Types of malignant neoplasms of the skin. Skin tumors: benign, precancerous and malignant

17.08.2019

Why neoplasms appear on the skin, by what symptoms can malignancy be determined. Types of tumors depending on malignancy, methods of treatment.

The content of the article:

Skin neoplasms are lesions at the cellular level caused by uncontrolled growth of the upper layer of the dermis. Currently, medicine has several hundred types of tumors, but the main classification is benign and malignant. Changes in the skin are caused by external and internal organic influences.

What are skin neoplasms

The skin covering the human body is a complex organ. It protects the body from external influences, maintains heat exchange, and participates in secretory processes. The upper epithelial layer is constantly renewed, cells age and peel off, being replaced by new ones. They are continuously produced by the basal layer and rise upward. New cells contain a coloring pigment - melanin.

If metabolic processes in the skin are disrupted, the reproduction process becomes uncontrolled. Not only mature cells divide, but also not formed, growing ones. New growths appear under the skin and on the skin, but it is difficult to establish exactly at what level the tumor has formed, even after a special examination - a biopsy.

Non-malignant formations do not pose an immediate danger to the vital activity of the body, but they can provoke a deterioration in health. For example, growths on the scalp compress blood vessels, causing headaches. Therefore, if tumors appear or grow, it is necessary to consult a doctor.

Causes of neoplasms on the skin

The appearance of neoplasms can be caused by disturbances in metabolic processes in the body and the influence of external factors.

The reasons include:

Genetic predisposition - a family history of a tendency to develop skin lesions or defects in the immune system.
Autoimmune diseases, pathological processes in the body that cause a violation of tissue division at the cellular level and malignancy.
Side effect of medical treatment: with testosterone, immunosuppressants, alkylating agents in the treatment of cancer.
Exposure to ultraviolet radiation or radiation.
Worm infestations or the introduction of infectious microorganisms.
Acquired immunodeficiency, including HIV infection.
Bad habits, including smoking, alcohol or drug addiction.
Lack of nutrition or an inadequate diet - most often this is the cause of the appearance of neoplasms on the child's skin.
Intoxication caused by poisoning or professional activities, during which it is impossible to avoid contact with harmful substances contained in heavy metals, gasoline, and some resins.
Poisoning with arsenic and metals - chromium and nickel.
Traumatic lesions of the skin with a violation of the integrity, after which scars remain. Thermal or chemical burns have the greatest negative impact.

Hemangiomas and moles as neoplasms on the skin can appear during the development of oncological processes in any of the organs or systems.

The main symptoms of skin neoplasms

It is not always possible even for a dermatologist with significant experience to establish whether a benign or malignant neoplasm is in appearance or symptoms accompanying changes in the skin.

Symptoms of various types of neoplasms are similar:

A pigmented spot may appear immediately;
The color varies - from light to completely black, the structure of the skin is denser;
In the initial stage of formation, itching is felt;
The mole rises above the surrounding tissues or is at the same level.

With malignancy of neoplasms, the following symptoms may appear, which indirectly indicate malignancy:

The shape of the spot becomes uneven, the edges are blurry, the color is uneven;
The neoplasm is rapidly increasing in size;
Itching, tingling appears, the surrounding areas turn red;
First, when touched, and then in a calm state, painful sensations arise;
If moles are damaged, crusts form on the surface that do not heal for a long time, or ulcerative defects;
When pressed, a seal may be felt under the top layer of the skin.

The cells that make up benign formations partially fulfill their functions. The cells of malignant tumors degenerate and lose their properties. When skin cancer appears, the general condition worsens: tachycardia, weakness, lethargy appear, the temperature indicator is constantly increased.

The main types of neoplasms on the skin

According to the modern classification, neoplasms are divided into 3 types: benign, precancerous and malignant. Benign tumors can degenerate into malignant when exposed to unfavorable factors.

Benign skin neoplasms

Benign formations, despite the names, appear with the development of pathologies. These include tumors of the following types:

Atheromas... These are smooth, dense bumps under the skin with clear outlines. Their structure is a greasy secret that has accumulated under the skin. With a secondary infection, an infectious process can develop, it is extremely rarely reborn.
Hemangiomas... These are vascular tumors. They look like red or purple lumps on the surface of the skin or in the subcutaneous layer.
Lymphangiomas... They appear due to pathological changes in the cells of the lymphatic ducts. There are several forms: cystic - develop near the lymph nodes and on the neck, cavernous - small soft seals along the nerve fibers, capillary - localized neoplasms on the skin of the face, near the upper lip or in the cheeks, are watery blisters.
Lipomas... These are tumors developing from adipose tissue, impairing the aesthetic appearance. They can interfere if they are in an "uncomfortable" place, for example, on the side or on the neck. Rapid increase is characteristic.
Papillomas and warts... Neoplasms of infectious etiology. The division of the basal layer is disrupted due to the introduction of pathogenic flora - the human papillomavirus. In turn, they are divided into flat warts - they occur more often in children and young people up to 18-20 years old, ordinary warts - unlike flat, convex, genital warts, similar to cauliflower inflorescences, appear on the mucous membrane of the genitals or anus.
Moles, birthmarks, or nevi... These are pigmented neoplasms. From convex to rough to flat smooth, can appear on any part of the body.
Fibromas... Tumors of connective tissue fibers - fibrin. Color - from pink to brown, are soft and hard, localized under the armpits, on the genitals, on the front of the neck.
Neurofibromas... The structure of neoplasms is the sheath of nerve fibers. They look like freckles, do not form on the palms and feet.

If you change the shape of benign neoplasms or rapid growth, you must contact a dermatologist. This may indicate malignancy.

Precancerous growths on the skin

Precancerous formations have a high risk of malignancy.

This group includes:

Actinic keratosis... More often, neoplasms appear on the skin of the hands and other parts of the body that are unprotected from exposure to ultraviolet radiation in people over 45 years old. The plaques are pink, the surface is rough.
Bowen's disease... Typical localization - phalanges of the fingers, temples. High probability of transformation into squamous cell carcinoma. It presents itself as pink spots of uneven distribution.
... Dark, scaly patches appear on exposed areas of the body. Scales from the surface are difficult to peel off, and bleeding may develop when they are removed.
Cutaneous horn... A neoplasm of a dense brown structure that rises above the surface of the skin is surrounded by a bright red rim.

Tumors of the precancerous type can resolve on their own, but since the risk of degeneration is high, their appearance requires constant monitoring.

Malignant neoplasms of the skin

Malignant neoplasms are characterized by gradual growth and introduction of atypical cells into the surrounding healthy tissues. When the nerves are damaged, acute pain appears, when spreading to the vessels, the formation of hematomas due to subcutaneous bleeding.

Types of malignant skin tumors:

Basalioma... A single papule is visually visible, in the middle of which there is an erosive bleeding lesion. It develops rapidly, does not form metastatic foci.
... A bleeding ulcer surrounded by a dense cutaneous areola.
Melanoma... This is the most common form of cancer. It develops from birthmarks - areas of increased pigmentation.
Kaposi's sarcoma... It develops against the background of HIV infection or after an exacerbation of the herpes simplex virus type 8. Multiple red spots, blistering rash, nodules and spider veins appear on the skin at the same time. The skin is peeling.
Liposarcoma... It is considered a male tumor, develops against the background of benign formations, regardless of the area of localization. Classification of neoplasms: poorly differentiated resembles a lipoma in appearance, myxoid - grows rapidly, pleomorphic - affects the limbs, dedifferentiated - often metastasizes. There are combined type liposarcomas.
Fibrosarcoma... Malignant cells of the tendons and muscle tissue on the feet and legs.

When painful spots appear on the skin, you cannot hesitate - skin cancer develops very quickly.

Diagnostics of skin neoplasms

A change in the appearance of birthmarks or the appearance of new ones is a sufficient reason to see a dermatologist.

There are several types of diagnostics:

Super early... It is possible only if the hospital is equipped with equipment that detects the genetic marker of the disease. It is rarely used due to its complexity.
Early... Malignant neoplasms are detected at stage 1. Carried out with the help of dermatoscopy - when examining the problem area of the skin using a special apparatus. If the patient has multiple birthmarks, a “neoplasm map” is drawn up and changes are regularly assessed.
Timely... The primary tumor is detected at the developmental stage, according to the patient's complaints about the deterioration of health.
Late... The neoplasms metastasized, the prognosis for recovery is poor.

Not all malignant tumors can be assessed visually, therefore, one should not refuse examinations for tumor markers and from histological examination. Patients should analyze their own condition and seek medical help in time.

Features of the treatment of skin neoplasms

The method of treating neoplasms depends on the etiology of the process, the type of tumor, the stage of the neoplasm and the depth of the affected tissues. The method of tumor removal is selected separately for each patient.

Classic removal of skin neoplasms with a scalpel

The surgical method is used at any stage of oncology. The affected tissue is removed, capturing partially healthy tissue in order to exclude further malignancy.

Advantage - a favorable prognosis for recovery to the stage of development of metastases.

Disadvantages - a long period of rehabilitation and a residual scar, and therefore it is problematic to use with neoplasms in open areas of the skin.

Operations are carried out in a hospital setting. After receiving the result of histology, the question of further treatment is decided.

Removal of skin lesions with liquid nitrogen

Removal of neoplasms with liquid nitrogen is called cryodestruction. The popular name is freezing. Liquid nitrogen is applied to the problem area of the skin using an applicator, capturing the surrounding tissues.

The most commonly used method is to remove papillomas and warts. After exposure to nitrogen, the neoplasm becomes denser, a bubble with serous exudate forms on the spot, which itself dissolves after a week. The crust dries up and the surgical site is cleaned within 2 weeks.

The advantages of the method are unexpressed soreness, accelerated rehabilitation.

Cons - the inability to control the process in full, which is why frequent relapses appear.

Removal of neoplasms with a laser

The most commonly used method was first used in Israel in 1980. It has now gained popularity all over the world.

Directional laser radiation acts on the problem area, vaporizing cancer cells. The procedure is performed under local anesthesia. The cell membranes form a crust, which later exfoliates itself.

Advantages of the method - no scars remain, prevents the development of bleeding, accelerated rehabilitation.

Cons - with individual intolerance to laser procedures, pigmentation of the operation area or secondary infection may occur.

Removal of skin neoplasms with radiation therapy

Indications for radiation therapy are multiple metastases or recurrence of the oncological process. With the help of directed radiation, all affected cells are destroyed.

Types of radiation therapy:

Proton beam - allows you to destroy malignant cells throughout the depth of the dermis layer;
Ion-beam - also deep penetration, but more gentle on healthy tissues;
Gamma-ray - stops damage to healthy cells and destroys malignant ones;
X-ray therapy - treatment is carried out with directed X-rays.

Because of the main disadvantage - damage to healthy tissues - radiation therapy is rarely used.

Removal of skin neoplasms by photodynamic method

The method is based on the reaction of tumor cells to ultraviolet exposure. First, drugs are injected into the body that increase sensitivity to light radiation. The photosensitizing drug accumulates in cancer cells, which are further destroyed after irradiation.

Stages of photodynamic treatment:

Injection of a photosensitizer with an applicator or intravenously.
The accumulation of the drug substance - the duration of the process depends on the type of tumor and the stage of the disease, it lasts from 3-4 hours to 3 days.
The tumor is irradiated with LEDs or with a laser.

With the correct diagnosis, tumor cells are destroyed within a month. The dose of the photosensitizer is determined individually.

Skin cancer treatment with radiography

When malignant neoplasms appear in open areas of the body - on the face, in the neck or on the ears - X-ray is used. This method is more affordable than laser removal or photodynamics, as it costs an order of magnitude cheaper.

It is very important that the surgeon who removes the tumor using directed X-rays has sufficient experience. It is necessary to correctly determine the required depth of penetration of the beam: if you make a mistake, then bone structures are damaged and the effect of exposure decreases.

Before starting treatment, the borders of the tumor are marked. The method is practically painless.

Treatment of neoplasms with chemotherapy

The method is applied after removal according to the methods already described, if the histological analysis for atypical cells turned out to be positive.

Local chemotherapy - special ointments are applied to the affected area or the problem area is injected with injections. The active ingredients of the preparations are aggressive alkalis or acids.

Systemic chemotherapy is used when multiple metastases appear; the solution is administered intravenously.

Currently, there are quite expensive targeted drugs that quickly stop the malignant process. In case of melanoma or squamous cell carcinoma, the use of older drugs in chemotherapy can be called a “gesture of despair” - recovery is possible in 40% of cases. Chemotherapy complements the surgical treatment of malignant neoplasms.

How to treat skin neoplasms - watch the video:

If the diagnosis was initially made incorrectly, after a histological examination, atypical cells were detected, metastases have already appeared, a relapse develops, then a complex technique is used to treat the disease. Using the classical method, the affected lymph nodes located near the neoplasm are removed, radiation or chemotherapy is performed. To avoid worsening of the condition, it is necessary to consult a doctor when the first symptoms of malignancy appear.

Skin neoplasms are malignant or benign lesions, growths on the skin as a result of the proliferation of abnormally dividing dermal cells. It is worth noting that it is recommended to remove even benign formations on the skin, since any injury or exposure to UV rays increases the risk of their degeneration.

Causes and mechanism of development

In the human body in full health conditions, the proportions of dead and new cells are approximately equal. However, under certain conditions and the influence of certain factors, the process of rapid uncontrolled cell division is triggered, and the cells multiply before reaching a state of maturity, as a result of which they lose their ability to perform their inherent functions.

Many factors are capable of provoking uncontrolled cell division, but the most important of them is frequent trauma to the skin, in which the cells of a certain area of the skin are forced to regenerate and renew themselves very often and actively, as a result of which this process can become uncontrollable. In addition, any radiation (including UV) can stimulate the appearance of neoplasms.

Heredity and fair skin with many moles can also be factors in the development of a tumor.

Any benign formation on the skin does not pose a serious danger to life, but with its significant size, it can cause disturbances in the functioning of organs and systems (for example, cause pain by squeezing nerve endings, or disrupt the flow of blood and lymph when the vascular network is compressed in a certain area ). Factors such as frequent rough mechanical action on the skin, infections, and chronic skin diseases significantly increase the risk of skin formations. In extremely rare cases, cancerous metastases from another organ can lead to a malignant formation on the skin.

