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Skin cancer: symptoms, treatment


Skin cancer is another confirmation that the determining factor for the development of cancer in humans is the aggressive influence of external factors.

Being a kind of “external spacesuit”, our skin first reacts to the uncomfortable effects of the environment and mitigates possible negative effects for the body through inflammatory and sclerotic processes. When depletion of compensatory mechanisms occurs at one of the defense sites, the uncontrolled and uncontrolled growth of tumor, immature cells from formerly normal tissue begins, with a tendency to expansion and destruction of surrounding organs.

It is oncological diseases of the skin and its appendages that the average person is more likely to get sick than tumors with localization in other organs. Proof can be considered the fact that more than half of people who live to seventy years, there was at least one histological variant of skin cancer.

And the sources from which a malignant tumor in the skin can form are quite enough.

The skin consists of the epidermis and its appendages.

The epidermis is represented by a multi-layered flat keratinizing epithelium lying on the basement membrane, limiting it from the underlying tissues.

Loose subcutaneous fatty tissue, located under the epidermis, not referring to the skin, is a kind of "buffer-shock absorber" between the outer integument and the internal organs.

Microscopic examination of the epithelium can be divided into the following layers:

  • basal (lower);
  • prickly (malpighian);
  • grainy;
  • horny (external).

In the basal layer of the epidermis, pigment melanin is found in varying amounts, which determines the color of the skin. Near the basement membrane, on either side of it, lie melanocytes that produce melanin. Here, near the membrane, there are also appendages of the skin, which include the sweat and sebaceous glands, hair follicles.

The tissue identity of the skin tumors is as follows:

  1. Basalioma. Develops from the cells of the basal layer of stratified squamous epithelium.
  2. Squamous cell carcinoma (otherwise: squamous cell carcinoma). Its source is the other layers of the epidermis.
  3. Melanoma. A tumor of melanocytes, produced under the influence of solar radiation, the pigment melanin. Excessive voltage of melanocytes leads to the development of this type of skin cancer.
  4. Adenocarcinomas. Glandular tumors from the secreting epithelium of the sweat and sebaceous glands.
  5. Of the elements of the hair follicle (as a rule, squamous forms).
  6. Mixed tumors. Have in themselves several tissue sources.
  7. Metastatic tumors. Metastases of cancers of the internal organs in the skin according to the frequency of occurrence: lungs, larynx, stomach, pancreas, large intestine, kidney, bladder, uterus, ovaries, prostate gland, testicle.

Earlier, part of the classifications attributed some soft tissue tumors to skin cancers by their superficial location and manifestations (dermatosarcoma of the skin, leiomyosarcoma of the skin, angiosarcoma, multiple hemorrhagic Kaposi's sarcoma, etc.). Undoubtedly, we must not forget about them during the differential diagnosis.

Causes and predisposing factors

  1. Excessive exposure to ultraviolet radiation and solar radiation. This also includes frequent visits to tanning salons. This factor is especially important for people with light skin and hair type (Scandinavian type).
  2. Professions with a long stay in the open air, in which open skin is exposed to aggressive polyfactory effects of environmental phenomena (solar insolation, extreme temperatures, sea (salty) wind, ionizing radiation).
  3. Chemical carcinogens, mostly associated with organic fuel (soot, fuel oil, oil, gasoline, arsenic, coal tar, etc.).
  4. Long-term thermal effects on certain skin areas. As an example - the so-called "Kangri cancer", common among the population of the mountainous regions of India and Nepal. It occurs on the skin of the abdomen, in the areas of contact with hot pots, which they wear to warm them.
  5. Pre-cancerous skin diseases:

- obligate (in all cases turning into cancer);

- optional (at a high enough risk, the transition to cancer is not required).

Obligatory disease includes Paget's disease, Bowen, Keir erythroplasia and xeroderma pigment.

Paget's diseases, Bowen's and Keir's erythroplacias look outwardly about the same: flaky red-brown pockets of uneven oval shape with a plate-like elevation. They occur in any parts of the skin, but Paget's disease is more often localized in the peripapillary region and on the skin of the genital organs. Their main differentiation occurs during histological examination, after taking a biopsy.

