleum products.

Weakened immune system. People who take immunosuppressants after organ transplants or who are HIV positive have an increased risk of developing squamous cell skin cancer.

Summary

Skin cancer in the vast majority of cases is not a fatal disease. In the early stages, it is treated quite successfully; there are many different methods in the arsenal of doctors. In the case of aggressive forms or a long course without treatment, skin cancer can be life-threatening.

Bibliography

Gantsev Sh. Kh., Yusupov AS Squamous cell skin cancer. Practical oncology. 2012; 2:80-91.
Miller AJ, Mihm MC. melanoma. N Engl J Med. 2006; 355:51-65.
I. A. Lamotkin. Clinical dermato-oncology: atlas / M.: BINOM. Knowledge Lab, 2011.

Cytograms of basaliomas are characterized by small hyperchromic cells with mild signs of atypicality, which are located in the form of dense tissue patches, complexes, strands or separate groups (dense cell cementation). The background of preparations can be represented by an interstitial substance, structureless masses of cellular decay, as well as keratinizing scales and horny masses.

There are three types of microscopic pictures.

The most common type of cytograms is characterized by small hyperchromic cells arranged in dense tissue patches. Due to the dense arrangement of cells, it is not always possible to determine their shape. Along the edge of such clusters, the cells turn out to be polygonal, sometimes with short processes or “disarranged”. The nuclei occupy almost the entire cell, are located centrally in it, are polymorphic, uneven contours, hyperchromic and diffusely stained, the nucleoli do not differ. The chromatin of the nuclei is coarsely clumpy. The cytoplasm of the cells is sparse and inhomogeneous, intensely basophilic stained.

In addition to small hyperchromic cells, lighter cells of medium size may be found. They are round or polygonal in shape with centrally located nuclei, reminiscent of squamous cell carcinoma cells.

In tissue shreds between cells, there may be dense oxyphilic strands and accumulations of interstitial substance. Sometimes cells seem to be walled up in such vast accumulations of interstitial substance.

In the second type of cytograms, the vast majority of cells are medium and small in size, round in shape, with light cytoplasm and rounded centrally or eccentrically located nuclei. The chromatin of the nuclei is clear, granular or stranded. It evenly fills the nucleus and is intensely colored; enlarged nucleoli are visible in some nuclei. Often there are binuclear cells with bean-shaped nuclei. Cells are located separately, in groups and complexes among abundant fine-grained or homogeneous oxyphilic substance and are, as it were, walled up in it.

In addition to light cells, the preparations contain small hyperchromic polygonal elements of the tumor with sharply hyperchromic, finely tuberous nuclei and not abundant, homogeneous, clearly defined cytoplasm. The background of the drug is oxyphilic intermediate substance and histiocytes.

The third type of cytograms is characterized by a relatively large number of pigment-containing cells (nevus-like variant of basalioma). Pigment-containing cells are oval, elongated, polygonal and, rarely, process-shaped, filled with slate-gray and gray melanin granules. These cells are located separately or are found in the form of strands and clusters. Their nuclei are round and oval, with a compacted contour, small-lumpy, with small nucleoli. Similar cells are found, but in a small number in other variants of basalioma cytograms.

The predominance of pigment-containing cells in the preparation makes it necessary to make a differential diagnosis between basalioma and pigmented nevus. Often it is not possible to establish an accurate diagnosis, and in conclusion it is only necessary to indicate that with such a cytogram, both pigmented basalioma and pigmented nevus can occur.

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

What is this type of cancer?

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

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

Causes of Skin Cancer

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

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

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

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

Provocateurs of basalioma

There are many risk factors for this disease:

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

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

Basalioma classification

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

solid basalioma;
pigment;
morphea-like;
superficial.

Differentiated is divided into:

keratotic basalioma;
cystic;
adenoid.

