Skin tumors

250px|thumb|Bazaliom víčka 250px|thumb|Pokročilý bazaliom horního víčka

Basal cell carcinoma

It is the most common malignant skin tumor. Its incidence has doubled in the last 15 years.

Occurrence

We observe an increased incidence after the age of 40, with the group over 60 being the most at risk. However, it can be at any age. It affects almost exclusively white individuals, if it occurs in pigmented races, it is associated with unusual etiological factors. The tumor arises from the keratinocytes of the epidermis.

Clinical picture, development

Typical cells are oval in shape and resemble the cells of the basal layer of the epidermis – hence the name. The tumor almost never metastasizes - more than 200 cases of metastases have been described worldwide, mainly to the lymph nodes. It usually starts as a nodule, boil, or scab that does not change significantly at first. It grows slowly as if crawling on the surface. It consists of one solitary nodule with raised edges, parts may undergo ulceration that does not heal. Sometimes there is an illusory improvement, the ulcer almost heals, only to reappear before long and slowly enlarge. An inconspicuous course often results in the formation eventually increasing to dimensions that can be a treatment problem in some locations. On the other hand, basal cell carcinoma on the mucous membranes metastasizes very often.

The cause of the disease

As with other malignant diseases, the cause of the disease is unclear. The main etiological factor is chronic, long-term exposure of the skin to UV radiation.

Prognosis

With the exception of extensive or invasively growing tumors, basal cell carcinoma does not threaten the patient's life . However, if the tumor grows long enough, it can form extensive foci with destruction of neighboring tissues.

Therapy

Surgical removal. If it is not cut out completely, it recurs! Excision is then necessary until the entire bearing is removed. Due to the place of occurrence (face), the aesthetic side of the procedure cannot be neglected.

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Spinal tumor

Squamous cell carcinoma is also classified as malignant epithelial tumors of the skin. It usually begins with intraepithelial growth, followed by destructive progression. It metastasizes mainly via the lymphatic route. The incidence in our population corresponds to about 11/100,000, compared to basal cell carcinoma which occurs less often (about 1:10).

Etiology

It usually develops from precancers (solar keratosis, leukoplakia, m. Bowen, etc.), especially in predisposed individuals with a lower amount of melanin in the skin (phototype I and II). Other risk factors are chronic degenerative skin changes ( scars, fistulas, skin ulcers ), immune disorders (immunosuppression), HPV infection, and long-term skin exposure to carcinogens.

Clinical presentation

The clinical picture of the tumor develops over time.

1. form: Diffuse infiltrating (inconspicuously elevated hyperkeratosis or hard, infiltrated focus with a bumpy surface, grows slowly, metastasizes late);
2. form: Ulcerative (the center may break down and form an ulcer with swollen, hard edges);
3. form: Exophytic (soft, aggressive, and rapidly growing formation with central disintegration and bleeding, metastasizes early).

Metastases to regional nodes occur in about 5-10% of patients. Nodules tend to be hard, and large in size, with the possibility of ulceration and fistula formation.

We recognize special forms with their typical precancer:

• Spinal tumor of the lip (from leukoplakia and cheilitis)
• spinalioma of the vulva (from lichen sclerosis et atrophicus)
• penile spinalioma (from erythroplasia)
• spinalioma of the tongue (from leukoplakia and erythroplakia)
• aggressively growing exophytic form (from m. Bowen and chronic irritation)

Diagnostics

The decisive examination for determining the diagnosis is the histopathological examination . Tumor prognosis is correlated with the degree of cell dedifferentiation.

Therapy and prognosis

Radical excision with a border of healthy tissue (peripherally and deeply). For smaller bearings, an intact edge of about 1 cm width is recommended. Excision of larger tumors should have a border of healthy tissue of 2-3 cm, especially on the trunk, where the spinalioma behaves more aggressively and the solution of the resulting defect does not cause major difficulties. In the case of metastases to regional nodes, we also remove them.

If surgery is not possible (e.g. in the elderly), we perform radiotherapy. In the presence of metastases, we add chemotherapy.

Prognosis depends on location, tumor size and degree of dedifferentiation. Tumors in the solar area have the best prognosis, worse on the ear, lips and scars. Tumors located on the mucous membranes have the worst prognosis.

Melanoma

Malignant melanoma is a cancer that arises from the neoplastic proliferation of melanocytes . It is classified as a neuroectoderm tumor. Malignant melanoma mainly affects the skin, but it can also affect the eye, ear, leptomeninges, GIT and mucous membrane of the mouth or genitals. The incidence of melanoma is increasing, affecting mainly the white population.

Melanoma occurs in four basic histological types: superficial spreading melanoma , lentigo maligna melanoma , acrolentiginous melanoma , and nodular melanoma . The basis of therapy is surgical resection of the tumor together with a sufficient margin of adjacent skin, or resection of lymph nodes. Adjuvant treatment with interferon α, specific vaccines, BRAF inhibitors (Vemurafenib), and CTLA-4 blockers (Ipilimumab) is considered.