Xeroderma pigmentosa is a genetically determined disease, manifested from childhood as an increased response to solar radiation. Under his influence, patients develop severe burns and dermatitis, alternating with foci of hyperkeratosis with subsequent skin atrophy and the development of cancer.

Optional precancerous skin diseases include chronic, resistant to treatment, dermatitis of various etiologies (chemical, allergic, autoimmune, etc.); keratoacanthoma and senile dyskeratosis; nonhealing trophic ulcers; cicatricial changes after burns and skin manifestations of diseases such as syphilis , systemic lupus erythematosus ; Dubreuil's melanosis; melanopaque pigment nevus (complex pigment nevus, blue nevus, giant nevus, nevus Ota); subjected to permanent traumatizing benign skin diseases (papillomas, warts, atheromas, birthmarks); cutaneous horn.

  1. Smoking and smoking habits (lower lip cancer in non-filter cigarette smokers).
  2. Contact exposure to aggressive methods of treatment of previously existing oncological diseases of other sites (contact radiation and chemotherapy).
  3. Decrease in the general immunity under the influence of various factors. For example - a history of AIDS. This also includes taking immunosuppressants and glucocorticoids in the treatment of autoimmune diseases and after organ transplantation. Systemic chemotherapy has the same effect in treating oncological diseases of other sites.
  4. Age over 50 years.
  5. The presence of skin cancer in close relatives.
  6. Some studies have noted the effect of dyshormonal disorders and the characteristics of the human hormonal status on the development of skin cancer. So, the fact of frequent malignancy (transition to cancer) of melanoopaque pigment nevi in ​​pregnant women was noted.
  7. Sexual characteristics: melanomas are more common in women.

Skin Cancer Symptoms

An important feature of the clinic of malignant neoplasm of the skin can be considered the theoretical possibility of detecting this disease in the early stages. The warning signs, which first of all draw attention to themselves, are the appearance on the skin of previously unobservable elements of a major rash and a change in appearance, with simultaneous itching or pain, previously existing scars, papillomas, moles (nevi), trophic ulcers.

The appearance of new elements of the rash, in contrast to the skin manifestations of infectious, allergic and systemic diseases, is not accompanied by any changes in the general condition of the patient.

Common signs to pay attention to!

  1. Darkening before the usual area of ​​skin with a tendency to increase.
  2. Long-healing ulceration with blood-stricken discharge or just a wet surface.
  3. Compaction of the skin with its elevation above the total surface, change in color, shine.
  4. These symptoms include itching, redness and induration around the area of ​​concern.

Different histological forms of cancer have their own clinical manifestations.

Squamous skin cancer

  1. Identified in 10% of cases.
  2. 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 very aggressive.
  3. Its appearance is preceded, as a rule, by optional precancers (dermatitis, trophic ulcers of various origins, scars).
  4. More often it has the appearance of a red scaly plaque with a clear boundary from the surrounding tissues. It is easily injured, after which it does not heal, but has an ulcerated moist surface, covered or not covered with scales. Ulcerative defects in the skin have a constant sharp unpleasant odor.
  5. There is no definite, characteristic for it localization, squamous cell carcinoma. Most often develops on the limbs, face.
  6. Localization of squamous cell carcinoma of the skin without signs of keratinization (formation of scales) on the head of the penis is called Keir's disease.
  7. The appearance of persistent, unstoppable pain in the area of ​​skin manifestations of skin cancer is a sign of germination in deep tissues, disintegration and attachment of a secondary infection.
  8. Hematogenous metastases, to distant organs are not characteristic, are detected only in isolated, severely neglected cases.
  9. The presence of metastases in the regional lymph nodes at the location of the tumor on the face, is more common than with the localization of the tumor on the limbs, torso and scalp. Regional lymph nodes first increase in size, remaining mobile and painless. Later there is their fixation to the skin, they become sharply painful, it comes from decay with ulceration of the skin in their projection.
  10. The tumor responds well to the onset of radiation treatment.

