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Tumors of the mucosa and skin are epithelial malignancies. There are two main groups of neoplasms – basal cell and squamous cell. However, the most common skin cancer is basal cell carcinoma, which is slow-growing and usually does not metastasize. It usually affects older men.
Basal cell carcinoma
Basal cell carcinoma (also known as carcinoma planoepitheliale, epithelioma basocellulare) is the most common skin cancer characterized by low local malignancy and relatively slow development. Basal cell carcinoma does not usually metastasize, but due to its local malignancy it is called basal cell epithelioma or basalioma. It is more common in elderly men.
The causes of basal cell carcinoma
The etiology of this ailment is unknown, but the sun’s rays may be a contributing factor. This cancer can develop from precancerous conditions such as:
• erythroplasia,
• leukoplakia,
• light inflammation of the corners of the mouth,
• lichen planus,
• lupus,
• congenital dyskeratosis,
• epithelial dysplasia,
• or in healthy skin
Additionally, we can list the risk factors:
• smoking and chewing tobacco,
• chewing betel nut,
• alcohol consumption,
• a diet low in fruit and vegetables,
• prolonged exposure to the sun,
• exposure to chemical agents, e.g. plant protection products (herbicides), petroleum derivatives, fungicides, aromatic hydrocarbons, arsenic compounds,
• infections with syphilis, HSV, HPV, Candida albicans,
• states of nutritional deficiencies.
Symptoms of basal cell carcinoma
The neoplasm is most often located on the exposed parts of the body – hands, face, neck, scalp. The patient develops a single, hard, transparent lesion that lasts more than three weeks. Early changes are asymptomatic and slowly increase in size. Over time, the boundaries of the lesions become blurry, jagged, harden and produce a central ulcer with pearly-shaped edges.
Symptoms include:
• pain,
• baking,
• swelling,
• speech and swallowing disorders,
• enlarged lymph nodes.
In neglected cases, local infiltration of deeper structures may occur.
Varieties: squamous cell carcinoma occurs as nodular-ulcerative, pigmented (differentiation from skin melanoma), sclerosis, superficial, fibrous-epithelial.
21.13. Basal cell carcinoma.
Basal cell carcinoma treatment
Treatment is a surgical excision with a histopathological examination of the excised lesion along with an assessment of the completeness of the excision (histopathological assessment – tumor description and assessment of the margin of healthy tissues around the tumor – 2-2,5 cm). Treatment of local recurrence consists in its surgical excision.
Neoplasm prognosis: depends on the clinical form, size, site of the lesion, oral hygiene and immune resistance. Basal cell carcinoma can be completely cured with surgery as it is rarely distant.
Squamous cell carcinoma
Squamous cell carcinoma (also known as squamous cell carcinoma, carcinoma planoepitheliale) is the second most common skin cancer after basal cell carcinoma, usually located in the mucous membranes and skin (usually in the head, neck, trunk, limbs, genitals, red lip) , floor of the mouth, side surfaces of the tongue, lower lip). It mainly occurs in the elderly who are exposed to UV radiation and can lead to metastasis in the lymph nodes and through the bloodstream.
Predisposing factors for skin cancer include:
• burn scars,
• actinic keratosis,
• senile keratosis,
• skin horn,
• choroba Yourself,
• white keratosis,
• Queyrat erythroplasia,
• Bowenoid papulosis – caused by the human papillomavirus in the genital area.
DIG. 21.14. Squamous cell carcinoma.
symptoms
The clinical picture is varied and depends on the location. The most common form of this cancer is ulcerative (ulcer with shaft-like edges) or papillary (hypertrophic lesions with much less penetration into the depths). Pain, itching and bleeding are late symptoms.
Treatment of a squamous cell tumor
Treatment is based on surgical removal of the lesion during histopathological examination and evaluation of the excision.
In the case of skin cancer located on the face – you can perform the so-called a sectional excision, which involves the excision of the skin cancer along with a small margin, which is subsequently examined intraoperatively. If the changes in the upper lip area progress rapidly, radiotherapy is used.
Treatment of local metastases is based on surgical excision and the use of radiotherapy. When the metastases have reached the local lymph nodes, the entire regional group of lymph nodes is removed. Topical chemotherapy with fluorouracil ointment is used in the elderly with skin cancer in the area of the ear or nose.
What’s the prognosis?
A good prognosis of survival for a five-year-old child is 90%. In the case of metastases to the local lymph nodes – 70%, and in the case of distant metastases – 30%.
Malignant melanoma
Malignant melanoma is a cancer of pigment cells. The most common site of melanoma development is the skin, but it can also appear around the gastrointestinal mucosa and in the eyeball.
The risk factors for melanoma include:
• fair skin, which is often exposed to sunburn,
• skin with numerous freckles,
• fair hair and eyes,
• frequent sunbathing,
• use of the solarium,
• frequent sunburn (especially in childhood),
• a syndrome of dysplastic moles and family history of melanoma.
Melanoma may develop on pigmented skin or on healthy skin. The cause of concern should be changes in existing moles: thickening, inflammation around the mole, itching, erosions and bleeding, enlargement, change of shape (e.g. from round to asymmetrical), uneven, jagged edges of the mole and changes in the color of the mole: uneven discoloration of the surface of the birthmark with various shades of brown, darkening, lightening, rapid enlargement.
Melanomas are most often located on the limbs, trunk, nail bed, mucous membranes, eyeball or in the central nervous system.
symptoms
Malignant melanomas developing in the mouth resemble lentil spots and may be overlooked. In addition, numerous minor discolorations within the mucous membranes make it difficult to diagnose – especially “amalgam tattoos”. On the mucous membranes of the genital organs, melanomas resemble melanocytic spots.
FIGURE 21.15. Malignant melanoma
Diagnosis of malignant melanoma
The diagnostics includes histopathological examination of the skin section – fine-needle biopsy, ultrasound examination of the regional lymphatic area, identification and examination of the sentinel node. Pathomorphological classification, Clark’s classification, Breslow’s classification, clinical classification, TNM scale – see chapter XXIII – malignant melanoma.
Treatment
Malignant melanoma therapy is based on:
• surgical excision with a margin of healthy skin and a certain group of lymph nodes,
• radiotherapy,
• chemotherapy,
• immunotherapy (which is complementary or palliative treatment).
The prognosis in malignant melanoma depends on the stage of the disease and the depth of infiltration. In the early stages, the curability is 100%.
Source: A. Kaszuba, Z. Adamski “Practitioner’s guide. Dermatology”; XNUMXst edition, Czelej Publishing House