Introduction: Early detection of people at risk of skin cancer will reduce the incidence of disease, lower the cost of health technologies and decrease anxiety level in patients. The aim of the work is to create a prognostic model for identifying people at increased risk of skin cancer development. Material and methods: We used the results of our previous research on identifying risk factors in patients with actinic keratosis (AK), squamous cell carcinoma in situ (SCCis) and cutaneous squamous cell carcinoma (cSCC), who were under dynamic observation at the State Institution of Science “Research and Practical Centre of Preventive and Clinical Medicine” State Administrative Department (hereinafter SIS) in 2014-2017. Results: The prognostic model is valid, AUC = 0.97 (95% CI 0.96 – 0.99) showing a significant association of the risk of skin cancer development with the following factors: patient’s age, sunburns, using skin sunscreens, exposure to the sun in recent times, exposure to radiological materials, drug administration (antiarrhythmic drugs, antihypertensive medications, hormonal contraceptives, antibiotics), burdened family history (melanoma, squamous cell cancer). Model sensitivity was 95.1% (95% CI 91.6% - 97.4%), specificity – 88.5% (95% CI 84.6% - 91.8%). Conclusions: The developed and analysed mathematical risk prediction system made it possible to identify 11 factors which are significantly associated with risk of skin cancer development. The prognostic model might be offered for specialists in taking decision at the stage of primary and secondary prevention of skin cancer.
. Improvement of prevention is impossible without the development and implementation of the most optimal ways of providing medical care to create a regulatory framework that regulates the provision of medical care at all levels. High-level scientific and medical information is summarized in clinical guidelines (clinical guidelines), which are the source of standards of care. Aim: To substantiate the application of a clinico-organizational approach to improving the prevention of epidermal dysplasia by developing a clinical algorithm for medical care for patients with epidermal dysplasia based on a process approach. Using the provisions of international standards of care. Material and Methods: The data of persons receiving medical care at the State Scientific Institution “Scientific and Practical Centre of Preventive andClinical Medicine” of the State Administrationduring 2014 to half of the 2019 were used. A retrospective analysis of scientific literature data on topical issues of prevention of epidermal skin dysplasia has been carried out. Results: Based on the analysis of the scientific literature, we have created a clinical algorithm of medical care for patients with epidermal dysplasia of the skin, which includes the screening stage, the stage of diagnosis and stage of treatment, stage of dynamic observation. In accordance with the tasks of each of the stages in the article the movement of patients is analyzed, frequencies of application of diagnostic and therapeutic methods are given. The functions of each specialist in the stages of the medical algorithm are determined. Conclusions: Systematization of scientific literature data, analysis of own research results and use of the principles of process approach allowed to substantiate and structure the clinical algorithm of medical care for patients with epidermal dysplasia of the skin.
Summary. Squamous cell carcinoma of the skin develops from the spectrum of facultative precancerous conditions, which in the course of malignant transformation through cancer stage in situ without early treatment fully transform into invasive squamous cell carcinoma. According to classical model of carcinogenesis, the transformation of actinic keratosis into squamous cell carcinoma of the skin occurs due to a mutation in one gene, more often a tumor suppressor, and undergoes a stage of development with lack of control of cell cycle. The aim of the research is to supplement current knowledge of genetic determination of pathogenetic mechanisms of epidermal dysplasia of the skin by studying the genetic determinant in the skin lesion of varying degrees of malignancy. Materials and Methods: We analyzed 85 skin bioptates of patients with epidermal dysplasia of the skin (Gr 1 — 43 patients with actinic keratosis; Gr 2 — 21 patients with non-invasive squamous cell carcinoma of the skin; Gr 3 — 21 patients with invasive squamous cell carcinoma of the skin) by molecular genetic testing of gene polymorphisms: TP53 (G13494A), L-myc (T3109G), TNF-α (G308A) in tumor tissue. The histological examination revealed the levels of dysplasia of the epidermis. Results: In case of the same disease duration in patients of Gr1/Gr3, L-myc (3109TT) is a genetic component of malignant transformation of epithelial skin cells (p = 0.004) and the development of invasive squamous cell carcinoma. Other variants of 3109TG and 3109GG genes do not have such prognostic value for the risk of skin cancer compared to 3109TT. Significant differences were found in the distribution of (13494GA) when comparing Gr 1 with Gr 3 (p = 0.014) and Gr 2 with Gr 3 (p = 0.038). A significant increase in the distribution of 13494GA genotype was revealed in patients with invasive form of keratinocyte intraepidermal neoplasia. 13494A allele was more likely to be detected in patients of Gr 3 compared to Gr 2 (p = 0.030) that proves the association of this allele with the development of invasive malignancies of the skin. The association of 308GG genotype and TNF-α (308G) allele with the development of malignant skin lesions was found. Comparing the distribution of 308G allele in patients of Gr 1 and Gr 2, we found its significant increase in patients of Gr 1. Comparative analysis of gene polymorphism with tumor invasion level showed a significant difference only in 308GG genotype between patients with grade III of KIN (keratinocyte intraepidermal neoplasia) in Gr 2 and patients with KIN III of Gr 1 (p = 0.007), and 308GA between patients with KIN III of Gr 2 and KIN III of Gr 1 (p = 0.027). Conclusions. Our work has supplemented modern vision of genetic component in pathogenetic mechanism of the development of epidermal dysplasia of the skin. Thus, the association of L-myc (3109TT) with the development of malignant skin lesions of different invasiveness and the modifying effect of TNF-α (G308A) and TP53 (G13494A) gene variants on pathological transformation in the focus of EDS depending on the level of epithelial dysplasia was revealed.
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