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

There are three types of microscopic images.

The most common type of cytogram is characterized by small hyperchromic cells arranged in the form of dense tissue shreds. Due to the dense arrangement of cells, it is not always possible to determine their shape. Along the edges of such clusters, the cells turn out to be polygonal, sometimes with short processes or “disheveled.” The nuclei occupy almost the entire cell, are located centrally in it, are polymorphic, have uneven contours, hyperchromic and diffusely colored, the nucleoli are not distinguishable. The chromatin of the nuclei is coarsely clumpy. The cytoplasm of the cells is scanty and inhomogeneous, intensely basophilic in color.

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

In tissue patches between cells there may be dense oxyphilic strands and accumulations of interstitial substance. Sometimes the cells seem to be immured in such vast accumulations of interstitial substance.

In the second type of cytogram, 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 stringy. It uniformly fills the nucleus and is intensely colored; enlarged nucleoli are visible in individual nuclei. Binucleate cells with bean-shaped nuclei are often found. The cells are located separately, in groups and complexes among the abundant fine-grained or homogeneous oxyphilic substance and are, as it were, immured in it.

In addition to light cells, the preparations contain small hyperchromatic polygonal tumor elements with sharply hyperchromatic, finely tuberous nuclei and sparse homogeneous, clearly defined cytoplasm. The background of the drug consists of oxyphilic interstitial substance and histiocytes.

The third type of cytogram is characterized by relatively a large number pigment-containing cells (nevus-like variant of basal cell carcinoma). Pigment-containing cells are oval, elongated, polygonal and, less commonly, process-shaped, filled with slate-gray and gray melanin granules. These cells are located scattered or found in the form of strands and clusters. Their nuclei are round and oval, with a compacted contour, small-clumped, with small nucleoli. Similar cells are found, but in small numbers, in other types of basal cell carcinoma cytograms.

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

Skin cancer, like most oncological diseases, is considered a polyetiological condition. And it is not always possible to reliably determine the main trigger for the appearance of malignant cells. At the same time, the pathogenetic role of a number of exo- 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, which 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.

If cancer is detected in its early stages and treated correctly, it can be eliminated forever, preventing the disease from returning. 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 promptly detect any kind of changes in the skin and consult a doctor for examination and treatment.

Skin cancer is enough frequent form a malignant type of tumor, in which both women and men are affected almost equally, their age is mainly from 50 years or more, although the possibility of developing the disease in one form or another at a younger age of patients cannot be ruled out.

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

Mechanism of disease development

Impact of UV and other causal factors leads in most cases to direct damage to skin cells. In this case, it is not the destruction of cell membranes that is pathogenetically important, but the effect on DNA.

Partial destruction of nucleic acids causes mutations, which leads to secondary changes in membrane lipids and key protein molecules. Predominantly 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 explained by the disappearance of dermal Langerhans cells and the irreversible destruction of some membrane antigens that normally activate lymphocytes. As a result, the functioning of the cellular immune system is disrupted and protective antitumor mechanisms are suppressed.

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

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

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

Moreover, hormone replacement therapy, taking contraceptives and pregnancy.

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

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

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

Skin cancer can form in the form of pigment spots that grow in size, become convex, and sharply darken to dark brown. Often occurs when moles degenerate into malignant neoplasms.

The tumor may also look like a simple wart.

REASONS

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

Precancers are divided into obligate and facultative. Obligate tumors degenerate into a malignant neoplasm in almost 100% of cases. This type of tumor includes:

• Bowen's disease;
• Erythroplakia of Keira;
• Xeroderma pigmentosum;
• Paget's disease.

The development of Bowen's disease is most common in older men. 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.

When examining the skin, a solitary plaque is detected, growing up to 10 cm in diameter. The shade varies in color from pale pink to purple.

The boundaries 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 internal organ cancer.

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

Upon visual examination, it appears as a single plaque, having a scarlet tint with clear boundaries and edges rising above the surface of the skin. A significant sign indicating malignant degeneration is a change in the clarity of the boundaries, the appearance of erosion and ulceration.

In Keir's erythroplakia, the ulcer is covered with fibrin or a hemorrhagic crust.

