skin cancer | National Union of Dermatologists-Vénéréologues

National Union of Dermatologists-Vénéréologues

Different TYPES of skin CANCER
There are several types of skin cancers the most serious of which is melanoma. Other skin cancers are less dangerous and rarely put life into play. The role of the dermatologist is to detect, if possible early, all these lesions whose prognosis varies according to their nature. The role of artificial or natural UV is important in the occurrence of these cancers.

The Actinic keratoses
"Actinic keratoses or solar" actinic-solar-111-200x200Les actinic keratoses premalignant lesions, for some of the real small in situ beginner cancers whose favourable factors are the clear phototypes whose skin has been Chronically subject to the sun and the elderly subject.
Clinically these are brown/red crusty lesions, with more or less thick crusts that measure from a few millimeters to a few centimetres in diameter, sometimes unique sometimes multiple.
These lesions predispose to the occurrence of skin cancer, which is called squamous carcinoma.
Sometimes these lesions regress spontaneously, sometimes they evolve into squamous carcinoma even if the rate of transformation into invasive carcinomas is very low.

Several therapeutic modalities are available to treat keratoses actinic such as liquid nitrogen in the case of single or few lesions.
The 5 fluoro uracil (which is a local chemotherapy, the imiquimod which is a local imumodulateur, dynamic phototherapy (P.D.T.).

Basal carcinomas
"Cell carcinoma Basal"
Carcinoma-basal-cell-1-copy-53-200x200Les carcinomas basal are the most common cancers of the adult and represent the majority of skin cancers.
The characteristic lesion of basal carcinoma is the pearl, i.e. a small papule of a few millimeters very firm, painless, translucent and not pigmented most often that is covered by small vessels.

Superficial basal carcinomas represent a group of good predictions. 

Nodular basal carcinomas are considered to be intermediate-risk tumours mainly based on the location of the lesion's size.

Of course these lesions never give metastases but are at risk of local recurrence in case of incomplete resection.

Infiltration basal carcinoma is a type of basal carcinoma whose surgical treatment needs to be wider due to the risk of incomplete initial resection and therefore recurrence. 

The treatment of basal carcinomas is based on surgery especially for the infiltration and nodular forms. For superficial basal carcinoma, the alternatives are to be discussed especially in case of large lesions or located in an aesthetic area (face, cleavage). 

These alternatives are imiquimod, immodulator, local application, and dynamic phototherapy.

Squamous carcinoma

"Spin-cell carcinoma" Spino-cell-1-copy-54-200x200Le squamous carcinoma formerly known as squamous carcinoma is less common cancer than basal carcinoma. Its risk factors are chronic solar exposures, a history of radiation therapy, chronic scarring, chronic inflammatory conditions, HPV infections especially for genital areas.

Clinically it is an infiltrated lesion in the form of a nodule most often that can ulcerate. Diagnosis is sometimes difficult with basal carcinoma. Most often we will find around this squamous carcinoma of actinic keratoses which are precancerous lesions.

Squamous carcinomas can metastasize at the lymph nodes and therefore need to 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, goes to discuss additional radiotherapy especially in case of incomplete resection and due to localization, and périnerveux or lymphatic swamping.

"Actinic of hands and cell carcinomas actinic-of-hands-and-carcinomas-spin-celles-110-660x660

Melanoma

Melanoma is a tumor of the younger subject but is also found in older subjects. The main risk factor is solar exposure especially on the lower limbs in women and the trunk in humans. 

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 prognosis:

The superficially extended melanoma called SSM corresponding to a pigmented spot gradually widening, with irregular contours, in the form of an asymmetric lesion of a size exceeding 5 mm most often, with Color differences. 

It's the most common form.

Melanoma-SSM-120-200x200

Dubreuilh melanoma occurs almost exclusively in older people, its clinical appearance is that of a stain that gradually extends over several years, most often on the face, cheeks, temples, forehead. 

The use of skin removal (biopsy) is most often necessary to diagnose it. 

Dermoscopie can help with early diagnosis. 

This melanoma is long limited to the superficial layers of the epidermis, its initial evolution is slow. It can be confused with lentigines solar benign lesions of the skin. After this long initial phase, he reaches the other types of melanoma in prognosis. 

Melanose-de-dubreuilh-enhancing-121-200x200

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 early diagnosis and stage of the disease where one of the elements is the thickness of the lesion that has been surgically removed. 

These criteria are essential and are defined by microscopic analysis. This is the thickness of the lesion in mm which is called the Breslow Index and the histological level which is called the Clark index.

The treatment is mainly surgically performed by dermatologists with appropriate margins depending on the type of melanoma. 

Other complementary treatments are sometimes necessary, the ganglionic clearing with the study of the first relay lymph node or "sentinel ganglion" of the chemotherapy.