skin melanoma

In the vast majority of cases, melanoma is located on the human skin and is visible to the naked eye, but often people mistake it for a mole or “some kind of sore”¹.

Melanoma is one of the most aggressive types of cancer, it grows rapidly and is prone to metastasis. It is formed from melanocytes – cells containing melanin. The incidence of melanoma is steadily increasing throughout the world, including Russia. The World Health Organization predicts a 25% increase in the disease by 2025 and calls for attention to be paid to the study of information about this pathology and methods for its prevention.².

Causes of skin melanoma

• To date, doctors have not established the exact cause of melanoma. Among the most significant factors are hereditary predisposition and ultraviolet radiation. The sensitivity of people’s skin to ultraviolet varies greatly – it depends on belonging to one or another of the six phototypes. The highest sensitivity was determined for phototypes 1 and 2. These people burn quickly and can get severe sunburns, which are fertile ground for the formation of pathology in the future. But people with the 5th and 6th phototypes suffer the least from skin problems due to ultraviolet radiation and, accordingly, melanoma³.
• Other risk factors include the presence of 10 or more dysplastic nevi on the skin, an abundance of moles, red hair, intense and frequent sunburn (especially in childhood).
• In addition, there is also a hereditary (genetic) predisposition to the development of melanoma.
• It is impossible to exclude the influence of immunodeficiencies, xeroderma pigmentosum, the use of PUVA therapy (in the treatment of psoriasis and other chronic dermatosis).

What does skin melanoma look like?

In the vast majority of cases, melanoma is located on open areas of the skin, but often people mistake it for a mole or “some kind of sore.” You can suspect melanoma by the following signs:

• unusual color (the mole turns pale or blackens),
• increasing size,
• pain,
• bleeding,
• hair loss from a mole.

Also, moles of an unusual shape, with jagged edges, require attention, especially if they have appeared recently.

Photo of melanoma

Melanomas can be located on different parts of the body, have a different color and shape.

But not every “suspicious” mole is skin cancer, and not every skin cancer is melanoma. There are also non-aggressive types of malignant neoplasms of the skin.

melanoma classification

There are 5 stages of melanoma – from zero to four.

• At the zero stage, the neoplasm is located only in the epidermis – the upper layer of the skin – and does not spread in depth.
• At the first stage, its thickness is less than one millimeter, it grows slowly and does not metastasize.
• In the second stage, changes in the skin or moles become noticeable – peeling, ulceration, sometimes bleeding and soreness appear. However, distant organs and lymph nodes are not yet affected.
• Melanoma begins to metastasize at the third stage of the disease, when, in addition to surgical treatment, patients are shown complex treatment, including chemotherapy.
• At the last stage, the disease affects distant organs, including the liver, lungs and brain, and the prognosis of the disease becomes unfavorable.

There is also a classification of melanoma according to the TNM system.

• T (tumor) – tissue damage at the site of the primary tumor. According to this criterion, melanoma is divided into 4 stages – from zero, when there is no primary tumor, to the fourth, when the size of the focus is more than 4 mm and has ulcerations.
• The second criterion – M – the presence of distant metastases. There are two options – stage 0, when there are no distant metastases, and stage 1 – when they are (these are metastases to other internal organs, skin, subcutaneous tissue or lymph nodes).
• The third criterion – N – the defeat of the lymph nodes. It is divided into stages from 0 to the second, the most severe, when distant lymph nodes are affected⁴.

Diagnostics

Both the person himself and any doctor during a general examination can suspect melanoma, but an oncologist (oncodermatologist) diagnoses it.

In modern clinics, dermatoscopy or the study of suspicious skin formations is available using an optical high-precision system – a dermatoscope, which allows you to examine in detail a suspicious tissue area with multiple magnification.

In the presence of ulceration, the doctor can “take glasses” – a smear from the wound for examination under a microscope.

The most informative diagnostic method is a histological examination, that is, the study of tissues of a tumor removed by a surgeon. Also with melanoma, it is important to identify and examine the sentinel lymph node for the presence of metastases. It is believed that it is he who “catches” the very first metastases, so his biopsy is necessary.⁵.

Melanoma treatment

The treatment regimen for melanoma depends on the stage at which the disease was detected, however, it always includes surgical excision of the neoplasm. At all stages except zero, doctors biopsy the node closest to the melanoma (“sentinel”) and, if necessary, remove it as well. At subsequent stages, depending on the course of the disease, chemotherapy, targeted, hormonal and immune therapy are added.⁶.

