Skin is very important protective barrier of our body, and one of its largest organs. Skin makes up 7% of body's mass, its area is 1.5-2 square meters. Skin performs many important functions for our health – protective, barrier, participates in water-salt, protein, carbohydrate, fat metabolism, as well as vitamin metabolism, performs respiratory, immune, excretory, thermoregulatory functions and many others. It is clear that skin is exposed to negative influence of various environmental factors every day, which can cause its diseases, in particular, tumors development.
Skin tumors can be benign or malignant, congenital or appear during life. In children, mostly benign skin neoplasms develop, malignant ones are extremely rare in childhood.
If you notice a strange neoplasm on your child's skin, be sure to consult a dermatologist. Specialist will examine the baby, possibly prescribe additional examinations and establish correct diagnosis. If neoplasm will require surgical removal, dermatologist will refer you to a professional pediatric oncologist.
Such highly qualified doctors work in Pediatric Oncology Department of Maimonides Multidisciplinary Medical Center. Our institution operates in close and fruitful cooperation with the best Israeli oncology centers. Children's oncology project of Maimonides Medical Center is managed by Israeli specialist Dr. Serhiy Postovsky and specialist in Pediatric Skin Oncology, Dr. Yakov Mashiah (head of Pediatric Dermatology at Tel Aviv Sourasky Medical Center – Ichilov). Together with our head of department, Dr. Yury Tymoshchuk, he supervises all clinical cases directly from Israel. This approach is unique, because in Ukrainian conditions, every small patient can get access to modern and effective Israeli medicine.
All pediatric oncology specialists of Maimonides Medical Center are highly qualified and have extensive practical experience . Most of them have repeatedly trained in the best oncology centers in the world and have mastered modern methods of diagnosis and treatment. In their medical practice, our specialists are guided only by modern recommendations and global treatment protocols, and not by 20-year-old domestic methods. At the same time, approach to each child is individual. Prescribing treatment, patient's age, state of health, type of tumor, its spread and stage of process, concomitant diseases presence, and ultimately, child’s wishes or his parents are taken into account. That is, treatment does not have a template character, but has a full-fledged patient-oriented approach.
Given that oncological diseases treatment is a rather expensive process, for our patients we have created an opportunity to receive financial assistance for treatment of seriously ill children. Maimonides Medical Center works under the patronage of “Keren Or for our Child” the Charitable Foundation, which can cover all or a part of costs on medical and diagnostic process. The fund's assets are supplemented by donations from various companies and ordinary caring people.
Treatment of any oncological diseases, especially malignant ones, is a complex process that requires involvement of several narrow specialists at the same time. In our Pediatric Oncology Department, modeled on the best Israeli clinics, not only oncologists work, but a whole multidisciplinary team – oncologists, dermatologists, pediatricians, surgeons, radiation therapists, chemotherapists, plastic surgeons, rehabilitators, psychologists and others. This ensures continuity of medical care for any patient, that is, all stages from diagnosis to complex treatment and recovery after it can be obtained within the walls of one medical institution.
Symptoms of skin tumors in children
Tumors of skin, unlike other oncological diseases, are easy to detect at an early stage. To do this, it is only necessary to regularly examine child’s skin and in case of suspicious elements appearance on skin – limmediately consult a dermatologist.
Examining child's skin we need to pay attention to:
- new elements appearance (pigmented or depigmented spots, nodules, ulcers, etc.) on skin.
- a change in size, shade, shape of nevusthat was on skin, appearance of ulcers on its surface, discharge of pus, pus or blood from it.
- pain appearance, burning or itching in certain neoplasm area on skin.
- frequent traumatization of certain birthmark on the body.
Types of skin tumors in children
All neoplasms on skin are divided into congenital (a child is born with them) and acquired (appear during life).
Depending on ability to spread and metastasize, skin tumors are divided into 3 groups:
- benign,
- malignant,
- borderline (borderline).
Malignant skin neoplasms in children are rare oncological diseases. Among them, children have basal cell carcinoma, squamous cell carcinoma, and extremely rarely melanoma.
Benign skin neoplasms predominate in childhood, including nevi, fibromas, dermatofibromas, lipomas, hemangiomas, papillomas, and others. These tumors almost do not pose a danger to life, although they can become malignant in rare cases. Therefore, it is better to remove such neoplasms with modern minimally invasive techniques, for example, cryodestruction or radio-wave coagulation.
Borderline neoplasms refer to precancerous (background) conditions, that is, at any moment such a tumor can turn into a malignant one and acquire the ability to metastasize. The most common are pigmented xerodermas and keratoacanthomas.
Skin tumors diagnostic methods in children
As a rule, diagnosis of skin neoplasms does not cause difficulties. If a suspicious element is detected on skin, you should consult a dermatologist. Specialist will conduct an examination, dermatoscopy (an examination of skin element using a special dermatoscope device that magnifies image in 20 times), collect complaints from patient or his parents, medical and life history, determine whether there are harmful factors of influence that increase malignant neoplasms risk on skin. If, according to data of initial examination and dermatoscopy , neoplasm will be classified as borderline or suspicious for malignancy, patient will be offered a biopsy and sent to an oncologist.
