| Abstract | Među najčešće zloćudne tumore kože ubrajaju se bazocelularni i planocelularni karcinomi, a sa stalnim porastom incidencije je i jedan od najzloćudnijih tumora kože, melanom. Dok je bazocelularni karcinom većinom samo lokalno invazivan, planocelularni karcinom i melanom imaju tendenciju stvaranja metastaza. Glavnim uzročnikom smatra se UV zračenje, a zbog izloženosti glave i vrata, 80 do 90% tumora nastaje u ovoj regiji. Porastu broja novootkrivenih slučajeva doprinosi i veća osviještenost pacijenata i odlazak na pregled kod dermatologa, čija je osjetljivost i specifičnost povećana primjenom dermatoskopa. Dijagnoza se postavlja na temelju anamneze, kliničke slike i dermatoskopske analize, a biopsijom ili ekscizijom u cijelosti se potvrđuje histološki. Zbog mogućnosti nastanka metastaza, kod većih planocelularnih tumora debljine >3 cm i melanoma ≥0,8 mm te kada postoji invazija potkožnog masnog tkiva ili kosti nužno je napraviti i biopsiju limfnog čvora čuvara. Izbor liječenja svih zloćudnih tumora ovisi o lokalizaciji i veličini tumora, bolesnikovoj dobi i njegovoj podobnosti za kirurški zahvat. Potpuno kirurško odstranjenje uz uklanjanje 3-5 mm zdrave kože, zlatni je standard u liječenju PCC-a i BCC-a. Liječenje melanoma većinom je kirurško, uz primarnu eksciziju, a nakon patohistološke potvrde slijedi reekscizija ožiljka. U području lica, zlatni je standard kirurška ekscizija, a vrlo učinkovita je i Mohsova operacija, koja omogućuje očuvanje tkiva, odnosno njegove funkcije i estetike. Radioterapija se primjenjuje kod inoperabilnih tumora. Topikalna terapija, fotodinamička i krioterapija primjenjuju se kod površinskih bazocelularnih karcinoma i aktiničkih keratoza. Razvojem ciljanih i imunoterapija omogućeno je dulje ukupno preživljenje i razdolje bez progresije bolesti u bolesnika s metastatskim zloćudnim tumorima. |
| Abstract (english) | Basal cell and squamous cell carcinomas are among the most common malignant skin tumors, and one of the most malignant skin tumors, melanoma, has a steady increase in incidence. While basal cell carcinoma is usually only locally invasive, squamous cell carcinoma and melanoma tend to metastasize. The main cause is considered to be UV radiation, and due to exposure of the head and neck, 80 to 90% of tumors arise in this region. The increase in the number of newly discovered cases is contributed by the greater awareness of patients and their visits to dermatologists, whose sensitivity and specificity have been increased using dermatoscopes. The diagnosis is made based on the medical history, clinical picture and dermatoscopic analysis, and it is confirmed histologically by biopsy or excision. Due to the possibility of metastases, in the case of larger planocellular tumors >3 cm in thickness and melanomas ≥0,8 mm and when there is invasion of subcutaneous fatty tissue or bone, it is necessary to perform a biopsy of the sentinel lymph node. The choice of treatment for all malignant tumors depends on the location and size of the tumor, the patient's age, and its suitability for surgery. Complete surgical excision with removal of 3-5 mm of healthy skin is the gold standard in the treatment of SCC and BCC. The treatment of melanoma is mostly surgical, with primary excision, followed by re-excision of the scar after pathohistological confirmation. In the area of the face, the gold standard is surgical excision, and a very effective method is Mohs surgery, which enables the preservation of tissue, i.e., its function and aesthetics. Radiotherapy is applied in inoperable tumors. Topical therapy, photodynamic and cryotherapy are used in superficial basal cell carcinomas and actinic keratoses. The development of targeted and immunotherapies enables longer overall survival and period without disease progression in patients with metastatic malignant tumors. |
