Epithelioma is a tumor of the skin and mucous membranes that develops from the cells of their surface layer — the epidermis. Epitheliomas differ in a variety of clinical variants from small nodules to tumors of significant size, plaques and ulcers. They may have a benign and malignant nature. Their diagnosis includes dermatoscopy, back-seeding of the discharge, ultrasound of the formation, histological examination of the removed tissues or biopsy material. Treatment is mainly surgical, with the malignant nature of the tumor — radiation, chemotherapeutic, photodynamic, using both general and local methods of exposure.
In modern dermatology, most authors attribute the following skin neoplasms to epitheliomas: basal cell carcinoma (basal cell epithelioma), squamous cell carcinoma (spinocellular epithelioma) and trichoepithelioma (adenoid cystic epithelioma). Attempts by some researchers to identify the epithelioma with skin cancer seem impractical, since among the epitheliomas there are benign skin neoplasms, only in rare cases undergoing malignant transformation. Most epitheliomas occur in mature and elderly patients. The most common epithelioma is basal cell carcinoma, which accounts for 60-70% of all cases of the disease.
Various adverse factors that chronically affect the skin and are often associated with professional activity lead to the development of epithelioma. These include:
- increased solar insolation;
- radioactive exposure;
- effects of chemicals;
- permanent traumatization of the skin;
- local inflammatory processes.
In this regard, the occurrence of epithelioma is possible against the background of chronic solar dermatitis, radiation dermatitis, occupational eczema, traumatic dermatitis, at the site of a scar after a burn.
Basal cell carcinoma
Basal cell epithelioma occurs more often on the skin of the face and neck. It is distinguished by a variety of clinical forms, most of which begin with the formation of a small nodule on the skin. Basal cell epithelioma is considered a malignant formation, since it has invasive growth, sprouts not only the dermis and subcutaneous tissue, but also the underlying muscle tissues and bone structures. However, it does not tend to metastasize.
Rare forms of basal cell carcinoma include self-scarring epithelioma and calcified Malherbe epithelioma. A self-scarring epithelioma is characterized by the disintegration of a typical basal cell nodule with the formation of an ulcerative defect. In the future, there is a slow increase in the size of the ulcer, accompanied by scarring of its individual parts. In some cases, it turns into squamous cell skin cancer.
Calcified Malherbe epithelioma
Pilomatrixoma is a benign tumor that appears in childhood from the cells of the sebaceous glands. It is manifested by the formation of a single very dense, mobile, slow-growing nodule in the skin of the face, neck, scalp or shoulder girdle, ranging in size from 0.5 to 5 cm.
It develops from the cells of the spiny layer of the epidermis and is characterized by a malignant course with metastasis. The favorite localization is the skin of the perianal area and genitals, the red border of the lower lip. It may occur with the formation of a node, plaque or ulcer. It is characterized by rapid growth both along the periphery and in the depth of tissues.
It occurs more often in women after puberty. In most cases, it is represented by multiple painless tumors up to the size of a large pea. The color of the formations can be bluish or yellowish. Occasionally there is a whitish color, because of which the elements of the epithelioma may resemble acne. In some cases, there is the appearance of a single tumor reaching the size of a hazelnut.
The typical localization of the elements is the auricles and the face, the scalp is less often affected, even less often the shoulder girdle, abdomen and limbs. Characterized by a benign and slow course. Transformation into basal cell carcinoma is observed only in isolated cases.
The variety of clinical forms of epithelioma somewhat complicates its diagnosis. Therefore, when conducting an examination, a dermatologist tries to connect all possible methods of research: dermatoscopy, ultrasound of skin formation, back-seeding of the separated ulcerative defects. However, the final diagnosis with the determination of the clinical form of the disease, its goodness or malignancy, allows you to establish only a histological examination of the material obtained during epithelioma removal or skin biopsy. Differential diagnosis is carried out with:
- red lichen planus;
- Bowen’s disease;
- systemic lupus erythematosus;
- seborrheic keratosis;
- Keir ‘s disease , etc .
The main method of treating epithelioma, regardless of its clinical form, is surgical excision of the formation. In small multiple tumors, cryodestruction, laser removal, curettage or electrocoagulation may be used. With deep germination and the presence of metastasis, the operation may be palliative in nature. The malignant nature of the tumor is an indication for a combination of surgical treatment with radiotherapy, photodynamic therapy, external or general chemotherapy.
With the benign nature of the disease, timely and complete removal of the tumor, the prognosis is favorable. Basal cell and spinocellular epithelioma are prone to frequent postoperative relapses, for early detection of which constant monitoring by a dermatologist is necessary. The most unfavorable in prognostic terms is the spinocellular form of the disease, especially with the development of tumor metastases.