Malignant skin neoplasms are neoplasms of external localization of epithelial, melanocytic, lymphocytic and vascular origin. They develop more often in old age. They appear in the form of plaques, nodules and seals with exophytic and endophytic growth. With progression, they often ulcerate. The underlying tissues can germinate, metastasize to lymph nodes and distant organs. The diagnosis is established on the basis of complaints, examination data and the results of additional studies. Treatment – surgical removal, chemotherapy, radiation therapy.
The concept of “malignant skin neoplasms” combines neoplasms of the skin originating from the epidermis (basal cell and squamous cell carcinoma), melanocytes (melanoma), vascular endothelium (sarcoma) and lymphocytes (lymphoma). According to various data, they account for 13-25% of the total number of oncological diseases. They occupy the third place in prevalence after lung cancer and stomach cancer. The probability of development increases with aging, the average age of patients in Russia according to data for 2004 is 68 years. Malignant skin neoplasms are more likely to occur in open areas of the body. Light-skinned blondes suffer more often than brunettes. The degree of aggressiveness may vary and depends on the morphological type of neoplasm. Diagnosis and treatment of this pathology is carried out by specialists in the field of oncology and dermatology.
The causes of the development of malignant skin neoplasms have not been definitively clarified. Among the main risk factors, experts traditionally indicate living in southern areas, age, fair skin, mechanical damage, prolonged insolation and adverse meteorological effects (wind, low temperature, high humidity). At the same time, in recent decades there has been an increase in the number of malignant skin neoplasms in urban residents of the middle lane who do not work outdoors.
Researchers attribute this fact to the deterioration of the environmental situation, increased radiation levels, the presence of a large number of carcinogens in food and household products, the fashion for tanning and the prevalence of immune disorders. Along with the listed factors, the presence of precancerous skin diseases is important, including senile keratoma, cutaneous horn, borderline pigmented nevus, erythroplasia and Bowen’s disease.
The most common malignant skin neoplasms include:
- Basal cell epithelioma.
- Squamous cell skin cancer (squamous cell epithelioma).
- Kaposi’s sarcoma.
- Skin lymphomas
Basal cell epithelioma
Basal cell carcinoma is a malignant tumor of the skin with local aggressive growth and a very low tendency to distant metastasis. It is the most common form of skin cancer. In 80% of cases, it is formed in the face and head area. It can occur on unchanged skin or become the result of malignant degeneration of the precancerous process. Characterized by a slow course and a high tendency to relapse. It is more often diagnosed in elderly people.
Initially, a small painless flat or protruding nodule of a flesh or pinkish color appears on the surface of the skin. Sometimes a malignant tumor of the skin has the appearance of a depressed reddish erosion resembling a scratch. The basal cell epithelioma grows for several years, reaching a size of 1-2 centimeters. As the neoplasm grows, a patch of wetness first appears on the surface, and then a small focus of decay, covered with a crust.
Under the crust there is an easily bleeding ulcer or erosion, surrounded by a dense narrow roller of pinkish, brownish or flesh color. The roller consists of many small nodules. Subsequently, the ulcer increases and deepens. Sometimes partial scarring is detected. With aggressive endophytic growth, the mobility of a malignant skin tumor decreases. The deepening of the ulcer is a sign of infiltrating growth and destruction of the underlying tissues.
There are several types of basal cell carcinomas. The superficial basal cell epithelioma is usually localized in the trunk area. It is an atrophic erizematous surface covered with a crust and surrounded by a thin dense roller. Flat cicatricial basal cell carcinoma, as a rule, is located in the temporal region, characterized by the presence of a site of atrophy and scarring with an indistinctly pronounced roller. A nodular malignant tumor of the skin can be multiple, localized on the scalp, the skin of the eyelids and forehead. It represents small nodules covered with crusts. It quickly ulcerates and destroys the underlying tissues. Scleroderma-like basal cell carcinoma resembles scleroderma. Prone to relapse.
A malignant skin tumor is diagnosed on the basis of an external examination and histological examination data. Treatment – surgical or nonsurgical removal. Excision, cryodestruction, electrocoagulation, irradiation, etc. are possible. In case of deep lesion of the underlying tissues, Mohs surgery is indicated – excision within visually unchanged tissues, followed by microscopic examination of tumor sections and (if necessary) gradual expansion of the tissue removal zone. After excision of a malignant tumor of the skin, patients are advised to avoid direct sunlight. Within 10 years, relapse is observed in 40% of patients.
Squamous cell skin cancer
Squamous cell carcinoma of the skin is a malignant tumor of the skin that develops from the spiny layer of the epidermis. It is detected 10 times less often than basal cell carcinoma, men suffer twice as often as women. Light-skinned people living in southern latitudes are more susceptible to the disease. The risk of a malignant skin tumor increases with prolonged use of immunosuppressants. The average age of patients is 50-60 years. It is usually formed on open areas of the skin, on the lower lip and in the perineum area. It can develop against the background of senile keratosis or occur at the site of traumatic injuries: scars after injuries, burns, purulent processes, bedsores or trophic ulcers.
