Melanoma is a malignant skin tumor consisting of melanocytes (melanin-producing pigment cells). The disease is characterized by an aggressive, unpredictable and changeable course.
Most often, melanoma is detected on the skin, less often - on the mucous membranes of different parts of the face and body. It is one of the most dangerous, life-threatening malignant tumors. Melanoma is prone to rapid progression and metastasis to many internal organs.
If it is not detected in a timely manner and an emergency removal is not carried out, it can be fatal to the patient.
What it is?
Translated from the ancient Greek term melanoma consists of 2 parts: melas - black, and oma - tumor. Melanoma is a formidable cancer of malignant nature, which develops against the background of irreversible degeneration of melanocytes and melanoblasts. Under the influence of these cells, melanin is synthesized, which is responsible for skin pigmentation.
Over the past decades, the incidence of melanoma has increased significantly. Doctors attribute this tendency to the intense effect of ultraviolet radiation on the skin and the increased demand for tanning - natural or artificial.
Causes of Melanoma
The main theory of development of this type of oncology is molecular genetic. According to her, normal cells undergo gene mutations caused by DNA damage. In parallel with this, the process of chromosome restructuring and violation of their integrity develops, which provokes a change in the DNA enzyme system. Subsequently, the cells acquire a tendency to tumor growth, uncontrolled reproduction and rapid metastasis.
The following factors can trigger a chain of pathological reactions:
- Exposure to UV radiation. This applies to both the sun's rays and artificial sources of ultraviolet - tanning beds, germicidal lamps, etc. It is therefore important to observe the safety rules when lighting or using a UV lamp. This applies not only to those areas of the skin that are exposed to radiation, but also to the protected areas of the epidermis. This results from the fact that the ultraviolet influences not only directly on the skin, but also on the whole organism. Also important is not the duration of exposure, but the degree of severity. Sunburn received in childhood can be a trigger for the development of melanoma in adulthood or advanced age.
- Electromagnetic radiation. Cases of melanoma are often recorded in people whose professional activities are related to tele-radio communications or television equipment.
- Mechanical damage to moles. Moles themselves are benign skin neoplasms. But under the influence of certain factors (the same UV exposure or frequent injury), they can ozlokachestvlyatsya, degenerating into melanoma. This factor in 35-80% of patients caused the formation of melanoma.
- Phenotype. Blond and fair-skinned people with blue eyes are considered to be at risk of developing malignant skin tumors.
- Unfavorable heredity. In people whose close relatives have had similar malignant diseases, their tendency to them increases significantly. Therefore, these patients should be more serious and careful about the health of the skin, and seek medical help if suspicious skin growths appear.
- Previously transferred melanoma. In this case, the risk of recurrence of the disease increases.
- A large number of moles on the body. Having a person more than 50 nevi on the skin increases the likelihood of their transformation into melanoma.
- Old age is another factor predisposing to the formation of melanoma. In persons older than 50 years of age, nevi are more malignant than in young people.
- Chemical exposure. Melanoma is not uncommon with pharmacists, chemists, coal industry workers, etc. These people need regular check-ups with an oncologist.
- Pregnancy. During the gestation period, the female body undergoes serious hormonal changes. Under their influence, nevi available on the skin can turn into melanoma. First of all, this risk is observed in pregnant patients over 31 years of age, as well as with large fetuses.
- Endocrine disorders. Melanoma can develop against the background of serious hormonal disorders in the human body.
- Improper nutrition. The predominance of food of animal origin over vegetable triggers the development of hypo-or avitaminosis. A lack of nutrients in the body can cause not only melanoma, but also other oncological diseases.
- Dubreus melanosis or pigment xeroderma predispose to the formation of melanoma.
- Gender affiliation. In men, the probability of developing melanoma is higher, which is associated with the peculiarities of hormonal levels. In this case, the disease is carried by them much harder than women.
- Immunodeficiency state in which immune cells cannot recognize and attack atypical structures.
The incidence of melanoma is almost the same among fair-haired and dark-haired people. 0.5% of Europeans, 0.1% of Africans and 2% of representatives of the Caucasian nation suffer from pathology.
There are 4 types of melanoma, 3 of which are characterized by slow development and damage only to the surface layer of the skin. The fourth type of tumor is prone to rapid germination in and metastasis.
Superficial melanoma occurs in 70% of cases. Symptomatology in this case persists for a long period of time against the background of relatively benign growth in the outer layer of the skin. And only after a long time the growth can go deep into the underlying layers of the dermis.
