When does skin pigmentation go away after irradiation? Treatment of skin cancer: evaluation of effectiveness and modern methods of therapy

When is basal cell carcinoma irradiation used?

Radiation therapy is effective independent method treatment of basal cell carcinoma. Irradiation of basal cell carcinoma is also used as an auxiliary method after surgical treatment in case not complete removal tumors. Or, if the basal cell carcinoma has grown so deeply into the skin that the doctor expects a relapse (recurrence) to develop in the future, despite the surgery performed. Radiation therapy is used primarily for basal cell carcinoma on the head and neck, as treatment on other areas (particularly the legs) is associated with slower healing, poor cosmetic results, and an increased likelihood of radiation dermatitis and necrosis later (see photo).
Radiation for basal cell carcinoma is the main treatment option for patients over 65 years of age. This is due to the fact that many years after radiation therapy there is a risk of new foci of basal cell carcinoma or squamous cell carcinoma. Patients under 65 years of age have a longer life expectancy and, accordingly, a greater risk of developing radiation-induced cancer.
Radiation is primarily indicated for very large basal cell carcinomas, tumors located on the eyelids, corners of the eyes, nose, ears and lips, where surgical treatment may lead to unacceptable cosmetic results or organ dysfunction. Irradiation of basal cell carcinoma is also prescribed for patients with severe concomitant diseases, who are elderly, and have contraindications for surgical treatment. If the tumor is less than 2 cm, the risk of relapse within 5 years after irradiation of basal cell carcinoma is 8.7%.

Massive basal cell carcinoma before irradiation in a 90-year-old woman who was refused surgical treatment.

The same basal cell carcinoma several weeks after irradiation. The tumor is eliminated, the remaining wound will turn into a white scar within six months.

How does radiation affect basalioma?

Irradiation of basal cell carcinoma is detrimental to its cells and the cells of surrounding tissues. This is due to the fact that radiation therapy acts on DNA, causing damage in it, leading to the inability to read information and cell death. Cells that are in the process of reproduction are damaged first. Due to the fact that basal cell carcinoma cells multiply more intensively, and the process of repairing damage in them is disrupted due to mutations, they die first. On the other hand, such a destructive effect on DNA does not go unnoticed by surrounding tissues. Many years after irradiation of basal cell carcinoma, due to mutations in the cells of surrounding tissues, new, newly developed foci of cancer may appear, nutrition and blood supply processes are disrupted.

Methods of irradiation of basal cell carcinoma.

Irradiation of basal cell carcinoma is carried out either with superficial X-rays (abbreviated BPRT) or (beta rays).

Close-focus radiation therapy (radiotherapy, x-ray therapy) as a method of irradiating basal cell carcinoma.

Irradiation of basal cell carcinoma using BPRT is much cheaper and is used in the vast majority of cases. The total radiation dose in the case of BPRT is calculated in grays (abbreviated as Gy), divided into several portions, which are delivered over a number of days. Basaliomas in the head and neck area and on the skin around the eyes are primarily treated with close-focus radiation therapy. A typical radiation regimen for basal cell carcinoma involves treatment 3 times a week
within 1 month. This regimen is changed at the discretion of the radiation oncologist. Radiation therapy is a relatively painless treatment method; each radiation session takes 10-20 minutes. The X-ray tube is quite maneuverable and allows the patient to sit comfortably on the couch with the applicator installed. In the case of round basal cell carcinoma, the boundaries of the irradiated tissue are marked. If the basal cell carcinoma has an irregular shape, a 1.5 mm thick lead plate with a cut hole in the shape of the irradiated tumor can be applied. Visible basal cell carcinoma and 0.5-1.0 cm of surrounding skin are irradiated if the tumor is less than 1 cm. If the basal cell carcinoma is large or its edge is unclear and uneven, up to 2 cm of surrounding skin is irradiated. The radiologist calculates the radiation dose for basal cell carcinoma and the time required for the session. Once the applicator is installed, the radiologist leaves treatment room. The treatment lasts for several minutes. During this period, the patient is monitored through a special window or using cameras.

Basal cell carcinoma exposed to radiation is outlined with a pencil for more precise focusing of the rays.

A special mask made of 1.5 mm thick lead sheet. It is applied to protect the eye from the effects of basal cell carcinoma radiation, including clouding of the cornea and lens.

Radiation therapy device. It is used not only to irradiate basal cell carcinoma, but also to treat squamous cell skin cancer.

Irradiation of basal cell carcinoma with beta rays (electrons) as a method of radiation therapy.

