Types of skin cancer:
- Basal cell and squamous – develop from epithelial cells. About 85% of all skin cancers occur in epithelial types.
- Adenocarcinoma is a rare lesion of the sweat and sebaceous glands.
- Melanoma originates from pigment cells called melanocytes.
The most common and most non-aggressive type of cancer is basalioma. Squamous cell carcinoma is more aggressive than basal cell carcinoma, but generally has a moderately malignant course.
Melanoma is a rare, but the most malignant type, prone to rapid progression and metastasis.
It is possible to distinguish a malignant formation of the skin and diagnose its appearance only after laboratory diagnosis of a sample of the affected tissue. It is important for a person to be able to recognize suspicious neoplasms in time, and contact a dermatologist or oncologist as soon as possible.
Skin cancer: symptoms
Most often, neoplasms appear on open areas of the body – the face, legs, arms, neck, etc. An exception is adenocarcinoma, which is localized in the folds, where there are many sebaceous and sweat glands.
External signs of skin cancer and the nature of the course of the disease depend on its type – these can be non-healing ulcers, “warts” and dark spots, papules, nodules, plaques. At first, they do not cause discomfort, but as the disease develops, pain, itching, and weeping ulcers appear. The center of the neoplasm may gradually scar, but in general it does not heal, but continues to grow from the edges. On palpation in the center, a seal can be detected.
As the cancer progresses, it grows deep into the tissue, destroying other layers – muscles, fascia, bones, and causing inflammation in nearby organs. For example, when localized on the face, it is possible to connect sinusitis, otitis, meningitis. Hearing, vision, and vital areas of the brain may be affected.
The spread of malignant cells (metastasis) first occurs through the lymphatic vessels. Lymph nodes thicken, increase in size. At first, they are painless on palpation and mobile, but over time they coalesce with surrounding tissues. The nodes become painful and immobile. With further absence of treatment, the lymph node disintegrates, forming an ulcer on the surface of the skin located above it.
With the bloodstream, cancer cells spread to other organs, causing metastases in the lungs, stomach, breast, bones, kidneys, and adrenal glands. Join the symptoms associated with cancer of these organs, as well as general weakness, pallor, fever.
According to the aggressiveness of the course, the tendency to metastasize and the type of skin manifestations, the types of skin cancer differ quite significantly.
Basaliomas, squamous cell carcinomas, and adenocarcinomas are non-melanoma types. Melanoma by origin and features of the course stands apart. In some medical sources, when they talk about skin cancer, they mean its non-melanoma forms.
Squamous cell skin cancer
Also known as squamous cell carcinoma or squamous cell epithelioma. It develops from superficial cells of the squamous epidermis – keratinocytes. The squamous form occurs in 11–25% of cases.
Carcinoma can be located on any part of the body, even the mucous membrane, but localization in areas exposed to sunlight is more typical.
The aggressiveness of squamous epithelioma is average. Sprouting into other tissues is possible – muscles, bones, cartilage, the addition of inflammation and pain. Metastasis occurs in about 16% of cases.
The five-year survival rate for a tumor less than 2 cm in diameter is 90%, but if it is large and has grown in depth, it is approximately 50% or less.
Squamous cell carcinoma is of the following types:
- Keratinizing – scaly or keratinized formation in the form of a plaque. It can be located in the same plane with the skin, or it can rise. Possible violation of its integrity and bleeding.
- Non-keratinizing endophytic (growing in the direction of surrounding tissues) . It manifests itself in the form of a long-term non-healing ulcer in the form of a crater with dense elevations and abruptly breaking edges. It has an uneven bottom, covered with crusts, which are formed from dried bloody-serous fluid (exudate).
- Exophytic nonkeratinizing form. A knot that, with its coarsely bumpy surface, resembles a cauliflower or mushroom. The color is bright red or brown. Prone to ulceration.
