Spinalioma

What is a spinalioma?

A spinalioma is a malignant skin change in the spiny cells (stratum spinosum) of the epidermis (epidermis). The epidermis serves as the outermost layer like a protective cover for the organism. It ensures that pathogens are kept out, it protects against moisture, cold and pressure and against UV rays. The epidermis consists of several layers and closes to the outside with the horny layer. Cell renewal takes place in the thickest layer of the epidermis, the prickle cell layer. The new cells that develop here migrate upwards to the horny layer over the course of a month, where they die and are then sloughed off. The cells of the spiny cell layer are very sensitive to UV rays. To protect themselves, they produce melanin, a brown-black pigment that can intercept ultraviolet rays – visually this appears to us as a tan. However, this protective mechanism can only work to a limited extent. If the skin is exposed to too much sunlight, the cell nuclei suffer and degenerate.

Experts refer to squamous epithelial tissue as cells that are closely connected to each other and form a protective layer. The epidermis is made up of several layers of keratinizing squamous epithelium. This is why spinalioma is also called squamous cell carcinoma. Squamous cell carcinomas usually occur where the skin is most frequently exposed to the sun, but they can also develop in completely different parts of the body.

Squamous cell carcinoma usually develops from a skin growth (actinic keratosis), which is also referred to as a precursor (precancerous lesion) to white skin cancer. Both spinalioma and actinic keratosis develop when cell division is disturbed. Too much ultraviolet light and especially repeated sunburns promote this loss of control. The transition from pre-damage to cancer takes place slowly and often goes unnoticed.

Spinalioma: causes and risk factors

Excessive exposure to the sun over long periods of time is the main cause of spinalioma. The risk of developing the disease increases with age.

All people who have been exposed to intensive sunlight for many years – at work or in their leisure time – have an increased risk of developing actinic keratosis and subsequently prickle cell carcinoma. Particularly at risk are sun-sensitive people with fair skin, blond or red hair and blue, green or gray eyes, and people whose immune system is weakened due to illness or medication. The transition from damaged cells to tumor development goes unnoticed. Causes of spinaliomas are

• long-term sun damage
• Actinic keratosis (precancerous lesion)
• Light skin types
• Outdoor occupations (occupational disease)
• certain skin diseases (Bowen’s disease)
• Chronic wounds or scars
• X-ray radiation
• Carcinogenic substances (arsenic, tar products)
• cancer-causing viruses (HPV)

Spinaliomas on the genitals can be caused by chronic inflammation or changes to the mucous membrane. A link is also seen between smoking a pipe and lip carcinoma. People with organ transplants, an HIV infection or a poor immune system also have a greater risk of developing this white skin cancer.

Symptoms: Spinalioma

Squamous cell carcinoma develops on sun-exposed areas of the body, usually the face, neck, ears or back of the hands. Spinalioma initially appears as a scaly, slightly crusty skin change or as a coarse small nodule. Calluses can form, which are difficult to remove, and the skin underneath can bleed easily. If you notice changes on your skin such as

• scaly, reddened areas of skin,
• scabby, crusty sores,
• hardened, keratinized nodules and
• non-healing skin areas,

then you should consult a doctor. The type of skin change you have can therefore be diagnosed. An untreated squamous cell carcinoma grows into the surrounding tissue and spreads laterally and in depth over time. There is a risk of metastasis, which means that the skin cancer can spread and grow in other parts of the body.

Spinalioma – Diagnosis at the USZ

We can usually recognize whether it is a spinalioma by the type of skin changes. We will talk to you about your sun habits, skin diseases and family history. We will use a reflected light microscope or dermatoscope to examine the affected areas of skin more closely. A tissue sample (biopsy) can clearly clarify the suspicion of squamous cell carcinoma. If the tumor is larger than two millimeters, the surrounding lymph nodes are also examined as a precaution. In some cases, an imaging examination of the lungs may also be necessary to rule out metastases.

Spinalioma – Self-examination

If you spend a lot of time in the sun, you should get into the habit of regularly examining your skin yourself. This mainly concerns the areas that are exposed to the sun (often unprotected):

• Auricles and head
• Forehead, upper cheek area, lips
• Décolleté, neck and nape
• Forearms, back of hands

You can already notice small changes by stroking the skin areas with your hand. You should seek medical advice if these signs persist over a period of time or change and increase in size:

• Rough patches that do not disappear despite applying cream
• small, skin-colored nodules
• reddish, scaly patches
• crusty areas with adherent cornifications

Spinalioma: Prevention

The best prevention strategy for white skin cancer is conscious and measured exposure to the sun. If you are a fair skin type with blue or green eyes and blonde to light brown hair, you should be particularly careful in the sun. Sensible protective measures are:

• Sun cream with a high sun protection factor
• Protective stick for the lips
• Long-sleeved clothing if possible
• Sun hat or cap for head (and bald head)
• Prefer shade
• No blazing midday sun

The number of cases of skin cancer has been rising in recent years and Switzerland unfortunately ranks high in the statistics. You should therefore take advantage of skin screenings and preventive examinations. During the examinations, the entire skin is examined and the mucous membranes are also checked. The examination is not very time-consuming and completely painless. The earlier malignant changes are detected, the better you can be helped.

Spinalioma – course and prognosis

Squamous cell carcinomas that are smaller than two centimeters usually do not form metastases in the body. If spinalioma is detected early, the prognosis improves considerably. After successful treatment, regular follow-up checks are necessary, as spinal tumors can recur even after treatment. It therefore remains important that you dose and control your sun consumption, ensure you have adequate protection and regularly examine your skin yourself.

Spinalioma: Treatment

The best treatment for spinalioma is surgical removal of the malignant skin lesion. Excision with subsequent histologic examination of the cells is considered standard therapy. The tumor is removed from the healthy tissue with a certain safety margin in order to remove as many altered cells as possible. This method reaches its limits with spinaliomas that have already spread further.