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[上皮性皮肤肿瘤及其前驱病变的外科治疗]

[Surgical treatment of epithelial skin tumors and their precursors].

作者信息

Häfner H-M, Schnabl S, Breuninger H, Schulz C

机构信息

Universitäts-Hautklinik, Eberhard Karls Universität, Liebermeisterstr. 25, 72076 Tübingen, Deutschland.

出版信息

Hautarzt. 2013 Aug;64(8):558-66. doi: 10.1007/s00105-013-2541-1.

Abstract

Squamous cell carcinomas of the skin and their precursors, actinic keratosis as well as basal cell carcinomas are classified as non-melanocytic skin cancer and belong to the group of epithelial skin tumors. This tumor entity is one of the most common forms of malignant cancer in western countries with an incidence of approximately 100-170 per 100,000 inhabitants per year in Europe. In German-speaking countries no exact numbers are available on the early forms of squamous cell carcinoma, actinic keratosis (carcinoma in situ); however, results from Great Britain show that at ages over 70 years old the prevalence of actinic keratosis is 34 % in men and 18 % in women. Because invasive epithelial cancer is very common and most commonly occurs in the head region, a safe but skin-sparing approach to surgical treatment is desirable. The safest procedure with respect to local recurrence is surgical excision with subsequent complete 3-dimensional histological preparation (micrographic surgery). With this method it is possible to excise tissue affected by tumor tissue in small steps. This facilitates defect coverage and leads to very good results as well as good esthetic results. The local recurrence rates are extremely low compared to alternative treatment methods, such as photodynamic therapy, topical application of imiquimod or cryosurgery and for the treatment of basal cell carcinoma, for example is 0.7 %. Dermatological operations are therefore interventions with a very high guarantee of tumor-free survival and functional and esthetic results.

摘要

皮肤鳞状细胞癌及其前驱病变光化性角化病以及基底细胞癌被归类为非黑素细胞性皮肤癌,属于上皮性皮肤肿瘤组。这种肿瘤类型是西方国家最常见的恶性肿瘤形式之一,在欧洲每年每10万居民中的发病率约为100 - 170例。在德语国家,没有关于鳞状细胞癌早期形式光化性角化病(原位癌)的确切数据;然而,英国的研究结果表明,70岁以上人群中,男性光化性角化病的患病率为34%,女性为18%。由于浸润性上皮癌非常常见且最常发生在头部区域,因此需要一种安全且保留皮肤的手术治疗方法。就局部复发而言,最安全的手术是手术切除并随后进行完整的三维组织学制备(显微外科手术)。通过这种方法,可以分小步切除受肿瘤组织影响的组织。这有利于缺损覆盖,并产生非常好的效果以及良好的美学效果。与替代治疗方法相比,局部复发率极低,例如光动力疗法、咪喹莫特局部应用或冷冻手术,对于基底细胞癌的治疗,局部复发率为0.7%。因此,皮肤科手术是一种对无瘤生存以及功能和美学效果有很高保障的干预措施。

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