RU2317016C1 - Method for evaluating the risk in the development of skin cancer - Google Patents

Abstract

FIELD: medicine, dermatooncology.

SUBSTANCE: the present innovation deals with evaluating the risk in the development of skin cancer in patients with skin diseases. It is necessary to detect the following values: sex, age, blood group, social status, address, accompanying pathology. Then it is important to calculate prognostic coefficient (PC) for every factor due to giving certain number of points for every factor. Then PC should be summarized. In case of PC sum ranged -26.5 up to -15.5 one should predict low risk in the development of skin cancer, at PC sum ranged -2.5 up to 9.5 one should predict high risk in the development of skin cancer. The innovation enables to evaluate the risk in the development of skin cancer in patients with skin diseases to carry out procedures on prophylaxis and matching the scheme of therapy to treat the disease in question.

EFFECT: higher efficiency and accuracy of evaluation.

3 ex, 3 tbl

Description

The invention relates to medicine, namely dermato-oncology, and can be used as a method for the prevention of skin cancer.

A known method for predicting the development of metachronous skin cancer [patent RU 2241232, IPC G01N 33/82, BIMP No. 33, publ. November 27, 2004], based on the determination of the level of vitamin E in peripheral blood lymphocytes fluorometrically. When the content of vitamin E is equal to or higher than 18.9 conventional units, the possibility of the development of metachronically developing foci of skin cancer is predicted.

However, the disadvantage of this method is that it allows you to evaluate only one factor.

The objective of the invention is to increase the effectiveness of preventive measures against skin cancer among the population by assessing the risk of developing skin cancer based on established risk factors.

The problem is achieved in that in the method of assessing the risk of developing skin cancer, indicators are determined: gender, age, blood type, social status, place of residence, concomitant pathology. Then calculate the predictive coefficient (PC) for each factor. In the system, the gender with the marker gender male is set to PC equal to (-1), with the marker female gender is equal to (+1). In the system, the age with a marker of 30-39 years old sets the PC to equal (-11.5), with a marker of 40-49 years old - (-5), with a marker of 50-59 years old - (-2), with a marker of 60-69 years - equal to (+2), with a marker of 70-79 years - equal to (+4), with a marker of more than 80 years - equal to (+3). In the system, a blood group in the presence of a marker, blood group I (+) is set to PC equal to (+1), when marker I (-) is equal to (-2), when marker II (+) is equal to (-0.5), when marker II (-) - equal to (-2), with marker III (+) - equal to (0), with marker IV (+) - equal to (-1). Under the system, social status with a marker, pensioners and people with disabilities set the PC to equal (+2), with a marker workers - equal (-1), with a marker employees - equal (-4), with a marker unemployed - equal (-7); in the system, the place of residence in the presence of the city marker is set by the PC equal to (+0.5), with the village marker - equal to (-1). In the system, a concomitant pathology - in the presence of a marker of a disease of the cardiovascular system (CCC), set the PC to (+1), with a marker of a disease of the gastrointestinal tract (GIT) - equal to (-0.5), with a marker of a disease of the genitourinary system - equal (0), with a marker of respiratory disease equal to (-4), with a marker of disease a combination of pathology is equal to (+1), with a marker of absence of concomitant pathology is equal to (-0.5). With a PC value of -26.5 to -15.5, a low risk of developing skin cancer is predicted, with a PC value of from -2.5 to 9.5, a high risk of developing skin cancer is predicted.

The novelty of the method:

Risk factors for skin cancer have been identified. A higher frequency of a number of risk factors was found: gender, age, blood type (ABO, Rh), place of residence, social status, and concomitant pathology.

The significance of each of the signs is proved by the method of normalizing intensive indicators with the determination of the weight index (Shigan E.N., 1977), reflected in table 1.

Table 1 Statistical indicator Nosological form Floor Age Blood type Location Social status Soputst. pathology Factor Weight Index Skin cancer 1,08 four 1.72 1.51 1,07 1,52

All the factors identified are significant, since they exceed 1.0.

