skin carcinoma epithelial

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inoducestion :

  • There are two main types of skin cancer :

The carcinomas basal cell (CBC), The most common (9/10 skin cancers in immunocompetent) qui sont des tumeurs d’slow evolution, mainly local, never metastasize.

The carcinomas spinocellulaires or squamous (THIS) have a local change much

aggressive and can metastasize. They represent 1 / 10th of skin cancer.

  • they are developed at the expense of the same cell, keratinocyte.

factors from risk of the epithelial carcinomas :

– genetic factors :

Phototypes clairs (red or pale skin, Blond hair, blue eyes, freckles, inability to tan ...)

genetic diseases : xeroderma pigmentosum, albinisme ...

– Age: la plupart des carcinomes cutanés surviennent après 40 ans

– Sun and ultraviolet rays (Sunbeds, UVA phototherapy) – ionizing radiation (X-rays…)

– acquired immune: anti-rejection treatment after transplant ...

– chronic inflammatory dermatoses : chronic ulcers – chemical carcinogens : tars (ramoneurs ...), tobacco (particularly implicated in the EC of the lower lip), arsenic (formerly used in pesticide).

basal cell carcinomas (CBC)

These are the most common and least aggressive of the skin cancers (no metastasis). The CBC concern in France about 150 individuals for 100 000 inhabitants per year.

A- Diagnostic positive :

They sit with favorite face (Photo exposed areas) and save the mucous. Many clinical forms exist; most are united by a common element :

the pearls. C’est une papule ou un nodule translucide, whitish, traveled fine telangiectasia type capillary scalp (= Vessel forming a red line).

Even in the forms of diagnosis difficult, a characteristic beaded edge is sometimes present.

There are varieties clinicopathological from severity variable:

– The nodular BCC

– The superficial BCC

– Pigmented forms or tattooed

– The forms ulcerative

– The CBC sclerodermiform

The CBC nodular is a farm tumor, very limited, smooth, rounded. C’is the most common form (60 p. 100 cases).

The CBC superficial (10 at 25 p. 100 cases) = In situ in the epidermis, d’évolution très lente : lesion oval erythematous scaly erythematous or limited well.

The forms pigmented or tattooed are related to the presence in the tumor and melanin pigments represent a differential diagnosis difficult with other pigmented lesions.

The forms ulcerous, hewn peak, parfois bordées dun bourrelet perlé. When the tumor invades and destroys underlying tissues (cartilage, the…), it is a form called "Boring".

The CBC sclerodermiform (2 at 3 p. 100 cases) associe une intense fibrose à la prolifération tumorale et se présente sous la forme dun placard atrophique infiltré mal limité. Its surface is whitish and vague limits clinically as histologically. This recurrence form more often.

B- anatomy-pathological :

If the diagnosis of skin carcinoma is often made clinically, it will usually confirm by biopsy allowing histology.

C- Evolution, prognosis :

– The CBC is slow growing.

– it n’results not from metastasis (or lymph node or visceral), but a local invasive potential that can result in significant tissue destruction. These advanced cases may require the use of mutilating surgery to functional and aesthetic sometimes severe consequences.

D- Treatment :

– The treatment of choice is the surgery car elle permet un contrôle histologique de la pièce dexérèse et permet ainsi daffirmer son caractère complet ou non.

– A repair plastic surgery is necessary in case of extensive tumor (lambeau, graft).

– Other methods:

Elles sont schématiquement réservées à des malades inopérables ou pour certaines localisations. Il sagit essentiellement de la radiothérapie et de la cryochirurgie (liquid nitrogen). The 5-fluorouracil cream can be proposed for treating multiple superficial lesions. D’autres traitements sont en train de transformer la prise en charge des CBC : Imiquimod cream Aldara = obtained a marketing authorization in superficial basal.

E- Prevention :

–     Elle repose sur la photoprotection et le suivi régulier des malades à risques.

–     Après traitement de toute forme de CBC, regular monitoring (every year for life) is recommended to screen for recurrence of the lesion, mais aussi en raison du risque élevé dapparition de nouveaux carcinomes cutanés, or melanoma.

The carcinomas spinocell or carcinomas squamous :

These are locoregional malignant tumors of more rapid and more pronounced than basal cell and can be a source of metastases.

A- Epidemiology:

L’incidence des CE cutanés est plus faible que celle des CBC: 10 at 20 for 100 000 habitants/an en France chez l’man and 5 at 10/100 000 residents in women.

the soleil

L’exposition solaire est le facteur causal principal, as cumulative dose. The sun is responsible for the formation of precancerous lesions on the skin photo-exposed, called actinic keratoses common after 60 years in patients clear phototype.

Précurseurs:

Unlike the CBC, CE often occurs on a precancerous lesion. The most common are:

the kératoses actiniques.

– radiodermatitis ;

– old scars of deep burns and other scars (exceptional) ;

– genital lichen sclerosus

– actinic cheilitis (bottom lip): with the aggravating role of poor oral hygiene and / or smoking.

The kératoses actiniques =

They develop on the areas exposed to UV (Pavilion ears, nose, front…), more likely in patients clear phototype.

the cutaneous horns =

Elles consistent en laccumulation localisée de kératine, in the form of’une petite colonne jaune-brun dure: they can either match actinic keratosis (lesion Pre-epitheliomatous) is a real EC : Histology is better.

B- On distinguished three forms clinics :

– The surface shape or Bowen's disease

– The shape ulcerative vegetating

– The burgeoning form

  1. The carcinoma intraepithelial or sickness from Bowen is strictly limited to the epidermis lesion. It comes as a erythematous macula pink or brown sometimes crusty, very limited, fixed character.(differential diagnosis difficult with the superficial basal cell carcinoma)
  2. ulcérovégétante form: The most common : L’aspect est en général évocateur : tumor budding and ulcerated, closed, adherent to the deep planes, serving most often on exposed areas (face, ears, bottom lip, back of the hands) often preceded by precancerous lesions. The biopsy confirmed the diagnosis.
  3. The form budding

C- Evolution, prognosis :

All EC should be considered potentially aggressive. We always look for a lymphadenopathy in the area drainage. It usually precedes the visceral metastases.

D- Treatment :

– The treatment of choice is the surgery car elle permet un contrôle histologique de la pièce dexérèse et permet ainsi daffirmer son caractère complet ou non. The outset margins are wider than for Basal cell.

– Other methods : it s’agit avant tout de la radiothérapie.

E- Prevention :

It is based primarily on photoprotection and regular monitoring of risk patients as well as the treatment of precancerous lesions in particular actinic keratoses .

The treatment of the kératoses actiniques : cryotherapy with liquid nitrogen, creams (aldara, Efudix)

 

CBasocellular

CEpidermoïde

Epidémiologie

 

precursors =

k. actiniques…

Clinique

PEARLS

 

Diagnostic

histology

Pronostic

 

metastases

Traitement

Surgery