Skin cancer: symptoms, treatment
- Causes and predisposing factors
- Skin Cancer: Symptoms
- Diagnosis of skin cancer
- Treatment of skin cancer
Skin cancer is another confirmation of the fact that the determining factor for the development of oncological diseases in humans is the aggressive influence of external factors.
Being a kind of "outer spacesuit", our skin is the first to react to the uncomfortable influence of the environment and to mitigate possible negative effects for the body through inflammatory and sclerotic processes. When exhaustion of compensatory mechanisms occurs on one of the defense sites, uncontrolled and unrestrained growth of tumor, immature cells from previously normal tissue begins, with a tendency to expansion and destruction of surrounding organs.
It is oncological diseases of the skin and its appendages, most often the average person is at risk of falling ill with tumors with localization in other organs. The proof can be considered the fact that more than half of people, who lived to the age of seventy, had at least one histological variant of skin cancer.
And the sources from which a malignant tumor in the skin can form is quite enough.
The skin consists of the epidermis and its appendages.
The epidermis is represented by a multilayered flat keratinizing epithelium lying on the basement membrane, bounding it from the underlying tissues.
Loose subcutaneous fat, located under the epidermis, not referring to the skin, is a kind of "buffer-shock absorber" between the outer covers and internal organs.
In microscopic examination, the following layers can be distinguished in the epithelium:
- Basal (lower);
- Spiny (malpighian);
- Horny (external).
In the basal layer of the epidermis, pigment melanin, which determines the color of the skin, is contained in varying amounts. Near the basal membrane, on both sides of it, lay melanocytes, which produce melanin. Here, near the membrane, are located and appendages of the skin, which include sweat and sebaceous glands, hair follicles.
Tissue accessory of skin tumors is as follows:
- Basalioma. It develops from the cells of the basal layer of multilayered planar epithelium.
- Squamous cell carcinoma (otherwise: squamous cell carcinoma). Its source is the other layers of the epidermis.
- Melanoma. A tumor of melanocytes, which produce under the influence of solar radiation, a pigment melanin. It is the excessive stress of melanocytes that leads to the development of this type of skin cancer.
- Adenocarcinomas. Glandular tumors from the secreting epithelium of sweat and sebaceous glands.
- From the elements of the hair follicle (usually squamous forms).
- Mixed tumors. They have several tissue sources.
- Metastatic tumors. Metastasis of cancers of internal organs to the skin according to the frequency of occurrence: lungs, larynx, stomach, pancreas, large intestine, kidney, bladder, uterus, ovaries, prostate gland, testicle.
Previously, part of the classifications included some soft tissue tumors to skin cancers by their surface location and manifestations (skin dermatosarcoma, skin leiomyosarcoma, angiosarcoma, multiple hemorrhagic Kaposi sarcoma, etc.). Undoubtedly, one should not forget about them when conducting differential diagnostics.
Causes and predisposing factors
- Excess exposure to ultraviolet radiation and solar radiation. This includes a frequent visit to solariums. Especially this factor is important for people with a light type of skin and hair (Scandinavian type).
- Professions with a long stay in the open air, in which exposed areas of the skin are subjected to aggressive polyfactorial effects of environmental effects (solar insolation, extreme temperatures, sea (salty) wind, ionizing radiation).
- Chemical carcinogens, mostly associated with organic fuel (soot, fuel oil, oil, gasoline, arsenic, coal tar, etc.).
- Long term exposure to certain areas of the skin. As an example - the so-called "cancer kangri", common among the population of the mountainous regions of India and Nepal. It appears on the skin of the abdomen, on touching areas with pots of hot coal, which they wear for warming.
- Precancerous skin diseases:
- obligate (in all cases, turning into cancer);
- facultative (at a sufficiently high risk, the transition to cancer is not necessary).
To obligate include illness Paget, Bowen, erythroplasia Keira and pigment xeroderma.
Diseases Paget, Bowen and erythroplasty Keira appear to look approximately the same: flaking red-brown foci of uneven oval shape with a plateau-like elevation. They occur in any part of the skin, but Paget's disease is more often localized in the nasal region and on the skin of the genital organs. The main differentiation occurs during histological examination, after taking a biopsy.
Pigment xeroderma is a genetically determined disease, manifested from childhood in the form of an increased reaction to solar radiation. Under its influence, the patients develop severe burns and dermatitis, followed by foci of hyperkeratosis, followed by skin atrophy and cancer development.