Epidemiology

The incidence of melanoma is increasing worldwide. In the white population in the United States, the incidence of melanoma has more than tripled over the past twenty years. The incidence of melanoma shows geographic variation. While in North America there are 6.4 new cases per 100,000 men and 11.7 new cases per 100,000 women, in Australia and New Zealand it is already 37.7 cases per 100,000 men and 29.4 cases per 100,000 women. [1] In 2006, the incidence of melanoma in the Czech Republic was 18.4 per 100,000 men and 15.6 per 100,000 women. [2]

Malignant melanoma accounts for approximately 4% of all skin cancers but is responsible for up to 73% of skin cancer deaths. Globally, survival is higher in developed countries (91% in the US, 81% in Europe) than in developing countries (approximately 40%). Lower mortality in developed countries is mainly due to greater awareness of the population, which leads to earlier diagnosis and treatment. [1]

Malignant melanoma mainly affects the white population. The prevalence of melanoma in the Hispanic population in the United States is approximately six times lower than in the white population. The prevalence is even twenty times lower in African-Americans. However, Hispanic and African-American mortality from malignant melanoma is higher than that of the white population. The reason is the more frequent involvement of acral melanoma and the more advanced stage of the disease. [1]

Up to the age of 39, the occurrence of melanoma is more common in women, and from the age of 40, it is more common in men. Overall, women are slightly more affected (male-to-female ratio, 0.97:1), but mortality is higher in men. [1]

The median age of melanoma diagnosis is 59 years, however, in women aged 25–29 years, melanoma is the most common type of cancer, and among women aged 30–34 years, it is the second most common type of cancer after breast cancer. Malignant melanoma affects more elderly individuals, who are more likely to succumb to the disease. Therefore, the elderly should be the main target for the secondary prevention of melanoma. [1]

Pathophysiology

The pathophysiology of melanoma development is not fully understood. Several pathogenetic mechanisms of melanoma development are hypothesized. Melanoma occurs not only on skin exposed to the sun, where UV radiation is the main pathogenetic factor , but also in places that are relatively protected from radiation (trunk). [3]

Malignant melanoma is accompanied by mutations in the BRAF , NRAS and KIT genes . The individual representation of mutations depends on the method of exposure to sunlight. While a BRAF mutation occurs more with intermittent sun exposure and is more common in superficial spreading melanoma, a mutation in KIT occurs more with chronic exposure or in relatively unexposed skin and is more common in nodular melanoma. [3]

Melanoma arises either by malignization of an already present melanocytic nevus or, more often, de novo (in more than 70% of cases). [3]

Risk factors include :

• age over 50 [4]
• higher sensitivity to sunlight,
• excessive exposure to sunlight in childhood, bullous dermatitis after sunburn in childhood,
• increased number of atypical (dysplastic) nevi [3] or large congenital nevus (larger than 20 cm in adulthood) [4]
• familial incidence of melanoma,
• the presence of a changing pigment spot [3]
• immunosuppression
• use of the solarium [4]

Dermatofibrosarcoma protuberans

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Dermatofibrosarcoma protuberans is a malignant fibrous tumor, characterized by local invasion and frequent recurrence. The tendency to metastasize is small.

Clinical picture

Histological picture of dermatofibrosarcoma protuberans

It occurs as a rigid bearing on the upper body. During development, they form as painful brownish-red or bluish bumps with vascular ectasia on the surface. The tendency for infiltrations of the lower layers of the skin is relatively common. It metastasizes exceptionally to regional nodes or lungs.

Diagnosis

Histopathologically, it contains CD34 + fibroblasts in a typical storiform arrangement.

Differential diagnosis

• Keloids
• Dermatofibroma
• Fibrosarkom

CT, dermatoribrosarcoma protuberans in the left axilla

Therapy

Surgical removal with a wide margin of at least 3-5 cm into healthy tissue and to a depth of fascia.

Dermatofibrosarcoma protuberans

Prognosis

Chronic course, frequent recurrences after surgical treatment. Metastasizes rarely.

Verukózní karcinom

__ Verukózní karcinom

Odkazy

Související články

• Prekancerózy v dermatologii
• Benigní kožní nádory

Externí odkazy

• Melanom (česká wikipedie)
• Melanoma (anglická wikipedie)

Odkazy

Související články

• Basaliom (preparát)
• Bazaliom/PGS
• Maligní kožní nádory: Melanom | Spinocelulární karcinom | Verukózní karcinom

• Prekancerózy v dermatologii
• Maligní mezenchymální nádory: Kaposiho sarkom | Dermatofibrosarcoma protuberans

Zdroj

• Převzaté a zpracované na souhlas autora MUDr. VLADIMÍRA JANEČEKA.

Kategorie:Onkologie Kategorie:Dermatovenerologie Kategorie:Patologie Kategorie:Oční lékařství