Skin basalioma (ICD-10 code C44) is the most common oncological disease. It develops slowly, however, the tumor constantly increases and grows into all layers of the skin, muscle structures and even bones. At the same time, it practically does not produce metastases. This does not mean that the pathology does not need to be treated; in the absence of therapy, complete destruction of the surrounding tissue occurs. If a tumor forms near the eyes or ear, the patient may permanently lose hearing and vision. If basal cell carcinoma develops on the head, damage to the skull bones can cause death.

In the international classification of diseases, basal cell carcinoma is classified as a malignant tumor. You need to look for its code in the COO-D48, “Neoplastic” section in section C44. The next number following this designation indicates the exact location of the basal cell carcinoma.

Basalioma on the forehead

• C44.0 – on the surface of the lip;
• C44.1 – on the skin of the eyelids;
• C44.2 – in the ear area;
• C44.3 – on other parts of the face;
• C44.4 – on the neck and scalp;
• C44.5 – on the surface of the body;
• C44.6 – on the skin of the hands and in the shoulder girdle area;
• C44.7 – on the skin of the legs and hip area;
• C44.8 – defeat of two border regions at once;
• C44.9 – unspecified localization.

The tumor develops mainly in older people.

Application to skin basal cell carcinoma

In the document described, basal cell carcinoma is in the same section as melanoma and squamous cell carcinoma. The code C44 unites a whole class of skin cancers, but each of them does not have its own separate digital designation. Only its location is indicated.

Therefore, in the medical history, in order not to write a long name of the diagnosis, the doctor uses a generalized numerical designation and indicates the localization of the formation.

Definition of basal cell carcinoma

The disease is diagnosed if it is possible to detect a tumor consisting of pathologically altered cells of the basal layer of the skin. The disease debuts with the appearance of a dense papule (plaque) on the surface of the skin. It has a flat shape, its upper part protrudes slightly above the surface of the epidermis.

At first, the color is no different from healthy areas. The formation does not bother the person in any way (does not hurt, does not itch, does not flake). Over time, if left untreated, it constantly increases in size and becomes covered with a crust that cracks and bleeds. An ulcer forms underneath.

Further development of the disease can proceed according to different scenarios. In some patients, basal cell carcinoma grows in width and becomes similar in appearance to a saucer with a diameter of up to 10 cm. In others, basal cell carcinoma grows in depth. The formation in this case takes the form of a mushroom-shaped node or a deep crater-shaped ulcer, which, increasing in size, affects the muscles and bones.

Stages of skin basal cell carcinoma

To draw up a treatment regimen, it is important to establish the stage of development of the formation. Basalioma goes through four stages in its formation.

1. At the first stage, atypical division of cells in the basal layer of the skin begins. Outwardly it does not manifest itself in any way.
2. At the second stage, a tumor up to 20 mm in size is formed. Its entire structure is within the tissues.
3. At the third stage, basal cell carcinoma invades structures adjacent to the basal layer and affects adipose tissue.
4. At the fourth stage, the formation grows and damages muscles, cartilage, blood and lymph vessels.

Diagnostics

If characteristic symptoms are detected, you must contact a dermatologist or oncologist to confirm the diagnosis. The doctor is able to determine the disease by examining the formation using a dermatoscope. An optical instrument allows you to see the affected areas at a hundredfold magnification and examine the deepest layers of the skin. In basalioma, the structure of the inner part, located under the surface of the skin, differs from the structure of the convex part. Modern diagnostic centers are equipped with digital LED dermatoscopes. They allow you to obtain more accurate and reliable knowledge and take high-digital resolution images suitable for dynamic study of the tumor.

For a final assessment of the structure of the formation, a scarified smear is taken from the erosive areas. Then it is examined cytologically. In addition, a biochemical blood test is required. As the disease progresses, it shows high levels of lactate dehydrogenase. When there is a suspicion of “seizure” of bones, an x-ray must be prescribed and performed.

Since basal cell carcinoma practically does not produce metastases, it responds well to treatment. There is only one way to eliminate it - surgical removal of the tumor. During the operation, surgeons cut off the tumor itself and the tissue adjacent to it. If inflammation of the lymph nodes is detected, they are removed. After surgery, chemotherapy is prescribed. Before and after surgery, the diseased area is necessarily exposed to radiation. It first helps to reduce the size of the tumor, and then destroys the remains of the cancer focus.

C44.3 Malignant neoplasm of the skin of other and unspecified parts of the face

Causes of skin basal cell carcinoma

The issue of histogenesis has not been resolved; most researchers adhere to the dysontogenetic theory of origin, according to which basal cell carcinoma develops from pluripotent epithelial cells. They can differentiate in different directions. In the development of cancer, importance is attached to genetic factors, immune disorders, and adverse external influences (intense insolation, contact with carcinogenic substances). It can develop on clinically unchanged skin, as well as against the background of various skin pathologies (senile keratosis, radiodermatitis, tuberculous lupus, nevi, psoriasis, etc.).

Basal cell carcinoma is a slow-growing and rarely metastasizing basal cell carcinoma that arises in the epidermis or hair follicles, the cells of which are similar to the basal cells of the epidermis. It is considered not as cancer or a benign neoplasm, but as a special kind of tumor with locally destructive growth. Sometimes, under the influence of strong carcinogens, primarily X-rays, basal cell carcinoma develops into basal cell carcinoma. The question of histogenesis has not yet been resolved. Some believe that basaliomas develop from the primary epithelial rudiment, others - from all epithelial structures of the skin, including from embryonic rudiments and malformations.

Risk factors

Provoking factors are insolation, UV, X-rays, burns, and arsenic intake. Therefore, basal cell carcinoma often occurs in people with skin types I and II and albinos who are exposed to intense sun exposure for a long time. It has been established that excessive sun exposure in childhood can lead to the development of a tumor many years later.

Pathogenesis

The epidermis is slightly atrophic, sometimes ulcerated, and there is a proliferation of tumor basophilic cells similar to the cells of the basal layer. Anaplasia is mild, mitoses are few. Basalioma rarely metastasizes, since tumor cells that enter the bloodstream are not capable of proliferation due to the lack of growth factor produced by the tumor stroma.

Pathomorphology of skin basalioma

Histologically, basal cell carcinoma is divided into undifferentiated and differentiated. The undifferentiated group includes solid, pigmented, morphea-like and superficial basal cell carcinomas, the differentiated group includes keratotic (with piloid differentiation), cystic and adenoid (with glandular differentiation) and with sebaceous differentiation.

The WHO international classification (1996) identifies the following morphological variants of basal cell carcinoma: superficial multicentric, codular (solid, adenoid cystic), infiltrating, non-sclerosing, sclerosing (desmoplastic, morphea-like), fibro-epithelial; with adnexal differentiation - follicular, eccrine, metatypical (basosquamous), keratotic. However, the morphological boundary of all varieties is unclear. Thus, in an immature tumor there may be adenoid structures and, on the contrary, with its organoid structure, foci of immature cells are often found. Also, there is no complete correspondence between the clinical and histological pictures. Usually there is correspondence only for such forms as superficial, fibroepithelial, scleroderma-like and pigmented.

For all types of basal cell carcinomas, the main histological criterion is the presence of typical complexes of epithelial cells with dark-colored oval nuclei in the central part and palisade-like complexes located along the periphery. In appearance, these cells resemble basal epithelial cells, but differ from the latter in the absence of intercellular bridges. Their nuclei are usually monomorphic and not subject to anaplasia. The connective tissue stroma proliferates together with the cellular component of the tumor, located in the form of bundles among cellular cords, dividing them into lobules. The stroma is rich in glycosaminoglycans, staining metachromatically with toluidine blue. It contains many tissue basophils. Retraction gaps are often detected between the parenchyma and stroma, which many authors regard as a fixation artifact, although the possibility of exposure to excessive secretion of hyaluronidase is not denied.

Solid basal cell carcinoma among undifferentiated forms it occurs most often. Histologically, it consists of various shapes and sizes of strands and cells of compactly located basaloid cells with unclear boundaries, resembling a syncytium. Such complexes of basal epithelial cells are surrounded at the periphery by elongated elements, forming a characteristic “picket fence”. Cells in the center of the complexes can undergo dystrophic changes with the formation of cystic cavities. Thus, along with solid structures, cystic ones can exist, forming a solid-cystic variant. Sometimes destructive masses in the form of cellular detritus are encrusted with calcium salts.

Pigmented basal cell carcinoma Histologically it is characterized by diffuse pigmentation and is associated with the presence of melanin in its cells. The tumor stroma contains a large number of melanophages with a high content of melanin granules.

An increased amount of pigment is usually detected in the cystic variant, less often in the solid and superficial multicentric. Basaliomas with pronounced pigmentation contain a lot of melanin in the epithelial cells above the tumor, throughout its entire thickness up to the stratum corneum.

Superficial basal cell carcinoma often multiple. Histologically, it consists of small, multiple solid complexes associated with the epidermis, as if “suspended” from it, occupying only the upper part of the dermis to the reticular layer. Lymphohistiocytic infiltrates are often found in the stroma. The multiplicity of foci indicates the multicentric genesis of this tumor. Superficial basal cell carcinoma often recurs after treatment along the periphery of the scar.

Scleroderma-like basal cell carcinoma, or the “morphea” type, is distinguished by the abundant development of scleroderma-like connective tissue, in which narrow cords of basal epithelial cells are “embedded”, extending deep into the dermis down to the subcutaneous tissue. Polygarden-like structures can be seen only in large cords and cells. Reactive infiltration around tumor complexes located among the massive connective tissue stroma, as a rule, it is scanty and more pronounced in the zone of active growth on the periphery. Further progression of destructive changes leads to the formation of small (cribrosoform) and larger cystic cavities. Sometimes destructive masses in the form of cellular detritus are encrusted with salts calcium.

Basal cell carcinoma with glandular differentiation, or adenoid type, is characterized by the presence, in addition to solid areas, of narrow epithelial strands consisting of several, and sometimes 1-2 rows of cells forming tubular or alveolar structures. The peripheral epithelial cells of the latter have a cubic shape, as a result of which the polysad-like character is absent or less clearly expressed. The internal cells are larger, sometimes with a pronounced cuticle; the cavities of the tubes or alveolar structures are filled with epithelial mucin. The reaction with carcinoembryonic antigen produces positive staining for extracellular mucin on the surface of cells lining the duct-like structures.

Basal cell carcinoma with cyloid differentiation characterized by the presence of keratinization foci in complexes of basal epithelial cells, surrounded by cells similar to spinous ones. In these cases, keratinization occurs bypassing the keratohyaline stage, which resembles the keratogenic zone of the isthmus of normal hair follicles and may have tricho-like differentiation. Sometimes there are immature milked follicles with initial signs of the formation of hair shafts. In some cases, structures are formed that resemble embryonic hair buds, as well as epithelial cells containing glycogen, corresponding to the cells of the outer layer of the hair follicle. Sometimes there may be difficulty in differentiating from follicular basaloid hamartoma.

Basal cell carcinoma with sebaceous differentiation It is rare and is characterized by the appearance of foci or individual cells typical of the sebaceous glands among the basal epithelial cells. Some of them are large, signet-shaped, with light cytoplasm and eccentrically located nuclei. When stained with Sudan III, fat is revealed in them. Lipocytes are much less differentiated than in a normal sebaceous gland; transitional forms are observed between them and the surrounding basal epithelial cells. This indicates that this type of cancer is histogenetically associated with the sebaceous glands.

Fibroepithelial type(syn.: Pincus fibroepithelioma) is a rare type of basal cell carcinoma that occurs mostly in the lumbosacral region and can be combined with seborrheic keratosis and superficial basal cell carcinoma. Clinically it may look like fibropapilloma. Cases of multiple lesions have been described.

Histologically, narrow and long cords of basal epithelial cells are found in the dermis, extending from the epidermis, surrounded by a hyperplastic, often edematous, mucoid-altered stroma with a large number of fibroblasts. The stroma is rich in capillaries and tissue basophils. Epithelial strands anastomose with each other and consist of small dark cells with a small amount of cytoplasm and round or oval, intensely stained nuclei. Sometimes in such cords there are small cysts filled with homogeneous eosinophilic contents or horny masses.

Nevobasocellular syndrome(syn. Gordin-Goltz syndrome) is a polyorganotropic, autosomal dominant syndrome related to phakomatoses. It is based on a complex of hyper- or neoplastic changes due to disorders of embryonic development. The cardinal symptom is the appearance in the early period of life of multiple basal cell carcinomas, accompanied by odontoten cysts of the jaws and anomalies of the ribs. There could be cataracts and changes in the central nervous system. It is also characterized by frequent changes in the palms and soles in the form of “indentations”, in which basaloid structures are also found histologically. After the early nevoid-basaliomatous phase, several years later, usually during puberty, ulcerative and locally destructive forms appear in these areas as an indicator of the onset of the oncological phase.

Histological changes in this syndrome are practically no different from the types of basal cell carcinomas listed above. In the area of ​​the palmoplantar “indentations” there are defects in the stratum corneum of the epidermis with thinning of its remaining layers and the appearance of additional epithelial processes from small typical basaloid cells. Large basal cell carcinomas rarely develop in these places. Individual basal cell lesions of a linear nature include all types of organoid basal cell carcinomas.

Histogenesis of skin basalioma

Basalioma can develop both from epithelial cells and from the epithelium of the pilosebaceous complex. Using serial sections, M. Hundeiker and N. Berger (1968) showed that in 90% of cases the tumor develops from the epidermis. Histochemical examination of various types of cancer shows that in most cells glycogen and glycosaminoglycans are found in the tumor stroma, especially in adamantinoid and cylindromatous patterns. Glycoproteins are constantly detected in basement membranes.

Electron microscopy revealed that most cells of tumor complexes contain a standard set of organelles: small mitochondria with a dark matrix and free polyribosomes. There are no intercellular bridges at the contact sites, but finger-like projections and a small number of desmosome-like contacts are found. In areas of keratinization, layers of cells with intact intercellular bridges and a large number of tonofilaments in the cytoplasm are noted. Occasionally, zones of cells containing cellular membrane complexes are found, which can be interpreted as a manifestation of glandular differentiation. The presence of melanosomes in some cells indicates pigment differentiation. In basal epithelial cells, organelles characteristic of mature epithelial cells are absent, which indicates their immaturity.

It is currently believed that this tumor develops from pluripotent germinal epithelial cells under the influence of various types of external stimuli. Histologically and histochemically, the connection of basal cell carcinoma with the anagen stage of hair growth has been proven and the similarity with proliferating embryonic hair buds has been emphasized. R. Holunar (1975) and M. Kumakiri (1978) believe that this tumor develops in the germinal layer of the ectoderm, where immature basal epithelial cells with the potential for differentiation are formed.

