BAZALIOMA (basalioma; late lat. basalis relating to the basis + - öma; synonym: basally cellular cancer, bazalnokletochny epithelioma, multiple erythematic epithelioma of Littl, superficial bazalioma, skin carcinoid, ulcus rodens) — a peculiar tumor of skin with mestnodestruiruyushchy growth; metastasises are very rare.
And in the International nomenclature of tumors of 1958 B. is carried by a number of authors to a carcinoma cutaneum.
B. is one of the most frequent tumors of skin; it makes 50% of all cancer damages of skin. The hl occurs equally often at men and women. obr. at advanced age. More often B. is localized on face skin less often — trunks. In considerable number of cases arises against the background of senile keratomas.
The pathological anatomy
Macroscopically B. has an appearance or a flat plaque, a small knot, or a superficial sore, and sometimes an extensive deep ulceration with a dark red bottom. Microscopically education tyazhy and the complexes consisting from small, intensively painted cells is characteristic of B. The formed cellular tyazh and complexes on the periphery are usually limited to prismatic cells with basally the located kernels, long axes to-rykh are located perpendicularly to border of a tyazh or complex, and cells are grouped in parallel each other. Cells contain a small amount of cytoplasm and the dark roundish oval or extended kernels. They remind cells of a basal layer of an epithelium of skin, but are deprived of intercellular bridges. In tyazhy and complexes of a cell have the smaller size, are located randomly and more rykhlo. In B.'s cells preferential correct mitoses and seldom atypical meet.
Depending on features of a microscopic structure distinguish several types B. (tsvetn, fig. 2, 3, 4): superficial multicentric, solid, cystous, adenoid. Meet hyalinized, osliznenny less often, pigmented, etc.
Superficial multicentric bazalioma it is allocated with certain authors in an independent form; others consider it as an initial phase of development of B. Nablyudayetsya is more often on skin of a trunk. It is macroscopically characterized by formation of a flat superficial oval or roundish plaque with a border from small knots on the periphery and slightly sinking down center covered with dry scales, under to-rymi the thinned integument with teleangiectasias is visible. The centers are often multiple. It is microscopically presented by the multiple small centers of the small dark cells as if slipping from basal layers of epidermis in a derma and which are located in superficial departments of a derma.
The solid bazalioma is observed most often. Distinctiveness in a microscopic picture are growths in a derma of small dark cells in the form of continuous tyazhy and the complexes having scalloped outlines and often merging in massive educations.
Cystous bazalioma is option solid, in a cut of a cell of the central departments of tumoral complexes are exposed to a necrosis and a lysis with formation of cysts.
Adenoid bazalioma it is characterized by formation of the peculiar zhelezistopodobny and cystous structures reminding lace. Cells are located with the correct ranks, bordering the small cysts executed by basphilic contents.
Almost in each B. it is possible to meet sites of a solid, cystous and ferruterous structure. From seldom found B.'s types pigmented (or pigmental) B. are characterized by existence in cells and a stroma of melanin; osliznenny differ in sharp sliming of a stroma and parenchyma; hyalinized are characterized by a sharp sclerosis and a hyalinosis of a stroma. This form, unlike other types, usually does not ulcerate.
Most of authors considers B. a disembriogenetichesky tumor, believing that gistogenetichesk it is connected with various appendages of skin.
Clinical manifestations of a bazalioma are diverse. Originally it is presented by the small knot of the size of lentil grain acting over the surface of skin (fig., 1), a dense consistence, pinkish, rozovozheltovaty or deadwhite color, reminding a pearl. Similar small knots can be a little, they merge, forming a plaque of a lobular look. On its surface there can be teleangiectasias. Separate small knots in the center of a plaque can spontaneously disappear or ulcerate, and on the periphery the roller consisting of opaque whitish small knots is formed. Further in one cases comes (after quite long period) the ulceration, at the same time in the center is formed an erosion with an uneven bottom or an ulcer with the crateriform edges (fig., 2). Gradually the ulcer extends on the area and in depth, destroying the subject fabrics (a cartilage, a bone). In other cases there is a formation of the not ulcerated tumor covered with the thinned brilliant skin with teleangiectasias. The tumor in the form of the speaker over the surface of skin of formation of a lobular structure (has an appearance of a cauliflower) on the wide or narrow basis is sometimes formed. Also the flat cicatrizing form B. is observed, the erosion which at a cut is originally formed in the center of a small knot spontaneously cicatrizes, and on the periphery growth of small knots and formation of new erozirovanny sites continues. At the pigmented B. small knots have more dark coloring (sinevatokorichnevy, brownish-black). B.'s current long, torpid, especially at a superficial form. At B.'s ulceration the current is complicated by accession of an infection with the advent of signs of an inflammation in a circle of a tumor. Destruiruyushchy growth of primary and recurrent tumor is shown by destruction of the subject cartilages, bones, germination in nearby cavities (transition from skin of a wing of a nose to a nasal cavity, destruction of cartilages of an auricle, etc.).