It is worth noting that a large number of moles or other benign neoplasms (papillomas, warts) is an indication of the person's predisposition to cancer.

Types of neoplasms on the skin

Neoplasms are divided into three types:

benign: moles or nevi, fibromas, lymphangiomas, adenomas, hemangiomas, atheromas, neurofibromas, papillomas, lipomas and some others.
borderline (or precancerous) tumors: keratoacanthoma, cutaneous horn, senile keratoma, pigmented xeroderma, etc.
malignant: sarcoma, melanoma, basalioma, epithelioma.

They all differ in their ability to metastasize, complications and other signs.

Benign formations

The cells of a benign tumor can be distinguished because their original functions remain intact. Such formations are characterized by: slow growth, in the process of development they press on nearby tissues, but do not penetrate into them due to the presence of a connective tissue capsule.

Old age

Primary the cutaneous horn is formed on healthy skin, arises spontaneously, does not have an inflammatory element.
Secondary develops after other skin conditions such as solar keratosis and lupus erythematosus. After complete formation, the tumor takes the form of a horny cone-shaped formation. This disease is characterized by a long course and a tendency to degeneration.

Malignant tumors

The cells of such tumors are extremely difficult to differentiate at an early stage of development, since they have lost the ability to perform their own functions, can grow into nearby healthy organs and tissues, and often metastasize through blood and lymphatic vessels, forming tumors throughout the body.

The main signs that indicate the degeneration of benign formations (age spots, nevi, etc.) into malignant ones are:

Consider which formations are malignant:

Regular examination at the dispensary and self-examination makes it possible to assess the condition of the skin in a timely manner, diagnose changes in the formations and consult a specialist.

Treatment and prevention

There are no special measures that can prevent the development of cancer. However, as a preventive measure for a large number of moles, after a mandatory consultation with a specialist, they must be removed. In the case of an existing genetic predisposition, it is necessary to limit exposure to the open sun, to use protective lotions and creams, to avoid contact with chemically aggressive substances, and not to consume foods that can cause the development of oncology.

In most cases, for the treatment of neoplasms on the skin, a surgical technique is used, when using which there is a complete excision of the affected, and, to prevent recurrence, partially nearby healthy tissues.

For the treatment of benign neoplasms, methods of cryodestruction and electrocoagulation, as well as the radio wave method, are used.

If the cancer is inoperable, radiation and chemotherapy are used for treatment. When a tumor initially develops as malignant, experts give an unfavorable prognosis, since in this case there is a high probability of deep metastasis to internal organs, even with minor manifestations on the skin. With the timely start of surgical treatment, any formation that did not have time to degenerate into a malignant one is completely cured without further recurrence.

Moles, warts, wen. Who would have thought that these completely harmless cosmetic defects are on a par with much more unpleasant oncological pathologies?

Numerous types of neoplasms on the skin are both completely safe for health and capable of harming surrounding tissues and even posing a threat to human life. The latter include mainly malignant skin tumors, less often - borderline precancerous conditions.

How and why do they appear? In what cases can they be removed in the beautician's office, and in which cases should you consult a doctor for full treatment? TecRussia.ru studies the issue with particular passion:

What are neoplasms and what they are

By their structure, all skin neoplasms (they are also called "tumors" or "neoplasias") are the result of uncontrolled multiplication of cells that have not yet reached maturity, and therefore have lost the ability to fully perform their functions. Depending on the clinical picture, they are usually divided into 3 types:

Benign
(atheroma, hemangioma, lymphangioma, lipoma, papilloma, mole, nevus, fibroma, neurofibroma)

They do not pose a threat to human life, but with poor placement or large sizes, they can cause disruptions in the work of other systems and / or organs of our body. Under external influences, they can sometimes transform into malignant neoplasms.

They grow rapidly and aggressively, penetrating the surrounding tissues and organs, often with the formation of metastases . The prognosis of such diseases is often unfavorable, given the difficulty of their cure and the tendency to frequent relapses, and in some cases, an active metastatic process is fatal if vital organs are irreversibly damaged.

Borderline or precancerous skin conditions
(senile keratoma, pigmented xeroderma, cutaneous horn, Bowen's dermatosis)
Formations, the tissues of which, under the influence of hereditary or current causes, have changed, having received the potential for degeneration into malignant tumors.

Benign neoplasms

The cells of these formations partially retain their original functions and have a slow growth rate. Sometimes they press on nearby tissues, but never penetrate them. In their structure, such neoplasms are similar to those tissues from which they originated. As a rule, they respond well to surgical and other apparatus treatment, rarely give relapses.

Tumor of the sebaceous gland, formed after its blockage. Most often it occurs on the scalp, neck, back, in the groin area, that is, in places with a high concentration of the sebaceous glands. It looks like a dense formation with clear contours, elastic and mobile on palpation, does not cause discomfort.

With suppuration, redness and swelling of tissues, soreness, and an increase in body temperature appear. An inflamed atheroma can break through on its own, releasing purulent-sebaceous contents. This epithelial cyst tends to transform into a malignant form - liposarcoma. The atheroma is removed only through surgical excision.

Photo 1,2 - atheroma on the face and on the back:

A tumor that grows out of nerve sheath cells. Most often located in the skin and subcutaneous tissue. It is a dense tubercle measuring from 0.1 to 2-3 cm, covered with depigmented or highly pigmented epidermis. Multiple neurofibromas are caused by hereditary or genetic causes and are considered as a separate disease - neurofibromatosis.

This tumor rarely transforms into a malignant one, but in itself it is quite dangerous - it can cause constant pain and cause serious functional disorders in the body, therefore it requires treatment, at least pharmacological (retinoids). In difficult cases, surgical excision or radiation therapy is indicated.

Malignant neoplasms of the skin

Formations of this type grow rapidly, penetrate into the surrounding tissues, and often form metastases even in organs remote from the focus due to the transfer of pathological cells through the circulatory and lymphatic systems. In these tumors, the body's control over cell division is completely lost, and the cells themselves lose the ability to perform their specific functions. Malignant neoplasms are quite difficult to treat, they are characterized by frequent relapses of the disease even after surgical removal.

The main signs of the degeneration of a benign tumor or a stable borderline state of the skin into a malignant formation are:
- pigmentation changing in color or saturation;
- sharp and rapid increase in size;
- spread of the tumor to adjacent tissues;
- bleeding, expression, etc.
Metastases of malignant neoplasms can manifest themselves in any organs and tissues, but most often the lungs, liver, brain, and bones become the target of damage. At the stage of metastasis, the prognosis of treatment is often negative and even fatal.

One of the most common types of cancer. In most cases, it is the result of malignancy of moles and nevi after severe trauma or excessive exposure to ultraviolet light. Gives metastases to almost any organs, starting with regional lymph nodes, often recurs. It is treated surgically, in combination with chemotherapy and radiation therapy.

Photo 17,18 - this is how melanoma may look:

Malignant tumor of adipose tissue. Most often occur in men, people aged 50 and over. In most cases, it develops against the background of benign formations - lipomas and atheroma. Liposarcoma usually grows slowly and rarely metastases. When localized in the subcutaneous fat, a single rounded knot with irregular outlines and uneven density is palpated as a rather large (up to 20 cm) unit, firm or elastic to the touch. Surgical treatment is used, chemotherapy in combination with radiation.

It develops in soft tissues, mainly connective tissues, most often in the lower extremities. With superficial localization, it can noticeably protrude above the skin, has a dark blue-brown color. With a deeper location, it is visually invisible. Distinguish between differentiated and poorly differentiated fibrosarcoma, the first is considered less dangerous - it grows relatively slowly and does not give metastases, but both types give a high percentage of relapses after removal.

Precancerous neoplasms of the skin

This group includes pathological conditions of cells, which are more or less likely to end in degeneration into malignant formations.

Formation in the epidermis without invading the surrounding tissue. If not properly treated, it transforms into invasive skin cancer with growth and metastasis. Most often observed in the elderly, localized on the head, palms, genitals. Some chronic dermatoses, keratinized cysts, skin trauma with scarring, radiation, ultraviolet and carcinogenic effects lead to the appearance of Bowen's disease.

At the initial stage, it looks like a reddish-brown spot from 2 mm to 5 cm without even borders, then it transforms into a towering plaque with raised edges and a flaky surface. After removing the scales, a non-bleeding, weeping surface opens. Ulceration is evidence of the transition of Bowen's disease to a malignant form.

Photo 27,28 - Bowen's disease:

A cone-shaped formation resembling a yellowish or brown horn, which is why it got its name. Typical for the elderly, it occurs mainly on open areas of the skin that are regularly exposed to friction or squeezing, is formed from the cells of the prickly layer of the skin. It develops as an independent entity, a consequence of benign tumors (most often, warts) or the initial stage of squamous cell carcinoma. It is removed surgically.

Removal and prevention of skin lesions

Experts agree that it is necessary to get rid of any neoplasms, regardless of whether they are benign or malignant. The only exceptions are completely harmless and inappropriate for removal, for example, a scattering of small moles all over the body.

The best way to say goodbye to the tumor forever is surgical excision. He has only one drawback: unaesthetic postoperative scars. However, this side of the issue is only relevant if we are talking about a safe neoplasm that is removed for cosmetic purposes. In this case, modern "sparing" methods will help, primarily laser (see, for example, the article "Removing moles with a laser").

With timely intervention, the prognosis for benign tumors and borderline precancerous conditions is positive - a complete cure, excluding relapses and malignancy of the formations. If the formation was originally malignant, the prognosis may not be so favorable, treatment will require significant efforts, but it will be completely ineffective only if metastases are formed in vital organs.

With regard to prevention, today there are no uniform measures agreed by doctors against the occurrence or malignancy of neoplasms. Among the main recommendations:
- regularly pay attention to the condition of your skin and, at the slightest suspicion of the formation of tumors and similar formations, contact a dermatologist or oncologist;
- remove moles, warts and other suspicious formations only after consulting a specialist who will confirm their good quality;
- avoid excessive ultraviolet exposure to the skin, constantly use special products with filters, especially for people prone to the formation of moles, age spots;
- avoid skin contact with carcinogenic and chemically active substances;
- to reduce the consumption of products that can cause the appearance of cancer - these include smoked meats, animal fats, sausages and other meat products with a large amount of food stabilizers.

It is necessary to adhere to the strict rule, according to which, at the slightest doubt about the diagnosis, a histological examination of the neoplasm is necessary.

There are several histological classifications of skin neoplasms. We considered it expedient to give an abbreviated histological classification of the World Health Organization 1996 | 42 |.

Malformations, tumor-like processes and benign tumors of the epi-dermis

Papillomatous malformation.

Epidermal cyst.

Papilloma.

Seborrheic wart.

Common wart.

Pseudocarcinomatous hyperplasia.

Clear cell acanthoma.

Keratoacanthoma.

Cystic epithelioma.

Precancerous conditions of the epidermis,neoplasms with localgrowth

Senile keratoma.

Cutaneous horn.

Actinic keratosis.

Verrucic carcinoma (Gottron carcinoid, giant condyloma of Buschke-Leve and Stein, verruciform opidermodisplasia of Levan don-Lutz).

Leukoplakia.

Bachaly cell carcinoma (basal cell carcinoma).

Cancerin situ

Bowen's disease.

Paget's extramammary cancer.

Erythronla.chiya Keira.

Squamous cell carcinoma: keratinizing, non-keratinizing stages I - III

hair follicle tumors

Comedonic nevus.

Winner's extended time.

Trichilemmal (hair) cyst.

Trichopholliculoma.

Trichoadenoma.

Trichoepithelioma (including plastic desmo).

Trichoblastoma.

Trichoblastic fibroma.

9. Acantoma of the hair follicle sheath.

Tumor of the hair follicle funnel (follicular keratoma).

Cylindrome with piloidal differentiation.

Tricholemmoma.

Pilomatrikoma.

Hairline mesenchymal tumorsfollicle

Trichodiskoma.

Perifollicular fibroma.

Tumors of the hair follicle with local growth and malignancyvein tumors of the hair follicle

Basalioma with piloid differentiation.

Malignant pilomatricoma.

Malignant tricholemmoma.

Malformations, benign andmalignant tumors of the sebaceous glands

1. Malformation of sebaceous jelly :; (ne- nous Jadasson).

Adenoma of the sebaceous glands, including Muir-Torre syndrome.

Basalioma with greasy differentiation.

Sebaceous gland cancer.

Malformations and benignsweat gland tumors

Eccrine hydrocystoma.

Syringoma.

Eccrine poroma, including simple hydradenoma.

Syringoadenoma (protocopy, papillary, mixed).

Eccrine acrospirome (syringolpthelioma).

Eccrine spiradenoma.

Cylindroma with glandular differentiation.

Chondroid syringoma.

Hydradenoma (papillary, glandular-cystic, light-flowered).

Tumors with localized growthvolume and malignant tumors of theout glands

Basalioma with glandular differentiation.

Malignant analogs of benign tumors.

Primary cancer of sweat jelly) (adenocystic, mucinous, microcystic adnexa, ductal).

Aggressive papillary adenocarcinoma of the fingers.

Unclassified tumors.

Complex structure malformations epidermis, pilossbaceous complex, complex tumor structure with localized growth (basalioma complex structure). Malformations andvascular tumors

Malformations: capillary, lymphatic, venous, arterial, complex structure - focal and diffuse.

Benign tumors: capillary, cavernous, arteriovenous hemangiomas

Lymphangioma.

Tumors of the transitional type: hemaigio-■ -dethelioma.

Malignant tumors: Kaposi's sarcoma, angiosarcoma, lymphangiosarcoma.

Perivascular tumors: hemanpupericytoma, glomus tumor and their malignant analogs.

Tumors of the melanocytic system

Intradermal, borderline, mixed nevus.

Large and giant congenital nevi.

Nevus Spitz.

Halonevus.

Blue nevus.

Dysplastic nevus (dysplastic nevus syndrome).

Malignant melanoma in situ.

Superficial spreading melanoma.

Nodular melanoma.

Melanoma of the type of malignant lentigo.

Acrolentiginous melanoma.

Fibrous, fibrohistiocytic andmuscle tumors

Fibrous hamartoma of childhood.
Digital (childhood ribromatosis.

Plexiform fibrohistiocytic tumor.

Giant cell fibroblastoma.