Symptoms of skin basal cell carcinoma

Skin basal cell carcinoma has the appearance of a single formation, hemispherical in shape, often round in outline, slightly elevated above the skin level, pink or grayish-red in color with a pearlescent tint, but may not differ from normal skin. The surface of the tumor is smooth; in its center there is usually a small recess, covered with a thin, loosely adjacent squamous crust, upon removal of which erosion is usually detected. The edge of the ulcerated element is thickened like a roller, consists of small whitish nodules, usually designated as “pearls” and having diagnostic value. In this state, the tumor can exist for years, slowly growing.

Basaliomas can be multiple. Primary plural form, according to K.V. Daniel-Beck and A.A. Kolobyakova (1979), occurs in 10% of cases, the number of tumor foci can reach several dozen or more, which may be a manifestation of non-basocellular Gorlin-Goltz syndrome.

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Forms

Surface view begins with the appearance of a limited scaly patch of pink color. Then the spot acquires clear contours, oval, round or irregular shape. Dense small shiny nodules appear along the edge of the lesion, which merge with each other and form a roll-like edge raised above the skin level. The center of the hearth sinks slightly. The color of the lesion becomes dark pink, brown. Lesions may be solitary or multiple. Among the superficial forms, self-scarring or pagetoid basalioma is distinguished with a zone of atrophy (or scarring) in the center and a chain of small, dense, opalescent, tumor-like elements along the periphery. The lesions reach a significant size. Usually has a multiple nature and a persistent course. Growth is very slow. Its clinical features may resemble Bowen's disease.

At pigmented form the color of the lesion is bluish, purple or dark brown. This type is very similar to melanoma, especially nodular, but has a denser consistency. Dermoscopic examination can provide significant assistance in such cases.

Tumor type is characterized by the appearance of a nodule, which gradually increases in size, reaching 1.5-3 cm or more in diameter, acquires a rounded appearance, and a stagnant pink color. The surface of the tumor is smooth with pronounced telangiectasias, sometimes covered with grayish scales. Sometimes its central part ulcerates and becomes covered with dense crusts. Rarely, the tumor protrudes above the skin level and has a stalk (fibroepithelial type). Depending on the size they distinguish small and large nodular forms.

Ulcerative appearance occurs as a primary variant or as a result of ulceration of the superficial or tumor form of the neoplasm. A characteristic feature of the ulcerative form is a funnel-shaped ulceration, which has a massive infiltrate (tumor infiltration) fused with the underlying tissues with unclear boundaries. The size of the infiltrate is much larger than the ulcer itself (ulcus rodens). There is a tendency to deep ulcerations and destruction of underlying tissues. Sometimes the ulcerative form is accompanied by papillomatous, warty growths.

Scleroderma-like, or scar-atrophic, appearance It is a small, clearly demarcated lesion with a thickening at the base, almost not rising above the level of the skin, yellowish-whitish in color. Atrophic changes and dyschromia may be detected in the center. Periodically, along the periphery of the element, foci of erosion of various sizes may appear, covered with an easily removable crust, which is very important for cytological diagnosis.

Pincus fibroepithelial tumor classified as a type of basal cell carcinoma, although its course is more favorable. Clinically, it manifests itself in the form of a skin-colored nodule or plaque, of dense elastic consistency, and practically does not undergo erosion.

The first place among malignant neoplasms in Russia is occupied by malignant breast cancer, which claims thousands of lives of young and active women. According to various sources, 400-600 thousand women fall ill each year. With age, the likelihood of the disease increases.

The likelihood of breast cancer increases steadily as a woman ages.

In the table below you can see how the age of the fair sex affects breast cancer:

Nowadays, many women are addicted to hormonal drugs, including contraceptives. This increases the risk of disease.

This group is at risk of developing breast cancer already at the age of 40 - 45 years. Abortion causes enormous harm to the female body in general and the mammary gland in particular.

Once a woman becomes pregnant, cells designed to produce milk are formed and gradually develop in the mammary gland.

Recently, a new trend has emerged in the world associated with the use of stem cells that have nonspecific activity and the ability to activate the cells of the organs into which they are introduced.

Let's look at what stem cells are in the human body and what functions they are responsible for at the natural level. “Stem cell” is a collective term that combines several things that have little connection with each other.

Common to all stem cells is the ability to specialize into different cell types. In some cases (as, for example, in the case of embryonic stem cells), this ability extends to everything in the body: from one fertilized egg, muscles, brain, and skin are ultimately obtained.

In other cases, stem cells may only give rise to certain types of tissue. For example, blood stem cells in the bone marrow give rise to red blood cells (erythrocytes) and, for example, lymphocytes, but it is not possible to grow a retina or spleen from them.

It is believed that transplantation of stem cells from bone marrow after radiotherapy or chemotherapy is by far the most reliable method of combating many forms of blood cancer.

One of the main problems of this approach is the difficulty of reproducing such stem cells: in a healthy person their number changes little. Researchers at the University of Pennsylvania have discovered a mechanism by which stem cells in the bone marrow maintain their numbers unchanged.

Recently, more and more scientific works devoted to stem cells have appeared. Some scientists print three-dimensional structures from them using 3D printers.

Others grow teeth, kidneys, livers and even “mini-brains” from them. Still others are developing methods that can turn stem cells into nerve cells with one click.

Liver cancer is staged depending on the size of the tumor and the extent of its spread.

Below is a description of each of them:

Stage I. There is one tumor that does not grow into blood vessels. The tumor can have different sizes.

Stage II. The tumor has grown into the blood vessels, or there are several tumors, the size of which does not exceed 5 cm. Having identified the symptoms of liver cancer at an early stage, treatment should begin immediately.

Stage III is divided into III - a, III - b and III - c.

Stage III-a means that there are several tumors whose size exceeds 5 cm; or one tumor that has grown into the main branch of a large vein (portal or hepatic).

Stage III-b means that the liver tumor has grown into another organ (other than the gallbladder), or the tumor has grown into the outer lining (capsule) of the liver.

Stage III-c means that the tumor has spread to nearby lymph nodes. Moreover, it can be either single or multiple.

Causes

According to the ICD-10 classification, basal cell carcinoma belongs to the group of malignant skin tumors of unknown origin.

However, there are general risk factors that can cause a tumor:

• age over 40 years;
• prolonged exposure to direct sunlight;
• light skin tone;
• frequent contacts with toxic and carcinogenic substances;
• systematic injury to a certain area of ​​the skin;
• ionizing radiation;
• taking immunosuppressants.

Initial basal cell carcinoma rarely causes any concern to the patient. Later stages are characterized by the appearance of specific symptoms, which becomes a reason to consult a doctor.

Important! The prognosis for basal cell carcinoma is generally positive, but treatment should not be neglected. Severe growth of the tumor and its subsequent removal can cause the appearance of unaesthetic scars.

The etiology of basal cell carcinoma is still unclear. It is thought to grow from stem cells located in protected, vascular, and well-innervated anatomical sites such as the junction of the levator pili muscle and the external root sheath.

One hypothesis is that tumor formation caused by local carcinogens depends on the hair growth cycle, since the accumulation of carcinogens in hair is 10 times higher in the telogen phase than in the anagen phase.

The important role of ultraviolet radiation (primarily UV-B) in the pathogenesis of basal cell carcinoma is confirmed not only by the predominant location of the tumor on open, light-damaged areas of the skin, but also by the special predisposition to it of people with skin phenotype I, II.

Statistics on the causes of cancer: in terms of the number of both cases and deaths, lung cancer ranks first. Breast cancer occupies the second place in the statistics of cancer patients in the structure of the incidence of malignant tumors in the world, and fifth place in terms of mortality.

In third place in terms of incidence, according to statistics of cancer cases, is colon cancer, and in terms of the number of deaths, colon cancer ranks fourth.

Stomach cancer ranks fourth in terms of incidence, although cancer of this localization ranks second in mortality.

In terms of the number of people affected by malignant tumors, liver cancer ranks fifth, and in terms of mortality of those who die from cancer, liver damage ranks third.

With the development of medical and biological sciences, viruses are becoming increasingly important in studying the causes of oncology. In oncology, a viral theory of cancer has been formed, based on modern advances in virology, which have revealed the presence of viruses in a number of malignant tumors.

Can viruses cause cancer and how do they do it? Among them, cervical cancer is one of the most common tumors. Harold Zurhausen received the Nobel Prize in Biology or Medicine in 2008.

He proved that cancer can be caused by a virus and showed this in cervical cancer. Essentially, in the example under consideration, cancer is a virus that infects healthy cells of the cervical tissue.

The Nobel Committee's resolution said that this discovery, made 20 years ago, is of great importance. By the time the Nobel Prize was awarded, the world's first vaccination against cervical cancer was made.

Few people know that the theory of the viral nature of cancer itself has its homeland in Russia.

The first in the world to discover the viral nature of cancer was the Soviet scientist Leah Zilber; he made this discovery in prison. His theory that viruses cause cancer was written on a tiny piece of tissue paper and given to the public.

At that moment, the scientist’s family was in a concentration camp in Germany. His son, the now famous professor Fyodor Kiselev, together with Zurhausen, studied the human papillomavirus, which causes cervical cancer.

This led to the creation of a preventive vaccine against human papillomavirus or a cancer vaccine. Today this vaccine is available in Russia.

Not all viruses that cause cancer are known to modern science; research continues.

It should be administered preventively, since this disease is sexually transmitted, before sexual activity begins. For those who already have cancer, this vaccine does not help.

In many countries around the world, this vaccination is given free of charge, as it saves women, saving enormous amounts of money for the state, because cancer treatment costs enormous amounts of money.

There is a particularly sharp difference between them of a biological and physiological nature: the ability of infiltrative and peripheral growth and the ability to produce a toxin, which, when a piece of tumor is transplanted into the brain of a rabbit, causes the death of the latter.

Soviet professor M.M.

Nevyadomsky, studying tumors, saw that they differ from normal tissues, which are characterized by complexity, polarity, immobility of location, reproduction in the basal layer, and so on.

A cancer cell does not form tissues and does not possess their properties. If the introduction of such drugs abroad is not a problem, then in Russia the situation is different.

Fungi, releasing external and internal toxins, change the metabolism and structure of the affected organ. With the arrival of the imperfect species of fungus Mycosis fungoides into this conglomerate, the process acquires a malignant character.

This fungus reproduces by division, spores, and budding. Small spores are quickly carried by the bloodstream to other organs.

According to the theory of the German scientist Enderlein, all warm-blooded animals, including humans, are initially infected with the RNA and DNA of all microorganisms. Under conditions favorable to them, they begin to develop from primitive forms to higher ones and transform into one another.

Clark calls the second component of the cancer process the presence in the body of propylene or benzene, which contain heavy metal compounds and other toxins.

In order for cells to begin to divide - this factor is called orthophosphating (the initial stage of cancer), it is necessary to accumulate a certain amount of propyl alcohol, propylene (or isopropylene) in the body.

All 100% of patients studied by Dr. Clark had these two components - propylene and trematode.

Liver cancer is a serious disease of the digestive system, which is characterized by the development of a malignant tumor in the liver. It is relatively rare and accounts for only about 0.7% of the total number of all neoplasms.

Currently, the exact causes of liver cancer are not known, but some of the most common risk factors can be identified:

• chronic viral hepatitis B and hepatitis C (it has been proven that pathogens of viral hepatitis cause mutations in liver cells and contribute to their transformation into cancerous ones);
• chronic alcoholism, alcoholic hepatitis, liver cirrhosis;
• consumption of foods containing aflatoxin B1 (a substance produced by the mold “Aspergillus flavus”, which multiplies during improper cultivation, processing and storage in rice, wheat, soybeans, corn, peanuts). Aflotoxin is also found in the milk and meat of domestic animals that eat contaminated foods.

There are two types of liver cancer: primary (about 25% of cases) and secondary (about 75%).

Primary liver cancer can develop from:

• liver cells (hepatoma);
• bile duct cells (cholangiocarcinoma);
• immature hepatocytes (hepatoblastoma);
• liver vessels (angiosarcoma).

Types of cutaneous keratoses

On forums, doctors identify several types of basal cell carcinoma. They may differ in appearance and location. There are several clinical forms of the tumor:

• nodular-ulcerative - has a round shape, surrounded by a specific “pearl” belt;
• perforating - develops in an area of ​​constant injury to the skin, grows very quickly and rapidly destroys nearby tissues;
• warty - looks like a cauliflower inflorescence;
• large-nodular - spider veins are visible on the surface, grows outward, gradually protruding;
• pigmented – has a dark color, which is why it can be confused with melanoma;
• sclerodermiformis - over time it becomes similar to a flat, rough plaque;
• cicatricial-atrophic - growing, an ulcer forms in the center, which moves to a certain edge;
• flat superficial - does not grow deep into the skin, forms peculiar pink plaques on the surface of the skin.

The most recognized classification is proposed by W. F

Lever, according to which, depending on the type of cell complexation and the direction of their differentiation, all basaliomas are divided into three groups: differentiated, undifferentiated and special forms.

The author includes cystic, adenoid, keratotic, granular and adamantine-like neoplasms as differentiated forms, and solid, pigmented, scleroderma-like (morphea) and superficial variants as undifferentiated.

In Russia they usually use the classification of A.K.

Apatenko (1973), which largely overlaps with the Lever classification, although it has a number of features. Of particular interest is the classification proposed by T.

V. Ackerman, in which 26 independent histological variants of basal cell carcinoma were identified, not combined into any groups.

Describing what skin basal cell carcinoma looks like, the author identified four histological subtypes of basal cell carcinoma (superficial, nodular, micronodular and aggressively growing) taking into account the nature of growth, shape, size of tumor complexes and the relief of their borders, the presence of a palisade-like arrangement of cells, the formation of strands or trains of tumor cells cells, type of stroma and epithelial-stromal relationships, depth of invasion and cellular polymorphism.

Lowe proposed his own classification, based mainly on morphological features that have prognostic significance. According to L. Lowe, such a division is of fundamental importance, since the histological structure of the tumor determines its biological behavior and has prognostic significance, and therefore affects treatment tactics.

Most often, histologically, basal cell carcinoma is a solid type of tumor and consists of strands and cells of various shapes and sizes, compactly located basaloid cells resembling a syncytium.

The superficial multicentric type is manifested by multiple solid cell strands, as if “sliding” from the basal layers of the epidermis into the superficial areas of the dermis.

The pigment type is characterized by a large number of melanocytes between tumor cells. There are also basal cell carcinomas with glandular, peloid, sebaceous, and squamous cell differentiation.

Special types are the scleroderma-like “morphea” type with the development of sclerotic connective tissue and the fibroepithelial type, in which narrow and long strands of basaloid cells are found in the dermis, surrounded by a mucoid-altered stroma with a large number of fibroblasts.

A major factor determining the success of treatment is early diagnosis. And here, dear readers, you cannot rely on chance, you yourself must take care of your health, the main thing is that you should not be afraid to go to the doctor.

Breast cancer is diagnosed by weekly self-examination and self-palpation of the breast, as well as mammography (best - a combination of these two methods).

According to the latest data, the method of breast self-examination is not an effective diagnosis, since it allows one to notice formations of only 0.5 mm, which corresponds to stages II-III of cancer, and in these cases therapy will be ineffective.