B.'s inclusion in group of a carcinoma cutaneum led to the accounting of this form of a tumor among a carcinoma cutaneum and to allocation of clinical stages. Since at B. there are practically no metastasises, the stage of process is defined by extent of local distribution and destruction of the subject fabrics. The I stage is characterized by existence of a tumor or ulcer of the skin to 2 cm in the diameter limited actually to a derma without transition to surrounding fabrics. The II stage — a tumor or an ulcer is more than 2 cm in the diameter, sprouting all thickness of skin, but not extending to hypodermic cellulose. The III stage — the tumor of the big sizes or any size extending to the subject soft tissues without germination of a cartilage and a bone. The IV stage — the tumor or an ulcer sprouting the subject soft tissues, cartilages and bones.
the Diagnosis of a bazalioma clinically is sometimes complicated. In initial stages of development of B. it is necessary to differentiate with not tumoral dermatosis (see), keratoacanthoma (see), senile keratosis (see), Bowen's disease (see. Bowen disease ), benign tumors of appendages of skin (seborrheal wart, ekkrinny ferry, tsilindroma, tichoepithelioma, etc.), lupus erythematosus (see), syphiloma, etc. In late stages of B. it is difficult to distinguish from a planocellular carcinoma cutaneum (see. Skin ). Therefore in each doubtful case the biopsy (is necessary for confirmation of the diagnosis at small not ulcerated tumors — in the form of full excision, and at ulcerated — excision of a piece on border with not changed skin). The cytologic research of prints or scraping, and also a puncture also can be made for confirmation of the diagnosis.
the Forecast at early stages in most cases favorable. Permanent treatment is reached in 95 — 97% of cases. At widespread process (the III—IV stage) treatment is reached in 40 — 60% of observations.
Treatment. At extensive defeats apply the combined treatment (beam and surgical). In initial stages and at superficial forms, at contraindications or impossibility to apply beam treatment it is possible to resort to medicinal therapy. Omainovy ointment in the form of daily applications is for this purpose used. Appoint also antineoplastic antibiotics — Bleomycinums which enter intravenously 15 mg 2 — 3 times a week. Total dose of 300 — 400 mg. Beam treatment is applied in the form of an interstitial gamma therapy (obkalyvany tumors radioactive drugs) and an application gamma therapy (see). The short-distance roentgenotherapy is most eurysynusic. At the I—II stages of B. it is equally effective both beam, and surgical methods, but cosmetic results it is better at beam, especially at localization of tumors on a face, near natural foramens. At exophytic forms B. on a face in the III stage it is also possible to use an interstitial gamma therapy with success; a total dose — 5000 — 6000 I am glad. At infiltrative forms B. in the III—IV stages more radical is the combined treatment. At the same time beam treatment is performed by a remote gamma therapy or electronic therapy (see) with a radiation energy apprx. 15 Mev. Total doses make 4000 — 5000 is glad. After subsiding of the reactive phenomena excision with plastic closing of defect is undertaken surgical (or electrosurgical). Surgical or electrosurgical excision is applied also at a recurrence after the beam or combined treatment. At surgical excision of B. delete otstupya on 1 — 2 cm from the center of defeat. Depth of excision is defined by extent of infiltration. At common infiltrative forms subjects a cartilage and a bone are removed. The tumors of a corner of an eye getting into cellulose of an eye-socket demand an ekzenteration (see. Ekzenteration of an eye-socket ). At localization preference should be given in an auricle to surgical treatment (excision). In zones of regional innidiation at B. surgical intervention is not made.
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G. V. Falileev.