Skin neoplasms are benign or malignant tumor lesions of the skin as a result of pathological proliferation of tissue cells. Benign neoplasms include warts, moles, papillomas, lipomas, angiomas, adenomas, etc. Malignant – melanoma, sarcoma, epithelioma. A special group consists of precancerous skin tumors: leukoplakia, cutaneous horn, senile keratoma, etc. Most of the skin neoplasms should be removed, because with injury or insolation, the probability of their malignant degeneration is high.
General information
Skin neoplasms are pathological overgrowth of the dermis, in which the size of cells or their number increases; pathologically altered dermal cells form into a limited tumor. The number of new cells in a healthy body is proportional to the number of dead ones, but when exposed to adverse factors, uncontrolled cell reproduction begins, cells divide before reaching maturity, as a result of which they are unable to perform their original functions. With malignant neoplasms of the skin, it is sometimes very difficult to differentiate from which layer of the dermis the tumor originated.
There are a lot of factors that can trigger the process of uncontrolled cell division, but the main predisposing factor for skin neoplasms are frequent skin injuries, as a result of which cells have to regenerate quite actively and as a result, control over division is lost. All types of radiation, including X-ray and solar irradiation, provoke skin neoplasms. Hereditary predisposition and fair skin with an abundance of moles in combination with other risk factors almost always lead to benign skin neoplasms, which can later malignate and transform into a cancerous tumor.
Despite the fact that benign skin neoplasms do not directly harm the patient’s life, they, having huge sizes, can disrupt the normal functioning of various organs, squeezing nerve endings – cause pain, and squeezing blood vessels – disrupt blood circulation in a particular area of the body.
Constant exposure to aggressive substances on the skin, bacterial and viral skin infections, as well as chronic skin diseases such as eczema, increase the likelihood of skin neoplasms. Skin neoplasms as a result of metastases of cancer cells from other organs and skin neoplasms in persons who are not at risk are rarely diagnosed. All skin neoplasms are divided into three groups: benign skin neoplasms, precancerous skin conditions and malignant neoplasms.
Benign
Cells of benign neoplasms of the skin, despite the lost control over division, can be differentiated, they also retain their original functions to a greater extent. Such tumors grow slowly, squeeze nearby tissues, but never droop into them.
A lipoma is a neoplasm of the skin from the fat layer, an atheroma is an epithelial cyst, which, unlike a lipoma, often becomes malignant into a liposarcoma.
Papillomas and warts – have a viral nature and outwardly look like a skin neoplasm in the form of bulges or growths on the leg. The latter, often traumatized, malignate and transform into cancerous neoplasms of the skin and other organs. A dangerous precancerous condition is the giant Bushke-Levenstein condyloma, it is caused by HPV, like ordinary condylomas, but is characterized by rapid growth, gigantic size and the release of exudate with an unpleasant odor. Unlike ordinary condylomas, it has a progressive course, a tendency to germinate into nearby tissues and recurs even after complete excision of the affected area, very quickly transforms into squamous cell skin cancer.
Dermatofibroma is a benign neoplasm of the skin and connective tissue; the pathogenesis of this tumor is unknown, but there is a link between histogenetic precapillary changes and the development of dermatofibroma. It is diagnosed in young and mature women, marked by slow growth and insignificant subjective sensations, in isolated cases this skin neoplasm begins to grow spontaneously and in even rarer cases it becomes malignified.
Externally, it looks like a deeply soldered node, only a small part of the skin neoplasm appears on the surface in the form of a hemisphere; the surface of the tumor is smooth, less often warty or hyperkeratotic. The localization of the tumor has no clear preferences, but it is more common on the lower extremities, the color of the neoplasm varies from light gray to brown and blue-black. The size of the tumor is small, from 0.3 to 3 cm in diameter, it should be differentiated from such skin neoplasms as pigmented nevus, basal cell carcinoma and dermatofibrosarcoma.