Cancer diagnostic methods make it possible to detect tumors much earlier.

Testicular cancer can be diagnosed at an early stage by testicular self-examination, which is why it is recommended for men with a family history of cancer. The American Urological Association recommends monthly self-exams for all young men.

High-intensity focused ultrasound (HIFU) - to destroy the tumor.

Description of the stages of liver cancer

Modern cancer diagnostics makes it possible to detect the oncological process in 100% of cases. Cancer is a long, multi-stage process.

It is known that it takes 5-10 years for a tumor of the lung, stomach or mammary gland to reach a size of 1-1.5 cm in diameter. Thus, most tumors develop between 25 and 40 years of age.

To protect the body, we must eat properly and take preventive measures.

The intensity and nature of tumor growth is difficult to predict; this process depends on many factors: the patient’s body, tissue resistance, and the characteristics of the tumor.

Depending on these and many other factors, the tumor may double in size within a few weeks. Sometimes this takes many months and years.

It is difficult to predict the rate of tumor growth. There are known factors that accelerate it: excessive exposure to the sun, thermal procedures, trauma, physiotherapeutic procedures (quartz, UHF, etc.

), depressed state of the patient, fear. The later treatment is started, the more difficult the cure.

In stage I, complete cure can be achieved. With stage IV cancer, the cure rate is almost zero.

Timely consultation with a doctor, a thorough history taking, and a careful examination of the patient often contribute to the diagnosis of cancer in its early, treatable stages. Particular attention should be paid to identifying precancerous diseases (xeroderma pigmentosum, Queyra's erythroplasia, Dubreuil's melanosis, congenital multiple polyposis of the colon), the presence of which requires both treatment and constant monitoring of the patient's health. To detect a tumor, all available diagnostic methods are used, which are available for early diagnosis of cancer, for example:

• Physical examination of the patient.
• X-ray, computed tomography, magnetic resonance imaging (MRI).
• General, biochemical blood tests, detection of tumor markers in the blood.
• Puncture, biopsy with morphological examination.
• Endoscopy (EGD, cystoscopy, bronchoscopy, etc.).
• For the final diagnosis of malignant tumors, a biopsy is used - taking a tissue sample for analysis

Unfortunately, some patients come to the doctor for the first time with a picture of relatively advanced cancer. Most often, they exhibit the following symptoms of colon cancer: abdominal pain, dysfunction of the intestine (in particular constipation), intestinal bleeding.

Symptoms of different stages of laryngeal cancer manifest themselves differently. At the initial stage of laryngeal cancer, there is a tumor or ulcer that is limited to the mucous membrane or submucosal layer and does not completely occupy one of the sections of the larynx.

When stage 2 of laryngeal cancer occurs, the tumor or ulcer already occupies any part of the larynx entirely, but does not extend beyond its boundaries. The mobility of the larynx is again preserved, and metastases are not detected.

The stages of breast cancer have important diagnostic significance in terms of prescribing the appropriate method of therapy. At different stages of breast cancer, the prognosis for a woman’s life can range from sharply negative to completely favorable.

Stages are also divided into degrees of breast cancer, which are indicated by the initial letters of the Latin alphabet.

The division is based on basic research, and includes the size of the tumor, the presence of metastases, and the general clinical picture:

• Stage 1 breast cancer is characterized by the minimum size of a nodular neoplasm, which does not exceed 20 mm in diameter, there are no metastases, the prognosis is favorable for complete recovery;
• Stage 2 breast cancer is diagnosed upon diagnosis of a tumor with dimensions from 20 to 50 mm, metastasis to regional axillary lymph nodes, the prognosis is favorable with early treatment;
• Stage 3 breast cancer has an unfavorable prognosis for life due to the large size of the tumor (more than 50 mm) and numerous metastases to internal organs and bones;
• Stage 4 of breast cancer is characterized by cachexia, general exhaustion, and a sharp decrease in immunity; due to these factors, total metastases are observed in all organs and systems, the prognosis is very unfavorable, survival rate is no more than 10% of the total number of patients.

The diagnosis of stage 3 breast cancer is automatically established for all patients with diffuse, pseudo-inflammatory and armored forms of oncology.

Currently, treatment for breast cancer always begins with surgery to remove the affected area of ​​tissue. This is due to the fact that such oncological tumors are very difficult to respond to radiation and radiological effects, as well as chemotherapy.

These methods do not provide adequate results in the treatment of breast cancer at any stage.

The stages of treatment for breast cancer include:

1. direct surgical intervention, during which both partial tissue resection and total removal of the gland along with axillary lymph nodes and subcutaneous fatty tissue can be performed;

2. subsequent use of combined methods of radiological, radiation or chemical exposure;

3. a long period of rehabilitation, during which it is necessary to restore immunity and carry out anti-relapse treatment;

4. breast prosthetics;

5. follow-up with an oncologist for 10 to 15 years with annual mammography of the remaining mammary gland.

Recently, hormonal therapy has been recognized as an effective additional method of treating breast cancer to replace insufficient levels of progesterone and estrogen. In such patients, cancer relapses are observed almost 4 times less often.

At the last stage, treatment of breast cancer can be reduced to pain management and providing appropriate care for the dying patient. In this case, surgical intervention is no longer advisable.

Stage III
Stage IVA
Stage IVB
Stage IVC

The differential diagnosis of squamous cell carcinoma of the oral cavity is carried out with leukoplasia, lichen planus and other tumors; the differential diagnosis of squamous cell carcinoma of the tongue is carried out with gumma, as well as with benign and malignant tumors of the tongue.

The main treatment method for squamous cell carcinoma of the tongue and oral mucosa is radiation therapy; less commonly, it is used in combination with surgery or in combination with surgery and chemotherapy.

Signs of cancer of the larynx and vocal cords

Smoking and alcohol abuse contribute to such a dangerous throat disease as laryngeal cancer. The causes of laryngeal cancer can also be various chronic inflammatory processes.

Malignant tumors of the larynx are predominantly found in middle-aged and primarily elderly men, but there are cases of the disease in young people. The etiology has not been definitively established. But the negative role of various irritating environmental factors is still undeniable.

A very vulnerable place in our body is the notorious “bag”, into which the remains of digested food are collected - the rectum.

Breast cancer can show symptoms only in late stages. The first signs of breast cancer can be detected only with constant self-monitoring of the condition of the breast.

Symptoms of breast cancer may vary depending on the type of cancer developing. The most commonly diagnosed:

1. nodular and fibromatous form with the formation of a limited tissue compaction with a diameter of the affected area of ​​no more than 50 mm;

2. diffuse form, which occurs most rapidly and has symptoms of a diffuse inflammatory process such as erysipelas, purulent mastitis or gangrene;

3. armored form of breast cancer with external manifestations in the form of a diffuse neoplasm covering the entire surface of the breast with a dense crust.

As strange as it may sound, the greatest difficulty in diagnosis is the diffuse pseudoinflammatory form of breast cancer. Her symptoms are very violent:

• a sharp increase in body temperature to extremely high numbers of 39 - 40 degrees Celsius;
• feeling unwell, weakness, muscle pain, dizziness;
• severe swelling and hyperemia in the area of ​​one breast (breasts can increase 2 or more times);
• discharge of pus from the nipples (may be mixed with blood).

All these symptoms of breast cancer in diffuse form enable the doctor to make an incorrect diagnosis and prescribe antibacterial treatment according to the treatment regimen for erysipelas or purulent mastitis. Unfortunately, this tactic can lead to the death of the patient.

The most reliable first signs of breast cancer are in the armored form. This is a fairly rapid process of formation of a dense crust that covers the entire surface of the mammary gland and tightens it with a decrease in volume.

Signs of breast cancer in the nodular form most often manifest themselves in the form of enlargement and pain in the regional group of lymph nodes. Usually this is the armpit, in which a dense, painful lump forms.

Upon examination by a doctor, a primary diagnosis of regional axillary lymphadenitis is established. This is a direct indication for the diagnosis of breast cancer, especially in women over forty years of age.

The first signs of breast cancer in the nodular form can be detected independently during a systematic examination of breast tissue using the palpation method.

A nodule with a dense surface may be detected. Its dimensions range from 5 to 150 mm.

The neoplasm is often immobile and tightly fused to the surrounding tissues. When you try to move or press, you feel a sharp, dull pain.

More obvious external symptoms of breast cancer in the latent nodular form appear in the later stages:

• change in the color of the outer skin over the affected gland;
• swelling and hyperemia with the formation of the “goose bumps” effect;
• the formation of retracted skin lesions, in the center of which the tumor may begin to grow outward;
• sharp asymmetrical enlargement of one breast.

Queyra's erythroplasia is a rather rare disease that is IN SITU cancer of the glans penis. It usually occurs in uncircumcised older men. HPV-8, 16, 18, 39, 51 are detected in tumor tissue.

Clinically and histologically it has much in common with Bowen's disease, but the tendency to malignancy is higher: up to 30% of cases transform into squamous cell carcinoma, which metastasizes in 20%.

Clinically, Queyr's disease is an asymptomatic, soft, slightly infiltrated, clearly demarcated, red plaque of irregular shape with a smooth or velvety surface, found on the mucous membranes, especially often on the glans penis, less often in the coronary groove or the inner layer of the foreskin.

Symptoms and diagnosis of liver cancer

Symptoms of basal cell carcinoma progress over time. The number of nodules on the surface of the dermis gradually increases. They merge with each other, forming peculiar plaques. In the area of ​​tumor formation, blood vessels begin to gradually collapse, which leads to the appearance of spider veins.

The earlier the tumor is detected, the more effective the treatment. Early detection of a tumor usually means that treatment will begin when the cancer is small, when it has not yet spread to other parts of the body. This usually means a greater chance of cure.

Often, the symptoms of early oncology are ignored by a person due to the fact that the person is frightened by the possible consequences and refuses to see a doctor or considers the symptom that appears to be insignificant.

Common symptoms of cancer, such as fatigue, are often not associated with cancer and therefore often go unnoticed, especially when there is an obvious cause or when they are temporary.

Likewise, the patient may think that a more specific symptom, such as a tumor formation in the mammary gland, is a simple cyst that will go away on its own.

However, such symptoms of cancer and oncology cannot be ignored, especially if they exist for a long period of time, for example, weeks, or there is a negative trend.

Specific symptoms of liver cancer, as a rule, are absent, since cancer develops against the background of chronic liver diseases.

Some signs overlap with others:

• stomach ache;
• heaviness in the right hypochondrium;
• prolonged causeless increase in body temperature (above 37.5°);
• the appearance of ascites;
• development of jaundice;
• also a sign of liver cancer is weight loss;
• severe weakness;
• lack of appetite.

Having identified the symptoms of liver cancer, diagnosis is carried out through the following studies:

• Determination of the level of alpha-fetoprotein (AFP) in the blood, which acts as a tumor marker. AFP is a substance that is produced by immature liver cells during fetal development.
• In liver cancer, liver cells lose their ability to mature and also produce large amounts of AFP.
• An ultrasound of the liver allows you to study its structure, density and detect the presence of a tumor.
• Liver cancer is also diagnosed using magnetic resonance imaging (MRI), which allows you to obtain images of thin sections of the liver and study the structure of suspicious areas from different angles.
• Biopsy is the most reliable diagnostic method. If cancer cells are found during examination of the tumor area under a microscope, the diagnosis is considered confirmed.

Early signs of cancer of the vestibule of the larynx are a feeling of tickling, a foreign body, as well as coughing, a feeling of awkwardness when swallowing, which later turns into pain, sometimes radiating to the ear. As the disease spreads to the pharynx, pain and dysphagia increase.

Over the course of several months, the tumor grows into the deep parts of the skin and subcutaneous fatty tissue, forming a dome-shaped node with a diameter of 2-3 cm or more, dense (cartilaginous) consistency, inactive, bleeding easily with mild trauma, necrotizing and ulcerating.

The papillomatous variety is characterized by even more rapid growth.

Look at the photo - in squamous cell skin cancer, the tumor is characterized by individual brown-red mushroom-shaped elements on a broad base, which gives the tumor the shape of a cauliflower or tomato:

At 3-4 months of illness, the element may ulcerate.

The ulcerative type can be superficial or deep. The superficial variety grows not in depth, but along the periphery, and is characterized by a superficial ulcer of irregular shape with clear edges in the form of an epithelial shaft, covered with a brown crust.

The deep variety spreads along the periphery and into the underlying tissues and is characterized by an ulcer with steep, undermined edges in the form of an epithelial shaft, the bottom of which is greasy, lumpy, yellowish-red in color with a yellow-white coating.

Regional metastases in the ulcerative type are observed earlier, usually at the 3-4th month of the disease.

A symptom of squamous cell skin cancer of the ulcerative type is enlargement of the lymph nodes, they become dense (sometimes acquiring a cartilaginous consistency), their mobility is limited (up to complete fixation to the surrounding tissues).

Histologically, squamous cell skin cancer is characterized by branching cellular cords infiltrating the dermis. Tumor elements resemble cells of the spinous layer of the epidermis. Cellular arrays may contain almost normal and atypical (pleomorphic and anaplastic) elements, differing in the severity of squamous differentiation and the ability to produce keratin. Cellular atypia is also manifested by different size and shape of cells, enlargement and hyperchromatosis of their nuclei. There are many pathological mitoses. Tissue atypia consists of a violation of stratification and vertical anisomorphy of the multilayered flat epidermis, loss of intercellular bridges. There are dyskeratotic and parakeratotic cells, often spirally arranged, forming layered structures and surrounding extracellular accumulations of horny masses.

Based on the severity of keratinization in the tumor, keratinizing and non-keratinizing squamous cell carcinoma, as well as 3 degrees of its differentiation, are distinguished.

Highly differentiated tumors in the skin are more common and are characterized by a regular layer-by-layer arrangement of cells in the tumor layers, preservation of intercellular bridges and pronounced keratinization with the presence of both individual keratinized cells and a large number of structures called horny pearls.

Horny pearls consist of concentric layers of spinous cells, the keratinization of which gradually increases towards the center; in the center there is usually incomplete or, rarely, complete keratinization.

In poorly differentiated tumors, stratification in the layers is completely absent; the strands are formed by sharply polymorphic cells that lose the ability to keratinize.

Keratin and/or intercellular bridges are preserved only in certain small areas of the tumor; the bulk of the cells are undifferentiated. Cells have different shapes and sizes, cell boundaries are poorly distinguishable.

The nuclei are small, hyperchromatic, there are pale shadow nuclei and nuclei in a state of decay. A large number of pathological mitoses are detected.

Moderately differentiated squamous cell carcinoma, according to a set of histological and cytological features, occupies an intermediate position between highly and poorly differentiated tumors.

Lymphoplasmacytic infiltration is invariably detected in the tumor stroma, which is a manifestation of the severity of the antitumor immune reaction. Its degree is higher in the early stages of the disease and in highly differentiated squamous cell skin cancer.

Poorly differentiated squamous cell carcinoma does not show symptoms of keratinization and is represented by soft, fleshy, granulating formations.