To assess the risk of developing skin cancer, the likelihood ratio method was used (E. Shigan, 1977), according to which for each symptom (risk factor) a study group (cancer patients) was allocated, for which coefficients and a comparison group (patients with melanoma, control group) (Tab.№ 2). Subsequently, by comparing the indicators for each item in both groups, a likelihood coefficient was obtained. The coefficient was subsequently logarithmic and rounded to integer values (Gubler E.V., 1964) to obtain a prognostic coefficient (Tab.№ 2).

PCs with a positive value increase the risk of skin cancer, with a negative value they decrease, while the information content of a PC increases with an increase in its absolute value. A number of signs turned out to be uninformative (in the system of concomitant pathology, the criterion of disease of the endocrine and genitourinary system, in the system, blood type - blood type III and IV blood type with a negative Rhesus factor, in the system social status - students, in the system age - up to 30 years). All significant factors are given in table 2.

It turned out that the greatest risk of developing skin cancer is among female patients in the age group of 70-79 years old, pensioners and people with disabilities, with I (+) blood type, living in the city, who have combined concomitant pathology and pathology of the cardiovascular system.

Given the results obtained, three risk groups can be distinguished by adding the prognostic factors of risk factors. First, the smallest values of prognostic coefficients are summarized, then the maximum. The resulting range is divided into three parts with the receipt of risk groups (tab. No. 3).

Table number 3 Skin cancer Group of favorable prognosis (low risk) from -26.5 to -15.5 Attention group from -15 to -3 Group of poor prognosis (high risk) from -2.5 to 9.5

Thus, the greatest risk of developing skin cancer with a prognostic coefficient of PC from -2.5 to 9.5.

The method is as follows. The examination is carried out once, the data are determined: gender, age, place of residence, social status, blood type and Rh factor according to the generally accepted method, from the anamnesis the existing concomitant pathology is clarified and laboratory and instrumental confirmation of this pathology is carried out. Data obtained by the indicated methods are analyzed. Detected by PC. Identified individuals with a high risk of developing skin cancer with a PC from -2.5 to 9.5 are recommended to take preventive measures.

a) Limiting the influence of exogenous factors (chemical and physical).

I. The sun's rays.

- Use of sunscreen (funds):

- white skin - SPF 30-50;

- ivory and darker skin - SPF 20-30.

- Wearing clothes in the summer, which hides the skin as much as possible from the influence of sunlight;

- Rationing of time spent in the sun (when sunbathing on the beach, in the garden, etc.).

II. Ionizing radiation:

- Avoid contact with radiation;

- Use a protective screen when working with a computer and limit the time it works with it;

- Use personal protective equipment (PPE) when working near radioactive sources and visiting an X-ray room (lead aprons, collars, screens, etc.);

- Minimize in the apartment such equipment as: microwave ovens, toasters, hair dryers, computer equipment.

III. Chemical substances:

- Wearing PPE (gloves, gowns, masks, suits) when working with chemicals;

- Limitation of contact with mineral oils, resins, arsenic, insecticides, herbicides, petroleum products.

b) Prevention of stress.

- Prevent stress (limiting meetings with unpleasant people, avoiding scandals, etc.);

- Medical correction using stress protectors and anxiolytics (after consultation with a doctor).

c) General strengthening therapy:

- intake of vitamins from the group of antioxidants (C, E, P) and trace elements (selenium).

d) Immunocorrection (according to indications).

e) General:

- Monitoring the condition of the skin and formations that occur on it;

- A visit to a dermatologist 1 time in 6 months.

f) Correction of existing comorbidity.

Example 1

Patient K., 65 years old, came to the regional dermatovenerological dispensary; a pensioner living in the city has I (+) blood type. A history of coronary heart disease (CHD). Complains of redness and rashes in the face and neck. Objectively: hyperemia, papules and peeling in the forehead, cheeks, chin and neck. After the examination, the diagnosis was acne rosacea. The risk of developing skin cancer has been calculated:

The amount of PC = 1 + 2 + 2 + 0.5 + 1 + 1 = 7.5;

which corresponds to a high risk group for developing skin cancer. Recommended preventive measures. A follow-up examination after 7 months revealed the presence of a tumor in the frontal region with a diameter of 1 cm, after the examination the diagnosis was made: basal cell region of the forehead on the right.

