I thought the painless and itchy patches on my body were just a minor illness, but it turned out to be skin cancer...

Recently, an elderly male patient came to the dermatology clinic, hoping to treat a rash patch on his scalp that he had scratched for a long time. This rash has been there for a long time, it feels like more than a year, but it has never been red or itchy. The patient always feels that he touches a raised rash, so he scratches it repeatedly out of habit. Over time, the rash has grown in half a year, especially in the past two weeks, there have been obvious changes in bleeding and scabs, and there is also redness under the skin. In order to get treatment as soon as possible, he came to the clinic.

After communicating with the family and the patient himself, a small piece of the suspicious rash was removed for skin biopsy. Pathology showed early well-differentiated squamous cell carcinoma . After a subsequent scheduled surgical resection, the patient has now recovered.

For most adults, especially in recent years, tumors are becoming younger , so if you find some recurring or special plaque-like changes on the head and face, you still need to be alert to skin tumor problems!

Common malignant tumors of the head and face skin

1

Basal cell carcinoma (BCC)

Basal cell carcinoma (BCC) is one of the most common malignant skin tumors, especially in the elderly, and the incidence rate is increasing year by year. Basal cell carcinoma usually presents as painless and itchy skin plaque nodules that grow slowly . The surface can appear skin color, light red, brown to blue-black , and capillary dilation can be seen. Common types are nodular, superficial and morphea-like. The specific rash manifestations are shown in the figure below.

Nodular

Superficial

All morphea-like images are from uptodate

The diagnosis of BCC is mainly based on clinical manifestations and dermoscopy, with histopathology being the gold standard for diagnosis . Once a painless or itchy lump or rash is found on the scalp, it is best to visit a dermatology clinic as soon as possible, so that the clinician can further confirm the diagnosis through face-to-face consultation + dermoscopy, or biopsy + pathological examination, and then arrange surgical excision treatment according to the stage of the disease. Early detection and excision are usually easier to cure , and there is less risk of recurrence, invasion of other tissues, or distant metastasis.

2

Squamous cell carcinoma (SCC) of the skin

Cutaneous squamous cell carcinoma (SCC) is a malignant tumor that originates from epidermal keratinocytes. In light-skinned individuals, SCC usually appears in areas of photodamaged skin, so in Asian populations, cutaneous squamous cell carcinoma is more common on the head and face. SCC can present as a variety of skin lesions, including papules, plaques, or nodules . The lesions may be smooth, hyperkeratotic, or ulcerated.

Image from uptodate

Early detection and early diagnosis of squamous cell carcinoma of the skin can be cured through surgical excision and skin grafting under local anesthesia. However, if the treatment is too late, the tumor cells will deeply invade the muscle and bone layers, making excision and treatment more difficult and recovery more difficult. Therefore , early attention, early detection, and early treatment are needed. Usually, it will not metastasize to the long term and is less likely to affect life expectancy.

3

Malignant melanoma

Although malignant melanoma is rare in China, it is highly malignant and has a high risk of fatality. It is easy to metastasize to other systems in the body and end life . Malignant melanoma is common in the extremities, such as the palms, fingertips, soles, etc., and is relatively rare in the head and face.

However, if some elderly people have long-term sunburned areas of their skin and suddenly develop flaky tan or brown macules in adulthood, which grow larger year by year and may become darker, asymmetrically pigmented lesions, mottled colors, and raised bumps, these changes suggest the possibility of melanoma in situ, also known as "lentigo maligna," as shown in the figure below .

Image from uptodate

Once you find a rash similar to the one in the picture above, it is not recommended to treat it with laser or medication . You must go to a dermatology clinic and undergo a skin pathology examination to confirm the diagnosis before further treatment.

There are also some melanocytic nevi on the head and face that are present at birth. If hard bumps, lumps, and ulcers appear with age, and the lesions continue to grow, the possibility of developing into malignant melanoma should be considered. It is recommended to go to the dermatology clinic for evaluation in a timely manner. For malignant melanoma, international professional organizations have proposed the ABCDE principle to help self-diagnosis:

A | Asymmetry;

B | Border irregularity;

C | Color variation;

D | Diameter greater than 6mm (Diameter>6mm);

E | Evolving lesions;

Remembering these ABCDEs will help you with self-examination and self-diagnosis!

Causes of attacks and prevention tips

The incidence of various types of skin cancer on the head and face is related to many factors, such as ultraviolet exposure, genetic factors, chronic inflammation, etc. Facial skin cancer, in particular, is closely related to sunlight (ultraviolet rays) . For the Chinese population, many middle-aged and elderly people, especially elderly men, do not pay attention to sun protection and like to be exposed to the sun for a long time, such as fishing and running, which may lead to the appearance of skin tumors.

Therefore, it is recommended that all middle-aged and elderly friends do a good job of daily sun protection. If you can insist on applying sunscreen, then do it. If you cannot insist on applying sunscreen, do a good job of physical sun protection, such as wearing a hat, long-sleeved sun-protective clothing, etc., to avoid long-term exposure of the skin to ultraviolet rays, which will help reduce the possibility of skin cancer.

Copyright images in the gallery. Reprinting and using them may lead to copyright disputes.

At the same time, if you find rash patches on the head and face that are painless and itchy but persist and grow slowly , you must not scratch them on your own or go to a random clinic to take random medications . See a professional dermatologist as soon as possible and choose the safest treatment method after clarifying the nature of the rash.

References

[1]uptodate.Basal cell carcinoma: Epidemiology, pathogenesis, clinical features, and diagnosis

[2]uptodate.Cutaneous squamous cell carcinoma (cSCC): Clinical features and diagnosis

[3]uptodate.Melanoma: Clinical features and diagnosis

Planning and production

Source: Health Express (ID: D- HealthExpress)

Author: Yu Jia, Master of West China Medical Center, Sichuan University, Dermatologist and Medical Aesthetic Doctor of Zhuozheng Medical

Editor: Yang Yaping

Proofread by Xu Lai and Lin Lin