Malignant skin tumors
About malignant skin tumors
Among the most common malignant skin tumors are basal cell carcinoma, squamous cell carcinoma and malignant melanoma.
Carcinoma (basal cell epithelioma)
Basal cell carcinoma is one of the most common malignant skin tumors that usually occurs after the age of 40. Its appearance is primarily related to exposure to solar radiation (people with light skin and hair are more likely to develop such lesions). It can also occur in people with certain pre-existing lesions, namely basal cell nevus syndrome or xeroderma pigmentosum.
Other causes that may promote basal cell carcinoma are:
• ionizing radiation
• chronic lesions, scars
Several treatment options are available for basal cell carcinomas:
• surgical excision - is the most effective treatment with a cure rate of 95%
• CO2 laser for low-risk tumors
The surgical treatment consists in the excision of the cutaneous tumor formation within the limits of secrecy and the sending of the piece to the histopathological examination that will give us the definite diagnosis. Depending on the size of the tumor, excision may be done under local anesthesia or may require general anesthesia.
Spinocellular carcinoma (epithelioma)
Squamous cell carcinoma is a less common malignant tumor than basal cell carcinoma. It can appear de novo on a skin without problems or it can appear on pre - existing lesions such as: actinic keratosis, Bowen 's disease or Queyrat' s erythroplasty, chronic lesions, postarsal scars, etc.
Other predisposing factors for squamous cell carcinoma are:
solar and ionizing radiation
• viral infections (there are certain subtypes of the HPV virus, such as subtype 16 that can promote the appearance of CCS in the penis)
long-term exposure to carcinogens: tar, asbestos, arsenic
• patients with xeroderma pigmentosum or warty epidermodysplasia
Squamous cell carcinoma has a rapid, invasive evolution and metastasizes by lymphatic and hematogenous route. The differential diagnosis is made with: basal cell carcinoma, keratoacanotomy or other premalignant skin formations, and in the early stages can be difficult to do.
The treatment in the case of squamous cell carcinoma is excision within the limits of oncological safety, followed by radiotherapy, and in the case of metastases, they are also surgically excised. Depending on the size of the tumor and the anatomical region in which the formation is located, the intervention may be performed under local anesthesia or may require a different type of anesthesia.
Melanoma is a malignant tumor whose origin can be any cell in our body capable of producing melanin. It can occur on both the skin and mucous membranes, is particularly aggressive and metastasizes to the lungs, liver, brain and bones.
The factors involved in the occurrence of malignant melanoma are:
• multiple nevi on the skin (dysplastic, giant nevi)
• repeated traumas of some nephews
• repeated and long-term exposure to solar radiation
• certain skin phototypes
• family history of malignant melanoma
From a clinical point of view, several forms of melanoma are known: extensive surface melanoma, nodular form, acral form or acrolentiginous melanoma and malignant lentigo melanoma.
The prognosis of malignant melanoma depends on the following factors:
• the level of invasion of Clark melanoma
• maximum tumor thickness or Breslow index
the patient's age
• the anatomical region in which the melanoma is located
• the presence or absence of metastases
The Breslow Index
The Breslow index determines the thickness of the malignant melanoma to see how deep the cancer cells have reached.
Clark invasion level
The level of Clark invasion shows us exactly the depth of the melanoma and which of the layers of the skin were invaded by cancer cells.
• level 1: atypical melanocytes are found only in the epidermis (first layer of skin)
• level 2: atypical cells do not extend beyond the papillary dermis
• level 3: atypical cells are found in the papillary dermis and invade the superficial vascular plexus
• level 4: atypical cells reach the level of the reticular dermis
• level 5: atypical cells reach the level of subcutaneous cellular tissue (the layer of fat under the skin)
The treatment of malignant melanoma is adapted according to the clinical form and stage of the disease:
• for the early stages the treatment of choice is the surgical excision of the tumor within the limits of oncological safety and the sending of the piece to the histopathological examination
• in the advanced stages in which metastases are present, lymph node dissection and chemotherapy are used
• other treatments used in the case of melanoma: interferon treatment, radiotherapy, etc.
The most important aspect in the case of malignant melanoma is its early diagnosis, so it is important to constantly examine the moles and signs we have on the skin and any changes to them should lead us to see a dermatologist.