The first sign of this type of melanoma is the formation of a flat spot with jagged, "torn" edges. The color of this growth changes, becoming brown, bluish, red, black, or even white. Neoplasms of this kind are usually formed at the site of moles.
Melanoma can form on any part of the skin, but more often it appears on the body in men, on the legs in women, or in the upper segment of the back in both sexes.
According to the mechanism of development, lentigo resembles superficial melanoma, since such a tumor also develops in the upper layers of the skin for a long time. In appearance, this growth is flat or slightly raised, unevenly pigmented area. Lentigo has a motley color with brown or close to black tint interspersing.
Such a tumor is most often diagnosed in elderly patients, and is localized on the skin of the face, ears, hands, and upper torso. It develops, as a rule, due to frequent exposure to ultraviolet radiation.
The vast majority of patients with skin tumors in the Hawaiian Islands suffer from this type of melanoma. If the neoplasm becomes invasive, the disease is called lentigo-melanoma.
Acral lentiginous melanoma
Before germination, such a neoplasm also develops superficially for a long time. This type of tumor is characterized by localization under the nail plates, on the skin of the palms or the feet.
Pathology progresses much faster than previous forms, and affects mostly dark-skinned people. Africans and Asians are most affected, while it is much less common in Europeans and Caucasians.
This is an invasive form of the disease. As a rule, even before it is detected, the tumor grows deep into the skin. Externally, the tumor looks like a bump.
Such a tumor is usually black, but it can also be:
Sometimes the skin color in the area of melanoma is unchanged. Such tumors are often located on the trunk and extremities. As a rule, they are detected in older people.
This type of melanoma is considered the most dangerous, aggressive. It is diagnosed in 10-15% of cases.
Symptoms of skin melanoma
Often it is not possible to independently determine the type of mole. However, it is possible to reveal signs of its malignancy - degeneration into a malignant tumor.
If this process was started, the specific symptoms of melanoma appear in the initial stage:
- itching in the mole area;
- hair loss on the pigmented area;
- changing the color of nevus;
- the appearance of moist areas on the growth;
- an increase in birthmarks;
- change in the shape of the tumor;
- the formation of torn edges in the area of growth;
- the appearance of blood on the surface of the nevus;
- knot formation.
Diagnosis of melanoma in oncodermatology is carried out according to the ABCDE scheme. It is based on the summation of all signs of skin cancer:
- A - asymmetry. Asymmetry is a characteristic of melanoma. If you draw a conditional line in the middle of the growth, it turns out that its halves are uneven, different.
- B - border irregularity. The edges of tumors are uneven, torn.
- C - color. The color of melanoma is not similar to the shades of healthy moles. A cancerous tumor may have blotches of a different color — blue, red, white, etc.
- D - diameter. If the tumor has a size of more than 6 mm in diameter, it requires increased attention to itself.
- E - evolution. Reborn in melanoma, the mole changes its structure. It becomes denser and larger.
Despite these signs of melanoma, only additional diagnostic manipulations can confirm the malignant nature of skin growth.
Stages of melanoma
The disease develops in several stages. There are several classifications of melanoma - they depend on the country or region of the patient. But there is a common gradation of the disease - international, and it is used by experts around the world:
|T - the degree of invasion (germination) of melanoma into the depths, the thickness of the melanoma itself is also taken into account||T1||melanoma is less than one millimeter thick|
|T2||one to two millimeters thick melanoma|
|T3||melanoma thickness of two to four millimeters|
|T4||melanoma thickness more than four millimeters|
|N - lymph nodes||N1||one lymph node is affected|
|N2||two to three lymph nodes affected|
|N3||more than four lymph nodes are affected|
|M - localization of metastases||M1a||metastases in the skin, subcutaneous fat and lymph nodes|
|M1s||metastases in internal organs|
Melanoma in the initial stage
The initial stage of development of melanoma is also called zero. At this time, the tumor does not grow, looks like a black mole, and may have red blotches.
The size of the tumor at the first stage varies in the range of 1 - 2 mm. Metastases are absent. The thickness of melanoma is less than one and a half millimeters. According to the clinical classification of melanoma, the first stage of its development is local. It is typical for her:
- the presence of a single primary skin tumor;
- the presence of associated tumors localized within a radius of 5 cm from primary melanoma;
- the formation of metastases located at a distance of more than 5 cm from the tumor.
Second stage of melanoma
According to the international classification of TNM, the second stage of melanoma is accompanied by a thickening of the tumor up to 2 - 4 mm against the background of the absence of metastases in the lymph nodes or internal organs (melanoma of the category T3N0M0).
