The number of new skin cancer cases is increasing massively from year to year. In addition to the extremely dangerous black skin cancer (malignant melanoma), there are a number of more “harmless” skin cancers, often referred to as “white skin cancer” because it does not behave quite as aggressively as melanoma. One form of these cancers is squamous cell carcinoma, often referred to as spinalioma. Spinalioma is the second most common form of skin cancer.
What is spinalioma?
Malignant melanoma or black skin cancer is a highly malignant tumor of pigment cells (melanocytes). Spinalioma is a malignant skin tumor that can occur on the skin and mucosa and typically grows in a wart-like pattern. Unlike black skin cancer (melanoma), it has a relatively good prognosis. Although spinalioma metastasizes extremely rarely when detected early, it can destroy bone and muscle tissue. Rarely, squamous cell carcinoma manifests as lung or bronchial carcinoma, but very often (90%) it manifests as esophageal or cervical cancer. Often, spinalioma is presented to the doctor quite late, because it does not seem threatening in the visual form of a wart, especially since it does not cause pain. In addition, patients often show more fixated on the black skin cancer and are more likely to observe their dark moles.
Causes
The cause of spinalioma, as with all forms of skin cancer, can be clearly pinpointed as excessive sun exposure. For this reason, skin cancer develops primarily on the so-called “sun terraces”, i.e. skin areas that are frequently exposed to the sun, such as the nose, forehead, ears or back of the hands. A significant increase in skin cancer can also generally be observed as a result of solarium visits. Recent studies indicate that human papillomaviruses (HPV) may also be responsible for the development of the disease. Since squamous cell carcinomas also occur on mucous membranes and can manifest themselves in the form of cervical cancer, vaccination, which has been recommended for several years, may be useful if necessary.
Symptoms, complaints and signs
Spinalioma or squamous cell carcinoma is characterized by skin changes that do not always lead to the correct diagnosis right away. They are red scaly patches of skin that look similar in many skin diseases. Even a distinction between precancerous lesions (keratosis) and actual carcinoma is only possible by tissue examination. In precancerous spinalioma (keratosis), reddened patches with a more firmly adherent scaling are noted on the skin. The skin lesions do not heal. Over time, palpable nodules may appear there. The nodules have a buildup of crusts and scales, which at times break open in an ulcer-like manner. This may already be a skin cancer. But it is also possible that there is only an advanced stage of keratosis. The distinction is not possible by visual appearance alone. The actinic keratosis does not have to turn into a squamous cell carcinoma. It can also heal again. After the actual spinalioma has developed, the skin remains scaly and horny. It feels rough. There is always a reddish to brownish discoloration of the skin in the affected area. Later, there is constant bleeding, and the wound becomes crusted and scabbed over. The bleeding recurs whenever the patient tries to scrape off the scab. A rough painless lump also develops. The cancer grows very slowly and very rarely metastasizes.
Diagnosis and course
Schematic diagram showing the anatomy and structure of the skin with black skin cancer. Click to enlarge. Spinalioma is therefore considered not quite so dangerous tumor, because it is detected early with a size of up to 2cm extremely rarely metastasizes. Thus, if removed in time, this skin cancer disease has a very good prognosis for complete cure. Nevertheless, spinalioma patients should go to cancer follow-up every three to six months over a period of five years and be thoroughly examined for recurrences, i.e. recurring skin cancer. In some states, this form of follow-up is part of the health insurance benefit.
Complications
Without treatment, the malignant tumor spreads and increasingly destroys the surrounding tissue. Depending on the localization, this may be accompanied by functional disorders.Multiple organ involvement always leads to a low probability of survival for the patient. This can only be prevented with the help of timely surgery. Damage caused by incisions in nerve tracts in the facial area may result in insensations or even paralysis as a complication. These can be of a permanent or short-term nature. The deeper the tumor has already penetrated into tissue structures, the higher the risk of additional damage caused by the intervention. Excessive scarring is also possible in some cases. It is usually an aesthetic problem for patients. Larger incisions may require specific reconstruction of skin areas. Allergic immune reactions cannot be ruled out in skin transplants. In general, undesirable consequences after surgery usually do not occur, provided the tumor was discovered early. A complete and uncomplicated incision allows a full recovery without cosmetic disadvantages. In later stages, this does not always succeed satisfactorily. Thus, the occurrence of daughter tumors is within the realm of possibility. Professional removal of the tumor for a favorable prognosis includes abundant surrounding tissue that is still healthy. Additionally, the draining lymphatics are included. In the absence of this surgical margin, even a spinalioma that has already been removed may recur in the identical or a different location after some time.