Moles and nevi are limited hyperpigmented areas of the skin due to an uneven accumulation of melanocytes, most of which are acquired neoplasms on the skin due to excessive exposure to the sun. About half of malignant melanomas develop from the melanocytes of moles and birthmarks. Therefore, if the number of moles and their size increases, the intensity of coloring increases, then it is necessary to consult an oncodermologist or dermatologist.
Precancerous
Pigmented xeroderma, in the pathogenesis of which lies an increased sensitivity of the skin to various radiation energy, a congenital disease, due to disorders in the enzyme system, the dermis loses its regeneration properties. This pathology can be suspected by the large number of freckles in children of the first year of life on the skin areas that are most often exposed to insolation. Freckles quickly transform into warty growths. Dispensary observation of children with a genetic predisposition and constant protection of the skin from solar radiation can reduce the likelihood of skin cancers. With such a skin neoplasm as pigmented xeroderma, the prognosis is unfavorable, since cellular and squamous cell carcinoma develops in almost all cases. Mortality in the age group up to 20 years is very high.
Precancerous senile age
Bowen’s disease or intraepidermal cancer is clinically manifested by neoplasms on the skin of a spotty-nodular nature, in the form of papules and plaques, which merge to form extensive surfaces covered with papillomatous outgrowths. The incidence is high among people of mature and senile age of both sexes. Predisposing factors are the presence of warts caused by the human papillomavirus; due to the pronounced polymorphism of cells of this skin neoplasm, Bowen’s disease ends in undifferentiated cancer with the development of metastases in other organs and tissues.
Keir’s disease occurs in elderly people; clinically, this skin neoplasm looks like a bright red velvety knot on the genitals, the course of the disease is long, over time the node can ulcerate and become covered with papillomatous outgrowths. Such skin neoplasms are usually painless, but due to localization, they are often injured, which causes bleeding and pain. Unlike Bowen’s Disease, this skin neoplasm has a benign course and is malignified less often.
Senile keratoma is a neoplasm on the skin from its epithelial layers, which occurs in senile people. The initial manifestations look like limited areas of solitary or multiple hyperkeratosis, which later become dense plaques of a rounded shape up to one and a half centimeters in diameter and eventually become covered with dense crusts. Such skin neoplasms are localized mainly in open areas, characterized by slow growth and in very rare cases malignized.
Such a skin neoplasm as a cutaneous horn occurs in elderly people and develops in open areas, mainly in places subject to frequent friction and compression. The primary cutaneous horn occurs on unchanged skin, whereas the secondary is preceded by various skin neoplasms, tuberculosis, lupus erythematosus and actinic keratosis. After formation, an adult tumor looks like a cone-shaped corneal formation, the length of which is several times larger than the diameter of the base of the tumor. It is localized on the skin, the red border of the lips, the course of the tumor is long, malignancy occurs quite often.
Malignant
Malignant neoplasms of the skin account for 7-10% of all malignant tumors. Affects persons of both sexes, but people of mature age are more susceptible. They differ from benign tumors in that dermal cells are difficult to differentiate already at the initial stages of the disease, they do not perform their functions, are able to infect nearby organs and tissues and metastasize through blood and lymphatic vessels, causing tumors throughout the body.
Melanoma is the most malignant of all skin neoplasms, the presence of congenital and acquired pigment spots increases the risk of melanoma, as it arises from melanocytes – pigment cells of the skin. Middle-aged and senile women with blonde hair and blue eyes are most susceptible to melanoma. Neoplasm on the skin is localized mainly on the lower and upper extremities, the pathogenesis of malignancy of moles and pigment spots has not been fully studied, but their traumatization, attempts to remove moles and spots with aggressive chemicals, cuts and insolation contribute to malignancy.
The main symptoms that indicate malignancy of such neoplasms on the skin as pigmented spots and moles are a change in the pigmentation of the nevus, a sharp increase in size, frequent bleeding and ulceration. That is, any previously nonspecific manifestations of a mole indicate its rebirth. And, despite its small size, the tumor quickly spreads to neighboring areas in the form of satellite nodules and metastasizes first to regional lymph nodes, and then to internal organs. Traumatization can lead to premature degeneration into cancer, since even a biopsy for cytological examination is carried out in the presence of erosions and ulcers, so as not to activate the cancer process.
