Skin cancers are malignant tumors that develop from the cells of the superficial layer of the skin (epidermis). There are 2 main types of skin cancers - basal cell and squamous cell. Both types have a favorable prognosis, as they quite rarely metastasize to lymph nodes and internal organs, and therefore, in most cases do not threaten the life of the patient. At the same time, these tumors are prone to the development of local recurrences (the appearance of a tumor in the place where it was previously removed), so they require certain approaches to surgical intervention.
The diagnosis of skin cancer is made after performing a biopsy (sampling a piece of the tumor) and histological examination, during which the type of tumor, its subtype, and other important indicators for clinical decision-making are determined.
Depending on certain clinical-anatomical and histological parameters, tumors are categorized into different risk groups for recurrence:
- Low or high risk for basal cell carcinoma
- Low, high, or very high risk for squamous cell carcinoma.
The diagnosis of skin cancer can only be established after a biopsy and histological examination.
Diagnosis and Treatment
If your tumor is of low risk, you will be offered surgical excision of the tumor with a margin of 4 to 6 mm under local or general anesthesia. If it is not possible to close the wound by bringing the edges together, you will undergo skin reconstruction using a free skin flap (skin graft from another site) or local tissues (closure of the wound defect through additional incisions and movement of skin flaps adjacent to the wound).
The main method of treating skin cancers is surgical removal.
Sometimes, for treating superficial forms of low-risk basal cell carcinoma, therapy with a special cream called Imiquimod (© Aldara) is prescribed, which is applied for six weeks. It is important to remember that the cream causes a local inflammatory reaction, so treatment should be conducted under the supervision of a doctor. The effect of the treatment is assessed eight weeks after its completion and may sometimes require a repeat biopsy to confirm its effectiveness.
If your tumor belongs to the high or very high risk group for recurrence, the treatment strategy should be approved by a multidisciplinary council, which includes specialists from various fields (surgical oncologist, clinical oncologist, radiation therapist, pathomorphologist, radiodiagnostician, etc.). Usually, in such cases, surgical excision of the skin tumor with Mohs micrographic control of the resection margins is preferred. The operation involves removing the tumor with a minimal margin (1-2 mm) from its edge, marking the edges of the skin flap with special dyes, and immediate histological examination of the margins of the excised skin area. If no tumor is found at the resection margins, the wound will be closed by bringing the edges together or through skin reconstruction. If tumor cells are present at the resection margins, additional removal of the affected skin area will be performed. The wound defect will only be closed after histological confirmation of the absence of tumor cells at the margins of the excised skin flap. This approach allows for ensuring the complete removal of the tumor while avoiding the removal of healthy, unaffected skin, which is especially important for cancers located on the face from an aesthetic standpoint.
Radiation therapy for skin cancers is prescribed in certain indications: in cases of serious comorbidities, in inoperable cases, and when it is impossible to achieve "clean" resection margins. In cases of extensive skin tumors, suspicion of lymph node or internal organ involvement may lead to additional examinations: magnetic resonance imaging (MRI) of the affected area, ultrasound of the lymph nodes, and computed tomography (CT) of the neck, thoracic organs, abdominal cavity, and pelvis with intravenous contrast, as well as consultations with relevant specialists (ophthalmic surgeon, maxillofacial surgeon, otolaryngologist, anesthesiologist).
The strategy for further treatment depends on the results of these examinations and is approved by a multidisciplinary council.
In the presence of metastases in the lymph nodes without involvement of internal organs, surgical intervention under general anesthesia is performed, which involves the removal of all lymph nodes in the affected area along with surrounding adipose tissue. In certain cases, after surgery, patients may be prescribed a course of radiation therapy.
If during the examination it is determined that the tumor has spread to internal organs, systemic therapy is prescribed, which means treatment with medications that will affect the entire body. This may include immunotherapy, chemotherapy combined with radiation therapy, or so-called targeted therapy. During treatment, periodic examinations (MRI of the affected area, ultrasound of the lymph nodes, CT of the neck, thoracic organs, abdominal cavity, and pelvis with intravenous contrast) are prescribed to assess the effectiveness.
Prevention
After treatment, you will be offered follow-up care with an oncologist. In the first year of follow-up, this will be once every three months; in the second to third years, once every six months; and in the fourth to fifth years, once a year.
Additionally, you will be advised to use sunscreen with a protection factor (SPF) of 30-50 and limit your time in direct sunlight.
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