What is melanoma?
Melanomais a malignant tumor of melanocytes that undergoes malignant transformation mainly in the skin but also in other places where melanocytes are located (in the intestine, eye, mucous membranes of the respiratory and digestive systems, meninges, eye, and even in the lymph nodes).
Is it a common skin tumor?
It is a rare type of skin tumor but is one of the most malignant skin tumors and is responsible for the largest number of skin-related deaths (80%). It occurs due to the inability to control the spread of pigment.
Melanoma typically looks like a pigmented skin lesion, black or dark brown in color, with irregular asymmetrical edges, larger than 6 mm in diameter. It is typical for him to grow constantly. There are two types of growth: radial growth (horizontal, surface expansion) and vertical growth (according to depth and height). For many years, melanoma grows in width (the so-called horizontal growth phase) and does not penetrate deeply. Only when it reaches a certain size of about 2-3 cm in diameter, it begins to grow towards the depth (the so-called vertical growth phase) where there is a risk of metastasis.
Where does it most often occur?
According to the World Health Organization, it very often occurs at the site of a mole. Malignant transformation is more common in dysplastic than nondysplastic moles, in congenital than acquired, in large than small.
Melanoma has been on a significant rise lately?
Yes. Recently, the incidence and mortality rates have been increasing significantly worldwide. The number of new patients doubles every eight to ten years in most European countries, so the rate of increase in incidence is higher than in any other type of cancer.
How many people in Croatia have melanoma?
According to the Cancer Registry, about 580 people in Croatia get melanoma every year,
Is the cause of melanoma known?
The real cause is still unknown.
In which parts of the world is melanoma present and who suffers from it?
Epidemiological studies show that it occurs more often in people with fair skin, blonde hair and eyes, and in those who have a large number of pigmented skin changes on the body. According to many authors, sunlight plays an important role in its formation. It is most common in countries near the equator (Australia and Israel have the highest incidence of the disease in the world around 40 cases per 100,000 people).
Melanoma most commonly occurs between the ages of twenty and sixty and is virtually equally represented in both sexes. It is more common in women on the limbs and in men on the trunk, but it should not be forgotten that malignant melanoma can also occur under the nail, between the fingers and in the scalp.
Is it a tumor that metastasizes?
Yes. If it metastasizes, melanoma behaves like all other malignant tumors. It first metastasizes through the lymph and only then through the blood. The most commonly affected distant organs are the lungs, liver and bones.
How are they shared?
The most commonly used division by histological type:
- superficial spreading melanoma (SSM)
- Nodular melanoma
- Acral lentiginous melanoma
- Lentigo malignant melanoma
Superficially spreading melanoma
It makes up about 70 percent of all melanoma, and is mostly caused by an existing mole. It is most common on the legs in women and the back in men. In the radial phase of growth, it looks like a slightly raised plaque larger than one centimeter in diameter, with irregular edges and uneven pigmentation. In the vertical phase of growth it looks like a papule or nodule, dark blue, blue-black or pink.
Modular melanoma
It is a tumor that has only a vertical growth phase – it grows in the form of polyps or nodules and is often ulcerated. Rarely, it arises from an existing mole. It is more aggressive than superficially spreading melanoma, and is most commonly localized on the trunk, head, and neck
Lentigo malignant melanoma
It usually starts as a brown spot, and its color can vary from yellow-brown to black. It has a better prognosis and mainly appears in places exposed to the sun, especially on the cheeks, most often in the seventh decade.
Acral lentigo melanoma
In the radial phase of growth it is distinctly black, and in the vertical it is dark blue, black or amelanotic. Ulcerations are common. It makes up about five percent of melanoma in whites, and in colored it is the most common type of melanoma. It usually appears in the elderly on the palms, soles, leaves and under the nails.
When can we suspect that a mole is turning into melanoma?
To prevent or detect melanoma (and increased survival rate) it is advisable to learn what it looks like.
Melanoma shows an irregular edge and color over 6 mm in size and asymmetry (A, B, C, D). One should be careful with each mole while controlling the change in edge, size, color of the itch or bleeding and show all suspicious moles to the doctor.
A popular method for remembering the signs and symptoms of melanoma is the mnemonic “ABCDE”.
- Asymmetrical skin lesion – asymmetric skin lesions
- Border – the edge of the lesion is irregular
- Color- melanoma usually has multiple colors
- Diameter – moles larger than 6 mm suspected of melanoma
- Evolution – Evolution is a change in a mole or its damage can be a sign that the mole has become malignant
- Elevation – The mole grows or elevates above the skin.
People with a family history of cutaneous melanoma or dysplastic nevus syndrome should visit a dermatologist at least once a year and check all moles.
What are the warning signs?
Characteristics that raise suspicion of melanoma or melanomatous transformation of the nevus are:
- Whether an existing mole grows or a new one appears (melanomas are constantly growing)
- Does the mole have an irregular or indented edge (moles have regular edges)
- Does it change color from brown to black, navy blue or red (melanomas change color)
- Is the mole uneven pigmentation (melanomas can have several colors within one mole)
- If the mole exceeds the size of 0.6 cm (most benign moles are smaller)
- Is the mole inflamed or red-edged (normal mole is not inflamed)
- Has the mole started to rise (in melanoma there is vertical growth)
- Is there bleeding, wetting, or crusting
- Is there a mild itching of the mole
- Did a lump appear around the mole?
The more of the listed characteristics we find in a certain patient, the higher the suspicion of the development of malignant melanoma.
When is the treatment most effective?
