LECTURE № 14. Skin tumors
Skin tumors are non-inflammatory neoplasms that are composed of skin structural elements that have no tendency to regress. All tumors are divided into epithelial, neuroectodermal and mesenchymal. There are benign, malignant and intermediate forms of the tumor – potentially malignant (prekankrozy skin). In the group of precancrosis, obligate (pigment xeroderma and melanosis of Dubreia) and facultative (chronic dermatitis caused by the action of carcinogens, radiation lesions of the skin, senile keratome, cutaneous horn, keratoacanthum, leukoplakia, Kouroz, chronic heylites, pigmented nevi) are isolated.
1. Epithelial tumors
Limited foci with verrucous surface brownish-brown. May be multiple, there is no favorite localization; sometimes arranged linearly.
Appears at the age of 30 – 40 years. Brownish or almost black formation with papillomatous surface, sharply limited, covered with fatty scales. Rise above the level of healthy skin.
Localization: closed areas of the skin, at least – the face, scalp.
Facultative prekankroz, arising in the elderly and old people.
Dense dry nodules brownish or gray, covered with scales, when removed, reveals a warty surface. Prone to peripheral growth with the formation of large plaques.
Localization: open skin (face, back of the hand).
Prekankroz. Elderly people in open areas (lips, nose, cheeks, auricles) localized brown horn cones on a broad base. The appearance of a peripheral inflammatory zone is one of the signs of malignancy.
Keratoacanthoma (greasy clam)
It is more common in persons older than 40 years. There is a link with insolation. Single hemispherical nodules or pink-colored nodes of unchanged skin, in the center of which there is a hollow filled with horn masses.
Localization: open skin (face, hands). Spontaneous regression is possible.
Prekankroz of the mucous membranes of the oral cavity, at least – the urinary organs. Development contributes to trauma (dentures, smoking, insolation). The following forms are distinguished: leukoplakia of smokers (nicotine stomatitis), flat, warty and erosive and ulcerative.
The beginning is preceded by a limited inflammatory response. In the future, the hearth becomes dense, sublime, acquires a whitish color. The smooth surface gradually becomes verrucous with cracks and erosion.
Calcified Maliba epithelioma
A benign tumor that develops in an epidermal cyst as a consequence of the embryonic anomaly of the epidermis. Deep single knot color unchanged skin, slowly growing. As a result, the deposition of calcium salts acquires a dense texture and can turn into cutaneous osteoma.
Preferential localization: head, limbs.
Nevoid formation with local destructive skin changes, prone to recurrence. Solitary, rarely multiple tumor, clinically occurring in several variants.
Nodular-ulcerative – the most frequent. Wax-like nodules and telangiectasias grow slowly. Gradually, the center ulcerates and becomes covered with a dense crust, which, when removed, causes bleeding. On the periphery – elevated roller, consisting of nodules (pearls).
Pigment – different dark brown color of the hearth.
Sclerosing – a towering, dense, scleroderm-like plaque that can ulcerate over time.
Superficial – foci are multiple, superficial, eczema-like.
Localization: face, neck, less often – other areas. Mucous membranes are not affected.
Bowen Disease (Bowen Cancer)
Isolated single sharply limited reddish-brown plaque raised above the skin surface. It is covered with a crust, under which a grainy (velvety) surface is found. Often the plaque has a warty or eczema-like character. Develops slowly, goes into spinocellular cancer.
Localization: trunk, eyelids, genitals.
Keira disease (Keira erythroplasia)
Intraepidermal Spinocellular Cancer. The center is bright red in color with sharp borders and a grainy surface. Develops slowly; lymph node metastases.
Localization: glans penis, preputial sac, vulva, oral mucosa.
Erythematous eroded focus with sharp edges, weeping surface, scales and crusts, resembling microbial eczema. In the underlying tissue, dense nodes are palpated; regional (axillary) lymph nodes are enlarged. The nipple is retracted. Mostly women are ill.
Localization: the nipple area and the surrounding skin.
Spinalioma (Spinocellular Cancer)
The development is often preceded by chronic heylity, leukoplakia (precancrosis). Mainly men are ill. There are 2 clinical forms.
1. Tumor form – dense (cartilage consistency), fast-growing nodes with papillomatous surface and roller-like edges.
2. Ulcerative form – rapid disintegration leads to the formation of superficial or deep ulcers with clear edges, a hilly bottom growing along the periphery. Metastasizes lymphogenous.