Example 2

A 38-year-old man living in the village turned to a dermato-oncologist. Works as a mechanic. Has II (+) blood type. A history of chronic gastritis. Complaint about a long-term non-healing wound on the chest (about 2 months). The risk of developing skin cancer has been calculated:

The amount of PC = (- 1) + (- 11.5) + (- 0.5) + (- 1) + (- 1) + (- 0.5) = - 15.5;

which corresponds to a low risk group for skin cancer. Recommended treatment by a surgeon. Biopsy material from the wound showed no cancer cells. Tissue excision and preservative treatment were completed, which ended with wound healing and complete recovery.

Example 3

Patient N., 70, turned to a dermato-oncologist, lives in the city, retired, has a II (+) blood type. A history of arterial hypertension is 10 years (working pressure 150/90 mm Hg). Peptic ulcer of 6 years, observed by a gastroenterologist. Two years ago she underwent surgery for skin cancer in the area of the tip of the nose. Complains of nodular formation in the left cheek area, which appeared 6 months ago, and constant bleeding in the area of this formation. Objectively: in the region of the left cheek, the tumor is pink in color, with a diameter of 1.5-2 cm, covered with a brown crust. The risk of developing skin cancer has been calculated:

The amount of PC = 1 + 4 + 0.5 + 2 + (- 0.5) + 1 = 8;

which corresponds to a high risk group for developing skin cancer. A pathological study revealed the presence of cancer cells (basal cell cancer) in the tumor material. The patient was operated on, a course of treatment. Recommended preventive measures, follow-up examinations 2 times a year.

Thus, when assessing the health status of patients with skin diseases with a suspicion of developing skin cancer, we can use the method we have proposed to predict quickly and with low material costs people with a high risk of developing skin cancer, in order to carry out preventive measures and choose a treatment regimen diseases.

Claims (1)

A method for assessing the risk of developing skin cancer, characterized in that in persons with skin diseases, indicators are determined: gender, age, blood type, social status, place of residence, concomitant pathology, then the prognostic coefficient (PC) for each factor is calculated, namely: in the system, gender with the marker gender male set the PC to equal (-1), with the marker gender female - equal to (+1); in the system, the age with a marker of 30-39 years old sets the PC equal to (-11.5), with a marker of 40-49 years old - (-5), with a marker of 50-59 years old - (-2), with a marker 60-69 years - equal to (+2), with a marker of 70-79 years - equal to (+4), with a marker of more than 80 years - equal to (+3); in the blood group system, in the presence of a marker, blood group I (+) is set to PC equal to (+1), when marker I (-) is equal to (-2), when marker II (+) is equal to (-0.5), when marker II (-) - equal to (-2), with marker III (+) - equal to (0), with marker IV (+) - equal to (-1); in the system, social status with a marker, pensioners and people with disabilities set the PC equal to (+2), with a marker workers - equal (-1), with a marker employees - equal (-4), with a marker unemployed - equal (-7); in the system, the place of residence in the presence of the city marker is set by the PC equal to (+0.5), with the village marker - equal to (-1); in the system, concomitant pathology in the presence of a marker of cardiovascular disease (CVS) sets the PC to (+1), with a marker of a disease of the gastrointestinal tract (GIT) - equal to (-0.5), with a marker of a disease of the genitourinary system - equal to (0 ), with a marker of a disease of the respiratory organs - equal to (-4), with a marker of a disease, a combination of pathology - equal to (+1), the absence of a concomitant pathology (-0.5), and with a value of the sum of PK from -26.5 to -15, 5 predict a low risk of developing skin cancer, with a PC value of from 2.5 to 9.5 predict a high risk of developing skin cancer.