Xeroderma pigmentosum is a disease that manifests itself in childhood. It is characteristic of him hereditary transmission according to the autosomal recessive type. Xeroderma pigmentosum manifests itself in the form of increased sensitivity to direct sun rays. Researchers have identified three main periods of the disease:

• Erythema and hyperpigmentation;
• Atrophic stage with the appearance of telangiectasia;
• Stage of neoplasms.

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

• Effect on skin chemical elements carcinogenic influence.
• Ionizing radiation.
• Frequent skin exposure ultraviolet rays.
• Mechanical damage to tissues, scar formation, which in the future can cause the formation of cancer cells and the development of oncology.
• Radiation burns or dermatitis can trigger the development of cancer.
• Degeneration of moles into malignant tumors.
• Heredity.
• The presence of precancerous diseases: nevi, skin pigmentation, skin ulcers, syphilis, tuberculosis, melanosis, etc. In case of improper or untimely treatment of these diseases, oncology of the skin may 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;
• long-term effect on the skin surface chemical carcinogens, tobacco smoke has a similar effect;
• genetic predisposition of an organism to cancer diseases, in particular to skin cancer;
• prolonged thermal effects on any area of ​​the skin;
• occupational hazards, for example, many years of work associated with skin contact with arsenic and tar;
• various diseases of the skin 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 illnesses, for example, lupus, syphilis, trophic ulcers or burns.

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

External reasons

There are many predisposing factors that can cause skin cancer.

• Excessive exposure to solar radiation and ultraviolet irradiation. 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).
• Long-term thermal effects on specific areas of the skin. An example is “kangri cancer”, it is common among people in 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 to warm up.
• Precancerous skin diseases (Bowen's disease, Paget's disease, xeroderma pigmentosum, Queir's erythroplasia and benign neoplasms that are subject to constant trauma).

You can also highlight following reasons skin cancer:

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

When considering the reasons that provoke the development of skin cancer, there are two main types of factors that are directly related to the process. In particular this exogenous factors, as well as endogenous factors, let’s consider them in more detail.

Otherwise they can be defined as external factors. The most important of these factors is ultraviolet radiation and sunlight in particular.

What is noteworthy is that the development of squamous cell and basal cell cancer is ensured by chronic damage to the skin resulting from exposure to UV radiation, but the development of melanoma occurs primarily 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 reasons contributing to the appearance malignant tumors skin, namely:

1. Long-term irradiation of the skin with UV rays. Proof of this can be the fact that residents of the southern regions suffer from skin cancer much more often than the northern ones.
2. Exposure of skin to radiation.
3. Long-term thermal effects on the skin.
4. Chemical exposure. For example, contact with soot, various resins, tar, arsenic.
5. Hereditary predisposition to skin cancer.
6. Frequent use of medications that suppress the immune system (antitumor drugs, corticosteroids.
7. 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).
8. Mechanical injuries to nevi, birthmarks, scars.

Why does skin cancer appear?

In addition to the above causes of skin cancer, there are also a number of diseases 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
• Keir's erythroplasia

Facultative precancers include all kinds of chronic skin diseases: dermatitis, inflammatory and dystrophic processes. Slow-healing wounds and ulcers on the skin are also considered an optional precancer.

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

Signs of skin cancer to watch out for

• the presence of new moles or spots on the surface of the skin;
• dark red growths 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 in each individual form?

CLASSIFICATION

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

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

There is no localization classification as such. Cancer can affect almost the entire skin, including the skin of the lips, external genitalia, scrotum, and 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 various layers of the dermis. Their classification is based on their 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 types of non-melanoma skin cancer are:

• Basal cell carcinoma (basal cell carcinoma) is a tumor whose cells originate from the basal layer of the skin. Can be differentiated or undifferentiated.
• Squamous cell carcinoma (epithelioma, spinalioma) - occurs from the more superficial layers of the epidermis. It is divided into keratinizing and non-keratinizing forms.
• Tumors originating from skin appendages (sweat gland adenocarcinoma, adenocarcinoma sebaceous glands, adnexal and hair follicle carcinoma).
• Sarcoma, whose cells are of connective tissue origin.

When diagnosing each type of cancer, the WHO-recommended clinical test is also used. TNM classification. It allows you to encrypt using numbers and letters various characteristics tumor: its size and degree of invasion into 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 cancerous tumor have their own growth characteristics, which are additionally reflected when making the final diagnosis. For example, basalioma can be tumoral (large and small nodular), ulcerative (in the form of a perforating or corrosive ulcer) and superficial transitional.