Modern treatments

Doctors, scientists and pharmaceutical companies around the world are experiencing great interest in melanoma, the development of new treatment methods is ongoing. Not all of them are effective in practice, but some open up new perspectives in the treatment of this type of cancer.

Today, dermato-oncologists can offer patients:

• Surgical treatment – surgical removal of the tumor, followed by a histological examination to determine the nature of the tissues and confirm the diagnosis.
• Immunotherapy is the use of specific substances that do not directly affect the tumor, but “tune” the body’s own immunity to fight cancer.
• Chemotherapy is the use of various drugs from the group of cytostatics that have a destructive effect on cancer cells.
• Radiotherapy (irradiation) is the impact on a tumor of a strictly adjusted flow of radiation particles that actively destroy cancer cells.
• Targeted therapy is a targeted effect on the tumor with specific drugs that do not affect healthy tissues.

In February 2020, physicians from the Russian Society of Clinical Oncology (RUSSCO) reported that the number of melanoma patients who have passed the five-year survival mark has increased markedly. This was achieved thanks to modern methods of treatment – targeted and immune therapy.

According to oncologists, over the past year, melanoma has already lost its position as one of the most dangerous and poorly responsive to treatment types of cancer. And further experts expect even better results, so the methods of effective impact on melanoma are constantly being improved.

Melanoma prevention

The main and most important way to prevent melanoma is to protect the skin from exposure to sunlight.

It is believed that a single sunburn, even in childhood, increases the risk of skin cancer later on.

To protect yourself from the negative effects of UV radiation, it is recommended:

• limit exposure to the sun during the hours of its peak activity (during the day from 11 am to 17 pm);
• refuse to visit solariums;
• use sunscreen even in the city, and even more so on the beach. It is necessary to make sure that the cream protects against spectrum A (UVA) and B (UVB) rays (this is indicated on the package), and has a sun protection factor (SPF) of at least 30. On the beach, the cream should be applied at least every two hours, and for children it is possible and more often, and also after each bathing in the sea or sports games, accompanied by active sweating. In the city, sunscreen on the face and exposed areas of the body should be applied 15 to 20 minutes before leaving the house.

The eyes should also be protected from the sun with “the right goggles” labeled UV 400 or 100% UV protection.

“Diary of Moles”

The “Mole Diary” is a very simple way not to miss the beginning of the malignant process. The patient draws up a kind of map of his moles – indicates the size, color, characteristics of the edges and photographs them. The fact is that it can be difficult for a person to keep in mind a lot of information regarding the shapes, sizes, colors of their moles, especially if there are a lot of them. Therefore, doubts are natural: did it really grow, it seems to me, or was it lighter, but there was a mole here or just appeared. When keeping a diary, its author can trace the changes in moles and, if necessary, consult a doctor without delay.

Popular questions and answers

We asked you to answer typical questions about melanoma dermato-oncologist Elena Tsoi.

Sources:

1. Laletin V. G., Minakin N. I., Kozhevnikov A. B. Diagnosis and treatment of skin melanoma // Sib. honey. magazine (Irkutsk). 1995. No. 1. https://cyberleninka.ru/article/n/diagnostika-i-lechenie-melanomy-kozhi
2. Chissov V.I., Starinsky V.V., Kovalev B.N. Malignant neoplasms in Russia: Statistics, scientific achievements, problems // Kazanskiy med. magazine – 2000. – T.81, No. 4. – P.241–248.
3. Fitzpatrick TB: The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 1988,124(6):869-871.
4. Ali Z., Yousaf N., Larkin J. Melanoma epidemiology, biology and prognosis // EJC Suppl. 2013. Vol. 11. № 2. P. 81–91.
5. Anna B, Blazej Z, Jacqueline G, Andrew CJ, Jeffrey R, Andrzej S: Mechanism of UV-related carcinogenesis and its contribution to nevi/melanoma. Expert Rev Dermatol 2007, 2(4):451-469.
6. Trapeznikov N. N., Demidov L. V., Khalyastov I. N., Kharkevich G. Yu., Bogdanov V. E., Pirogova N. A. Effectiveness of prophylactic chemotherapy with DTIC and aranose in patients with regional skin melanoma metastases / / Vestn. RONTS im. N. N. Blokhin RAMS. 1998. No. 1. https://cyberleninka.ru/article/n/effektivnost-profilakticheskoy-himioterapii-preparatami-dtic-i-aranoza-u-bolnyh-s-regionarnymi-metastazami-melanomy-kozhi