squamous cell carcinoma | Skin squamous Carcinoma

Skin squamous Carcinoma

THE SECOND MOST COMMON SKIN CANCER
The squamous cell carcinoma skin (CE), also called squamous Carcinoma, comes second to cancers of the skin in order of frequency, after the Bcc. In a country like the United States, it is estimated the number of new cases to 450000 of CE per year.

This type of skin cancer develops from cells of the thorny layer of the epidermis, which is the top layer of the skin. The EC can reach all parts of the body, including the mouth and genital Mucosa, but they are more common on areas of skin exposed to the Sun such as the face, ears, lower lip, bald scalp, neck, back of the hands the arms and legs. Often, these areas of skin shows signs of damage from the Sun, such as the presence of wrinkles, brown spots or a loss of elasticity.

WHO CAN BE AT?

People with fair skin, light hair and blue, green or gray eyes, are more likely to develop a CE. But anyone who has been exposed to the Sun of consistently has also increased risk. People whose job requires long hours of work outside the home and those who practice outdoor recreation are particularly exposed. People who have already presented a BCC are also more likely to have a CE, just like people with specific genetic diseases such as xeroderma pigmentosum.

The EC is two times more common in men than in women. They rarely appear before age 50 are especially seen from the age of 70.

The majority of skin cancers in people with dark skin are the EC, which usually occur on areas of skin where there was previously an inflammatory disease of the skin or a burn. Although people with dark skin are at less risk that people with skin cancer of the skin, it is essential that they protect themselves from the Sun.

WHAT ARE THE CAUSES?

Most of the cases of this are caused by chronic exposure to the rays of the Sun. Regular use of tanning booths also multiplies the risk of it; Indeed, people who attend these cabins have twice the risk of developing a CE. However, pre-existing skin lesions are also a risk factor. A CE may occur on Burns, scars, sores, chronic or on sites exposed to the radiation or chemicals (such as arsenic or oil-based products).

In addition, inflammation or chronic infections of the skin can stimulate the development of a this. HIV and other situations that lower the immune system, as some diseases, like treatments for type of chemotherapy or immunosuppressants, such as excessive exposure to the sun itself, make the skin less apt to be defend and more at risk of developing EC and other skin cancers.

It sometimes happens that a CE appear spontaneously on the seemingly normal skin, not injured and not exposed to the Sun. Some researchers believe that the predisposition may be hereditary.

PRE CANCEROUS LESIONS:

OFTEN THE FIRST STAGE OF THE EC

Some pre-cancerous lesions, resulting in the majority of the damage of sun exposure, can be associated with the subsequent development of a this.

ACTINIC KERATOSIS

Actinic keratoses are rough, scaly and slightly protruding, lesions that can vary in color from Brown to red and can measure 1 mm to several cm in diameter. They appear on areas of the body that frequently exposed to the Sun, most often in the elderly. They can be the first stage on the way to the development of a CE, and some experts consider that it is the first stage of the. Indeed, 2% of untreated actinic keratoses are transformed into, and 40 to 60 percent begin by some Actinic Keratosis untreated.

ACTINIC CHELITIS

It is a form of Actinic Keratosis that typically occurs on the lower lip, making it dry, cracked, scaly and pale or white. She reached the lower lip because it usually more exposed to sunlight than the upper lip. If it is not treated effectively, the Actinic chelitis can promote the occurrence of a CE of the lip.

LEUKOPLAKIA

These small white plates occurring on the tongue, gums, inside of the cheeks or elsewhere in the mouth, can potentially become EC. Leukoplakia can be caused by chronic irritations, like the regular consumption of alcohol or tobacco, or by rubbing the teeth or dental crowns. It can also be caused by a habit of mordillement of the lower lip; However, the leucoplasies of the lips are mainly caused by the Sun.

BOWEN DISEASE

In general, currently considered the Bowen disease as an early stage and superficial to this. It looks like a scaly Red-Brown, persistent, plate, which may look like in psoriasis or eczema. If it is not treated, Bowen disease can spread in depth. She is often induced by exposure to sunlight or arsenic, but other carcinogenic products, radiation, genetic disease or injury may be caused. Papillomavirus (HPV) human, very contagious through sexual contact, may be the cause of disease of Bowen affecting the genitals. A vaccine can now be used in young girls to prevent HPV infection and thus reduce the risk of genital, cancer of the cervix and Bowen disease.