Beta rays are electrons produced by a linear accelerator or from radioactive isotopes such as strontium 90. X-ray energy is lost in tissue as depth increases. The energy of the electron beam increases to a peak at a certain depth and then drops sharply, this is very useful property. The effective treatment depth in centimeters is approximately one-third of the beam energy, so a 4.5 MeV electron beam will be effective to a depth of 1.5 cm, and a 12 MeV beam to a depth of 4 cm.
Electrons are absorbed equally well by tissues, regardless of density, X-rays are absorbed more dense fabrics. Where bones are close to the surface of the skin, X-rays can damage the bones, and electron irradiation is recommended. With basal cell carcinoma of the auricle,
For the scalp, dorsum of the hand and lower leg, electron radiation therapy is currently preferred. It is also possible to irradiate the entire surface of the skin with electrons, which is extremely useful for multiple lesions of basal cell carcinomas.
Unfortunately, the possibility of using electron beams is limited, first of all, by the high cost of equipment. The minimum size of a basal cell carcinoma exposed to electron irradiation should be 4 cm2, since it is difficult to adjust the device to a smaller area. In general, setup and focusing during electron beam therapy are quite labor-intensive processes. When treating basal cell carcinoma located around the eye, it is not possible to protect the eye tissue; therefore, electron irradiation is not applicable here.

Short-term side effects of basal cell carcinoma radiation. Prevention methods.

Even the modern method of irradiating basal cell carcinoma can cause side effects. During each session, redness and slight soreness may develop, the severity of which increases by the 3rd week. They usually go away 4-6 weeks after completion of irradiation of the basal cell carcinoma and can be mitigated by the use of glucocorticoid-based ointments (prednisolone, hydrocortisone, sinaflan). During the entire course of irradiation, ulcers and crusts may form in the area of ​​the basal cell carcinoma and on the skin around it - signs of radiation dermatitis, which disappear upon completion of the course of treatment. The skin is treated with Vaseline, argosulfan, and silver-based dressings are applied to mitigate radiation reactions. In case of severe ulceration and infection, the skin is usually recommended to be treated with dioxidine. The skin must be protected from additional damage during the course of radiation and beyond. It is necessary to protect yourself from sunlight, heat, cold and friction. The patient needs to use sunscreen on irradiated skin with a protection factor of at least 15. For basal cell carcinomas of the neck and head, it is necessary to wear a hat with a brim. This protection must be maintained throughout life.

Radiation dermatitis with scarring, vasodilatation (telangiectasias), crusting. Developed after irradiation of basal cell carcinoma.

Local side effects of basal cell carcinoma irradiation, treatment of complications.

Other side effects depend on the region of the skin being irradiated.
These include mucositis - inflammation of the mucous membranes of the mouth and nose during irradiation, accompanied by burning, mucus secretion or, conversely, dryness, the appearance of superficial ulcers. To prevent mucositis, you need to use a soft toothbrush, rinse your mouth with decoctions of sage, chamomile, and chlorhexidine. When basal cell carcinoma is irradiated near the eye, conjunctivitis may develop. Treatment of conjunctivitis must be carried out with collargol or protargol (also based on silver), taufon will also help. During radiation therapy for basal cell carcinoma on the scalp, baldness is possible.

Long-term complications of radiation therapy for basal cell carcinoma.

Once the redness disappears, most patients rate the cosmetic outcome of radiation therapy as good or excellent. Over the course of a year, irradiated skin typically becomes pale and thinned. Within a few years there may appear
telangiectasia (vasodilation), hypopigmentation (pallor) or hyperpigmentation (darkening) of the skin. Scars from irradiation of basal cell carcinoma become worse in appearance over time, unlike scars after surgical treatment. The likelihood of long-term consequences increases with increasing total radiation dose, dose size per session, and volume of irradiated tissue. After irradiation of basal cell carcinoma for 45 years or more, there remains an increased risk of the formation of new foci of squamous cell and, to a greater extent, basal cell skin cancer. This side effect of radiation therapy is most relevant to younger patients. Long-term consequences of basal cell carcinoma irradiation can also include scarring of the skin and underlying tissues, leading to limited mobility. Active and passive exercises of the irradiated areas help maintain mobility and prevent contractures (stiffness due to scarring). Due to changes in blood vessels, once irradiated skin recovers less well from surgical interventions. Hair loss that begins during irradiation of basal cell carcinoma usually lasts for life. Additional long-term effects also depend on the location of the irradiated area. For example, irradiation of basal cell carcinoma near the eyes can cause ectropion (turning of the eyelid) and cataracts (clouding of the lens), but such consequences are extremely rare.

As shown by radiometric and morphological research, the degree of radiation damage to the skin, and therefore the possibility of its restoration, are directly related to the distribution of energy in depth. That's why absolute value The falling dose measured on the skin surface cannot characterize the expected effect when exposed to radiation of different energies. It is known that large doses of soft radiation cause less biological effect than small doses of hard radiation [Osanov D. P. et al., 1976; Dvornikov V.K., 1975]. At the same time, soft radiation, which has lower energy, in comparable doses, more quickly causes local manifestations of radiation damage to the skin than hard X-rays, y-rays and neutrons, which have greater penetrating ability [Ivanovsky B. D., 1958; Borzov M.V. et al., 1972].

Pathogenesis structural changes skin varies significantly depending on where the energy is primarily absorbed - in the epidermis, superficial or deep layers of the dermis, or in the underlying tissues. Therefore, calculations of the magnitude and depth of distribution of doses of absorbed energy show that primary changes in the epidermis become less pronounced as the severity of radiation energy increases and, conversely, the severity of damage to the deep layers of the dermis and underlying soft tissue increases accordingly. For example, when irradiated with an energy of 7 keV at the level of the basal layer of the epidermis, the absorbed dose is 2 times higher than when irradiated with an energy of 18 keV [Dvornikov V.K., 1975; Samsonova T.V., 1975]. After external influence p-radiation in a dose of 5000 R possible full recovery epidermis, whereas with γ-irradiation with megavolt energy there may be no damage to the epidermis, but in the long term fibrosis of the subcutaneous tissue develops [Dzhelif A.M., 1963].

