Молодежный инновационный вестникМолодежный инновационный вестник2415-7805Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации6320UnclassifiedPREVALENCE AND MORPHOLOGICAL CHARACTERISTICS OF SKIN CANCER ON THE EXAMPLE OF ONE OF THE SUBJECTS OF THE RUSSIAN FEDERATIONLeiferO. V.Olesya.shorstova@yandex.ruhttps://orcid.org/0000-0001-7888-166XLeiferEleifer2013@icloud.comhttps://orcid.org/0000-0002-7209-4726IvanovEgorolesya.shorstova@yandex.ruhttps://orcid.org/0000-0002-2268-623X1405202110S11211250302202105032021Copyright © 2021, Молодежный инновационный вестник2021<p>Skin cancer occupies one of the leading positions in the structure of oncological diseases both in Russia and around the world. In recent years, there has been a steady increase in the number of detected cases of skin cancer. This pathology is one of the socially significant problems. This article deals with the main issues of carcinogenesis of malignant neoplasms of the skin, their morphology and epidemiology on the example of the Novgorod region. Basal cell carcinoma accounts for the largest number of cases in the overall morbidity structure. This trend is typical both for the Novgorod region and for the whole world. Thus, according to the International Agency for Research on Cancer GLOBOCAN, by 2040 it is expected to increase the number of newly detected cases of skin cancer by 1.3 million, compared with the same value in 2018. (1.4 million). The problem of increasing the incidence of malignant neoplasms of the skin today is extremely relevant, which is due not only to the increase in the incidence, but also to the emergence of new methods that allow with high reliability and in the shortest possible time to make the correct diagnosis of the patient and effectively conduct his surgical treatment. The relevance of this topic is primarily due to the constant increase in the incidence of this pathology and the need for an interdisciplinary approach to solve this problem. In this study, the analysis of histological preparations was carried out on the basis of the pathology department of the oncology dispensary of Veliky Novgorod, in order to identify the dynamics and morphology of malignant skin neoplasms.</p>malignant neoplasms of the skin, squamous cell carcinoma, basal cell carcinoma, carcinogenesisзлокачественные новообразования кожи, плоскоклеточный рак, базальноклеточчный рак, канцерогенез<p>Relevance. In recent decades, there has been an increase in the incidence of skin malignancies all over the world. Among all malignant tumors, skin cancer accounts for about 10% of their total number. The greatest predisposition to this type of pathology can be noted in elderly people, regardless of gender. Most often, malignant neoplasms of the skin develop in light-skinned people living in conditions of increased insolation (high-altitude zones, countries with a hot climate). Among the predisposing factors, it is also possible to distinguish the hereditary characteristics of the body, which are caused by family cases of the disease. A number of diseases leukoplakia, pigmented nevi, Bowen's disease, Keir's erythroplasia, pigmented xeroderma, senile keratoma, cutaneous rock, and others-can undergo malignant degeneration over time. These diseases belong to the so-called precancerous conditions. [1, 2]<br />Thus, the expected increase in the incidence of almost 2 times.<br />Among the causes of malignant neoplasms of the skin at the moment, the following are distinguished:<br />1) Ultraviolet radiation (especially for people with 1-2 Fitzpatrick skin phototypes)<br />2) Precancerous conditions and diseases (injuries, scars, genital warts, psoriasis, etc.)<br />3) Mutation of the TR53 gene (for squamous cell skin cancer)<br />4) Human papillomavirus (16,18, 31, 33, 35 and 45 types) [3]<br />5) Exposure to carcinogenic substances (soot, kerosene, arsenic, mineral oils, etc.)<br />Ultraviolet radiation can have mutagenic and carcinogenic effects on the cell's DNA. As the thickness of the ozone layer decreases, these impacts become more severe. Changes in the skin under the influence of ultraviolet light are mostly due to its phototype.<br />Fitzpatrick identified 6 main phototypes [4-5]:<br />Type 1-Celtic. People of this phototype have the lightest skin tone, freckles, red hair and blue eyes. They almost never tan, the risk of sunburn is very high.<br />Type 2-Nordic. This type of skin is also characterized by a light shade and high sensitivity to UV radiation. The risk of burning is high, as in the previous case. However, the Nordic phototype of the skin is insignificant, but takes a tan. Skin without freckles.