Localization: open skin (back of the nose, lips, eyelids, ears, back surface of the hands).
Benign proliferation of the epithelium in chronic dermatoses of various etiologies. Clinically resembles spinalioma.
2. Tumors of the glands of the skin and hair follicle
Sweat gland tumors
Tumors emanating from eccrine (eccrine poroma, eccrine helicdenoma, syringoepithelioma) and apocrine glands (syringoma, syringoadenoma, papillary hydroadenoma, syringostomystadenoma). Develop from the excretory ducts of the sweat glands. Most of them are single hemispheric formations of the color of the unchanged skin or slightly erythematous, not prone to ulceration (except syringaadenoma) and relapse after removal. The diagnosis is established on the basis of histological examination.
Syringoma is characterized by a multiplicity of small nodules as large as millet grain, representing cysts of the excretory ducts. Light translucent rashes are located on the face, chest, abdomen, thighs. Occur in women during puberty.
Tumors of the sebaceous glands
Fordyce disease. On the red border and the mucous membrane of the lips, oral cavity – small yellowish hemispheric nodules.
Nodular hyperplasia of the sebaceous glands. Small yellowish nodules on the face (usually on the chin) that occur in older people.
Adenoma of the sebaceous glands. Solitary tumor the size of a hazelnut hemispherical shape color unchanged skin. Most often located on the face.
Atheroma. Retention cyst of sebaceous glands. Tumor formation prone to infection.
Hair follicle tumors
Nevus hair. It appears mainly on the face in the form of a small pigmented nodule with a large amount of hair.
Trichoepithelioma. During puberty, single or multiple yellowish papules appear on the face (less commonly on the extremities). Can be combined with a hair nevus.
Cylinder Multiple, rarely solitary tumors the size of a pigeon egg of a dense consistency with a smooth surface. Grouping, the nodes form conglomerates that cover the head in the form of a bumpy hat (“turban tumors”). Localization: scalp, at least – the face.
3. Neuroectodermal tumors
Changes in the skin of a patchy or papular character, caused by accumulations of nevus or pigment cells in the epidermis and dermis. The clinical picture is varied. The following types are distinguished: border nevus (localized mainly on the palms, soles, and in the ano-genital area); intraepidermal (the most frequent and diverse in the clinical picture with a smooth or papillomatous surface); mixed.
Nodules bluish-gray in color with sharp borders, located more often on the face, limbs. Their surface is smooth, rounded shape.
Mongolian spot – one of the varieties of blue nevus. Blue-brown spots without clear outlines, determined at birth and disappearing with age.
Single limited knot of hemispherical or flat pinkish-red or yellowish-brown color of various shades. On the periphery – an erythematous corolla with telangiectasias. Hair growth is absent. It occurs more often in children. For benign.
Localized on any part of the skin.
Melanosis precancerous Dubrae
Limited brown or black pigment with irregular contours without compaction. It grows slowly. It is an obligate precancrosis of melanoblastoma. Occurs in the elderly.
Localization: face, chest, less often – other sites.
The most malignant tumor, metastatic lymph or hematogenous. It develops most often on the basis of pigmented nevi after their traumatization or intense insolation. Signs of malignancy: accelerated growth of the pigment spot, color change (darkening or reduction of pigmentation), the phenomenon of reactive inflammation (erythema nimbus), the appearance of daughter nodules, increased vulnerability and bleeding, itching. Formed melanoma can be superficial or nodular – the formation of dark brown or black color above the skin with a mirrored or rough surface. However, weakly pigmented melanomas are found. Grows quickly and ulcers early.
4. Tumors of mesenchymal tissue
Adipose tissue tumors
Lipoma. Benign tumor. Knot color unchanged skin or yellowish, soft, often lobed, painless. Often, multiple tumors.
Fibrolipoma. Fibrous tissue develops, and therefore the tumor has a dense texture.
Liposarcoma. Multiple nodes or diffuse infiltration in the subcutaneous tissue without clear outlines. For malignant. Metastasis to visceral organs.
Dermatofibroma. Slightly towering dense nodules brown, dense texture.
Fibroma. Knots color unchanged skin. Solid fibroids are isolated – dense nodules are whitish in color; soft – papillomatous soft formations on a thin stalk with a wrinkled surface.