L. A. Afrikanova(1975) distinguishes 3 zones of structural disturbances when the skin is irradiated with soft X-ray radiation: the actual zone of necrosis, the reserve zone of necrosis and the zone of reactive changes. At the same time, the author notes that necrotic changes in the papillary and other layers of the dermis occur (reserve zone of necrosis) only after the death of the epidermis due to the cessation of physiological regeneration of the latter under the influence of radiation. However, such a clear division into zones and such a sequence are characteristic only of skin lesions caused by soft radiation in a dose of up to 5000-10,000 R, when the main amount of energy is absorbed by the surface layers of the skin.

When in action hard radiation due to the geometry of the distribution of the maximum dose of absorbed energy morphological changes in irradiated skin have their own characteristics. They appear most clearly in places of maximum direct exposure to gamma rays or fast neutrons with uneven irradiation of the body. This type of radiation damage to the skin, judging by the literature, is possible during accidents at nuclear installations in industrial or laboratory conditions, which deserves special attention from a practical point of view. It should be noted that in in this case Along with the early changes in the epidermis described above, significant disturbances simultaneously occur in the deep layers of the dermis, subcutaneous tissue and skeletal muscles.

Moreover, if the radiation does not cause immediate death epidermis, then morphological changes cover epithelium and are less severe than disorders of the dermis and underlying soft tissues. In the first days of the disease, significant swelling of the dermis and physicochemical changes in collagen fibers are noticeable, which is especially clearly revealed by their metachromatic violet coloring using the Mallory method. In addition, gross changes in elastic fibers are detected, which, as is known, is not typical for the early stage of skin damage by X-rays [Afrikanova L.L.. 1975].

IN subcutaneous tissue are also observed in skeletal muscles signs massive edema, accumulation of interstitial tissue and walls in the ground substance blood vessels acid mucopolysaccharides (glycosaminoglycans), dystrophic changes in fibrous structures and striated muscles. In the following days, these changes increase and spread from the deep layers of the skin to the superficial ones. Microscopically visible voids or gaps are formed between the basal layer of epidermal cells and the basement membrane due to vacuolization of cells and rejection of the epidermis due to swelling of the reticular layer. Thus, the death of the epidermis and the formation of necrotic-ulcerative defects when damaged by gamma-neutron or neutron radiation are primarily due to severe circulatory disorders and degenerative changes in the subcutaneous tissue and dermis. This corresponds to the deep distribution of absorbed energy and the peculiarities of the interaction of fast neutrons with tissues.

As is known, 85% of the energy of a beam of fast neutrons is spent on education recoil protons during the interaction of neutral particles with hydrogen atoms. Therefore, the maximum exchange of energy occurs in the subcutaneous tissue, which contains 15-20% more hydrogen than other tissues [Dzhelif A., 1964; Grammaticati V.S. et al., 1978].

According to statistics, in last years The number of people with skin cancer is rapidly increasing, regardless of their age and gender. Despite the use best practices diagnosis and treatment of oncological pathologies, to answer the question that worries everyone: “is it possible to cure skin cancer?” There is still no clear answer.

The concept of “skin cancer” includes a group of cancer neoplasms that develop from cells of various layers of the epidermis and are localized on the surface of the skin.

Depending on the structure of the affected cells, several forms of this disease are distinguished.

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Basalioma or basal cell carcinoma, develops from the upper layer of the epidermis, is the most common form of cancer pathology. Characterized by tissue germination and absence of metastases.

Squamous cell carcinoma originates from the cells of the spinous layer of the epidermis, develops against the background of skin pathology, and is diagnosed less frequently than basal cell carcinoma. This form is characterized by an aggressive course and metastasis in the early stages of development. With the development of this form, facial skin is damaged.

Metatypical cancer It has clinical manifestations, similar to the symptoms of basal cell carcinoma, but the features of the course are similar to the nature of the development of squamous cell carcinoma. This form occupies an intermediate position between these two types.

Melanoma develops from melanocytes - pigment cells of the epidermis. It is characterized by rapid development and extreme malignancy. May arise as a result pathological changes nevi (birthmarks).

Kaposi's sarcoma develops from the vascular endothelium, and is characterized by multifocal malignant lesions of the dermis and diversity clinical forms. There are red, nodular, infiltrative, disseminated (lymphadenopathic) forms of the tumor. Kaposi's sarcoma is characterized by multiple bluish-red spots that gradually transform into tumor formations up to 5 cm in size.

The choice of the most effective treatment tactics depends on the form of the tumor, its location, degree of differentiation, extent of the process, and the age of the patient.

Video: Skin cancer. Types, symptoms, treatment

Surgical treatment (operation)

The main goal in the treatment of skin cancer is radical removal of the tumor, which is carried out by excision of the primary tumor to healthy tissue. Currently, there are several methods of surgical treatment.

