Older people often have patches on their faces, and many people don’t pay much attention to them. They take it for granted that it is normal for people to grow something on their face when they are old. For the treatment of such plaques, patients are not active and often go to the dermatology department for laser or cryotherapy. In fact, this kind of thinking and practice is extremely wrong. Because, many plaques may be malignant tumors.
The common malignant skin plaques on the face of the elderly include basal cell carcinoma, squamous cell carcinoma, melanoma and other skin cancers, while the common benign skin plaques include pigmented nevus, age spots, solar keratosis, keratoacanthoma and so on. The initial stages of these malignant skin plaques are often similar to benign skin plaques, which are difficult to distinguish and patients often neglect treatment.
Basal cell carcinoma: It is often asymptomatic at the beginning, and at the beginning, it is mostly a hard basal plaque-like papule, some of them are raised in the shape of warts, and then it breaks down into ulcerative foci, irregular, with elevated edges, resembling craters, uneven bottom and slow growth. Basal cell carcinoma is generally divided into 4 types, and the most common one is nodular ulcer type.
1.Nodular ulcer type: Initially, a small wax-like nodule with the size of a grain of rice to a pea appears on the epidermis, and the epidermis is usually quite hard, and there are often a small number of dilated capillaries on the surface, which is slightly higher than the skin surface, or only resembles erythema without elevation, or slightly nodular, and the skin on the surface is mildly depressed.
The nodules may gradually expand or new damage may appear in the vicinity, fusing with each other to form a waxy disc-shaped plaque, often with a brown, yellowish-brown or dull gray central scab, followed by an ulcer under the scab, which gradually expands to form a round, oval or unshaped ulcer, ranging in size from the size of a fingernail to a copper coin, with a firm and rolled-up edge, often translucent and uneven, without inflammation of the surrounding skin. The base has a pearly or wax-like appearance, and sometimes the damage surface is completely covered by scabs. The ulceration slowly expands to the surrounding area and deeper, like a mouse bite, forming a typical clinical form of basal cell carcinoma called erosive ulcer. Occurring on the face can destroy cartilage and bone tissue in the nose, ear, orbit and maxillary sinus, causing bleeding or intracranial invasion or disfigurement. The following is a before and after surgery comparison.
2. Pigmented type: the nodules are shallower than the plane and the damage is the same as the nodular ulcer type. Due to the presence of more pigment, in addition to the pearly luster, the edges of the lesions are dotted or reticulated with dull brown or dark brown pigmentation, and pigmentation can also be seen in the central part. The following is a comparison of before and after surgery.
3.Sclerotic or fibrotic type: Commonly found on the head and neck, it is a hard yellowish or yellowish-white plaque, slightly elevated, with unclear borders, resembling scleroderma-like, which can remain intact for a long time and eventually ulcerate.
4. Superficial type: superficial lesions, mostly on the trunk, with one or several infiltrative erythematous patches, with flaking or crusting on the surface, slightly elevated edges or the whole lesion, at least part of the edges are fine pearl-like or line-like dikes. This type may eventually become fibrotic. It resembles psoriasis, eczema, or seborrheic dermatitis.
Basal cell carcinoma needs to be differentiated from geriatric warts and solar keratosis.
The warts are also called seborrheic keratosis, a benign wart-like growth on the epidermis, mostly on the back of the hands, forehead and trunk, and are pinhead to soy size or larger, light brown to dark brown or even black, slightly higher than the skin, or papillary, often with greasy scales on the surface, soft to the touch, painless and non-itchy, no health problems. However, if the rash expands rapidly within 6 months and the number increases or is accompanied by obvious itching, there is a possibility of malignant transformation into basal cell carcinoma.
Squamous cell carcinoma: often transformed from keratosis, mucous membrane white spots and other precancerous diseases. It grows faster and forms ulcers at early stage. Some of them are nodular or cauliflower-like, with small invasion to the deep, and the base can be moved; some are butterfly-like, with more obvious infiltration to the deep and large destructive, often involving bones. Squamous cell carcinoma is often associated with purulent infection, with malodor and pain. Regional lymph node metastasis is mostly seen, and the patient has giant squamous cell carcinoma of the head, which has incomparable malodor, more purulent secretions and easy bleeding; lymph node metastasis of the neck occurs. The development of squamous cell carcinoma at its site of origin is fastest at the mucosal skin junction, and those with mucosal onset are more likely to metastasize. The following is the before and after surgery comparison.
