DR. MED. KALVIS PASTARS
Certified plastic surgeon, microsurgeon, hand surgeon.
View
Skin cancer is still the most common cancer in the world.
Although it is more common in people over 50, the incidence among younger people (under 30) has also been on the rise recently.
The risk group includes
The main carcinogenic factor in the development of skin tumors is ultraviolet radiation. Therefore, most of these tumors (> 85% of cases) develop in areas of the body exposed to the sun. In patients with a history of a personal or family oncological disease, the risk of developing skin cancer increases by 40%.
Skin cancer refers to a group of skin tumors that includes different types of malignant skin tumors.
They are made up of cells from different layers of the skin, and each type of skin cancer has its own characteristics and course. There are basically two groups of skin cancers:
Basaloma has different forms with different characteristics and varying severity. Nodular and superficial basal cell carcinomas are low-risk basal cell carcinomas with a relatively low risk of recurrence. Infiltrators are the most aggressive forms with a high risk of relapse. Basal cell carcinomas are very rare.
The localization and size of the basal cell carcinoma are important in assessing the severity and the risk of recurrence. Anatomical risk areas for non-melanoma tumors include the central part of the face, eyelids, eyebrows, eye area, nose, lips, chin, and jaw, as well as the area around the ears and temples, scalp, hands, and feet (especially if the tumor has reached size exceeding 6 mm).
Clinical picture:
It should be noted that basal cell carcinoma is initially painless and does not cause any complaints, so it is important to have a regular body examination and, in case of doubt, see a doctor to review any suspicious or proliferative formations on the body, especially in high-risk patients and after the summer season.
Prolonged reddening of the skin, itching, peeling of the skin (flaking), a new birthmark or a change in the existing birthmark, a chronic non-healing wound or ulcer that does not heal within 2 weeks or periodically scabs and alternates with bleeding episodes, may indicate malignant skin cancer.
At these times, be sure to go to the doctor to track the potential development of skin cancer. There are different forms of basal cell carcinoma.
Nodular basal cell – initially reminiscent of the rise of flesh or mother-of-pearl color above the skin or nodule, in which a cavity is formed over time with transparent or mother-of-pearl rounded edges and clearly visible tiny blood capillaries on their surface. Even minor trauma (such as wiping your face with a towel after washing) can cause surface bleeding. At this point, a scab forms, which is easily broken again, causing a small amount of surface bleeding. All this time, the formation is slowly progressing in size.
Ulcerated basal cell carcinoma – at the moment when the nodular basal cell carcinoma begins to form on the surface, it becomes an ulcerated basal cell carcinoma. Over time, the nodular formation acquires a wide range.
Superficial basal cell carcinoma – usually localized on the body (abdomen, back), less often on the extremities. The lighter raised edge of the pearl color borders the red central part with peeling skin or scales. The formation is very often reminiscent of eczema, psoriasis, or a source of fungal infection of the skin. Typically, these areas of the skin respond poorly or not at all to treatment.
Infiltrating or sclerosing basal cell carcinoma – usually flat or even sunken and resembling a scar with peeling skin, yellowish-pale color, with indistinct borders, palpable to the touch.
Pigmented basal cell carcinoma can resemble any other pigmented formation. All of the above forms of basal cell carcinoma can be pigmented at the same time. It is more common in people with darker skin phototypes.
Diagnostics
An experienced doctor will issue the diagnosis easily. Dermatoscopy of skin formations can be informative, helping to define the morphological type of tumors, tumor boundaries, aggressive forms, and the optimal biopsy site more precisely. However, the diagnosis can be confirmed only by cytological or histological analysis.
Treatment:
The main goal of treatment is to perform complete excision of the formation within the boundaries of healthy tissues, reducing the risk of relapse and achieving the best possible cosmetic result. The treatment of skin tumors, especially in the head and neck area, is very complicated because, in addition to oncology treatment, patients have high aesthetic requirements, which also require a high level of reconstructive and plastic surgery skills. The choice of treatment depends on the type of tumor, its location, its spread, and the general condition of the patient. There are also methods of applying topical medications, lasers, curettage, and cryotherapy. However, studies recommend these methods when surgical treatment is not possible.
“Gold” standard therapy in the treatment of skin cancer today is surgical excision, which has proven to be the safest method, as it provides the best treatment and aesthetic results. Studies have shown that a cut excised> 4 mm in healthy tissue provides a long-term cure of the tumor in up to 95% of cases.
At the microsurgery center, it is possible to perform microsurgical excision of tumors under optical magnification, performing microscopic resection lines during the operation, as well as performing reconstructive and / or plastic surgery at the end of the operation, using local plastic options. If necessary, tissues from other parts of the body can be transplanted microsurgically.
