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L. E. Denisov, M. I. Kurdina, N. S. Potekayev, V. D. Volodin
ACTIVE IDENTIFICATION OF MALIGNANT NEW GROWTHS OF SKIN
HH-y the century filled up the long list of diseases of a civilization with "silent" epidemic of malignant tumors of skin in many economically developed countries including in Russia.
Tumors of skin hold special position in the general structure of new growths of the person. On the one hand, they are exclusively diverse on the kliniko-morphological picture, and with another - are easily available to clinical and laboratory trial. However the problem of early diagnosis of malignant transformation of skin and research devoted to the organization of dermatoonkologichesky service still remain exclusively actual.
Now statistics of dermatoonkologichesky incidence concern only malignant new growths, and a precancerous dermatosis is not considered by statistics. Therefore studying of true incidence of the precancerous dermatosis and malignant new growths of skin revealed actively at constant population of the population will promote improvement of the organization of dermatoonkologichesky service, improvement of the diagnostic and medical help to this contingent of patients.
It is conventional that the most real and effective way of fight against the majority of forms of malignant new growths is a solution of the problem of the active identification based, first of all, on the organization and implementation of effective routine inspections of the population. The comparative assessment of efficiency of various forms of anticarcinogenic actions in the different countries shows a low performance of mass routine inspections in Russia. It is explained, first of all, by the bad organization of dispensary system of service of patients, in particular, lack of succession, non-compliance with terms and volumes of carrying out medical examinations and poor quality in the majority of establishments of practical health care. As for a dermatoonkologiya, studying of efficiency of a dispensary method of inspection of patients was not carried out earlier. Meanwhile, the high specific weight of malignant new growths of skin in the general structure of oncological pathology and the prompt growth of cancer cases of skin and a melanoma and mortality from them does these researches very actual.
The present monograph is prepared taking into account the tasks stated above. During the conducted research authors integrated literary data with personal long-term experience with patients. Results of researches were repeatedly reported at congresses, conferences and symposiums, published in magazines and collections, used in pedagogical work when carrying out occupations with students of medical higher education institutions and listeners of FPK.
Need of preparation and the edition of this monograph, in addition to the relevance of a dermatoonkologiya noted above, was dictated by also increasing distribution in our country of the principles of family medicine. The leading role in identification of malignant new growths of skin belongs to the general practitioner (the family therapist) as he much more, than doctors of other specialties, contacts to patients, and at each routine inspection or the address to him of the patient with complaints has to examine completely integuments and mucous membranes of the patient.
Authors of the monograph included in it those diseases which at this stage of development of domestic health care have the greatest value for the doctor of broad practice, without aiming at comprehensive illumination of a problem of a dermatoonkologiya. Thus, the monograph is counted on dermatologists, oncologists, general practitioners (family doctors), stomatologists, urologists, and also students of older years of medical institutes.
It is undoubted that some questions which are insufficiently fully covered in the present monograph still wait for the permission, and we hope that this book will serve as one more incentive for this purpose.
Authors will be grateful for all wishes and critical remarks according to the monograph and will try to use them in future activity.
The tumoral pathology, most widespread in the world, - skin new growths. Steady growth of incidence of malignant tumors of skin and mortality from them owing to reduction of an ozone layer of the atmosphere and strengthening of cancerogenic action of sunlight is called "silent" epidemic of the 20th century (Marks R.). In structure of oncological incidence the share of a carcinoma cutaneum reaches 50% in the USA and Australia, a melanoma share — 4% in the USA (1990) (Marks R., 1987; Cancer facts, 1990). Specific weight of the other malignant new growths of skin (MNGS) (vascular, fibrous, fatty, muscular, neurogenic, skin appendages, etc.) is much lower therefore further it will be a question only of epitheliomas and a melanoma.
In the USSR in 1990 tumors of skin are revealed at 11% of total number of patients with for the first time in life the established diagnosis of a malignant new growth (2-3 place): a carcinoma cutaneum - at 9,6%, a melanoma - at 1,1%. In Russia in 1991 ZNK took the 3rd place in structure of incidence of the population, 7,8% and 13% respectively at men and women fell to their share (Dvoyrin V. V. and soavt., 1992). During 25 flyings (1965-1990) in the USSR incidence of ZNK grew by 41% among men and 28% — among women (Trapeznikov N. N. and soavt.). In Russia by 2000 the gain of incidence of ZNK for 84% in comparison with 1980 is expected (Dvoyrin V. V. and soavt., 1992).
Mortality from a carcinoma cutaneum makes 0,01% of total number of the diseased (Marks R., 1987). From a melanoma in the USA in 1990 1,2% of persons among all dead died of oncological diseases (Cancer facts, 1990). Mortality of patients from ZNK in the USSR for 25 flyings (1965-1990) among men grew by 167%, among women - for 171% (Trapeznikov N. N. and soavt., 1990).
It is known that one of paramount problems of clinical medicine — active and early detection of patients with malignant new growths. The most effective remedy of achievement of this purpose — system of an individual approach of the family therapist of high professional qualification having special oncological preparation (Engelhardt N. et al., 1990; Love R. R., 1988). This situation belongs also to ZNK — tumors of outside localization which main diagnostic method there is a survey. The leading role in identification of ZNK belongs to the therapist since he has to examine completely integuments and mucous membranes of the patient at routine inspection or the address to it of the patient with any complaints. Efficiency of visual screening of ZNK, according to Begany A. et al. (1990), Hoffmann K. et al. (1990), Koh N. To. et al. (1990), it is not worse than results of screening on programs of search of tumors of other localizations. Therefore abroad, for example in Great Britain (Whitehead S. et al., 1989) and the USA, programs (with justification of expenses) prevention of ZNK for term since 2000-2050 are developed (Murdoch J. Page of et al., 1990).
In domestic literature of the data on incidence, circumstances of identification of ZNK, mortality from them of the population which is under continuous supervision of the family therapist, and also on identification of ZNK from groups of the increased oncological risk, programs of prevention of ZNK, functions of the family doctor and specialists of a narrow profile (the dermatologist, the oncologist) are absent. Meanwhile, development of these questions is absolutely necessary from the point of view of improvement of organizational forms dermato-for the oncological help to the population.
Besides, there is no consensus about expediency of allocation of groups of the increased oncological risk or active supervision over patients with a pretumor dermatosis (Bekhtereva E. I., Bivalkevich V. G., 1989; Histologic classification of tumors of skin, 1980; Trapeznikov N. N. and soavt., 1976; Red L. V., Goldbert 3. Century, 1988., Churilova L. A. and soavt., 1987; Khalilov I.-H. M, Ganiyev K. D., 1989; Shumay N. I., 1991, etc.).
The stated theoretical and directly related practical sides of a problem caused relevance of this research.