How freedom of movement influenced the growth of skin cancer diseases, who spoils the statistics on syphilis in Moscow, and why the world has not learned how to treat psoriasis - the chief dermatovenerologist and cosmetologist of the Ministry of Health of Russia and the Department of Health of the city of Moscow, director of the Moscow Center of Dermatovenerology told Profil about all this and cosmetology, doctor of medical sciences, professor Nikolay Potekaev.
- Nikolai Nikolaevich, let's start the conversation with the most pressing question, given the current hot summer: how much can the sun's rays harm the skin?
- The question is really topical. The sun's rays are unambiguously harmful to the skin if sunburned excessively. The result of their impact can be divided into two types: the nearest one - when a person has been in the sun in the active phase for several hours and a burn occurs in the form of redness or even blisters on the skin; and delayed - which appears after not even months, but years. These changes appear in people after 45-50 years. Then the person begins to pay attention to the appearance of neoplasms on the body. They can be benign or cancerous.
In addition to the early and delayed adverse effects of exposure to sunlight, there is a third, and more aesthetic side. Prolonged exposure to the sun leads to premature aging of the skin - the so-called photoaging. In people who often sunbathe, over time, small and sometimes large wrinkles appear, even in those places where there is no movement of facial muscles. Many probably met people with a face that looked like a baked apple or, as they said in Soviet times, with the neck of a collective farmer: as a result of constant work in the field in the sun and in a bent position, deep creases were formed on the face and neck of villagers. This is what skin elastosis looks like. Now it is called heroderma - when the skin looks old.
- The number of people with melanoma has been growing lately. Where do you see the reasons?
- There is such a thing as the accumulation of a genetic defect. There are cells in the body that produce melanin, and these sometimes turn into tumor cells. The development of tourism also played a role. In the 1990s, it became easier to go on vacation to countries with hot climates. The sun's rays there are much more active and intense than in Russia, and people go and sunbathe unprepared. Let me give you a concrete example from practice. A twenty-year-old girl from Russia worked as a diving instructor and animator in Egypt. Returning home, she came to our center for an examination, as she developed moles and large age spots (lentigo). We carried out the survey using the modern apparatus "Photofinder". This is an apparatus for assessing the condition of the skin and drawing up a skin passport. So, this young girl was diagnosed with a first stage melanoma, and if she had not come on time for an examination, the consequences could have been the most sad.
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Solarium is also one of the reasons for the development of melanoma. This is the same ultraviolet light, because the rays actively affect the skin so that it begins to produce pigment. Sunburn is a protective reaction of the body. Why does not the skin of the Negroid race get burned? And because they have a lot of melanin in their bodies and, accordingly, they have a strong natural protective screen, unlike people with fair skin. A third cause of melanoma is moles (nevi), which can develop into melanoma. But not all, of course. And fourth, melanoma can be spontaneous, when melanoma suddenly appears on apparently healthy skin without any nevi.
- What is a skin passport?
- With the help of the mentioned apparatus, a skin map is created. An overview picture is taken from 4 positions, and each element is entered into the passport, and moreover, each mole has its own number. If there are no malignant neoplasms, but moles are detected that need to be monitored, and for preventive purposes the patient does not want to remove them, a year later the doctor takes a new picture and compares it with the previous one. There are patients who have hundreds of moles on their skin, and, of course, the doctor will not be able to diagnose everything. Thanks to the skin passport, it is almost impossible to miss a dangerous neoplasm.
- How are the stages of skin cancer development?
- The first and second stages of melanoma are only superficial manifestations on the skin, the third - when there are already metastases in the lymph nodes. Fourth - when metastases can already be anywhere. Starting from the brain, liver and ending with bones.
- Has the detection rate of melanoma increased due to clinical examination?
Since this year, dermatologists have been taking part in the prophylactic medical examination of the population.
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- Earlier, dermatologists did not take part in medical examination. It was an independent service, and we were contacted for preventive and medical examinations. But last year Tatyana Alekseevna Golikova instructed the Russian Ministry of Health to involve dermatologists in routine examination of the population.
As a freelance specialist dermatovenerologist and cosmetologist of the Ministry of Health of Russia, I was instructed to work out the issue of training therapists in our methods of detecting melanoma. Together with the chief physician of the Ministry of Health of Russia Oksana Mikhailovna Drapkina, changes were prepared in the order of medical examination. Since this year, dermatologists have already taken part in it. For therapists, we have developed educational modules that are posted on the portal of continuing medical and pharmaceutical education, doctors can enter their personal account, select and study the training program for the early detection of malignant neoplasms.
Now the state pays great attention to the problems of oncology. The incidence of skin cancer ranks first among all cancers in people over 60 years of age. In men under sixty years of age, prostate cancer is in first place, bronchopulmonary system is in second, and skin disease is in third. But in women, breast cancer is in the first place, and in the second - skin.
- World Melanoma Diagnostic Day is held annually in May. How is this day held in Russia, and what is the main purpose of this event?
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- We have been spending this day in Russia since 2007. The promotion takes place every third Monday in May in all European countries. In our country, 120 cities take part in it. On this day, state and many private clinics examine patients. Free, of course. In total, more than 1,300 dermatovenerologists take part in this large-scale action in one day. Prior to that, a hotline operates on the website melanomaday.ru, where people can make an appointment at the nearest clinic for examination. During the existence of the project in Russia, more than 100,000 people were examined, and 1,700 of them were suspected of having melanoma. Timely diagnosis helped save the lives of these people.