Forecast:
In the early stages, the incidence of skin cancer cures is 95%. Patients who do not receive treatment at an early stage are at risk of relapse, which depends on the stage of cancer. Patients with a history of skin cancer have the highest risk of relapse (30-50% of cases). Recurrence of skin cancer is most common within the first two years and accounts for up to 70% of cases. Therefore, the patient is observed for 5 years after treatment, coming to the doctor every 3-12 months.
Squamous cell carcinoma in most cases develops from the so-called cancer pathology – actinic or solar keratosis, or Bowen’s disease, which is a form of squamous cell carcinoma. It has been observed that almost 60% of squamous cell carcinoma develops from actinic keratosis, and 3-5% of Bowen’s disease progresses to invasive squamous cell carcinoma.
Actinic keratosis manifested as a pink, fuzzy flat area of skin covered with yellowish scales, is most commonly localized in the head, ears, neck, torso, or on the front surfaces of the feet and palms. It is also the most common localization of squamous cell carcinoma.
The localization and size of squamous cell carcinoma are important in assessing the degree of aggression and the risk of recurrence. Anatomical risk areas for non-melanoma tumors include the central part of the face, eyelids, eyebrows, eye area, nose, lips, chin, and jaw, as well as the area around the ears and temples, scalp, hands, and feet (especially if the tumor has reached size). > 6 mm).
There is a risk of metastasis in squamous cell carcinoma. The risk of metastasis is increased by tumor size (especially> 2 cm), localization in high-risk anatomical areas, type of growth ,and histological structure.
Clinical picture:
It should be noted that squamous cell carcinoma is initially painless and does not cause any complaints, so it is important to have your body examined regularly and, in case of doubt, see a doctor to review any suspected or multiplied formations. This should be strictly observed in patients at risk, especially after the summer season.
Prolonged reddening of the skin, itching, peeling of the skin (flaking), a new birthmark or a change in the existing birthmark, a chronic non-healing wound or sore for more than 2 weeks that temporarily forms scabs and alternates with bleeding episodes, giving a false impression that the wound is healing. evidence of malignant skin cancer.
At these times, be sure to see a doctor to rule out the development of skin cancer.
Diagnostics:
Dermatoscopy of skin formations can be informative, helping to define the morphological type of tumors, tumor boundaries, aggressive forms, and the best biopsy site more precisely. However, the diagnosis is confirmed only by cytological or histological analysis. In squamous cell carcinoma, regional lymph nodes should also be examined, and remote metastases should be ruled out in admitted cases.
Treatment:
The main goal of therapy is to perform complete excision of the formation within the boundaries of healthy tissues, reducing the risk of recurrence and achieving the best possible cosmetic result. The treatment of skin tumors, especially in the head and neck area, is very complicated because, in addition to oncology treatment, patients have high aesthetic requirements that require a high level of reconstructive and plastic surgery skills. The choice of treatment depends on the type of tumor, its location, its spread, and the general condition of the patient. There are also methods of applying topical medications, lasers, curettage, and cryotherapy. However, studies recommend these methods when surgical treatment is not possible.
“Gold” standard therapy in the treatment of skin cancer is currently the excision of a surgical formation, which has proven to be the safest method, as it provides the best treatment and aesthetic results. Studies have shown that formation excreted with a> 4 mm margin in healthy tissue provides a long-term cure of up to 95% of the tumor.
At the Latvian Microsurgery Center, it is possible to perform microsurgical excision of tumors under optical magnification, performing microscopic resection lines during the operation, as well as performing reconstructive and / or plastic surgery in the final stage of the operation, using local plastic options. If necessary, tissue transplantation from various other parts of the body can be performed using microsurgical techniques.
Forecast:
In the early stages, the incidence of skin cancer cures in 95% of cases. Patients who did not receive treatment at an early stage are at risk of relapse, which depends on the stage of cancer. Patients with a history of skin cancer have the highest risk of relapse (30-50% of cases). Recurrence of skin cancer is most common within the first two years and accounts for up to 70% of cases. Therefore, the patient is observed for 5 years after treatment, coming to the doctor every 3, 6, 12 months.
Melanoma is a malignant and serious skin condition. Early detection and early treatment can prevent this, but if a diagnosis is not issued early, melanoma can become a serious illness with a relatively high mortality rate. Genetic factors and environmental conditions (exposure to UV rays) play a very important role in the development of melanoma. UV-ray exposure is especially relevant for children. Melanoma develops from pigment-synthesizing cells – melanocytes. The risk of developing melanoma most often increases from the age of 50. But lately, melanoma has been more often diagnosed in younger people. In the age group of 20 to 30 years, melanoma is the most common malignancy among all tumors.
Clinical picture:
Melanoma is completely asymptomatic at the beginning of its development. In later stages, melanoma exhibits skin changes and various sensations. It is very important to evaluate and monitor changes in skin formation:
It is recommended for each person to look carefully at the entire skin surface twice a year at home in the mirror. If a suspicious formation is observed during the examination (the formation has not existed before, the formation has changed compared to the previous observations), a doctor’s consultation is required.
