Precancerous skin diseases are multiple or single papules, nodules, growths, spots, foci of hyperkeratosis or irritation of various shapes.
Even though the skin’s malignant process is in visual accessibility; nevertheless, the staging and variability of its development and a wide variety of benign dermatological pathologies often do not allow timely recognition of a cancerous tumor.
In connection with the above, the problem of early diagnosis and treatment of a “pre-morbid” disease or pathological condition, that is, precancer, against which the development of a malignant neoplasm is more or less likely, has acquired great urgency in dermatology and oncology.
In some cases, people consider anal skin tags as one of the symptoms of precancerous skin diseases. But keep in mind that hemorrhoid skin tags are not precancerous skin disease.
Precancerous skin diseases are multiple or single papules, nodules, growths, spots, foci of hyperkeratosis or irritation of various shapes, colors and sizes, etc. They are benign epithelial formations and pathological conditions of non-neoplastic origin but which can transform into malignant tumors.
The cause of malignancy can be:
- various external factors of a non-specific nature – frequent or persistent mechanical irritation or injury, prolonged contact with chemicals (aniline dyes, derivatives of oil, coal, arsenic, pesticides), exposure to temperature factors (frostbite and burns), excessive sun exposure, ionizing radiation, chapping;
- endogenous factors (in the body itself) – endocrine disorders, dysfunctions of the immune system, and some others;
- lack of timely treatment of benign pathology;
- age – among middle-aged and older adults, transformation into cancer occurs much more often.
Diagnosis and treatment of precancerous skin pathologies are carried out by specialists of a dermatological or oncological profile.
Classification and diagnosis
The generally accepted classification of precancerous skin pathologies has not yet been developed due to the lack of sufficiently clear theoretical ideas about these pathological conditions. Therefore, the main ones are very conditionally divided into two groups:
Obligate precancerous skin diseases
Obligatory pathological conditions are characterized by a high degree of probability of transformation into a malignant formation. These include:
- pigmented xeroderma;
- limited precancerous hyperkeratosis of the skin of the red border of the lips;
- Bowen’s disease;
- erythroplasia of Keira;
- Paget’s disease.
The last three pathologies are currently considered a form of skin cancer ( cancer in situ – in situ), a local pre-invasive (intraepithelial) malignant process that does not extend beyond the skin. However, traditionally they are still referred to as precancerous pathological conditions.
It is a genetically determined staged disease characterized by excessive sensitivity to even little solar radiation. The first symptoms of this pathology with lesions of the face and hands’ skin appear already in the first three years of a child’s life.
After a short exposure to the sun in open areas of the skin, limited erythematous spots and small pigmented yellowish-brownish spots that resemble freckles appear above the skin surface. Their number gradually increases; the skin in these places becomes dry and flaky.
In the future, atrophic changes develop in their place, areas with telangiectasias, and a smooth, shiny surface appear. Even later, against this background, ulcerations, cracks occur, growths of papillomatous and warty nature, transforming into a basal cell or squamous cell form of cancer, melanoma, or sarcoma.
Malignancy occurs in 100% of cases. Malignant formations have a high tendency to decay and metastasis. Most patients die before 15 – 20 years of age due to the generalization of the tumor process.
However, although the gene for this pathology is found in approximately 0.28% of people, it is inherited in an autosomal recessive manner. Therefore the disease develops in only one out of 250 thousand cases.
Treatment of xeroderma pigmentosa is carried out after a histological examination. With single growths, it consists of electro excision, laser, or try destruction, with multiple growths – in conducting a course of close-focus X-ray therapy.
Limited precancerous hyperkeratosis of the skin of the red border of the lips
Unlike other obligate precancerous diseases, it more often affects young and middle-aged people. Among all the precancerous pathology of the lips, 80% falls on this form of the disease. The lesion is polygonal in shape and sizes from 2 mm to 1.5 cm, localized mainly on the lower lip directly on the red border.
