The course of squamous cell skin cancer characterized by steady progression with infiltration of the underlying tissues, the onset of pain and impaired function of the corresponding organ. Over time, the patient may develop anemia, general weakness; metastases in internal organs lead to the death of the patient.
The grade of squamous cell skin cancer evaluated by its invasiveness and ability to metastasize. Different forms of squamous cell skin cancer differ in their propensity to metastasize. The most aggressive is spindle cell carcinoma, as well as acantholytic and mucin-producing. The frequency of metastasis of the acantholytic variety of squamous cell skin cancer varies from 2% to 14%; with a tumor diameter over 1.5 cm correlated with the risk lethal outcome. Extremely rarely, verrucous cancer metastasizes, such cases are described when a true tumor developed against its background. squamous cell carcinoma mucous membrane of the mouth, anogenital region or soles, and metastasis occurred in the regional lymph nodes.
Usually the risk of metastasis increases with an increase in the thickness, diameter of the tumor, the level of invasion, and a decrease in the degree of cell differentiation. In particular, well-differentiated tumors are less aggressive than anaplastic ones. The risk of metastasis also depends on the location of the tumor. For example, tumors on open areas of the skin are less aggressive, although tumors located on auricles, in the nasolabial folds, in the periorbital and parotid regions have more aggressive current. Tumors localized in closed areas of the skin are much more aggressive, characterized by rapid growth, have a more pronounced tendency to invasion, anaplasia and metastasis, compared with tumors of open areas of the skin.
Particularly high aggressiveness and frequency of squamous cell carcinoma metastasis genitals and perianal region. The frequency of metastasis also depends on whether the neoplasm develops against the background of precancerous changes, scars, or normal epidermis. So, with the development of squamous cell skin cancer de novo, metastases are diagnosed in 2.7-17.3% of cases, while with squamous cell skin cancers that have arisen against the background of solar keratosis, the frequency of metastasis is estimated at 0.5-3%, with squamous cell carcinomas , against the background of solar cheilitis - in 11%. The frequency of metastasis of squamous cell skin cancers that developed against the background of Bowen's disease and erythroplasia of Queyre, respectively, is 2 and 20%, squamous cell carcinoma formed against the background of burn and X-ray scars, ulcers, fistulas in osteomyelitis, are observed with a frequency of up to 20%. The risk of metastasis is significantly increased in genetically determined (xeroderma pigmentosa) or acquired immunological deficiencies (AIDS, lymphoproliferative processes, conditions after organ transplantation). The average metastasis rate for squamous cell skin cancer is estimated at 16%. In 15% of cases, metastasis occurs in visceral organs and 85% to regional lymph nodes.
Diagnosis of squamous cell skin cancer is established on the basis of clinical and laboratory data, among which histological examination is of decisive importance. Histological diagnosis is most difficult in the earliest stages of the disease and in undifferentiated forms. In some cases, the pathologist cannot resolve the issue of the precancerous or cancerous nature of the process. In such cases, a study of the tumor by serial sections is required. In the diagnosis of verrucous cancer, a deep biopsy is necessary. Detection of squamous cell skin cancer is especially successful when there is close contact between the pathologist and the clinician. In order to develop the most rational tactics for the treatment of patients with squamous cell skin cancer, it is necessary to carefully examine for the detection of metastases.
Differential diagnosis for squamous cell skin cancer performed with solar keratosis, basalioma, keratoacanthoma, pseudocarcinomatous epidermal hyperplasia, Bowen's disease, Queyre's erythroplasia, Paget's disease. skin horn, sweat gland cancer. In typical cases, the differential diagnosis is not difficult, but sometimes it can be difficult to make. Although squamous cell skin cancer and solar keratosis present with atypia, single cell dyskeratosis, and epidermal proliferation, only squamous cell carcinoma is accompanied by invasion of the reticular dermis. At the same time, there is no clear boundary separating both diseases, and sometimes, when studying histological preparations of a focus of solar keratosis, serial sections reveal one or more areas of progression with a transition to squamous cell carcinoma.