Optional facial skin diseases include chronic, non-treatable, dermatitis of various etiologies (chemical, allergic, autoimmune, etc.); Keratoacanthoma and senile dyskeratosis; Long-term non-healing trophic ulcers; Cicatricial changes after burns and skin manifestations of such diseases as syphilis , systemic lupus erythematosus ; Doucherayle melanosis; Melanoma-hazardous pigment nevi (complex pigment nevus, blue nevus, giant nevus, nevus Ota); The benign skin diseases (papillomas, warts, atheromas, moles) are constantly traumatized; Cutaneous horn.
- Smoking and features of smoking habits (cancer of the lower lip in cigarette smokers without a filter).
- Contact influence of aggressive methods of treatment of previously existing oncological diseases of other localizations (contact radiation and chemotherapy).
- Decrease in overall immunity under the influence of various factors. For example - the presence of a history of AIDS. Here also include the use of immunosuppressors and glucocorticoids in the therapy of autoimmune diseases and after organ transplantation. The same effect has systemic chemotherapy in the treatment of oncological diseases of other localizations.
- Age over 50 years.
- Presence of skin cancer in close relatives.
- Part of the research notes the effect of dyshormonal disorders and features of human hormonal status on the development of skin cancer. So, the fact of frequent malignancy (transition to cancer) of melaneopasic pigment nevi in pregnant women was noted.
- Sexual features: melanomas are more common in women.
Skin Cancer: Symptoms
An important feature of the clinic malignant neoplasm of the skin can be considered a theoretical possibility of detecting this disease in the early stages. The signs appearing on the skin, first of all attracting attention, are the appearing on the skin of previously not observed elements of a large rash and the change in appearance, with the simultaneous itching or pain sensations previously on the skin of scars, papillomas, moles (nevi), trophic ulcers.
The appearance of new elements of the rash, unlike skin manifestations of infectious, allergic and systemic diseases - is not accompanied by any changes in the general condition of the patient.
Common signs that you should pay attention to!
- Darkening before the usual skin area with a tendency to increase.
- Long healing ulceration with sacculent discharge or simply moist surface.
- Sealing the skin area with lifting it above the general surface, changing the color, gloss.
- These signs are accompanied by itching, redness and tightness around the zone causing anxiety.
Different histological forms of cancer have their own peculiarities clinical manifestations.
Squamous cell carcinoma of the skin
- Identify in 10% of cases.
- Its highly differentiated form develops from the moment of the first manifestations to the extreme stages, very slowly - which makes it prognostically favorable in terms of diagnosis and treatment. However, there are also forms with very low histological differentiation, the course of which can be quite aggressive.
- Its appearance is preceded, as a rule, by facultative precursors (dermatitis, trophic ulcers of various origin, scars).
- More often it looks like a red scaly patch with a clear border from the surrounding tissues. It is easily traumatized, after which it does not heal, but has a wounded wet surface, covered or not covered with scales. Ulcerative defects in the skin have a permanent sharp unpleasant odor.
- Squamous cell carcinoma does not have a definite, characteristic for it localization. It often develops on the limbs, face.
- The localization of squamous cell carcinoma of the skin without signs of keratinization (formation of scales) on the head of the penis - was called the disease of Keira.
- The appearance of constant uncontrollable pain in the area of cutaneous manifestations of skin cancer - serve as a sign of germination in deep tissues, disintegration and attachment of a secondary infection.
- Hematogenous metastases, to remote organs are not characteristic, are detected only in isolated, severely neglected cases.
- The presence of metastases in regional lymph nodes with the location of the tumor on the face, occurs more often than when the tumor is localized on the limbs, trunk and scalp. Regional lymph nodes first increase in size, remaining mobile and painless. Later, their fixation to the skin occurs, they become sharply painful, occurs from the decomposition with ulceration of the skin in their projection.
- The tumor responds well to the onset of radiation treatment.
Basal cell carcinoma (basal cell carcinoma)
- Appears at the age of 60 years.
- Sometimes it is combined with tumors of other internal organs.
- It occurs in 70-76% of cases of all cancers of the skin.
- The characteristic localization is the open parts of the body. Most often on the face (with one side of the bridge of the nose, the superciliary region, the outer edges of the wings of the nose, the temple, the wings of the nose, the upper lip and the nasolabial fold area). Basalomas are also often found on the neck and the auricles.
- Initially appears as a flat individual (reaching, on average, 2 cm in diameter) or draining (from several small, up to 2-3 mm knotted elements) formation, with a rich dark pink color and pearlescent shine. The tumor grows very slowly. The spread of basal cells to other parts of the body, outside the primary focus, is noted in very rare cases. Unlike other forms of skin cancer, the surface of the basal cell remains whole for a long time, up to several months.
- Over time, the plaque becomes ulcerated and takes the form of an ulcer spreading over the surface of the skin, with characteristic raised edges in the form of a thickened shaft. The bottom of the ulcer is partially covered with a dry crust. Unshielded areas retain their whitish shine.