Squamous cell carcinoma can also grow exophytically with the formation of papillary outgrowths or endophytically, that is, as an ulcerative-infiltrative tumor. Melanoma can be nodular or non-nodular (superficially widespread).

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, metastases in the skin from other neoplasms.

The type of tumor in these cases can only be determined using diagnostic procedures– MRI, computed tomography and biopsies.

Adenocarcinoma

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

The node is characterized by slow growth, but in some cases it can reach large sizes(8-10 cm). Growing deeper beyond skin tissue and metastasis is rare. After removal, the tumor may recur in the same place.

Verrucous carcinoma

Verrucous carcinoma is a rare type of skin cancer, a type of squamous cell carcinoma. Appears on the skin of the hands appearance resembles a wart, which makes correct diagnosis difficult 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 is significant variation in the tumors that affect them. Therefore, the concept of cancer in this case is very collective in nature and defines all pathologies of a malignant nature.

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

Squamous cell skin cancer

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

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

This tumor is not gender-selective, but as for age, pensioners are more often affected. Experts indicate tissue scarring after burns or mechanical damage, which are systematic in nature.

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

Basalioma or basal cell skin cancer.

It got its name from the place where it “grows” - the basal layer of the epidermis. This tumor lacks the ability to metastasize and recur. Its migration is directed mainly into the depths of tissues with their inevitable destruction.

About 8 out of 10 all cases of skin cancer are of this type.

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

Basalioma, or skin cancer, is a malignant tumor that can arise from skin cells (epithelium). There are three types of skin cancer:

basal cell carcinoma or basal cell carcinoma (about 75% of cases); squamous cell carcinoma (about 20% of cases); other types of cancer (about 5% of cases).

Basalioma is the most common type of skin cancer. It does not give distant metastases. It is also called borderline skin tumor due to its benign course. Among doctors it is believed that you cannot die from basal cell carcinoma. However, as with squamous cell carcinoma, everything depends on the degree of neglect and the speed of the disease.

A feature of basal cell carcinoma that all oncologists note is the high risk of relapse. Not a single method of treating skin basal cell carcinoma, even deep excision, provides a guarantee that the cancer will not reappear. On the other hand, skin basal cell carcinoma may not reappear even with small-scale interventions.

Small basalioma of the skin is almost always a successful treatment. If you missed the time, the skin basalioma has probably already turned into a fetid ulcer about 10 cm in size. It begins to grow into blood vessels, tissues and nerves. In most cases, the patient dies from complications caused by the disease. 90% of skin basal cell carcinoma cases are located on the face.

Squamous cell skin cancer

Squamous cell skin cancer is also called true cancer. It often recurs, gives metastases to regional lymph nodes, and causes the appearance of isolated metastases in various organs.

The causes of squamous cell carcinoma and basal cell carcinoma are:

ionizing radiation radiation; thermal and mechanical injuries; scarring; impact of all kinds chemical compounds: tar, arsenic, fuels and lubricants.

Externally, squamous cell carcinoma and basal cell carcinoma of the skin can appear as an ulcer or tumor formation (nodule, plaque, “cauliflower”).

Diagnosis of skin cancer

The diagnosis is made to the patient after examination and a series of tests, including histological or cytological examination. For histological examination, a surgical biopsy of the tumor is necessary, and for cytological examination, a scraping or smear is sufficient.

If squamous cell carcinoma and enlarged lymph nodes are detected, a biopsy of these same lymph nodes may be required, followed by a cytological examination of the resulting material. Also, as part of a routine examination for this form of cancer, an ultrasound scan of regional lymph nodes, liver and lungs is performed.

Principles of treatment

If you are diagnosed with skin basal cell carcinoma or squamous cell carcinoma, the treatment may be different - it all depends on the stage of the disease. In most cases, squamous cell skin cancer, no matter what symptoms it causes, requires surgery. Thus, the method of excision of skin within healthy tissue is often used: the distance from the border should be about 5 mm. This procedure is performed under local anesthesia. If skin cancer has reached serious stages and has metastasized, then treatment involves excision of regional lymph nodes.

For skin basal cell carcinoma, treatment can be carried out using methods plastic surgery. This is justified in the presence of large tumors.