Distinguish squamous cell carcinoma from basalioma in most cases it is not difficult, basalioma cells are basophilic, and in squamous cell carcinoma cells, at least of low grade, have eosinophilic staining of the cytoplasm due to partial keratinization. Cells in high-grade squamous cell carcinoma may be basophilic due to the lack of keratinization, but they differ from basalioma cells in greater nuclear atypia and mitotic figures. It is also important to take into account that keratinization is not the prerogative of squamous cell skin cancer and also occurs in basalioma with piloid differentiation. However, keratinization in basaliomas is partial and leads to the formation of parakeratotic bands and funnels. Less commonly, it can be complete, with the formation of horny cysts, which differ from "horny pearls" in the completeness of keratinization. Only sometimes the differential diagnosis with basalioma can be difficult, especially when two types of cells are detected in the acanthotic cords: basaloid cells and atypical cells, such as cells of the spinous layer of the epidermis. Such intermediate forms are often regarded as metatypical cancer.
Insofar as standard methods not always helpful differential diagnosis squamous cell skin cancer, for this purpose special methods based on the analysis of the antigenic structure of tumor cells can be used. In particular, immunohistochemical methods can help distinguish poorly differentiated squamous cell skin cancer from those similar in clinical manifestations, but having a completely different course and prognosis, non-epithelial tumors of the skin and subcutaneous tissues. Thus, the detection of certain antigens that serve as histogenetic markers of epidermal differentiation, such as keratin intermediate filaments, distinguishes elements of squamous cell carcinoma from elements of tumors derived from non-keratinized cells, such as melanoma. atypical fibroxanthoma, angiosarcoma, leiomyosarcoma, or lymphoma. An important role in the differential diagnosis of squamous cell skin cancer is played by the detection of the epithelial membrane antigen. Diffuse expression of this marker is observed even with severe anaplasia on late stages tumors.
The difference between epithelial neoplasms is determined based on the study of the composition of cytokeratins. For example, basalioma tumor cells express low molecular weight cytokeratins, and tumor keratinocytes of squamous cell carcinoma express high molecular weight cytokeratins. In the differential diagnosis of squamous cell skin cancer, the detection of oncofetal antigens is also used. For example, unlike squamous cell carcinoma in situ, tumor cells in Paget's disease and extramammary Paget's disease stain when reacting to CEA.
Expression of a marker of terminal differentiation keratinocytes- Ulex europeus antigen - is more pronounced in well-differentiated squamous cell skin cancers, decreases in poorly differentiated squamous cell skin cancers and is absent in basalioma. Expression of the urokinase plasminogen activator correlates with low differentiation of squamous cell skin cancer.
Importance in differential diagnosis of squamous cell skin cancer from keratoacanthoma has the detection on cells of the last expression of free arachidic agglutinin, transferrin receptor and blood group isoantigens, while their expression in cells of squamous cell carcinoma in situ and squamous cell skin cancer is reduced or absent. In particular, partial or complete loss of expression of a blood type isoantigen (A. B or H) is early manifestation transformation of keratoacanthoma into squamous cell carcinoma. In the differential diagnosis between squamous cell skin cancer and keratoacanthoma, RBTL on a water-tissue extract from the tissue of keratoacanthoma and squamous cell skin cancer, as well as flow cytometry data, can help. A significant difference in peak DNA index and highest DNA content between keratoacanthoma and squamous cell skin cancer (85.7 and 100%, respectively) was described. It has also been shown that most cells in squamous cell skin cancer are aneuploid.
Skin cancers originating from the epidermis and dermis include basaliomas, squamous cell carcinomas, and melanomas.