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

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

Types of basalioma by type of manifestation

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

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

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

Symptoms of the disease

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

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

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

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

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

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

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

In humans, basal cell skin cancer is the most dangerous. Treatment in this case is quite difficult. Pathology, as a rule, is localized on the face, skin around the eyes and nose.

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

How can the disease be diagnosed?

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

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

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

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

Pathology therapy

Once a diagnosis of basal cell skin cancer is confirmed, treatment should begin immediately. Most often, the following methods of dealing with this pathology are used:

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

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

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

Radiation therapy in the presence of basalioma is rarely used, but if surgery is not possible, then it is simply irreplaceable. Doctors admit that it is quite effective. Irradiation is indispensable even with a high degree of malignancy of the tumor. At the same time, one should be careful about radiation therapy in young patients, since the risk of developing radiation dermatitis and induced malignancies is high.

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

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

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

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

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

Surgical treatment of basalioma

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

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

Consequences of basal cell skin cancer

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

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

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

Preventive actions

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

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

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

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

Skin cancer, like most cancers, is considered a polyetiological condition. And it is far from always possible to reliably find out the main trigger for the appearance of malignant cells. At the same time, the pathogenetic role of a number of exogenous and endogenous factors has been proven, and several precancerous diseases have been identified.

Skin cancer is a malignant neoplasm in the form of a tumor that develops as a result of atypical transformation of cells under the influence of subjective and objective factors. The disease is very dangerous because it affects the largest and most important organ of the human body.

By identifying cancer in its early stages and prescribing the right treatment, it can be permanently eliminated, preventing the return of the disease. In the case of the development of a severe, aggressive form, other organs of the human body are often affected, which leads to irreversible consequences, and sometimes even death.

It is extremely important to detect any kind of changes in the skin in a timely manner and consult a doctor for examination and treatment.

Skin cancer is a fairly common form of a malignant type of tumors, in which both women and men are affected almost equally, their age is mainly from 50 years or more, although the likelihood of developing the disease in one form or another in more than one form is not ruled out. young patients.

The area of the lesion is, as a rule, areas of the skin that are open to one or another effect. The development of skin cancer is noted in 5% of the total number of cases of cancer as such.

The mechanism of the development of the disease

Exposure to UV radiation and other causative factors leads in most cases to direct damage to skin cells. At the same time, it is not the destruction of cell membranes that is pathogenetically important, but the effect on DNA.

Partial destruction of nucleic acids is the cause of mutations, which leads to secondary changes in membrane lipids and key protein molecules. Mostly basal epithelial cells are affected.

Various types of radiation and HPV have not only a mutagenic effect. They contribute to the appearance of relative immune deficiency.

This is due to the disappearance of dermal Langerhans cells and the irreversible destruction of some membrane antigens that normally activate lymphocytes. As a result, the work of the cellular link of immunity is disrupted, protective antitumor mechanisms are suppressed.

Immunodeficiency is combined with increased production of certain cytokines, which only exacerbates the situation. After all, these substances are responsible for cell apoptosis, regulate the processes of differentiation and proliferation.

The pathogenesis of melanoma has its own characteristics. Malignant degeneration of melanocytes is promoted not only by exposure to ultraviolet radiation, but also by hormonal changes.

Clinically significant for disrupting the processes of melanogenesis are changes in the levels of estrogens, androgens and melanostimulating hormone. That is why melanomas are more common in women of reproductive age.

Moreover, hormone replacement therapy, contraceptives and pregnancy can act as a provoking factor in them.

Another important factor in the appearance of melanomas is mechanical damage to existing nevi. For example, tissue malignancy often begins after the removal of a mole, accidental injuries, and also in places where the skin is rubbed with the edges of clothing.

A malignant neoplasm originates from one or more pinkish spots that begin to peel off over time. This initial stage can last from one to two weeks to several years.

The main localization is the front part, dorsal shoulder and chest. It is here that the skin is the most delicate and susceptible to physiological changes in the body.