Squamous cell carcinoma needs to be differentiated from certain precancerous lesions such as solar keratosis and keratoacanthoma.
Actinic keratosis, also known as senile keratosis, is mostly seen in middle-aged and older men. The lesions are brown keratotic patches covered with dark brown scales that cannot be easily peeled off. It is often solitary. The course of the disease is chronic. If the lesions expand rapidly and become wart-like or nodular, or even break down, it suggests the possibility of deteriorating squamous carcinoma.
Keratoacanthoma often occurs in sun-exposed areas and rapidly appears as smooth red nodules with central keratinous emboli and dilated capillaries at the edges of the nodules within 2 to 3 weeks without any aura. The nodules of squamous cell carcinoma, which is distinguished from it, are not smooth and have translucent nodule edges. The early stage of this disease is similar to squamous cell carcinoma in terms of clinical manifestations and pathological changes, so it is difficult to distinguish between them. However, the development of this disease is faster than that of squamous carcinoma, and it can usually heal by itself without rupture.
Melanoma occurs more in middle-aged and elderly people: more men than women. It is more common in men than women. It is more common in the lower extremities and feet, followed by the trunk, head and neck and upper extremities. The symptoms are mainly rapidly growing melanoma nodules. Initially, melanosis may occur in normal skin or pigmented nevi with increased pigmentation and deepening of black color, followed by enlargement of lesion damage and increased hardness with itching and pain. Melanoma lesions may be raised, patchy, nodular, or myxoid or cauliflower-shaped. They may appear as subcutaneous nodules or masses when they grow into the subcutaneous tissue, or as stellate dark spots or small nodules when they spread in the periphery. The common presentation is regional lymph node metastasis of melanoma, or even regional lymph node enlargement. In advanced stage, the metastasis is from blood stream to lung, liver, bone and brain organs.
Malignant melanoma needs to be distinguished from some pigmented skin lesions, especially pigmented nevi, if the pigmented skin lesions have the following changes, it often suggests the possibility of early malignant black.
(1) color change, pigmentation or deepening or lightening.
(2) Marginal changes, often jagged and jagged, caused by the tumor spreading and expanding to the surrounding area or by self-induced degeneration.
(3) surface changes, becoming unsmooth, often rough and accompanied by scaly flaky desquamation, sometimes with blood and exudate, which may be higher than the skin surface.
(4) Skin changes around the lesion, which may appear edematous or lose the original skin luster or turn white or gray.
(5) abnormal sensation, local itching, burning pain or pressure pain.
2, prevention of melanoma should avoid sunlight as much as possible, the use of sun screen is an important primary prevention measure, especially for those high-risk groups, strengthen the education of the general public and professionals, improve the three early, that is, early detection, early diagnosis, early treatment, more important.
(1) For pigmented nevi occurring in areas prone to friction, biopsies should be taken for pathological examination. For example, children with large hairy nevi in the waist, which are often rubbed and squeezed by the belt, should have all of them removed as early as possible.
(2) It is not advisable to stimulate the nevus with corrosive drugs or thorough freezing. It is dangerous to freeze it once but repeatedly several times, because moles are often stimulated by trauma and become malignant, which leads to the formation of melanoma.
As seen above, many facial plaques in the elderly are skin cancer, but they are extremely similar to some benign plaques, which are not easy to distinguish. If new skin plaques appear on the face of the elderly or the previous plaques change, please go to the plastic surgery department of the hospital as soon as possible for a definite diagnosis. Before a clear diagnosis is made, remember not to treat the plaques indiscriminately such as laser, potion or freezing, which will not only delay the best time for treatment, but also promote the deterioration of the plaques and cause cancer metastasis. In conclusion, facial plaques in the elderly should not be ignored.