Classic excision . This method is applicable to any form of tumor on early stages development. The surgeon removes the tumor, capturing 1-2 cm of the adjacent healthy skin. It is subsequently examined under a microscope for the presence cancer cells in not damaged tissue.

Microsurgery MOHS . This method is most effective in the development of basal cell carcinoma or squamous cell carcinoma. The peculiarity of this operation is the layer-by-layer removal of the tumor and instant microscopic examination of each layer for the presence of cancer cells. Sections are made until healthy tissue without cancer appears under the microscope. Microsurgery is performed to minimize the removal of healthy tissue and preserve the cosmetic effect.

Fulguration (electrocoagulation) and curettage . This simple method is also suitable for removing small squamous or basal forms. The operation is performed using a curette, a small spoon-shaped instrument. When damaged tissue is removed, an electrical current is applied to the area to destroy any remaining cancer cells and prevent bleeding. For complete removal it is necessary to carry out several stages of treatment.

Cryotherapy . This method is used to remove Kaposi's sarcoma, melanoma, basal cell carcinoma or squamous cell carcinoma when the tumor is small. The essence of the operation is to remove cancerous tumor liquid nitrogen, which is applied directly to the affected area.

As a result of shock freezing of a tumor, cancer cells are destroyed, but along with them, nerve damage can occur, which often leads to loss of sensitivity in this area.

Laser therapy . Removing cancer cells with a laser is a modern and highly effective method, since with layer-by-layer removal of affected tissue, which is carried out with high precision, healthy tissue are not injured. Laser therapy is performed quickly and under local anesthesia.

Radiation therapy

Very often, skin cancer treatment is carried out using the method laser therapy. At stages 1-2 of basal cell carcinoma development, with its small size, close-focus radiotherapy is indicated. In case of extensive damage, it is prescribed combination treatment using remote gamma therapy.

This treatment method is indicated in the early stages of the tumor process, or after surgical removal of squamous cell and metatypical cancer in case of relapse. He shows good effect, since with the help of a powerful stream of radio rays the structure of cancer cells is destroyed, as a result of which they stop multiplying and die. In some situations, radiotherapy is prescribed in combination with the drug Prospidin.

Radiation therapy is prescribed to elderly people if primary tumor reaches a diameter of up to 20 mm. In this case, a tolerable radiation dose is selected, which is calculated individually for each patient. The advantage of radiation therapy is the destruction of cancer cells and the preservation of healthy, undamaged ones. However, after it is carried out, they may develop local complications in the form of perichondritis, dermatitis, conjunctivitis.

If a patient is diagnosed with melanoma, radiation therapy is prescribed at the stage when the tumor begins to progress, and only at complex treatment with chemotherapy or immunotherapy, since very often melanoma exhibits resistance to the effects of radiation.

If a patient develops Kaposi's sarcoma, namely when large painful lesions are identified, local exposure to radiation is carried out. However, this is only true for HIV-infected patients. For patients in the AIDS stage desired result almost impossible to achieve.

Chemotherapy

The chemotherapy method is the most effective field of surgical intervention. It is appointed in front of everyone possible forms skin cancer. Chemotherapy is especially effective when the tumor recurs or when the size of the tumor is critical, which prevents surgery. In this case, chemotherapy drugs are prescribed that destroy tumor cells.

For basal cell tumors it is prescribed local chemotherapy using external ointment for cancer (prospidin or 5-fluorouracil), which should be applied locally twice a day for several weeks.

Most often, chemotherapy involves the use of local applications using cytostatics (Fluorouracil, Doxorubicin, Metatrixate, etc.)

To know how to cure squamous cell skin cancer with chemotherapy, you should determine the stage of development of the process, since this method is effective only for small tumors or when relapses occur. The patient is prescribed local chemotherapy using 0.5% omain or 5-fluorouracil ointment. Otherwise, highly effective chemotherapy drugs are prescribed.

Metastatic epidermal cancer, which can cause lesions on the skin of the nose, cheeks, forehead and face in general, is treated in the same way as squamous cell carcinoma, since the clinical manifestations of both forms are almost similar.

For the treatment of melanoma, chemotherapy is usually not indicated, or is indicated only last stage diseases when extensive metastasis occurs and the primary tumor reaches critical sizes. The destruction of cancer cells in both the primary and secondary tumors occurs when chemotherapy drugs are applied directly to the tumor.

When Kaposi's sarcoma is diagnosed, the patient is prescribed chemotherapy along with other treatment methods: antiretroviral therapy, interferon therapy. For a course of chemotherapy, Vinblastine, Vincristine, Prospidin, Taxol, Etoposide and other drugs of the latest generation are prescribed.

Modern methods allow you to expand your capabilities complete cure oncological diseases. But only depending on the form of skin cancer with a timely start and correctly chosen treatment protocol can one reliably determine whether skin cancer is curable and whether a recurrence is possible.

A large number of skin diseases are now known. Some of them are quite harmless, but there are also those that require special attention. This includes skin cancer. This pathology can develop in absolutely anyone; age and gender do not affect this in any way, but this disease is most often diagnosed in old age.

