| Objective:1.To provide clues for the study and discussion of the clinical characteristics and epidemic trend of facial skin malignant tumor.2.To further analyze the clinical and pathological features of different facial skin malignant tumors and to deepen the understanding of facial skin malignant tumors.3.To summarize the similarities and differences and identification points of facial and cutaneous malignant tumors,so as to improve early diagnosis coincidence rate,reduce misdiagnosis rate,early diagnosis,early treatment,improve prognosis and reduce facial lesion.method:Methods from January 2011 to December 2017 in Department of Dermatology,the First Affiliated Hospital of Kunming Medical University,the clinical and pathological diagnosis of basal cell carcinoma,keratosis,Bowen disease,squamous cell carcinoma and certain screening criteria were retrospectively analyzed.The clinical and pathological features of different types of facial skin malignant tumors were classified according to the clinical and pathological data.results:1.In 597 cases of facial skin malignant tumor,175 cases were male and 422 cases were female,the ratio of male to female was 1:2.41.Among them,basal cell carcinoma(BCC)was seen in 315 cases,accounting for 52.76%,243 cases of actinic keratosis(AK),40.7%,33 cases of squamous cell carcinoma(SCC),5.53%and 6 cases of bowen’s disease(BD),accounting for 1.01%.2.Basal cell carcinoma were found in 315 cases(52.76%).2.1 The ratio of men and women to 1:1.89.2.2 The age of onset is 8-94 years old.The average age of onset is 62.51 + 13.13 years(median age 63 years).The peak age is 50-79 years old.2.3 Location:10 cases(3.17%),43 cases of orbital(13.65%),7 eyebrow cases(2.22%),4 cases of eyebrow(1.27%),18(5.71%)in the temporal region,98 in the cheek,94 cases in the nose,nasolabial groove,lip,lip,lip and upper jaw.There were 1 cases(0.32%),4 cases(1.27%)in the chin,and 4 cases(1.27%)in the face.2.4 Clinical manifestations:249 cases of nodular ulceration,accounting for 79.05%,43 cases of hard spot disease(13.65%),19 cases of superficial phenotype(6.03%),and 4 cases of pigmented type(1.27%).2.5 The longest course of disease was 61 years,the shortest 1 weeks,an average of 5.23 years.2.6 Pathological manifestations were 238,75.56%,10 adenoids,3.17%,43 sclerosing,13.65%,superficial 19,6.03%,4,1.27%,75.56%keratinization,0.32%.2.7 The coincidence rate of clinical and histopathology was 81.27%.Most of them were misdiagnosed as pigmented nevus,seborrheic keratosis,squamous cell carcinoma,actinic keratosis,bowen’ s disease,eczema and melanoma.3.Actinic keratosis were found in 243 cases(40.7%)3.1 The ratio of men and women to 1:3.86.3.2 The age of onset is 12-99 years old.The average age of onset is 67.69 + 11.68 years(median age 70 years).The peak age is 50～79 years old.3.3 Location:11 cases(4.53%),19 cases of orbital(7.82%),6 eyebrow cases(2.47%),36 eases in the temporal region(14.81%),113 cheeks(46.50%),28 in the nose(11.52%),nasolabial gully 1 cases(0.41%),lip cases,lower chin and facial multiple cases.3.4 Clinical manifestations:red brown spots in 95 cases,accounting for 39.09%,black brown spots in 68 cases,accounting for 27.98%,black papules in 68 cases,27.98%,erosive spots 12 cases,accounting for 4.94%.3.5 Self-conscious symptoms:itching in 122 cases(50.21%),pain in 39 cases(16.05%),itching pain in 11 cases(4.53%),and no obvious symptoms in 71 cases,accounting for 29.22%.3.6 The longest course of disease was 60 years,the shortest in January,the average of 4.18 years.3.7 Tissue pathology:Hypertrophic 135 cases,55.56%of atrophy,70 cases of atrophy,4 cases of pigment,1.65%,3 cases of acanthosis,4 cases of moss type,1.65%,27 cases of abalone like 11.11%,AK and cortex corneum,the disorder of cell arrangement,cell heteromorphosis,and peripheral blood lymphocytes around the superficial layer of epidermis The main inflammatory cell infiltration,collagen basophilic degeneration.3.8 The coincidence rate of clinical and histopathology is 72.84%.It is easily misdiagnosed as basal cell carcinoma,squamous