Atypical fibroxanthoma.

Juvenile xanthogranuloma.

Reticulohistiocytic granuloma.

Fibrous histiocytoma.

Bulging dermatofibrosarcoma.

Myxoid fibrosarcoma.

Leiomyoma of the skin from the muscles that raise the hair.

Leiomyosarcoma of the skin.

Tumors of adipose tissue

Lipoma: angiolipoma, myolipoma, chondroid, fusiform, pleomorphic.

Hibernoma.

Atypical lipoma.

Liposarcoma.

Neurogenic tumors

Post-traumatic neuromas.

Limited solitary neuroma.

Schwannoma.

Neurofibroma and its variants.

Tumors of the membranes of peripheral nerves (perineural fibroma, myxoid and cellular neurotekeoma).

Granular cell tumor.

Malignant tumors of the peripheral nerve sheaths.

Merkel cell tumor.

Lymphoproliferative Disordersskin

Benign lymphocytic prostate liferation

Reaction to insect bites.

Angiolymphoid hyperplasia with eosinophilia.

Actinic reticuloid.

T-cell skin pseudolymphomas (Jessner-Kanof lymphocytic infiltration).

T-cell lymphomas of the skin

Mushroom mycosis.

Lymphatic papulosis.

B-cell pseudolymphomas of the skin (benign Beefverstet lymphadenosis, skin lymphocytoma, Spiegler-Fendt sarcoid).

Clinical classification of tumorsskin

Clinical manifestations are an important diagnostic factor, since the color, shape, growth dynamics of an element and its localization, as well as the patient's age, can provide a preliminary idea of the origin of the neoplasm. However, with the help of visual assessment it is not always possible to determine the nature of the process, since some of the neoplasms may have similar clinical characteristics, but different histological structure; others, on the contrary, with different clinical manifestations have a similar morphological structure, and finally, some of the neoplasms do not have pathognomonic clinical signs and are a histological finding.

The grouping of neoplasms on the basis of their clinical signs can, to some extent, outline the steepness of the alleged nosological forms and help in the formulation of a preliminary diagnosis.

Flat tumors of skin color: flat viral warts, leukoplakia.

Flat pigmented tumors: nevi, usually of the intraepidermal type, but can be dysplastic, lentigo, coffee-au-lait spots, histiocytoma, Mongolian spot, melanoma (superficial spreading type).

Towering tumors of the bodilycolors: viral warts, soft fibromas (papillomas), nevi, usually of the intradermal type, cysts, lipoma, keloid scars, basal cell carcinoma (usually a scleroderma-like variant), squamous cell carcinoma, molluscum contagiosum, xanthogranuloma.

Towering tumors brownishth color: viral warts, nevi, seborrheic keratomas, soft fibroids (papillomas), actinic keratomas, basal cell carcinoma,

noma, squamous cell carcinoma, keratoacantoma.

Towering tumors of redcolors: hemangiomas, actinic keratomas, pyogenic granulomas, glomus tumors, senile or cherry angiomas.

Towering tumors of blackcolors: seborrheic keratomas, nevi, pyogenic granuloma, melanoma, blue nevus, thrombosed angiomas or hemangiomas.

In a preliminary diagnosis of the nature of the proliferative process, the fact that many neoplasms prevail in certain age groups of patients can also help. This group includes molluscum contagiosum and viral warts, since they often have to be differentiated from skin tumors.

skin sores in children: viral warts (most common), molluscum contagiosum, intradermal nevi, hemangiomas, coffee-with-milk spots, pyogenic granulema, Mongolian spot, xanthogranuloma.

Tumors and tumor-like proskin processes in adults: viral warts (plantar warts are most common), nevi, cysts, soft fibromas (skin papillomas, acrochords), sebaceous hyperplasia, histiocytoma (dermatofibroma, sclerosed hemangioma), keloids, lipoma, pyogenic granule.

Tumors and tumor-like processesskin seams in the elderly: seborrheic keratomas, actinic keratomas, capillary hemangiomas, basal cell carcinoma, squamous cell carcinoma, leukoplakia.

In establishing the origin of this or that neoplasm, its location also has a certain value. Below are examples of localization of the most common neoplasms in the practice of a dermato-cosmetologist.

Hairy part of the head: seborrhea-

keratomas, epidermal and hair cysts, pevus, follicular keratomas, papillomas, basal cell carcinoma and squamous cell carcinoma, sebaceous nevus, cylindroma, syringocystadenoma.

Auricles: seborrheic and actinic keratomas, basal cell carcinoma, squamous cell carcinoma, nevus, keloids, epidermal cyst, nodular chondrodermatitis, hibernoma, gouty nodules, Lyme disease, keratoacanthoma.

Face: seborrheic and actinic keratomas, hyperplasia of the sebaceous glands, lentigo, milia, nevi, basal cell carcinoma and squamous cell carcinoma, lentiginous melanoma, flat warts, trichoenithelioma, fibrous nasal papules, keratoacanthoma, pyogenic granuloma, gena mangioma sebaceous glands, hydrocystoma of apocrine and eccrine glands, trichilemmoma, trichopholliculoma, Merkel cell cancer, Ota nevus, atypical fibroxanthoma, angiolymphoid hyperplasia with eosinophilia.

Eyelids: soft fibromas, seborrheic keratomas, milia, syringoma, xantelasma, basal cell carcinoma.

Neck: soft fibromas, seborrheic keratomas, epidermal nevi, hair cysts, keloid.

Lips and mouth area: Fordys disease, lentigo, telangiectasia, pyogenic granuloma, squamous cell carcinoma, granular cell tumor of the tongue, peripheral osteoblastoclastoma of the jaw, verrucous carcinoma, white nevus, lentiginous melanoma.

Armpits: soft fibroids, epidermal cyst, molluscum contagiosum, lentigo.

Chest and back: seborrheic keratomas, angiomas, nevi, actinic keratomas, lipoma, basal cell carcinoma, squamous cell carcinoma, epidermal cyst, keloid, lentigo, coffee-with-milk spots, melanoma, hemangioma, histiocytoma, multiple steatocystoma, cyst, go-

bast nevus, Ito's nevus, Becker's nevus, Paget's disease.

Groin area: soft fibromas, seborrheic keratomas, molluscum contagiosum, warts, Bowen's disease, Paget's extramammary cancer.

Genital organs: warts, molluscum contagiosum, angiokeratoma (in the area of the scrotum), epidermal cyst, miliary papules of the penis (along the edge of the glans penis), squamous cell carcinoma, Keir's erythroplasia, Bowen's disease, penile cyst in the median suture area, verrucous carcinoma , papillary hydradenoma on the labia majora.

Upper limbs: warts, seborrheic and actinic keratomas, lentigo, myxoid cyst (in the proximal areas of the nail), squamous cell carcinoma, glomus tumor (in the area of the nail bed), blue nevus, acral and lentiginous melanoma, pyogenic granuloma, recurrent finger fibroma in children, post-traumatic fibroma, xanthoma, Dupuytren's contracture.

Feet: warts, nevus, blue nevus, acral and lentiginous melanoma, seborrheic keratomas, verrucous carcinoma, eccrine pore, Kaposi's sarcoma.

Shoulders and shins: seborrheic and actinic keratoses, lentigo, warts, histiocytoma, squamous cell carcinoma, melanoma, lipoma, xanthoma, Kaposi's sarcoma.

16.2. Benign epidermal tumors

Seborrheic keratomas are a very common type of epithelial tumors in old age. At the same time, the number of keratomas can vary greatly - from single to several hundred, especially in persons with oily skin. An abundance of seborrheic keratomas can sometimes be a manifestation of paraneoplasia.

Fig. 16.1. Seborrheic keratomas on the face.

Clinical manifestations. Seborrheic keratomas are most often localized on the face, neck, scalp, back and upper half of the chest, less often on the forearms, legs and lower half of the body (Fig. 16.1). Usually their diameter does not exceed 1 cm, less often it reaches 3 cm or more. Rashes of yellow, brown, sometimes black color prevail. Keratomas have an oval shape with a warty surface, somewhat rise above the skin level, covered with a thin fatty film, for which they got their name. A characteristic symptom is white, brown or black keratotic plugs (pseudo-horny cysts).

Development stages. At an early stage, small papules practically do not rise above the skin surface and are often pigmented. Their surface is speckled with numerous small thimble-like depressions. At later stages of development, keratomas transform into warty plaques that rise above the surrounding skin in the form of a nail head.

Pigmented nevi exist for a long time, have a smooth surface and elastic consistency. Flat warts are observed in the main

Most often in children and young people, they appear suddenly, often in large numbers. Melanoma is rare and is usually characterized by rapid growth with a thickening at the base.

Treatment. With typical clinical signs of seborrheic keratomas and there is no doubt about the diagnosis, you can immediately start removing them. In this case, surgical excision, laser destruction, electrosurgery, cryodestruction and other methods are used, the simplest of which is curettage followed by cauterization with 35% trichloroacetic acid solution or electrodesiccation.

When the number of keratomas is in the hundreds, you can apply 5% fluorouracil solution or 30 % solution of prospidin, and inwardly prescribe aromatic retinoids (isotretinoin or acitretin) at a dose of 20-40 mg / day for 2-4 months.

If the diagnosis is in doubt (pronounced superficial hyperkeratosis, hyperpigmentation, condition after mechanical trauma), keratomas are subjected to histological examination.

Soft fibromas (papillomas, acro-chords). Perhaps the largest group of patients seeking skin neoplasms is people who want to get rid of papillomas. The preferred localization of papillomas is the neck, axillary regions and the skin under the mammary glands, less often they are found on other parts of the body. Mostly papillomas occur in middle-aged patients, often with endocrine system disorders.

Clinical manifestations. Papillomas are usually flesh-colored and range in size from a few millimeters to the size of a pea. Soft large solitary papillomas up to 1–2 cm in diameter are rare (Fig. 16.2). In case of injury or torsion of the thinner base with the feeding vessel of the papillary

crowbars become inflamed, undergo thrombosis, as a result of which they acquire a black color.

Papillomas are characterized by slow growth, but during pregnancy they often rapidly increase in size and number.

Filamentous warts are located on the fingers of the hands, resembling a cutaneous horn. Seborrheic keratomas are usually larger, dark in color, and warty. Neurofibromas are rather large, more often localized on the skin of the back, and are hereditary in nature; single elements are not an indicator of systemic disease.

Treatment. Removal of papillomas is performed due to their possible trauma and secondary infection, as well as for aesthetic reasons. There are many ways to remove papillomas, the simplest of which is cutting with scissors from subsequent coagulation of the blood vessel.

Cysts. There are several types of cysts: epidermal, hairy (sebaceous) and milia.

Fig. 16.2. Papilloma on the elbow.

Clinical manifestations. An epidermal cyst is localized on the face, ears, neck, back and scalp (Fig. 16.3). An epidermal cyst occurs as a result of the formation of a closed cavity and filling it with horny masses and skin

Fig. 16.3. Epidermal cyst.

Fig. 16.4. Giant hair cyst.

Fig. 16.5. Miliums for a century.

lard. The cyst wall is relatively thin and is an inverted full-thickness epidermis that can be easily damaged. In this case, the contents of the cyst penetrate into the dermis and cause

an inflammatory reaction like a granule of foreign bodies and soreness.

Hair cysts are more common in women and represent multiple smooth dense dome-shaped nodes with a diameter of 0.5 to 5 cm (Fig. 16.4). They are distinguished from epidermal cysts by the structure of the capsule, in which there is no granular layer, and the character of keratin, which has a homogeneous fat-like consistency, in contrast to the laminar, characteristic of keratin of the epidermal cyst. Damage to the cyst is accompanied by inflammation and severe pain.

Milium is a miniature retention cyst that looks like a yellow-white papule 1-2 mm in diameter, containing keratin (Fig. 16.5). The favorite localization of milia is the eyelids, cheeks and forehead. Milia occurs in people of all ages and occurs spontaneously or as a result of trauma.

Differential diagnosis. Lipoma has a larger size, a dense consistency, a lobular structure, and less distinct boundaries. Dermoid cyst outwardly resembles the cysts described above, and is usually represented by a single element; during histological examination, hairs, remnants of eccrine and sebaceous glands are found in the dermoid cyst. Cysts of mucous membranes are usually transparent, pea-sized or smaller, located on the lips. Synovial cysts are spherical, transparent, pea-sized and localized around the joints on the fingers and toes.

Treatment. The success of therapy depends on the location and number of cysts, as well as on the quality of the operation, since in the case of incomplete removal of the capsule, the cyst may recur.

Removal of an individual cyst with a diameter of 1-3 cm is performed by excision with a scalpel followed by suturing. The operation can be performed in two ways: either by dissecting the skin along the entire diameter of the cyst with a

the next complete removal of its capsule, or a small dissection of the kitty and squeezing out the contents. The latter technique is the easiest to implement and is carried out fairly quickly.

Multiple cysts on the scalp are removed in another way. First, an incision of the cyst with a length of 3-4 mm is made, then the contents of the cyst are squeezed out with a curette. The capsule is removed with surgical forceps through the incision.

If during the operation a solid tumor is found instead of a kitty, it is completely excised and sent for histological examination.

Removal of milia is performed by preliminary puncture with a needle, followed by evacuation of the contents using a comedo extractor. Another method of removal is surface electrodesiccation of the elements.

Keratoacanthoma is a rapidly growing epithelial tumor with a centrally located massive accumulation of horny masses surrounded by a high ridge. The favorite localization of keratoacanthoma is the face and upper limbs (Fig. 16.6).

Fig. 16.6. Keratoacanthoma.

Clinical manifestations. The tumor resembles squamous cell carcinoma, but unlike it often spontaneously

regresses in 6-9 months after onset. Although this tumor is usually not regarded as a primary malignant neoplasm, the frequency of keratoacanthoma malignancy, according to some authors, reaches 60%. In this case, the main sign of malignancy is prolonged bleeding of the bottom of the ulcer after rejection of the horny masses and the appearance of compaction at the base of the element.

The most common type of element is solitary. Less common are atypical keratoacanthomas (giant, mushroom, centrifugal, multinodular, etc.), constantly appearing throughout the patient's life. They do not have a favorite localization.

