Melanoma – how to recognize, symptoms, cause, prevention. Is this dangerous cancer curable?

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Melanoma is one of several malignant skin cancers, but also one of the most aggressive. Data from the National Cancer Registry show that melanoma is more and more common in young people aged 24–40, and especially among women. Every year in Poland 3 thousand. patients find out that they have melanoma. Have you noticed pigmentary changes (so-called moles)? This is a good time to check skin changes with a dermatologist.

Basic information about melanoma

1. Young people most often suffer from melanoma, especially those with fair skin and hair.
2. In order to diagnose melanoma, it is worth examining the changes on the skin, following the ABCDE principle.
3. It is best to do a mole examination in the fall to check for current and new changes.
4. Melanoma is a malignant tumor that metastasizes, so early detection is important.

Melanoma is the most common malignant tumor that affects the skin, but it can also occur in the mouth and nose mucosa, as well as on nails and eyeball. This cancer arises from melanocytes, which are skin pigment cells that produce the pigment melanin. This dye causes the skin to darken in contact with ultraviolet radiation, such as the sun or lamps used in tanning beds. In order to avoid the harmful effects of sunlight, you should apply a cream with a high SPF filter before each going out.

Melanoma, which initially appears on the surface of the skin, grows deeper than 1 mm over time. Thus, it gradually goes beyond the dermis to the blood vessels. Then, through them, it reaches the entire body in a very short time (up to three months).

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Characteristic for melanoma is its aggressive growth and the possibility of forming early and numerous metastases, which are very difficult to treat pharmacologically. Exactly that metastatic melanoma it is the most lethal form of the disease. It occurs when the cancer spreads beyond the skin’s surface to other organs, such as the lymph nodes, lungs, brain, and other areas of the body.

Meanwhile, removal local melanomawhen the disease is not yet spread in the body, it can cure as much as 97 percent. sick. Therefore, it is extremely important to diagnose it quickly and correctly.

Diagnostics and symptoms – ABCDE of melanoma

Melanoma is one of the easiest cancers to diagnose because it grows on the surface of the skin, most often on exposed parts of the body. It can appear on previously unchanged skin or within the scope of already existing moles.

Regular and careful observation of your own skin allows for early detection of cancer. Any birthmark, growth, or mole that is disturbing or changes over time should be checked as soon as possible. It is recommended that the lesion be examined by a dermatologist or surgeon-oncologist as soon as possible and, in case of any doubts, its removal. You can buy a test package that includes dermatoscopy and consultation with a dermatologist at Medonet Market.

You can make an early diagnosis of melanoma yourself using ABCDE criteria for melanoma:

1. A – asymmetry, eg a mark “pouring out” on one side;
2. B – edges that are irregular, uneven, jagged, with thickenings;
3. C – red or black and non-uniform color;
4. D – large size, lesion size greater than 0,5 cm;
5. E – evolution, that is, progressive changes taking place in the birthmark.

Symptoms such as itching, bleeding and cracking of the birthmark are an alarm signal and require immediate medical consultation. Make an appointment with an internist from whom you will receive a referral for diagnostic tests.

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Examination of birthmarks performed by a specialist is quick, painless and non-invasive. The doctor carefully examines the skin of the entire body, including the scalp, feet, the skin between the toes, as well as the anus and genitals. For this purpose, he uses a dermatoscope – a device that allows for 10- or 12-fold magnification and additional illumination of the observed area, thanks to which the deeper structure of the nevus is visualized, allowing to capture any atypical changes.

Do you want to consult a disturbing skin change with a dermatologist? Make an appointment online today. The doctor can see you within 10 minutes.

Base further diagnosis of melanomawhich ensures correct diagnosis of the disease is a biopsy, i.e. microscopic examination of the entire pigmented lesion removed by the surgeon. This procedure is performed under local anesthesia – a section of the skin lesion is collected with 1-2 mm of unchanged skin. It is subjected to histopathological evaluation carried out under a microscope, which should take into account, inter alia, the thickness of the lesion, the presence or absence of ulceration, and the mitotic index, i.e. the number of cells during division.

Also included are prognostic information, i.e. melanoma subtype (e.g. mutation of the BRAF gene or expression of PDL-1 proteins), presence of neoplastic vascular invasion, presence of intensification of infiltration of the lesion by cells of the immune system, as well as the degree of skin layers involvement.