Bowen's disease (syn.: bowenoid dysplasia, vulvar intraepithelial neoplasia stage III) is an intraepidermal squamous cell carcinoma of the skin IN SITU. It occurs predominantly in older people (average age 55 years). The ratio of Bowen's disease in men to women is 5:1.

Several etiological factors have been suggested to play a role in the development of this disease, including genetic defects and defects in DNA repair. Localization of lesions in open areas of the skin involves UVR (including PUVA and UV-B) and mechanical damage to the skin as one of the factors.

Cases of the development of Bowen's disease in women and men in closed areas of the skin are associated with chemical carcinogens - with exposure to inorganic arsenic compounds (medicines, industrial hazards).

In Bowen's cancer lesions, HPV-16 and HPV-18 are found, almost always associated with bowenoid papulosis, as well as HPV-31, 54, 61, 62, 73. Cofactors of carcinogenesis are immunosuppression and smoking.

The clinical picture is characterized by clearly demarcated scaly plaques - persistent, scattered, irregular in shape. Being erythematous, covered with scales or crusts, they resemble psoriasis.

As you can see in the photo, with Bowen's disease these plaques can be located on any part of the skin:

The main localization is on the torso (50% of cases), head and neck, upper extremities, including fingers (including periungual areas, nail bed), in the perineum, on mucous membranes (oral cavity, anogenital area, conjunctiva of the eye).

The dependence of the localization of lesions on gender was traced.

Pay attention to the photo - in men, the symptoms of Bowen's disease are more often associated with the scalp and ears, in women - with the lower extremities and cheeks:

The key clinical signs are: variegation (areas of atrophy, hyperkeratosis, warty growths) and uneven growth of the lesion along the periphery with elevation of the marginal zone.

Sometimes Bowen's disease is represented by several, including widespread, foci that are closely located and merge with each other as they increase in size.

The pigmented form of Bowen's disease occurs in 2% of cases. Bowen's disease of the nail bed manifests as peeling around the nail plate, onycholysis, or erosion with crusting and discoloration of the nail plate. Bowen's disease in skin folds is characterized by erythema with a strong, unpleasant odor or dark spots

Progression of Bowen's disease to invasive squamous cell carcinoma is accompanied by the appearance of a solid tumor with ulceration within its boundaries.

Histologically, Bowen's disease is characterized by acanthosis with elongation and thickening of the epidermal processes, focal parakeratosis. The basal layer is not changed.

The spinous cells are arranged randomly, many of them with pronounced atypia of large hyperchromic nuclei. Large multinucleated cells containing clusters of intensely stained nuclei are found, and mitotic figures are found.

Dyskeratosis of large round cells with homogeneous eosinophilic cytoplasm and a pyknotic nucleus is noted. Foci of incomplete keratinization can be detected in the form of concentric layers of keratinizing cells, reminiscent of “horny pearls.”

Some cells are intensely vacuolated and resemble Paget cells, but lack bridges. The boundary between the epidermis and dermis remains clear, and the basement membrane is intact.

The upper dermis usually has a mild chronic inflammatory infiltrate, which often extends into the infundibulum and causes replacement of the follicular epithelium with atypical cells down towards the entrance to the sebaceous gland duct.

When Bowen's disease transforms into squamous cell carcinoma in a limited area, acanthotic cords deeply immerse into the dermis with disruption of the basement membrane and pronounced polymorphism of cells in these cords. Detection of such a site is made by serial sections of the preparation.

Flow. Despite its steadily progressive course, the vast majority of cases of Bowen disease remain cancer in situ throughout life.

Transition to invasive squamous cell carcinoma occurs in 5-11% of cases, many years after the onset of the disease. Metastases (lymphogenous or hematogenous), developing during invasion of the dermis, are detected in approximately 18%, and death occurs in 10% of cases.

Warts caused by HPV are the most common type of keratosis in humans. Viral keratoses are relatively rarely precancerous.

Only certain, oncogenic types of HPV can lead to dysplastic and malignant changes. The most common are HPV-16 and 18, which are classified as “high oncogenic risk” HPV.

The risk of malignancy increases when exposed, along with HPV, to co-factors such as UVR, PUVA therapy, herpes infection, smoking, immunosuppression (associated with organ transplantation, HIV infection).

Dysplastic variants of viral keratoses include bowenoid papulosis, verruciform epidermodysplasia of the Lewandowski-Lutz epidermis, and giant Buschke-Levenshtein condyloma.

Diagnostic methods

Basalioma can be removed only after a correct diagnosis. For this purpose, cytological and histological analysis of scrapings is used.

It is also possible to make a diagnosis using a smear of the tumor. Most often, a combined method is used to make a diagnosis - diagnostic photos and test results.

Please note! Since the pathology may be similar in appearance to other dermatitis, it may be necessary to exclude similar pathologies to make an accurate diagnosis. This usually requires blood tests and, in rare cases, additional scrapings or smears.

To diagnose nasal basal cell carcinoma, it is necessary to undergo a comprehensive examination:

• examination by a specialist. The doctor visually examines the tumor. if facial skin cancer is suspected, prescribe other diagnostic methods;
• biochemical diagnostics. Tumor markers are designed specifically to detect cancer. But their increase will not always indicate the presence of a tumor in the body;
• biopsy. Using a scalpel, a small piece of material is taken and sent to the laboratory. After the biopsy, the biomaterial is sent for cytology and histology:

1. cytology - studies the structure of cells, their shape, determines the type of neoplasm and thanks to this the doctor begins earlier correct treatment;
2. histology - helps to identify malignant processes and determine how aggressive the tumor is. The resulting fabric is mixed with paraffin and cut very thin. After special staining, I place it under a microscope and examine it;

• radioisotope diagnostics. Positron emission tomography (PET) is a new diagnostic method that allows one to detect the presence of small cancer tumors and distant single metastases.

Diagnosis of colon cancer includes intracavitary examination using sigmoidoscopy. Colon cancer is also diagnosed using magnetic resonance imaging techniques.

The determining factor is the collection of homologous material (biopsy) for histology (determination of cellular composition). Next, let's look at how you can recognize the disease.

Another advantage of the prenosological approach to the prevention of colon cancer is the possibility of early diagnosis of the functional state of bradyentery using non-invasive chronoenterography in childhood, in contrast to the dangerous and invasive colonoscopy, which is recommended for screening for colon cancer at 45-50 years of age (when blood is already appearing in the stool and polyps in the intestine).

Laboratory diagnostic tests for pancreatic cancer and endocrine tumors:

Pancreatic tumors	Diagnostic tests
Pancreatic cancer (carcinoma)	General blood analysis
	Determination of pancreatic enzyme activity in blood serum
	Determination of bilirubin concentration, activity of AST, ALT, GGTP, ALP in blood serum
	Determination of carcinoembryonic antigen, CA 19-9 antigen in the blood
	Determination of the level of α-fetoprotein in the blood
	Cytological examination of pancreatic juice
Insulinoma	Determination of glucose convergence and insulin levels in the blood
Gastrinoma	Study of HC1 secretion in the stomach
	Determining the level of gastrin in the blood
Glucanoma	Determining the level of glucagon in the blood
	Determination of 5-hydroxyindoleacetic acid in urine
	Determination of the level of vasointestinal polypeptide in the blood
Somatostatinoma	Determination of the level of somatostatin in the blood

Laboratory criteria for diagnosing focal formations of the duodenopancreatic region:

Laboratory indicators	Nosological form
	Pancreas cancer	Duodenal papilla cancer	Hyperplastic form of CP
Creatorea
Steatorrhea
	May be?	Maybe T	Not promoted
	Maybe T	Maybe T	Not promoted
Bilirubin			Maybe T
	Maybe T	Maybe T
		Maybe T	Not promoted	Not promoted
Carcinoembryonic antigen		Maybe T	Not promoted	Not promoted

An effective combination of biochemical tests in the diagnosis of pancreatic cancer:

Biochemical test	Direction of change
Amylase in the blood	Decline
Amylase in urine	Decline
Lipase in the blood	Decline
Lipase in urine	Decline
Trypsin in the blood	Decline
Trypsin in urine	Decline
Blood glucose
Glucose in urine	Promotion
Neutral fat in feces (triacylglycerols)
Bilirubin in the blood	Promotion
Antithrombin titer in blood	Promotion
Duodenal contents: enzyme activity	Decline
Duodenal contents: secretion volume	Decline
Secretin test: volume of duodenal secretion	Decline
Secretin test: concentration of bicarbonates in duodenal contents	Decline
Secretin test: amylase in duodenal contents	Decline

In conclusion, it should be noted that in recent years, along with a true increase in pancreatic diseases, there has been a tendency towards overdiagnosis of chronic pancreatitis.

There are often cases when unclear pain in the upper abdomen is attributed to non-existent pancreatitis without sufficient evidence. There are also frequent cases of underdiagnosis of pancreatic diseases, especially for mild forms of CP and pancreatic cancer.

Therefore, for the timely detection of chronic pancreatitis, a comprehensive examination is necessary, in which laboratory methods, characterizing the functional state of the pancreas, occupy key positions in the diagnostic process along with methods that study the morphological state of the organ.

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The initial diagnosis of breast cancer must be confirmed or refuted using various tissue examination methods. Breast cancer can be reliably determined only after a biopsy and histological examination of the obtained material. Metastases in regional lymph nodes are similarly detected.

Diagnosis of breast cancer begins with an examination by an oncologist. The specialist will then schedule a mammogram.

This is a method of high-precision radiographic examination of glandular tissue. If it is necessary to obtain additional data, ultrasound scanning of the breast is used.

If there are typical signs of malignancy of the neoplasm, a puncture is performed to collect cells for histological examination.

Diagnosis of breast cancer at an early stage can be carried out using tests for so-called tumor markers. Currently, the most productive analysis is for the presence of aggressiveness towards HER2NEU receptors.

This parameter provides insight into the presence of aggressively mutated genomes in breast tissue. The probability of breast cancer in this case is 90 - 95%.

Gene mutation and breast cancer testing

British scientists have created a fundamentally new device that can detect breast cancer within 8 seconds and acts as a mine detector. The operating principle of the device, unlike a mammograph, is based not on X-ray radiation, but on radio wave radiation.

The scientists used technology similar to that used in a mine detector designed to detect non-metallic explosive devices in the ground.

More interesting information. Using a blood test, scientists can now detect the presence of a specific breast cancer gene, which makes it possible to predict the development of breast cancer in women several years before the disease begins to develop.

Gene mutations cause breast cancer in approximately 90% of examined patients.

Blood tests were collected from 640 women with breast cancer and 741 women without the disease. The first group of women had their tests collected approximately 3 years before they were diagnosed with cancer.

Researchers have found that women with the highest levels of a special gene in their blood, called ATM, are 2 times more likely to develop cancer than patients with low levels of this gene.

Treatment

Therapy depends not only on the stage of the disease, but also on the patient’s health condition and the location of the lesion. Nasal basalioma is one of the fairly common, but at the same time very noticeable, tumors.

Its treatment requires the use of gentle methods that guarantee the formation of a minimum of scar tissue.

New technologies for treating this pathology are constantly discussed and proposed on medical forums. Basalioma of the eyelid, like basalioma of the skin of the nose, requires very careful intervention, since in these areas the skin is very thin and sensitive.

Cryodestruction

Cryodestruction of basal cell carcinoma is one of the most popular methods of therapy. Liquid nitrogen is used to carry out the procedure, which eliminates the possibility of relapse.

This measure is effective in the presence of superficial damage that does not affect the deeper layers of the skin. In complex cases, irradiation of basal cell carcinoma can be combined with surgical intervention.

Surgical intervention

Laser removal of basal cell carcinoma is performed in cases where conventional surgery can cause complications. This procedure is prescribed mainly to older people. It leaves few scars, and therefore can also be used to remove tumors on the face.

Direct surgical removal is carried out in areas that are located in relatively safe places. If radiation therapy does not show effectiveness, surgical removal is used. This type of treatment is considered one of the most effective treatment methods.

Alternative medicine

Treatment with folk remedies includes the use of agents that have a powerful antiseptic and drying effect. In any case, basal cell carcinoma is a malignant tumor, and therefore it must be treated under medical supervision.

The use of folk remedies is appropriate as an addition to the main treatment.

• Celandine juice. In its pure form, it is applied to the tumor twice a day. On the tenth day, the tumor should dry out.
• Golden mustache juice. Used as a compress of fresh leaves. The compress is fixed with a damp swab or rag.
• Burdock root. 100 g of dried root is mixed with 100 g of oil. The composition must be boiled for 1.5 hours. The ointment is very convenient for use in areas where it is difficult to use compresses.

Basalioma is one of those types of tumors that have a generally favorable prognosis. But in the absence of timely intervention, it can cause large-scale skin damage.

Despite significant advances achieved in the treatment of basal cell carcinoma, tumor relapses are quite common. According to various authors, the frequency of relapses of basal cell carcinoma after treatment varies from 1 to 39%. High risk factors for relapse are considered to be localization of the tumor in the nose and ears, large diameter of the tumor (more than 2 cm), aggressive histological type (morphea-like, infiltrative, metatypical).

Thus, in the presence of sclerosis and a tendency to infiltrative growth, basal cell carcinoma recurs after irradiation or other therapy in 12-30% of cases, whereas with a solid type of structure, relapse is observed only in 1-6% of cases.

Additional risk factors for relapse include non-compliance with sun protection, immune disorders, and non-radical treatment.

Treatment of basal cell carcinoma by cryodestruction is a method of freezing the tumor with liquid nitrogen used in outpatient practice. The most common application method is using copper disks.

In this case, tumor destruction is achieved by alternating at least two cycles of freezing and thawing.

Treatment of basalioma with cryodestruction is a “blind” method, carried out with the capture of 1-1.5 cm of visible healthy skin, but without determining the possible boundaries of tumor cell dispersion.

Exposure time, depending on the clinical form, size and depth of tumor invasion, is from 30 to 180 s. Treatment of basalioma with cryodestruction is carried out for superficial (area up to 3 cm2) and micronodular forms of the tumor.

The relapse rate after treating basal cell carcinoma with nitrogen is 4-7.5% for a primary tumor, and 13-22% for a recurrent tumor. Contraindications to cryodestruction with nitrogen (due to the high frequency of relapses) are: nodular, ulcerative and scleroderma-like forms, tumor diameter more than 3 cm, localization in the medial part of the face (at the corner of the eye, in the nasolabial fold, on the nose), cryoglobulinemia.

See how basal cell carcinoma is treated with nitrogen in these photos:

The advantages of photodynamic therapy (PDT) for basal cell carcinoma compared to other methods of treating this tumor are: selective effect on tumor tissue; the possibility of repeating the procedure many times in the case of a large tumor diameter and multiple tumor processes without the risk of complications; treatment for tumor localization in hard-to-reach places; good cosmetic effect.

External cytostatic therapy for basal cell carcinoma includes use for 2-4 weeks. ointments with 5-fluorouracil, 5-10% fluorofur, 30-50% prospidin.

