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It is one of the most aggressive skin cancers, it affects people of all ages, and its incidence is constantly increasing. In Poland, about 4 of people hears the words: “it is HIM”. And although we know the “golden rules” of protection against melanoma, we still apply them too rarely …
It touches small and large …
Melanoma is a malignant neoplasm of the skin that originates from pigment cells – melanocytes. It most often appears on the skin – in women on the legs around the knees and below, in men on the chest, neck or head. It can also occur in the mouth, nose and eyeball (intraocular melanoma), rarely in the meninges, digestive system, lymph nodes or other areas where melanocytes are found.
The number of melanoma cases around the world is increasing every year – on the one hand, it is the result of increased and earlier detection. On the other hand, what experts pay attention to, intensive tanning and the use of solariums.
The most cases are in Australia and the United States. In Europe, the incidence of cutaneous melanoma is geographically declining towards the south due to the darker skin color of the Mediterranean. In Poland, melanomas are neoplasms with the highest growth rate of disease – the number of melanomas doubles every decade. The incidence of melanoma is also increasing among children and people under 20 years of age.
What is disturbing, the mortality from melanoma in our country is about 20 percent. higher than the average for the European Union. The main reason is the late detection and lack of awareness about the prevention of melanoma – out of approx. more than 4 patients annually suffer from advanced or disseminated cutaneous melanoma!
– Poles definitely too rarely visit dermatologists, surgeons-oncologists or oncologists to check the skin. Unfortunately, we do not have the same awareness as our western neighbors. In Germany, the detection of melanoma is 10 times higher than in our country, while the mortality rate is very similar. What it comes from? The Germans simply detect melanoma very early, when the patient has a very good prognosis. In Poland, although these cases are relatively few, the most common are melanomas diagnosed too late, to a high degree of advancement, when systemic treatment is required, and the patient’s prognosis is much worse – comments oncologist Magdalena Ciążyńska, MD, PhD.
The phototype matters
While the causes of melanoma development remain unclear, both genetic and environmental factors play a role. About 10 percent. melanomas run in families. For this reason, family members of the XNUMXst degree of melanoma patients should be under constant dermatoscopic monitoring.
– The main risk factor for developing melanoma is exposure to intense ultraviolet radiation. This is why people who spend a lot of time in the sun are at increased risk. The risk of developing melanoma also increases in patients who have suffered severe burns in childhood or adolescence, have had melanoma or other skin cancer in the past, or have a family history of melanoma or other skin cancers. We also know that although anyone can develop melanoma, people with fair skin, blond or red hair, blue eyes, numerous freckles, i.e. phototypes I and II, are particularly vulnerable. Given that we are a nation of predominantly phototype I or II, theoretically most of us have a high risk of developing skin cancer during our lifetime – explains Dr. Ciążyńska.
“Czerniakowe abecadło”
Melanoma can be a new birthmark on the skin, but it can also arise from an already existing healthy birthmark under the influence of the sun or UV light used in tanning salons. It is estimated that approx. 50 percent. melanomas develop in unchanged skin. The cancer most often takes the form of an irregular lump, spot or lump.
In the diagnosis of melanoma, the “melanoma alphabet” helps us to indicate the characteristics of the cancer. And so the letter A reminds us that it is asymmetrical – the birthmark spills over to one side. The letter B indicates jagged, uneven, and thickened edges. The letter C describes the color – black, red, non-uniform. The letter D corresponds to the size – especially changes with a diameter of more than 6 mm should arouse our concern. In turn, the letter E stands for “evolution”, that is, the progressive changes taking place in the birthmark.
While in the early form of melanoma the lesions are flat, in the advanced form they are often raised above the skin level, in some cases ulcerated, and blood-serous fluid may ooze from their surface. Usually, however, melanomas do not cause pain.
All moles, growths, moles that qualify for one of the ABCDE points should be examined by a dermatologist, surgeon-oncologist or oncologist.
Skin examination does not hurt!
Do not be afraid of dermoscopic (dermatoscopic) examination! It is non-invasive and completely painless, and allows you to detect malignant skin cancers at a very early stage. After collecting a medical interview, the dermatologist will examine the changes on our skin using a dermoscope, i.e. a device with magnification (usually 10x) and built-in lighting. Thanks to this, it is able to assess the nature of the edges, asymmetry, uniformity of color and surface shape.
A great facilitation in making an accurate diagnosis is videodermotoscopic examination, which enables the registration and analysis of the skin image on a digital medium, and thus monitoring the possible evolution of the skin lesion. It enables a diagnosis with high sensitivity and specificity, reduces the number of unnecessarily removed moles, and gives the doctor and the patient psychological comfort.