If the disease is classified according to the western scheme, the thickness of the skin tumor at the second stage of its development ranges from 1.5 to 4 mm. In this case, the tumor spreads to the surface of the entire dermis, however, the subcutaneous fat layer is still not involved in the oncological process - just like lymph nodes.
In the clinical classification of melanomas in the second stage of progression, the disease affects regional (located in close proximity to the tumor) lymph nodes.
Gradation of melanoma of the third stage can be in the forms T4N0M0 or T1-3N1-2M0.
In the first case we are talking about melanoma, reaching 4 mm in size, but not having metastasis. The second option describes a malignant skin tumor, having a depth of 1 to 4 mm with a parallel lesion of 2 to 3 lymph nodes, but without the involvement of internal organs in the process.
Characteristic signs of melanoma 3 degrees of severity is considered to be:
- thickness over 4 mm;
- the defeat of a malignant neoplasm of the subcutaneous fat layer;
- the formation of concomitant (satellite, daughter) tumors at a distance of 2 to 3 cm from the main (primary) melanoma;
- spread of metastases to regional lymph nodes.
If we consider the clinical classification of melanoma, then the third stage of its development includes generalized lesion of internal organs.
What does the melanoma look like in the photo?
It is important to know what a malignant tumor of the skin looks like, as this will help in its prompt diagnosis. In the photo you can see what kind of melanoma has:
Diagnosis of Melanoma
Diagnosis of melanoma in the early stages of its development is difficult, due to the large variety of the clinical picture and the lack of specific symptoms characteristic specifically for this disease. But to suspect the transformation of a mole into a malignant tumor of the skin, nevertheless, you can do it yourself. To do this, you need to pay attention to the change in its color, shape, size, the appearance of suspicious inclusions on its surface. The appearance of an inflamed area around the growth, drops of blood on his body and weeping areas are disturbing signs that cannot be ignored. When they occur, you should immediately contact the oncologist-dermatologist.
To begin with, a visual inspection of the growth is carried out, during which its contour, density and displaceability relative to adjacent tissues are assessed. In parallel, the tissues surrounding the tumor are examined.
It is also important to study other areas of the skin to detect metastasis. Palpation of the regional lymph nodes is obligatory, since it allows to evaluate their condition, structure, albeit palpation.
If necessary, assigned radioisotope study. To conduct it, the patient takes a special radio preparation on an empty stomach, after which, with the help of radiometry, the specialist evaluates isotope accumulation in the neoplasm and in healthy areas of the skin.
Diagnosing melanoma never implies a biopsy! Such a procedure may aggravate the course of pathology, triggering active tumor growth.
A preliminary diagnosis is made on the basis of the results of cytology, which is carried out on the basis of the detection of atypical melanocytes in a smear imprint taken from the surface of the tumor. But the final confirmation of the presence of melanoma is possible only according to histology, performed after removal of the neoplasm.
Treatment of melanoma can be surgical or instrumental, hardware. The choice of a particular technique depends on the stage of development of the disease and the characteristics of the tumor.
The choice of treatment depending on the stage of melanoma:
|Initial Stage (0)||It involves excision of the tumor with the capture of up to one centimeter of healthy tissue. Further, it is recommended only observation by an oncologist in dynamics.|
|Stage I||Initially, a biopsy is performed, followed by excision of the tumor. In this case, the capture of healthy tissue is already 2 centimeters. If there are metastases in the lymph nodes, then they are removed.|
|Stage II||Surgical treatment and chemotherapy are used. Initially, a study is conducted on the defeat of lymph nodes by metastases. Next is a widespread excision of melanoma (grabbing healthy tissue by more than 2 centimeters), followed by removal of the lymph nodes. At the same time, the removal of melanoma and lymph nodes can be carried out in one or in two stages. Chemotherapy follows after removal.|
|Stage III||Chemotherapy, immunotherapy, excision of the tumor. There is also a widespread excision of melanoma, in which the capture of healthy tissue is carried out more than 3 centimeters. This is followed by regional lymphadenectomy - removal of lymph nodes located near the primary focus. Completion of chemotherapy treatment. For the resulting defect after removal of melanoma and nearby tissue, plastic is used.|
|Stage IV||There is no standard treatment. Radiation therapy and chemotherapy are used. Operational (surgical) treatment is rarely used.|
Indications for surgery
Surgery is the main treatment for melanoma. The earlier it is carried out, the more favorable the survival projections will be. The purpose of this treatment is to remove the growth of the growth with the capture of healthy skin. This approach helps in the future to prevent metastasis.