Another treatment method is Mohs surgery. This technique involves excision of the tumor to the borders of the end of the cancerous tissue. Radiation therapy is used when the tumor is very small in size or, on the contrary, late stages. In some cases, the use of laser destruction, cryodestruction and photodynamic therapy is relevant. Metastatic, or advanced forms of cancer are treated with chemotherapy.

This disease has many names - it is basalioma, basal cell epithelioma, ulcusrodens or epitheliomabasocellulare. It refers to diseases that are common among sick people. Basically, in our country, the term “basiloma” is more common in the specialized literature. Since the tumor on the skin has a clear destabilizing growth that regularly recurs. But there is no metastasis with this cancer.

What causes skin basal cell carcinoma?

Many experts believe that the reasons lie in the individual development of the body. In this case, squamous cell carcinoma begins its origin in pluripotent epithelial cells. And they continue their progress in any direction. In the production of cancer cells, genetic factors play an important role, as well as various types of disorders in the immune system.

Strong irradiation or contact with harmful substances influence the development of the tumor. chemicals, which can cause malignant neoplasms.

Basalioma can also form on skin that does not have any changes. And the skin with various skin diseases (posriasis, actinic keratosis, tuberculosis-type lupus, radiodermatitis and many others) will be a good platform for the development of cancer.

In basal cell epithelioma, all processes proceed very slowly, so they do not develop into squamous cell carcinoma, complicated by metastases. Often the disease begins to arise in the upper layer of the skin, in the hair follicles, since their cells are similar to the basal epidermis.

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

Regarding histogenesis, when the tissues of a living organism develop, researchers cannot yet say anything.

Some people think that squamous cell carcinoma begins in the primary skin germ. Some believe that formation will occur from all parts of the epithelial structure of the skin. Even from the embryonic primordium and developmental defects.

Risk factors for the disease

If a person often comes into contact with arsenic, gets burns, or is exposed to X-rays and ultraviolet radiation, then the risk of developing basal cell carcinoma is very high. This type of cancer often occurs in people with skin types 1 and 2, as well as in albinos. And all of them for a long time experienced the effects of radiation exposure. If even in childhood a person was often exposed to insolation, then a tumor may appear decades later.

Origin and development of the disease

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

VIDEO

Signs of cutaneous basalioma

Basal cell epithelioma of the skin is a single formation. The shape is similar to half a ball, the appearance is more round. The tumor may protrude slightly above the skin. The color is more pink or grayish-red, with a pearlescent tint. In some cases, basilioma cannot be distinguished from ordinary skin at all.

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

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

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

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

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

Types of basalioma

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

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

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

The ulcerative type appears as a variation of the primary variant. And also as a result of the manifestation of superficial or tumor basilioma. Typical sign This form of the disease is considered to be a funnel-shaped ulcer. It looks massive, its fabric seems to be glued to the lower layers, their boundaries are not clearly visible. The size of the accumulations is much larger than the ulcer. In this embodiment, there is a noticeable tendency to strong expressions, due to which it begins to collapse bottom part fabrics. There are times when ulcerative appearance complicated by growths in the form of papillomas and warts.

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

Pincus fibroepithelial tumor is a type of squamous cell cancer, but it is quite mild. Externally, it looks like a nodule or plaque matching the color of a person’s skin. The consistency of such a stain is dense and elastic; erosion is not observed on it.

Basal cell epithelioma is treated conservatively. Doctors surgically remove lesions along the border healthy skin. Cryodestruction is also practiced. This treatment is used if there may be a cosmetic defect after surgery. You can smear the spots with prospidin and colchamine ointments.

Basalioma (syn. 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 of age due to prolonged insolation, exposure to chemical carcinogens or ionizing radiation. More common in men. In 80% of cases it is localized on the scalp and neck, in 20% it is multiple.

Clinically, the following forms of basal cell carcinoma are distinguished:

superficial– characterized by a scaly patch pink color, round or oval in shape with a thread-like edge consisting of small shiny pearl nodules, dull pink in color;

ABOUT downy begins with a dome-shaped nodule, reaching a diameter of 1.5–3.0 cm over several years,

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

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

Histologically, the most common (50–70%) type of structure, consisting of strands of various shapes and sizes and cells of compactly located basaloid cells, resembling a syncytium. They have round or oval hyperchromatic nuclei and scant basophilic cytoplasm, along the periphery of the cords there is a “picket fence” of prismatic cells with oval or slightly elongated nuclei - characteristic feature basal cell carcinomas. Mitoses often occur, the cellular fibrous connective tissue stroma forms fascicle structures, contains a mucoid substance and an infiltrate of lymphocytes and plasma cells.