Basalioma
Basalioma ( basal cell carcinoma skin, corrosive ulcer, etc.) - a tumor with a locally destructive effect that does not give metastases. Destructive tumor growth can lead to significant tissue destruction. At present, the prevailing point of view is that basalioma develops from a primary epithelial primordium, which can differentiate in the direction various structures. In its development, certain importance belongs to genetic factors, immune processes, the influence external factors(insolation, carcinogens, etc.). Basalioma can occur on intact skin, and may be the result of malignancy of various precancerous diseases. Preferential localization - face, more often in older people age groups. The process is slow, often lasting for years.
clinical picture. Basalioma most often initially has the appearance of a translucent dense pearly nodule of the pearl type, pinkish gray color, sometimes such a nodule is covered with a tightly fitting crust. In other cases, a flat, slightly depressed, smooth red erosion occurs, the base of which is slightly compacted, and along appearance the element resembles a scratch. As the basalioma develops, the central part of the tumor (nodule) begins to get wet, a superficial ulceration appears, covered with a crust, which, when removed, exposes a superficial bleeding erosion or ulcer. Around the erosion or ulcer, you can usually see a thin, skin-colored dense roller. When the skin is stretched, it is clear that this roller consists of separate small “pearls”. In the future, the ulcer deepens, increases in size, its edges become ridge-like, and the entire ulcer becomes dense. Ulceration and ulcer enlargement occurs very slowly. With the spread of the process deep into the tumor loses its mobility. Can simultaneously occur scarring of the ulcer in the center or from one of its edges. Deepening of an ulcer is less often observed; in this case, its infiltrate destroys underlying tissues, including bone. Basalioma can have various clinical variations.
Of the varieties of basalioma, we indicate:
superficial , located mainly on the skin of the body and manifested by plaques slowly growing along the periphery with a characteristic thin dense rim, consisting of small pearl nodules; a scaly-crust is formed in the center, after rejection of which an atrophically altered erythematous surface is exposed;
flat cicatricial , located superficially, usually on the skin of the temple, characterized by serpiginous spread along the periphery with the formation of a roller-like edge and cicatricial-atrophic changes in the center;
scleroderma-like - dense plaques up to the size of a small coin, ivory, usually located on the skin of the forehead;
knotty - dense, spherical nodules ranging in size from lentils to peas, covered with small crusts and scars, localized on the skin of the forehead, eyelids, scalp (uclus rodens). There is also a tendency to deep ulceration with dense crateriform edges and an uneven bottom (usual localization is the skin of the upper part of the face - uclus terebrans), characterized by a rapid progressive destructive process with necrosis of deep-lying tissues, the absence of a "pearl" roller, destruction of the bone and cartilage tissue, heavy bleeding and soreness, but without a tendency to metastasize (usual localization is the wings of the nose, earlobes, corners of the mouth, eyelids).
Histopathology. There are atypical growths of cells resembling the basal cells of the epidermis, in the form of anastomosing branched narrow strands that penetrate deep into the dermis. Cells do not tend to keratinize.
Treatment. Removal of the tumor within healthy tissue. Currently, cryodestruction, diathermocoagulation, surgical excision, prospidin or kolhamin ointment, etc. are usually used. Prospidin is used intramuscularly or intralesionally.
Squamous cell carcinoma (spinocellular carcinoma, squamous epithelioma) originates from the cells of the spinous layer of the epidermis. Squamous cell carcinoma occurs on the skin much less frequently than basalioma. It is mainly localized on the red border of the lower lip, in the perianal region, on the external genitalia. Squamous cell skin cancer, unlike basalioma, proceeds relatively quickly and severely, in general, no different from cancer of other localization, and metastasizes.
Squamous cell carcinoma can occur against the background of solar or senile keratosis, develop in scar tissue at the site of a burn, injury, chronic inflammation, x-ray dermatitis, xeroderma pigmentosum, etc.
