Diagnosing cutaneous carcinomas

In order to accurately diagnose cutaneous (skin) carcinomas, a complete evaluation of the patient is required: detailed anamnesis, physical examination, paraclinical and laboratory tests.

Anamnesis should provide information on: onset date, progression, treatments followed, relapses, history of nonmelanoma skin cancer, family history of skin cancer / other cancers, other diseases that may be related to skin carcinoma or may alter the patient’s medical condition.

The clinical examination helps determine tumor expansion, the subtype and the involvement of important cosmetic and functional structures. A dermatoscopy is paramount in establishing the operating plan, as it can assess the type of carcinoma and thus we can establish proper oncological safety for the surgery.

Paraclinical and laboratory tests include:

• Hemolithogram, liver function tests to detect carcinoma effects. Blood gases, chest x-ray, lung and cardiovascular functional tests.
• Tumor markers (proteins, other cellular products, abnormal genes) provide accurate information for population control, early detection, monitoring, and treatment planning.
• Tests to highlight metastases or invasion of the underlying tissues:
• sentinel lymph node biopsy
• imaging tests:
  • Computed tomography (CT) provides three-dimensional models of the organs
  • magnetic resonance imaging (MRI) – noninvasive, allows tumor staging and detection of metastases, especially cerebral and medullary.
  • PET (positrons emission tomography) – provides functional information useful in the localization of metastases and small tumors.
• Histopathological test – sometimes helps differentiate between basocellular carcinoma and spinocellular carcinoma. The tissue to be examined is obtained through a biopsy, which can be incisional, for large tumors adhering to the underlying tissues, or an excision performed within safety margins (3-4 mm for basal cell carcinoma and 5-10 mm for spinocellular carcinoma).

The correct diagnosis of skin carcinoma will be obtained after examining the entire skin surface in order not to neglect the existence of multiple cancers. The temporal relationship between them allows the classification of cancers into:

• multicentric – multiple discrete tumors in an anatomical area
• simultaneous – concurrent cancer seconded at least 2 cm from the first
• synchronous – secondary cancer occurring less than 6 months after the first
• metachronous – secondary cancer occurring more than 6 months after the first cancer diagnose