There are 3 stages of keratoacanthoma development: growth stage, stabilization stage and regression stage. At the growth stage, a suddenly appeared small papule acquires a rich red color, its diameter reaches 1 - 2 cm within a few weeks. At the same time, there are no subjective sensations. During the stabilization of the keratoacanthoma, the growth of the element stops and a crater-shaped depression is formed, filled with gray corneous masses. At the stage of regression, the stratum corneum are detached and the tumor completely regresses, leaving an inconspicuous atrophic scar.

Treatment usually performed 2-4 months after the appearance of a neoplasm, when there is no longer any hope of spontaneous regression. If necessary, excision or curettage is performed, followed by cauterization, cryodestruction, less often aromatic retinoids are prescribed orally.

16.3. Precancerous tumors of the epidermis

Precancerous neoplasms of the epidermis, which are often encountered by dermatocosmetologists, include

Fig. 16.7. Actinic keratomas on the dorsum of the hand.

Fig. 16.8. Cutaneous horn.

actinic keratomas and leukoplakia; radiation dermatitis and xeroderma pigmentosa are very rare, which we will not talk about. Actinic keratomas occurs mainly in the elderly, more often in men with fair skin who have been on the sun for a long time. UVB radiation is of particular importance for the development of these elements.

(280-320 nm). The danger of actinic keratomas lies primarily in the fact that in 20-25% of cases they can transform into squamous cell carcinoma.

Clinical manifestations. Actinic keratomas are multiple elements up to 1.5 cm in diameter, which look like papules that are flat or slightly raised above the skin surface. They often merge into brownish plaques and become covered with hard keratinized scales. Actinic keratomas are located, as a rule, in areas exposed to prolonged sun exposure (face, ears, neck and shoulders) and slowly, over the years, increase along the periphery and into the depth of the epidermis (Fig. 16.7).

The cutaneous horn is a proliferative, hyperkeratotic form of actinic keratomas. It got its name from its resemblance to the horn of an animal (Fig. 16.8). It should be taken into account that elements in the form of a cutaneous horn can also be a manifestation of seborrheic keratomas, viral striae, squamous cell carcinoma, basalioma and keratoacanthoma.

Usually actinic keratomas persist for years, but spontaneous disappearance of elements is also possible. Sudden growth of keratomas may indicate transformation into squamous cell carcinoma.

Differential diagnosis. Unlike seborrheic keratomas, actinic keratomas occur in areas that have been exposed to insolation for a long time. Since actinic keratomas are often transformed into squamous cell carcinomas, any suspicious growths rapidly increasing in size should be removed and referred for histological examination. Discoid lupus erythematosus should also be excluded by histological examination.

Treatment. Before proceeding with the removal of actinic keratomas, the issue of histological

com research. In case of thickening or inflammation of the keratoma, histological examination is mandatory.

Several methods have been developed for the removal of actinic keratomas.

Surgical methods include cryodestruction and curettage. Cryodestruction is carried out with liquid nitrogen for 7-10 s, after which the elements are destroyed and after 7-10 days the formed crust is rejected.

Another way to remove keratomas, especially large and thickened ones, is curettage followed by cauterization of the wound surface with concentrated trichloroacetic acid or electrocautery. Small wounds heal within 7-14 days; no dressings are required.

Numerous hyperkeratotic elements on the shoulders and scalp can also be removed by mechanical dermabrasion.

Chemical methods consist in applying 5-fluorouracil preparations to multiple surface elements (fluoroplex - 1% solution or cream, efudex - 2% solution and 5% cream) 2 times a day for several months. When keratomas are localized on the face due to the irritating effect of 5-fluorouracil preparations, the course of therapy usually lasts no more than 2 weeks and only on limited areas of the skin 164]. Another method of treatment with 5-fluorouracil is pulse therapy, when the drug is applied 2 times a day for 2-4 days every week for 3-4 months until the complete disappearance of actinic keratomas. An alternative to 5-fluorouracil in the treatment of actinic keratomas is a medium chemical peel with trichloroacetic acid and Jessner's solution (see Chapter 8).

With common actinic keratomas, an effective conservative method of treatment can be the use of 10-20 mg Roaccutane per day for 1-2 months.

The cutaneous horn is removed in the same way

dogs as actinic keratomas. If a tumor transformation is suspected, removal is performed together with the base of the cutaneous horn with subsequent histological examination.

Leukoplakia- a form of dysplasia of the mucous membranes, develops as a result of smoking, insolation, as well as due to chronic diseases of the mucous membranes, for example, recurrent actinic cheilitis and presenile or senile atrophy of the vulva.

Clinical manifestations of leukoplus- cues - clearly delineated flat whitish single or multiple plaques on the mucous membranes of the external genital organs, vagina, lips and mouth (Fig. 16.9).

Clinically, the following variants are distinguished: leukoplakia of Tuppainer smokers, flat leukoplakia, verrucous leukoplakia and erosive leukoplakia.

Fig. 16.9. Leukoplakia in the mouth.

Tuppainer's leukoplakia proceeds most easily. After

the patient quits smoking, the elements most often regress on their own. Flat leukoplakia is a continuous whitish film tightly attached to the underlying tissue. Verrucous leukoplakia is characterized by separate flat papules with a warty surface. Erosive leukoplakia is regarded as a complication of the flat or verrucous form of the disease, which most often (up to 50% of cases) undergoes malignancy. Other forms of leukoplakia become embittered much less frequently.

Differential diagnosis. Lichen planus on the mucous membranes of the cheeks and the red border of the lips is represented by whitish papules, similar to leukoplakia. The diagnostic difference from leukoplakia is that on the surface of lichen planus papules, a characteristic Wickham mesh is determined. In addition, elements with lichen planus are localized not only on the mucous membranes, but also on the skin. In this case, the papules take the form of shiny polygonal elements with a central umbilical depression and are localized on the flexion surfaces of the wrist joints and forearms, the anterior surfaces of the legs, etc. In difficult cases, it is necessary to take a biopsy for histological examination.

Lichen sclerotic atrophic in the vulva does not have a thickening at the base characteristic of leukoplakia and can spread beyond the mucous membranes, to the skin of the inguinal and perianal regions; often patients are worried about severe itching. An accurate diagnosis can often only be made through histological examination.

Treatment. In male smokers, small plaques of leukoplakia occur mainly on the lower lip. For successful therapy, complete smoking cessation is necessary, since even this step can lead to the complete disappearance of leu-

coplakia. Any irritating toothpastes and harsh toothbrushes should also be avoided, and lipstick should be used.

To eliminate small persistent elements, electrosurgical methods are used, less often cryodestruction. In torpid cases, it is possible to prescribe Roaccutane at 10-20 mg / day for 1-3 months.

16.4. Malignant tumors of the epidermis

Malignant neoplasms of the epidermis in terms of prevalence occupy one of the leading places among all human tumors. Most of them are either basal cell carcinoma or squamous cell carcinoma, less often malignant melanoma. In many ways, their appearance depends on the type of skin. Thus, the annual incidence of non-melanoma malignant tumors on the skin of white people in the United States is 230 per 100,000 of the population, while among African Americans it is only 3 per 100,000 of the population [33, 70].

Basal cell carcinoma(basal cell carcinoma, basal cell epithelioma) can occur at any age, but is most often recorded in patients over 60 years of age.

Epidemiology. In regions with high solar activity, inhabited by people with fair skin, basal cell carcinoma accounts for 75% of all malignant neoplasms of the skin. So, in Western Europe, the frequency of registration of various forms of basal cell carcinoma (per 100,000 population) is 40-80, in Russia - 20.3 in men and 27.3 in women, in the south of the United States - 300, and in Australia - more than 1600, and over the past 15 years, the incidence rates in these countries have doubled. In the United States alone, more than 500,000 people are found to have basalias every year.

Etiology. There are many hypotheses for the origin of basal cell carcinoma.

Genetic hypothesis. In recent years, using the methods of molecular biology and embryology, the gene for the nevoid banal cell syndrome, located on chromosome 9q22.3, has been found. This gene is in many ways analogous to the Drosophila Iatch gene. The latter takes part in the segmental development of the insect, controls its growth and regulates its shape. A number of patients with basal cell carcinoma were found to have mutations in this gene [15, 52]. Of the other genetic factors, skin color is of great importance: basal cell carcinoma develops primarily in patients with fair skin.

UV radiation. It has been established that increased skin insolation can provoke the development of basal cell carcinoma. It is no coincidence that most of the tumor elements are localized in open areas of the body (face, neck, hands).

Ionizing radiation. A radiation dose of approximately 10 Gy significantly increases the risk of developing basal cell carcinoma | 36]. On average, the latency period can last up to 25 - 35 years, and in some cases, tumors can develop much faster.

Carcinogenic substances. Long-term intake of food or drugs containing inorganic arsenic salts can lead to the development of basal cell carcinoma and other tumors.

Chronic skin diseases. Basalioma can develop against the background of chronic skin diseases, ulcers that do not heal for a long time, in the area of traumatized scars or in places where the skin contacts the prosthesis. At the same time, these factors more often provoke the appearance of squamous cell carcinoma.

Surprisingly, for many years the main cause of basal cell carcinoma - the most common human tumor - has remained a mystery.

that the development of basal cell carcinoma is due to the malignancy of the basal cells of the epidermis. Indeed, in microscopic examination, tumor cells look small, have a rounded shape, basophilic, resemble basal cells, which in the form of islets, lobules or cords are introduced into the dermis from the epidermis (Fig. 16.10). Nevertheless, with the help of immunohistochemical studies, it was shown that basalioma develops from pluripotent epidermal cells of either the basal layer or the inner root layer of the hair follicle. The patient should be warned about this.

♦ Excision. Most dermato-oncologists prefer this approach to treatment. In this case, not only the entire tumor is completely excised, but also areas of apparently healthy skin, departing from the edge of the neoplasm by 5 mm, and in the case of a scleroderm-like shape - by 1 cm. It is optimal to use microscopic control of the edges of the surgery.

gic wound, since due to the irregular serrated contour of the basalioma, it is possible to miss the growth of the tumor in the deep parts of the skin.

Micrographic methods of excision of neoplasms (Moza microsurgery) lead to positive results in more than 99% of cases. This method is used primarily for recurrent basaliomas, for surgical wounds that must be closed with a flap or graft, for large basaliomas with invasion into the bone, for basaliomas localized in risk areas, for example, in the nasolabial triangle, in areas of the eyes and ducklings, with sclerosing basal cell carcinoma, when it is difficult to determine the boundaries of the tumor. Microsurgery Moza is hardly necessary when removing single small tumors, since it is a very expensive method.

Cryodestruction. An alternative to surgical excision is deep cryodestruction, especially when the tumor is localized on the eyelids and nose, as well as in superficial basal cell carcinoma. In the experienced hands of a trained surgeon, this method is optimal for the treatment of elderly patients. The cryodestruction technique is described in Chapter 7. Immediately after the procedure, the tumor ulcerates and often bleeds, but as it heals, an acceptable cosmetic result is achieved.

Curettage and electrical desiccation. When small (up to 1 cm in diameter) or superficial basaliomas are localized on the trunk or upper extremities, curettage followed by cauterization or electrodesication can be applied. The disadvantage of this method is the impossibility of histological control of the tumor margins, which makes it unsuitable for removing scleroderm-like basal cell carcinoma. Pro-

the healing process also takes longer, and the cosmetic results are worse than with other methods, therefore it is better not to use electro-surgical methods in areas with a high risk of formation of noticeable scars (in the nasolabial triangle, near the eyes and ears ).

Radiation therapy. When basalioma is irradiated at a dose of 3-5 Gy 4-5 times a week at a total dose of 50-60 Gy, good therapeutic and cosmetic results are achieved [15, 36]. Radiation therapy is carried out fractionally, with the seizure of the adjacent apparently healthy skin by 0.5-1 cm. The depth of the necessary penetration is assessed by biopsy or ultrasonography. Radiation therapy is especially effective in patients over 60 years of age, when the risk of radiation-induced tumors is minimal, or when patients are afraid of surgery. In difficult cases with large basal cells, prospidine is additionally prescribed intramuscularly or intravenously, 100 mg daily; per course 3.0-3.5 g | 4].

With multiple superficial basaliomas localized on the trunk, applications of 5-fluorouracil are sometimes used, but after that, relapses often occur. A number of studies have also shown the efficacy of 5-fluorouracil with epinephrine in the form of a gel, as well as interferon a-2b injected into the tumor. The ratio of basaliomas to squamous cell carcinomas varies from 5: 1 to 10: 1.

Etiology. Squamous cell carcinoma arises from fairly well differentiated epithelial cells. As in the case of basal cell carcinoma, a number of etiological factors contribute to the development of squamous cell carcinoma:

constant exposure to the sun on the skin;

human papillomavirus (types 16, 18, 31, 33, 35 and 45);

X-ray irradiation;

exposure to carcinogens (resins, oils);

treatment with immunosuppressants;

genetic factors (pigmentary xeroderma).

Clinical manifestations squamous cell carcinomas change according to the degree of malignancy. There are several types of squamous cell carcinoma.

Squamous cell carcinoma with cutaneous horn is a tumor node with pronounced hyperkeratosis at the apex in the form of a cutaneous horn.

Nodular squamous cell carcinoma is a rapidly growing single node, in the center of which an ulcer develops rapidly, and along the periphery there is a dense, rising ridge with a reddish tint (Fig. 16.15). It is the most malignant type of squamous cell carcinoma.

Squamous cell carcinoma with exophytic growth often occurs in patients with Bowen's disease in the form of a loose nodule that bleeds easily (Fig. 16.16).

The verrucous form of squamous cell carcinoma clinically resembles a wart and is also often induced by the human papillomavirus.

Etiology. Nonvoid cells in melanocytic nevi are of dual origin. First, when migrating into the epidermis from the neural ridge during embryonic development, melanocytes do not reach it and remain in the dermis. Secondly, melanocytes can transform into neovid cells directly in the epidermis. The most important etiological significance in the appearance of mslanocytic nevi are genetic predisposition, hormonal effects, and UV radiation. The position of nevoid cells within the dermis determines the type of nevus, which usually, after passing through several stages of development, ends with involution and fibrosis (Fig. 16.22).

The borderline type of melanocytic nevi is characterized by the accumulation of nevoid cells at the border of the epidermis and dermis in the region of the dermoepidermal junction.