cell carcinoma,bowen,s disease,pigmented nevus,verruca vulgaris,seborrheic keratosis and melanoma.4.Squamous cell carcinoma were found in 33 cases(5.53%).4.1 The ratio of men and women to 1:1.36.4.2 The age of onset is 39～87 years old.The average age of onset is 68.06 + 11.77 years(median age is 68 years).The peak age is 60～79 years old.4.3 There were 2 cases(6.06%),2 cases(6.06%),1 eyebrows(3.03%),4 temporalis(12.12%),10 cheeks(30.30%),4 nasal(12.12%),lip 9 cases(27.27%),and lower chin.4.4 Clinical manifestations:14 cases of nodular protuberant,accounting for 42.42%,17 cases of ulcerative type,51.52%,and 2 cases of ulcerative type,accounting for 6.06%.4.5 The longest course of disease was 8 years,the shortest 20 days,an average of 1.31 years.4.6 Pathological findings:high differentiation in 23 cases,accounting for 69.70%;middle differentiation in 8 cases,accounting for 24.24%,low differentiation in 2 cases,accounting for 6.06%,and 4 cases of squamous cell carcinoma secondary to AK.4.7 The coincidence rate of clinical and histopathology was 33.33%.Most of them were misdiagnosed as basal cell carcinoma,bowen’s disease,actinic keratosis,suppurative granuloma and pyoderma gangreno.5.Bowen’s Disease was found in 6 cases(1.01%).5.1 The ratio of men and women to 1:2.5.2 The age of onset is 42-83 years old,and the average age of onset is 63.33 + 15.02 years(median age 60 years).5.3 The locations of lesions were temporal(1)(16.67%),buccal(3)(50%),and lip(2)(33.33%).5.4 Clinical manifestations:3 cases of erythema,2 cases of black brown plaque,1 cases of verrucous hyperplasia,of which 3 cases of scab,2 cases of erosion and ulcer surface.5.5 Self-conscious symptoms:4 cases of itching,1 cases of pain,and 1 cases of no symptoms.5.6 The longest course of disease was 2 years,the shortest in February,the average of 1.22 years.5.7 The main pathological features of histopathology are hyperkeratosis,hyperkeratosis,hypertrophy of the spinous layer,atypical keratinocytes in the whole epidermis of the epidermis,disorder of cell arrangement,cell heteromorphism,and abnormal keratinized cells and mitotic images,and complete basement membrane.The proliferation and expansion of capillaries in the dermis and infiltration of lymphocytes are mainly seen in peripheral blood.5.8 The coincidence rate of clinical and histopathology was 16.67%.Most of them were misdiagnosed assquamous cell carcinoma,basal cell carcinoma,actinic keratosis,igmented nevus and seborrheic keratosis.Conclusion:1.In the incidence of facial skin malignancies,basal cell carcinoma(BCC)is common,accounting for 52.76%,actinic keratosis(AK)40.7%,squamous cell carcinoma(SCC)rare,5.53%,and bowen’s disease(BD)only 1.01%.basal cell carcinoma>actinic keratosis>squamous cell carcinoma>bowen’s disease.2.The incidence of facial skin malignant tumors was 1:2.41 between men and women,and the difference was statistically significant(P=0.021<0.05).3.The malignant tumor of the facial skin can occur at any age.The proportion of the elderly is large(60-79 years old is 358 cases,accounting for 59.96%),and the highest coincidence rate between the clinical and pathological diagnosis is BCC(81.27%),and the BD coincidence rate is the lowest(16.67%).4.Of basal cell carcinoma,nodule ulceration is the most common form,accounting for 79.05%,and the most common entity is 75.56%.Hyperkeratosis is usually seen in hypertrophic type(55.56%),and itchy sensation(50.21%)is the most common symptom.Squamous cell carcinoma is highly differentiated(69.7%).The higher the degree of differentiation,the lower the malignancy.5.There was no significant difference in the number of confirmed cases of facial skin malignant tumors in the past seven years.6.The early clinical manifestations of facial cutaneous malignant tumors are not specific.They are easy to misdiagnose.We need to strengthen clinical observation and make clear diagnosis in time.7.The combination of clinical manifestations and histopathological features is very important for diagnosis and typing of facial cutaneous malignancies. |