When should you see a doctor?
In the case of spinalioma, medical treatment must be carried out in any case. Only proper and especially early medical treatment of this disease can prevent further complications or discomfort. Since spinalioma is a cancerous disease, regular examinations should be performed even after successful treatment to prevent the tumors from spreading in the body. A doctor should be consulted if the affected person suffers from various changes on the skin. This may include redness or black spots on the skin. If these occur or if the skin complaints change in shape, size or color, a doctor should be consulted in any case. Permanent scaling or lumps on the skin may also indicate spinalioma and should also be examined by a doctor. In some cases, the affected areas may even bleed. Either a dermatologist or a general practitioner can be consulted for spinalioma. In most cases, the symptoms can be relieved relatively well.
Treatment and therapy
In all cases, spinaliomas are surgically removed and the removed tissue is then examined histologically to confirm the diagnosis in the laboratory. Usually, this operation is performed on an outpatient basis, but such procedures can also be performed on an inpatient basis in special cases, for example, in very elderly people or patients with additional, high-risk diseases. In most cases, however, health insurance companies only pay for outpatient treatment. The suspicious area of skin is cut out over as large an area as possible to prevent the need for subsequent incisions. Nevertheless, it often happens that the histological findings reveal that the spinalioma has not been completely removed, in which case a re-excision should always be made.
Prevention
Since the influence of sunlight is considered to be the main cause of the development of the disease, it is essential to avoid excessive exposure to sunlight as a preventive measure. Solarium visits are often downplayed, but have been shown to trigger skin cancers. The more a person is exposed to the sun or sunlight, the greater the risk of developing skin cancer. Since the papilloma virus is also suspected of causing squamous cell carcinoma, vaccination can also be useful, especially for young women because of the risk of developing cervical cancer. Parents should be proactive here, as in young women the vaccination should be given before the first sexual intercourse. A consultation with a doctor, whether the vaccination makes sense in the individual case, should always take place in advance. Conspicuous moles, especially those that have changed rapidly, should always be shown to an expert physician. If detected early, all forms of skin cancer have a favorable prognosis.The surgical procedure to remove the suspicious mole is usually comparatively uncomplicated, which is why high-risk patients should not be afraid to consult a dermatologist.
Aftercare
Follow-up care is exceedingly important in the case of spinalioma. For example, there is a risk that the squamous cell carcinoma will recur at a later date. For this reason, patients are advised by dermatologists to undergo follow-up skin examinations every three to six months, even after successful therapy. These should be performed over a period of five years. Thus, recurrences and metastases (daughter tumors) usually show up within two years after the first therapy. During follow-up care, tumor recurrences and second malignancies can be detected at an early stage and treated accordingly. Patients are examined on a regular basis, depending on the type of tumor in question. Tumor parameters and the stage of the disease play an important role. Important follow-up examinations after spinalioma include imaging procedures such as sonography (ultrasound examination), computer tomography (CT) and magnetic resonance imaging (MRI). X-rays can also be taken. Furthermore, the physician informs the patient about the risk factors for the development of squamous cell carcinoma and how they can be avoided. If the patient is a high-risk patient who has been diagnosed with the disease at an advanced stage, the follow-up takes place in a special skin tumor center. All other patients may follow up with their primary care physician. As part of follow-up, patients should use a sunscreen for their skin every day that contains a high SPF.
Here’s what you can do yourself
If necessary, spinalioma may recur at a later time. Therefore, ongoing check-ups are necessary after successful treatment. Recommended here are regular, semiannual examinations of the entire skin area over a period of at least five years. An important goal of the dermatological examination is also the early diagnosis of a second spinalioma, for which patients have a significantly increased risk. Protection of the skin is many times more important for the treated patient with spinalioma. Thus, excessive exposure of the skin to the sun should be avoided. The best protection against the sun is appropriate clothing. Therefore, it is imperative that sunscreen with a high sun protection factor be regularly applied to the skin by the patient. This is especially true for people with fair skin types and weakened immune systems. Sunburn should be avoided in any case. The skin must be protected from chemical influences. Skin dryness should be avoided. Soap-free products should therefore be used for skin cleansing. The selection of the appropriate skin care cream should be coordinated with the attending physician. Dietary supplements such as selenium, vitamin A, and beta-carotene should be able to be added to the diet of the treated patient with spinalioma. These substances have been shown to help protect against spinalioma recurrence.