Basal cell carcinoma (basal cell carcinoma)

  1. Skin cancer initial stage Appears at the age of 60 years.
  2. Sometimes combined with tumors of other internal organs.
  3. It occurs in 70-76% of cases of all skin cancers.
  4. The characteristic localization is open parts of the body. Most often on the face (on one side of the nose bridge, brow area, outer edges of the nose wings, temple, nose wings, on the upper lip and in the area of ​​the nasolabial fold). Basaliomas are also often detected on the neck and auricles.
  5. Initially, it appears as a flat single (reaching, on average, 2 cm in diameter) or drain (from several small, up to 2-3 mm. Knotty elements) formation, with a rich dark pink color and pearlescent luster. The tumor grows very slowly. The spread of basal cell carcinoma 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 basal cell carcinoma remains intact for quite a long time, up to several months.
  6. Over time, the plaque ulcerates and takes on the appearance of an ulcer spreading over the skin surface, with characteristic raised edges in the form of a thickened shaft. The bottom of the ulcer is partially covered with a dry crust. Non-ulcerated areas retain their whitish shine.
  7. The bottom of the ulcer defect gradually deepens and expands, growing into deep tissues and destroying muscles and bones in its path. Defects over time can occupy large areas of skin, spreading in breadth. Metastases in basal cell carcinoma are not observed.
  8. When localized on the face or auricles, the tumor is dangerous due to the possibility of germination in the nasal cavity, in the eyeball, bone structures of the inner ear, up to the brain.

The following types of basal cell carcinoma are distinguished:

  • adenoid;
  • hyalinized;
  • dermal;
  • cystic;
  • pedzhetoidnaya;
  • multicentric;
  • keratinizing;
  • pigment (acquires a black-brown or even black-blue color similar to melanoma in the later stages, due to blood pigment, hemosiderin, in the bottom of the ulcer defect);
  • mesh;
  • trabecular;
  • nodular and ulcerative;
  • keratinizing

Skin adenocarcinoma

  1. This very rare form of cancer occurs in the richest places of the sebaceous and sweat glands: in the folds under the mammary glands, in the groin, in the armpits.
  2. In these areas, a single, protruding above the surface, small knot of several millimeters of bluish-purple color appears. The node has a very slow growth. In rare cases, the tumor reaches a large size (up to 8-10 cm). It also very rarely grows into deep muscles and intermuscular spaces and metastasizes.
  3. The main complaints are associated with the pain of the tumor in ulceration and the addition of a secondary infection.
  4. After surgical removal, recurrence is possible in the same place.


  1. Photos of the initial stage of skin cancer Diagnosed in 15% of cases of cancer of the skin, in 2-3% of cases of malignant tumors of other organs and systems, which indicates its rarity.
  2. Most of the cases (about 90%) are women.
  3. The favorite localization in descending order is the face, the front surface of the chest, limbs. In men, it is often found on the plantar surface of the feet, the toes of the foot. Rare localizations which, nevertheless, meet: palms; nail beds; conjunctiva of the eye; mucous membranes of the mouth, anal area, rectum, vagina.
  4. There is a change in the color of the existing mole (nevus) in a bright red color or vice versa, discoloration with different shades of gray.
  5. The edges of the birthmark become uneven, asymmetrical, blurred, or vice versa, jagged.
  6. The change in a short time consistency (edema, compaction) and the appearance of the surface (glossy shine) of the existing mole.
  7. The appearance of pain and itching in the area of ​​birthmarks.
  8. An increase in the size of the birthmark with the appearance of a watery discharge.
  9. The disappearance of hair from moles.
  10. The appearance next to a mole that has changed in color and size, in nearby areas of the skin, multiple pigment spots with maternal ulceration, bleeding and itching. This appearance is characteristic of melanoma in the later stages.
  11. The appearance, painted in red-brown shades, uneven spots, resembling a birthmark, on previously clean skin areas.
  12. The spots that appear may include black, white or bluish dotted inclusions.
  13. Sometimes the appeared education may take the form of a black bulging node.
  14. The size of the tumor is on average about 6 mm.
  15. Immediately after the onset, the tumor grows actively and can almost instantly grow into the deep parts of the subcutaneous tissue.
  16. Metastasis is multiple, one-time, lymphogenous, and blood flow. Metastases are found in the bones, the meninges, the liver, the lungs, and the brain. In the foci of screenings, almost immediately and at high speed, tumor tissue begins to develop, corroding the tissue of the organ that “sheltered” it and again spreading further along lymphatic and blood vessels. Predicting the path of metastasis and the number of organs affected by distant metastases is impossible.