Melanoma comes in several forms
In situ melanoma – this is the earliest stage of melanoma or 0, when the tumor has spread only to the top layer of the skin – the epidermis. The risk of local recurrence and distal spread of these tumors is very low. Tumor diagnosis at this stage is possible thanks to dermatoscopy. Visually, melanoma at this stage is no different from a benign pigmented formation – nevus (birthmarks).
Superficial melanoma – the most common form of melanoma – ~ 70%. It usually develops in people with periodic sunburn during their lifetime. Observe any part of the body. More common in women than men. This is because women typically visit doctors more actively in case of suspicion and melanoma is diagnosed earlier. At this stage, the formation grows mainly horizontally (its diameter increases) and only slightly vertically – in deeper tissues. This type of melanoma has classic visual features.
Nodular melanoma – about 15% of all melanomas. It is more common in men than women. Also develops in any part of the body, but slightly more often on the torso, head, and neck. This type of melanoma is round, raised above the skin, characterized by rapid growth. This type of melanoma grows only vertically and has the worst prognosis.
Lentigo malignant melanoma (LMM) – up to 10-15% of all melanomas. This type of melanoma is particularly associated with prolonged and cumulative exposure to the sun. Typically, the formation is observed in the elderly in places exposed to the sun – face, lower legs, forearms. This type of melanoma often reaches large sizes – may exceed 10 centimeters in diameter, is flat, irregularly pigmented, with irregular edges. The formation is also accompanied by other chronic signs of UV damage (solar lentigo, actinic keratosis, seborrheic keratosis, basal cell carcinoma, or squamous cell carcinoma). Lentigo malignant melanoma often develops against the background of lentigo maligna (the initial form of melanoma).
Acral lentiginous and nail melanoma – for fair-skinned people on the palms and soles. Occurs relatively rare, they are 2-3% of all melanomas. More often – for dark-skinned people with IV, V, and VI skin phototypes. Like all melanomas, initially, it is an unattractive small stain or pigmented line on the nail. Non-pigmented, amelanotic melanoma is a tumor without pigmentation that visually resembles a reddish, pink, or whitish asymmetrical spot, often with irregular darker edges. Dermatoscopy is particularly useful for recognizing this tumor due to its specific features.
Diagnostics:
The diagnosis of melanoma begins with an examination, in addition to the following methods:
Ultrasonography, computed tomography, magnetic resonance imaging, lymph node scintigraphy, positron emission tomography – these are additional examination methods commonly used in metastatic melanoma.
However, the only accurate diagnostic method for melanoma is biopsy, which involves surgical excision of the formation with a deviation within the boundaries of healthy tissue and histological examination of the tissue. In case of suspicion (unclear skin formations), the pigmented formulation should only be subjected to a biopsy. It must not be treated with cryodestruction (liquid nitrogen or any other refrigerant), electrocoagulation, curettage, laser destruction, or any locally destructive means (eg celandine juice or tincture, anti-wart agents). During a proper biopsy, the formation is removed to its full depth, except for all layers of skin and adipose tissue. Excision biopsy is suitable for small (<1.5 cm in diameter) formations. Superficial shave biopsy is not permitted for cosmetic purposes. The biopsy is performed under local anesthesia. The most suitable is an elliptical incision with a scalpel to facilitate wound closure.
Treatment:
The basic treatment is surgery. The formation is excised in healthy tissues, the material is sent for histological examination. The size of the tumor, the degree of ingrowth, and the cleanliness of the excision lines are determined there. In the case of small formations, an excision biopsy is a treatment.
Additional treatments include
The group of target therapy drugs is based on the effect on a certain “target” molecule in tumor cells, which plays a role in various basic processes important to the cell – growth, division, death.
The goal of immunotherapy, in turn, is for the cells of the immune system to recognize and destroy the tumor cells.
Radiation therapy is usually used to treat solitary (single) metastases when surgical removal is not possible. Radiation therapy is also used to treat multiple head metastases, to relieve severe pain (more often to bone-localized metastases), and when surgical treatment of metastases is not possible due to localization.
At the Latvian Microsurgery Center, it is possible to perform microsurgical excision of tumors under optical magnification, performing microscopic resection lines during the operation, as well as performing reconstructive and / or plastic surgery at the end of the operation, using local plastic options. If necessary, tissue transplantation from other parts of the body can be performed in microsurgical techniques.
Prevention:
Patients with a personal history of melanoma have an increased risk not only of relapse but also of recurrence of new melanoma. Therefore, these patients should have their skin checked regularly and consult a doctor if they have any doubts. Also, avoid direct sunlight, wear sunscreen, wear appropriate clothing and a hat when staying in the sun. It is not recommended to visit solariums until the age of 35.
Skin cancer
Calculated individually
Apply for a visit through our online system and our administrator will contact you
Apply for a consultation