The complex type of melanocytic nevi combines features of borderline and intradermal nevi.

Intradermal type of melanocy-

Tary nevi characterize nests of “nevoid cells in the dermis, where the nevus continues to grow or enters a dormant state. As it sinks into the dermis, nevoid cells lose the ability to synthesize melanin and the melanocytic nevus loses pigmentation.

Clinical manifestations. Some melanocytic nevi are present at birth, but most appear during adolescence. At this time, their number reaches a maximum; the appearance of new melanocytic nevi is possible in adulthood, but it is quite rare. In this case, special attention should be paid to nevi that appear after prolonged sun exposure or during pregnancy. According to clinical manifestations, melanocytic nevi are subdivided as follows.

♦ Congenital nevi are found in 1% of newborns. They vary in size (from tiny to gigantic), light brown to black, and blotchy, but often become bulging and covered with hair. The onset of congenital nevi is likely.

associated with impaired differentiation of melanoblasts. There are three types of congenital nevi: small (less than 1.5 cm in diameter), large (1.5 to 20 cm), and giant (more than 20 cm). The latter, when localized in the head and neck region, are often combined with damage to the meninges. The risk of developing melanoma depends on the size of the nevus: the larger it is, the greater the likelihood of malignancy. For example, with large and giant congenital nevi, the probability of transformation into melanoma during life (especially in children under 10 years of age) is 5-15%, with small ones - 0.8-4.9%. The risk of malignancy is also associated with the localization of a congenital nevus: the highest on the trunk and the lowest on the lower and upper extremities.

Complex nevi are usually in the form of papules or nodes less than 1 cm in diameter, round or dome-shaped with a smooth surface and dark color (Fig. 16.23). Large elements resemble warts or papillomas, protrude significantly above the surface of the skin and are covered with hair. Complex nevi do not have a favorite localization. Border nevi are represented by flat formations ranging in size from 2 to 10 mm, light or dark brown in color, round or oval in shape, with clear, even borders. Deprived of hair, they are found on the trunk, palms, soles and external genitals and very slowly change in size and color. Intradermal nevi are common moles that are found in almost all people, and their number can reach several dozen. Distinctive signs of these formations are persistent hyperpigmentation, clear boundaries, soft consistency and the absence of inflammatory

Fig. 16.23. Complex melanocytic nevus.

phenomena. They usually become noticeable between the ages of 10 and 30 and never regress on their own. Over time, intradermal nevi can become warty, develop fibrosis, and lose pigmentation.

Fig. 16.24. Nevus Spitz.

♦ Nevus Spitz is a dense, reddish-brown, rounded nodule, most often located on the face of children (Fig. 16.24). Characterized by a good-quality course and fast

Fig. 16.25. Blue nevus.

Fig. 16.26. Multiple Halonevuses on the back.

height. Spitz's nevus is also called benign juvenile melanoma, emphasizing the fact that in some cases, histological examination shows a picture similar to that of melanoma.

The blue nevus got its name from its gray-blue hues (Fig. 16.25). A nevus occurs as a separate papule or nodule of dark blue, gray or black color, has a dense consistency with clear borders without hair. Blue nevus is most often localized on the face, buttocks, legs, feet, soles. There are several clinical varieties: simple blue nevus, cellular blue nevus, combined blue and non-cellular nevus.

Halonevus (Sutton's nevus) is an element surrounded by a depigmented corolla. It is not uncommon for many Halonevuses to appear at the same time. In children and adolescents, they are located mainly on the trunk (Fig. 16.26). Depigmentation is caused by the destruction of nevoid cells by immune cells. Halonevuses usually resolve spontaneously. The reason for the development of Halonevus is unknown, but, apparently, the mechanism of their development is similar to that in vitiligo.

Becker's nevus, a rare variant of nevi, usually develops in adolescents as unilateral formations on the upper back or chest (Fig. 16.27). At first they become hyperpigmented, and later become covered with hair.

Ota's nevus is also called a dark cyanotic orbital-maxillary nevus. A typical localization of this formation is the face (the area of innervation of the first and second branches of the trigeminal nerve). Ota's nevus consists of one large or many merging dark-cyanotic spots located in the cheek, upper jaw, zygomatic arch, with the spread of pigmentation to the sclera and the inner surface of the buccal mucosa (Fig. 16.28 ).

Ito's nevus has a similar histological picture with Ota's nevus, but is localized along the neck and shoulder.

Dysplastic nevi can be sporadic and hereditary, single and multiple, often more than 7 mm in diameter, irregular margins and uneven pigmentation (Fig. 16.29). Dysplastic nevi often appear in adulthood, localized mainly on the upper half of the body and limbs (Fig. 16.30). It is estimated that 2 to 8% of people have one or more dysplastic nevi. Individuals with dysplastic nevi, the risk of their transformation into melanoma is sharply increased.

In the USA, it was decided to use the name atypical nevus instead of the term "dysplastic nevus".

Patients with dysplastic nevi should avoid prolonged exposure to the sun and be monitored by a dermatologist or oncologist at all times.

Differential diagnosis. Freckles are spotted

Fig. 16.27. Becker's nevus on the shoulder.

a brown rash on areas of the skin exposed to sunlight. Lentigo manifests itself as multiple, often merging hyperpigmented spots and occurs in people over 40 years of age. Seborrheic keratomas are tightly seated verrucous elements with keratinous crusts.

Fig. 16.28. Oty's nevus.

Fig. 16.29. Dysplastic nevi. ;

Fig. 16.30. Melanoma that developed from a dysplastic nevus.

mi. Hemangioma develops from the vessels and is sometimes pigmented. Dermatofibroma is usually located on the lower extremities in the form of a knot of dense consistency, often with pigmentation. Pigmented ba-zalioma is often located on the face, has "pearly" inclusions, rapidly increases in size, and ulcerates. Melanoma has different colors and contours, rapidly grows in size, can become inflamed, ulcerate and bleed.

Epidermal nevi are a defect in the development of the epidermis and are usually present at the birth of a child or develop in infancy. Epidermal nevi, as a rule, grow in parallel with the patient's growth without any changes or regression. There are several types of epidermal nevi.

♦ The unilateral nevus is characterized by a unilateral lesion in the form of verrucous, often pigmented papules, which, when localized on the extremities, are elongated along their length, and on the trunk can occupy an entire segment

(FIG. 16.31).

Linear verrucous epidermal nevus, the most common of the group of epidermal nevi, manifests itself in linear limited grouped warty rashes on the skin surface.

The ILVEN nevus (English abbreviation, translated as inflammatory linear verrucous epidermal nevus) is characterized by red, scaly and itchy papules located in a line. Persistent inflammation is not associated with injury or infection.

Fig. 16.31. Unilateral epidermal nevus.

Fig. 16.32. Comedonic nevus.

Comedonic nevus is characterized by follicular papules, the central part of which is expanded and contains a horny plug (Fig. 16.32).

Epidermolytic ichthyosis is manifested by generalized, often symmetrical rashes on the trunk and extremities.

Often, the epidermal nevus is so large that it occupies an entire area of the body. After their excision, relapses are often observed.

An epidermal nevus in the area of the hairy part of the head is called the nevus of the sebaceous glands (Fig. 16.33). It can also appear on smooth skin, face and neck as a yellow plaque with a rough surface that lacks hair. The preference for surgical excision (taking into account the size and location) is due, firstly, to the fact that full-thickness removal guarantees the absence of secondary seborrhea, which can be a complication of incomplete removal of deep sebaceous glands when using dermabrasion, and secondly, a more favorable cosmetic result.

Principles of treatment for nevi. When choosing tactics for managing patients with nevi, it is convenient to adhere to the classification of nevi proposed by N.N. Trapeznikov et al. ... This classification was created taking into account the risk of developing melanoma from nevi

and predetermines the appropriate treatment measures, being a good guide for the doctor. According to this classification, there are two main groups of neoplasms: melanomone-dangerous nevi and some non-void skin formations; melanoma-prone nevi and skin lesions.

Fig. 16.33. Sebaceous gland nevus.

Most nevi, especially in children, do not require any intervention. Their excision is indicated for suspected malignancy, if they cause discomfort and for aesthetic reasons.

In addition, excision of the Spitz nevus is desirable, since the exact cause of its occurrence remains unknown. The tactics of treating multiple halonevus depends on the nature of the newly appeared central nsvus: if it is good-quality, then the rest do not need to be removed. If malignancy is suspected, all Halonevuses should be excised. Previously, it was not recommended to remove melanocytic nevi located in areas prone to trauma as a preventive measure, but now the attitude towards their excision has changed dramatically.

The group of melanoma-prone nevi and skin lesions includes borderline pigmented nevus, blue nevus, Ota and Ito nevi, giant congenital nevus, and dysplastic nevus. It has been proven that melanoma-dangerous nevus are much less common than melanomone-dangerous formations. Nevertheless, if they are present, regular observation is necessary, a thorough collection of a family history for the presence of dysplastic nevi or melanoma, patients are given recommendations for protection from insolation; the elements must be photographed. At the slightest suspicion of malignancy, a biopsy of the nevus and histological examination of the material should be performed. Taking biopsy specimens of malignant formations by tangential excision or by the curettage method is not recommended. Excisional biopsy is indicated for small (up to 1.5 cm in diameter) lesions and when they are located in those parts of the body where the reserve of skin makes it easy to tighten the wound, for example on the trunk. Incisional excision is rarely performed and only in cases where, for anatomical reasons,

a full excisional biopsy is possible.

Therapy for melanomone-dangerous melanocytic and epidermal nevi should be individualized. Not only the cosmetic effect, but ultimately the result of the therapy depends on the chosen treatment tactics. For this purpose, surgical, electrosurgical methods, laser therapy, cryodestruction and dermabrasion are used. In surgical treatment, the optimal excision boundary is the distance from the nevus 0.2-0.3 cm on the trunk and 0.1-0.2 cm on the fingers, face and neck 115.281.

In case of epidermal nevi, in addition to excision, sometimes corticosteroid injections are used directly into the elements or 5-fluorouracil I is used externally! combined with tretinoin.

The only correct approach to the treatment of melanoma-prone nevi is their excision along with the surrounding skin and subcutaneous tissue. When the nevi are localized on the trunk and extremities (except for the fingers), the incision is made, stepping back from the edge of the nevus in all directions by 0.5-1.0 cm. The arrangement of the elements on the fingers, auricle, the face allows limiting this distance to 0.2 -0.3 cm. Histological examination of the removed nevus is mandatory.

With nevi Ito and Ota, patients should be under dispensary supervision (examination every 3 ms). Surgery is usually not indicated.

The optimal approach to a giant congenital melanocytic nevus is to remove it. It is usually performed in the first 2 weeks of a child's life by curettage or dermabrasion, or by a series of resections or excisions followed by closure of the wound with a skin flap 115 |.

When deciding on the removal of a small or medium-sized congenital nevus, you should first discuss with the patient or with

Fig. 16.34. Capillary hemangioma.

Connective tissue nevi are rare, look like multiple smooth papules or flesh-colored plaques. With a predominance of collagen, connective tissue nevi have a flesh color, in the case of a predominance of elastin they become yellowish. An example of connective tissue nevi can be cobblestone nevi (“shagreen” spots) in tuberous sclerosis.

16.8. Vascular nevi

Vascular nevi include hemangiomas characterized by proliferation of endothelial cells in vessels, as well as malformations of vessels without proliferation of endothelial cells (for example, with various forms of flaming nevus).

Hemangiomas. IN depending on the depth of location, clinical manifestations and localization, the following types of hemangiomas are distinguished: superficial, cavernous, mixed (there are signs of both superficial and cavernous hemangiomas), spider-like, in the form of wine stains, nuchal , capillary, in the form of venous "lakes" and angiokeratoma.

Superficial hemangiomas. IN this group includes capillary (strawberry nevi), arachnid and senile hemangiomas.

Capillary hemangioma (strawberry nevus) is a red or dark red nodule or plaque of soft consistency, most often localized on the head and neck. The size of a capillary hemangioma varies from 1 to 10 cm. It appears during the first year of life in the form of a red flat nodule the size of a pinhead, which grows rapidly (Fig. 16.34). Girls get sick in

Fig. 16.35. Capillary-cavernous hemangioma.

3 times more often than boys. Full resolution of elements in 50% of children occurs by the age of 5, and by the age of 12, they disappear in 97% of children.

In the case of an increase in size and spread to the subcutaneous tissue, a cavernous type of hemangioma, or giant hemangioma, is formed (Fig. 16.35).

Spider hemangioma (stellate hemangioma) consists of a small superficial central arterio-

Fig. 16.36. Spider-like hemangiomas.

las the size of a match head with even smaller vessels - "spider legs", radially extending from it. Most often, spider hemangiomas are localized on the face and trunk (Fig. 16.36). Sometimes they can be observed in large numbers in pregnant women or in patients with chronic liver diseases. Capillary senile hemangiomas are found in young people, as well as in people of mature and elderly age (Fig. 16.37). They are also called cherry hemangiomas, as they are bright red flat or raised papules with a diameter of 2-3 mm or more. Capillary hemangiomas are localized on

Fig. 16.37. Capillary senile hemangiomas.

torso and do not bother patients, except when they are damaged and bleed.

Cavernous and mixed hemangio- we. Deep hemangioma is also called cavernous. Cavernous hemangioma is a malformation of the venous and lymphatic vessels of the skin, subcutaneous tissue and looks like a tumor-like formation of a soft spongy consistency. Mixed hemangiomas are formed as a result of changes in superficial and deep vessels.

Hemangioma of the neck is a red vascular lesion located on the back of the neck below the edge of the scalp. It does not disappear with age and practically does not lend itself to modern methods of therapy. Since the back of the neck is also a characteristic localization of neurodermatitis, it should be borne in mind that the erythema remaining after its cure may be a symptom of neck hemangioma, which has existed for many years and was not noticed by the patient.

Venous hemangioma (varicose varicose veins) - flat or slightly raised above the level of the skin soft formation of dark blue or violet color, localized on the face, lips, ears. It is more common in people over 50 years old and practically does not bother patients (Fig. 16.38). Weak pulsation of the venous hemangioma on the lower lip distinguishes it from the convoluted segment of the anterior labial artery.