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

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

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

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

Affects mainly elderly people. Can develop on any area of ​​the skin, but most often on open places (upper part face, nose, lower lip, dorsum of the hand) or on the mucous membranes of the mouth (tongue, penis, etc.). As a rule, it develops against the background of skin precancer. Metastasizes lymphogenously with a frequency of 0.5% in malignant solar keratosis to 60–70% in squamous cell carcinoma of the tongue (on average 16%). Foci of squamous cell skin cancer can be solitary or primary multiple.

Clinically, tumor and ulcerative types of skin cancer are distinguished.

Tumor type, initially characterized by a dense papule surrounded by a rim of hyperemia, which turns over the course of several months into a dense (cartilaginous consistency) sedentary red-pink node (or plaque) fused with subcutaneous fatty tissue with a diameter of 2 cm or more with scales or warty growths on the surface (warty variety), easily bleeds at the slightest touch, necrotizing and ulcerating; its papillomatous variety differs more rapid growth, individual sponge-like elements on a broad base, which sometimes have the shape of a cauliflower or tomato. Ulcerates in the 3rd–4th month of the tumor’s existence.

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 type (spreading along the periphery and into the underlying tissues) is an ulcer with a yellowish-red color (“greasy”) base, steep edges and a lumpy bottom with a yellow-white coating. Metastases to regional lymph nodes occur in the 3rd–4th month of tumor existence.

Histologically, squamous cell skin cancer is characterized by cords of cells of the spinous layer of the epidermis proliferating into the dermis. Tumor masses contain normal and atypical elements (polymorphic and anaplastic). Atypia is manifested by cells of different size and shape, hyperplasia and hyperchromatosis of their nuclei, and the absence of intercellular bridges. There are many pathological mitoses. There are keratinizing and non-keratinizing squamous cell carcinoma. Well-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; they contain strands of sharply polymorphic epithelial cells, the boundaries of which are difficult to determine. The cells have different shapes and sizes, small hyperchromic nuclei, pale shadow nuclei 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 into the underlying tissues, pain, and dysfunction of the corresponding organ.

The diagnosis is established based on the clinical picture, as well as the results of cytological and histological studies. Differential diagnosis is carried out with basal cell carcinoma, keratoacanthoma, solar keratosis, Bowen's disease, cutaneous horn, etc.

Treatment is carried out by surgical removal tumors 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, extent of the process, the nature of the histological picture, the presence of metastases, age and general condition sick. Thus, when the tumor is localized in the area of ​​the nose, eyelids, lips, as well as in elderly people who are unable to undergo surgical treatment, radiotherapy is more often performed. The success of treatment largely depends on early diagnosis. Prevention of squamous cell skin cancer consists primarily of timely and active treatment precancerous dermatoses. The role of sanitary propaganda among the population of knowledge about clinical manifestations squamous cell skin cancer, so that patients see a doctor as soon as possible when it occurs. It is necessary to warn the population about the harmful consequences of excessive insolation, especially for blondes with fair skin. Important also has compliance with safety precautions in production where there are carcinogenic substances. Workers employed in such industries must undergo systematic medical examinations.

The most common type of non-melanoma malignant skin tumors is basal cell skin cancer (basal cell carcinoma), which accounts for 45 to 90% of all skin cancers. Incidence rates vary significantly, from low in regions with low solar radiation to high in regions with hyperinsolation.

Medical statistics do not specifically record the incidence of basal cell carcinoma. At the same time, the incidence in the Russian Federation of any type of non-melanoma epithelial tumor per 100,000 population is about 43 people and ranks first in the structure of all cancer incidence. Its annual increase is approximately 6% among the male population and 5% among the female population.

Risk factors

Basal cell skin cancer is a slow-growing and recurrent malignant formation that develops in the epidermal layer or skin appendages, has destructive growth (can penetrate into surrounding tissues and destroy them), and in rare cases - the ability to metastasize and lead to death outcome.

The etiopathogenesis of the tumor is not well understood. However, in the mechanisms of disease development, the main role of one (SHH) of the intracellular molecular signaling pathways that control cell metabolic processes, their growth, motility, DNA-based RNA synthesis and other intracellular processes is considered to be proven.