Skin cancer can form in the form of age spots that grow in size, become convex, darken sharply to a dark brown color. It often occurs under the condition of the degeneration of moles into malignant neoplasms.

The tumor may also look like a simple wart.

THE REASONS

Before the formation of a full-fledged malignant tumor, precancerous formations often appear, that is, precancerous diseases that have a high tendency to malignancy.

Precancers are divided into obligate and facultative. Obligate in almost 100% of cases degenerate into a malignant neoplasm. These types of tumors include:

Bowen's disease;
Erythroplakia Keira;
Pigmentary xeroderma;
Paget's disease.

For older men, the development of Bowen's disease is most characteristic. Precancer of this type is characterized by a violation of the integrity of the skin in any part of the body, however, it was noted that the surface of the body is more often affected.

Examination of the skin reveals a solitary plaque growing up to 10 cm in diameter. Hue varies in color from pale pink to purple.

The borders of the tumor are clear, moderately rising above the surface of the skin. During development, the surface of the formation may become crusted and eroded.

Bowen's disease is characterized by slow growth and a 100% chance of degeneration into squamous cell carcinoma. There is an increased risk of a combination of skin lesions and cancer of the internal organs.

A peculiar variation of Bowen's disease is Keyra's erythroplakia, the only difference is the predominant lesion of the mucous membranes. Compared to other tumors, it is considered a rare disease.

On visual inspection, it is a single plaque that has a scarlet hue with clear boundaries and edges rising above the skin surface. An essential sign indicating malignant degeneration is a change in the clarity of the boundaries, the appearance of erosion and ulceration.

With erythroplakia Queira, the ulcer is covered with fibrin or hemorrhagic crust.

Pigmentary xeroderma is a disease that manifests itself in childhood. It is characterized by hereditary transmission in an autosomal recessive manner. Pigmentary xeroderma manifests itself in the form of increased sensitivity to direct sunlight. The researchers identified three main periods of the course of the disease:

Erythema and hyperpigmentation;
Atrophic stage with the appearance of telangiectasias;
Neoplasm stage.

The exact causes of the development of skin cancer cannot be established, but experts name a number of prerequisites that can provoke the disease:

Exposure to the skin of chemical elements of a carcinogenic effect.
Ionizing radiation.
Frequent skin exposure to ultraviolet rays.
Mechanical damage to tissues, scarring, which in the future can cause the formation of cancer cells and the development of oncology.
A burn or radiation dermatitis can provoke the development of cancer.
The degeneration of moles into malignant tumors.
Heredity.
The presence of precancerous diseases: nevi, skin pigmentation, skin ulcers, syphilis, tuberculosis, melanosis, etc. In case of incorrect or untimely treatment of these diseases, oncology of the skin can develop.

Causes are a condition or situation that is fertile ground for the development of a particular disease.

The causes of skin cancer are:

influence of direct ultraviolet and ionizing radiation;
prolonged exposure to the surface of the skin of chemical carcinogens, a similar effect is exerted by tobacco smoke;
the genetic predisposition of the body to cancer, in particular to skin cancer;
prolonged thermal effect on any area of the skin;
occupational hazards, for example, long-term work associated with skin contact with arsenic and tar;
various skin diseases related to precancerous conditions, for example, chronic dermatitis, keratoacanthoma, senile dyskeratosis, a large number of warts, atheromas and papillomas, which are often injured;
scars left after past illnesses, such as lupus, syphilis, trophic ulcers or burns.

The causes of skin cancer can be divided into external and internal.

External causes

There are many predisposing factors that can cause skin cancer.

Excessive exposure to solar radiation and ultraviolet radiation. This factor is especially dangerous for fair-skinned and fair-haired people.
Professions that involve prolonged exposure to the sun.
Chemical carcinogens (fuel oil, arsenic, oil and others).
Prolonged thermal effect on specific areas of the skin. An example is "kangri cancer", it is common among the people of the mountainous regions of Nepal and India. This type of cancer develops on the skin of the abdomen, in those areas where pots of hot coal are placed for warming.
Precancerous skin diseases (Bowen's disease, Paget's disease, xeroderma pigmentosa, Queyre's erythroplasia and benign neoplasms that are subject to constant traumatization).