Wounds in squamous cell carcinoma may not heal for months or even years, crusting over and then ulcerating again. This type of cancer is dangerous because patients do not pay attention to non-healing ulcers for a long time, since at first they do not particularly bother them.
Basal cell carcinoma
Basalioma, basal cell carcinoma. Occurs with malignancy of basal epithelial cells, which are located under the squamous epithelium and have a round shape. It accounts for 60-75% of all skin cancer cases. It most often occurs in people over 50 years of age. Children and adults under 40 do not get sick.
Basal cell carcinoma is characterized by slow progression, practically does not metastasize (no more than 0.5%). It grows less into deep tissues and rarely causes pain. Mortality from basalioma is generally low, and it occurs only in very advanced cases.
Basal cell carcinoma develops from cells that have a hair follicle. It is localized on the face – in the nose, forehead, eyelids, sometimes on the neck. This creates difficulties in treatment, since the main method is the surgical removal of the neoplasm.
This type of cancer is characterized by a wide variety of skin manifestations:
- flat (surface).
Basalioma begins, as a rule, with a small pink translucent or pearly nodule that resembles a pearl. Therefore, this formation has a name – a horn pearl. Gradually, it grows in size, and a crust appears in the center. Then there is an ulcer, which soon again becomes covered with a crust. Therefore, the most characteristic surface of a basalioma is an ulcer in the center, and “pearl” nodules on the sides (nodular-ulcerative form). This type of basalioma is localized on the eyelid, in the region of the nasolabial fold or in the inner corner of the eye.
Cicatricial-atrophic basalioma also begins with the formation of a papule. But in its central part, tissue scarring occurs, and the ulcer moves to the edges. Such a basalioma has a scar in the center, and its edges are ulcerated.
The flat or superficial form is a red spot with a possible pearly sheen, which does not rise above the surface of the skin and does not grow into the depths. May peel off.
Sclerodermiform basalioma appears as a scar that extends below the surface level of the skin, sometimes with ulceration. It is extremely rare.
Warty (papillary, exophytic) tumor similar to cauliflower
These are dense papules that have a hemispherical shape. Deep into the surrounding tissues, a warty basalioma usually does not germinate.
The pigmented appearance has a more intense dark color, so on superficial examination it is sometimes confused with melanoma.
A rare type of skin cancer. It develops from the sweat and sebaceous glands, therefore it is characterized by localization in the armpits, inguinal zone and folds under the mammary glands. It looks like a small papule or nodule. Adenocarcinomas are characterized by slow growth and small size. Occasionally, they can reach a size of up to 8 cm and grow into deep tissues.
It develops with an atypical degeneration of melanocytes – skin cells that produce pigment. The most aggressive and dangerous species. Prone to rapid progression and deep germination, as well as the formation of metastases.
Melanoma accounts for only 4% of the total number of skin cancers, but it is responsible for 80% of skin cancer deaths.
Most often, melanoma affects women under the age of 40. Upon reaching the age of 40, the risk of morbidity in men doubles compared to women.
In men, the neoplasm is more often located in the face, neck and ears. Skin cancer on the leg is a disease that women are more susceptible to. Moreover, it usually occurs in an open area – the area of \u200b\u200bthe lower leg.
Melanoma grows from pigmented cells in the skin, mucous membranes, and even the eyes. There is especially a lot of pigment in nevi (birthmarks), and they are sometimes malignant (malignant).
What does melanoma look like?
To recognize melanoma neoplasms, there is the ABCDE principle:
- And symmetry (asymmetry). The tumor has an asymmetric shape, i.e. one half of it differs in shape from the other.
- In order (borders). Irregularly shaped borders may be blurry. Can be raised above the surface of the body.
- Color (color). There are several colors in the neoplasm body (brown, black, gray, pink). Sometimes there is depigmented melanoma, the color of which does not differ from the rest of the skin or is lighter than it.
- Diameter (diameter). Melanomas are usually large – their size is more than 6 mm.
- Evolution (changes). Education grows, changes shape and color.
