| Ch 15 | Page 8 / 13 Paragraph 2 / 7 |
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| Palliative care | Skin tumours | |
Primitive skin tumours are very frequent particularly among elderly patients.
Patients in palliative care for other cancers may suffer from skin tumours, for instance basal cell carcinoma or squamous cell carcinoma. These cancers should always be treated (local exeresis, superficial radiotherapy) in order to avoid in-depth disease progression which may provoke pain and local infectious complications.
Kaposi's sarcoma is a multifocal skin cancer associated with immunodepression, for instance during AIDS. Superficial radiotherapy or chemotherapy by chlorambucil are most useful.
Skin T lymphoma or fungoid mycosis are lymphomas strictly limited to the skin during a number of years and only become generalised lymphomas during the terminal phase. Many such patients are elderly and light treatment should be performed such as skin irradiation or photochemotherapy (PUVA). Pruritus is the major symptom of this rare disease.
Skin angiosarcomas are rare, and most frequently observed on the face, occasionally in an irradiated zone. Surgical exeresis is difficult and the tumour therefore progresses locally. Radiotherapy and chemotherapy are disappointing, but paclitaxel might be efficient in secondary tumours.
They are relatively frequent for some locations:
- Breast carcinoma: primitive or secondary location,
- Ovarian carcinoma: umbilical lesion called 'Sister Mary' metastasis,
- Head and neck cancers: particularly node infiltration,
- A variety of other tumours: kidney, endometrium, and so on.
Most often, these skin metastases may necessitate local treatment, if only to ameliorate hideous local neoplastic progression, a very depressing condition for the patient, as well as frequent concomitant infectious problems.
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