What is the disease

This pathology begins its development from squamous epithelial cells and is a cancerous tumor. Quite often such neoplasms can be seen on open areas of the body; on the limbs and trunk they form in only 10% of cases.

According to statistics, skin cancer on the face or other areas is often diagnosed; it ranks 3rd among cancer diseases.

Who is at risk

No one is immune from cancer pathologies, but there are categories of people whose risk of developing skin cancer is much greater. These include:

• Patients with fair skin are genetically designed to synthesize less melanin.
• Elderly people.
• Having a hereditary predisposition to the appearance various kinds neoplasms.
• Having precancerous diseases.
• Smokers.

• Bowen disease can also cause skin cancer.
• Patients diagnosed with xeroderma pigmentosum.
• Having inflammatory skin pathologies.
• Long-term exposure to ultraviolet rays.

Important. Visiting a solarium increases the risk of developing cancer several times.

A predisposition to a disease does not always mean that it will definitely develop. But often some factors become strong provocateurs and act as a trigger.

Causes of skin cancer

There are some causes that cause skin cancer:

• Constant contact with harmful substances, which have a carcinogenic effect on the body. These include: cigarette components, lubricants, arsenic compounds.
• Long-term exposure to radioactive radiation on the skin.
• Constant exposure to thermal radiation.
• Mechanical injuries, damage to moles.
• Mechanical damage to old scars.
• Eating large amounts of foods that contain chemical additives, many of which may be carcinogenic.

The development of oncology is not always provoked by a single cause; most often, a complex influence of negative factors is observed.

Types of skin cancer

The skin contains a large number of cells belonging to various tissues. This is why developing tumors can differ from each other. Experts recognize several types of skin cancer:

1. Squamous. It can form in different places, but usually on exposed areas and lips. The causes are often mechanical damage and scarring of tissue after a burn.

Important. In 30% of cases, old scars subsequently become the cause of the development of cancer.

1. Basal skin cancer characterized by a tendency to relapse, the cause is most often a hereditary predisposition and problems at work immune system. But experts also assign an important role in the development of pathology to the effects of carcinogens and ultraviolet radiation. Basalioma, as this type of cancer is also called, is often located on the head and can form single tumors or entire clusters.
2. Cell cancer has a similar course to basal cell carcinoma, but can produce “sprouts”, which significantly worsens the prognosis for the patient.
3. develops from pigment cells.

Skin cancer symptoms

Skin cancer symptoms may vary depending on the type of pathology, but there are also general signs, which always appear:

• Fatigue and rapid fatigue during any type of activity.
• Sudden weight loss for no apparent reason.

• Poor appetite.
• The temperature remains at 37 °C for a long time.
• The lymph nodes become enlarged and can be easily palpated.
• Moles can change their shape, color and size.
• If already late stage disease, then pain also becomes a sign.

But each type of cancer has its own features, which allow specialists to diagnose them.

Manifestations of various types of cancer

When visiting an oncologist, the first thing the doctor examines is the patient and pays attention to his tumors. Often only after external signs the type of cancer can be preliminarily determined, and then the diagnosis can be confirmed by other studies. It is the different manifestations that help doctors distinguish one type of tumor from another.

Important. Depending on the type of cancer, the signs of pathology will differ.

For ease of study, the information is presented in the table.

Type of skin cancer	Symptoms
Squamous cell carcinoma	The neoplasm of this variety is often red in color, has a dense consistency, is lumpy and bleeds. The tumor is different accelerated growth and may appear as a plaque, ulcer or nodule. Sometimes the formation resembles cauliflower. This variety is different rapid growth and easily spreads in width and depth.
Basal cell carcinoma	Unlike the previous form, it grows slowly and can develop over many years, but is distinguished by the presence of a variety of external forms. It can be: nodular-ulcerative, warty, flat, pigmented. It usually begins with the appearance of a small gray or pinkish nodule with a pearlescent sheen. The neoplasm has a smooth surface, and there are scales in the center. The favorite place of education is the face.
Melanoma	This is a pigmented tumor that is dark in color, ranging from brown to black. During development, it can increase in different directions, so there are horizontal and vertical forms. This variety is considered the most dangerous, as it metastasizes and spreads quickly. It does not appear on its own, but necessarily occurs at the site of a mole, freckles or other heavily pigmented areas. The affected area often itches and swelling appears, which forces patients to consult a doctor.
Adenocarcinoma	It is less common than other varieties. Favorite places are areas with a high content of sweat and sebaceous glands. By appearance resembles a small nodule or tubercle. It grows slowly, but during development it affects muscle tissue.

Stages of development of skin cancer

All oncological pathologies pass through several stages in their development. The earlier the disease is diagnosed, the easier it is to treat. To determine the extent of skin cancer, doctors may use a CT scan, blood test, or biopsy. Lymph nodes must be examined. For malignant neoplasms skin development stages are characterized by:

• First. If skin cancer initial stage, then the neoplasm does not exceed 2 centimeters. Metastasis does not form, but the lower layers of the epidermis are affected. If therapy is started at this stage, then almost complete recovery occurs.