Usually at 1 - 2 stages of pathology, surgical intervention is the only method of therapy. But, nevertheless, patients with the second degree of melanoma are not always operated on - in most cases they are registered by the oncodermatologist, who monitors the dynamics of the course of the disease and periodically assesses the state of the regional lymph nodes.
Features of surgical treatment:
- the operation is carried out exclusively under general anesthesia, since local anesthesia may cause injury to the tumor with a needle, which may lead to the spread of cancer cells;
- healthy tissues remain maximally unaffected;
- melanoma itself is not affected - the incision is made with an indent of 8 cm from the tumor, on the legs or arms - 5 cm;
- contact of melanoma with healthy skin cells is excluded;
- during excision, neoplasms make the capture of healthy skin (this helps prevent the recurrence of the disease), subcutaneous tissue, ligaments, muscles;
- the operation is usually performed with a surgical or electric knife;
- before the manipulation of the skin make contours in the field of incision.
Cryotherapy with melanoma is not recommended, since it is impossible to accurately determine the depth of melanoma germination during freezing with liquid nitrogen. As a result, after the manipulation on the skin can remain cancer cells.
The boundaries of healthy tissue removal are regulated by WHO:
|Tumor thickness||The boundaries of the capture of healthy tissue|
|In the phase of radial growth||0.5-1.0 cm|
|0 to 1 mm||1-2 cm|
|2-4 mm||2 cm|
|More than 4 mm||2-3 cm (sometimes 4-5 cm)|
It is believed that when removing melanoma, there is no need to excise as much of the healthy tissue as possible. This does not affect patient survival, but such an approach may hinder the recovery process after manipulation. But in practice, this is not always an easy condition, so the decision is made individually in each case.
The volume of excised healthy tissue depends on the location of melanoma:
- on the fingers, hands, feet, the amputation of the fingers or a separate zone of the limb is performed;
- earlobe: it is possible to remove its third lower part;
- when a neoplasm is localized on the face, neck or head, with large melanomas, the growth and 2 cm of healthy tissues are removed, regardless of the thickness of the tumor.
Surgical removal of melanoma leads to scarring. But they can be removed with the help of autotransplantation, combination skin grafts and other procedures.
In case of melanoma, polychemotherapy may be prescribed, based on the use of several drugs at once. Usually, Bleomycin, Vincristine and Cisplatin are used for this purpose. The chemotherapy regimen depends on the type of melanoma.
Most often, treatment is carried out using:
- Roncoleukin in combination with Bleomycin and Vincristine. Drugs injected at 1.5 mg / day every other day. Conduct 6 courses of therapy with 4-week breaks.
- Roncoleukin in combination with Cisplatin and Reaferon. The drugs are injected in a milligram and a half intravenously every other day. Conduct 6 courses of therapy with 4-week breaks.
In disseminated forms of melanoma, the drug Mustophoran is effective. It has the ability to penetrate the BBB, which makes it possible to use it in metastasis of skin cancer to the brain. The drug can also be used in the combined treatment of melanoma with metastases to the lymph nodes and internal organs.
Prognosis - how much live after removal of skin cancer?
The main condition for achieving long-term remission of the disease is its early detection, as well as the knowledge and experience of the attending physician. At the same time, the awareness of the patient about the first signs of the manifestation of a malignant skin neoplasm is also important. People with precancerous conditions (nevi, melanoses) should regularly undergo prophylactic examination by a dermatologist or dermatologist-oncologist.
Projections for survival in melanoma are determined on the basis of:
- gender of the patient (for women, prognoses are more favorable);
- the location of the tumor and the depth of its germination in the skin tissue;
- the presence of metastases in other organs;
- presence or absence of genetic defects.
With the timely start of treatment of melanoma, patient survival is:
- at stage 1 of melanoma - 90%;
- at the second stage - 75%
- at the third stage in the presence of metastases - 45%
- at the fourth stage - no more than 10%.
In Australia, the incidence of melanoma is the highest. For this reason, a program has been introduced in general education schools in the country, according to which children study the characteristics of malignant tumors and the malignancy of moles. Thanks to this, practically every person, including a child, can suspect the degeneration of a nevus into cancer.
This program has helped improve the survival of melanoma patients for 5 years. Such results were achieved due to the fact that the patients themselves sought medical help for suspicious changes on the surface of moles.