Local use of cytostatics is possible for superficial tumors and for the treatment of elderly patients. Also, treatment of basal cell carcinoma with ointments is possible in case of relapse after close-focus radiotherapy.

Abroad, encouraging results (with recovery in 79-82% of cases) were obtained when treating the superficial form of basal cell carcinoma with 5% imiquimod cream.

Currently, the following main methods of cancer treatment are used in official medicine, which are:

Surgical treatment of cancer continues to occupy first place, since it is not only a therapeutic method, but also a diagnostic method. In the early stages of the development of malignant tumors, it provides a certain chance of cure.

Treatment with cytostatics is used everywhere, as it gives visible results in a short time. Modern methods of treating malignant tumors include the so-called cytostatic therapy, which includes the use of chemotherapy and antitumor antibiotics, as well as radiation therapy.

Despite all the differences in methods, in both cases, along with tumor tissues, normal tissues are affected to one degree or another, which is the main obstacle to a complete cure.

Therefore, treating cancer with cytostatics is a complex and dangerous process for the body.

Canadian scientists have proven that radiation chemotherapy for oncology causes irreversible changes in the brain. However, radiation treatment for cancer is the most effective and is used in the vast majority of patients.

Chemotherapy is considered one of the most effective methods of treating cancer, although the side effects of its use have long been known. However, Canadian scientists have discovered another factor worth thinking about.

These are new cancer treatments, not fully tested therapies that are at the stage of scientific, clinical research and experimentation that have not been included in the therapeutic standards adopted in WHO oncology.

The effectiveness and safety of any experimental technique requires further study, since there is no complete information about the effect of new cancer treatment methods on cancer cells and the body.

However, it is assumed that there is a scientific hypothesis that explains what effects are expected and why. Experimental treatments require sufficient scientific evidence and clinical trials.

Using alternative cancer treatments on patients is complex and requires special legalization compared to using standard therapy.

Innovative cancer treatments can be effective, but their implementation in health care depends on complex administrative procedures that are now standardized across all countries.

Dendritic cells against cancer are a kind of “command room” of immunity within the body. Dendritic cell vaccination is a cancer treatment that uses the remarkable ability of dendritic cells to label antigen (the hallmark of cancer).

Dendritic cells convey information about antigens to immune cells called T cells, which, with the provided identification marks (CTL: cytotoxic T lymphocytes), recognize and specifically attack cancer cells that have that antigen.

This is a treatment that specifically targets cancer cells by transmitting information about the cancer to dendritic cells.

Healthy cells are not attacked, so there are virtually no side effects. Since there is no heavy burden on the body, this type of treatment is suitable for patients with advanced stage cancer.

Cancer cells are recognized and attacked at the molecular level, as a result of which one can expect an effect in the treatment of small, unrecognizable lesions, as well as in the treatment of cancer with dendritic cells of the infiltrating type, which is difficult to remove surgically.

Outpatient treatment is possible. Once every 2 weeks, a small amount of blood is taken from a vein (25 ml).

Monocytes are isolated, after cell division, and a large number of dendritic cells are cultured. By culturing the cells with a cancer antigen obtained from the patient's tumor cell material or artificial antigens (long-chain peptides), a dendritic cell vaccine is obtained.

The cancer vaccine is given by subcutaneous injection into the area of ​​a nearby lymph node associated with the site of the disease. Killer T lymphocytes, supported by T helper cells, which transmit information about target cells, attack cancer cells.

The course of treatment with dendritic cells takes about 3 months, during which the patient donates blood every 2 weeks and receives an injection of the prepared vaccine.

Taking blood from a vein (each time) takes about 5 minutes. A new vaccine is prepared every 2 weeks; there is no need for refrigeration, which allows a fresh vaccine to be administered each time.

The Japanese are especially successful in this area. It must be said that cancer cells have many types of antigen (identification marks).

However, sometimes cancer cells hide these identifying marks to avoid immune system surveillance. Accordingly, the more information a vaccine has that indicates cancer cells (peptides), the higher the likelihood of identifying cancer cells and, as clinical studies show, the more effective the vaccine will be.

Many Japanese medical centers have had success in preparing highly effective dendritic cell vaccines with long-chain peptides WT1, NY-ESO-1 and others.

Due to the function of memory T cells, the therapeutic effect of the vaccine lasts for a long time, so this treatment meets the criteria for assessing the effectiveness of treatment according to the irRC system (immune response related criteria).

Cell division is carried out in a highly sterile culture center, completely isolated from contact with the outside world. The level of sterility of laboratory equipment in the production of vaccines can rival the so-called clean room - sterile rooms used in the pharmaceutical industry.

Impeccable control is carried out to prevent bacteria and viruses from infecting immune cells important to the patient. A system has been developed to prevent the human factor: the entire process of cell cultivation is carried out under the control of computer systems.

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How then to treat obstructive jaundice due to a tumor and all its manifestations? The first thing to say: despite all the successes of modern medicine, there is still no medicine that can neutralize bilirubin.

Currently, a whole series of similar experiments with drugs are being carried out, but their introduction into practical medicine, due to their heterogeneity of action, may not even take place in our lifetime.

Doctors put a lot of effort into preventing jaundice, and rightly so. But for liver cancer, this approach is simply not suitable - it is impossible to control the growth of a cancerous tumor, to direct it in one direction or another.

Therefore, to treat obstructive jaundice in oncology, so-called palliative operations are performed, aimed not at treating the disease (liver cancer), but at relieving various complications - in this case we are talking about jaundice.

Liver cancer is certainly a very serious disease, but this is by no means a death sentence. The key to successful treatment of the disease is its early detection.

How to treat liver cancer depending on the form of the disease and its stage? The most commonly used treatments are surgery, radiation and chemotherapy.

Numerous studies are currently underway to develop new treatment methods:

• Laser therapy (separation of small secondary tumors using a laser).
• Destruction of tumors using injections of ethyl alcohol.
• Cryotherapy is treatment with artificial cold (created by liquid nitrogen or argon): destruction of pathological tissues using low temperatures.
• The use of drugs created using nanotechnology: they make it possible to deliver substances - “cancer cell killers” directly to the tumor site.

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Here you will learn how to treat laryngeal cancer at all stages. Exclusively surgical treatment is indicated only for the first stage of vocal fold damage. In other cases, radiation therapy or combination treatment is prescribed for laryngeal cancer.

Depending on how much the tumor has spread, the larynx is either completely removed (laryngectomy), or various types of partial resections are performed (removal of the supraglottic part of the larynx, one vocal fold, its anterior or anterolateral parts).

In this case, natural breathing is immediately restored. The indication for this type of operation is mainly cancer of the middle part of the larynx.

Lasers are also currently being successfully used to treat laryngeal cancer.

When there are metastases to the cervical lymph nodes, a Crail-type operation is indicated, in which the cervical tissue, internal jugular vein, and all deep cervical lymph nodes are removed in one conglomerate, often involving the sternocleidomastoid muscle. After the operation, radiation is given.

Both radiation therapy and surgery must be combined with the prescription of antibiotics, which will prevent the development of infection, primarily radiation perichondritis, as well as vitamin therapy.

Now, along with the main type of treatment or in the fourth stage of the disease, chemotherapy (methotrexate, cyclophosphamide, thiophosphamide, etc.) is carried out.

If the disease recurs, laryngectomy and subsequent chemotherapy are indicated. Radiation therapy is contraindicated in this case, since it inhibits the immune cellular response around the tumor and can cause anaplasia or sarcomatous transformation with rapid dissemination.

Prevention of skin basal cell carcinoma

To reduce the risk of developing malignant skin tumors, you must follow simple rules:

• try to avoid exposure to direct sunlight and avoid visiting solariums;
• use nourishing creams if the skin is constantly dry;
• prevent injury to existing scars on the body;
• try to cure ulcers and fistulas that do not heal for a long time as soon as possible;
• change your diet, enriching it with fruits and vegetables rich in vitamins;
• change the climate or change place of work (to eliminate contact with harmful factors);

Remember. Despite the fact that basal cell carcinoma is not as dangerous as other cancers, its occurrence should not be ignored.

This is an insidious pathology that destroys tissue, including cartilage and bone. Therefore, when you detect its first signs, you must immediately contact a dermatologist-oncologist in order to begin proper treatment as soon as possible.

Primary prevention consists of active detection of basal cell carcinoma in risk groups with recommendations for limiting insolation and the use of photoprotectors, as well as mandatory treatment of precancerous dermatoses.

Secondary prevention measures are limited to radical treatment of the primary tumor, prevention of relapses of multiple and recurrent basal cell carcinomas. For this purpose, immunocorrection techniques can also be used: oral administration of the aromatic retinoid neotigazone 10 mg/day 2 times a week.

3-month courses. The use of external retinoids (0.25-0.5%) after removal of basal cell carcinoma also helps to reduce the frequency of relapses.

After treatment of patients with solid basal cell carcinomas, it is advisable to undergo lifelong clinical observation with quarterly examinations during the first year, and then once a year.

For primary multiple basal cell carcinoma, lifelong follow-up is recommended with quarterly examinations during the first 5 years, and then twice a year, not only with dermato-ocological examination, but also with general oncological examination due to the high frequency of concomitant oncological pathology.

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Prevention of breast cancer in women includes regular self-examination and emergency medical care in some cases.

The reason for an urgent visit to a mammologist is the appearance of nodules and lumps, changes in the shape of the breast, redness of the skin, enlargement of one of the mammary glands due to swelling, retraction of the nipple, brown or bloody discharge.

What is the most effective and simple cancer prevention suitable for every person? Of course, preventing cancer by normalizing your diet and diet. The following are products for cancer prevention that significantly inhibit cancer processes in the body.

What can you do to prevent cancer besides normalizing your diet? Do not smoke. The cause of 30% of tumors is smoking.

Cancer prevention at work: Wear protective clothing at work. The cause of 4% of tumors is industrial harmful substances.

Don't worry. 16% of tumors are the result of stress and negative emotions. The immune system is at great risk in people who are depressed and do not have mental support.

Cancer prevention measures advise: keep alcohol consumption to a minimum. The cause of 3% of tumors is alcohol consumption.

The best prevention for skin cancer: do not sunbathe after 11 am, 3% of tumors are the result of prolonged exposure to the sun.

Use hormonal medications only when absolutely necessary. The cause of 1% of tumors is painkillers and medical procedures.

Avoid:

All of you, of course, are well aware of the statement that any disease is easier to prevent than to treat. And therefore, any modern person should be well aware, first of all, about the consumption of which products is a kind of prevention of the development of colorectal cancer.

How to prolong life with cancer: proper nutrition for cancer patients

Proper nutrition during oncology is one of the important points for a speedy recovery. Stick to separate meals. Eliminate from food smoked, fried, fatty, salty, highly ground flour products (white bread and the like), confectionery, sugar, strong coffee, tea, tobacco.

Eat lean meats (boiled, stewed), lard, unrefined vegetable oil, butter, cereals, skim milk, fermented milk products, curdled milk, koumiss, buttermilk, matsoni, homemade cheese, egg yolks, soy products.

Porridge with water, oatmeal and buckwheat are best. Use onions in any form, do not forget about garlic.

The diet of patients with oncology should contain as much plant food as possible - fiber, vitamins, macro- and microelements, which are found in sprouted grains, cereals, salads, green vegetables, citrus fruits, apricots, any natural juices, especially beetroot, carrot, apple, cucumber, citrus fruits or combinations thereof.

If there are no citrus fruits, you can use cranberries or 1 tbsp. spoon of apple cider vinegar in a glass of water before meals.

Pay attention to the lack of iodine, which causes the body to lack oxygen, causing excessive fermentation and hypoxia, which cancer cells love (so-called anaerobic conditions).

A particularly correct diet is good as a preventative measure, because due to the excess of organic acids, vitamins, and microelements entering the body, the acid-base reaction of the body shifts to the alkaline side, which is detrimental for patients and a favorable environment for healthy cells.

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Ulkuns rodens or cutaneous basal cell carcinoma is a neoplasm on the dermis. Pathology is one of the most common diseases and occupies an intermediate place between a benign tumor and a malignant one. This is due to the fact that the disease occurs practically without metastasis, but is capable of destroying the patient’s body. Basalioma or basal cell skin cancer occurs more often in men than in women over the age of 40.

What is basalioma? What is it and who is at risk? Not knowing what basal cell carcinoma looks like, many people who find an anomaly on their skin do not attach any importance to it, which leads to serious consequences.

Basal cell skin cancer is a formation that develops from epidermal cells and follicles of the upper layer of skin. It most often occurs on the face, but can appear on the back. The tumor looks like a small, rough, reddish plaque raised above the skin. Often patients scratch or tear off the surface of the tumor, which provokes bleeding from the capillaries located in it. After some time, the basal cell carcinoma ulcerates.

The risk group for skin cancer or basal cell carcinoma includes people with fair skin type I - II, as well as albinos and those who are more often exposed to the sun without protective cream or a hat. In addition, basal cell carcinoma disease can affect those who often have contact with petroleum products and arsenic. Children and adolescents practically do not suffer from this pathology.

Important! Strong sun exposure in childhood can provoke this disease in the future.

Basal cell cancer has a code according to ICD 10 - C 44. All subsequent numbers after the dot indicate the location of the tumor.

Forms and symptoms

Based on histology, basal cancer is divided into differentiated and undifferentiated. In 1996, according to the WHO international scale, the following morphological types of basal cell skin cancer were identified:

• Cylindroma or Spiegler's tumor - this type of cancer is localized on the scalp and visually resembles a cluster of purple semicircular nodules. The nodes have a dense structure, a wide base and range in size from 1 to 10 centimeters. The surface of the tumor is covered with telangiectasia.
• Pigmented - due to the large amount of melanin, it has scattered pigmentation and resembles a slightly flat mole. As the disease progresses, the formation increases and an ulceration appears in the center, which over time begins to heal. A ridge forms along the edges of the basilioma.
• Scleroderma-like - at the initial stage, the neoplasm resembles a light nodule with a dense consistency. As the disease progresses, it develops into a plaque covered with thinned skin.
• Exophytic or warty - this type of formation is distinguished by the fact that it does not grow deep, but grows along the surface. This type of skin pathology, basilioma, is often compared to cauliflower. This is due to the fact that the tumor looks like an inflorescence, consisting of light-colored hemispherical nodes.
• Perforating is a rare form of skin abnormality. The formations are located in those areas of the skin that are most often damaged. They look like nodules covered with ulcers. The disease is characterized by rapid development and severe destruction of nearby body tissues.
• Large nodular nodular - this type of cancer is localized in the corners of the inner eyelid, on the eyelid and in the nasobuccal folds. Basilioma does not grow inward, but outward. The skin of the tumor is pinkish or yellow with small vessels. As the disease progresses, the formation grows and affects the skin.
• Pagetoid superficial cancer is localized in closed areas of the body. The neoplasm has a flat, round shape, pinkish or dark red, edged with a ridge.
• Ulcerative or nodular - is a round, dense node. It can be clearly seen on the surface of the skin without special devices. Over time, the dermis on the tumor becomes thin, matte or shiny. As the disease progresses, the tumor enlarges, takes on an uneven shape, and the ulcer becomes deeper. The bottom is covered with a greasy coating. The tumor does not metastasize, but is characterized by destructive power.
• The adenoid tumor looks like lace. It consists of cystic structures and glandular tissues. Atypical cells are arranged in even rows, framing small cysts.

