Reconstructive plastic surgery

Cutaneous neoplasms are abnormal growths of the dermis in which the size or number of cells increases; the abnormal cells form into a tumour. Benign neoplasms include warts, moles, papillomas, lipomas, angiomas and adenomas. Malignant ones are melanoma, sarcoma, basal cell and squamous cell skin cancer. A special group consists of precancerous skin tumours: leukoplakia, dermal horn, senile keratoma, etc. Most skin neoplasms must be removed, because constant trauma or insolation increases the risk of malignant skin re-growth.

-UV radiation (sunlight and solarium). People with fair skin, light-coloured eyes, freckles and those who suffer burns from direct sunlight exposure are at risk;
- X-rays;
-infrared radiation;
-human papillomavirus;
Carcinogens (of chemical, physical and biological origin) - Pre-cancerous diseases. A distinction is made between those with a 100% chance of malignisation (progressing to cancer) and those that do not necessarily lead to it. The former includes Paget's disease, Bowen's disease, and xeroderma pigmentosa. The latter include chronic dermatitis, keratoacanthoma, dermal horn.

One rule for diagnosis is ABCDE, which aims at self-diagnosis of neoplasms on the body. A doctor must be consulted if pre-existing skin neoplasms show the following signs or if new skin lesions with these features appear:

The 7-point diagnosis of melanoma is also used, which includes:

1 - Change in size (change in size, volume)

2 - Change in shape (change in shape, outline)

3 - Change in colour (change in colour)

4 - Inflammation

5 - Crusting of bleeding

6 - Sensory change

7 - Diameter (diameter greater than 7 mm)

The gold standard of diagnosis is when the doctor performs dermatoscopy and histological examination (excision biopsy)

Melanoma of the skin is a malignant neoplasm of neuroectodermal origin origin originating from melanocytes (pigment cells) of the skin.
Normally melanocytes are present in different organs and tissues (including mucous membranes of the gastro-intestinal tract, genital tract, brain membrane, ophthalmic membrane etc.), a primary tumour can arise in any of these organs.

According to the literature data (S.Z.Fradkin, I.V.Zalutsky, Minsk, 2000) 17 main factors have been described, which have the most serious influence on the prognosis of the disease:

1. Gender

2. Age

3. The background against which the melanoma originated

4. Localisation of the tumour

5. Its size (cm)

6. Shape of growth

7. Presence of pitted surface

8. Bleeding

9. Perifocal inflammation

10. Histological variant of tumour

11. Pigmentation

12. Tumour thickness according to A. Breslov in mm.

13. Level of infestation according to W.Clark et el.

14. Intradermal satellites

15. Number of regional metastases

16. Volume of surgery

17. Tumour extent (stage)

To choose an effective treatment, melanoma has to be staged. This is possible after surgical removal of the tumour and evaluation of regional lymph nodes clinically and histologically, sentinel lymph node biopsy. After histological confirmation of the diagnosis of melanoma, additional instrumental methods of diagnosis and evaluation of the extent of the cancer process (ultrasound, radiology, clinical and biochemical blood tests, LDH levels, etc.) are performed.

Stage 0 (Tis, N0, M0) - the earliest stage, the tumour is located in the epidermis without penetrating the dermis.

IA stage (T1a, N0, M0)-the malignant neoplasm is thinner than 1 mm, the melanoma is not erupting. The rate of metastasis is less than 1/mm2.

IB stage (T1b or T2a, N0, M0)-the malignant neoplasm is thinner than 1 mm, it is excised, the speed of metastases is less than 1/mm2. Also in this stage, melanoma can be undeveloped, but thickness can reach 1.01 to 2.00mm.

Stage IIA (T2b or T3a, N0, M0)-The melanoma can range in thickness from 1.01 to 2.0 mm, and is erupted. Also melanoma can be 2.01 to 4.00 mm thick, but not removed.

Stage IIB (T3b or T4a, N0, M0) - melanoma can be 2.01 to 4.00 thick, but the lesion is excised. Thickness of neoplasm can be greater than 4.00 mm, but it is not withdrawn.

Stage IIC (T4b, N0, M0) - The melanoma is 4 mm thick and not excised. No lymph node or distal organ involvement.

Stage IIIA (T1a to T4a, N1a or N2a, M0)- melanoma is any thickness, not withdrawn. 1-3 lymph nodes adjacent to the affected skin area are affected. Melanoma is only visible when viewed closely under a microscope. No distant metastases.

Stage IIIB:
-T1b to T4b, N1a or N2a, M0 - melanoma any thickness, pitting. 1-3 lymph nodes adjacent to the affected skin area are affected. Melanoma is only visible with close microscopic examination. No distant metastases.
-T1a to T4a, N1b or N2b, M0- 1 to 3 lymph nodes adjacent to the affected skin area are affected. Melanoma is only visible when viewed closely under a microscope. No distant metastases.
-T1a to T4a, N2c, M0 Melanoma of any thickness, not withdrawn. Melanoma spreads to the surrounding skin or possibly to lymphatic channels adjacent to the neoplasm. Lymph nodes are not affected. No distant metastases.

Stage IIIC:
-T1b to T4b, N1b or N2b, M0. Melanoma at this stage is withdrawn, with any thickness. 1-3 regional lymph nodes are affected. Enlargement of lymph nodes is seen. No distant metastases.
-T1b to T4b, N2c, M0. Melanoma is erupted, any thickness. In this case, it has spread to the lymphatic channels adjacent to the tumour and to adjacent skin areas. Regional lymph nodes are not affected. No distant metastases.
-Any T, N3, M0. The melanoma may or may not be erupting and its thickness could be variable. It has already spread to 4 or more regional lymph nodes. It may also spread to lymphatic ducts near the neoplasm and to nearby skin areas. Lymph nodes are enlarged. No distant metastases.

Stage IV:
Any T, any N, M1(a, b, or c). Distant metastases are detected.

The main method of radical treatment for patients with melanoma of stage 0-III skin melanoma is surgery. Radical excision of the primary tumour within healthy tissue is recommended as the mainstay of treatment for local melanoma of the skin. The choice of surgical margin depends on the thickness of the melanoma.
If after excision of the primary tumour, tumour cells are found at the resection margin in invasive or desmoplastic melanoma, and resection is not possible, adjuvant (postoperative) radiotherapy to the area of the primary tumour (postoperative scar) is recommended.
To determine the indication for adjuvant therapy, the risk of progression and death from skin melanoma after radical surgical treatment is assessed. This is decided by the oncologist after the main phase of treatment.