In order to determine the stage of the tumor, the condition of the lymph nodes and the presence of metastases are determined. For this purpose, an X-ray of the chest and an ultrasound of the abdominal cavity are performed, and in patients with non-specific symptoms, tests using computed tomography (CT) or positron emission tomography (PET-CT) are additionally performed.

Factors that contribute to the formation of melanoma include:

1. light complexion;
2. bright Eyes;
3. red or blonde hair;
4. freckles or multiple moles and pigmented lesions;
5. low sun tolerance and difficult tanning;
6. easy to sunburn;
7. skin injuries;
8. scars from inflammation and burns;
9. HPV infection.

Most often, melanoma affects middle-aged and elderly people.

The following tips should be considered in the prevention of melanoma:

1. Avoid exposure to very intense sun, especially between 11:00 and 16:00.
2. Use creams with high UVA and UVB filters for the whole body.
3. Wear sunglasses and a hat.
4. Do not sunbathe in the solarium.
5. Regularly, once a month, check your skin to quickly spot new and suspicious changes.
6. Consult a dermatologist or surgeon-oncologist if you suspect that something is wrong with the birthmark.
7. Have an annual check-up with a dermatologist or surgeon-oncologist.

An important element in the prevention of melanoma and skin cancers is the abandonment of the solarium. In 2009, tanning beds were recognized by the World Health Organization as one of the most carcinogenic factors, along with smoking and asbestos. Artificial UV radiation emitted by tanning beds is a significant factor responsible for the formation of primary lesions and metastasis of melanoma.

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The radiation of the solarium is about 10-15 times stronger than that of the sun on the hottest day. Therefore, it can be assumed that a 10-minute visit to the solarium strains the skin like almost 100 minutes of exposure to full sun without any skin protection. In people who use tanning beds, the risk of developing melanoma increases by 55% more than once a month, and in people under 30, the risk increases by as much as 75%. It is especially dangerous to use the solarium in the fall and winter period, when the skin is unprepared for strong ultraviolet radiation.

Is melanoma curable?

Treatment of melanoma begins with determining the type of melanoma and the stage of the disease. Once the cancer cells have spread into deeper parts of the body to the lymph nodes or other organs, sentinel lymph nodes must be completely excised and systemic treatment initiated.

In the advanced stage of melanoma, surgery, systemic treatment (mainly immunotherapy and targeted therapy) and radiotherapy are used. The oncologist will help you choose the best form of therapy during the consultation.

In recent years, the greatest hope for patients with advanced melanoma has been immuno-oncology. Immuno-oncology uses drugs that act not on cancer cells but on the patient’s immune system to help him fight cancer. In the case of metastatic melanoma, as part of immunotherapy, in the first and second line of treatment there are modern drugs that bind to the checkpoint receptor PD-1 (present on T lymphocytes) or PDL-1 (present on cancer cells) and drugs that bind to CTLA-4 checkpoint receptor in the second line of treatment in Poland.

Also read: 10 symptoms that could be a sign of your developing cancer

For the first time, immuno-oncology significantly prolonged the survival of patients with disseminated melanoma. Data from clinical trials show a significant prolongation of overall survival in both previously untreated and previously treated patients with advanced melanoma compared to prior chemotherapy.

Additionally, in the case of the presence of BRAF mutations in melanoma cells, patients may benefit from molecularly targeted therapy. It involves the use of a drug that targets the cancer cell with this genetic change directly. In Poland, BRAF inhibitors are the drugs of choice in the treatment of patients with melanoma, in which the presence of the V600E mutation in the BRAF gene was found. Additional effectiveness of treatment with BRAF inhibitors is obtained with the use of combined therapy against the BRAF and MEK protein receptors, which are also currently reimbursed in Poland.

In 2018, the European Medicines Agency (EMA) approved a drug that binds to the CTLA-4 checkpoint receptor on T lymphocytes for the treatment of pediatric patients aged 12 years and older with inoperable or metastatic melanoma.

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However, the prognosis of survival in melanoma is influenced not only by the stage of the lesion (type, thickness, depth of infiltration), but also by the patient’s metastases. Therefore, people suffering from local melanoma have a better chance of successful treatment. Worse prognosis appears in metastatic melanoma.

