Skin neoplasms: etiology and pathogenesis

Natalya Sachuk, head of the Farmosa medical center, dermatovenerologist, trichologist, dermato-oncologist, cosmetologist, member of the All-Ukrainian Academy of Dermatovenerology, Association of Psoriasis, Association of Preventive and Anti-Aging Medicine, Society of Trichologists of Ukraine, All-Ukrainian Association of Dermatovenerologists and Cosmetologists (Ukraine)

A huge danger masquerading as a cosmetic defect can be a death sentence!

Many skin defects and diseases that do not outwardly indicate danger actually border on cancer. For example, a regular seborrheic keratoma that is exposed to highly concentrated acids can turn into squamous cell carcinoma. Abuse of solariums and solar insolation, taking certain medications, infectious skin diseases and even the wrong selection of cosmetic procedures or home self-medication annually lead to an increase in precancerous and cancerous skin diseases. Every aesthetic specialist should know and remember about them.

Often, patients seek treatment for rosacea; they want to remove a “nodule,” “crust,” “papilloma,” and timely recognition of cancer will save the patient’s life and prevent the deterioration of his condition.

The group of squamous cell and basal cell skin cancers, especially melanoma, are quite dangerous, and any manipulation in the area of the tumor can provoke active growth and progression of the disease. Such patients should be referred for treatment and follow-up to an oncologist.

Skin cancer

Among malignant skin tumors, basal cell carcinoma occurs most often - about 75% of cases.

Basal cell skin cancer , basal cell carcinoma, (BCSC) is a malignant tumor, but with slow locally destructive growth and a very low ability to metastasize. It is formed from epidermal stem cells or precursor cells of the hair follicle.

The main features of BCRC are:

• red spot or irritation in the face, neck, hands that does not go away for more than a month;
• flat pink formation with elevation along the periphery;
• shiny pearl-colored knot;
• erosion or ulcer that does not heal for more than a month;
• scar zone with unclear contours and a shiny surface.

Delayed treatment or incorrect treatment tactics can lead to fatal consequences. The main primary diagnostic method is dermatoscopy and diagnostic biopsy of the formation, as a result of which the form of BCC will be clear from the histological picture.

When dermatoscopy, signs of basal cell skin cancer are the detection of a pronounced vascular pattern: tree-like vessels - in 95% of cases, linear - in 40%, polymorphic - in 20%, point vessels - in 10%.

BCC is divided into morphological forms that differ in clinical presentation, localization, and degree of aggressiveness.

Superficial occurs in young patients and is localized on the upper body, often in the form of multiple lesions. Externally, these are pink or red asymmetrical scaly spots that often ulcerate and bleed. This form of cancer grows slowly, over months or even years.

Nodular, the most common form, is localized mainly on the face, nose, ears, and back. Externally, it is a small shiny pink surface that rises above the skin like a knot; it may have a crater in the central part. It begins to bleed when it has been present for more than six months, this is the reason for contacting a dermatologist or cosmetologist.

Sclerosing - a formation of pale pink or waxy color, in the central part has slight erosion, spreads along the nerves in the skin. Most often localized on the forehead.

Pigmented - a plaque of brown or gray-gray color, with a cyanotic tint. It may resemble melanoma, but histological examination does not confirm this diagnosis.

Basal squamous cell is a combined form of squamous cell and basal cell skin cancer, very aggressive, with rapid growth.

Precancerous diseases

Basalioma very often appears at the site of precancerous skin diseases, which include:

• xeroderma pigmentosum;
• Bowen's disease;
• Paget's disease;
• Keir's erythroplasia.

Xeroderma pigmentosum is a hereditary skin disease in which solar (ultraviolet) radiation causes irreversible changes in all layers of the epithelium. The cause of the disease is the congenital absence of an enzyme that destroys melanin synthesized by the skin under the influence of ultraviolet radiation. In response to solar radiation, an inflammatory reaction appears and subsequently atrophy with malignant tumor degeneration of individual foci.

Bowen's disease occurs due to the aggressive effects of solar radiation and harsh chemicals on the skin. Clinically, the disease is manifested by the formation of a spot with uneven outlines, which over time transforms into a slowly growing plaque. The plaque has a smooth copper-colored surface, and over time becomes covered with scales, ulcers and cracks.

Paget's disease most often develops after fifty years in patients of both sexes. Its first manifestations include slight redness of the nipple or a certain area of the areola, with superficial peeling and increased sensitivity. Subsequently, burning, itching and pain occur, and serous-bloody discharge from the nipple appears. Classic symptoms are retraction of the nipple and the formation of an area on the areola and the skin around it that resembles an orange peel in appearance.

Queir's erythroplasia is an inflammatory skin disease of the glans penis and foreskin, often leading to the development of squamous cell or basal cell carcinoma. It develops more often in men aged 40 to 70 years. Clinically, it is a red, shiny spot, a plaque on the mucous membrane of the glans penis, often extending to the foreskin. The formation is painless to the touch and protrudes slightly above the surface of the skin. A disease with similar clinical manifestations that develops on the mucous membranes of the genital organs in women is described as Bowen's disease of the genital area.

Benign neoplasms

Under unfavorable conditions, neoplasms initially diagnosed as benign can also become precursors of squamous cell carcinoma:

• keratoacanthoma;
• solar keratosis;
• seborrheic acanthoma.

Keratoacanthoma is a fairly common disease. It is a benign tumor of epithelial tissue, located mainly on open areas of the body, less often on the mucous membranes of the mouth, nose and genitals. It is characterized by high growth rates, despite the high degree of differentiation characteristic of benign tumors. Clinically, keratoacanthoma manifests itself as a pink, red, sometimes bluish-colored node or plaque protruding above the surface of the skin, with an island of keratin in the center and raised crater-shaped edges. The typical size of this formation ranges from 1–5 cm. Aestheticians quite often mistake it for an inflamed papilloma and begin to remove it quite superficially by cryodestruction or coagulation, which leads to further progression and degeneration.

Solar keratosis is usually provoked by genetic predisposition and intense sun exposure. This type of keratosis consists of numerous foci of skin peeling, which over time become denser and rise above the surface of the skin.

Seborrheic acanthoma, or actinic keratosis, develops mainly in older people and is a uniformly pigmented soft tumor covered with oily crusts. As the tumor grows, the crusts may crack and be rejected, being replaced by similar crusts located deeper. This formation grows extremely slowly, sometimes for several decades. Rebirth occurs quite often.

All of the above-described skin non-pigmented precancerous and cancerous conditions are quite common when seeking aesthetic procedures, and therefore it is very important to know them and not provoke growth with peelings and partial removals.

However, the most dangerous are pigmented precancerous diseases , mainly dysplastic nevi , which, when traumatized, degenerate into melanoma. Macroscopically, they have a dark and uneven color, uneven edges, asymmetrical, with multicolor and sometimes a pronounced vascular component. Size (more than 6 mm) and hereditary predisposition to melanoma play an important role. Most often, dysplastic nevi are located on the extremities and can be exposed to laser hair removal, mainly diode, which can lead to tragic consequences.

First published in Les Nouvelles Esthetiques 2018/№2