In the later stages of melanoma, signs of general intoxication and the manifestation of metastasis take precedence:

  • enlarged lymph nodes, especially in the armpit or groin;
  • compaction under the skin with its excessive pigmentation or discoloration over them;
  • unexplained weight loss;
  • dark gray all skin (melanosis);
  • paroxysmal, intractable, cough;
  • headaches;
  • loss of consciousness with the development of seizures.

You should know that the appearance of benign nevi, or, as they are called by the people, birthmarks, moles - stops after puberty. Every new, similar type of education that appeared on the skin in adulthood requires close attention!

Diagnosis of skin cancer

  1. Identification in the skin of tumors, previously not marked or change in appearance, texture and size previously available. To do this, the entire surface of the skin is examined and palpated, including the places of natural cavities and folds, the area of ​​the external genital organs, the perianal zone and the scalp.
  2. Epiluminescence microscopy of a modified skin area using an optical dermatoscope device and an immersion medium.
  3. Determining the state of available inspection and palpation of all superficial lymph nodes.
  4. Taking smears-prints in the presence of ulcerated surfaces of tumor-like formations for cytological examination.
  5. For the diagnosis of melanoma, radioisotope methods are additionally used with the help of phosphorus (P32), which accumulates in it 2-7 times more intensively than a similar skin area on the other side of the body.
  6. Thermography data may indicate the presence of melanoma, according to which, in a tumor, the temperature exceeds the surrounding tissues by 2-4 ° C.
  7. As an alternative method for diagnosing melanoma in the early stages, in many countries, specially trained dogs are already used, which detect malignancy before visual changes on the skin.
  8. Аспирационная тонкоигольчатая биопсия увеличенных лимфоузлов с исследованием на цитологию или пункционная на гистологическое исследование.
  9. Рентгенологическое исследование органов грудной клетки на наличие метастазов.
  10. Ультразвуковая диагностика региональных лимфоузлов и органов брюшной полости.
  11. КТ или МРТ тазовых органов при увеличении лифмоузлов пахово-подвздошной группы.
  12. Для определения отдаленных метастазов, при наличии изменений со стороны внутренних органов, дополнительно проводится остеосцинтиграфия (на наличие метастазов в костях), КТ или МРТ головного мозга.
  13. Дополнительно производят ряд лабораторных исследований: серологическую реакцию на сифилис; общие анализы крови и мочи; биохимическое исследование крови (для определения степени функционального напряжения почек и печени).
  14. Исключается метастазирование аденокарцином из внутренних органов.

Лечение рака кожи

Большинство опухолей и опухолевидных образований кожи – доброкачественные процессы. Их лечение ограничивается механическим удалением с обязательной последующей отправкой на гистологическое исследование. Подобные операции проводят на поликлиническом этапе.

Unfortunately, new surgical techniques (electrocautery, for example) used to remove an education without prior cytological examination do not always make it possible to accurately examine the removed material. This leads to a great risk of “losing” the patient from the view until the moment he recurs or signs of common metastasis of previously malignant skin pathology that is not diagnosed.

If the question of the presence of melanoma is not raised, then the treatment of any diagnosed skin cancer is standard - removal.

Operation features:

  1. The size of the tumor is less than 2 cm. The tumor is cut out 2 cm from its edge on the sides and inland, with part of the subcutaneous tissue and muscle fascia at its location nearby.
  2. If the tumor exceeds 2 cm, but in addition to this, the postoperative scar and the surrounding 3-5 cm of tissue are irradiated with the nearest regional lymph nodes.
  3. In case of detection of metastases in regional lymph nodes, lymph node dissection is added to the surgical manipulations described. Of course, the treatment program in the postoperative period includes radiation with the expansion of the zone and with a certain dose course.
  4. If, as a result of studies, distant metastases are identified, the treatment becomes complex: chemotherapy is added to the described methods. In this case, the sequence of methods, the volume of surgical intervention, the number of courses of irradiation and the administration of cytostatics are determined individually.