<br />Type 3-Dark European, with dark hair and brown eyes. A phototype characterized by a light shade and minimal sunburn. The skin lends itself well to a tan.<br />Type 4-Mediterranean. Light brown skin tone. The chance of sunburn is minimal. Tan on the skin always falls well.<br />Type 5-Indonesian. Brown skin tone. People with this skin phototype almost never get sunburned. Tan is characterized by a dark shade.<br />Type 6-African-American. People of this phototype have the darkest skin tone. The chance of sunburn in the sun is almost zero. Sunburn only makes the skin even darker.<br />Malignant neoplasms of the skin are most susceptible to people with 1 and 2 phototype of the skin.<br />Substances such as paraffin, kerosene, mineral oils, arsenic, soot, and tar have a high carcinogenic effect on the skin. With frequent contact with such irritants, foci of inflammation, hyperplasia and atrophy occur on the skin, which can then degenerate into cancer.<br />Morphologically, all types of malignant neoplasms of the skin can be divided into the following types:<br />1-squamous cell carcinoma-occurs from the flat cells of the epidermis located on the surface<br />2-basal cell carcinoma-formed by basal cells that have undergone malignant degeneration<br />3-adenocarcinoma of the skin-is quite rare, formed by cells of the sweat or sebaceous glands<br />4-melanoma one of the most malignant tumors, formed by pigment<br />cells melanocytes<br />The most common type of cancer in the general structure of malignant neoplasms of the skin is basal cell, it accounts for about 60-75% of the total number of cases. The squamous cell form accounts for 11 to 25% of cases.<br />According to the type of structure, malignant neoplasms of the skin can also be divided into keratinizing and non-keratinizing. The keratinized form is a highly differentiated type of cancer and has the most benign course, characterized by slow growth and a low degree of invasion. Undifferentiated cancers are non-cancerous, grow rapidly, have a high degree of invasion, many atypical mitoses, and a rather poor clinical prognosis. [6-7]<br />Squamous cell carcinoma (epidermoid cancer, squamous cell epithelioma) is a malignant epithelial tumor that develops from keratinocytes of the skin and mucous membranes. Macroscopically, it is a solitary node of gray-pink color with a rough surface, when palpated, it is dense, often covered with crusts, and may bleed. There is an exophytic and endophytic type of growth.<br />Endophytic forms, and (ulcerative-necrotic) most often develops against the background of keratomas. The disease debuts with the formation of a papule, which in a few months develops into a dense node, soldered to the subcutaneous fat. The resulting node quickly ulcerates. The bottom of the ulcer is located centrally, often covered with a white film, the rough and dense. The edges of the ulcer are raised. This form of cancer progresses rapidly, and can be complicated by bleeding. It is characterized by a high degree of atypia, multiple mitoses, and frequent metastasis.<br />Exophytic form (papillary cancer) - has the appearance of "cauliflower" - it is a lumpy nodule with rapid growth. The base of the tumor is wide, has many small vessels.<br />Squamous cell carcinoma usually has single foci and is localized most often on the face (the back of the nose, the auricle, the temples, the skin of the forehead), less often on the limbs and trunk. The risk of metastasis is higher in tumors located on closed areas of the body. [8]<br />Basal cell carcinoma is one of the most common types of tumor in humans. There are several forms of this neoplasm. The most common is the nodular form. This rounded eszopiclone the formation of pink, different sizes. Most often found on the face and neck. It is characterized by slow growth and a conditionally favorable course.<br />The ulcerative variant is a continuation of the nodular growth form. In the central part there is a zone of necrosis, covered with a crust. The size of the ulcer can reach gigantic sizes.<br />The surface shape is characterized by the presence of a pink spot with a rough surface. Most often it can be found on the limbs and trunk. Foci of growth can be multiple. The course of the disease is most favorable.<br />The infiltrative form also develops against the background of a nodular variant with a pronounced squamous cell component. Prone to relapses. [9-10]<br />The purpose of the study: 1. Determine the number of malignant neoplasms in the structure of the general oncological morbidity. 