- The bottom of the ulcer defect gradually deepens and expands, growing into deep tissues and destroying muscles and bones on its way. Defects in time can occupy large areas of the skin, spreading in breadth. Metastases with basalioma are not observed.
- When localized on the face or the auricles, the tumor is dangerous by the probability of germination into the nasal cavity, into the eyeball, the bone structures of the inner ear right up to the brain.
There are the following varieties of basal cell:
- Pigmented (it acquires a black-brown or even black-blue color similar to melanoma in the late stages, due to the pigment of blood, hemosiderin, in the bottom of the ulcerative defect);
Adenocarcinoma of the skin
- This very rare form of cancer occurs in places most rich in sebaceous and sweat glands: in folds under the mammary glands, in the groin, in the armpits.
- In these areas there appears a single unit, projecting above the surface, a small cluster of a few millimeters in a bluish-violet color. The knot is very slow. In rare cases, the tumor reaches a large size (up to 8-10 cm). It is also very rare that it grows into deep muscles and intermuscular spaces and metastasizes.
- The main complaints are associated with soreness of the tumor in case of ulceration and attachment of secondary infection.
- After surgical removal, it is possible to relapse in the same place.
- Diagnose in 15% of cases of skin cancer, in 2-3% of cases of malignant tumors of other organs and systems, which indicates its rarity.
- Most of the cases (about 90%) are women.
- Favorite localization in descending order - the face, the front surface of the chest, limbs. In men, foot, toes often occur on the plantar surface. Rare localizations, which, nevertheless, occur: palms; Nail bed; Conjunctiva of the eye; Mucous membranes of the mouth, anal area, rectum, vagina.
- There is a discoloration of the existing mole (nevus) in a bright red color or vice versa, discoloration with different shades of gray.
- The edges of the birthmark become uneven, asymmetric, blurred or vice versa, jagged.
- Change for a short time the consistency (edema, compaction) and the appearance of the surface (glossy sheen) of the existing mole.
- The appearance of painful sensations and itching in the field of birthmarks.
- Increase in the size of the birthmark with the appearance of a watery discharge.
- The disappearance of the hair covering from a mole.
- Appearance next to the mole, changed in color and size, in nearby areas of the skin, multiple pigmented spots with ulceration of the "maternal", bleeding and itching. This appearance is characteristic of melanoma in the late stages.
- Appearance, painted in red-brown shades, uneven patch resembling a birthmark, on clean earlier sections of the skin.
- Emerging spots can include point inclusions of black, white or bluish color.
- Sometimes the appearance of the formation may take the form of a protruding black color of the node.
- The tumor size is about 6 mm on the average.
- The tumor immediately after the appearance is actively growing and can practically instantly grow into the deep sections of the subcutaneous tissue.
- Metastasis is multiple, lump, lymphogenous and blood flow. Metastases are found in the bones, meninges, liver, lungs, brain. In the centers of screening, almost immediately and with great speed, the tumor tissue begins to develop, eroding the tissue of the "sheltered" organ and again spreading further along the lymphatic and blood vessels. Predicting the ways of metastasis and the number of organs affected by distant metastases is impossible.
In the later stages of melanoma, the predominant significance is signs of general intoxication and manifestations of metastasis:
- Enlarged lymph nodes, especially in the armpit or groin;
- Seals under the skin with its excessive pigmentation or discoloration over them;
- Unexplained weight loss;
- A dark gray shade of the entire skin (melanosis);
- A paroxysmal, cumulative, coughing;
- Loss of consciousness with the development of seizures.
You should know that the appearance of benign nevi, or, as they are called in the people, birthmarks, moles - ceases after puberty. Every new, similar kind of education that appears on the skin in adulthood requires close attention!
Diagnosis of skin cancer
- Identification in the skin of neoplasms previously unchanged or a change in appearance, consistency and size previously available. For this purpose, the whole surface of the skin is examined and probed, including the places of natural depressions and folds, the area of the external genital organs, the perianal zone and the scalp.
- Carrying out epiluminescent microscopy of the altered skin area using an optical dermatoscope and immersion medium.
- Determination of the condition of the available inspection and probing of all superficially located lymph nodes.
- Taking of smears-prints in the presence of ulcerated surfaces of tumor-like formations on a cytological study.
- For the diagnosis of melanoma, radioisotope methods using phosphorus (P32) are additionally used, which accumulates in it 2-7 times more intensively than a similar section of skin on the other side of the body.
- The presence of melanoma can speak thermography, according to which, in the tumor, the temperature exceeds the surrounding tissues by 2-4 ° C.
