Tumors of the skin and other lesions
We already know a lot about skin tumors, especially in recent times, thanks to advances in technology and a better understanding of the biology and pathology of skin changes.
Fortunately, in most cases, any new malignant changes can be well controlled by relatively simple measures.
HOW AND WHY ARE SKIN AND SUBCUTANEOUS GROWTHS FORM?
Skin cancer and other skin and subcutaneous growths occupy a significant range of changes and possible diagnoses.
The incidence of skin cancer and the changes that precede it (precancerous lesions) are increasingly taking on real epidemic proportions. In general, skin cancer occurs in the epidermis (outer layer), making it visible. It mostly occurs on parts of the body exposed to the sun (scalp, face, lips, ears, neck, chest, arms, palms, but also the skin on the feet). The most common warning sign is a new change that does not heal. The most important risk factors are:
- naturally brighter skin complexion
- family preference
- previously treated skin cancer in the same person
- excessive sun exposure (as part of an occupation but also a hobby)
- suffered burns in childhood or adolescence
- a type of skin that reddens slightly or gets burns, blemishes or becomes painful when exposed to the sun
- light eye color (blue, green), blonde or red hair
- certain types of moles and their excessive number
The most well-known proven cause of skin cancer is ultraviolet (UV) radiation in the sun’s rays and commercial sunscreens (quartz lamps). It should be noted that both UVA and UVB contribute to the development of skin cancer. The best way to prevent this is to protect yourself from the sun.
HOW TO RECOGNIZE A SUSPICIOUS LESION?
The most common warning sign of possible skin cancer is a new change that does not heal.
Cancer can manifest as a small, smooth, shiny, pale, or protruding lump. It can also occur as a reddish change. Occasionally there is a small spot of bleeding or scab. It can also appear as a formation at the level of the skin – reddish, rough, rough stain, dry consistency.
There is also the so-called actinic keratosis, a change that looks like a rough, reddish, or brownish spot of various sizes that sometimes results in cancer. Characteristic of actinic keratosis is that it occurs in places exposed to the sun, but also elsewhere on the skin.
We recommend a clinical examination for all new changes that last longer than a month
TYPES OF SKIN CANCER
There are basically three types of skin cancer:
- Basal cell carcinoma (BCC), approximately 70-75% of cases. It usually spreads aggressively only locally, around the site of origin and grows very slowly
- Squamous cell carcinoma (SCC), about 25% of cases, may be more aggressive and rarely spreads to local lymph nodes (metastases)
- Malignant melanoma (MM), 1-5% of cases. This tumor can be very dangerous, with frequent development of regional and/or distant metastases
HOW TO TREAT MALIGNANT LESION?
If your doctor recommends, surgical removal of the entire change (or slightly less often part of it) is performed. This procedure is called a biopsy. The removed tissue sample is sent for pathohistological analysis (PHD) where the pathologist checks what kind of change it is, ie. whether the removed change corresponds to the cancer.
It should be noted that the standard treatment of skin growths is complete surgical removal, i.e. excision. Only a completely removed tumor guarantees a complete cure. In this sense, the surgeon’s task is to ensure safe (healthy) surgical borders. Of course, the aesthetics of the scar is certainly important, but not with the compromise of leaving remnant of the residual (rest) tumor.
The ideal type of removal may depend on the appearance and size of the cancer, the individual risk of scarring, age, and general health. There are several removal options:
- Surgical removal is the main and safest way. The tumor is removed with a secure healthy border that is typically a few millimeters. The resulting defect is closed by primary suturing of the wound edges or can be closed By “borrowing” tissue from the edge, ie. so called flap. Sometimes (in large lesions) a free transplant of healthy skin taken from another part of the body is sutured into the resulting defect. There is also the possibility that the wound does not close at all, but that the whole so-called secondary type of healing. For some regions on the face it is a very convenient way for the final appearance of the scar.
- Excochleation and cauterization – under local anesthesia, the cancer is removed with a sharp instrument, and the surrounding tissue is treated with a special instrument (electrocautery) to control bleeding and destroy any remnants of lesion around the borders of the wound. Most patients develop a flat, whitish scar upon completion of healing, no larger than the removed lesion.
- So called cryosurgery (freezing with liquid nitrogen) for very small changes or actinic keratosis, often used by dermatologists.
- Laser removal is sometimes used for tumors that affect very superficial parts of the skin. In similar cases, dermabrasion can be used. It is not recommended for the removal of malignant changes due to the difficult pathohistological analysis of the borders.
- Radiotherapy (radiation), a method used somewhat less frequently, in special cases and in places more difficult to access surgery
- Topical chemotherapy with cream or lotion.
We emphasize that biopsy and pathohistological analysis (PHD) of a sample of altered skin is the only way to be sure with certainty whether it is cancer.
Postoperative controls are mandatory for all skin cancers. According to some data, there is as much as a 50% chance that other skin cancers will occur after the first one is removed. The recommended time for regular check-ups is approximately 3-5 years after removal of the first tumor.
SKIN CANCER PREVENTION
Put simply, there are 5 most important ways to protect against skin cancer:
- Avoid excessive sun exposure, stay in the shade, especially at noon (10 h -16 h) when UV rays are strongest and most harmful
- Covering the skin with clothes and shoes
- Wear headgear (hat, scarf) or covering head, ears and neck
- Umbrellas that provide approximately 100% UVA and UVB protection
- Apply sunscreen or oil (SPF) 15 or more
- Surgical removal of a skin lesion with primary reconstruction: 800 – 1000 HRK
- Removal of skin lesion with local flap reconstruction or
free skin graft: 1000 – 2000 HRK
- Removal of another type of lesion on the face or neck under local anesthesia
(lipomas, etc.): 1000 – 3000 HRK
- Pathohistological analysis of the preparation (PHD): 400 HRK