Also read: Tumor metastases to bone

Melanoma – tumor statistics

1. Melanoma is the 9th most common cancer in Europe.
2. 1 in 100 European citizens will develop melanoma at some point in their life.
3. In Poland, about 50 thousand. new cases of skin malignant neoplasms, including over 3 are cases of melanoma.
4. Melanoma accounts for only 6 percent. of all skin cancers, yet it contributes to the death of as much as 80 percent. skin cancer patients.
5. Over the past 20 years, the incidence of melanoma has increased by as much as 300%.
6. The number of cases of melanoma in Poland doubles every 10 years.

Early detection of melanoma, when the disease is not yet advanced, allows for almost 100%. recovery of over 80% sick.

Other skin cancers

1. Other skin cancers – basal cell carcinoma

It is one of the most common forms of skin cancer – compared to other types of the disease, it is about 5 times more common. The nodule is usually hard, usually white, transparent or partially colored. It appears predominantly on the face and can be nodular-ulcerative, periwinkle, scleroderma, superficial and fibro-epithelial. The scleroderma-like form grows the fastest, it is also considered the most aggressive form of the disease.

Basal cell carcinoma manifests as an ulcer with a rolled edge – for example, around the eyes, near the eye, and on the nose. It is sometimes associated with ulcerations on the forehead and nose. The cause of basal cell carcinoma is ultraviolet radiation associated with increased ambient temperature and chronic infection, e.g. with the human papillomavirus HPV. The tumor may shrink and expand at the same time.

Treatment of basal cell carcinoma consists in removing the nodule – this is done by surgery. In a situation where it is not possible to perform a surgery, radiotherapy is used, unless there are any contraindications for it. Other acceptable methods of treatment of basal cell carcinoma are also cryotherapy, laser therapy, and electroagulation.

1. Other skin cancers – squamous cell carcinoma

It is one of the most commonly diagnosed malignant neoplasms. It can develop in different parts of the body, such as the skin, mouth, lungs and cervix. The development of the disease is preceded by the process of epithelial metaplasia – then healthy cells replace cells with the ability to develop cancer. There are 4 types of squamous cell carcinoma: squamous cell carcinoma, basal cell carcinoma, keratinizing and non-keratinizing.

Squamous cell carcinoma occurs as a result of chronic exposure of the skin to sunlight. It is also caused by infection with the human papillomavirus (HPV), especially around the genital area, and other diseases causing the development of the neoplastic process, e.g. actinic keratosis, x-ray skin damage, skin damage with chemicals.

One way to treat metastatic skin squamous cell carcinoma is to remove the tumors by surgery – as long as they are small and few. Patients with metastases are also treated with systemic immunotherapy such as cemiplimab, a drug given by intravenous infusion. Yet another method of treatment is surgical removal of the lesion using the freezing method.

1. Other skin cancers – Merkel neuroendocrine carcinoma

This type of cancer is rare – in Poland 2-3 people per million suffer from it. In turn, in Europe, the incidence is about 2500 people a year. Merkel cell neoplasm arises from neuroendocrine cells of the skin and is most often located on the scalp and neck. The tumor is purple-purple in color, grows quickly and is painless. It often coexists with other neoplasms

A Merkel cell tumor is a hard lump. It also occurs on the legs and arms, but much rarer than on the head and neck – in this case, the lump may be red, purple, or flesh-colored. The nodules come in different sizes. To diagnose the disease, a visual and physical examination is performed. It is also necessary to collect material for a biopsy. Merkel cell carcinoma is not easy to assess due to the wide variety of nodules.

The disease is treated primarily with the use of a surgical method. In some cases, sentinel node biopsy and scar excision may be used. The final stage of treatment is sometimes radiotherapy, which is a complementary treatment – irradiation is a method by which patients who are unable to participate in surgical treatment are treated. The method of treatment depends on the stage of the tumor.

1. Other skin cancers – Kaposi’s sarcoma

It is a tumor made of spindle-shaped cells. His tumors are small and have different colors. They appear in different parts of the body and have different symptoms. They are especially dangerous when they appear on the lungs – in this case they can be life-threatening. Most people with this cancer have a virus called HHV-8. In the United States, 10% of the population is infected with it, and in some parts of Africa about 90%.

