Diagnosis and treatment of neoplasms in dermatological practice

Olga Vasilenko , doctor of the highest category, plastic surgeon, chief physician of the plastic surgery clinic of the Institute of Dermatology and Cosmetology Dr. Bogomolets, full member of VAPREH, OPREH and LARSO

For a patient, the word “neoplasm” always sounds quite alarming, so the doctor’s task is to prescribe the most informative diagnosis and effective treatment. This is partly due to the psychological connotations of the term, which is often used in oncology, causing unpleasant associations. But we, as specialists in the field of medicine, understand that if even a very simple disease is not treated in time, then sooner or later we will face adverse consequences for the patient’s health.

Let's talk about skin tumors that are most often encountered in a dermatology clinic.

Pyogenic granuloma

Pyogenic granuloma ( Granuloma pyogenum ), or botryomycomoma, telangiectatic granuloma, pyococcal granuloma, benign pedunculated granuloma, is a tumor-like formation, it is single, painless, round in shape, and small in size. Affects the skin and mucous membrane of the oral cavity.

Etiopathogenesis: Pyogenic granuloma is not a tumor, but a reactive response of the body to mechanical trauma, infection (Staphylococcus aureus, mixed microflora), treatment with retinoids, hormonal changes. The course of the pathology is chronic. More rarely, it develops on the basis of a flaming nevus or telangiectasia.

Visual signs: Under the influence of traumatic factors, the neoplasm quickly increases in size - from a pea to 1–1.5 cm in diameter. It has a dense elastic consistency, a smooth or granular surface (similar to a raspberry), and sometimes has a relatively thin stem. The color of the new growth is bright, dark or bluish-red, reaching even dark brown shades, and may be covered with yellowish-brown crusts, depending on the location. On the palms and soles, pyogenic granuloma is most often surrounded by a rim of exfoliated epithelium. When injured, it bleeds easily, the surrounding skin is hyperemic, pasty, and swollen. Over a long period of time and in the absence of injury, it may spontaneously decrease with the formation of fibroma.

Differential diagnosis and diagnosis: The diagnosis is made based on the clinical picture and anamnesis. Confirmation is histological examination. Differential diagnosis is carried out between hemangioma, basal cell carcinoma, squamous cell carcinoma and nodular form of melanoma.

Treatment: Previously, treatment consisted of surgical excision of the tumor. Recently, combined removal is most often used - radio wave, with contact cryodestruction of the wound bed. A histological examination is mandatory.

Prognosis: Healing duration is from 2 weeks to 1 month, depending on the size of the formation and the state of health in general. Relapse is extremely rare.

Angiokeratoma

Angiokeratoma is a collection of thin-walled blood vessels covered with a warty layer of skin. Externally it manifests itself as a capillary vascular malformation.

Visual signs: Angiokeratoma is formed by persistent subepidermal capillary dilations and changes in the epidermis with the phenomena of hyperkeratosis, papillomatosis and acanthosis. Appears in the form of soft nodules of pink and red color, sometimes with a bluish tint, with a diameter of 1 to 6 mm. After some time, keratosis appears on the surface, and at the base, the vascular part of the formation can be seen through a thin rim.

Clinical forms of angiokeratoma:

• angiokeratoma of the scrotum or vulva (Fordyce's disease) - multiple small vascular nodules (1–4 mm) of a reddish-bluish color, located on the scrotum in men and on the mucous membrane of the vaginal opening in women, sometimes along the superficial veins on the skin of the labia majora;

• limited angiokeratoma - vascular nodules of irregular shape, 2–5 mm in size, with symptoms of hyperkeratosis, from dark red to deep ink color, located mainly on the skin of the lower extremities (hips, legs, feet), and bleed when injured;

• Mibelli angiokeratoma (limited nevoid angiokeratoma of the fingers) - small vascular spots of red color, rising above the skin level, which gradually increase in size to 4-5 mm, becoming covered with hyperkeratosis and acquiring a darker color; extremely rarely, ulcerations appear in places of trauma; located on the fingers of the limbs;

• angiokeratoma solitary papular - nodules of dark red or bluish-ink color, rising above the surrounding skin, with a pronounced warty surface;

• Fabry angiokeratoma (diffuse angiokeratoma of the trunk) - multiple keratized vascular nodules the size of a pinhead, dark red in color, located on the lips, scrotum, cheeks, axillary regions, umbilical region, fingers; 20% of patients have symptoms of polyneuritis (pain in the limbs, abdomen); An in-depth study reveals trihexoceramides in the blood and urine.

Differential diagnosis and diagnosis: Clinical diagnosis is carried out on the basis of dermatoscopy, clinical manifestations and anamnesis. Differential diagnosis is carried out between verrucous hemangioma, lymphangioma, and melanoma. In cases suggesting Fabry angiokeratoma, a differential diagnosis is made with Randu-Osler disease (hereditary hemorrhagic telangiectasia).

Treatment: Consists of laser, radio wave removal, electrocoagulation. Combination therapies may also be used.

Prognosis: Healing duration is from 10 to 20 days. Poor prognosis in homozygous men, possible death from uremia or stroke before the age of 40 years.

Keratoacanthoma

Keratoacanthoma , or benign acanthoma, vegetative sebaceous cysts, pseudoepithelioma, pseudocarcinomatous molluscum, tumor-like keratosis, epithelium-like verrucoma, is a benign epithelial tumor that rises above the level of the skin. Refers to facultative precancerous diseases.

Etiology: Mechanical trauma, ultraviolet radiation, ionizing radiation, immunosuppression, chemical irritants, genetic predisposition, viral infection (HPV types 9, 16, 19, 25, 37). Keratoacanthoma is characterized by stages of development: progress (growth period), stabilization (latent phase), involution (regression).

Visual signs and pathogenesis: Hemispherical in shape, with a crater-shaped recess and horny masses in the center. It begins with the appearance of a dense nodule, filled in the center with horny masses, which in 3–4 weeks reaches a size of 2–3 cm in diameter. After 1.5–3 months, the tumor node may spontaneously decrease in size, the horny masses will fall off, and subsequently a rough scar may form.

Clinical forms of keratoacanthoma:

• typical (mollusc-shaped, crater-shaped) - a dome-shaped solitary node with a dense ridge at the base, 1–2 cm in diameter, with a crater-shaped depression in the center filled with easily separated horny masses;

• persistent - visually similar to typical, but development - more than 1 year;

• giant - identical to the first, but has a diameter of more than 2 cm;

• recurrent - keratoacanthoma that develops after initial removal, is large in size, has a long course, and is capable of malignancy.

Differential diagnosis and diagnosis: Based on the clinical picture, anamnesis and dermatoscopy. Differential diagnosis is carried out between squamous cell skin cancer (SCC), skin metastases of internal organ cancer, ulcerated form of basal cell carcinoma, senile and seborrheic keratomas.

Treatment: Laser, radio wave removal, electrocoagulation, combined treatment, contact cryodestruction and surgical excision with mandatory histological examination.

Prevention: Protection from ultraviolet radiation, contact with chemical irritants (mineral oils, gasoline, coal, etc.), avoidance of injury.

Prognosis: Favorable or relatively favorable.

For a dermatologist, one must be able to differentiate skin tumors during dermatoscopy and visual examination, as well as be responsible for diagnostic methods, and not neglect consultations with colleagues, including those from other fields of medicine. Continuous improvement of one's professional skills and knowledge is important because each clinical case is unique, as is the patient himself, to whom we are obliged to provide quality medical care.

First published: Les Nouvelles Esthetiques Ukraine, No. 3 (79), 2013