Unlike basal cell carcinoma, this malignant skin tumor proceeds like a typical cancer of any localization. Squamous cell epithelioma progresses rapidly, gives metastases to regional lymph nodes and distant organs. In the initial stages, it is a single globular nodule. Subsequently, with exophytic growth, it becomes uneven and increases in size. With endophytic growth (ulcerative-infiltrating form), it is located in the thickness of the skin, forms a painful crater-shaped ulcer with dense, pitted edges.
All malignant skin tumors with exophytic and endophytic growth quickly germinate the underlying tissues and become immobile. Possible destruction of muscles, blood vessels, nerves, cartilage and bones. The probability of early metastasis is especially high with malignant skin neoplasms that have arisen in the area of post-burn scars, auricles, lower lip, hand and external genitalia. Patients complain of intense local pain and deterioration of the general condition. There are weakness, fatigue, loss of appetite, weight loss, hyperthermia and signs of general intoxication.
Without treatment, a fatal outcome occurs 2-3 years after the appearance of a malignant skin tumor. The cause of death is exhaustion, infectious complications or bleeding from damaged vessels. The diagnosis is made on the basis of symptoms and histological examination data. The treatment is operative. With metastases to the lymph nodes, radiation therapy is additionally used, with distant metastases, chemotherapy is prescribed.
Melanoma is the most malignant neoplasms of the skin. It arises from melanocytes. It can develop on unchanged skin or in the area of pigmented nevus. Fair-skinned people suffer more often. In patients with dark skin, the neoplasm rarely appears, usually on the soles and palms. The average age of development of a malignant skin tumor is 20-45 years. Risk factors include excessive insolation, multiple nevi, congenital pigmented nevus and dysplastic nevus. In patients with relatives with melanoma, the probability of the disease increases by 8 times, in patients who have previously undergone surgery to remove melanoma – by 9 times.
A malignant tumor of the skin is a flat spot or a protruding nodule of black or dark brown color. The color of the neoplasm can be homogeneous or heterogeneous, sometimes pigmented areas alternate with foci of flesh color. Melanomas devoid of melanin are very rarely detected. With progression, the tumor rapidly increases in size or begins to protrude more and more above the surface, becomes rough. Peeling is possible. The neoplasm is easily damaged and bleeds. It can occur without unpleasant local sensations or be accompanied by itching and burning.
A malignant skin tumor quickly metastasizes to regional lymph nodes and distant organs. It gives metastases to the skin in the form of pigmented and non–pigmented neoplasms, initially located near the primary tumor, and then scattered throughout the body. The diagnosis is made on the basis of symptoms, radiophosphoric test, thermography and cytological examination data. The presence of melanoma may be indicated by visual signs such as asymmetry, discoloration, uneven contours and an increase in the diameter of the nevus of more than 5 mm.
A biopsy with this malignant skin tumor is categorically contraindicated. If melanoma is suspected, smears are taken for cytological examination, a thorough external examination is carried out, lymph nodes are palpated, special attention is paid to signs of possible metastasis to internal organs. Patients with suspected malignant skin tumor are referred for chest x-ray, MRI and CT of internal organs, liver scintigraphy and other studies are prescribed. The treatment is surgical. In the postoperative period, chemotherapy and immunochemotherapy are used. The prognosis is unfavorable.
Kaposi’s sarcoma is a malignant skin tumor that develops from the cells of the inner lining of lymphatic and blood vessels. It usually occurs in the presence of immune disorders (in the elderly, HIV patients, patients who have taken immunosuppressants). Oncogenic viruses, injuries and hereditary predisposition are among the possible risk factors. The endemic African form is usually detected in young people, characterized by early metastasis.
The classic form of a malignant skin tumor is more often diagnosed in older men. It is manifested by the formation of multiple purple or bluish-brown nodes and plaques on the lower extremities. For many years, there has been a local, gradually spreading lesion, over time complicated by swelling and elephantiasis of the limbs. Subsequently, dissemination with damage to lymph nodes, internal organs, skin of the face and trunk is possible.
An immunosuppressive form of malignant skin tumor develops in patients who received immunosuppressants after organ transplantation. The epidemic form is detected in AIDS patients, it is characterized by rapid rapid development and early metastasis. The tactics of treating a malignant skin tumor depends on the prevalence and form of the disease. In the classical form with a local lesion of the extremities, excision of neoplasms is performed. With generalization, radiation therapy and chemotherapy are prescribed. The prognosis depends on the form of the disease.
Skin lymphomas are a group of malignant skin neoplasms developing from T- and B-lymphocytes. The causes of the occurrence have not been established. Some viruses, contact with chemicals, increased radiation levels and excessive insolation are considered as possible risk factors. Hereditary predisposition is not excluded. Neoplasms can be primary (malignant cells primarily affect the skin) or secondary (a tumor forms in a lymphoid organ, and then spreads into the skin).
Malignant skin neoplasms are manifested by itching, rashes, changes in the blood formula and an increase in regional lymph nodes. With the progression of the process, damage to internal organs is possible. The diagnosis is established on the basis of examination data, blood tests, ultrasound and CT of internal organs, sternal puncture, lymph node biopsy and other studies. The treatment plan for a malignant skin tumor is made taking into account the type of lymphoma and the prevalence of the process. Surgical removal is performed, immunostimulants and glucocorticosteroid drugs are treated, radiation therapy and chemotherapy are prescribed. The prognosis depends on the type of lymphoma.