IN last years the significance of certain human papillomaviruses in the development of silt cell carcinoma has been established. The process of carcinogenesis occurs under the synergistic action of the virus with physical and chemical carcinogens and is due to genetically regulated immune mechanisms.
clinical picture. Squamous cell carcinoma is usually a solitary tumor in the form of a dense spherical formation in the thickness of the skin, initially the size of a pea. In the future, the tumor acquires an exo- or endophytic form. In the exophytic form, the tumor rises above the level of the skin, has a wide base, the surface of such cancer becomes uneven, warty. At the same time, the tumor grows in depth. Subsequently, she ulcerates. In the endophytic form, otherwise called ulcer-infiltrating, a dense small knot is formed in the thickness of the skin, which quickly ulcerates. The resulting ulcer is painful, especially on palpation, has an irregular shape, raised dense, everted and corroded edges, often it has a crater-like shape. The depth of the ulcer depends on the degree of infiltrating growth.
Tumor growth leads to significant destruction of the surrounding and underlying tissues, it becomes immobile. The bottom of the ulcer is uneven, bleeds easily, the tumor usually destroys blood vessels and even bones. Soon, lymph nodes (metastases) are involved in the process. The general condition of patients gradually worsens. Death occurs after 2-3 years from cachexia or bleeding caused by tumor decay and vascular damage.
Histopathology. An atypical growth (infiltrating growth) of the epithelium is detected due to the cells of the spiny layer in the form of intertwining strands that go deep into the thickness of the skin with the germination of the basement membrane. The cells themselves are mostly atypical and randomly arranged. There are keratinizing and non-keratinizing, more malignant, skin cancer. Atypia is characterized by a different size and shape of cells, hyperplasia and hyperchromatosis of the nuclei, the absence of intercellular bridges, and the presence of pathological mitoses. With keratinizing cancer, cells retain a tendency to keratinize, as a result, so-called horny "pearls" are found in the thickness of the epithelial layer. It should be noted that atypia is more pronounced in nonkeratinized cancer.
Diagnosis. The diagnosis should be confirmed by histological examination or cytological examination of a scraping from the surface of the ulcer, in which atypical cells are easily detected. It should be remembered about the possibility of metastasis of squamous cell carcinoma, primarily to regional lymph nodes.
Treatment. Performed by an oncologist. In this case, the tumor is usually surgically excised within healthy tissues, and regional lymph nodes are also removed; if necessary, additional chemotherapy is carried out, etc.
Melanoma (melanoblastoma, melanocarcinoma) is extremely malignant tumor, primary focus which is most often found in the skin. Skin melanoma occurs mainly against the background of a pigmented nevus after injury, strong insolation, etc.
Pigmented nevus, which can transform into melanoma, can be congenital or acquired, i.e., appearing after birth, while malignancy can occur quickly or after a considerable time. It all depends on the injury to the nevus in the broad sense of the word. special attention in relation to injury, pigmented nevi are deserved, located on the sole, nail bed, perianal region, in places injured by clothing, etc.
clinical picture. Schematically, the malignancy of the pigment nevus can be represented in following form. Previously "calm" congenital or life-spanning flat pigmented nevus, which has the appearance of a spot or a flat papule slightly raised above the skin without hair, often rounded, black, brown or gray, not increasing and not showing itself in any way, after a single or repeated mechanical injury or massive insolation, it begins to gradually increase along the plane of the skin or exophytic, sometimes changes color, becomes rough, begins to peel off.
As exophytic growth increases, the possibility of re-injury increases. As a result, the nevus becomes easily injured, bleeds after a slight touch of clothing, becomes infected, and gets wet for a long time. Each subsequent injury enhances exophytic growth. Gradually, at the site of the nevus, a tumor forms in the form of a flat nodule that rises slightly above the skin with uneven rough surface, usually repeating the shape of the former nevus, or in the form of a node on a wide base, covered with easily removed dry and weeping, loose bloody crusts. On the surface of such a tumor, there may be brownish-pink papillomatous outgrowths.
Basalioma, or skin cancer is called malignancy, which can arise from skin cells (epithelium). There are three types of skin cancer:
basalioma 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 a borderline skin tumor due to the benign course of the disease. Among physicians, it is believed that one cannot die from basalioma. However, as with squamous cell carcinoma, it all depends on the degree of neglect and the speed of the disease.