• Stage 2 cancer characterized by an increase in formation up to 4 centimeters. Sometimes, already at this stage, metastases can be detected in a neighboring lymph node. The site of injury causes discomfort and sometimes pain to the patient. The tumor grows into all layers of the skin. Therapy at this stage leads to recovery in 50% of cases.

• Stage 3 cancer affects the lymph nodes, but metastases have not yet penetrated the organs. The neoplasm takes on a lumpy appearance, and the patient experiences discomfort. The prognosis is favorable for only 30% of patients.

Need to know. At this stage of the disease, patients often experience elevated temperature bodies.

• Stage 4. The tumor is more than 5 centimeters in diameter. It has uneven outlines, the top is covered with crusts and bleeding ulcers. Patients lose a lot of weight, constantly feel weak, headache. Metastases appear in the lungs, liver and bones. Even after treatment, only 20% of patients survive.

You should know it. Basal cell cancer does not have stages in its development; the tumor simply gradually increases and negatively affects neighboring tissues.

Skin cancer treatment

The choice of therapy method is influenced by several factors:

• Stage of development of the neoplasm.
• Availability concomitant diseases at the patient.
• General condition of the body.
• Patient's age.
• Location and type of cancer.

Important. Oncological diseases skin responds quite well to therapy if it is started in a timely manner.

TO modern methods treatments include:

• Radiation therapy.
• Laser treatment.
• Surgical removal of the tumor.
• Cryodestruction.
• Drug therapy.

Sometimes, to achieve a complete cure, you have to resort to several types of therapy at once..

Getting rid of cancer with radiation therapy

Irradiation of skin cancer is quite effective way, since malignant cells are quite sensitive to radiation. The latest treatment regimens have now been developed that allow minimal impact on healthy cells.

Radiation therapy is often prescribed:

• If there are contraindications to surgery or general anesthesia.
• There is a relapse of the disease.
• A good cosmetic effect is important.
• The tumor is large.
• Located away from important organs.

Important. For each patient, the radiation dose is selected strictly individually, as well as the duration of treatment and the number of procedures. If such therapy is carried out at the first stage of cancer, the effectiveness reaches 95%.

Chemotherapy

This type of therapy involves introducing substances into the body that are harmful to cancer cells.. Indications for such treatment are:

• Recurrence of basal cell carcinoma.
• Large tumors that cannot be operated on.
• Stages 3 and 4 cancer.

Medicines can be used externally, or do intravenous injections. The effectiveness of this method is good when it is an addition to radiation therapy or surgical removal of the tumor.

Safe treatments

They are also called gentle and include:

• Cryotherapy- freeze the tumor and cut it off.
• Laser treatment carried out using a laser, which burns out the tumor.
• Local therapy. It involves the use of drugs administered using electrophoresis, they stop the growth of malignant cells.

It is important to know. Skin cancer treatment should be carried out only in an oncology clinic. Folk remedies To get rid of the disease, you can use it at your own peril and risk.

How to prevent the development of the disease

How skin cancer manifests itself is now clear, but the question arises: is it possible to prevent the development of pathology? Everyone knows that preventing any disease is much easier than treating it later. This also applies to cancer. Preventing skin cancer involves following these recommendations:

1. Everyone is looking forward to a vacation to go closer to the sea and soak up the warm rays of the sun, but this is not at all safe for health. It is necessary to protect your skin from prolonged exposure to ultraviolet radiation.

Important. Tanning is harmful to health and has serious consequences.

1. Every time you go outside in the summer, use sunglasses and protective creams.

A tanned body is beautiful, but prolonged exposure to direct sunlight does not have the best effect on our skin.

1. If there are long-term non-healing wounds or ulcers on the skin, then you need to see a doctor.
2. If there are old scars, they should be protected from mechanical irritation.
3. Pay attention to moles; if their shape or color changes, visit an oncologist.
4. News healthy image life.
5. Limit consumption of foods containing carcinogens.
6. When working with household chemicals, be sure to use gloves.
7. Any skin diseases treat in a timely manner.

Among all cancer pathologies, skin cancer is considered highly treatable. It is easy to diagnose, and can be cured in one day if you contact a specialist at the very beginning of the development of the disease.

It is important not to waste time, and for this you just need to be more attentive to yourself and your health.

Basalioma of the skin is considered a fairly common pathology among Europeans. This type of cancer occurs more often in older people. The most common is basal cell carcinoma of the face. The most effective method of eliminating this type of skin cancer is radiation therapy. Let's take a closer look at the main methods of treatment, removal, complications, and side effects that radiation therapy can cause for basal cell carcinoma.

Experts classify basal cell carcinoma as a borderline cancer. The growth of the formation occurs deep into the tissues, and the lump (depending on the type of oncology) can occupy a large area on the skin and take the form of an ulcer. Initially, the tumor appears on the basal layer of the epidermis. If basalioma is not treated for a long time, it will spread to cartilage and bone.

More often, this type of oncology develops in the dermis of the face and neck. Basal cell carcinoma can also appear in other areas that are negatively affected by aggressive factors. The most dangerous are basal cell carcinomas in the area of ​​the wings of the nose, on the ears, and near the eyes.

