Rak kolczystokomórkowy złośliwym nowotworem naskórka
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Rak kolczystokomórkowy złośliwym nowotworem naskórka

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Głównym czynnikiem wywołującym rak kolczystokomórkowy jest ekspozycja na promieniowanie UVB. Rak kolczystokomórkowy powstaje z keratynocytów i częściej dotyka mężczyzn. Ma tendencję do miejscowego szerzenia się jak również przerzutów.

Wśród innych czynników, które mogą się przyczynić do zachorowania na ten złośliwy nowotwór naskórka są wirus brodawczaka ludzkiego – HPV, radioterapia, ekspozycja na arsen oraz rakotwórcze substancje chemiczne, takie jak smoła czy dziegcie. Rak kolczystokomórkowy może również wywołać immunosupresja jatrogenna lub spowodowana zakażeniem HIV/AIDS.

Jak objawia się rak kolczystokomórkowy?

Najczęstszą postacią tej odmiany złośliwego nowotworu naskórka jest nadmiernie zrogowaciała grudka lub blaszka, którą bardzo często pokrywa strup lub owrzodzenie. Bardzo trudno jest odróżnić rak kolczystokomórkowy od zmian prekursorowych. Różne jest również ryzyko przerzutów oraz tempo wzrostu. Najlepiej rokują zmiany na skórze powstałe na podłożu rogowacenia słonecznego. Natomiast najgroźniejsze są raki kolczystokomórkowe umiejscowione na wargach, prąciu i sromie.

Diagnostyce powinien zostać poddany każdy typ rogowacenia słonecznego oraz inne nowotwory (ograniczające się do jednej tkanki), które są oporne na leczenie lub mają charakter wrzodziejący.

Typy raka kolczystokomórkowego

Wyróżnia się kilkanaście typów tego złośliwego nowotworu naskórka. Wśród nich rogowiak kolczystokomórkowy, rak podstawnokomórkowy, podrażniona brodawka łojotokowa, brodawki zwykłe i nowotwory przydatków skóry. Rakiem kolczystokomórkowym będą również wcześniej występujące zmiany, takie jak rogowacenie słoneczne, erytroplazja i choroba Bowena.

Leczenie raka kolczystokomórkowego polega na wycięciu zmiany z zachowaniem histologicznej kontroli marginesów. Zdecydowanie gorzej będą sprawdzały się takie metody jak radioterapia, ablacja laserowa, terepia fotodynamiczna czy kriochirurgia.

Rak kolczystokomórkowy, który nie kwalifikuje się do operacji lub któremu towarzyszą przerzuty powinien być leczony zgodnie z procedurą paliatywną, która znajduje się w programie leczenia onkologicznego głowy i szyi. Pacjenci z tego rodzaju rakiem leczeni są metotreksatem lub cysplastyną w skojarzeniu z doksorubicyną lub 5-fluorouracylem.

Pacjenci z rakiem kolczystokomórkowym powinni być badani co 3-6 miesięcy przez 5 lat. Przerwa między badaniami powinna być uzależniona od ryzyka przerzutów. Z uwagi na to, iż większość z tej grupy pacjentów doświadcza liczne stany przedrakowe, chorym powinno się wykonać badanie na obecność dodatkowych guzów.

Źródło: Sterry W., Paus R., Burgdorf W., Dermatologia, Wydanie I Polskie Lublin 2009, s. 310

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