Basal cancer has two classifications of disease stages.

The first consists of five stages:

1. Null basilioma – the tumor has not developed, but there are atypical cells.
2. The first is superficial - there is a formation or ulcer with a limited location. It reaches 2 cm in size.
3. The second flat is a tumor or ulcer that exceeds 2 cm in volume and grows in the inner layer of the skin, but does not affect the fatty tissue.
4. The third is deep - the tumor exceeds three centimeters and is visible to the naked eye. Grows into the inner tissue.
5. The fourth papillary - exceeds 5 cm, affects and destroys the skeletal system and cartilage.

The second has three stages:

1. Initial – the nodule does not exceed 2 cm in diameter.
2. Expanded - the formation has ulcers and is more than 2 cm.
3. Terminal – the tumor grows into soft tissues and bones in a volume of more than 5 cm.

During diagnosis, specialists use the first classification, but the second can also be used.

Important! Codes recognized by TNM are important in determining a more accurate assessment of the location of the disease and the degree of malignancy.

The symptoms of basilioma are almost invisible at first glance. For this reason, many patients at an early stage cannot recognize the pathology. At the initial stage, the tumor is small in size and looks like a small pimple on the neck or face. As the disease progresses, the pimple develops into a painless nodule of yellowish or dull white color.

The nodules grow very slowly, for several years without causing any discomfort to the patient, only aesthetic.

Important! If the disease is in an advanced form, the tumor destroys the surrounding tissue, bones, and cartilage, which leads to severe pain.

Timely treatment of basilioma gives a positive result.

Diagnostics

Diagnosis of bcc is carried out by an oncologist and does not cause difficulties. The examination begins with a medical history, after which the specialist examines the scalp, palpates the lymph nodes, and examines the tumor. Next, the oncologist prescribes histology and ultrasound examination. This is necessary to determine the stage of the pathology and the degree of its growth.

• A biopsy is prescribed for a tumor larger than five centimeters that has an intact surface. It is carried out in several ways, numbing the puncture site:

• Using a scalpel, a piece of the tumor is excised;
• The formation is completely cut off with a blade;
• A piece of tissue is separated from the growth with a special needle;
• Resection of the source of inflammation and adjacent tissues is performed.
• Scraping is done for almost all types of formations
• A smear - an impression is taken when a neoplasm is in the form of an invasive nodule.

A biochemical blood test for skin cancer in the later stages shows an elevated level of lactate dehydrogenase.

Cytology studies the patient’s cells and helps determine whether oncology is present or whether the tumor is benign. Also, with the help of cytological analysis, the type of formation is clarified, which makes it possible to draw up an accurate treatment regimen.

Radioisotope research or positron emission tomography allows us to identify microtumors, single metastases and the location of cancer cells.

If, after all the prescribed studies, the diagnosis of skin cancer is confirmed, then additional examination may be prescribed. It is necessary for prescribing treatment and after chemotherapy.

• Examination of the lymph nodes and abdominal cavity for the presence of metastases using ultrasound.
• MRI and CT.
• Electrocardiogram.
• General blood and urine analysis.
• Biochemical analysis of blood serum.
• Hemostasiogram.
• Blood testing to determine the presence of diabetes mellitus and to establish the blood group and Rh factor.
• Chest X-ray.
• Rapid HIV test.

Important! If you find any abnormal formation on your body in the form of a nodule, plaque, ulcer or spot, you should immediately consult a dermatologist. This must also be done if the existing homeland has changed its appearance, began to hurt or become wet.

After the examination and diagnosis, the doctor will prescribe the necessary treatment.

Treatment methods

Treatment for skin basilioma is carried out by an oncologist. Therapy is carried out using various methods - surgery, radiation, laser, medication, cryogenics and complex therapy.

The treatment method is selected individually, depending on the type of formation, stage of the disease and location, as well as concomitant chronic pathologies.

Skin cancer therapy has the following goals:

• At the initial stage of the disease there is a complete cure.
• Extending the patient’s life if the cancer has metastasized or the tumor grows deep into the body.
• Improved quality of life.

Treatment of cancer patients diagnosed with basilioma is carried out on an outpatient basis, hospitalization is prescribed only for surgical intervention.

Despite the fact that the treatment of each patient is individual, the main principle must be observed - radical resection of the tumor without excision of healthy tissue.

• During surgery, the incision is made at a distance of half a centimeter from the edge of the tumor. For squamous cell skin cancer, the tissue is incised at a distance of half the diameter of the formation.
• Cryotherapy is an effective treatment method for basilioma. The procedure is simple to perform, leaves no scars, and is practically painless and bleeding-free. For RCC, cryodestruction treatment is not performed.
• Electroexcision is done in cases where the size of the tumor is insignificant.
• Destruction of a tumor using a laser is done for any type of tumor.

Indications for surgical intervention are:

• Large tumor;
• The formation has grown deep into the tissue;
• Relapse of pathology;
• The tumor was localized on the scar.

The operation has many advantages over other types of skin cancer therapy:

• Removal of all cancer cells in one procedure;
• The ability to control healthy tissue remains;
• The risk of relapse is low;
• The largest tumor can be excised.

Radiation therapy is an independent method of treating skin cancer. It is performed in cases where surgery to remove the tumor is impossible due to:

• The patient's condition does not allow the use of anesthesia;
• Large tumor, late stage cancer using supportive care;
• Hard-to-reach location;
• Relapse therapy;
• For cosmetic purposes.

Important! In order to avoid relapse of the disease, radiation is used in conjunction with surgical treatment. This is necessary to destroy any remaining cancer cells.

Chemotherapy

Skin cancer is one of those types of oncology that is difficult to treat with chemotherapy, only in the case of complex therapy - surgery or radiation.

To combat squamous cell skin cancer, the following medications are used in different combinations:

This therapy has many contraindications, and the course of treatment takes a long time. Chemotherapy is prescribed if:

• The patient chooses surgical intervention;
• There are metastases;
• Therapy for recurrent basal cell skin cancer;
• Stage 1 cancer using ointments in treatment.

External treatment

Ointment for basal cell carcinoma is prescribed to patients who have severe psychosomatics or have contraindications to other methods of therapy and if the tumor is located in an unfavorable location. For treatment, 5% dibunol liniment is prescribed. The cream is used to treat basilioma nodes or ulcers, as well as the area around them. The procedure is carried out twice a day for a month.

Photodynamic treatment

Photodynamic therapy for skin basal cell carcinoma is prescribed for single or multiple formations, for tumors of different sizes. This method is used for relapses, if another type of treatment is impossible.

This method of therapy is based on the ability of certain drugs to increase the perception of the dermis to solar and ultraviolet artificial rays. Light-sensitive substances used in treatment accumulate in the body and have a toxic effect on cancer cells after exposure to light. In addition to its toxic effects, photodynamic therapy destroys the blood vessels that feed the tumor.

Cryogenic method

Cryogenic therapy is considered the safest and most effective way to treat the disease. The principle of therapy is based on the freezing effect of the tumor followed by its destruction under local anesthesia. With this method, the patient does not change his usual lifestyle, and the rehabilitation period is short. It is with the cryogenic method of tumor treatment that a cosmetic effect can be achieved - scars on the skin are barely noticeable.

Important! Basalioma cannot be treated at home. The patient needs to remember this.

Further management of the patient

After the patient has had the tumor removed on an outpatient basis, he is observed by an oncologist every three months for two years. After this, the patient visits the doctor once every six months or a year.

When visiting an oncologist, the specialist conducts:

• General examination;
• Patient weight control;
• History of general condition;
• Inspection of the postoperative scar;
• Chest X-ray;
• Ultrasound of the lymphatic system and abdominal cavity.

The doctor talks with the patient and explains to him what is necessary:

• Visit your oncologist regularly;
• Avoid sun exposure and injury to the surgical site;
• Carry out regular examination of the skin and postoperative scar for the patient himself.

The mortality rate for skin cancer is much lower than for other types of cancer. The prognosis depends on the type of tumor and the degree of the disease. Skin cancer is a disease that can be detected in its early stages. To do this, you need to be more attentive to your body and in case of any incomprehensible formation, immediately consult a doctor.

If the disease was diagnosed on time and the correct treatment was prescribed, the patient’s five-year survival rate will be 95%. With local forms, the survival rate is 100%. In the advanced form, the prognosis is unfavorable; there is a possibility of basal cell carcinoma growing into the skull bones.

Recurrence of the disease after therapy occurs in 15% of cases within a period of one to ten years.

Prevention

Middle-aged people should remember that it is better to prevent the occurrence of basal cell carcinoma than to treat it. To do this, you need to remember a few rules:

• In summer, do not go out in the sun without sunscreen or a wide-brimmed hat between 11:00 and 16:00.
• Eat properly. Reduce your intake of animal proteins and switch to plant proteins, which are found in seeds, nuts, and beans.
• Treat old scars with care - do not injure them.
• Treat any poorly healing wounds or ulcers with special care so that they do not provoke skin cancer in the future.
• Care must be taken when working with petroleum products.

Skin basal cell carcinoma (basal cell carcinoma)

Basal cell carcinoma (syn.: basal cell carcinoma, basal cell epithelioma, ulcus rodens, epithelioma basocellulare) is a common skin tumor with pronounced destructive growth, a tendency to recur, as a rule, does not metastasize, and therefore is more accepted in the domestic literature the term "basal cell carcinoma".

ICD-10 code

Causes of skin basal cell carcinoma

The issue of histogenesis has not been resolved; most researchers adhere to the dysontogenetic theory of origin, according to which basal cell carcinoma develops from pluripotent epithelial cells. They can differentiate in different directions. In the development of cancer, importance is attached to genetic factors, immune disorders, and adverse external influences (intense insolation, contact with carcinogenic substances). It can develop on clinically unchanged skin, as well as against the background of various skin pathologies (senile keratosis, radiodermatitis, tuberculous lupus, nevi, psoriasis, etc.).

Basal cell carcinoma is a slow-growing and rarely metastasizing basal cell carcinoma that arises in the epidermis or hair follicles, the cells of which are similar to the basal cells of the epidermis. It is considered not as cancer or a benign neoplasm, but as a special kind of tumor with locally destructive growth. Sometimes, under the influence of strong carcinogens, primarily X-rays, basal cell carcinoma develops into basal cell carcinoma. The question of histogenesis has not yet been resolved. Some believe that basaliomas develop from the primary epithelial rudiment, others - from all epithelial structures of the skin, including from embryonic rudiments and malformations.

Risk factors

Provoking factors are insolation, UV, X-rays, burns, and arsenic intake. Therefore, basal cell carcinoma often occurs in people with skin types I and II and albinos who are exposed to intense sun exposure for a long time. It has been established that excessive sun exposure in childhood can lead to the development of a tumor many years later.

The epidermis is slightly atrophic, sometimes ulcerated, and there is a proliferation of tumor basophilic cells similar to the cells of the basal layer. Anaplasia is mild, mitoses are few. Basalioma rarely metastasizes, since tumor cells that enter the bloodstream are not capable of proliferation due to the lack of growth factor produced by the tumor stroma.

Pathomorphology of skin basalioma

Histologically, basal cell carcinoma is divided into undifferentiated and differentiated. The undifferentiated group includes solid, pigmented, morphea-like and superficial basal cell carcinomas, the differentiated group includes keratotic (with piloid differentiation), cystic and adenoid (with glandular differentiation) and with sebaceous differentiation.

The WHO international classification (1996) identifies the following morphological variants of basal cell carcinoma: superficial multicentric, codular (solid, adenoid cystic), infiltrating, non-sclerosing, sclerosing (desmoplastic, morphea-like), fibro-epithelial; with adnexal differentiation - follicular, eccrine, metatypical (basosquamous), keratotic. However, the morphological boundary of all varieties is unclear. Thus, in an immature tumor there may be adenoid structures and, on the contrary, with its organoid structure, foci of immature cells are often found. Also, there is no complete correspondence between the clinical and histological pictures. Usually there is correspondence only for such forms as superficial, fibroepithelial, scleroderma-like and pigmented.

For all types of basal cell carcinomas, the main histological criterion is the presence of typical complexes of epithelial cells with dark-colored oval nuclei in the central part and palisade-like complexes located along the periphery. In appearance, these cells resemble basal epithelial cells, but differ from the latter in the absence of intercellular bridges. Their nuclei are usually monomorphic and not subject to anaplasia. The connective tissue stroma proliferates together with the cellular component of the tumor, located in the form of bundles among cellular cords, dividing them into lobules. The stroma is rich in glycosaminoglycans, staining metachromatically with toluidine blue. It contains many tissue basophils. Retraction gaps are often detected between the parenchyma and stroma, which many authors regard as a fixation artifact, although the possibility of exposure to excessive secretion of hyaluronidase is not denied.

Solid basal cell carcinoma among undifferentiated forms it occurs most often. Histologically, it consists of various shapes and sizes of strands and cells of compactly located basaloid cells with unclear boundaries, resembling a syncytium. Such complexes of basal epithelial cells are surrounded at the periphery by elongated elements, forming a characteristic “picket fence”. Cells in the center of the complexes can undergo dystrophic changes with the formation of cystic cavities. Thus, along with solid structures, cystic ones can exist, forming a solid-cystic variant. Sometimes destructive masses in the form of cellular detritus are encrusted with calcium salts.

Pigmented basal cell carcinoma Histologically it is characterized by diffuse pigmentation and is associated with the presence of melanin in its cells. The tumor stroma contains a large number of melanophages with a high content of melanin granules.

An increased amount of pigment is usually detected in the cystic variant, less often in the solid and superficial multicentric. Basaliomas with pronounced pigmentation contain a lot of melanin in the epithelial cells above the tumor, throughout its entire thickness up to the stratum corneum.

Superficial basal cell carcinoma often multiple. Histologically, it consists of small, multiple solid complexes associated with the epidermis, as if “suspended” from it, occupying only the upper part of the dermis to the reticular layer. Lymphohistiocytic infiltrates are often found in the stroma. The multiplicity of foci indicates the multicentric genesis of this tumor. Superficial basal cell carcinoma often recurs after treatment along the periphery of the scar.

Scleroderma-like basal cell carcinoma, or the “morphea” type, is distinguished by the abundant development of scleroderma-like connective tissue, in which narrow cords of basal epithelial cells are “embedded”, extending deep into the dermis down to the subcutaneous tissue. Polygarden-like structures can be seen only in large strands and cells. Reactive infiltration around tumor complexes located among the massive connective tissue stroma is usually scanty and more pronounced in the zone of active growth on the periphery. Further progression of destructive changes leads to the formation of small (cribrosiform) and larger cystic cavities. Sometimes destructive masses in the form of cellular detritus are encrusted with calcium salts.