Early detection of melanoma is key to successful treatment. After the diagnosis is made, surgical treatment – surgical removal of melanoma – comes into consideration.
What to do when metastases occur?
Chemotherapy and radiotherapy are therapy of choice in advanced stages. Genetic therapy is still being investigated, that is. genetic modification of tumor cells.
Does a mole injury cause melanoma?
Until much was known about the disease, the first stage would often be neglected and patients would only see a doctor when a black nodule or bleeding occurred. Because advanced tumors can cause bleeding after only minimal injury, patients would associate the diagnosed disease with a mole injury, so there is often a history of injury. Today,mole injury has been ruled out as a possible cause of melanoma.
Is increased UV radiation due to the loss of the ozone layer the main cause of increased melanoma?
There is no evidence to support a generally accepted view that the rise is malignant melanoma in recent years associated with ozone depletion. An article published in the British Journal of Cancer shows that the prevalence of malignant melanoma in Norway since 1957. – 1984. increased by 350 percent in men and 440 percent in women. During this period, there were no changes in the ozone layer over Norway, nor significant changes in annual exposure to UV rays originating from the sun.
Can fluorescent light cause melanoma?
A study published in the prestigious medical journal The Lancet states that fluorescent light can even and before cause the development of melanoma rather than sunlight. The results of a study conducted in the Lancet on a sample of nearly 900 women suggest that women who work indoors under fluorescent light have a 2.1-fold higher risk of developing melanoma.
Why can fluorescent light cause melanoma?
Dr. Ott found that the cathodes located at the ends of the light tubes emit X-rays and electromagnetic rays.
Do you then usetanning beds or use them?
The WHO has recommended that people under the age of 18 be banned from using tanning beds, precisely because of the alarming data on the increased incidence of malignant melanoma. The solarium emits a large amount of energy in a short period of time, which corresponds to 5 times more energy that the sun emits in the middle of summer at noon.
What is the relationship between taking hormonal contraceptives and the risk of developing melanoma?
The incidence of melanoma has risen sharply among women in America, Australia and Europe, in the countries where the pill is most used. In a study from Walnut Creek, California, most women with developed melanoma before the age of forty used birth control pills. Until 1981. the global increase in melanoma risk for pill users was statistically more important by three times. Furthermore, like breast cancer cells, these tumors also have estrogen receptors, so women on HRT are more prone to developing melanoma than those who do not use this therapy.
Do distant metastases already exist at the time of diagnosis?
Although there is a fear of patients that there are already distant metastases at the time of diagnosis, this is fortunately very rare. According to the American Cancer Society, only four percent of patients have distant metastases at the time of diagnosis (e.g., in ovarian tumor malignancies, up to 60 percent of patients already have distant metastases at the time of diagnosis).
Can a biopsy lead to tumor disintegration?
It was thought that biopsy and topical application of anesthetics could lead to tumor disintegration. The opinion is based on the fact that in history such procedures have been performed in patients at a later stage of the disease in whom metastases already existed or occurred shortly after the procedure, and are associated with surgical intervention. On the contrary, numerous works have proven that the only good and right treatment for melanoma is surgical removal, ie. excision.
Do large scars appear when melanoma is removed?
This opinion dates back to a time when melanomas of different degrees of invasion were not known to behave differently. Today, melanomas are classified according to Clark (according to the depth of the layers of skin they affect) and according to Breslow (according to the thickness of the tumor expressed in millimeters). The former recommendation that the excision edge be five centimeters from the edge of the tumor has been changed, so the current view is that resection must be as many centimeters from the edge of the lesion as Clark or Breslow’s degree (eg grade II tumor – 2 cm resection). . In recent times, this distance is also decreasing.
What to do if a person has a very large number of moles on the body?
If a person has a large number of moles that have the potential for alteration in melanoma, then photodocumentation and control every 6-8 months is also recommended.
What is the forecast?
Melanoma is one of the tumors with the worst prognosis – practically without the possibility of cure.The prognosis of melanoma depends on various factors, the most important of which are:
1. growth phase
2. tumor thickness
3. depth of invasion into the skin, ie subcutaneous tissue.
Tumors in the radial phase do not have the ability to metastasize, and if they are completely removed, they do not return, ie. do not relapse.
Patients with metastases in regional lymph nodes have a five-year survival of only 30 percent, and patients with distant metastases five to 10 percent.
What are the chances of survival in metastases?
According to statistics from the American Cancer Society, melanoma is one of the tumors with the best prognosis in the United States. Five-year survival is 90 percent, and ten-year for in situ melanoma (without metastases) 100 percent, for melanoma up to 1.5 mm thick (there is a possibility of metastasis) 90 percent, for those 1.5 – 3 mm thick 75 percent, for those 3 – 4 mm 55 percent and 40 percent with tumor thickness greater than 4 mm.
How to prevent melanoma?
Minimal exposure to surface ultraviolet radiation from the sun and solarium, sun protection, wearing sun-protective clothing (long-sleeved shirt, long-legged jeans and a wide-brimmed hat) can provide protection. Use sunscreen with an SPF protection factor of 30 or more on exposed areas.
To prevent or detect melanoma (and increased survival rate) it is advisable to learn what it looks like.
Misconceptions in the people
The biggest misconception among our people is that moles should not be touched or surgically removed.
Quite the opposite: when the benign mole is removed and when the pathologist confirms by pathohistological (PH) analysis that it has been removed completely, all danger to the patient’s life ceases.
The most important thing to know is that malignant melanoma can be colorless and other suspicious signs must be taken into account.
Ante Perica, MD dermatovenerologist