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A growth resembling a wart that form scabs and bleeding occasionally.

A red plate flaky, with irregular edges, that persists and can form crusts or bleed.

A lump with a central depression that occasionally bleeds. A lump of this type may increase in size very quickly.

An open wound that bleeds, form crusts and persists for several weeks.

A growth resembling a wart that form scabs and bleeding occasionally.

A red plate flaky, with irregular edges, that persists and can form crusts or bleed.

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In addition to signs of this shown here, any change of a preexisting skin lesion, any wound that is slow to heal, or any new size you must consult a doctor quickly.

THERAPEUTIC OPTIONS

The EC detected and treated early can often be cured and cause minimal risk. However, if they are not treated, they can extend to the underlying tissue and disfiguring patients. A small percentage EC can even extend to other organs and be life-threatening. So, any lesion or suspicious skin size should be seen by a doctor. A sample of skin (biopsy) of the lesion will be examined under a microscope to confirm the diagnosis. If tumor cells are present, treatment will be necessary.

Fortunately, there are several effective techniques to treat a CE. The choice of treatment depends on the type, size, location and depth of the tumor, as well as the age and general State of the patient.

Almost always, the treatment can be performed on an outpatient basis in the office of the doctor or clinic. We use a local anaesthetic for most interventions. The pain and discomfort is usually minimal and the patient suffers rarely thereafter.

MOHS MICROGRAPHIC SURGERY

Using a scalpel or a curette (spoon-shaped cutting instrument), the surgeon removes the visible tumor and a thin layer of surrounding tissue. This layer of tissue is then immediately reviewed on-site at the microscope. If there is cancer cells on the edges or deep, the procedure is repeated until the removed tissue layer contains more no cancer cells and the tumor is completely eliminated. This method allows you to save the maximum of healthy tissue, reduces the risk of local recurrence and present the highest cure rate (estimated at between 94 and 99%). It is frequently used for tumors having re-offended, for those who are poorly delimited, in areas where the aesthetic result is important, or for difficult locations, like the nose, ears, mouth, around the eyes, the neck, the hands and feet. After surgery, we let the wound heal naturally or we can help the healing process with reconstructive surgery techniques.

CLASSIC SURGICAL EXCISION

The doctor removes the knife the entirety of the visible tumor, as well as a surrounding healthy skin area, to have a "margin of safety". The wound is then closed with stitches. The removed tissue is sent to the laboratory to be examined under a microscope, in order to verify that all cancerous cells have been removed. The success rate of this technique used in first intention is about 92%. This rate drops to 77% in the case of a recurrence.

CURETTAGE - ELECTROCOAGULATION

The surgeon removes the cancerous tissue by scraping the skin with a curette then uses a needle of electric Cauterization to burn the residual tumor and stop the bleeding. This procedure is repeated several times, from increasingly deep being removed and burned every time, to make sure that he doesn't persist of tumor cells. This technique can have success rates that are close to those of conventional surgery for of this superficial low risk. However, it is not considered to be effective for the EC invasive or aggressive, for this high risk or in difficult locations, such as the eyelids, genitals, lips or ears.

CRYOSURGERY

The doctor destroys the cancerous tissue by freezing it with liquid nitrogen, using a kind of cotton swab or a spray. There is no cutting or bleeding, and no anesthesia is necessary. The technique can be repeated several times during the same session, to increase the chances of destruction of all of the cancer cells. The skin will then make crusts, which will fall in a few weeks. Redness, swelling or blisters may occur, and in some cases we can see a depigmentation. This technique is cheap and easy to make, and can be a treatment of choice for patients with bleeding disorders, or a contraindication to local anesthesia. However, cryosurgery has a cure rate lower than that of surgical techniques. Based on the expertise of the doctor, the rate of healing in 5 years can be at least 95% for some this superficial; but for the more invasive tumors, this technique is barely used nowadays because the deepest portions of the tumor can be forgotten and because the scar treatment can hide a recurrence.

RADIOTHERAPY

Bundles of rays X are directed to the tumor, without the need for cutting or anesthesia. The total destruction of the tumor requires usually several sessions, several times a week for one to four weeks, or sometimes once a day for a month. Success rates vary considerably, from about 85 to 95%, and the technique may cause aesthetic problems in the long term and the risks associated with radiation, and requires many medical visits. For these reasons, this treatment is reserved for patients who are difficult to treat surgically, for which there is a contraindication to surgery or in some older patients or in bad condition.