The symptoms of cancer are nodules of various sizes. They also have the form of flat infiltrates, bruises and skin peeling. These lesions are not pruritic but may be painful. Neoplastic changes sometimes appear on the gastrointestinal wall, in the respiratory system, and lymph nodes except for the central nervous system. In order to diagnose the disease, it is necessary to collect a fragment of the diseased skin or a lymph node – it is checked during a histopathological examination.

The method of treatment depends on the patient’s health and the severity of the disease. Patients with unoccupied internal organs, with lesions only on the skin or with minor changes on the oral mucosa have the best prognosis. When the disease is in the epidemic stage, antiretroviral therapy is performed. Single tumor foci are also removed surgically.

1. Other skin cancers – Paget’s skin cancer

It is a rare type of skin cancer that originates in the skin’s apocrine glands. There are two types of this cancer – the first one develops in the epidermis and spreads in the epithelium of the hair follicles and in the ducts of the sweat glands. The second begins in the genitourinary or digestive system and moves to the epidermis. Another name for Paget’s skin cancer is Paget’s Disease (EMPD)

Symptoms of the disease are erythematous spots, causing itching and burning. Sometimes fluid is released from them and erosions appear. Most often, changes are visible in the genital area, which is rich in apocrine and eccrine glands. Cancer can also be found in the upper thighs, buttocks, armpits and around the navel – but is rare here. There are isolated cases of the disease in the external auditory canals.

The disease is treated surgically – the lesion is excised with a safety margin. When the disease affects, for example, the vulva, all or part of the external genitalia is removed, but the organ does not lose its function. When the disease occurs in the rectal area, sometimes abdominoperineal resection or surgery and chemoradiotherapy are performed.

What factors can cause melanoma?

There are many factors that can contribute to cancer formation. People who have relatives in the family suffering from melanoma and people with previously diagnosed melanoma are much more exposed to it. The risk of developing the disease is increased by the presence of the FAMM atopic nevus syndrome among family members. The presence of cancer in the family is a high risk factor – the risk of developing it in a first-degree family member is higher by 1,7. On the other hand, when the disease occurs in two family members, the risk of developing the disease increases 9 times.

Another factor contributing to the development of the disease is solar radiation – it is one of the main factors in the development of cancer. People who have:

1. blond hair,
2. fair skin
3. numerous freckles,
4. skin injuries,
5. low sun tolerance and difficult tanning,
6. HPV infection.

People with red hair are the most vulnerable. In turn, the risk of falling ill among blondes is already moderate. People with freckles are twice as likely to develop the disease as people without freckles. The first skin phototype is also a risk factor. People with fair skin are more likely to develop an uncolored form of melanoma – this type of cancer can be more difficult to diagnose and may delay diagnosis of the disease.

Contrary to appearances, prolonged exposure to the sun does not contribute to the development of the disease more than short-term exposure to radiation. It turns out that short-term exposure to UV radiation, e.g. during holidays, is particularly dangerous. Therefore, you should take care of sun protection from an early age – it is especially important before the age of 10, when the risk of disease is high.

A factor contributing to the formation of cancer is also sunbathing, e.g. in a solarium or in a beauty salon. The client receives twice the dose of UV radiation there than during natural tanning, which may result in a higher risk of complications. The UV rays used in medicine, which can cause secondary cancer, are also at risk.

Skin cancer – a handful of statistics

1. Basal cell carcinoma is the most common skin cancer, accounting for 80 percent. all diagnoses.
2. One should take into account the underestimation of all diagnoses of basal cell carcinoma in Poland.
3. In 2013, the first molecularly targeted drug in Europe (vismodegib) dedicated to the treatment of basal cell carcinoma was registered.
4. Basal cell carcinoma at an early stage of development is almost 100%. curable.
5. Squamous cell carcinoma of the skin accounts for 20 percent. skin cancer and is the second skin cancer after basal cell carcinoma.
6. The incidence of squamous cell carcinoma increases with age, most often in the elderly.

Also read:

1. Have you noticed such changes on your face? It could be lung cancer
2. What do Polish women die most often?
3. They know they are dying. How do I talk to cancer patients?
4. WHO: Breast cancer is the most commonly diagnosed cancer in the world. Not lung cancer anymore
5. Poland: more and more malignant tumors