Diagnosis and treatment of malignant skin lesions

The term “malignant skin lesion” primarily refers to skin cancer characterized by the uncontrolled proliferation of any of many types of skin cells. Each subtype of skin cancer has its own unique characteristics.

The most common forms of skin cancer are:

• basal cell carcinoma (BCC)
• squamous cell carcinoma (SCC), including keratoacanthoma
• melanoma

Early, superficial skin cancers include:

• superficial basal cell carcinoma (superficial BCC)
• intraepidermal squamous cell carcinoma (Bowen’s disease, in situ squamous cell carcinoma (SCC)) and actinic keratoses (precancers)
• melanoma in situ.

Skin cancer most often affects older adults, but it can also affect younger adults and, rarely, children.

It usually occurs in people with fair skin ( Fitzpatrick skin phototype I, II and III), although people with darker skin can also develop malignant skin changes.

People who have already had some form of skin cancer have an increased risk of developing a new skin cancer. A family history of skin cancer also increases the risk.

The most important factor in the development of skin cancer is excessive exposure to ultraviolet radiation (from sunlight or tanning beds).

Some of the other risk factors are smoking, HPV infection, immunosuppression, HIV infection, exposure to ionizing radiation, chronic wounds or certain genetic conditions such as albinism, basal cell nevus syndrome, epidermolysis bullosa, Xeroderma pigmentosum and others.

What are the clinical features of skin cancer?

Skin cancer generally manifests clinically as a lump/nodule, a sore that does not heal, or a lesion that progressively grows and changes.

What are the complications of skin cancer?

Skin cancer is a type of cancer that is very treatable in the early stages, and the person remains under continuous medical supervision for future prevention.

Signs of advanced, aggressive, or neglected skin cancer may include:

• ulcerations/wounds
• bleeding
• local invasions and destruction of adjacent tissues and structures
• distant spread of the tumor to the lymph nodes and other organs such as the liver and brain (metastases)

Skin cancer is generally diagnosed clinically by a dermatologist or family doctor. Dermoscopy (using a special magnifying lens) is most often used to confirm the diagnosis, detect early skin cancers, and rule out benign lesions.

A partial skin biopsy may be taken in cases of suspected non-melanoma skin cancer to confirm the diagnosis or determine the subtype, which may affect treatment.

Complete excision is usually performed to diagnose melanoma, as partial biopsy is not recommended as a diagnostic method in cases of suspected melanoma. The diagnosis is confirmed by laboratory tests by a histopathologist. In cases of suspected metastasis, a more extensive diagnostic workup is performed.

Timely treatment of skin cancer results in a complete cure.

Treatment options for superficial skin cancers include:

• minor surgical procedures including curettage, cauterization or electrosurgery
• cryotherapy
• local therapy with preparations such as fluorouracil cream or imiquimod cream
• photodynamic therapy
• radiotherapy (treatment with X-rays)

The treatment of choice for all forms of skin cancer is surgery using a local anesthetic. Surgical techniques include:

• excisional biopsy
• wide local excision
• Mohs micrographic surgery

Treatment of advanced or metastatic skin cancer, including basal cell carcinoma, squamous cell carcinoma, and melanoma, is carried out in specialized clinical centers that have access to appropriate treatment, monitoring, and modern targeted therapy that has greatly contributed to the overall survival of patients with advanced disease.

Patients with skin cancer have an increased risk of developing other skin cancers and are advised to:

• apply adequate sun protection
• regularly perform self-skin examinations at home, alone or with the help of family members
• regularly come for check-ups with a dermatovenerologist

Given the significant increase in non-melanoma skin cancers (basal cell carcinoma, squamous cell carcinoma) and the increase in the incidence of melanoma, especially in the younger population, it is clear that regular dermatoscopic examinations (at least once a year) are the best “weapon” for the prevention and early diagnosis of malignant skin diseases.

To schedule a consultation and examination with our expert team, you can contact us by calling +3851 2444646 or via our online form .

We will be happy to welcome you to the premises of the LF Polyclinic at Trg John Fitzgerald Kennedya 6b, Zagreb. You can easily reach us by public transport, and parking is available in front of the building with prior notice by phone.

Contact us with confidence and let us work together to find the best solutions and answers to all your questions.