2. To identify the dynamics of clinical cases on the example of the Novgorod region. 3. Evaluate the structure of malignant neoplasms of the skin<br />Materials and methods. The data of the pathology department of the Novgorod Regional Clinical Oncology Dispensary were studied. Histological preparations were made from fragments of intravital biopsies, which were evaluated microscopically. The macroscopic assessment was performed on the operating material and according to the medical records.<br />Further, a comparison of similar morbidity rates for 2017, 2018 and 2019, respectively, was carried out.<br />The tumors were classified according to the WHO International Histological Classification of Skin Tumors from 2006.<br />For the analysis, the following types of skin neoplasms were identified: basal cell carcinoma (8090/3), squamous cell carcinoma keratinizing (8071/3), squamous cell carcinoma non-keratinizing (8070/3), melanoma (8720/3).<br />Results. In the course of the study, the following results were obtained:<br />1. In 2017, 141 cases were identified, in 2018 this figure was 229 cases, but in the next 2019-196 cases.<br />2. The share of cases of skin neoplasms in the structure of the total cancer incidence in 2017 was 30.6%, in 2018-40.1%, and in 2019-42.5%.<br />3. Number of cases of basal cell carcinoma in 2017-95 cases, in 2018 - 40, in 2019-133. Number of cases of squamous cell non-cancerous cancer-2017-9 cases, 2018 -30, 2019 -22. Squamous cell carcinoma in 2017 4 cases, in 2018-16 cases, in 2019 22 cases. Melanoma was detected 33 times in 2017, 43 times in 2018, and 35 times in 2019.<br />Discussions. The total number of cases of skin neoplasms does not have a stable tendency to progress or regress. The specific weight of cases of skin neoplasms in the structure of the general oncological morbidity increases every year. Basal cell carcinoma is the most common among all cases of ZNA.<br />Conclusion. Thus, despite the absence of a steady increase in the number of cases of skin malignancies, their specific weight in the structure of the overall cancer incidence increases every year.<br />This indicates the need for the following activities:<br />1. Introduction of new methods of early diagnosis of malignant neoplasms (stationary devices for diagnosis in medical institutions, mobile applications for dynamic control of skin neoplasms)<br />2. Periodic organization of actions for mass screening of the population<br />3. Popularization of the use of skin products against ultraviolet radiation (sunscreens, sprays, etc.)<br />Dynamic monitoring of patients with precancerous diseases by oncologists and dermatologists is a key link in the prevention of malignant neoplasms of the skin, as it allows timely detection of signs of tumor degeneration and the necessary treatment.</p>[1. Rodriguez-Niedenfuhr M., Vazquez T., Nearn L., Ferreira B Parkin I., Sanudo J.R. World Cancer Report. Cancer research for cancer prevention. — Lyon: International Agency for Research on Cancer, 2019. — 611 с.][2. Модестов А. А. Семёнов Э. В. Зуков Р.А. Слепов Е. В. Еремина Е. Н. Новые подходы к организации скрининга злокачественных новообразований кожи // Сибирский онкологический журнал. — 2017. — № 2. — С. 61-65.][3. Шляхтунов Е.А. Гидранович А.В. Луд Н.Г. Луд Л. Н. Кожар В. Л. Рак кожи: Современное состояние проблемы// Вестник Витебского государственного медицинского университета. — 2014. — № 3. — С. 20-27.][4. Basal cell carcinoma with a skip lesion on the nose after repeated cryotherapy / N. Nakai [et al.] // J.of Dermatology. – 2010 Apr. – Vol. 37, N 4. – P.390–392.][5. Incidence, mortality, and prevalence Worldwide in 2008. Global cancer statistic. IARC. Available from: http://globocan.iarc.fr/factsheet.asp.][6. Jacobs, G. H. Prediction of aggressive behavior inbasal cell carcinoma / G. H. Jacobs, J. J. Rippey,M. Altini // Cancer. – 1982 Feb. – Vol. 49, N 3. – P.533–537.][7. Surface microscopy of pigmented basal cell carcinoma / S. W. Menzies [et al.] // Archives of][Dermatology. – 2000 Aug. – Vol. 136, N 8. – P.1012–1016.][8. Ламоткин, И. А. Опухоли и опухолеподобные поражения кожи: атлас / И. А. Ламоткин. – М.: БИНОМ. Лаборатория знаний, 2006. – 166 с.][9. Kokoszka, A. Evidence-based review of the use ofcryosurgery in treatment of basal cell carcinoma/ A. Kokoszka, N. Scheinfeld // DermatologicSurgery. – 2003 Jun. – Vol. 29, N 6. – P. 566–571.][10. Incidence of nonmelanoma skin cancer in New Brunswick, Canada, 1992 to 2001 / R. C. Hayes [et al.] // J. Cutan. Med. Surg. – 2007 Mar-Apr. – Vol.11, N 2. – P. 45–52.]