A feature of basalioma, which is noted by all oncologists, is high risk relapse. No method of treating skin basalioma, even deep excision, guarantees that oncology will not reappear. On the other hand, skin basalioma may not reappear even with small interventions.
Basalioma of the skin of small sizes is almost always successful treatment. If you missed the time, surely the skin basal cell carcinoma has 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 that are caused by the disease. 90% of skin basalioma 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, causes the appearance of separated metastases in various organs.
The causes of squamous cell carcinoma and basalioma are:
ionizing radiation radiation; thermal and mechanical injury; scarring; impact of all kinds chemical compounds: tar, arsenic, fuels and lubricants.
Externally, squamous cell carcinoma and basalioma of the skin can be an ulcer or tumor formation (nodule, plaque, "cauliflower").
Diagnosis of skin cancer
The diagnosis is made to the patient after an examination and a series of tests, including a histological or cytological examination. For a histological examination, an operational biopsy of the tumor is necessary, and for a 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 material obtained. Also, in the format of a planned examination for this form of cancer, ultrasound of regional lymph nodes, liver and lungs.
Principles of treatment
If you have a basalioma of the skin or squamous cell carcinoma, then 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, involves surgery. So, the method of excising the skin within healthy tissues is often used: the indentation from the border should be about 5 mm. This procedure is performed under local anesthesia. If skin cancer has reached serious stages and metastasized, then treatment involves the excision of regional lymph nodes.
With basalioma of the skin, treatment can be carried out using methods plastic surgery. This is justified in the presence of large tumors.
Another method of treatment is Mohs surgery. This technique involves the excision of the tumor to the borders of the end of the cancerous tissue. Radiation therapy It is used when the tumor is very small or, on the contrary, in the later 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. basalioma, basal cell epithelioma, ulcusrodens or epitheliomabasocellulare. It refers to diseases that are often found among patients. 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, regularly recurring. But metastasis this cancer can not be.
What causes skin basalioma?
Many experts believe that the reasons lie in individual development organism. In this case, squamous cell carcinoma begins its origin in pluripotent epithelial cells. And they continue their progress in any direction. When developing cancer cells Genetic factor plays an important role, as well as various disorders in the immune system.
Affect the development of the tumor strong radiation, or contact with harmful chemicals that can cause malignant neoplasms.
Basalioma is also able to form on the skin, which does not have any changes. And the skin, which has different skin diseases(posriasis, senile keratosis, tuberculous 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 turn into squamous cell carcinoma complicated by metastases. Often, the disease begins to emerge 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. Not as malignant or benign tumor. There are cases when the patient was exposed, for example, to strong exposure to the harmful rays of the x-ray machine. Then the basalioma is able to develop into basal cell carcinoma.
Regarding histogenesis, when the development of tissues of a living organism is carried out, researchers still cannot say anything.
Some think that squamous cell carcinoma begins its origin in the primary skin germ. Some believe that the formation will come from all parts of the epithelium of the skin structure. Even from the germ of the embryo and malformations.
Disease Risk Factors
If a person often comes into contact with arsenic, gets burns, is irradiated with X-rays and ultraviolet radiation, then the risk of developing basalioma is very high. This type of cancer is common in people with type 1 and 2. skin and also in albinos. And all of them long time experienced the effects of radiation exposure. Even if in childhood a person was often exposed to insolation, then a tumor may appear decades later.
The origin and development of the disease
The outer layer of the skin in patients is slightly reduced in size, sometimes pronounced. Basophilic cells begin to grow, the tumor becomes a single layer. Anaplasia is almost invisible, ontogeny is slightly pronounced. There are no metastases in squamous cell carcinoma, because the cells of the neoplasms, entering the blood ducts, cannot multiply. Since they do not have growth factors, which the tumor stroma should produce.
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Signs of cutaneous basalioma
Basal cell epithelioma of the skin is a solitary formation. The shape is similar to a half ball, the view is more rounded. The neoplasm may slightly protrude above the skin. The color is more pink or greyish-red, with a shade of mother-of-pearl. In some cases, basilioma is indistinguishable from normal skin at all.