Early detection saves lives
Early skin melanoma is very easy to heal by simple surgical excision of the skin lesion along with a wide margin of surrounding tissue. In the case of larger melanomas with a thickness of more than 0,8 mm (deep into the skin) or less, but with ulceration on their surface, the lymph nodes closest to the tumor are biopsied. If there are neoplastic cells in the collected nodes, it is necessary to completely excise them and start systemic treatment of the melanoma.
– In fact, early detection of melanoma is almost 100 percent. curable. The problem begins when the melanoma metastasizes to the lymph nodes, and then to distant organs: liver, lungs, brain, bones. And so, in the case of confirmed presence of sentinel lymph node metastases, we can use adjuvant treatment aimed at reducing the risk of relapse in the form of local recurrence and / or distant metastases. Currently, in the drug program B.59, 3 complementary therapies are available for patients with melanoma: immunocompetent therapy in the form of pembrolizumab or nivolumab, and targeted therapy in the form of dabrafenib with trametinib, aimed at patients with confirmed BRAF mutation presence. Such treatment is used for up to 12 months and the final duration depends on its tolerability and effectiveness. Also in stage 4, i.e. when there are metastases to distant organs, we have a wide range of possibilities. Depending on the presence of the BRAF mutation, we can offer the patient either immunotherapy or therapy with BRAF and MEK inhibitors. So our capabilities are very similar to those of almost the entire world – explains Dr. Ciążyńska.
The prognosis of melanoma depends on the depth of infiltration and the degree of clinical advancement. In the early stages (thickness of infiltration up to 1 mm), the curability reaches 90-100%.
– Unfortunately, patients who develop lymph node metastases are less likely to be successful. The risk of relapse is as high as 60%. Nevertheless, thanks to new therapies: immunotherapy and molecularly targeted therapy, the prognosis of patients with advanced, metastatic melanoma is much better than before. Patients who respond to treatment often achieve long-term survival – adds the oncologist.
A few “golden rules” …
The risk of developing melanoma can be minimized by sunbathing with your head. A simple rule of thumb is: avoid the sun and protect your skin when your shadow is shorter than you, which is between 10.00am and 14.00pm. If we have to be outside, we should wear clothes with long sleeves and legs, and we should not forget to cover our heads.
When choosing cosmetics, you should check whether they provide protection against UVA and UVB radiation (at least 30 SPF). It is worth remembering that they only work for a certain time, so after a few hours or after leaving the water, you should re-lubricate all parts of the body exposed to sunlight.
You should also protect your eyes against harmful UV radiation. In this case, choosing the right sunglasses is key. The label should state that the lenses absorb at least 99% of the glass. UVA and UVB radiation.
One of the most important rules is to completely refrain from tanning in a solarium, which emits several times more ultraviolet radiation than the sun.. During one session, the skin receives a dose of UV radiation comparable to a full day of sunbathing in natural conditions. It is estimated that people using the solarium before 35 years of age the risk of melanoma is increased by 59%. and increases in proportion to the frequency of exposure. In women before the age of 30 who use tanning salons, the risk of melanoma is even six times higher.
Another element of prophylaxis is monthly self-examination, recommended especially for people with risk factors for developing melanoma. How to do it? After taking a bath, stand in front of a mirror in a well-lit room and examine the skin carefully. Pay attention to hard-to-reach places: back, neck, scalp. Look for new or ugly looking moles that meet the ABCDE criteria for melanoma. Keep in mind that as your hormone levels change, moles can change. Therefore, watch your skin during hormonal changes such as puberty, pregnancy and menopause.
— Every patient should see a doctor once a year to have the skin moles assessed. This is the key “golden rule” that increases the chance of an early diagnosis of skin cancers, including melanoma. Patients with a history of skin cancer should see their doctor more often. Depending on the time elapsed since the diagnosis, dermatoscopy is recommended every three months in the first year, and every six months in the following years. This is a rule that applies to the patient for the rest of his life – underline Ciążyńska.
The perfect time to check birthmarks comes after holidays, during which we sunbathe and play sports outdoors.
– In summer we are particularly exposed to solar radiation. And unfortunately, the dose of ultraviolet radiation that reaches our skin may predispose some moles to change or new ones to appear on the skin. Therefore, if we have to see a doctor once a year, it is best to do it after the holidays. I recommend that patients who care about themselves visit before and after the summer holidays. Remember that the skin is our largest organ and it is worth keeping an eye on it – adds the oncologist.
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