Malignant melanoma (melanoma malignum)
Malignant melanoma is a cancer that develops from the epidermal pigment cells. It can develop de novo (from the beginning from a single pigment cell), on the basis of dysplastic skin changes or birthmarks. It can be found all over the skin and in all different organs. It is a potentially lethal tumor, because it is characterized by a high inclination to distant metastases. Chances of survival depend on the early diagnosis of cancer directly: a shallow infiltrating lesion limited only to the epidermis and superficial layers of the skin does not pose a serious threat. This does not mean, however, that it can be ignored.
The treatment is mainly surgical excision of lesions with a margin of 1-2 cm of healthy skin.
On the basis of the research, doctors specified certain types of behavior, the innate qualities and acquired characteristics conducive for the development of melanoma.
- intense tanning, which cause the sunburn with blistering
- dysplastic syndrome (congenital disease characterized by the presence of a large number of atypical features on the skin, >50)
- immunosuppressive treatment e
- too frequent exercise of solarium
- familial occurrence (mainly melanoma in a first-degree relative)
- migration of Caucasian race, towards the equator
- working at the open air (especially before the age of 20)
- people with fair complexion with blue eyes and blond or red hair, numerous freckles,
- tendency to sunburn,
- people with a history of melanoma or other skin cancer;
The occurrence of several factors at once, increases the risk of developing malenoma, although it may be developed with with anyone.
OPRICE znamion The assessment of melanomas can develop on the basis of pigmentary dyes, which we have a lot, on the skin. Only the histopathological examination can clearly distinguish the usual harmless mark from the melanoma. The doctor, following the certain criteria and watching a suspicious change, may initially decide on further treatment.
There are the criteria:
A (aasymmetry) – asymmetry of change
B (border) - irregularity of the edges
C (color) - color variation from black to light brown
D (diameter) – large size over 6mm.
It should also pay attention to the hue of the change over the skin, and the speed of the growth. These criteria concerns to the basic melanoma’s variety. Unfortunately, it can take many different forms and “become similar” to other changes – seborrhoeic warts, freckles, etc.
Any change that raises our doubts should be examined by a doctor.
What should our attention be drawn to?
- the appearance of a rapidly growing sign with features, that clearly distinguish it from other skin’s changes
- irregular and asymmetrical shape
- color changes, uneven distribution of dye size over 0.5cm
- small infiltration of the base, inflammatory rim
- bleeding that appears without prior injury
|shape||round or oval||irregular|
|edge||equal, clearly demarcated||irregular|
|color||plain, consistent||patchy with different shades|
|size||up to 0.5cm||over 0.5cm|
Prophylaxis and prevention – autoexamination
Routine self-examination allows you to easily detect the presence of suspicious changes on the skin, the appearance of changes in their structure or enlargement. The test should be carried out exactly three to four times a year. It is recommended to pay special attention to the skin:
- face (also ears)
- scalp skin
- hands, including nail
- elbows, arms and armpits
- chest and abdomen
- back, neck and buttocks
- feet, especially soles
It there is a change, corresponding to the above-described criteria or appearance of changes in the aspect of existing features – you should ask your doctor for medical attention- health-related behavior.
Many factors favoring the development of melanoma are impossible to modify (hair color, presence of birthmarks and freckles). Modification of other-ones is difficult (place and manner of work performed, place of residence). However, the factor, that we can easily control is the intensity of exposure to sunlight. The employing of creams with an UV filter, protective clothing, reduction of intensity and duration of tanning, significantly reduce the risk of melanoma.
Treatment of cutaneous melanoma
The primary treatment, that has been shown to be unambiguous is surgical excision of melanoma. In the case of suspected melanoma, a notch with at least 5mm margin of healthy skin, should be made, depending on the location. Detection of melanoma infiltrating the skin requires a rmrgin of at least 1cm. The change removed by the dermatologist is passed to the histopathological examination.
The degree of the advancement of melanoma is given on the basis of the assessment of the depth of infiltration of the skin in Clark’s five-degree scale (involvement of individual layers of epidermis, dermis and subcutaneous tissue) and/or a 4-point Breslow’s scale (thickness of tissue, count in mm.) A patient with diagnosed melanoma is always referred for further treatment to oncologists. Then, diagnostics are extended to a biopsy with a histopathological examination of the sentinel node. It is the first lymph node in the way of lymph vessels, running from the melanoma. The lack of metastases in the sentinel node should exclude the presence of metastases in other nodes and organs. In the case of metastases to the sentinel node, it is necessary to dissect all regional lymph nodes. If regional nodes are enlarged, it is necessary to remove them without the first trying of find the location of the sentinel node. In addition, 20 Kz ultrasound, digital tomography and magnetic resonance are used in the diagnosis of melanoma. In the case of advanced changes and the existence of metastases, complementary treatment is used: radiotherapy, chemotherapy, immunotherapy and immune-chemotherapy. “Melanoma” vaccines are also being tried.
Chances of survival depend on the early detection of cancer. Melanoma, which does not infiltrate the skin, does not pose a serious threat to life. If you are worried about changes on the skin, report to the doctor!!!