Neoplasm biopsy of skin neoplasms does not cause difficulties, because all elements are located superficially and are available for examination. Material is taken without anesthesia or under local anesthesia, general anesthesia is rarely used – in cases of child’s expressed fear before procedure. After biopsy, we send all material for revision to the best pathogistological laboratories in Israel, USA, and Germany. Thanks to such "molecular checks", we are absolutely sure of diagnosis correctness and adequacy of further treatment tactics. In case when malignant nature of neoplasm (especially often in the case of melanoma) is confirmed, in addition to standard histological examination, material is also examined by modern immunohistochemical, molecular genetic methods. This is necessary in order to determine certain types of mutations in malignant cells presence, certain receptors on their surface presence. In future, they become a target for innovative drugs created individually for each patient (targeted therapy, immunobiological drugs). Such test system for molecular genetic testing are the Foundation One panel and Caris Molecular Testing.
If after biopsy we received confirmation of malignant type of neoplasm on skin, patient is referred for further diagnostics in order to determine general state of his health (before comprehensive treatment), spread of tumor, presence of distant metastases, which will allow us to clearly determine the stage of disease. For this purpose, we use a set of general clinical and biochemical blood tests, ultrasound of internal organs, CT, MRI with and without contrast, PET-CT, which allows us to "track down" all existing metastases in body and plan a treatment program.
Treatment methods of skin tumors in children
Plan and scheme of treatment completely depend on the main diagnosis and stage of disease. Benign or borderline neoplasms do not require complex treatment, they are removed either by careful (not wide) excision of skin, or by modern minimally invasive methods – cryodestruction, laser coagulation, radio wave ablation, electrocoagulation. After such interventions, there is almost never a trace of the tumor on skin, the wound after removal heals quickly without scar formation.
Surgical coagulation with a high-intensity current (electrocoagulation) is widely used in dermatology to remove various benign skin neoplasms. This technique allows us to remove the tumor quickly (in one visit), almost painlessly and effectively (without recurrence risks). Israeli dermatologist Dr. Tomashu.He removes all skin neoplasms using this modern technique: viral papillomas, senile keratomas, condylomas, atheroma, warts, molluscum contagiosum, hemangiomas, postacne, telangiectasia, rosacea, pigmented nevi.
A special device – an electrocoagulator– is used for electrocoagulation procedure. It generates a high-frequency electric current, with the help of which thermal coagulation of neoplasm takes place (its tissues are destroyed, while healthy skin is not damaged). At site of electrocoagulator action, a dry crust is immediately formed, which eventually disappears on its own, and no trace remains under it. Doctor gives recommendations on how to care for crust to each patient, so that a scar does not form in its place in future.
If malignant neoplasm on skin is detected in diagnostic process, treatment program is, of course, expanded. In metastases are absent and on initial stage of disease, neoplasm surgical removal is performed by wide excision (together with certain area of surrounding healthy skin). After such intervention, a significant defect may remain on skin, which heals with scar formation. Sometimes patient even undergoes skin graft to cover the defect that was formed after tumor was removed. Also, the second stage after radical treatment can be reconstructive and plastic surgeryto hide the scar after primary intervention, if it is, for example, on face. Malignant neoplasms are prohibited to be removed by minimally invasive methods, only by wide excision. This makes it possible to prevent disease relapse, especially in case of melanoma, and to completely rid the patient from this pathology.
If tumor has progressed to stage 3-4 , for instance, there is spread to regional lymph nodes or metastases to distant organs, treatment program is supplemented by other methods besides surgery.
Such patients are necessarily prescribed courses of radiation therapy. It can be remote, when radiation source is outside the body, or contact, when radioactive material is brought directly to tumor bed (brachytherapy).
Chemotherapy is also actively used in complex treatment of advanced stages in malignant skin neoplasms. Unfortunately, such a tumor as melanoma is resistant to standard chemotherapy (both systemic and contact). Therefore, in such patients, treatment is supplemented with modern methods of drug therapy – targeted drugs, immunobiological drugs.
The basis of targeted therapy is application of such drugs that act on certain targets of malignant cells, they do not affect healthy cells of body, which is a big advantage over classical chemotherapy. In many patients with melanoma, a mutation in BRAF gene is found at the stage of molecular genetic research after biopsy. Targeted drugs for melanoma include, for example, inhibitors of abnormal protein BRAF (vemurafenib, dabrafenib) and inhibitors of the MEK protein (вемурафеніб, дабрафеніб) та інгібітори MEK protein (trametinib, cobimetinib). In such patients (with this mutation in malignant cells), targeted therapy will be very effective.
In immunotherapy , patient's own immune system is used to destroy cancer cells. A number of immunotherapeutic agents are being investigated for treatment of melanoma. Some drugs block signals that control cancer cells growth. Other biological agents use special proteins to attach cancer cells in such a way that immune cells can recognize and destroy them (a sort of “marks”).
An undeniable bonus for our patients is the opportunity to participate in clinical trials of experimental drugs. For some of them, this is a real chance for a full recovery, especially for those children for whom all standard treatment regimens have proven ineffective.