Such a neoplasm is easier to notice if it suddenly appeared on a clean area of \u200b\u200bthe skin. But what if a person has a lot of moles or papillomas? When self-examination, one must be guided by the so-called principle of the “ugly duckling” – a melanoma tumor is “not like everyone else”, and stands out from other formations in shape and color.
When is there a risk of melanoma?
Ordinary moles are rarely reborn, but there are certain types of nevi with an increased tendency to malignancy. These are dysplastic or atypical nevi. Outwardly, they resemble melanoma – they have uneven edges, heterogeneous pigmentation, and a large diameter. Whether we are dealing with a dysplastic nevus or an early stage of melanoma can only be said by microscopic analysis of a piece of tissue taken from this formation. Sometimes atypical moles are removed prophylactically.
You can understand that a mole has begun to regenerate by the following signs:
- It begins to grow rapidly.
- New shades appear or the pigment disappears.
- The nevus begins to grow vertically, forming a knot.
- Redness and inflammation appear on the skin along the edges of the formation.
- Cracks, erosion, crusts, liquid droplets appear on the surface of the birthmark. Ulcers and spotting occur at a late stage.
- Itching and soreness of the nevus.
There are a number of factors for which a person may be included in the risk group:
- Multiple nevi. The likelihood of a birthmark rebirth is very low. But the number of moles around 100 increases the likelihood of melanoma by 50 times.
- The presence of one atypical nevus gives a lower degree of risk. Several of these neoplasms increase the risk of the disease by 16 times.
- Heredity. If a person has close relatives who had melanoma, the risk increases by 50%.
- Frequent sun exposure, visits to the solarium.
- Sunburn with blisters. The more of them a person had, the higher the likelihood of the disease. Especially dangerous are burns received before the age of 15.
- Relapse. If you have already been treated for melanoma, there is a chance that the disease will recur.
- Nevi are huge. If at the birth of a person his birthmark had a size of 7 cm, and upon reaching maturity it grew to 20 cm and above, the probability of his rebirth is quite high.
- Working with carcinogens.
Representatives of the Caucasian race with fair skin and hair (I and II phototype) are more likely to get sick, especially if they are exposed to intense solar radiation. Among Caucasians of the Mediterranean type (dark and black-haired), the incidence is lower.
Important! Regular visitors to solariums have a 75% higher risk of getting melanoma. WHO categorically does not recommend visiting solariums for people under 18 years of age.
Diagnosis of skin cancer
First of all , a dermatologist or dermato-oncologist conducts a visual examination of the neoplasm and palpation of the lymph nodes.
Then dermatoscopy is performed – an examination using a magnifying apparatus of a dermatoscope. Modern digital dermatoscopes allow you to zoom in dozens of times, and study in detail the structure of the tumor, its symmetry and type of borders. They also scan the lower layers of the skin, which makes it possible to assess the degree of tumor growth.
The main method for diagnosing cancer is cytological and histological examination of a tumor fragment.
Reference! Cytological analysis – the study of the cellular structure of the sample under a microscope. Histological analysis – the study of tissue structure under a microscope
To take biological material for research, a biopsy of the affected skin sample is performed with the capture of healthy tissue along the edges, which is then sent to the histopathological laboratory.
Only on the basis of the results of cytology and histology can a diagnosis be established, its type and nature of the tumor, as well as the degree of tissue damage, can be determined.
If metastasis is suspected, diagnostics of other internal organs is prescribed using ultrasound, CT, MRI.
If the examinations did not show the presence of metastases in the organs, a sentinel biopsy of the lymph nodes is performed. This is necessary to exclude early metastases, since the initial stage of metastasis cancer cells are found primarily in the lymph nodes. An isotope is injected into the tissues surrounding the tumor, which, spreading, “marks” the lymph nodes. Then their contents are taken for histological analysis. Usually, a sentinel lymph node biopsy is performed for melanoma.
Treatment tactics depend on the type of cancer and its stage.
