Precancerous diseases of the skin and soft tissues are two different groups that must be considered separately. Their common characteristic is that this complex of diseases is characterized by the appearance of malignant tumors. It is divided into two subgroups: obligate (high degree of malignancy) and optional (with optional malignancy).
Description of this pathology
Precancerous skin diseases are characterized by single or multiple nodules, growths, foci of hyperkeratosis, papules, age spots or foci of irritation of different colors, shapes and sizes. The diagnosis is established on the basis of examination and the results of histological studies. Treatment - surgical removal, chemotherapy, cryotherapy, interferon therapy.
Precancerous skin diseases are neoplasms of an epithelial origin of a benign nature and pathological conditions of the skin of a non-tumor nature, with a tendency to transform into a malignant tumor. The risk of rebirth can vary significantly. A photo of precancerous skin disease is presented just above.
The main cause of malignancy
The main cause of malignancy is external nonspecific irritations (insolation, mechanical friction, temperature exposure), lack of timely treatment and various endogenous factors. Mostly elderly and middle-aged people suffer from such pathologies. There are also some congenital ailments of this kind, which mainly affect adolescents and children. Diagnosis of precancerous skin diseases and therapy is carried out by doctors in the field of dermatology and oncology.
Pathologies of the mucous membrane of the mouth and facial tissues
Diseases of these obligate areas include cheilitis Manganotti, limited hyperkeratosis, warty precancer. To the optional type of precancerous diseases of the skin of the face and the red border of the lips include keratoacanthoma, dermal horn, and papilloma.
Papillomatosis of the sky, hyperkeratotic and erosive-ulcerative forms of lichen planus and lupus erythematosus, erosive-ulcerative and verrucous forms of leukoplakia are also included here.
Classification of precancerous diseases of the skin of the face and oral mucosa includes:
- The cutaneous horn is a limited area of hyperplasia with severe hyperkeratosis, having the form of a horny protrusion. Such a focus is limited, has a brownish-gray color and a diameter of up to 1 cm.
- Keratoacanthoma is a benign epidermal tumor in the form of a painless hemispherical node with a dense consistency. In its central section there is a funnel-shaped depression of a small size, filled with horny dense masses of a white hue. The tumor is mobile, not associated with the underlying tissues. This neoplasm is similar to squamous cell carcinoma of the skin and is often transformed into cancer.
- The papilloma of the red border of the lips is limited from the surrounding tissues. Its surface is rough or villous, sometimes covered with horn structures. Pathology is characterized by exophytic and endophytic growth, which, according to many scientists, brings it closer to cancer.
In chronic injuries of areas of papillomatosis of the oral mucosa, ulceration, inflammation, and foci of necrosis develop. The seal formed at the base of the papilloma is one of the symptoms of malignancy.
Background pathologies include dermatitis, actinic, meteorological and post-radiation cheilitis, chronic fissures and ulcers of the red border of the lips and oral mucosa, flat leukoplakia.
Patients with obligatory precancerous diseases of the skin and mucous membranes are usually subject to surgical treatment (excision is performed using a conventional scalpel or by laser excision, surgical diathermy, laser coagulation, cryogenic exposure).
Surgical intervention allows not only radical therapy, but also morphological verification of tissues that were removed in its process.
Patients with facultative precancerous pathologies such as cutaneous horn, papilloma, keratoacanthoma, papillomatosis, erosive-ulcerative and verrucous forms of leukoplakia also undergo surgery. Patients with leukoplakia in some cases can be treated conservatively (according to indications). The same treatment is required for patients with lupus erythematosus, lichen planus, background pathologies of the oral mucosa.
Classification of precancerous skin diseases
As noted above, there are two categories of precancerous lesions: obligate and optional. It should be noted that such a separation is rather arbitrary. Diseases are known that some physicians attribute to obligate precancerous conditions, and others to optional ones. Thus, the category of skin pathologies of the first type includes Paget's disease, Bowen's disease and Keir erythroplasia, which are specific forms of skin cancer - in situ cancers, local oncological processes that do not extend beyond the skin. In addition, pigmented xeroderma is considered an obligate precancer.
Optional precancerous skin diseases are senile keratosis and other non-specific lesions. The probability of malignant transformation of senile keratosis degeneration is approximately 10%. Radiation dermatitis of chronic forms, arsenic hyperkeratosis, tuberculosis and syphilitic skin lesions are malignant in about 6% of cases. Fistulas for osteomyelitis, trophic ulcers (long-existing) and extensive scars after burns malignant in 5-6% of patients. Skin lesions with lupus erythematosus are converted to cancerous tumors in about 2-4% of cases.
Let us consider in more detail precancerous diseases of the skin of the face and mucous membrane of the oral cavity.
Bowen's disease
This is a rather rare pathology described in 1912. It can occur at the age of 20-80 years, equally often it is diagnosed in men and women. The main factors predisposing to the development of this disease are human papillomas, virus infection, ultraviolet radiation and contact with toxic substances (tar, tar, arsenic). Precancerous pathology can occur on any area of the skin, but most often the genital area and trunk are affected.