Angiokeratomas are dark red, pinhead-sized, wart-sized, keratinized papules and are of three types. Angiokeratoma Mibelli occurs on the dorsum of the fingers and feet, as well as on the knees of girls; angiokeratoma Fabry affects the lower half of the trunk of men (Fig. 16.39, a); Angiokeratoma Fordyce, the most common form of angiokeratoma,

Fig. 16.38.

located on the scrotum (16.39, b). With angiokeratomas of Mibelli and Fordys, no treatment is carried out.

Fabry angiokeratoma (diffuse angiokeratoma) is a cutaneous manifestation of a systemic disorder of phospholipids, in which they accumulate both in the skin and in internal organs. Patients usually die before reaching the age of 50 due to the deposition of phospholipids in the blood vessels, heart and kidneys.

Flaming nevus (port wine stain) detected in 0.3% of children at birth. This dermal vascular malformation has the appearance of reddish spots of various sizes, often localized on the cheeks, forehead, upper eyelids, extremities and often disfiguring these areas (Fig. 16.40). The color of the nevus intensifies when the baby cries. The flaming nevus increases in proportion to the growth of the body, never disappears on its own and with age acquires a darker color with the appearance of papules and nodes on the surface of the spot. When the nevus is located above the eyelid, it can communicate with the underlying underlying hemangioma in the meningeal space, which can sometimes lead to epileptic seizures, for example, with Sturge-Weber-Crabbe syndrome. There are four clinical forms of flaming nevus:

Unna's nevus is localized in the occiput, eyelids and above the bridge of the nose;

Sturge-Weber-Krabbe syndrome includes a nevus located along the branches of the trigeminal nerve, with malformations of the vessels of the eyes and meninges;

Klippel-Trenone syndrome includes a malformed nevus

Fig. 16.39. Angiokeratoma.

a - Fabry type; b - Fordyce type.

Fig. 16.40. Flaming nevus.

vessels of soft tissues and bones in the form of hypertrophy of one limb;

Cobb's syndrome includes a nevus flaming with malformations of the vessels of the spinal cord, which leads to neurological disorders.

Differential diagnosis. Venous asterisks are small cyanotic telangiectatic formations localized on the legs and face, less often on other parts of the body. If desired, they can be removed by the same methods as spider hemangiomas.

Hereditary hemorrhagic teleangiectasias (Osler-Randu disease) are located on any part of the body or internal organs in the form of small red vascular spots or papules with a tendency to bleed. This disease is characterized by a triad of symptoms: numerous elements on the fingers and palms, on the red border of the lips, mucous membranes of the mouth and nasal passages; gastrointestinal and nosebleeds; burdened family history.

Treatment hemangiomas, especially superficial ones, are the subject of much debate. Color, size, depth, localization of hemangiomas and associated aesthetic problems are factors that must be considered in each case. Alertness in chemangiomas, especially of a large size, is due to two reasons. First, the very presence of hemangioma on the skin worries parents, especially if it is located in open areas. Secondly, if the hemangioma is localized near the eye, nose, mouth, neck, external genitals and in the anus, then it can cause dysfunctions of these organs.

Some dermatosurgeons believe that all types of superficial and cavernous hemangiomas should be removed, others believe that they should be left alone and await spontaneous involution. The latter rely on the data of a number of authors who showed that by the end of the first year of life the growth of most hemangiomas stops, about 85% of hemangiomas disappear without leaving noticeable scars by the age of 7 years. Other arguments in favor of refusing therapy are that the hemangiomas remaining in a child after 5-7 years may look better than the scars left after hemangioma excision, as well as the high cost of treatment. In this case, camouflage cosmetics can be recommended (see chapter 4).

Nevertheless, early treatment of small superficial or cavernous gsmaiomas has the following advantages. First, they can be eliminated completely or almost completely. Secondly, there is still no evidence that the therapy provoked an increase in hemangioma. Thirdly, the treatment performed reduces the fear of parents and relatives regarding the course of hemogomas. After a correctly performed operation, there are no visible scars, in any case, they look no worse than if the hemapgioma remained intact.

In case of cavernous or mixed hemangioma, different methods of treatment are used: surgical excision, ligation of the central vessel feeding the hemangioma, broad-spectrum antibiotics, administration of corticosteroids into the lesion focus. Oral corticosteroids are considered the treatment of choice for complicated hemogiomas. If hormonal therapy is ineffective, high doses of drugs based on interferon are used<х-2Ь.

With a flaming nevus, pulsed lasers using liquid dyes or copper vapor with a wavelength of 585 nm are most effective. This energy is selectively absorbed by oxyhemoglobin molecules, which leads to the destruction of capillaries with minimal damage to the surrounding tissues. The best results are achieved in early childhood. Recently, the use of selective pulsed phototherapy has become an alternative to laser therapy. The essence of the method lies in the application of pulsed broadband irradiation in the wavelength range from 515 x 1200 nm. The wavelength, energy, duration of pulses and the interval between them are selected individually. Other treatments for flaming nevus include high-dose oral or intralesional corticosteroids, surgical excision, interferon injections, em-

artery bolization and laser therapy. Melanoma affects people of any skin color, but most often the Caucasians living in countries close to the equator.

Melanoma is mainly a disease of mature people (average age about 45 years) and people with fair skin. U lit! in the age group from 20 to 60 years old, superficially spreading and

Etiology melanoma is not yet precisely established Nevertheless, among the main risk factors, the relationship between intense insolation, sunburn, as well as a large number of atypical melanocytic nevi and the occurrence of melanoma is particularly noteworthy | 9, 12, 59, 701. Other risk factors are shown in Fig. 16.41.

In addition, any of the following changes in nevi or other pigmented lesions can also be a harbinger of their transformation into melanoma | 9, 70]:

asymmetry of the shape and distribution of pigment;

the edges (borders) become irregular or jagged and often bleed;

melanoma can have a different color: in addition to the typical brown, its surface can acquire

Fig. 16.41. The main risk factors for the development of melanoma. Explanation I! text.

shades of blue, gray, pink, red or white. With any change (chan-ge), education must be revisited; the diameter (diameter) of most melanomas exceeds 6 mm, but the small size of the formation does not exclude the possibility of a malignant nature. Thus, signs of the development of melanoma by the initial letters of English words - (Asymmetry, Borders, Bleed, Change, Diameter).

Clinical manifestations of melanoma.

There are four main clinical variants of melanoma.

♦ Superficially spreading melanoma accounts for approximately 39-75% of all skin melanomas and has two phases of development: horizontal and vertical. Superficially spreading melanoma is a tumor in the form of a flat or raised spot that can develop from an existing nevus and grow slowly over several years (Fig. 16.42). The tumor has clear contours and a dense consistency. In the future, rapidly growing nodules or hypo-pigmented areas may appear on the surface of the neoplasm. The most common localization of superficial melanoma is the back. Often in men, tumors are also observed on the scalp, neck, chest, abdomen, and in women - in the thighs and legs. The fatality rate in this form of melanoma reaches 31 %.

Nodular melanoma occurs in 15-30% of skin melanomas, mainly in men, and is often localized in the trunk region. The development of the nodular form begins immediately with the phase of vertical growth, therefore it is called deeply penetrating melanoma (as opposed to superficially spreading). Clinically, this form of melanoma is a nodule or polyp on a pedicle of dark blue or black color, often ulcerating and bleeding (Fig. 16.43). Mortality in nodular melanoma reaches 56%.

Lentiginous malignant melanoma. Long-term malignant lentigo can transform into lentiginous malignant melanoma (Fig. 16.44). This type of melanoma occurs in 10-13% of patients. Lentiginous melanoma more often affects the skin of the face in elderly people who have been exposed to sun exposure for many years. It is characterized by two stages of development - horizontal, lasting 10, 20 and more years and vertical, in which invasion into the dermis occurs.

Clinically, lentiginous melanoma is a flat spot with blurred edges of a loose brown or black consistency.

The tumor is characterized by slow growth, however, in the phase of vertical growth, rapidly growing nodes are formed on the surface, and at the same time, rapid metastasis occurs. Mortality in lentiginous melanoma reaches 10%.

♦ Acral lentiginous melanoma accounts for approximately 10% of all melanomas. The favorite localization of acral melanoma is palms, soles and nail beds (Fig. 16.45). In the latter case, pigmentation of the proximal part of the nail is observed - a symptom of Hat-

Fig. 16.42. Superficial spreading melanoma.

Fig. 16.43. Nodular melanoma.

chinson, characteristic of melanoma. This form is often diagnosed late and therefore has a poor prognosis.

Fig. 16.44. Malignant lentigo with irregular outlines and pigmentation.

Fig. 16.45. Acral lentiginous malignant melanoma.

The course of most forms of chalk usually has two stages (Fig. 16.46) - horizontal and vertical. The horizontal stage is characterized by the proliferation of malignant melanocytes within the epidermis. Later, malignant cells penetrate into the dermis, and the process passes into the stage of vertical growth.

Local invasion by tumor

cells are assessed using the Breslow method based on measuring the distance (in millimeters) between the granular layer of the epidermis and the deepest identified melanoma cell.

Another method for assessing melanoma invasion is the Clarke grading.

Because melanoma tends to recur, all areas of the skin should be carefully examined, including the scalp, palms, soles, and perineum. If there are suspicious skin lesions similar to melanoma recurrence, atypical nevus and / or subcutaneous metastases, biopsy is necessary. When the lymph nodes are enlarged, they are biopsied either by excision or aspiration with a thin needle with further histological or cytological examination.

The minimum research volume for patients with melanoma also includes chest x-ray (if necessary, computed tomography is performed to assess the presence of possible tumor nodes) and determination of the level of liver enzymes in the blood. If an abdominal mass is detected or if there are symptoms of metastatic lesion of the internal organs, a CT scan of the abdominal / pelvic organs may be required.

Differential diagnosis. The clinical diagnosis of melanoma is sufficient

Fig. 16.46. The staging of the melanoma. The thickness of the skin layers according to the Breslow method. 1 - subcutaneous fat layer; 2 -derma; 3 - epidermis.

but difficult for a doctor of any specialty. Erroneous diagnoses amount to 10-20%. Therefore, let us point out neoplasms on the skin, reminiscent of melanoma:

Melanocytic neoplasms: melanocytic nevus, especially dysplastic and recurrent; nevus Spitz; blue nevus.

Vascular neoplasms: angiokeratoma; thrombosed or traumatized hemangioma; pyogenic granuloma; venous hemangiomas; Kaposi's sarcoma; glomus tumor.

Epithelial neoplasms: pigmented basalioma; seborrheic keratomas, especially inflamed; common warts with hemorrhages, pigmented hydrocystoma; pigmented actinic keratomas; pigmented tumors of the skin appendages.

Other neoplasms: dermatofibroma.

The complexity of diagnosis lies not only in the clinical, but also in the histological similarity of the tumor with

other lesions, for example, with dysplastic nevus, Spitz nevus, combined nevus, recurrent nevus, halonevus, melanocytic nevus with partial regression, acral nevus, genital juvenile nevus, congenital nevus, deep penetrating nevus, lanocytic nevus, injured by melanocytic nevus, melanocytic proliferation in the epidermis.

Forecast with melanoma, depends on the thickness and depth of penetration of the tumor. It can be good (if the tumor is less than 1.5 mm thick), doubtful (1.5-3.5 mm), and bad (more than 3.5 mm). Below are the indicators of 5-year survival of patients depending on the depth of penetration of melanoma .

Fig. 16.47. Flattened superficial melanoma with good prognosis.

Fig. 16.48. Thick, disintegrating nodular melanoma with poor prognosis.

Besides Moreover, to assess the prognosis, the so-called prognostic index is used, which reveals the ratio of the mitotic index to the tumor thickness and reflects the likelihood of the risk of metastases of medium-thickness melanoma. When assessing mito-

The technical index is the number of mitoses per 1 mm 2.

There are also other predictive factors, the most important of which are as follows.

Tumor thickness. Breslow tumor thickness is the most important prognostic factor, but requires the involvement of highly trained histologists. It should be noted that metastases are not typical for melanoma localized only in the epidermis. Examples of flattened and thickened tumors are shown in Fig. 16.47 and 16.48.

Floor. Men have a worse prognosis than women.

Localization of the tumor. For melanomas located on the back, shoulders, neck and scalp, the prognosis is worse than for other localizations.

Melanoma type. In nodular and acral melanomas, the prognosis is worse than in superficially spreading and lentiginous melanoma, even in cases where the tumors are of the same thickness.

Ulceration. Some oncologists regard ulceration of melanoma as an unfavorable prognostic factor.

Treatment. The main method of treatment is the complete excision of melanoma only in an oncological hospital, therefore, without considering the details of the operation, we will note only the general points of therapy.

When removing a melanoma with a thickness of 1 mm or less, not only the tumor itself is excised, but and apparently healthy tissue, stepping back 1 cm from the tumor. If the tumor is more than 1 mm thick, excision is performed with the capture of 2–3 cm from the edge of the tumor, in case of recurrence or with long-term melanoma - 5 cm (Fig. 16.49). The localization of the tumor is also of great importance. Melanoma on the face is not

it is possible to excise to the same extent as is done on the trunk.

If the lymph nodes are involved in the tumor process, then their excision can stop the development of metastasis, but will not lead to an increase in the patient's life expectancy. Prophylactic excision of local lymph nodes is performed in some cancer centers in the treatment of intermediate or thick tumors, but the results obtained are quite contradictory.

In the case of excision of melanoma with a high degree of malignancy without metastases, various schemes of chemotherapy and immunotherapy are used. The rationale for immunotherapy is that melanoma is an immunogenic tumor and has a higher likelihood of spontaneous remission than other tumors. The appearance of T-cell infiltrates may indicate regression of melanoma. In addition, the appearance of vitiligo in patients with melanoma is a good prognostic sign indicating the beginning of the development of an immune response to melanocytes, including malignant ones. A number of techniques have been proposed that force immune cells to fight malignant melanocytes. For example, it has been shown that nonspecific immunostimulation with BCG vaccines or from Corinebacterium parvum leads to some regression of the tumor process. However, in general, this technique does not increase the life expectancy of patients and does not lead to lengthening the remission of the disease.

Another method is a combination of radiation therapy or surgical excision with local microwave hyperthermia. This method, although it reduces the frequency of relapses, does not increase survival.