The five-year survival prognosis for skin cancer patients is:

  • at the beginning of treatment in stages I-II, the survival rate is 80-100%;
  • if, in the course of diagnosis, metastases in regional lymph nodes are detected with tumor invasion, the underlying tissues and organs survive about 25%.

Melanoma treatment

The main treatment method is surgical removal of the tumor with a combination of radiation and chemotherapy in the presence of screenings.

Initially, local anesthesia is allowed to remove pigment lesions that do not have signs of malignancy, with the obligatory condition of “distant” anesthesia (the needle and the anesthetic injected should not affect the superficial and deep skin sections in the projection of the object to be removed).

In cases of melanoma diagnosed, the operation is performed under general anesthesia in an oncologic hospital. A mandatory condition for the removal of the tumor should be the possibility of intraoperative histological examination to clarify the degree of germination and the amount of further operational benefits.

Borders of visually unchanged tissues, within which melanoma is removed, no less than:

in situ 0.5 cm
£ 1.0 mm 1.0 cm
1.01 - 2 mm 1-2 cm
more than 2 mm 2 cm

If the tumor already has a large size and an ulcerated surface, then excision takes place at least three centimeters from the edge in the direction from the group of the regional lymph nodes and at least 5 cm in the direction to them. Removal occurs simultaneously, a single area with subcutaneous tissue and underlying fascia.

If the tumor is located on the phalanges of the extremities, then amputation of the fingers is performed.

When the tumor is located in the upper thirds of the auricle, it is removed entirely.

Removal of the affected regional lymph nodes occurs simultaneously with the removal of the tumor.

To eliminate skin defects resulting from the operation, use elements of plastic surgery to eliminate them.

General tactics of treatment according to the stages of the disease

Stage I and II (pT1-4 N0 M0) Removal of the tumor with single or subsequent plasty.
Stage III (any pT N1–3 M0)
  1. Removal of melanoma (including daughter screenings and metastases to lymph nodes on the opposite side).
  2. Regional lymph node dissection.
  3. Postoperative local radiation of the lymphatic collector SOD 60 Gy.
  4. Regional injection chemotherapy for the detection of multiple metastases (N2c) on the limbs.
IV stage (any pT any N M1)
  1. If the general intoxication is not expressed, then the volume of complex treatment is strictly individual.
  2. The terminal stage of the disease, unfortunately, allows the use of new experimental methods of treatment, giving the patient a chance to prolong life, such as chemoimmunotherapy under normal or variant conditions (hyperthermia, hyperglycemia, etc.).
  3. Palliative radiation therapy is allowed.
  4. Surgical interventions are auxiliary.

Five-year survival prognosis for patients with melanoma:

  • Stage I - 97-99%
  • Stage II - 81-85%
  • Stage III - 54-60%
  • Stage IV - 14-19%

Forecast of ten-year survival of patients with melanoma:

  • Stage I - 94-95%
  • Stage II - 65-67%
  • Stage III - 44-46%
  • Stage IV - 10-15%

Prevention of skin cancer :

  1. Elimination of damaging factors.
  2. Regular self-examination of existing pigment formations.
  3. An urgent appeal for medical assistance in case of disturbances of rash on the skin.

    | 2 May 2015 | | 8 456 | Uncategorized
    Leave your feedback

    Exotic: Dude I’m so scared I have a mole on my bum and it doesn’t hurt at all but it’s pretty big and I’m kinda scared it’s cancerous. Recently I’ve been sitting down real slow lol NO seriously this is no joke help I’m scared

    Ailar Arumets: I just was laying on bed and watched my hand and i discovered little dots like up right photo 1:05 but i don't have like that i have much less dots . And im like wtf .😮😑😐

    MESA design-ideas: Lady you have to check this out https://womanuniverse.net/five-subtle-mole-changes-that-might-be-signaling-something-worse/

    Dogseatlemons 36: Im checking all signs of cancer to know if anyone else has cancer in my family because I already lost my mom and I am NOT going to loose anyone else

    Allie Carlson: I have four large flat moles on my neck that have been there since I was born and today my sister was talking about how it could be cancerous like the same four ones my mom had on her neck and how she had to get them burned off with acid and how mine are big enough that if they where cancerous it might’ve spread by now so now I’m terrified