It is assumed that the difference in the morphological forms and biological behavior (degree of aggressiveness) of basal cell skin cancer is due to genetic and supragenetic regulatory mechanisms. The disease begins to develop as a result of mutations in a certain chromosomal gene encoding the receptor of the SHH signaling pathway, resulting in its pathological activity with the subsequent growth of atypical cells.

Factors contributing to gene mutation and the implementation of mechanisms for the development of cancer cells are:

1. The influence of sunlight. Their role is given the utmost importance. Moreover, if for development it is the intensity of ultraviolet rays that is more important, then for development it is the duration, “chronic” nature, that is, the cumulative effect of their exposure. This probably explains the difference in localization malignant tumors: melanomas, as a rule, develop in closed areas of the body, basal cell carcinomas - in open ones.
2. Age and gender, the influence of which is partly explained by the cumulative effect of UV rays - in 90% of basal cell carcinoma develops at the age of 60 years, and the average age of those seeking medical help for this matter is 69 years. Skin cancer occurs more often in men compared to women. Most likely, this is due to the more frequent and long-term exposure they are exposed to the sun due to the nature of their professional activities. At the same time, such a difference in the incidence of the disease in recent years is increasingly erased due to changes in lifestyle and women's fashion (exposed areas of the body).
3. Exposure of the skin to X-rays and radioactive rays, high temperature(burns), inorganic compounds and arsenic compounds contained in contaminated water and seafood.
4. Chronic inflammatory processes of the skin, frequent mechanical injury on the same area of ​​the body, skin scars.
5. Chronic conditions associated with immunosuppression diabetes mellitus, hypothyroidism, HIV infection, blood diseases (leukemia), taking glucocorticoid drugs and immunosuppressants for various diseases.
6. Individual characteristics of the body - a tendency to form freckles in childhood, skin phototype I or II according to the Fitzpatrick classification (in persons with dark skin, basal cell carcinoma develops much less frequently), albinism, genetic disorders (hereditary xeroderma pigmentosum).
7. Localization of the neoplasm. So, the risks of a tumor and its more frequent recurrence are higher when localized in the head, especially the face, neck, and much less with primary lesions, for example, the skin of the back and extremities.

Risk factors for relapses include tumor subtype, its nature (primary or recurrent), and size. In the latter case, an indicator such as the maximum diameter of carcinoma (more/less than 2 cm) is taken into account.

Symptoms of basal cell skin cancer

This tumor is characterized by very slow growth (many months and even years). The peripheral parts of the lesion have the greatest growth activity. Here, the phenomena of cell apoptosis are observed, as a result of which an erosive or ulcerative surface is formed in the center of the neoplasm.

This fact is taken into account during surgical treatment, for choosing the volume of which it is very important to clearly define the boundaries of the peripheral growth zone, since the most aggressive cancer cells are localized there.

In the case of long-term development, the initial stage of basal cell carcinoma gradually passes into the next, which are characterized by infiltration and destruction of deeper underlying soft tissues, periosteum and bone, and metastasis to regional lymph nodes. In addition, pathological cancerous tissues tend to spread along the periosteum along the tissue layers along the nerve branches. The most vulnerable in this regard are the border zones of contact of the embryonic layers, represented, for example, by nasolabial folds on the face.

The histopathological picture is characterized by the presence of cells containing a small amount of cytoplasm and large ovoid-shaped nuclei, which consist mainly of matrix. The index, determined by the ratio of the nucleus to the cytoplasm, significantly exceeds that of normal cells.

Intercellular tissue (stroma) grows along with tumor cells. It is located in bundles between cell cords and divides them into separate lobules. In the peripheral sections, the formation is surrounded by a layer of cells, the arrangement of the nuclei of which resembles a palisade. This layer contains cells that have a high potential for aggressiveness and malignant growth.

In accordance with clinical and histological characteristics, several subtypes, or variants of basal cell carcinoma, are distinguished.

Nodular (nodular) or solid basal cell carcinoma

Accounts for an average of 81% of all cases of the disease. It is a slowly growing, rounded, pink-colored formation that rises above the healthy surface of the skin, the size of which in its largest diameter can range from several to 20-30 millimeters.

