Skin Cancer: Actinic keratosis of precancerous lesions, for some of the real small cancers in situ
Early factors, with which factors are clearly photographed. Spread rapidly before the sun and the elders.
Clinically it is crusty brown / red lesions. With more or less thick crusts that measure from a few millimeters to a few centimeters in diameter, sometimes only sometimes multiple.
These lesions predispose to the occurrence of skin cancer called squamous cell carcinoma.
Sometimes these lesions regress spontaneously. Sometimes they evolve to squamous cell carcinoma even if the rate of transformation into invasive carcinomas is very low.
Several therapeutic modalities are available to treat actinic keratoses such as liquid nitrogen in case of single or few lesions.
Fluorouracil (which is a local chemotherapy, imiquimod which is a local imimodulator, dynamic phototherapy (P.D.T.).
Basal Cell Carcinomas(Skin Cancer):
Basal cell carcinomas are the most common cancers of adults and represent the
majority of skin cancers.
The characteristic lesion of basal cell carcinoma is the pearl. That is to say a small papule of a few millimeters very firm, painless, translucent and not pigmented most often which is crossed by small vessels.
Superficial basal cell carcinomas represent a group of good prognoses.
Nodular basal cell carcinomas are considered to be intermediate-risk tumors. Essentially depending on the location of the lesion size.
Of course these lesions never give metastases but are at risk of local recurrence in case of incomplete excision.
Invasive basal cell carcinoma is a type of basal cell carcinoma that requires a broader surgical treatment because of the risk of incomplete initial resection and therefore recurrence.
The treatment of basal cell carcinoma is based on surgery, particularly for infiltrating and nodular forms. For superficial basal cell carcinoma, alternatives are to be discussed especially in case of large lesions or located on an aesthetic area (face, décolleté).
These alternatives are imiquimod, immodulator, locally applied, and dynamic phototherapy.
Squamous Cell Carcinoma:
Squamous cell carcinoma formerly known as squamous cell carcinoma is a cancer
less common than basal cell carcinoma. Its risk factors are chronic sun exposure. A history of radiotherapy, chronic scars, chronic inflammatory conditions, papillomavirus infections especially for the genital regions.
Clinically it is an infiltrated lesion in the form of a nodule most often that can ulcerate. The diagnosis is sometimes difficult with basal cell carcinoma. Most often we find around this squamous cell carcinoma actinic keratoses which are precancerous lesions.
Squamous cell carcinomas can metastasize in the lymph nodes and must be treated quickly. The surgery should be as early as possible with margins between 5 and 10 mm depending on the size of the lesion.
In rare cases, will discuss complementary radiotherapy especially in case of incomplete excision and due to localization, and perineural or lymphatic invasion.
Melanoma is a tumor of the younger subject but is also found in the elderly. The main risk factor is sun exposure, particularly on the lower limbs in women and the trunk in men.
It should be noted that 10% of melanomas can occur in genetically predisposed families.
If melanoma can occur in a third of cases on a “mole” that previously existed most often it occurs on healthy skin from the outset.
Several aspects of melanoma exist with different prognoses:
The surface-extending melanoma called SSM corresponds to a gradually widening, irregularly contoured, pigmented spot in the form of an asymmetric lesion of more than 5 mm in size, with differences in hue.
This is the most common form
The Dubreuilh melanoma occurs almost exclusively in older people, its clinical appearance is that of a stain that extends gradually over several years, most often on the face, cheeks, temples, forehead.
The use of skin sampling (biopsy) is most often necessary to make the diagnosis.
Dermoscopy can help early diagnosis.
This melanoma has long been limited to the superficial layers of the epidermis, its initial evolution is slow. It can be confused with solar lentigines benign lesions of the skin. After this long initial phase, he joins in prognosis the other types of melanoma
Nodular melanoma is in the form of a nodule most often pigmented, which will evolve rapidly and sometimes ulcerate. Its evolution is faster.
In any type of melanoma, the prognosis will depend on the earliness of the diagnosis and the stage of the disease, one of the elements of which is the thickness of the lesion that has been removed surgically.
These criteria are essential and are defined by microscopic analysis. It is the thickness of the lesion in mm called the Breslow index and the histological level called Clark’s index.
The treatment is mainly surgical performed most often by dermatologists with appropriate margins depending on the type of melanoma.
Other complementary treatments are sometimes necessary, ganglionic dissection with study of the first lymph node relay or “sentinel ganglion” chemotherapy.