PHOTOTHERAPY (PDT) DYNAMICS

PDT is particularly useful for lesions of the face or scalp. A product photosensibilisant, as the 5 - ALA, is applied to injuries to the doctor's office; It is absorbed by the cancerous cells. Later, the treated areas are exposed to a light that activates the photosensitizing cream. Treatment can selectively destroy the EC, resulting in minimal damage to the level of the surrounding skin. However, this treatment is not approved yet for the treatment of this. Although it can be effective for EC early and invasive, this technique is for the moment not recommended for the this invasive, the recidivism rate varies considerably (from 0 to 52% according to surveys). Redness and swelling are common side effects. After treatment, patients are sensitive to the Sun for 48 h, in the place where the product has been applied, so they must avoid the Sun.

LASER TREATMENT

The outer layer of the skin and some deeper layers are removed with a laser CO2 or erbium YAG. This method has the advantage of not not lead to bleeding and gives the doctor a good control of the depth of the tissue removed. The laser open blood vessels it sections, which can be very useful for patients at risk of hemorrhage. This technique could be useful when conventional treatments have failed, but its use in the treatment EC has not been sufficiently studied and is currently not allowed. However, the risk of scarring and depigmentation is more important with the laser than with other techniques, and recidivism rates are roughly similar to those of PDT.

TREATMENTS LOCAL

5-fluorouracil (5 - FU) and imiquimod, two creams used for the treatment of Actinic Keratosis and superficial cell carcinomas, have also been tested for the treatment of a few this superficial. The effectiveness of these two products has been reported in Bowen disease, a non-invasive form of this. However, for the EC invasive, 5 - FU may not be used. About imiquimod, some studies have shown that it could be effective in the treatment of some this invasive, but its use is not yet approved for this indication. Imiquimod stimulates the immune system to produce interferon, a molecule that destroys cancerous and precancerous cells.

WHAT YOU SHOULD KNOW

CE is generally confined to the epidermis (the surface layer of the skin) at the beginning of its evolution. However, more the tumor grows, the treatment should be wide. The EC can eventually penetrate underlying tissues, which can disfigure the patients, sometimes even resulting in the loss of an eye or an ear nose. A small percentage of it, estimated between 2 and 10%, extends (metastasis) to bodies or remote tissues. When this happens, the EC can be life-threatening. It counts about 2500 deaths resulting from the evolution of this serious in a country like the United States.

Cutaneous metastases occur mainly when the EC reached an area of chronic skin disease, ears, nose, lips, mucous membranes such as the mouth, the nostrils, genitals, anus or the membrane of the internal organs.

Since the majority of the options requires surgery, the patient should expect to have scars. Most often, these are aesthetically acceptable when the tumor is small, but the removal of a large tumor often requires reconstructive surgery, skin graft or flap (fragment of skin and subcutaneous tissue type moved on the wound) to cover the wound.

WHEN THE RECURRENCE

Any individual who has had a CE was more likely to have another, particularly in the same area as the first, or nearby. This is because the Sun damaged skin of irreversibly. Recurrences usually occur in the first two years after treatment of the. A this can recur, even if he has been treated well the first time. Thus, it is crucial to pay special attention to monitoring sites already achieved by a CE, and any changes to this place must be shown immediately to a doctor. The EC of the nose, ears or lips have greater risk of recidivism.

Even if no warning sign is noted, regular medical follow-up consultations programming, including a review of all the skin, is an essential part of care. If the tumor recurred, the doctor may recommend a different treatment of the treatment used initially. some methods, such as Micrographic Surgery Mohs, can be very effective in case of recurrence.

PREVENT CANCERS OF THE SKIN

Even if the EC and the other skin cancers can almost always be cured when detected and treated early, it is better to prevent their occurrence. Here are some tips of solar protection, to implement every day:

Seek shade, particularly between noon and 4 pm.

Do not sunburn.

Avoid sunbathing or attend the cabins to UV.

Protect yourself from the Sun with clothing, including a wide-brimmed hat and sunglasses.

Use daily a sunscreen with an SPF (protection factor) of 15 or more.

Apply the equivalent of 2 tablespoons soup of sunscreen on your body 30 minutes before you go outside. Re-apply again every 2 hours or after a bath or a physical effort.

Keep newborns out of the Sun. Sunscreens should be used for babies from 6 months.

Check your skin from head to feet once a month.

Go see your doctor once a year for a complete skin exam.