The entire lesion is represented by papules with a pearlescent shiny surface and small branched telangiectasias. The surface of the entire tumor bleeds easily with minor trauma. Its size gradually increases, and over time a crust appears in the center and subsequently an ulcer. Over 90% of formations of this variant are localized in the head (cheeks, nasolabial folds, forehead, eyelids, ears) and neck.

On histological examination, a solid tumor consists of compactly grouped epithelial cells, similar to the cells of the basal layer of the epidermis, between which neutral mucopolysaccharides and glycosaminoglycans are located. These complexes have unclear boundaries and are surrounded by elongated elements, resulting in a characteristic “picket fence” appearance. As a result of the progression of destruction of normal tissue, small (various sizes) cavities are formed in the form of cystic cells. Calcium salts are sometimes deposited in the destroyed cell mass.

1. Solid form of basal cell skin cancer
2. Sclerosing form

Ulcerative form

It is considered as the result of a natural further development of the previous version. The processes of programmed cell death (apoptosis) in the central zone of the tumor cause the destruction of the malignant focus with the formation of an ulcerative defect covered with purulent-necrotic crusts, surrounded by an elevation in the form of a pink roller with small “pearls” (nodular thickenings) of a grayish color.

Basal cell carcinoma of the ulcerative form, as a rule, does not metastasize. However, it can exist for up to 10-20 years, during which the ulcers increase from millimeters (1-2) to gigantic sizes (5 cm or more), penetrating deeply into the underlying tissue and destroying surrounding structures as they grow. Advanced cases can cause bleeding, purulent and other complications with a fatal outcome.

Surface form

Approximately 15%. It is characterized by the appearance of a pink spot with raised edges, clearly defined boundaries and a shiny or flaky surface, on which a brown crust often forms. The most common (60%) localization is various parts of the trunk and limbs. Multiple lesions are quite common. As a rule, the disease affects younger people - the average age is 57 years.

This form is characterized by benign growth - existing for decades, the tumor slowly increases in area and, as a rule, does not penetrate into neighboring tissues or destroy them, but after surgical treatment it often recurs in the peripheral parts of the postoperative scar.

Histologically, the formation consists of many complexes that are located only in the upper layers of the dermis up to the reticular layer. Some (about 6%) superficial tumors contain excess melanin and are classified as the pigmented form. They have a brownish or even black color and cause certain difficulties in differential diagnosis with melanocytic tumors.

Superficial form of pathology

Pigmented basal cell carcinoma

Flat or sclerosing form of basal cell carcinoma

Averages 7%. It is a plaque with unclear boundaries, raised edges and a depression. The color of the formation is flesh-colored, ivory with a pearlescent tint or reddish. Visually, it is similar to a “patch” or has the appearance of a scar. There may be small crusts, erosions or telangiectasias on its surface. The predominant areas of localization are the head (especially the face) and neck (95%). The course of the flat form is more aggressive with germination into the subcutaneous fatty tissue and muscles, but there is no ulceration or bleeding.

Infiltrative option

Develops in cases of progression of nodular and flat forms of basal cell carcinoma. It is characterized by a pronounced infiltrative component of the tumor, a tendency to recur after treatment and a more negative prognosis.

Pincus fibroepithelioma

It is a rare type of basal cell carcinoma. It is characterized by localization in the skin of the lumbosacral region and clinical similarity to fibroepithelial polyps or. Histological examination reveals epithelial strands consisting of dark small cells of the basaloid type. The strands are interconnected and extend from the epidermis, sometimes small cysts are visible in them. Elements of the surrounding stroma are often enlarged and edematous, and contain many basophils and capillaries.

Basosquamous or metatypical form

Characterized by the fact that upon histological examination, one part of the tumor has signs of basal cell carcinoma, and the other - squamous cell carcinoma. Some of the metatypical formations are formed as a result of the overlap of these two types of skin cancer. The metatypical variant is the most aggressive in terms of growth, spread and distant metastasis like squamous cell carcinoma.

Basal cell neoplasia syndrome (Gorlin–Goltz syndrome)

A rare autosomal dominant disorder characterized by variable, multiple symptoms. The most characteristic and frequently occurring is a combination of such signs as:

1. The presence of multiple areas of basal cell carcinoma in different parts of the body.
2. Palmar and plantar pits are dark or pink in color, which arise as a result of a defect in the stratum corneum.
3. Cystic formations in the jaw bone that can destroy bone tissue, change the shape of the jaw and lead to tooth loss. Often these cysts are detected by chance on an x-ray.