Other causes of skin cancer include:

Smoking.
Contact radiation and chemotherapy. These methods, which were used to treat oncological diseases of other localization, can also cause skin cancer.
Reduced immunity due to the influence of various factors. These factors may include: AIDS, the use of immunosuppressants and glucocorticoids after organ transplantation and in the treatment of autoimmune diseases.
genetic predisposition.
Sexual features. For example, melanomas, which occur mainly in women.

When considering the causes that provoke the development of skin cancer, there are two main types of factors that are directly related to the process. In particular, these are exogenous factors, as well as endogenous factors, we will consider them in more detail.

Otherwise, they can be defined as external factors. The most important of these factors can be distinguished ultraviolet radiation and the sun's rays in particular.

Remarkably, the development of squamous cell and basal cell carcinomas is mediated by chronic skin damage caused by exposure to UV radiation, while the development of melanoma occurs predominantly as a result of periodic intense exposure to sunlight.

Moreover, in the latter version, even a single exposure is sufficient for this.

There are several predisposing causes that contribute to the appearance of malignant skin tumors, namely:

Long-term exposure of the skin to UV rays. This can be proved by the fact that residents of the southern regions suffer from skin cancer much more often than the northern ones.
Skin exposure to radiation.
Long-term thermal effect on the skin.
Chemical impact. For example, contact with soot, various resins, tar, arsenic.
Hereditary predisposition to skin cancer.
Frequent use of drugs that suppress the immune system (anticancer, corticosteroids.
Age over 50 years. At a younger age, malignant skin diseases appear less frequently, and skin cancer in children is diagnosed even less frequently (0.3% of all cancers).
Mechanical injuries of nevi, birthmarks, scars.

Why Skin Cancer Occurs

In addition to the above causes of skin cancer, there are also a number of diseases that are considered precancerous. Precancerous diseases are divided into obligate and facultative precancer. Obligate precancer, as a rule, is a rare, slowly developing disease, which, however, completely turns into cancer. These include:

xeroderma pigmentosum
Paget's disease
Bowen's disease
erythroplasia of Queira

Optional precancers include all kinds of chronic skin diseases: dermatitis, inflammatory and dystrophic processes. Slow-healing wounds and skin ulcers are also considered facultative precancer.

Skin cancer, symptoms and signs in different forms have significant differences

Signs of skin cancer to look out for

the presence of new moles or spots on the surface of the skin;
dark red neoplasms that rise above the surface of the skin;
wound surfaces that do not heal for a long time;
moles that have been on the body for a long time began to change shape, color and size.

How does skin cancer manifest itself in each individual form?

CLASSIFICATION

There are several classifications according to which types of skin cancer can be distinguished. According to histological characteristics:

Basal cell carcinoma or basal cell carcinoma is the most common type of skin cancer. A more favorable type of cancer, because there is no tendency to infiltrative growth and metastasis;
Squamous cell carcinoma - often formed against the background of existing precancerous skin diseases. Oncoprocess is prone to germination of the thickness of the skin, early screening of metastases.

As such, there is no classification by localization. Cancer can affect almost the entire skin, including the skin of the lips, vulva, scrotum, anus.

The TNM classification includes four stages of skin cancer development, depending on the size of the tumor node, damage to regional nodes, and the presence of distant metastases.

Skin adenocarcinoma

Most often, skin cancer refers to all non-melanoma malignant neoplasms that originate from different layers of the dermis. Their classification is based on the histological structure. Melanoma (melanoblastoma) is often considered an almost independent form of carcinodermatosis, which is explained by the peculiarity of its origin and very high malignancy.