Treatment of basal cell carcinoma through the use of radiation therapy is possible at any stage of the disease. But now I use it less often due to the effectiveness of modern techniques such as laser and radio wave therapy.

The initial stage of basal cell carcinoma can be eliminated with medication or with minimal surgical intervention. To make basal cell carcinoma therapy faster and easier, it is necessary to detect the disease at the initial stages of its development.

Radiation therapy for basal cell carcinoma is indicated in the following cases:

• very large tumor;
• localization malignant formation in an area considered difficult to reach;
• age (over 65 years);
• penetration of oncology deep into the skin, cartilage and bone tissue;
• the presence of diseases in the patient that are a contraindication to other therapeutic methods.

Radiation therapy is used in complex treatment of oncology.

Ionizing exposure may be required after surgery if it is impossible to completely eliminate pathological basal cell carcinoma cells. Also, exposure to rays helps reduce pain syndrome, other signs of illness.

Radiation therapy methods

Radiation therapy is effective due to the effect of ionizing rays on cell DNA. Y-irradiation destroys the DNA of the pathological cell, making it unable to divide, which means the spread of basal cell carcinoma stops.

The initial target of therapeutic radiation is considered to be cells that are dividing intensively. Y-rays also affect healthy tissue, provoking various consequences of treatment of basal cell carcinoma using this method.

Contact irradiation with isotopes of cobalt (Co60), iridium (Ir92), radium (Ra226) is carried out in such a dosage that could destroy malignant cells and prevent their further reproduction. Therapy is performed using applicators made of plastic material. They are prepared individually for each sick person.

A plate (1 cm thick) is placed in boiling water and applied to the affected area of ​​the dermis.. This applicator is modulated, giving the plate the relief of the skin. Radioactive substances and protection in the form of a lead plate are applied on top of the plate. Passing through tissue, the intensity of radiation decreases. Therefore harm internal organs This method of eliminating basal cell carcinoma will not cause damage.

Near focus therapy, which is carried out from a distance of less than 7.5 cm, requires the use of power ranging from 10 to 250 W. Changing the power changes the depth of impact, which is represented by several millimeters and reaches 7–8 cm.

The beams are focused using a tube. The area of ​​the dermis that should be irradiated is limited by filters made of different metals (brass, aluminum). The thickness of such filters is up to 3 mm. The level of absorption of rays by tissues is influenced by the stage of development of oncology and the patient’s condition. Taking into account these features, the dosage is selected individually by the oncologist.

A feature of β-irradiation is the use of radioactive isotopes of such substances:

• phosphorus (P32);
• thallium (TI204).

Before exposure to rays inside the basalioma, the doctor injects colloidal solutions such metals:

• silver (AG188);
• gold (Au111).

These solutions are administered by a specialist in the form of special granules, which are initially treated with catgut threads.

According to reviews from oncologists, it is quite difficult to perform this method of irradiation, and not all clinics have unique equipment for its implementation. The described treatment method is used to eliminate those forms of basal cell carcinoma that are resistant to other methods of radiation exposure.

What are the risks of basal cell carcinoma irradiation?

In any case, the consequence of radiation treatment of basal cell carcinoma is damage to healthy cells located in the tissues surrounding the tumor.

Following the rules of the procedure cannot prevent radiation damage to healthy tissues.

The sensitivity of the epidermis to radiation is influenced by many factors:

• excess weight (obese patients have more susceptible dermis);
• localization of oncology. The dermis of the anterior surface of the neck will be more delicate and sensitive to rays. The skin of the back of the head, wings of the nose, etc. is considered rougher;
• age-related changes;
• air temperature. Due to increased blood supply in the heat, the likelihood of complications increases;
• The permeability of the epithelium increases in the presence of scratches and cracks.

Side effects that occur during irradiation

The majority of patients treated for basal cell carcinoma with radiation therapy do not develop systemic consequences. Experts explain the manifestation of such effects by the reaction of the dermis. It is represented by the epidermite.

When carrying out each procedure, the following consequences appear on the epithelium:

• redness;
• edema;
• itching

During therapy for basal cell carcinoma with rays, these symptoms become more pronounced. They become brightest by the 3rd week of the course. Such consequences disappear 1 - 1.5 months after the course of treatment for basal cell carcinoma is completed. To reduce their severity, experts recommend using ointments with glucocorticoids (Sinaflan, Hydrocortisone, Prednisolone).

Minor ulcers and crusts may also appear. They indicate the development of radiation dermatitis, which will disappear at the end of the therapeutic course.

The following signs indicate the development of changes in the skin:

• pigmentation disorder;
• formation of “stars”;
• disappearance of the surface pattern on the skin;
• peeling, increased dryness.

If oncology occurs near the mucous membranes of the nose and mouth, there is a possibility of inflammation (mucositis). This pathology is accompanied by burning, dryness of the dermis, and pain after touching. Said consequence considered very rare. When exposed to radiation to basalioma localized in the eye area, there is a risk of recurrent conjunctivitis.

Long-term complications that may occur after radiation

Radiation therapy can cause not only immediate consequences, but also long-term complications. Exposure to radiation contributes to the thinning of the skin and the appearance of vascular networks. After a year or a year and a half after irradiation, lighter and darker areas of the epithelium may appear. The brightness of such manifestations depends on the duration of previous therapy, the radiation dose received by the skin, and the area of ​​exposure.