Very high doses of recombinant IFN-ce-2b drugs in patients with severe melanoma increase the 5-year survival rate from 37 to 46%. Interferon

Fig. 16.49. Melanoma excision boundaries.

used intravenously daily for 4 weeks at the rate of 20 million units per 1 m 2 of the skin surface, and then subcutaneously 3 times a week during the year at the rate of 10 million units per 1 m 2. The disadvantages of this technique are the high cost and the possibility of systemic toxic effects. Another modification of immunotherapy - treatment with activated lymphocytes (lymphokine-activated T-lymphocytes infiltrate the tumor) - is under study.

In case of detection of metastases, intensive radiation therapy, polychemotherapy, regional perfusion chemotherapy, immunotherapy, and hyperthermia are performed.

It should be noted that today none of the methods and schemes of cytostatic therapy can completely cure the disease, but is exclusively palliative in nature. Nevertheless, in some cases, the excision of isolated metastases in internal organs in combination

with polychemotherapy can lead to a decrease in relapses.

The most predictable feature of melanoma is its unpredictability. Despite the seemingly successful therapy, it should be borne in mind that melanoma can recur even after 8 and 10 years. Therefore, patients operated on for melanoma should regularly visit an oncologist in order not to miss a relapse of the disease. M. Wood and P. Bani. At the terminal stages, polychemotherapy is started, ie. several cytostatics from different groups at once.

TESTS

1.Specify the age category of patients for which hemangiomas are characteristic:

a) children; c) adults;

b) adolescents; d) old people.

2.Specify the age category of patients, which is characterized by the occurrence of basal cell and squamous cell carcinoma:

a) children; c) adults;

b) adolescents; d) old people.

3. Flat pigmented tumors do not include:

a) lentigo;

b) soft fibroids;

c) superficially spreading type of melanoma;

d) histiocytoma;

e) keratoacanthoma.

4. Of the listed removal methods for multiple large seborrheic keratomas on the face, it is preferable to apply:

a) electrocoagulation;

b) moxibustion of feresols;

c) cryodestruction;

d) application of 5% fluorouracil;

e) laser destruction.

5. A 50-year-old patient has a tumor-like formation in the region of the nasal dorsum: a red tumor with a diameter of 1 cm rising above the skin surface with a crater-like depression in the center filled with gray horny masses. The edges of the tumor are dense, smooth, without telangiectasias. Itching and soreness are absent. A year ago, a similar element appeared on the cheek, but independently regressed, leaving a small atrophic scar. Indicate the presumptive diagnosis:

a) basalioma;

b) epidermal cyst;

c) nodular melanoma;

d) keratoacanthoma;

e) seborrheic keratoma.

6.Distinguish the following clinical

forms of basal cell carcinoma. Besides:

a) nodal;

b) nodular;

c) superficial;

d) scleroderma-like;

e) ulcerative.

7. Of the listed neoplasms of the epidermis, precancerous include:

a) erosive leukoplakia;

b) epidermal cyst;

c) nodular melanoma;

d) actinic keratomas;

e) seborrheic keratomas.

8.Malignization is more often exposed to:

a) Leukoplakia of Pap-Payner smokers;

b) flat leukoplakia;

c) verrucous leukoplakia;

d) erosive leukoplakia;

e) listed.

9.Specify the most typical localization for basal cell carcinoma:

a) shins;

b) trunk;

e) the scalp.

10. Of the listed forms of basalioma, squamous cell carcinoma is more often transformed:

a) nodal; d) metatypical:

b) ulcerative; e) cystic.

c) pigmented;

11. Of the listed methods of treatment of the nodular form of basal cell carcinoma, the highest efficiency has:

a) systemic intake of cytostatics;

b) radiation therapy;

c) microscopically controlled surgery;

d) curettage;

e) cryodestruction.

12. Of the listed types of squamous cell carcinoma, the greatest malignancy and metastasis is characterized by:

a) nodal;

b) cutaneous horn;

c) squamous cell carcinoma with exophytic growth;

d) verrucous;

e) all of the above.

13.In patients aged 70 years with a large squamous cell tumor, lo-

calibrated in the upper eyelid area, preferably to use:

a) surgical excision;

b) cryodestruction;

i) polychemotherapy;

d) radiation therapy;

e) curettage.

14. A 40-year-old patient has a neoplasm in the lower leg area that appeared more than 2 years ago, which is often injured during shaving: a slightly raised brown knot 5 mm in diameter; when squeezing the knot with your fingers, it is slightly pulled inward. Indicate the presumptive diagnosis:

a) epidermal cyst;

b) melanocytic nevus;

c) keratoma;

d) keratoacanthoma;

e) dermatofibroma.

15. Melanocytic nevi do not include:

a) nevus Spitz;

b) halonevus;

c) nevus ILVEN;

d) Ito's nevus;

e) comedonic nevus.

16. Of the listed melanocytic nevi, the highest risk of transformation into melanoma has:

a) intradermal nevus;

b) Becker's nevus;

c) halonevus;

d) dysplastic nevus;

e) Igo's nevus.

17. A 47-year-old patient has a “mole” in the area of the right shoulder, which has existed for more than 30 years, after a long vacation at sea began to grow rapidly, itch and bleed. The element rises slightly above the skin surface, 1.5 cm in diameter, irregular in shape, black in the center and yellow-brown in the periphery; along the border of the element there are small hemorrhagic crusts. Indicate the presumptive diagnosis:

a) nevus Spitz;

b) dermatofibroma;

c) superficially spreading melanoma;

d) superficial hemangioma;

e) psoriatic plaque.

18. Specify the preferred localization of the pathological process of CTKL:

a) the stratum corneum of the epidermis;

b) the basal layer of the epidermis;

c) epidermis and papillary dermis;

d) reticular layer of the dermis and hypodermis;

e) lymph nodes.

19.Immunopathological reactions in patients with CTCL are mainly carried out by:

a) B- and T-lymphocytes;

b) B-lymphocytes, Langerhans cells, melanocytes;

c) T-lymphocytes, Langerhans cells, epithelial cells;

d) fibroblasts, epithelial cells, T-lymphocytes;

e) plasma cells, epitheliocytes, B-lymphocytes.

20.Specify the cells, the predominant proliferation of which in the skin is noted with CTCL:

a) T-helper lymphocytes;

b) T-killer lymphocytes;

c) B-lymphocytes;

d) Langsrgans cells;

e) T-suppressor lymphocytes.

Right answers. 1a; 2d; 36; 4c, d; 5d; 66; 7a, d; 8g; 9g; South; PV; 12a; 13g; 14d; 15c, d; 16g; 17c; 18c; 19c; 20a.

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Tutorial

Sergei Nikolaevich Akhtyamov, Yuri Sergeevich Butov

PRACTICAL DERMATOCOSMETOLOGY

Head editors T.P. Osokina Editor L. V. Pokrasina Art editor S.L. Andreev Technical editor N.A. Birkina Corrector L.P Kolokoltseva

ЛР No. 010215 dated 04.29.97. Donated to the set 06/25/2003. Signed for printing on August 11, 2003. Paper size 70xl00 "/ i6. Offset paper No. I. Typeface Time. Offset printing. Serv.print sheet 32.50. Cond.cr.-Ott. 95.55. Academic-edition sheet 33.25 . Circulation 5000. Order No. 7590ik-.ii

State Enterprise of the Order of the Red Banner of Labor "Medicine" publishing house. 101990, Moscow, Petroverigsky per., 6/8.

Printed from the original layout at the Federal State Unitary Enterprise Smolensk Polygraphic Plant of the Ministry of the Russian Federation for the Press, TV and Radio Broadcasting and Mass Media. 214020, Smolensk, st. Smolyaninov, 1.

There are different types of skin growths. This pathology has a large classification, and each type in it differs in its symptoms, features and prognosis. The variety of nosological forms of cutaneous oncology is explained by the fact that the source of the tumor is different types of cells. The most dangerous are malignant neoplasms, but this is determined only after diagnosis. Taking into account the type of tumors, different methods of treatment are used today.

What is a neoplasm on the skin

The skin covering the human body has a complex structure. Its functions are to support heat exchange, protection from external influences, participation in secretory processes. The skin consists of three main layers:

Epidermis. This is the outer layer formed by stratified squamous epithelium. Its surface consists of keratinized cells with keratin in the composition. The function of the epidermis is to protect against chemical agents and irritants.
Dermis. The middle layer is 1-3 mm thick. It is formed by the fibers of the mesh and connective tissue, which determines the ability of the skin to compress and stretch.
Subcutaneous adipose tissue. It is a deep layer of skin formed from connective tissue. It contains many groups of fat cells.

Skin growths can occur in each layer. In medicine, they are understood as tumors consisting of clusters of identical cells localized in a specific area. These formations can be benign or malignant. Regardless of the type, they arise against the background of abnormal proliferation of skin cells. Oncology is engaged in the study of neoplasms.

Views

The main classification of neoplasms divides them into types depending on the ability to metastasize to other organs, lead to complications and death. Taking into account these criteria, there are:

Benign. They do not directly harm a person's life, but at large sizes they can limit the normal functioning of organs, squeeze nerve endings, cause pain and disrupt blood circulation.
Precancerous conditions. This is a borderline form, which over time can develop into a malignant one. It develops as a result of tissue modification under the influence of hereditary or current causes.
Malignant. These are aggressive types of neoplasms that are difficult to diagnose in the early stages. They develop due to the intensive growth of immature atypical cells. Skin neoplasms grow rapidly, often cause metastases, and, if vital organs are damaged, lead to death.

The reasons

One of the provoking factors for the appearance of neoplasms is the action of ultraviolet radiation. Scientific research confirms the role of sunlight in the cancerous transformation of the epithelium. Risk factors are also alcohol abuse, smoking, viruses, radiation. The common cause of malignancy is mutation, i.e. degeneration of normal cells. When the immune system does not recognize the transformation, the pathology progresses and gives metastases.

Some people have a genetic predisposition to skin growths. In others, they are noted as a result:

the course of serious diseases leading to pathological processes;
a defect in the immune system;
taking strong drugs, including testosterone, immunosuppressants, alkylating agents;
radiation exposure to the body;
chronic skin conditions such as eczema;
unknown factors, such as acquired immunodeficiency;
lack of a balanced diet;
receiving mechanical or thermal injuries.

Benign skin neoplasms

If neoplasms grow slowly or remain unchanged throughout life, then they are called benign. Their difference is that the skin cells in the focus retain their original functions. Benign - do not penetrate into nearby tissues, but can only squeeze them. Their structure is similar to the neighboring cells from which they originated. Such formations respond well to hardware and surgical treatment. Relapses are rare, but there is a risk of becoming malignant.

Lipoma

It is also called a wen, because it develops from adipose tissue. This type is very common. A neoplasm occurs on almost any part of the body, but rarely occurs on the abdomen and legs. Lipoma does not cause much discomfort to a person, because it is not accompanied by pain. The bump only spoils the aesthetic appearance of the skin. Signs of a lipoma:

the presence of a seal 0.5-15 cm in size under the skin;
high mobility of the neoplasm, its slow growth;
no pain even with mechanical stress;
with constant rubbing of the wen on clothing, inflammation and suppuration may develop.

Papilloma

This neoplasm is a wart in the form of a nodule or papilla. The origin is viral. The pathology is caused by the human papillomavirus (HPV). It is activated against the background of weakened immunity, autonomic disorders, stress. Externally, papilloma is different. These are growths of light, gray or dark brown color. This group is divided into several types:

Flat warts. The most common type. Warts rise above the skin only by 1-2 mm.
Genital warts. They resemble cauliflower in appearance. More often appear on the genitals, around the anus, on the oral mucosa.
Common warts. Outwardly similar to flat, but rise above the skin by 2-3 mm. The surface of the warts is rough.

Hemangioma

It develops from an accumulation of cells on the inner surface of blood vessels. Most hemangiomas are solitary, but sometimes they appear in groups. The formation chooses the scalp, eyelids, forehead, cheeks, nose and neck as localization sites. There are several types of hemangiomas:

Capillary. Located on the surface of the skin, it can reach large sizes. Its color ranges from bluish black to red. Growth takes place to the sides.
Cavernous. This is a hemangioma in the deep layers of the skin. It is a limited subcutaneous formation of a nodular structure. Color - from normal skin tone to bluish.
Combined. Combines the previous two forms.
Mixed. Vascular formation on the skin, affecting the surrounding tissues, more often connective tissue.

Lymphangioma

Formed from the walls of the lymphatic vessels. It occurs in children even during development in the womb. Lymphangioma is more often diagnosed before the age of 3 years. The formation itself is a thin-walled cavity of 1-5 mm. There are several types of lymphangioma:

Cystic. Consists of isolated or communicating cysts. It is more often noted on the neck in the area of the lymph nodes.
Cavernous. These are small formations hidden by intact skin. Detected only by touch.
Capillary. Such a neoplasm appears on the face. The boundaries are blurred, the dimensions are small. A frequent site of localization of a neoplasm on the skin of the face is near the upper lip or on the cheeks.

Dermatofibroma

Another name is simply fibroma. Women of young and mature age are more susceptible to the mild type of this tumor. There is also a hard fibroma. Size - no more than 3 cm. Externally, it is a deeply welded knot. It protrudes above the surface of the epidermis, has a gray, brown or blue-black color. The fibroma is smooth to the touch, but it can also be warty. Depending on the form, the symptoms of this tumor are as follows:

Solid fibroma. It has a low level of mobility, it can be single or multiple. It is noted on various parts of the body and limbs.
Soft fibroma. This is a kind of pouch on a leg of pink or brown color. It is more often localized in the armpits, around the mammary glands and genitals.

Pigmented nevus

Moles or nevi are acquired and congenital. In structure, these are clusters of cells with an excess of melanin. Moles vary in color, shape, surface texture. The danger of some of them lies in the possible degeneration into melanoma. The risk of a pigmented nevus is especially high. Its main features and characteristics:

it is a flat brown or gray knot;
its surface is dry and uneven;
a pigmented nevus is removed with surgery.

Keratoacanthoma

This is the name of tumor-like hyperkeratosis. It is a benign neoplasm of the skin of epidermal origin, which tends to malignant transformation. Externally, a keratoacanthoma is an oval or round node. It is wide at the base, and matches the color of the skin. Other characteristics of this tumor:

in the center it is filled with keratinized cells;
has raised edges that form a kind of roller;
sometimes the color of the tumor changes to bluish red or pink;
the diameter reaches 2-3 cm.