Basal cell carcinoma with glandular differentiation, or adenoid type, is characterized by the presence, in addition to solid areas, of narrow epithelial strands consisting of several, and sometimes 1-2 rows of cells forming tubular or alveolar structures. The peripheral epithelial cells of the latter have a cubic shape, as a result of which the polysad-like character is absent or less clearly expressed. The internal cells are larger, sometimes with a pronounced cuticle; the cavities of the tubes or alveolar structures are filled with epithelial mucin. The reaction with carcinoembryonic antigen produces positive staining for extracellular mucin on the surface of cells lining the duct-like structures.

Basal cell carcinoma with cyloid differentiation characterized by the presence of keratinization foci in complexes of basal epithelial cells, surrounded by cells similar to spinous ones. In these cases, keratinization occurs bypassing the keratohyaline stage, which resembles the keratogenic zone of the isthmus of normal hair follicles and may have tricho-like differentiation. Sometimes there are immature milked follicles with initial signs of the formation of hair shafts. In some cases, structures are formed that resemble embryonic hair buds, as well as epithelial cells containing glycogen, corresponding to the cells of the outer layer of the hair follicle. Sometimes there may be difficulty in differentiating from follicular basaloid hamartoma.

Basal cell carcinoma with sebaceous differentiation It is rare and is characterized by the appearance of foci or individual cells typical of the sebaceous glands among the basal epithelial cells. Some of them are large, signet-shaped, with light cytoplasm and eccentrically located nuclei. When stained with Sudan III, fat is revealed in them. Lipocytes are much less differentiated than in a normal sebaceous gland; transitional forms are observed between them and the surrounding basal epithelial cells. This indicates that this type of cancer is histogenetically associated with the sebaceous glands.

Fibroepithelial type(syn.: Pincus fibroepithelioma) is a rare type of basal cell carcinoma that occurs mostly in the lumbosacral region and can be combined with seborrheic keratosis and superficial basal cell carcinoma. Clinically it may look like fibropapilloma. Cases of multiple lesions have been described.

Histologically, narrow and long cords of basal epithelial cells are found in the dermis, extending from the epidermis, surrounded by a hyperplastic, often edematous, mucoid-altered stroma with a large number of fibroblasts. The stroma is rich in capillaries and tissue basophils. Epithelial strands anastomose with each other and consist of small dark cells with a small amount of cytoplasm and round or oval, intensely stained nuclei. Sometimes in such cords there are small cysts filled with homogeneous eosinophilic contents or horny masses.

Nevobasocellular syndrome(syn. Gordin-Goltz syndrome) is a polyorganotropic, autosomal dominant syndrome related to phakomatoses. It is based on a complex of hyper- or neoplastic changes due to disorders of embryonic development. The cardinal symptom is the appearance in the early period of life of multiple basal cell carcinomas, accompanied by odontoten cysts of the jaws and anomalies of the ribs. There could be cataracts and changes in the central nervous system. It is also characterized by frequent changes in the palms and soles in the form of “depressions”, in which basaloid structures are also found histologically. After the early nevoid-basaliomatous phase, several years later, usually during puberty, ulcerative and locally destructive forms appear in these areas as an indicator of the onset of the oncological phase.

Histological changes in this syndrome are practically no different from the types of basal cell carcinomas listed above. In the area of ​​the palmoplantar “indentations” there are defects in the stratum corneum of the epidermis with thinning of its remaining layers and the appearance of additional epithelial processes from small typical basaloid cells. Large basal cell carcinomas rarely develop in these places. Individual basal cell lesions of a linear nature include all types of organoid basal cell carcinomas.

Histogenesis of skin basalioma

Basalioma can develop both from epithelial cells and from the epithelium of the pilosebaceous complex. Using serial sections, M. Hundeiker and N. Berger (1968) showed that in 90% of cases the tumor develops from the epidermis. Histochemical examination of various types of cancer shows that in most cells glycogen and glycosaminoglycans are found in the tumor stroma, especially in adamantinoid and cylindromatous patterns. Glycoproteins are constantly detected in basement membranes.

Electron microscopy revealed that most cells of tumor complexes contain a standard set of organelles: small mitochondria with a dark matrix and free polyribosomes. There are no intercellular bridges at the contact sites, but finger-like projections and a small number of desmosome-like contacts are found. In areas of keratinization, layers of cells with intact intercellular bridges and a large number of tonofilaments in the cytoplasm are noted. Occasionally, zones of cells containing cellular membrane complexes are found, which can be interpreted as a manifestation of glandular differentiation. The presence of melanosomes in some cells indicates pigment differentiation. In basal epithelial cells, organelles characteristic of mature epithelial cells are absent, which indicates their immaturity.

It is currently believed that this tumor develops from pluripotent germinal epithelial cells under the influence of various types of external stimuli. Histologically and histochemically, the connection of basal cell carcinoma with the anagen stage of hair growth has been proven and the similarity with proliferating embryonic hair buds has been emphasized. R. Holunar (1975) and M. Kumakiri (1978) believe that this tumor develops in the germinal layer of the ectoderm, where immature basal epithelial cells with the potential for differentiation are formed.

Symptoms of skin basal cell carcinoma

Skin basal cell carcinoma has the appearance of a single formation, hemispherical in shape, often round in outline, slightly elevated above the skin level, pink or grayish-red in color with a pearlescent tint, but may not differ from normal skin. The surface of the tumor is smooth; in its center there is usually a small recess, covered with a thin, loosely adjacent squamous crust, upon removal of which erosion is usually detected. The edge of the ulcerated element is thickened like a roller, consists of small whitish nodules, usually designated as “pearls” and having diagnostic value. In this state, the tumor can exist for years, slowly growing.

Basaliomas can be multiple. Primary plural form, according to K.V. Daniel-Beck and A.A. Kolobyakova (1979), occurs in 10% of cases, the number of tumor foci can reach several dozen or more, which may be a manifestation of non-basocellular Gorlin-Goltz syndrome.

All symptoms of skin basalioma, including Gorlin-Goltz syndrome, allow us to distinguish the following forms: nodular-ulcerative (ulcus rodens), superficial, scleroderma-like (morphea type), pigmentary and fibroepithelial. With multiple lesions, these clinical types can be observed in various combinations.

Surface view begins with the appearance of a limited scaly patch of pink color. Then the spot acquires clear contours, oval, round or irregular shape. Dense small shiny nodules appear along the edge of the lesion, which merge with each other and form a roll-like edge raised above the skin level. The center of the hearth sinks slightly. The color of the lesion becomes dark pink, brown. Lesions may be solitary or multiple. Among the superficial forms, self-scarring or pagetoid basalioma is distinguished with a zone of atrophy (or scarring) in the center and a chain of small, dense, opalescent, tumor-like elements along the periphery. The lesions reach a significant size. Usually has a multiple nature and a persistent course. Growth is very slow. Its clinical features may resemble Bowen's disease.

At pigmented form the color of the lesion is bluish, purple or dark brown. This type is very similar to melanoma, especially nodular, but has a denser consistency. Dermoscopic examination can provide significant assistance in such cases.

Tumor type is characterized by the appearance of a nodule, which gradually increases in size, reaching 1.5-3 cm or more in diameter, acquires a rounded appearance, and a stagnant pink color. The surface of the tumor is smooth with pronounced telangiectasias, sometimes covered with grayish scales. Sometimes its central part ulcerates and becomes covered with dense crusts. Rarely, the tumor protrudes above the skin level and has a stalk (fibroepithelial type). Depending on the size they distinguish small and large nodular forms.

Ulcerative appearance occurs as a primary variant or as a result of ulceration of the superficial or tumor form of the neoplasm. A characteristic feature of the ulcerative form is a funnel-shaped ulceration, which has a massive infiltrate (tumor infiltration) fused with the underlying tissues with unclear boundaries. The size of the infiltrate is much larger than the ulcer itself (ulcus rodens). There is a tendency to deep ulcerations and destruction of underlying tissues. Sometimes the ulcerative form is accompanied by papillomatous, warty growths.

Scleroderma-like, or scar-atrophic, appearance It is a small, clearly demarcated lesion with a thickening at the base, almost not rising above the level of the skin, yellowish-whitish in color. Atrophic changes and dyschromia may be detected in the center. Periodically, along the periphery of the element, foci of erosion of various sizes may appear, covered with an easily removable crust, which is very important for cytological diagnosis.

Pincus fibroepithelial tumor classified as a type of basal cell carcinoma, although its course is more favorable. Clinically, it manifests itself in the form of a skin-colored nodule or plaque, of dense elastic consistency, and practically does not undergo erosion.

How to treat basalioma of the skin of the nose

Basalioma of the skin of the nose (basal cell carcinoma, basal cell carcinoma) is a malignant pathology growing from the basal cells or structures of the hair follicle. But not all oncologists think so. Many people believe that basal cell carcinoma is an intermediate link between nevi and carcinomas. The pathology extremely rarely metastasizes and is the most common among all skin cancers. In the advanced stage of the disease, the neoplasm can melt the underlying skin layers, muscles, even cartilage and bones.

Basalioma of the skin of the face and nose

The pathology develops extremely rarely in children and is practically not registered in newborns. Both men and women in the age group over 50 years old are equally affected. The disease is coded C 44 (other malignant neoplasms of the skin) according to ICD 10. So how to treat basalioma and how to quickly identify it?

Classification and causes of neoplasm: briefly

Correct classification for basal cell carcinoma of the face and nose is very important. Further treatment and the correct choice of specific therapy method depend on the type of tumor. There are 4 stages of neglected pathology, where the first stage is the beginning of the disease, and the 4th stage is the final stage of the disease, often leading to irreversible consequences for the whole organism (cachexia, melting of bone tissue, etc.). Features of the classification of the disease include the identification of several forms of basal cell carcinoma. These include: nodular, superficial, cicatricial, ulcerative.

The causes of the disease remain unclear, since all the triggers for the onset of the disease have not been identified. For decades now, such a topic has been a subject of dispute among world-famous aesculapians. There are certain predisposing factors that increase the risk of pathology. Let's list some of them:

• prolonged exposure to aggressive UV radiation, including in a solarium;
• radiation;
• burdened heredity;
• persistent decrease in immunity;
• age;
• albinism;
• obligatory precancerous conditions (Bowen's disease, Paget's disease, Queyra's erythroplasia)
• relative precancerous pathologies (keloid scars, cutaneous horn, syphilitic gummas or granulomas, tuberculosis, etc.);
• contact with petroleum derivatives or tar;
• exposure to strong chemical irritants, especially arsenic;
• occupational hazards (high temperatures, finely dispersed pollution, constant injury to the skin area).

Symptoms of the disease

Symptoms of basalioma of the facial skin are similar to the manifestations of a neoplasm on the wings of the nose. The symptoms depend on the type of disease and quite clearly characterize the form of the disease. To identify it, you should carefully examine the appearance, quantity, size and shape of the tumor. An experienced oncologist will be able to make the correct diagnosis.

Nodular (nodular) basalioma, located on the skin of the face, is characterized by a rounded shape. The knot is pink in color and has a small pit (notch) in the center. Even the slightest trauma to the tumor is the beginning of bleeding, which is difficult to stop. It is often complicated by the formation of erosive and ulcerative surfaces, which complicates treatment.

The ulcerative form of basal cell carcinoma is the most dangerous. It melts the surrounding tissue, the ulcerative bottom is localized below the level of the epidermis. The ulcerative edges do not have a clear shape and rise above the epidermal layer of the skin. Sometimes the ulcer can “heal”, becoming covered with a dense, hard, almost black crust. If this cover is disturbed, a greyish, blackish or scarlet bottom will be exposed. The following symptoms are also typical:

• color grayish-pinkish;
• dense consistency;
• tendency to re-grow after treatment;
• slow, almost imperceptible growth;
• in advanced cases, ulcerative surfaces form along the edges of the tumor.

Superficial basal cell carcinoma is a borderline condition between a benign and a malignant process. As a pathology, it develops in people after 50 years of age, damaging exposed areas of the epidermis. On the face, the most dangerous tumor formation is considered to be the area affected by the inner and outer corners of the eye. It grows “inside out”, rising as a pink spot above the surrounding tissues. The skin over the tumor is thin, has an atrophic appearance, and often ulcerates.

All types of basal cell carcinoma, especially the solid form, are absolutely painless. A lot of time passes from the first manifestation to contacting a specialist; the neoplasm manages to grow many times over, which worsens the prognosis of the disease. With multiple lesions, the tumor leads to cachexia, severe, frequent bleeding, and destruction of bone tissue. All types of neoplasms and outcomes from lack of treatment can be seen in the photo.

Diagnostics

Diagnostic methods are aimed at verifying the diagnosis and preventing medical errors. Nasal basalioma requires histological examination. A small section of skin is sent to a histologist. After the study, the type of cancer, the degree of development and the type of cancer cells are determined. Histology is prescribed in all doubtful cases, to exclude other skin diseases that have similar symptoms.

Skin cancer - description.

Short description

Malignant skin diseases account for about 25% of cancers. Skin cancer usually occurs on exposed areas of the body; characterized by slow growth, late and rare metastasis, in 90% of cases it affects the scalp or neck. Main histological forms- squamous cell (30%) and basal cell (basal cell carcinoma) cancer (60%).

Basal cell carcinoma- characterized by limited and slow growth. Clinical picture The disease begins with the appearance on the skin of a small, clearly demarcated nodule with a smooth surface of pink or red color. Characterized by the presence of a translucent pearly belt. The tumor can contain varying amounts of melanin pigment, so its color varies from pink to dark brown. As the nodule grows, its central part ulcerates and becomes covered with crusts. The tumor can be represented by nodes - satellites or a central area of ​​ulceration covered with a crust. Common sign- concomitant telangiectasia. The tumor can ulcerate and invade underlying tissues. Types basal cell carcinoma: superficial, nodular, pigmented, scleroderma-like (sclerosing). There is no metastasis.
Squamous cell carcinoma Squamous cell carcinoma consists of stratified squamous epithelial cells, often keratinizing. Tumor cells are held together by desmosomes (intercellular bridges in a light microscope). The central part of the epithelial nests may contain concentric aggregates of keratin (keratin pearls). The tumor grows rapidly and metastasizes (hematogenously and lymphogenously). Genetic aspects. Ferguson Smith epithelioma (*132800, 9q31, ESS1 gene, Â). Clinical picture The tumor is represented either by satellite nodes or by a crusty central area of ​​ulceration. Localization of the tumor: lips, paranasal and axillary areas.
Bowen's disease- a form of intraepidermal squamous cell carcinoma or carcinoma in situ. Occurs on the skin and mucous membrane of the oral cavity. More often it manifests itself as nodular-type rashes or limited erythematous plaques covered with a yellow keratinized crust or scales. They can merge with each other into large areas, often with papillomatous growths. Appears during the 4th–6th decade of life. Undifferentiated cancer often develops against the background of Bowen's disease.