At the initial stage, the disease is an uneven spot, which subsequently transforms into a red plaque with a velvety, moist surface. On it, areas of hypo- and hyperpigmentation are revealed. Sometimes the surface of this spot is covered with uneven dry scales, as a result of which this formation strongly resembles a psoriatic plaque. Formations can be single and multiple, which merge with each other. Usually a long course of the pathological process is noted, the plaque can persist for several years.
In the absence of therapy, this precancerous pathology of the skin becomes squamous cell carcinoma. The diagnosis is made on the basis of histological studies. Therapy is surgical removal along with nearby healthy tissues. In addition, cryodestruction, electrocoagulation or laser coagulation are often used.
Keir erythroplasia
This is a subspecies of Bowen's disease, which affects the skin of the penis. Men 40-70 years old suffer from pathology. The disease is a reddish smooth plaque with a velvety, moist surface. Education slowly grows over several years, its outcome is marked by malignant degeneration.
Paget's disease
This precancerous disease of the skin is usually localized in the paralosal region. In about 20% of cases, this tumor can be located in other areas: on the back, face, hips, perineum, buttocks, and on the external genitalia. In some medical classifications, the disease is considered as a form of breast cancer. It is diagnosed in both sexes in 50-60 years. In men, this pathology develops less frequently, but is more malignant. At the initial stage, such a precancerous disease is similar to an eczema-like lesion, which is accompanied by itching, burning, tingling and pain.
In the future, the lesion area increases, erosion, scales and ulcerations form on the surface of the formation. Nipple retraction is detected, pathological discharge may appear. This precancerous disease progresses over several years and spreads to neighboring tissues. Metastasis and local infiltrative growth are also noted. Diagnosis of precancerous skin diseases should be timely. Treatment is represented by radical breast resection or mastectomy in combination with hormone therapy, radiotherapy and chemotherapy.
Xeroderma pigmentosa
This is a rare hereditary precancerous disease of the skin. It manifests itself in the form of increased sensitivity to ultraviolet radiation. The pathological process proceeds in 3 stages. The first occurs at the age of 2-3 years, most often in the summer, against the background of even slight insolation. Red inflamed spots appear on the open areas of the child’s body. Subsequently, in their place there are zones of uneven hyperpigmentation. Each case of exposure to the sun is accompanied by the appearance of new lesions and increased signs of hyperpigmentation.
In the second stage, several years after the onset of the first symptoms of the disease, zones of atrophy and telangiectasia are formed in the affected areas. Due to spider veins, uneven areas of pigmentation, the skin becomes mottled, cracks, crusts, sores and warty growths form on it. Pathological changes in the cartilaginous tissues, which are often noticeable in the form of a deformation of the nose, are also noted. Eye lesions also occur: corneal opacity, keratoconjunctivitis, inflammation of the eyelids, lacrimation, and photophobia.
The third stage occurs in the puberty or post-puberty period. Malignant and benign neoplasms occur on the affected areas of the skin: angiomas, fibromas, keratomas, basal cell carcinomas, melanomas, squamous cell carcinoma. Particularly malignant are tumors that form in the area of the warty growths. About 60% of patients do not live up to 15 years. The main cause of death is distant metastasis and local infiltrative tumor growth.
Solar keratosis
This precancerous skin disease is also called actinic keratosis - a pathology with a low risk of malignant transformation. The disease is caused by excessive insolation. She most often suffers from blue-eyed fair-skinned blondes of the elderly and middle age. In women, pathology is diagnosed less frequently. Open areas of the skin are affected, where a yellowish spot initially forms. Subsequently, it is covered with dense scales. Therapy - cryodestruction, laser removal, cytostatic ointments. It is not necessary that this pathology degenerates into cancer. This will only happen if the problem is constantly exacerbated through frequent exposure to the sun.
Clinical recommendations for these dangerous pathologies
Clinical recommendations for precancerous diseases of the skin of mucous and soft tissues are to timely diagnose these pathologies, treat existing lesions and prevent the development of new foci of the pathological process.
In order to reduce the risk of the occurrence of such phenomena in oncological tumors, it is necessary to limit or eliminate the damaging effects on the skin and mucous membranes of UV rays, electromagnetic radiation, ionizing radiation and chemical carcinogens.
In addition, people and doctors should be aware of the potential dangers of using certain hormonal medications (exogenous estrogens).
Another area is the identification and clinical examination of individuals with an inborn predisposition to cancer and dysplastic nevus syndrome.
The immunological area is useful for identifying and treating individuals with various forms of immunosuppression, immunodeficiency, and patients with transplanted organs.
Examination of the skin in the presence of suspicion of a precancerous condition is carried out in the examination room when a specialist visits the first contact. An examination by an oncologist is carried out in the first year of observation every 3 months, then, after successful therapy, less often. It is important to independently examine your body for the appearance of new moles or age spots.