The course of the syndrome is usually non-aggressive - without involving deep-lying soft tissues and facial bones in the process. Other (also variable) symptoms may include increased sensitivity to sunlight, abnormal development of skeletal bones, big body and some others. Even within the same family, symptoms and their combination may vary among its members. The presence of neoplasms at a young age or their multiplicity should be a reason for the presumptive diagnosis of Gorlin syndrome.

Treatment of basal cell skin cancer

According to statistics, about 20% of patients or more with various forms of basal cell carcinoma, before seeing a doctor, were treated with folk remedies or various external medicines. Such independent therapy is unacceptable, since it is not only ineffective, but can increase the area and depth of the lesion and even provoke the development of metastases.

Main methods of treatment:

1. Surgical.
2. Close focus radiation therapy.
3. Curettage with electrocoagulation.
4. Cryodestruction.
5. Photodynamic therapy (PDT).
6. Chemotherapy.

Surgical method

It consists of an ellipse-shaped excision within healthy tissue at a distance of 4-5 mm from the tumor borders with mandatory subsequent histological examination of the edges of the removed area. In the case of locally infiltrative growth of the formation, extensive resection is performed followed by plastic reconstructive surgery.

The effectiveness of surgical treatment of the primary tumor is 95.2% with an average follow-up of 5 years. High rates of relapse were noted when the lesion size was more than 10 mm, removal of recurrent tumors, as well as cancer localization in the nose, ears, scalp, eyelids and periorbital area.

In most cases, the microsurgical technique is considered standard. It allows you to preserve unaffected tissue areas as much as possible, which is especially important during operations on the face, fingers and genital area. The method consists of excision of a visually visible tumor, followed by serial layer-by-layer horizontal sections of tissue and their histological examination and mapping. This method makes it possible to achieve clean edges economically.

Close focus radiation therapy using X-rays

The main method in the presence of contraindications for use surgical excision. It is indicated mainly for people 60 years of age and older. The radiation method can cause diffuse alopecia, radiation dermatitis, provoke the development of malignant neoplasms, etc.

Curettage with electrocoagulation

They are used most often in the treatment of basal cell skin cancer, due to their high availability, ease of implementation, low cost and rapid achievement of results. The essence of the method is to remove the bulk of the affected tissue (with exophytic growth of the tumor) using a metal curette and subsequent electrocoagulation of the tumor bed. Its disadvantages are the impossibility of histological control, a high risk of relapse for tumors larger than 1 cm, and unsatisfactory cosmetic results (the formation of areas with reduced pigmentation is also possible).

Cryodestruction using liquid nitrogen

Despite the possibility of outpatient use, low cost procedures and satisfactory cosmetic results for the treatment of basal cell carcinoma, it is rarely used. This is explained by the need for repeated sessions, the impossibility of histological control, and the presence of a high percentage of relapses.

Photodynamic therapy

It is a relatively new technique in which the treatment of basal cell skin cancer with a low-intensity wavelength laser is carried out against the background of the action of a photosensitizer and oxygen. The impact is:

• damage to tumor vessels;
• direct toxic effect on cells of substances that are formed as a result of a light-chemical reaction; these substances lead tumor cells to apoptosis, as a result of which the latter become foreign to the body;
• formation of an immune response to foreign cells.

Chemotherapy

It is not widely used because it is not effective enough. It can be used for superficial lesions of a small area, mainly as an additional remedy to other methods or in cases of contraindications to their use.

With monotherapy, the effectiveness of the method can reach 70%. Systemic chemotherapy for basal cell skin cancer consists of intravenous drip administration of Cisplastin in combination with Doxorubicin according to the scheme or Cisplastin in combination with Bleomixin and Methotrexate also according to the scheme. In addition, creams, emulsions and ointments containing bleomycin, cyclophosphamide, prospidin, and methotrexate are produced for topical use.

Forecast

The prognosis for basal cell skin cancer is generally quite favorable, since metastasis occurs mainly in cases of transformation of its various forms into metatypical, which metastasizes on average in 18%.

In practical activities, it is especially important to carry out timely differential diagnosis of dermatological pathology and, in particular, different options carcinoma, which allows you to choose the right method of therapy, prevent the possibility of relapse and achieve acceptable cosmetic results.