It is surrounded by a thin whitish ridge, located approximately midway between the corner of the mouth and the lip’s center, soft and painful on palpation. The level of its surface in most patients is slightly below the level of the surrounding red border of the lip, because of which the lesion seems to be sunken. The surface is covered with densely spaced grayish-brownish scales.
Usually, the formation exists for several years in a peaceful state. Still, sometimes it transforms into a malignant tumor within the first year and even the first months from the moment of its appearance. The main symptoms that partially help in the diagnosis of malignancy of education are:
- the appearance of a seal at its base;
- the appearance of erosion on its surface;
- strengthening of keratinization processes.
Treatment consists of electro excision, laser destruction, or surgical excision within healthy tissues, followed by histological examination. The decision on further treatment depends on the results of the latter.
It occurs with the same frequency among men and women over 40 years old. The factors that provoke a precancerous condition are ultraviolet rays and some toxic substances (arsenic, resin, tar). Any skin areas can be affected, but most often – closed (trunk, genitals), less often – the face and neck.
Depending on the clinical manifestations, four forms of the disease are distinguished:
- papular scaly;
- papular cortical;
As a rule, the disease manifests itself as single or multiple plaques ranging in size from 1 mm to 10 cm. They are prone to peripheral growth and have oval or irregular outlines, slightly rising above the skin’s surface, clear or blurred borders, yellow-red, and later yellow-brown coloring. An atrophic area of tissue or scar in the central part of the plaque is characteristic.
Sometimes the elements are covered with uneven crusts or scales, which resemble psoriatic elements. When these crusts or scales are removed, they may expose growths in the form of papillae with a smooth or warty surface. On palpation of bumps, the density of paper or cardboard is determined.
Bowen’s disease is long-term (years). Against its background, papillary (a type of squamous cell) cancer develops.
It is a variant of the previous pathology and occurs only in 40 – 70-year-old men in the area of the glans penis or, less often, on the foreskin. In older men, the pathology is characterized by a more malignant course.
The disease is manifested by single or multiple plaques with pronounced borders. The elements have raised edges and regular outlines, a smooth velvety surface of reddish or bright red color. In case of infection, purulent or tiny white plaques are possible.
Treatment of Bowen’s disease and Keir’s erythroplasia consists of electro excision or cryodestruction of single lesions that are small in size. In other cases, the use of close-focus X-ray therapy is recommended.
It is a focus of erythema, accompanied by local soreness, itching, tingling, burning. On its pinkish and slightly pigmented surface, resembling eczema in appearance, epithelial scales, ulceration, and erosion appear.
The lesion has well-defined boundaries and tends to gradual slow (over several years) expand and spread to adjacent tissues. Localization – mainly in the areola, but in 20% – in the face, head, back, thighs and buttocks, perineum and external genitalia, on the armpits’ skin.
The disease occurs after 50-60 years, mainly in women, but in men, the course’s nature is more aggressive. Despite the slow development, the transformation of precancerous pathology into an invasive malignant tumor always occurs.
Treatment consists of radical resection of the mammary (breast) gland or complete mastectomy combined with hormonal therapy, chemotherapy, and radiotherapy. The treatment scope depends on the spread of the lesion and is carried out after a histological examination.
Optional precancerous skin diseases
Diseases of this group are united by a relatively low degree of probability of degeneration into cancer. These include mainly:
- actinic, or solar, senile (senile) keratosis;
- cutaneous horn;
As a rule, it develops in mature and old age in people with fair skin in its open areas, which are subject to prolonged (at least 10-20 years) solar irradiation. The disease’s basis is the dysplastic processes of the epithelium, as a result of which it can degenerate into squamous cell carcinoma.