More dangerous consequence The described treatment method is considered to be a radiation ulcer. It is provoked by the effect of radioactive isotopes on the microcirculation of blood vessels localized under the layer of the epidermis. The likelihood of an ulcer increases in proportion to the depth of cancer penetration and the strength of radiation.

The most dangerous consequence of basal cell carcinoma therapy is the development of squamous cell carcinoma, which is considered more dangerous pathology than basal cell carcinoma. Therefore, experts do not recommend undergoing radiation therapy for those under 50 years of age.. The considered method of treating basal cell carcinoma should not be carried out in the presence of a relapse of the disease.

The effects of radiation therapy carried out in the scalp area of ​​the skin are accompanied by hair loss. Gradually the hair grows back, but it is no longer as strong as before. The scalp is characterized by a faded color, increased fragility, and lack of healthy shine.

If therapy has been carried out for basal cell carcinoma localized near the eyes, there is a possibility of developing a consequence of therapy such as cataracts. Scientists have not yet been able to establish a threshold dose of radiation to the lens, so oncologists do not know how high the risk of developing such consequences as cataracts is.

Another consequence of basal cell carcinoma therapy is scarring.

This consequence, which appears after exposure to radiation, limits the mobility of muscle fibers, negatively affecting facial expressions. In order for the muscles to maintain mobility, as well as to prevent contracture (immobility caused by scars), experts recommend performing active and passive exercises in the area of ​​radiation exposure. Doctors also note changes in the functioning of the sebaceous and sweat glands.

Once the redness caused by radiation therapy disappears, patients are generally satisfied with the cosmetic result. But after several years, the scars become rougher and more noticeable.

How to relieve side effects after radiation therapy

Treatment of the epidermis surrounding basalioma with the following means is considered to prevent radiation dermatitis:

• "Petrolatum";
• a mixture of such medicines “Shostakovsky Balm” + vegetable oil;
• "Methacyl emulsion".

Doctors recommend using these measures after the first radiation therapy procedure. If an ulcer does appear, you need to do everything to prevent bacterial inflammation from starting. For this purpose, lotions with such solutions (dioxidine, silver) are placed on the irradiated area of ​​the epidermis.

The following gels help speed up wound healing after basal cell carcinoma:

• "Iruksol".
• "Solcoseryl".
• "Methyluracil ointment."
• "Actovegin".

Washing and rinsing with herbal decoctions (chamomile, sage), and chlorhexidine will help prevent the consequences after radiation therapy, which manifest themselves in the form of damage to the mucous membrane.

Conjunctival lesions should be treated with antibacterial drops. Exposure to the dermis of the sun's rays can provoke indurative edema, which is treated with antibiotics and anti-inflammatory drugs. They help prevent such a consequence of therapy as pigmentation ascorbic acid, vitamin R.

Prevention of complications

Before carrying out radiation therapy for basal cell carcinoma, doctors must conduct a thorough examination, collect anamnesis, and refer for diagnostics to detect concomitant diseases. Having all the necessary information, the doctor correctly calculates the dosage, duration of the procedure, and frequency of irradiation sessions. This helps reduce the risk of side effects from radiation therapy.

Considering the size of the basal cell carcinoma, the specialist in the process of performing radiation therapy capture several centimeters of healthy tissue (1 – 2 cm). This is considered necessary to prevent the re-development of basal cell carcinoma in this area.

To reduce the likelihood of developing consequences from radiation therapy used to eliminate basal cell carcinoma, lead plates are used. In these products, holes are made that correspond to the shape of the basal cell carcinoma. This plate is applied to the dermis during each procedure. Before each irradiation, the doctor notifies the patient that the skin should be protected from damage. You can reduce the likelihood of consequences after irradiation if you follow all the doctor’s recommendations:

1. Protect the epidermis from exposure to direct sun rays. You cannot visit the solarium. It is advisable to wear long sleeves when walking outside. Skin Faces should be covered with a wide-brimmed hat. To protect exposed areas of the dermis from negative impact ultraviolet radiation should be applied with high level SPF
2. It is important to perform carefully hygiene procedures so that the marks with which the doctor marked the radiation exposure area are not washed off.
3. It is forbidden to rub or massage the epidermis that has been exposed to rays. The use of mustard plasters, cans, and treatment is also contraindicated. alcohol solutions, antiseptics, if the doctor did not prescribe such procedures.
4. It is prohibited to use heating pads or compresses on the area exposed to rays.
5. Before using personal hygiene products (soap, cream-shower gel) with fragrances again, you should consult your doctor.
6. Before carrying out radiation therapy to eliminate basal cell carcinoma, it is necessary to remove decorative cosmetics 4 hours before the procedure.
7. Limit visits to the pool and bathhouse.

Radiation therapy is considered a very heavy burden on the body. Accordingly, any unusual consequences in the area of ​​the irradiated dermis require contacting a specialist for help. To make the consequences of basal cell carcinoma therapy milder, you need to follow all the recommendations of the oncologist. It is also worth consulting with him regarding changes in diet and climate.