To the touch, the tumor is smooth, in its middle there is a small depression, which is covered with a thin, slightly loose sanious crust. If you remove it, then under it you will find a small erosion. 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, according to which basilioma is determined. A person can have such a tumor for many years, only becoming a little larger.
Such neoplasms on the patient's body can be in large numbers. Back in 1979, scientists K.V. Daniel-Beck and A.A. Kolobyakov found that the primary multiple species can be found in 10% of patients. When there are dozens or more tumor foci. And this is then revealed in the 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 ulcer (ulcusrodens); superficial; scleroderma-like (morphea type); pigment; fibroepithelial.
If a sick person has a large number of foci, 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 rounded shape. On its edges you can see small nodules slightly shiny. 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. And also over the entire surface of the hearth there is a rash of dense, small particles. Almost always, the nature of the rash is multiple, and basilioma flows constantly. Its growth is very slow. 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 carried out.
The tumor type begins with the appearance of a small nodule. Then it gets bigger and bigger. Its diameter becomes about three centimeters. And it looks like a round speck of stagnant 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 she has no legs. There are two forms of this type: with small and large nodules. It 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. A typical feature this form of the disease is considered an expression in the form of a funnel. It looks massive, its fabric seems to be glued to the lower layers, their borders are not clearly visible. The size of the accumulations is much larger than the ulcer. In this variant, 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 cicatricial-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 various sizes appear. They have a peel that is very easy to remove. This positive moment when conducting cytological studies.
Pinkus fibroepithelial tumor is a type of squamous cell carcinoma, but it is quite mild. Outwardly, it looks like a nodule or plaque in the color of a person's skin. The consistency of such a spot is dense and elastic, erosion is not observed on it.
Basal cell epithelioma is treated conservatively. Doctors surgically remove lesions along the border of healthy skin. Cryodestruction is also practiced. This treatment is used if surgical intervention may be cosmetic defect. It is possible to smear spots with prospidin and colhamic ointments.
Basalioma (synonymous with basal cell carcinoma) is the most common malignant epithelial neoplasm of the skin (80%), arising from the epidermis or hair follicle, consisting of basaloid cells and characterized by locally destructive growth; metastasizes extremely rarely.
Usually develops after 40 years due to prolonged insolation, exposure chemical carcinogens or ionizing radiation. More common in men. In 80% of cases, it is localized on the skin of the head and neck, in 20% it is multiple.
Clinically distinguish the following forms basaliomas:
superficial- characterized by a flaky patch Pink colour, round or oval in shape with a filiform edge, consisting of small shiny knots of pearl, murky pink;
ABOUT puffy begins with a dome-shaped nodule, reaching a diameter of 1.5–3.0 cm within a few years,
ulcerative develops primarily or by ulceration of other forms; a basalioma with a funnel-shaped ulceration of a relatively small size is called ulcus rodeus (“corrosive”), and spreading deep into (up to the fascia and bone) and along the periphery - ulcus terebrans (“penetrating”);
scleroderma-like basalioma has the appearance of a dense whitish plaque with a raised edge and telangiectasias on the surface.
Histologically, the most common (50–70%) type of structure, consisting of various shapes and sizes of strands and cells of compactly located basaloid cells resembling syncytium. They have rounded or oval hyperchromic nuclei and scanty basophilic cytoplasm, along the periphery of the strands there is a "palisade" of prismatic cells with oval or slightly elongated nuclei - feature basalioma. Often there are mitoses, the cellular fibrous connective tissue stroma forms bundle structures, contains a mucoid substance and an infiltrate of lymphocytes and plasma cells.
The course of basaliomas is long. Relapses occur after inadequate treatment, more often with a tumor diameter of more than 5 cm, with poorly differentiated and invasive basaliomas.
The diagnosis is established on the basis of clinical and laboratory (cytological, histological) data.
