Head and Neck TumorsHead and Neck TumorsОпухоли головы и шеи2222-14682411-4634Publishing House ABV Press61110.17650/2222-1468-2021-11-1-51-72DIAGNOSIS AND TREATMENT OF HEAD AND NECK TUMORSДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ ГОЛОВЫ И ШЕИCurrent strategy of squamous cell carcinoma diagnosis and treatmentСовременная стратегия диагностики и лечения плоскоклеточного рака кожиhttps://orcid.org/0000-0003-2095-5931PolyakovA. P.ПоляковА. П.
Russian Federation

Andrey Pavlovich Polyakov

3 2nd Botkinsky Dr., Moscow 125284

Андрей Павлович Поляков

125284 Москва, 2-й Боткинский пр-д, 3

appolyakov@mail.ruhttps://orcid.org/0000-0002-9181-7811GevorkovA. R.ГеворковА. Р.
Russian Federation

3 2nd Botkinsky Dr., Moscow 125284

125284 Москва, 2-й Боткинский пр-д, 3

StepanovaA. A.СтепановаА. А.
Russian Federation

11 Volokolamskoe Hwy, Moscow 125080

125080 Москва, Волоколамское шоссе, 11

P.A. Hertsen Moscow Oncology Research Institute — branch of the National Medical Research Radiological Center, Ministry of Health of RussiaМосковский научно-исследовательский онкологический институт им. П.А. Герцена — филиал ФГБУ Национальный медицинский исследовательский центр радиологии Минздрава РоссииMedical Institute of Continuing Education, Moscow State University of Food ProductionМедицинский институт непрерывного образования ФГБОУ ВО Московский государственный университет пищевых производств2404202111151722304202123042021Copyright ©; 2021, Polyakov A.P., Gevorkov A.R., Stepanova A.A.Copyright ©; 2021, Поляков А.П., Геворков А.Р., Степанова А.А.2021Polyakov A.P., Gevorkov A.R., Stepanova A.A.Поляков А.П., Геворков А.Р., Степанова А.А.https://creativecommons.org/licenses/by/4.0https://ogsh.abvpress.ru/jour/article/view/611

Squamous cell carcinoma (SCC) is the second most common skin cancer after basal cell carcinoma. Usually, antitumor treatment is sufficiently effective: recovery rate is about 90 %. Primary SCC is characterized by variable growth rate, as well as by involvement of regional lymph nodes (from 1 % for well differentiated tumors to 10 % for poorly differentiated tumors, size >3 cm and /or invasion depth >4 mm). In case of SCC development near post-burn scar, the rate of regional metastasis is 10-30 %. A relatively small possibility of distant metastasis also exists, with overall mortality of 2-3 %. In SCC of the head and neck, both hematogenic and perineural advancement into the CNS are possible. Total rate of local recurrences is 25 %. The main factors of local and regional recurrences are location (head and neck), size (tumor diameter >2 cm), invasion depth (>4 mm), tumor differentiation, perineural involvement, patient's immune status and previous treatment. Tumors in areas that weren»t subjected to solar radiation and tumors in the areas of pervious irradiation, thermal damage, scarring or chronic ulcers are more prone to recurrences and metastasis. Poorly differentiated and anaplastic SCC is more likely to metastasize compared to well differentiated tumors. Medially located SCC is the area of the face mask and lip is more prone to neural invasion. Multidisciplinary approach with involvement of all specialists in antitumor treatment is necessary for development of treatment tactics.

Плоскоклеточный рак кожи (ПКРК) - второй по распространенности рак кожи после базальноклеточного. Противоопухолевое лечение, как правило, достаточно эффективно: частота излечения достигает 90 %. Особенностью первичного ПКРК является вариабельность темпов роста, а также склонность к поражению регионарных лимфатических узлов (от 1 % при высокодифференцированных опухолях до 10 % при низкой степени дифференцировки, размере >3 см и/или глубине инвазии >4 мм). В случае развития ПКРК в области послеожогового рубца частота регионарного метастазирования достигает 10-30 %. Существует также относительно небольшая вероятность отдаленного метастазирования с общей летальностью 2-3 %. При ПКРК головы и шеи возможно как гематогенное, так и периневральное распространение в ЦНС. Общая частота локальных рецидивов составляет 25 %. К основным факторам риска локорегионарного рецидива относятся локализация (в области головы и шеи), размер (>2 см), глубина инвазии (>4 мм), дифференцировка опухоли, периневральное поражение, иммунный статус пациента и предыдущее лечение. Опухоли, возникшие на участках, которые не подвергались воздействию солнечной радиации, и опухоли, возникшие в зоне предшествующего облучения, термического повреждения, рубцевания или хронического язвенного поражения, более склонны к рецидивированию и метастазированию. Низкодифференцированный и анапластический ПКРК метастазирует чаще, чем высокодифференцированный. Срединно расположенные опухоли в области маски лица и губы наиболее склонны к невральной инвазии. При определении тактики лечения требуется мультидисциплинарный подход, определяемый с обязательным участием всех специалистов по противоопухолевому лечению.

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