Lentigo

These are benign age spots. They appear as a result of the accumulation of melanin in the chromatophores of the dermis and proliferative disorders in the basal layer of the epidermis. Outwardly, lentigo looks like a cluster of brown spots with a clear outline and a rounded shape. Pathology occurs in adolescents and the elderly. The main signs of lentigo:

round shape of spots, their size does not exceed 2 cm;
the spots are not grouped, each has its own contours;
ulcers, peeling and itching are absent;
spots are formed on open parts of the body, on the genitals and back - rarely.

Atheroma

It is a cyst of the sebaceous gland. Frequent places of localization of pathology are parts of the body where there is a high concentration of sebaceous glands, such as:

back;
groin area;
scalp.

Outwardly, atheroma is a dense formation with clear boundaries. On palpation, it is mobile and elastic. Atheroma does not bring discomfort to a person. The condition worsens with inflammation of the neoplasm on the skin. In this case, suppuration, swelling and redness of the tissues are noted. Against this background, the temperature may rise and atheroma soreness may appear. It breaks through on its own with the release of pus. With such a cyst, there is a risk of developing liposarcoma - a malignant formation.

This group includes neoplasms that are more or less likely to transform into malignant ones. They are on the verge of degenerating into various forms of cancer. This happens under certain unfavorable conditions. Doctors do not identify an explicit criterion or sign of rebirth. Because of this, it is difficult to clearly define the boundary between precancerous and early malignant tumors. Timely detection of these borderline conditions plays an important role in the prevention of skin cancer.

Pigmented xeroderma

With this disease, age spots turn into warty growths due to too high sensitivity of the skin to ultraviolet radiation. Xeroderma is a rare pathology, more often associated with heredity. Risk group - children born from closely related relationships. The first signs of the disease appear in childhood. Their list includes:

thinning of the skin, cracking and increased dryness;
swelling, redness and blistering at the site of ultraviolet radiation;
preservation after inflammation of age spots, similar to freckles;
ophthalmic diseases;
deterioration of the condition of the teeth;
stunting;
papillomas and warts in the late stage of the disease.

Giant condyloma Buschke-Levenshtein

This neoplasia is progressive and viral in nature. It is caused by a rare type of human papillomavirus. The outward resemblance to carcinoma (skin cancer) causes frequent confusion between these diseases. The tumor itself is a carcinoma-like genital warts. More often it is localized on the glans penis and the coronal sulcus. In women, condyloma is located on the clitoris, labia, in the anus. The symptoms are as follows:

the appearance of small formations resembling papillomas;
the rapid increase in their size;
fusion of warts, the formation of a single area - a giant warts;
its base is wide, the surface is covered with villi;
small warts are observed around the formation.

Bowen's disease

This is one of the rare ailments. The disease affects the mucous membranes and skin. It has a high risk of developing invasive cancer, especially in people over 70 years old. Bowen disease symptoms:

a red, round spot with jagged edges that appears on any part of the body;
its overgrowth into a copper-red plaque, forming an extensive surface of inflammation;
the appearance of yellow or white scales that completely cover the weeping area of the epidermis;
change in the structure of the plaque to warty;
ulcers that indicate the development of cancer.

Keir's disease

Another rare disease is non-invasive cancer of the mucous membranes. Affects the head of the penis, the inside of the foreskin. Rarely affects the cervix, oral cavity, vulva and perianal area. The main symptoms of Keir's disease:

a bright red plaque with a velvety shiny surface;
the epidermis in the affected area is moist;
the spot has clear boundaries;
single lesion;
sometimes there is a white bloom that is easy to remove;
pain observed when injuring the affected area;
bleeding with mechanical damage;
purulent exudate when a bacterial infection is attached.

Senile keratoma

This is a precancerous condition that is characteristic of the elderly. This is the reason for this name. The risk is high over the age of 50 and a concomitant tendency to dry out the skin. The disease is an overgrowth of the upper layer of the epidermis against the background of keratinization of some cells. With senile keratoma, the following symptoms are observed:

a spot of yellowish or brownish tint;
the appearance of several spots, they are rarely single;
gradual pigmentation and color change to red or brown;
papules and multiple depressions are formed;
a plaque with a diameter of 6 cm in the late stage of the disease;
covering the spots with keratinized scales, after the removal of which bleeding develops.

Cutaneous horn

Neoplasms of this species are entirely composed of the prickly layer of the epidermis. The name is due to the appearance of the growth. It looks like an animal's horn. Signs of the development of such a pathology:

overgrowth of epidermal cells of a conical shape of brown or yellow color and dense structure;
slow growth of the horn and only in length;
the appearance of a red rim around the horn.

Malignant neoplasms

If pathological formations grow and spread rapidly, cause metastases in organs distant from the focus and penetrate into the surrounding tissues, then they are called malignant. Cell transfer occurs through the lymph and blood. The difference between malignant tumors is the complete loss of control over cell division in the affected area by the body. The cells in it can no longer perform their functions.

Melanoma

The most common type of malignant tumor. Nevi or moles can become malignant after injury or excess exposure to ultraviolet light. This becomes the cause of the development of melanoma. The following symptoms indicate it:

the mole is rapidly increasing in size;
then it changes color - it darkens or brightens;
the mole takes on a different shape, which is not accompanied by symmetry;
the pigment merges with neighboring tissues, has no clear boundaries;
ulcers form at the site of the mole, hairs fall out.

Epithelioma

The name of the disease is due to the fact that it affects the upper layer of the skin - the epithelium. There are many clinical variants of epithelioma, but any of its forms has one clinical sign. These are nodules, the volume of which varies from a few millimeters to 5 cm. The self-shredding form is distinguished by the appearance of a small ulcerative defect. Malerba epithelioma develops from the cells of the sebaceous glands. This pathology is typical for children. The tumor can be located on:

scalp;
face;
ears;
on the shoulders, hands.

Squamous cell carcinoma

It is a malignant tumor that develops from the mucous membranes and skin. The disease is characterized by aggressiveness and rapid development. Cancer affects the lymph nodes, penetrates into neighboring organs, disrupts their structure and function. Among all species, it is about 25%. Such cancer can be suspected by a number of signs, such as:

domed knot with a diameter of 2-3 cm;
dense, cartilaginous structure of the tumor;
inactivity of education;
bleeding with mild trauma;
the form of a tumor in the form of cauliflower.

Basalioma

The tumor in this disease develops due to the accumulation of epithelial cells. The risk is higher in older adults. Basalioma is not accompanied by metastases, rarely leads to death. This does not apply to its squamous cell form. Basal cell carcinoma can be recognized by the following signs:

surface formations - solitary, with a dense structure;
there is a small depression inside each spot;
the tumor rises above the surrounding skin;
over time, slight itching appears;
when the skin is stretched, nodules of white, gray or yellow are noticeable;
overgrowth pain;
crusts on the surface of spots, when removed, bleeding opens.

Fibrosarcoma

This is a rare type of malignant tumor. It can appear in almost everyone, regardless of age, gender, etc. Fibrosarcoma affects the tendons and connective tissue of muscles. Its development is indicated by:

the appearance of a dense subcutaneous node;
bluish brown color of the inflammation focus;
no pain;
apathy, weakness;
drastic weight loss;
feverish condition.

Liposarcoma

It affects soft tissues, more often in men over 40 years of age with benign tumors. The risk group also includes people who have contact with asbestos or take hormones. Liposarcoma has several types:

Poorly differentiated. They resemble fatty compounds that are actively growing.
Myxoid. This is a borderline form in which cells look normal but can start to grow at any time.
Pleomorphic. A rare form that affects only the limbs.
Dedifferentiated. Aggressive, causes many metastases.
Mixed. Includes signs of several forms of liposarcoma.

Kaposi's sarcoma

The highest risk of developing this disease is in HIV-infected patients. Kaposi's sarcoma is triggered by the herpes simplex virus type 8. More dangerous than the formations themselves are disorders of the digestive and respiratory systems. The following signs indicate the development of this disease:

blue, red, purple or pink spots that do not brighten when pressed;
a blistering rash similar to lichen planus;
gradual growth of pathological formations;
drying out of the affected area, its peeling;
pain when squeezing the spot.

Diagnostics

The main method for determining whether a tumor is precancerous or malignant is differential diagnosis. It involves the following procedures:

Digital epiluminescent dermoscopy. Has 95% sensitivity. It consists in instrumental screening of education using dermatoscopes.
Intracutant analysis using the SIAscope technique. The method consists in examining skin lesions without a scalpel. The results are displayed on the monitor screen, where you can see the structure of the tumor, the concentration of hemoglobin and melanin.
Histological examination. During a biopsy, tumor material is taken, after which it is examined. This allows you to differentiate malignant pathology from benign.

Treatment of neoplasms

In most cases, treatment consists in removing the formation, and with partial excision of healthy tissue. This is done in a variety of ways. In addition to radical surgical methods, there are less invasive ones. If the cancer is inoperable, chemotherapy and radiation therapy are used. Benign formations are removed by cryodestruction, electrocoagulation, radio waves. In a malignant course due to multiple metastases, there is a high probability of death from internal bleeding, autointoxication and multiple organ failure.

Chemotherapy

It consists in the use of drugs that inhibit tumor growth and cause their death. Oncology uses about 60 types of anticancer agents. They are administered intravenously in certain courses. The disadvantage of chemotherapy is the development of side effects in almost all patients, including nausea, vomiting, osteoporosis, leukemia, baldness, anemia. The advantages of the procedure: the ability to remotely influence metastases and remove cancer cells after radical surgical treatment.

Radiation therapy

Almost 80% of patients with malignant tumors receive radiation therapy. It is an effect of ionizing radiation: corpuscular and photonic. They differ in the degree of energy distribution over the tumor tissues. Radiation therapy can be remote, interstitial and contact. It is often combined with chemotherapy. The main disadvantage of radiation therapy is considered to be a large number of adverse reactions. The advantages of this treatment method:

reducing the risk of metastasis;
elimination of pain at an advanced stage;
destruction of abnormal cells after surgery;
cure for cancer at an early stage.

Laser removal

The effectiveness of the use of a laser in the treatment of neoplasms is due to the ability to focus the beam exactly on the pathological focus. In the course of the beam, tissue necrosis is observed. The laser method is especially effective when combined with the intake of cytostatics. The lack of a not fully understood mechanism of laser action on biological objects, but this does not prevent medicine from widely using this method. It has several undeniable advantages:

the ability to remove several defects in one session;
bloodlessness;
short duration of the procedure;
disinfecting effect;
contactlessness, which eliminates the risk of secondary infection.

Electrocoagulation

This method is used to remove moles, warts, rosacea, papillomas, and calluses. The essence of the procedure is to cauterize soft tissues with an electric current. Its advantage is the ability to regulate the depth of exposure, thereby removing pathological cell proliferation in different layers of the epidermis. Soreness can be considered a disadvantage, but with pre-treatment with anesthetics, this symptom is minimized.

Cryodestruction

This procedure consists in freezing the pathological focus, which leads to its destruction. The method is used only for benign tumors. Of the minuses, it is noted that sometimes one procedure is not enough to destroy the entire focus. In addition, the tumor is difficult to remove if large vessels are located nearby. Cryodestruction has several advantages:

lack of rough scars;
freezing hemostatic effect;
the possibility of complete destruction of pathological tissue;
painlessness.

Radio wave method

Treatment of benign lesions with radio waves is considered one of the most adequate methods. Its advantage lies in its scientific validity. Evidence for the effectiveness of radio wave therapy has been established experimentally. As a result of the action of the waves, the tissues move apart. It turns out the thinnest incision in which the vessels do not bleed and the skin does not suffer from overheating. Another plus - during the operation, accidentally trapped microbes immediately die.

The radio wave method is effective for both single and group warts, condylomas, papillomas. The disadvantage of the procedure is its high cost. In addition, large moles and warts cannot be removed this way. Among the advantages are:

short duration of the operation;
no bleeding;
keeping healthy tissue intact;
painlessness;
short rehabilitation.

Prophylaxis

Any disease is easier to prevent than to cure. Prevention of the occurrence of pathological formations on the skin is as follows:

removal of benign neoplasms that arouse suspicion, but only after consulting a specialist;
the use of special sunscreen products, especially for people prone to the formation of age spots or moles;
reducing the consumption of smoked meats, animal fats, sausages and other products with a large amount of stabilizers in the composition;
limiting exposure to the sun in the summer from 11 to 15 hours;
exclusion of contact with chemically active and carcinogenic substances.

What are skin neoplasms

Causes of neoplasms on the skin

The main symptoms of skin neoplasms

The main types of neoplasms on the skin

Benign skin neoplasms

Precancerous growths on the skin

Malignant neoplasms of the skin

Diagnostics of skin neoplasms

Features of the treatment of skin neoplasms

Classic removal of skin neoplasms with a scalpel

Removal of skin lesions with liquid nitrogen

Removal of neoplasms with a laser

Removal of skin neoplasms with radiation therapy

Removal of skin neoplasms by photodynamic method

Skin cancer treatment with radiography

Treatment of neoplasms with chemotherapy

Causes and mechanism of development

Types of neoplasms on the skin

Benign formations

Old age

Malignant tumors

Treatment and prevention

What are neoplasms and what they are

Benign neoplasms

Malignant neoplasms of the skin

Precancerous neoplasms of the skin

Removal and prevention of skin lesions

What is a neoplasm on the skin

Views

The reasons

Benign skin neoplasms

Lipoma

Papilloma

Hemangioma

Lymphangioma

Dermatofibroma

Pigmented nevus

Keratoacanthoma

Lentigo

Atheroma

Pigmented xeroderma

Giant condyloma Buschke-Levenshtein

Bowen's disease

Keir's disease

Senile keratoma

Cutaneous horn

Malignant neoplasms

Melanoma

Epithelioma

Squamous cell carcinoma

Basalioma

Fibrosarcoma

Liposarcoma

Kaposi's sarcoma

Diagnostics

Treatment of neoplasms

Chemotherapy

Radiation therapy

Laser removal

Electrocoagulation

Cryodestruction

Radio wave method

Prophylaxis

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