Malignant Skin Tumors
Overview
Malignant skin tumors can present in various forms. There is no simple rule, such as “black spots are always dangerous” or “red spots indicate malignancy.” Therefore, if you have concerns about a skin lesion, the best approach is to have it examined by a dermatologist through visual inspection.
For more accurate diagnosis, we use dermoscopy, a specialized magnifying lens that enhances visualization of skin structures.
Diagnosis
To confirm malignancy, a biopsy is performed. This involves taking a small tissue sample from the lesion and analyzing it under a microscope (pathological examination).
If advanced disease is suspected, imaging tests such as CT or MRI may be conducted to assess tumor spread or metastasis.
Once the diagnosis is confirmed and the extent of the disease is determined, we formulate a treatment plan, which may include surgical removal, chemotherapy, or radiation therapy.
Advancements in Skin Cancer Treatment
Skin cancer treatment is advancing rapidly. New therapies are emerging each year, expanding beyond traditional surgical options.
At our department, specialists in skin malignancies provide cutting-edge treatments. We are also one of the few institutions in Japan affiliated with the JCOG (Japan Clinical Oncology Group) Skin Tumor Unit, collaborating with other institutions to conduct clinical trials for evidence-based therapies.
Squamous Cell Carcinoma (SCC)
Frequently occurs in the cheek or temple of elderly individuals.
Typically presents as raised, ulcerated lesions that may bleed or become infected, sometimes causing an unpleasant odor.
May spread to lymph nodes or internal organs.
Can arise from burn scars, chronic ulcers (pyoderma), or infected wounds, particularly in areas like the buttocks or armpits.
Vulvar SCC can also occur in women.
Treatment
Surgical removal is the primary treatment.
For patients who cannot undergo surgery, radiation therapy may be effective.
If metastasis occurs and the tumor is inoperable, chemotherapy is considered.
Basal Cell Carcinoma (BCC)
Common in middle-aged and elderly individuals, especially on the nose or central face.
Appears as black nodules with central ulceration.
Rarely metastasizes, making complete excision highly effective.
Treatment
Surgical removal is the standard approach.
Reconstruction of the surgical site considers both cosmetic and functional aspects.
Radiation therapy may be an option for patients who cannot undergo surgery.
Malignant Melanoma
Malignant melanoma resembles a mole, often beginning as an irregular, dark-colored patch that later becomes raised.
There are five main types:
- Lentigo Maligna Melanoma
(Facial melanoma resembling age spots) - Superficial Spreading Melanoma
(Common among Caucasians, appears on the body and limbs) - Nodular Melanoma
- Acral Lentiginous Melanoma
(Common in Japanese, occurs on the palms, soles, and nails) - Mucosal Melanoma
(Affects areas such as the nasal cavity and vagina, more prevalent in Japan than in Western countries)
Treatment
Complete surgical removal is the standard.
Sentinel lymph node biopsy (using dye methods, radioisotope techniques, or fluorescence techniques) and lymph node dissection may be performed in necessary cases.
If distant metastases are present, immune checkpoint inhibitors or targeted molecular therapies can be used.
Treatment selection is personalized, as immune checkpoint inhibitors may cause side effects affecting various organs. We collaborate with other departments to manage these side effects.
Angiosarcoma
A rare highly aggressive tumor, mainly affecting the face and scalp of elderly individuals.
Appears as purplish bruises or raised lesions, often developing in multiple locations simultaneously.
Has a poor prognosis, frequently leading to lung metastases, which may result in pleural effusion, pneumothorax, or sudden death.
Treatment
Radiation therapy or a combination of radiation and chemotherapy is used for skin lesions.
Chemotherapy or targeted therapy is considered for metastatic cases.
Extramammary Paget’s Disease (EMPD)
Develops in the genital area of elderly individuals:
- In men, it affects the penis and scrotum.
- In women, it occurs on the labia and vaginal area.
Initially presents as red, scaly, or eroded patches, often misdiagnosed as eczema or fungal infection.
If untreated, it may lead to thickened, raised plaques and spread to inguinal lymph nodes or distant organs.
Treatment
Surgical removal is the primary treatment.
Skin grafting or flap surgery may be necessary for extensive defects.
Metastatic disease has a poor prognosis.
If you have a persistent genital rash that does not respond to topical treatments, consult a specialized hospital for evaluation.
Final Notes
If you have a suspicious skin lesion, do not delay seeking medical attention.
Skin cancer treatment is evolving rapidly, with new options emerging each year.
April 2023