Keloid. Benign neoplasm of connective tissue – fibroma. It develops as an independent process (primary keloid), as well as after thermal burns, wounds, surgeries and with the resolution of certain skin diseases (boils, acne). Dense limited education with a smooth surface, sometimes fancy outlines. The color is purple-red, further whitish. Itching occurs in the initial phases.
Fibrosarcoma. For malignant. Metastasizes to lymph nodes and visceral organs. Tight yellowish-brown nodules with a smooth surface, located in isolation or in groups.
Muscle tissue tumors
Leiomyoma. Tumors emanating from smooth muscle fibers. Multiple leiomyomas of smooth muscles of the skin are distinguished, solitary – of the genital and breast nipples, solitary vascular. Thick knots, painful on palpation, that can shrink when irritated. For benign.
Leiomyosarcoma. A painless single large node with fuzzy contours. For malignant.
5. Tumors of blood and lymphatic vessels
Benign vascular formation of non-apparent origin. There are clinical forms such as: flat angioma (vascular spots with telangiectasias); cavernous (soft, towering swelling of the crimson-red color – “blood sponge”, easily injured); stellate (resembles the shape of a spider); ruby dots (dark red small dotted nodules on the body, less often on the face); tuberous (purplish-red tumor nodules on the face); verrucous (has hyperkeratotic growths on the surface).
Congenital disease that is manifested by multiple telangiectasias of the skin, mucous membranes and internal organs, a tendency to bleeding.
Considered as one of the atypical forms of pyoderma. It is a capillary hemangioma. The rounded education up to the size of a hazelnut of a soft or dense consistency is whitish-gray or crimson-red, sometimes has a stem. Easily ulcers and bleeds, becoming covered with a dark brown crust. Localization: fingers of hand, back surface of brushes, red border of lips.
Benign tumor, which is almost always located at the tips of the fingers in the area of the nail bed. Differs sharp paroxysmal soreness.
Multiple vascular nodules of a dark red color the size of a pea with a warty surface and horny scales, which when removed, bleeding occurs. Young women are ill more often. Localization: the back surface of the hands and fingers, ears. Angiokeratoma Fabry torso is a rare variant of angiokeratoma. Rashes disseminated in the form of small horny nodules of dark red color, resembling beads. When traumatized bleed. They are combined with hypertension, kidney and heart disease.
Tumor-soft nodule or node with a smooth or bumpy surface of the color of the unchanged skin, when damaged, a clear liquid is released.
Bluish-red spots that resemble nevoid formations are transformed into knots and plaques the size of a pea to plum, towering above the level of healthy skin. Gradually, they acquire a brownish-red hue. As a result of the merger, large foci are formed.
The surface of the foci may be smooth or warty, covered with scales. Characterized by telangiectasia and hemorrhages. Long-lasting ulcers may form. Elephantiasis often develops. Multiple nodes are located symmetrically, mainly on the feet and legs, less often – on the upper limbs and mucous membranes. Mainly men in old age are ill. Chronic progressive course with involvement of the visceral organs.
Histopathology. In the dermis, the blood vessels are dilated, many neoplasms. Perivascular infiltration with lymphoid and plasma cells; hemosiderin deposition. Differentiate with fungal mycosis and lymphoreticular diseases of the skin.
Treatment. Penicillin injections of 20–30 million IU per course, radiotherapy (up to 2000 happy per course), Prospidin 75–100 mg per day (per course up to 2000– 3000 mg); Rezokhin drugs (delagil, chloroquine, hingamin), arsenic, vitamins B1 and D. It is also advisable to include corticosteroids in the complex treatment. Surgical removal of nodes.
Nevi can not be treated. In some cases, removal for cosmetic reasons, with trauma and tendency to rebirth. Benign tumors can be removed surgically, by electrocoagulation or cryodestruction.
Treatment of keloids: cell lesion with lidaza, hydrocortisone suspension and other steroids; excision followed by radiotherapy; electrophoresis of potassium iodide, phonophoresis of collagenase or hydrocortisone; cryotherapy.
Treatment with basalis should be differentiated. For surface forms, ointments with cytostatics are widely used (0.5% colchaminic or methotrexate, 5% fluorouracil or fluorofuric). Nodular-ulcerative variants undergo cryosurgical treatment; in some cases, radiation therapy and surgical removal.
Malignant neoplasms of the skin to be treated in a specialized oncological institution.
Therapy is based on the principle of complexity (surgical removal, radiation therapy, polychemotherapy, general strengthening treatment).