Rare forms
Basal cell carcinoma with whiteheads and coarse sparse hair (109390, Â vs. À dominant). Basal cell carcinoma, multiple whiteheads on the face and extremities, increased sweating, increased facial pigmentation, coarse and sparse hair on the head.
Basal cell nevus syndrome (*109400, loci 9q22.3 - q31 and 9q31, PTCH and BCNS genes, B). Multiple basal cell carcinoma of the skin with cysts of the jaws, erythematous pits on the palms and soles, and (often) skeletal abnormalities, especially the facial one. More rare symptoms: strabismus, hypertelorism, coloboma, glaucoma, kyphoscoliosis, defects of the ribs and cervical vertebrae, cysts and fibromas of parenchymal organs, ovarian cancer, brachydactyly, possible mental retardation. Significantly increased sensitivity to x-ray radiation.
Basal squamous cell carcinoma of the skin in structure and biological behavior is considered as a transitional form between basal cell carcinoma and squamous cell carcinoma; the term is not used for the keratotic variant of basal cell carcinoma, which contains basal-type tumor cells, as well as small areas with incomplete keratinization. Synonyms: basal squamous cell carcinoma, intermediate carcinoma, metatypical carcinoma, basal squamous cell carcinoma, mixed cancer Rombo syndrome is named after the oldest member of a family affected by this pathology for many generations.
TNM - classification (see also Tumor, stages) Tx - insufficient data to assess the primary tumor Tis - carcinoma in situ T0 - the primary tumor is not determined T1 - tumor up to 2 cm in the greatest dimension T2 - tumor up to 5 cm in the greatest dimension T3 - tumor more than 5 cm in the greatest dimension T4 - a tumor growing into the underlying structures: cartilage, skeletal muscle, bones In the case of synchronous development of multiple tumors, classification is made according to the largest of them, and the number of tumors is indicated in parentheses - T2(5) Nx - cannot be determined condition of regional lymph nodes N0 - No metastases in regional lymph nodes N1 - there are metastases in regional lymph nodes.

Grouping by stages Stage 0: TisN0M0 Stage I: T1N0M0 Stage II: T2–3N0M0 Stage III T3N0M0 T1–4N1M0 Stage IV: T1–4N0–1M1.
Treatment Skin cancer currently does not cause serious problems due to its slow growth and diagnosis, as a rule, in the early stages.
Close focus radiation therapy. Used for facial tumors (to avoid cosmetic defects). Recovery occurs in 90% of cases. The disadvantages of the method are depigmentation and atrophy of the skin in the areas of irradiation.
X-ray therapy is the optimal treatment method for patients with high surgical risk (for example, the elderly). Sometimes the method is used for cosmetic reasons (for example, when basal cell carcinoma is localized on the lips and eyelids). Application and interstitial methods (brachytherapy) are also used.
Excision with primary wound closure. Allows you to examine a tissue sample with healthy edges. If necessary, plastic surgery is performed at the same stage. For large tumors (T3), preoperative remote gamma therapy is indicated, followed by wide excision of the tumor and autodermoplasty. Excision of regional lymph nodes is indicated only if they are affected. Regional lymphadenopathy often accompanies ulcerated formations. Differential diagnosis with various processes (including tumors) is necessary. Tumors of the sweat glands are rarely recorded neoplasms of the exocrine (both ordinary and apocrine) glands - they occur in old age. They often metastasize to regional lymph nodes, so the latter are removed during excision of the primary tumor. 5 - year survival rate - 40%.
Micrographic surgery Mosaics involves drawing the contours of the tumor to determine the extent of resection. The method is acceptable for tumor recurrences, sclerosing form of the tumor, tumor localization on the nose and in the paranasal space. The cure rate is 99%, and immediate repair provides good cosmetic results.
Basaliomas of the area of ​​the nasolabial folds, medial and lateral canthus and retroauricular zone are clinically aggressive. They can grow deeply and therefore require extensive resection.
Cryotherapy. The likelihood of scarring is minimal.
Electrodissection. Used for tumors with a diameter of less than 1 cm and in elderly people.
Local treatment with ointments (colchamine 0.5%; prospidin 50%) is carried out in weakened (elderly) patients if there are contraindications to radiotherapy or refusal of surgery.
Recurrences are treated with wide excision.
Prophylactic lymphadenectomy is not indicated.
Chemotherapy is carried out only for extensive inoperable forms, when other treatment options have been exhausted.

Course and prognosis Adequate treatment ensures recovery in 90–95% of cases. The largest number of relapses occurs during the first 5 years after tumor removal.
Prevention Prevention of prolonged exposure to direct sunlight on the skin, use of sunscreens Regular self-examination of the skin by patients for timely detection of tumors Prevention of contact with the skin of inorganic arsenic compounds.

ICD-10 C44 Other malignant neoplasms of the skin D04(0 - 9) Cancer in situ

Malignant neoplasms (tumors) of the eyelids

Protocol for providing medical care to patients with malignant neoplasms of the eyelids

ICD code - 10
C 44.1
From 49.0

Signs and diagnostic criteria:

Skin cancer of the eyelids (basal cell carcinoma, basal cell carcinoma)- develops in middle-aged and elderly people, is located on the lower eyelid or in the corner of the eye, manifests itself in two forms - nodular form - a nodule of hard consistency, often telangiectasia along the edge of the nodule, an ulcer forms in the center of the tumor; flat form (squamous cell carcinoma) - hard consistency with ill-defined edges. It may appear as a scaly, red, flat lesion or cutaneous horn. Basal cell carcinoma does not metastasize, but is accompanied by local invasion, especially when localized in the corner of the eye.

Spinocellular epithelioma- a nodular formation that enlarges, becomes lumpy, and subsequently disintegrates to form an ulcer. Gives metastases to regional lymph nodes. Localized on the upper or lower eyelid.

- first looks like a chalazion, which recurs after removal; can metastasize and spread to the orbit; has progressive growth, an ulcer forms that destroys the eyelid.

Fibrosarcoma- a childhood tumor, localized on the upper eyelid, has the appearance of a subcutaneous node without clear boundaries, the skin is bluish in color, telangiectasias of widespread vessels are visible. As the tumor enlarges, ptosis is observed, and the eye shifts downward—orbital damage.

Kaposi's sarcoma- a tumor in the form of a red or purple subepidermal node. Occurs in HIV-infected patients.

Melanoma- can be in the form of flat lesions with fuzzy edges of a light brown color or a nodular form - protrudes above the skin, pigmented, has progressive growth, ulcers form, spontaneous bleeding is noted. Gives metastases.

Levels of medical care:
Third level - ophthalmology hospital

Examinations:
1. External inspection
2. Visometry
3. Perimetry
4. Biomicroscopy
5. Ophthalmoscopy

Mandatory laboratory tests:
1. General blood test
2. General urine test
3. Blood on RW
4. Blood sugar
5. Hbs antigen

Consultations with specialists according to indications:
1. Pediatrician
2. Therapist
3. Oncologist (if necessary)

Characteristics of treatment measures:

Eyelid skin cancer (basal cell carcinoma, basal cell carcinoma)— surgical removal of the tumor with simultaneous plastic surgery of surrounding tissues; cryodestruction; brachytherapy, chemotherapy; orbital exenteration.

Spinocellular epithelioma— tumor removal, radiation therapy

Adenocarcinoma (cancer of the meibomian or sebaceous gland)— removal of the tumor with simultaneous plastic surgery of the surrounding tissues; irradiation with a narrow medical proton beam, chemotherapy, if the tumor spreads to the fornix, bulbar conjunctiva - orbital exenteration.

Fibrosarcoma— removal of the tumor with simultaneous plastic surgery of the surrounding tissues; radiation therapy, chemotherapy; orbital exenteration.

Kaposi's sarcoma— cryodestruction, laser cutting, radiation therapy, chemotherapy, immunotherapy.

Melanoma— melanomas no larger than 10 mm in diameter are subject to surgical treatment and, in the absence of metastases, removal using a laser scalpel or electric knife with simultaneous plastic surgery of the surrounding tissues; radiation therapy - a narrow medical proton beam (an alternative is orbital exenteration). Cryodestruction for melanomas is contraindicated!

If it is impossible to carry out adequate treatment on site, refer the patient to the onco-ophthalmology center of the Institute of Eye Diseases and Tissue Therapy named after V.P. Filatov AMS of Ukraine.

If the tumor grows into the orbit - orbital exenteration, radiation therapy, chemotherapy.

After removal of tumors, a mandatory histological examination of the removed tissue is required.

Treatment quality criteria:
No inflammatory symptoms, cosmetic effect.

Possible side effects and complications:
Relapse of the disease, invasion into the orbit

Dietary requirements and restrictions:
No

Requirements for the regime of work, rest and rehabilitation:
Patients are unable to work for 2 weeks. Further periods of disability depend on radiation or chemotherapy treatment.

The article was written based on materials from the sites: onkoexpert.ru, ilive.com.ua, kakiebolezni.ru, gipocrat.ru, zrenue.com.

There are 2 classification options for determining the stage of skin cancer (squamous cell or basal cell, excluding melanoma). One, is widely used by most oncologists. The other is intended for oncodermatology specialists. There are not many differences between them. The stages established by one and the other systems most often coincide.
Skin cancer stages are determined based on three signs. For this purpose, the TNM system was created, where the T characteristic refers to the tumor itself, the N characteristic refers to regional lymph nodes, and M encrypts metastases. Knowing the indicators in the TNM system, you can determine the stage using the table.
Also indicated and deciphered in the article.

Determination of the stage of skin cancer in the old classification.

In order to determine the stage of skin cancer in the old classification, first, the maximum size of the tumor is determined. If in one place the tumor reaches 2 cm, and in another, already 3 cm, take the largest value.

There may be several options here:

• If the growth is less than 2 cm in size and does not grow anywhere, then its size is encrypted as T1.
• If the tumor size is from 2.1 cm to 5 cm, then it is encrypted as T2.
• If the tumor is more than 5 cm in diameter and has not grown anywhere, it is encrypted as T3.
• If skin cancer grows into the muscles, cartilage and bones located underneath it, it is assigned a T4 code.
• Tis means Bowen's disease, it doesn't matter what size the tumor is, the main thing is that histology has confirmed it.

Metastases to regional lymph nodes are denoted by the letter N. If the lymph node is not classified as regional, then its lesion already falls into the M1 category (which means stage 4 skin cancer). To know which lymph nodes are regional, you need to know the structure of the lymphatic system and the pathways of lymph drainage from a specific region of the skin.
If damage to regional lymph nodes is detected (by palpation, ultrasound, puncture), then in the old classification the indicator is simply assigned the value N1. If regional lymph nodes are not affected - N0. There are no other meanings provided in the old classification.
The M indicator is related to distant metastases. In the old and new divisions of the stage of skin cancer, the methods for determining it are the same. When there are no metastases, M0 is assigned. When they are - M1.

Table for determining the stage of skin cancer based on TNM signs (old classification).

Skin cancer stage	T	N	M
0 Stage	Tis	N0	M0
First stage	T1	N0	M0
Second stage	T2	N0	M0
Second stage	T3	N0	M0
Third stage	T4	N0	M0
Third stage	T1-T3	N1	M0
Fourth stage	Any T	Any N	M1
Fourth stage	T4	N1	M0

Skin cancer stage one. Dimensions up to 2 cm in diameter, does not grow deeply. Regional lymph nodes are not affected. There are no distant metastases.

The photo shows stage 2 skin cancer in the form of a flattened growth. The dimensions are more than 2 cm, the thickness is large. Regional lymph nodes are not affected. There are no metastases.

Stage 3 skin cancer is more than 5 cm in diameter and more than 2 mm in thickness with signs of low differentiation. Regional lymph nodes are not affected.

The photo shows stage 4 skin cancer with invasion of the skull bones (visible on x-ray). To the touch there is an increase in regional lymph nodes.

New classification for determining the stage of skin cancer.

In the new system, tumor size is no longer so important. Risk factors are taken into account, the main one being depth. And growth into the bone does not always mean T4.
The new classification differs in the size of lymph nodes and their number. From here we get N1, N2, N3. But this doesn’t change the meaning much. Is it possible that metastases not only to distant organs or distant lymph nodes, but also large metastases to regional lymph nodes are now equated to the fourth stage of skin cancer.
The size of the lymph nodes is determined by the maximum dimension. Typically, the length of a lymph node exceeds its width. If there is only one lymph node, no more than 3 cm, then it is assigned N1 status. If there is only one lymph node, but its size is from 3 to 6 cm, or there are several lymph nodes, and they are all up to 6 cm, then the value N2 is assigned. If the lymph node is more than 6 cm in diameter, then the indicator N3 is set. When everything is fine with the lymph nodes.

Characteristics according to the TNM system for determining the stage of skin cancer (new classification).

Values	Their signs
Tis	Bowen's disease (by histology);
T1	Up to 2 cm in size, and there are less than two risk factors;
T2	The tumor is more than 2 cm in diameter. Or the tumor is smaller, but 2 or more risk factors are present;
T3	Growth into the bone of the upper jaw, lower jaw, orbit or temporal bone of the skull;
T4	Germination into the bones of the skeleton, base of the skull;
N0	No regional metastases;
N1	Regional metastasis in only 1 lymph node on the same side, less than 3 cm in diameter;
N2	Metastasis to 1 regional lymph node from 3 to 6 cm. Or metastases to regional lymph nodes up to 6 cm in diameter;
N3	Metastases to reginal lymph nodes more than 6 cm in maximum dimension;
M0	No metastases;
M1	Metastases to distant lymph nodes or internal organs.

Determining the stage of skin cancer using a new classification.

Skin cancer stage	T	N	M
0 Stage	Tis	N0	M0
First stage	T1	N0	M0
Second stage	T2	N0	M0
Third stage	T3	N0	M0
Third stage	T1-T3	N1	M0
Fourth stage	Any T	Any N	M1
Fourth stage	T1-3	N2	M0
Fourth stage	T4	N0	M0

Skin cancer code according to ICD-10 (and basal cell carcinoma).

This classification is for service purposes only. C 44 means skin cancer (basal cell carcinoma or squamous cell carcinoma). The number after the dot indicates a specific region. This is important for statistics and for financial calculations.

Codes by region in ICD-10:

• C44.0 Lip skin
• C44.1 Skin of the eyelid, including the commissure of the eyelids;
• C44.2 Ear and external auditory canal;
• C44.3 Other and unspecified parts of the face;
• C44.4 Scalp and neck;
• C44.5 Torso;
• C44.6 Skin of the upper limb, including the shoulder girdle area;
• C44.7 Lower limb, including hip area;
• C44.8 Skin cancer extending beyond one or more of the above areas;
• C44.9 Malignant neoplasms of skin, unspecified area.

Code in the histological report indicating the degree of differentiation.

Sometimes, for greater importance, oncologists can include the G indicator in the diagnosis. It can be important in distinguishing between the first and second stages of skin cancer. Indicates the degree of differentiation.

G values ​​in skin cancer diagnosis:

• G1 - highly differentiated;
• G2 - moderately differentiated;
• G3 - low differentiated;
• G4 - undifferentiated.

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