The main non-melanoma skin cancers are:

Basal cell carcinoma (basalioma) is a tumor whose cells originate from the basal layer of the skin. It can be differentiated and undifferentiated.
Squamous cell carcinoma (epithelioma, spinalioma) - occurs from the more superficial layers of the epidermis. It is subdivided into keratinized and non-keratinized forms.
Tumors originating from the appendages of the skin (adenocarcinoma of the sweat glands, adenocarcinoma of the sebaceous glands, carcinoma of the appendages and hair follicles).
Sarcoma, whose cells are of connective tissue origin.

When diagnosing each type of cancer, the WHO recommended clinical classification of TNM is also used. It allows using numerical and alphabetic designations to encrypt various characteristics of the tumor: its size and degree of invasion into the surrounding tissues, signs of damage to regional lymph nodes and the presence of distant metastases. All this determines the stages of skin cancer.

Each type of cancer has its own characteristics of growth, which is additionally reflected in the final diagnosis. For example, basalioma is tumor (large and small nodular), ulcerative (in the form of a perforating or corroding ulcer) and superficially transitional.

Squamous cell carcinoma can also grow exophytically with the formation of papillary outgrowths or endophytically, that is, according to the type of ulcerative-infiltrative tumor. And melanoma is nodular and non-nodular (superficially common).

Other types of skin cancer are much less common and account for a fraction of a percent of all skin cancers. These can be tumors of the sweat and sebaceous glands (adenocarcinoma), tumors from the tissues that make up the follicles, skin metastases from other neoplasms.

To determine the type of tumor in these cases is possible only with the help of diagnostic procedures - MRI, computed tomography and biopsy.

Adenocarcinoma

Adenocarcinoma is a fairly rare type of skin cancer. It develops from glandular cells (sweat and sebaceous glands), grows slowly. It looks like a dense nodule of blue-violet color or a papule rising above the skin, it is formed in the armpit, in the groin, under the mammary glands in women.

The node is characterized by slow growth, but in some cases it can reach large sizes (8-10 cm). Germination deep into the skin tissue and metastasis is rare. After removal, a recurrence of the tumor in the same place is possible.

Verrucous carcinoma

Verrucous carcinoma is a rare type of skin cancer, a type of squamous cell carcinoma. Appears on the skin of the hands, looks like a wart, which makes it difficult to correctly diagnose in the early stages of the disease. However, these formations can bleed, which allows you to pay attention to them in time.

Since the skin is made up of cells that belong to a large number of tissues, there are significant differences in the tumors that affect them. Therefore, the concept of cancer in this case is very collective and defines all pathologies of a malignant nature.

However, experts distinguish the most common types, which include basilomas, melanomas, squamous cell formations, lymphomas, carcinomas, and Kaposi's sarcoma.

Squamous cell skin cancer

This type of pathological process on the skin has several synonyms, it can also be called squamous epithelioma or spinalioma. It occurs regardless of the area of the body and can be located anywhere.

But the open parts of the body, as well as the lower lip, are most susceptible to this lesion. Sometimes doctors find squamous cell carcinoma localized on the genitals.

This tumor is not selective to people by gender, but with regard to age, pensioners are more likely to suffer. As the reasons provoking its appearance, experts indicate scarring of tissues after burns or mechanical damage that is systematic.

Actinic keratosis, chronic dermatitis, lichen, lupus tuberculosis and other diseases can also provoke the appearance of squamous cell carcinoma.

Basalioma or basal cell carcinoma of the skin.

It got its name from the place of its "growth" - the basal layer of the epidermis. This tumor lacks the ability to metastasize and recur. Its migration is directed mainly into the depth of tissues with their inevitable destruction.

About 8 out of 10 of all skin cancers are of this type.

This is the least dangerous of all types of skin tumors. The exception is those cases when the basalioma is located on the face or auricles: in such circumstances, it can reach impressive volumes, affecting the nose, eyes, and damaging the brain. Most often occurs in older people.