Epitheliomas are all skin neoplasms from epithelial cells and are diagnosed in 50-60% of all skin cancers. Epitheliomas occur in areas that are not affected by other skin neoplasms. Initially, a small nodule of pinkish-yellow shades is observed, which has been growing for many years, but its size is not significant – up to 1-1.5 cm in diameter, therefore it remains unnoticed. The activation of the process is indicated by the presence of a yellowish-gray crust, which eventually covers the epithelioma. The roller around the neoplasm on the skin consisting of cartilaginous seals with a shiny sheen is an unfavorable diagnostic sign. In the future, ulceration and bleeding are observed, the tumor quickly metastasizes to regional lymph nodes and other organs.
Kaposi’s sarcoma or angioretyculosis is more common in AIDS patients, but the classic form of sarcoma and neoplasms on the skin in patients with immunodeficiency are clinically and histologically identical. Men are more susceptible to this type of malignant skin tumors; Kaposi’s sarcoma is localized mainly on the lower extremities. At first, purple, less often purple spots without clear outlines appear, in the future, dense rounded nodules of bluish-brown color with a diameter of up to 2 cm appear on this background. nodules are prone to fusion and ulceration, in patients with HIV infection, the disease takes on an aggressive character, sometimes with lightning-fast damage to the lymph nodes and metastasis throughout the body.
Low-grade forms of skin cancer
Despite their small size, such skin neoplasms are extremely dangerous, the cells lose their ability to keratinize and there is a pronounced cellular atypism. Such oncological diseases of the skin are manifested by minor changes, usually the tumor is no more than a pea in size, but the more pronounced the atypism and the inability to differentiate the type of cells, the more unfavorable the prognosis for these skin neoplasms. Endophytic tumor growth leads to germination into blood vessels and to bleeding, cancer cells are disseminated through blood vessels throughout the body, causing numerous metastases. As a rule, such forms of cancer end in death from cachexia, bleeding or auto-intoxication a few years after diagnosis.
Diagnostics
Self-diagnosis and regular dispensary examinations are of great importance in early diagnosis. The doctor’s attentiveness during visual examination allows to diagnose pathological conditions and neoplasms of the skin and refer the patient for further examination.
Being attentive to your health and to the health of your loved ones makes it possible to notice changes in moles, pigmentation and birthmarks in time. And, if skin changes occur without objective reasons, then you should be examined by a dermatologist or an oncodermatologist, where, based on visual examination, histological studies and studies of the general condition of the body, the tumor-like nature of skin neoplasms will be confirmed or excluded.
Treatment and prevention
There is no specific prevention of oncological diseases, preventive measures include the removal of moles and the removal of warts at the initial stage of their occurrence, especially if there are many moles. Persons with a genetic predisposition to oncological diseases should avoid insolation, carefully approach the workplace and avoid contact with carcinogenic substances, excluding foods from the diet that can provoke an oncological process, it is possible to significantly reduce the likelihood of oncocharacter diseases.
Treatment of skin neoplasms most often consists in removing the affected area with partial excision of healthy tissues. Laser removal gives a lower percentage of relapses, since in addition to removal, the wound surface is cauterized and does not allow further dissemination of tumor cells. Electrocoagulation and cryodestruction of benign skin neoplasms can be used, as well as a radio-wave method of removal.
In the event that skin neoplasms are in the stage of inoperable cancer, radiation and chemotherapy are used. But if the neoplasm is initially malignant, the prognosis is always unfavorable, since the tumor metastasizing causes deep lesions of the internal organs, although the manifestations on the skin may be insignificant. The probability of death is quite high, patients die from auto-intoxication, massive internal bleeding, multiple organ failure and from cachexia.
If the skin neoplasm has a benign course or a precancerous condition, then timely surgical intervention almost completely eliminates the possibility of relapses and corrects cosmetic defects of appearance.