- As an alternative method of diagnosing melanoma in the early stages, many countries already use specially trained dogs that detect malignancy even before visual changes on the skin.
- Aspiration fine needle needle biopsy of enlarged lymph nodes with cytology or puncture examination for histological examination.
- X-ray examination of chest organs for the presence of metastases.
- Ultrasonic diagnostics of regional lymphonoduses and organs of the abdominal cavity.
- CT or MRI of pelvic organs with an increase in the lymph nodes of the inguinal iliac group.
- To determine distant metastases, with changes in the internal organs, osteoscintigraphy (for the presence of metastases in the bones), CT or MRI of the brain is additionally performed.
- In addition, a number of laboratory tests are performed: a serological response to syphilis; General blood and urine tests; Biochemical blood test (to determine the degree of functional stress of the kidneys and liver).
- Metastasis of adenocarcinoma from internal organs is excluded.
Treatment of skin cancer
Most tumors and tumorous skin formations are benign processes. Their treatment is limited to mechanical removal with the obligatory subsequent sending to a histological study. Such operations are performed at the polyclinic stage.
Unfortunately, new surgical techniques (electron knife, for example), used to remove the formation without a preliminary cytological study - do not always make it possible to sufficiently accurately examine the remote material. This leads to a great risk of "losing" the patient from the species until he has treated with relapse or signs of a common metastasis of undiagnosed earlier malignant skin pathology.
If the question of the presence of melanoma is not put, then the treatment of any diagnosed skin cancer is standard - removal.
Features of the operation:
- The size of the lesion is less than 2 cm. The tumor is cut off 2 cm from its edge laterally and inward, with part of the subcutaneous tissue and muscular fascia when it is located side by side.
- If the tumor exceeds 2 cm, but in addition to this, irradiation of the postoperative scar and surrounding tissue for 3-5 cm of tissue is carried out together with the nearest regional lymph nodes.
- When metastases are detected in regional lymph nodes, lymphadenectomy is added to the surgical procedures described. Of course, the program of treatment in the postoperative period includes irradiation with the expansion of the zone and with a certain course of the dose.
- If remote studies reveal distant metastases, the treatment becomes complex: chemotherapy is added to the methods described. In this case, the order of the procedures, the extent of the operation intervention, the number of irradiation courses and the intake of cytotoxic drugs, are determined individually.
The prognosis of five-year survival of skin cancer patients is as follows:
- At the beginning of treatment in I-II stages, the survival rate is 80-100%;
- When detecting during the diagnosis of metastases in regional lymph nodes with tumor germination, the underlying tissues and organs survive about 25%.
Treatment of melanoma
The main method of treatment is surgical removal of the tumor with a combination of radiation and chemotherapy in the presence of screenings.
Initially, local anesthesia with the obligatory condition of "distant" anesthesia is allowed to remove pigmented formations that do not show signs of malignancy (the needle and injected anesthetic should not affect the superficial and deep parts of the skin in the projection of the removed object).
In diagnosed cases of melanoma, the operation is under general anesthesia in an oncological hospital. An obligatory condition for the removal of the tumor should be the possibility of intraoperative histological examination to determine the degree of germination and the volume of further operational benefit.
The boundaries of visually unchanged tissues within which melanoma is removed is not less than:
|In situ||0.5 cm|
|£ 1.0mm||1.0 cm|
|1.01-2 mm||1-2 centimeters|
|More than 2 mm||2 centimeters|
If the tumor is already large and ulcerated, excision occurs at least three centimeters from the edge in the direction from the group of regional lymph nodes and at least 5 cm towards them. Removal occurs simultaneously, as a single site with subcutaneous tissue and the fascia that lies beneath it.
If the tumor is located on the phalanges of the extremities, then the fingers are amputated.
When the tumor is localized in the upper third of the auricle, it is removed entirely.
Removal of affected regional lymph nodes occurs simultaneously with the removal of the tumor.
To eliminate skin defects resulting from the operation, plastic surgery elements are used to eliminate them.
General treatment strategy for disease stages
|I and II stages (pT1-4 N0 M0)||Removal of a tumor with one-stage or subsequent plastic.|
|III stage (any pT N1-3 M0)|
|IV stage (any pT any N M1)|
Prognosis of five-year survival of melanoma patients:
- I stage - 97-99%
- II stage - 81-85%
- III stage - 54-60%
- IV stage - 14-19%
Prognosis of ten-year survival of melanoma patients:
- I stage - 94-95%
- II stage - 65-67%
- III stage - 44-46%
- IV stage - 10-15%
Prevention of skin cancer :
- Elimination of damaging factors.
- Regular self-examination of the available pigmented formations.
- Emergency treatment for medical care when there are disturbing rashes on the skin.