Treatment of solitary basaliomas is surgical, as well as with the help of a carbon dioxide laser, cryodestruction; with a tumor diameter of less than 2 cm, intralesional administration of intron A is effective (1,500,000 IU every other day No. 9, the course consists of two cycles). With multiple basaliomas, cryodestruction, photodynamic therapy, chemotherapy (prospidin 0.1 g intramuscularly or intravenously daily, per course of 3.0 g) are performed. X-ray therapy (more often close-focus) is used in the treatment of tumors located near natural openings, as well as in cases where other methods are ineffective.
Squamous cell skin cancer (syn.: spinocellular cancer, squamous epithelioma) is a malignant epithelial tumor of the skin with squamous differentiation.
It mainly affects the elderly. It can develop anywhere on the skin, but is more common on open places (top part face, nose, underlip, back of the hand) or on the mucous membranes of the mouth (tongue, penis, etc.). As a rule, it develops against the background of precancer of the skin. It metastasizes lymphogenously with a frequency of 0.5% for malignant solar keratosis to 60–70% for squamous cell carcinoma of the tongue (average 16%). Foci of squamous cell skin cancer are solitary or primary multiple.
Clinically isolated tumor and ulcerative types of skin cancer.
tumor type, initially characterized by a dense papule surrounded by a halo of hyperemia, which turns over several months into a dense (cartilaginous consistency) inactive node (or plaque) soldered with subcutaneous adipose tissue, red-pink in color with a diameter of 2 cm or more with scales or warty growths on the surface (warty variety), bleeding easily at the slightest touch, necrotizing and ulcerating; its papillomatous variety differs more rapid growth, separate spongy elements on a wide base, which are sometimes shaped like a cauliflower or tomato. It ulcerates on the 3-4th month of the existence of the tumor.
Ulcerative type characterized by a superficial ulcer irregular shape with clear edges, spreading not in depth, but along the periphery, covered with a brownish crust (superficial variety); the deep variety (spreading along the periphery and into the underlying tissues) is an ulcer with a yellowish-red color (“greasy”) base, steep edges and a bumpy bottom with a yellow-white coating. Metastases to regional lymph nodes occur on the 3rd-4th month of the existence of the tumor.
Histologically, squamous cell skin cancer is characterized by proliferating into the dermis strands of cells of the spinous layer of the epidermis. Tumor masses contain normal and atypical elements (polymorphic and anaplastic). Atypia is manifested by cells of various sizes and shapes, hyperplasia and hyperchromatosis of their nuclei, and the absence of intercellular bridges. There are many pathological mitoses. Distinguish between keratinizing and non-keratinizing squamous cell carcinoma. Highly differentiated tumors demonstrate pronounced keratinization with the appearance of "horny pearls" and individual keratinized cells. Poorly differentiated tumors do not have pronounced signs of keratinization; strands of sharply polymorphic epithelial cells are found in them, the boundaries of which are difficult to determine. Cells have different shapes and sizes, small hyperchromic nuclei, pale nuclei-shadows and nuclei in a state of decay are found, pathological mitoses are often detected. Lymphoplasmacytic infiltration of the stroma is a manifestation of the severity of the antitumor immune response.
The course is steadily progressive, with germination in the underlying tissues, pain, dysfunction of the corresponding organ.
The diagnosis is established on the basis clinical picture, as well as the results of cytological and histological studies. Differential diagnosis is carried out with basalioma, keratoacanthoma, solar keratosis, Bowen's disease, skin horn, etc.
Treatment is carried out by surgical removal 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, prevalence of the process, the nature of the histological picture, the presence of metastases, age and general condition sick. So, with the localization of the tumor in the area of the nose, eyelids, lips, as well as elderly people who are unable to endure surgical treatment, radiotherapy is more often performed. The success of treatment largely depends on early diagnosis. Prevention of squamous cell skin cancer is primarily in the 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 early dates upon its occurrence. There is a need to warn the public about harmful effects excessive insolation, especially for blondes with fair skin. It is also important to comply with safety regulations at work where carcinogenic substances are present. Workers employed in such industries should be subjected to systematic professional examinations.