- Tell us more about the program for early detection of melanoma
- A year ago, we made a decision that it is necessary to introduce new organizational models for the detection of melanoma. That is, to build a specific route to improve the quality of diagnosis and expert opinion for each patient. Our center has 16 branches, and there is a head expert building, where the Center for non-invasive skin diagnostics is located. It employs specialists who have undergone international training in dermatoscopy, diagnostics of malignant neoplasms. The center employs 23 doctors of medical sciences, 80 candidates of medical sciences, and in total we have 1840 people on our staff, of which more than 500 dermatovenerologists and about 100 doctors of related specialties and laboratory assistants, plus also middle and junior medical personnel.
We decided to open a special room in each of our branches, in which dermatovenerologists trained in the early detection and diagnosis of malignant neoplasms work. These doctors know skin oncology better than ordinary dermatovenerologists. The system of work is as follows: patients come for examination in these rooms, they are examined by a specialist, and if any questions arise, the doctor can remotely contact the doctors at the head center, if necessary, the patient is referred to us, and here he is examined by experts. If a malignant neoplasm is confirmed, it is referred to an oncologist, if a dysplastic nevus, dynamic observation or prophylactic removal is offered.
- Is it on a paid basis or on compulsory medical insurance?
- All this is carried out under the compulsory medical insurance.
- How do you assess the results of this program?
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- Over a year, more than a hundred thousand patients passed through these rooms. Of these, about five thousand were sent to our head center for expert opinion, of which more than two thousand people had malignant neoplasms and four hundred were with melanoma. And these are the figures only from our center, and there are also departmental dermatologists, private clinics, federal medical institutions. That is, unfortunately, the prevalence of malignant neoplasms is high. I recently proposed a model, and I hope that it will be approved by the Ministry of Health of the Russian Federation, on the creation of the same system in all constituent entities of the Russian Federation, where the head will be the regional dermatovenous dispensary, and all other offices or dispensaries located in the region, if necessary, will send patients there. … And if the leading dispensaries in the regions have questions, we are ready to help and give expert opinions. We really want to improve the early diagnosis of melanoma, plus, as I said earlier, we involve therapists.
- What is the current situation with the incidence of syphilis in Russia? As far as we know, in the 90s we had an outbreak of the disease.
- Until 1998, there was a difficult epidemic situation for syphilis. We still have echoes of the 1990s. In those years, many offices worked, and just doctors, licensed and unlicensed, treated syphilis in their apartments. Moreover, it is far from always correct. There is a durant drug that can be injected, and the next one - only after a week, and such procedures require only one to three. But one must understand that not all types of syphilis can be treated with this simplified treatment. Unfortunately, after some would-be doctors, some of the people found themselves in a situation where the treatment seemed to be carried out according to the scheme, but not in accordance with their form of the disease. Thus, now we are meeting with the presence of late forms, for example, neurosyphilis, when the central nervous system is affected, which can lead to serious consequences. Such patients, of course, are few, but nevertheless they are. We are seriously dealing with this problem. At the moment, we are conducting scientific work. For neurosyphilis, for visceral syphilis, in particular, for cardiosphilis, these are also late forms.
- To date, what percentage of patients with syphilis is detected?
- Due to the fact that in 2015 we became an authorized organization for the examination of foreign citizens who want to obtain a patent for work in Moscow, the detection rate of syphilis has become higher. So, when, until 2015, commercial clinics were engaged in the examination and issuance of a medical opinion, only a minimal part of syphilis diagnoses was recorded in foreign citizens who applied for a medical opinion, the vast majority of diagnoses - respectively from Muscovites. But as soon as commercial structures were banned from issuing opinions and transferred these powers to state budgetary institutions in Moscow, in 2016, out of 100% of syphilis diagnoses, almost half were in migrants. What conclusion can be drawn? That some private medical institutions were not able to make a diagnosis or simply sold medical reports. Now imagine how many patients were among the residents of Moscow! The Moscow government decree radically changed the situation with regard to migrants. After all, people who come to work with us, it is not clear where they were examined and may not even know that they are sick, and they need medical help.
- That is, you think that this is undetectability of diseases, and not an increase in the number of cases?
- I am absolutely sure that this is not an increase in the number of cases. New organizational management models have been introduced in the country, which make it possible to efficiently and smoothly carry out work on the detection of diseases.
- One of the causes of psoriasis is stress. It turns out that after the end of the coronavirus pandemic, can we expect an increase in the number of exacerbations and new diagnoses of this disease?
- You are right that psoriasis is a "stressful" disease, although it is hereditary. Moreover, it can manifest itself in a generation, and sometimes in two. 3% of the world's population suffers from psoriasis. Stress provokes this disease, or rather, its way out. The second factor affecting the severity of the course of psoriasis is alcohol. As for exacerbations of psoriasis after a pandemic, it is impossible to say unequivocally. For some, self-isolation is stress, for others it is relaxation. I will not guess, let's look at the statistics next year. At the moment, I have not noticed a sharp jump in exacerbations of the disease.
- A lot of people are diagnosed with psoriasis. Medicines for a complete cure for this disease have not yet been invented.
- Even John Rockefeller promised a special prize to the one who invents such a medicine, but it has not yet been found. Unfortunately, there are no drugs that cure psoriasis, but there are those that allow you to prolong remission for a long period, which makes the patient's life much easier. Now there is a boom in the creation of genetically engineered drugs - the so-called biologically active therapy. It is enough to make an injection with such a drug, and the skin is cleansed, but once starting to use these drugs, the patient will already have to use them for life. To some of these drugs, resistance arises, and the person is forced to switch to another drug. This can happen in a year, in ten years - depending on the individual characteristics of the organism.