Important! It is impossible to remove incomprehensible neoplasms and keratinized areas in beauty salons where a histological analysis of the tissue is not performed. Even formations of the usual type can be malignant. This is the case when it is better to “overdo it than not do it”.
This tumor must be treated, despite its relatively benign course. The “observe” tactic is unacceptable.
The most reliable option and first choice therapy is complete excision of the basal cell mass. However, due to its location in the face, in particular the nose and eyes, this can be difficult. In some cases, the operation may threaten with defects in the patient’s appearance, as well as a violation of the functionality of these organs. If surgical treatment is not possible, radiation therapy is prescribed.
The third choice therapy is chemotherapy.
In case of impossibility of surgical, radiation and chemotherapy treatment and a low probability of recurrence, the following methods can be prescribed:
- cryodestruction of basalioma;
- photodynamic therapy (PDT);
- the use of antitumor ointments based on Fluorouracil;
- immunomodulatory ointments.
Reference! Cryodestruction – “freezing” of the tumor by high temperatures. Photodynamic therapy – exposure of the tumor to light waves of different lengths and light-sensitive particles, leading to necrosis of its cells and damage to blood vessels.
Squamous cell carcinoma
If the risk of recurrence and metastasis is low, the best method is to excise the neoplasm along with a 4 to 6 mm area of surrounding healthy tissue. With a more aggressive course, the capture of healthy tissue should be greater.
If metastasis has not occurred, surgical treatment is sufficient.
If surgery is not possible, radiation and chemotherapy are used.
With metastases to other organs, radio- and chemotherapy are performed.
With this disease, it is necessary to remove the tumor with healthy surrounding tissues so that there are no cancer cells left in them. At an early stage of development, the tumor is localized in the superficial layer of the skin, and only this surgical procedure is sufficient to completely cure the patient.
If malignant cells have penetrated into the lymph nodes, their complete removal in the area surrounding the melanoma is mandatory.
If melanoma has metastasized to other organs and tissues through the blood , chemotherapy or radiation therapy is necessary in addition to surgical treatment .
How to protect yourself from skin cancer
Early detection of the disease
It is impossible to guarantee a person that he will never get skin cancer, even if he does not belong to the risk group and takes all the precautions.
Therefore, early diagnosis and timely treatment is the most reliable way to recover.
Regularly (if you are at risk – monthly) conduct a self-examination. If you have the slightest concern, see a dermatologist .
Important! Self-exams reduce melanoma deaths by 63%.
UVA and UVB radiation cause skin cancer. Try to avoid prolonged sun exposure and especially sunburn with blisters. The more often they occur, the higher the likelihood of developing skin oncopathology, especially melanoma.
Be less in the sun at noon and lunch hours.
If you are a summer resident or a farmer and you have to work under scorching rays, try to wear hats, long-sleeved shirts, trousers and long skirts made of light cotton and linen fabrics.
Staying at the resort, go out to sunbathe in the morning and evening hours, when solar activity is lower. Try to spend more time in the shade.
Remember – it’s better to be pale but healthy than tanned but sick.
Use sunscreens designed to protect against both UVA and UVB rays. The SPF should be at least 15. The lighter your skin, the higher the SPF should be. Each unit of the number means protection against sunburn for 20 minutes.
Attention! When using sunscreen, people sometimes allow themselves to be in the sun much longer, thinking that they are avoiding exposure, but in fact they are getting more of it, as the total dose increases. Therefore, using creams, do not increase the duration of insolation.
Take care of children
Intense sun exposure and burns received in childhood significantly increase the risk of getting melanoma.
Babies under 6 months are not allowed to be in direct sunlight. Sunscreens are not recommended.
Upon reaching 6 months, the child can be taken out into the sun for a short time with low solar activity (in no case, noon and lunch time!). Consult your pediatrician about the duration of sunbathing for an infant. To these measures, you can add a baby cream with a high protective factor.
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