Typically, senile keratosis is localized on the sun-altered skin (with uneven pigmentation, thinned) in the region of the back of the nose, cheeks, ears, scalp, lower lip, and hands. Depending on the severity of clinical symptoms, stages, or types of lesions are distinguished:
- Erythematous, which is the onset of the disease and is characterized by the appearance of reddish-pink plaques and spots with sharply delineated boundaries. The elements’ diameter at first does not exceed a few millimeters and then gradually increases to 1-2 cm. Spots and plaques can have an irregular, oval or rounded shape and a bumpy, rough surface, against which the “translucency” of telangiectasias is noted, and bleeding occurs after light scraping.
- The keratotic stage of a precancerous condition is the further development of lesions. They acquire a yellowish-brown or grayish-black color due to dense, easily detachable, oily layers of the corneal epithelium in the form of crusts. A narrow inflammatory border surrounds the lesions.
- Severe hyperkeratosis – elements protrude significantly above the surrounding skin surface and can transform into a cutaneous horn.
The development of senile keratosis is slow (over several years), after which malignancy in the form of squamous cell carcinoma is possible (in 20-25%). With malignant degeneration, itching occurs, increased inflammatory symptoms, compaction of the base, and an increase in the lesion’s thickness, the formation of an erosive, easily bleeding surface.
Single large lesions are removed surgically, by electro excision, cryodestruction, or laser therapy. Therapy of multiple foci is carried out through the application of fluorouracil ointment, tretinoin, imiquimod cream.
It is an epithelial tumor with pronounced hyperkeratosis and is currently considered as a variant of senile keratosis. Education can develop against the background of scars, lupus erythematosus, lichen planus, and other keratoses, and on externally intact skin.
The cutaneous horn is localized mainly on the head, face, and areas of the body that are subject to constant or frequent friction or pressure. In rare cases, it can occur in the area of the red border of the lips.
Clinically, the cutaneous horn is a cylindrical, cone-shaped, or branched formation consisting of a dense accumulation of masses of horny epithelium, whitish, dirty-grayish, brownish-gray, or yellowish-brown in color. It is firmly welded to its base, grows relatively slowly, reaching sizes, mainly 0.5-1 cm, but often 4-5 cm.
Malignancy does not depend on the disease’s duration and is possible in 12-15% of cases. Its onset is accompanied by the appearance of soreness, compaction of the base, inflammation around the tumor, and sometimes a sharp acceleration of keratinization.
Treatment is only surgical. The formation is removed along with nearby healthy tissue.
As a rule, it is a single, less often multiple epidermal tumors that occur in older people (usually at the age of 60 – 65 years of age). It is characterized by rapid growth, cyclical flow, and spontaneous regression. Malignancy occurs quite rarely (in 7%).
The development of a keratoacanthoma is provoked by prolonged and intense solar radiation, inflammatory forms of dermatoses (seborrheic dermatitis, eczema), exposure to chemicals, and chronic skin trauma. The disease begins with a small pimple’s appearance, which increases in diameter to 1.5-2 cm within 3-4 weeks.
The morphological basis of a precancerous tumor is the so-called “horny cup.” The formed formation has a grayish-pink color, a dense consistency, and a hemispherical shape. It rises above the surrounding surface, not soldered to the underlying tissue (movable when trying to displace). In the “sinking” central part of the formation, there are grayish dense horny masses surrounded by a zone that rises in the form of a ridge. Around the “horny cup,” skin relief is smoothed.
In the absence of independent reverse development of a single keratoacanthoma, treatment with try destruction, laser destruction, or surgical excision is necessary, in rare cases – with the use of radiation therapy. With multiple formations, methotrexate is administered orally.
Although the primary diagnosis of precancerous skin diseases is based on the clinical picture described above, histological examination plays the leading role.
In practical terms, the meaning of the concept of “precancerous skin pathology” is that it makes it possible to identify groups with an increased risk of developing cancer from a significant number of persons with dermatological pathology and to carry out systematic monitoring of these patients with more in-depth research.
In medicine, the current strategy of combating malignant pathology is based on the early detection and treatment of precisely various precancerous pathology forms.
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