The Best Treatments for Skin Melanoma
Often, upon hearing the diagnosis of skin melanoma, people panic, believing that the disease is incurable. However, today there are many effective methods of treating melanoma that can prolong the life of the patient and maintain its quality.

First, let’s figure it out – what is melanoma of the skin? Melanoma of the skin is a malignant formation that develops from melanocytes – cells located in the upper layers of the skin (epidermis and dermis). They produce the pigment melanin, which is responsible for the color of human skin and hair. It is melanocytes that are responsible for protecting the skin from the harmful effects of ultraviolet radiation, but sometimes ultraviolet radiation still damages cells, which is why melanoma is formed.1.

Most often, melanoma of the skin manifests itself in the form of a small patch of uneven shape and uneven color. It can be brownish, dark blue or even black, which is why very often melanoma is confused with a mole (nevus).

Melanoma is not so common and accounts for only 1,5-2 percent of the total number of malignant tumors. At the same time, melanoma has a fairly high mortality rate – precisely because it is often detected already in the later stages, when metastases have appeared. Not everyone is in a hurry to see a doctor after discovering a “minor little mole”. Skin melanoma most often occurs in people around the age of 60, but gender does not really matter.2.

Fortunately, modern medicine does not stand still. To date, there are several effective methods of treating melanoma of the skin, consider the main ones.

Skin melanoma treatment methods

The main methods of treating melanoma of the skin include surgical treatment (removal of melanoma), drug therapy, and in some cases, radiation and chemotherapy may be prescribed.

Diagnostics

– The main method of primary diagnosis of skin melanoma is dermatoscopy, that is, examination of formations on the skin with a special device. The diagnostic accuracy of this procedure can reach 90-95%, depending on the experience of the physician. It is important to understand that a simple examination with the naked eye is not enough. The diagnostic accuracy in this case is only about 60%.3. This means that out of 100 people who come for an eye examination, 40 will receive an incorrect diagnosis, explains PhD, member of the European Society of Surgical Oncology, dermato-oncologist Dmitry Beinusov.

If during dermatoscopy the doctor found signs characteristic of melanoma, then the next mandatory diagnostic step is an excisional biopsy. During this procedure, a suspicious formation is removed with a scalpel with a small seizure of healthy tissue (about 1-3 mm), after which it is sent for histological examination. The pathologist, having studied tissue samples under a microscope, makes the final diagnosis, on which the choice of treatment depends4.

“The previously extremely popular scrapings, punctures, and imprint smears are now not recommended by the clinical guidelines of the Ministry of Health for the primary diagnosis of melanoma,” the expert notes.

Removal of melanoma

If it was possible to identify the disease at an early stage, then, as a rule, surgical treatment is prescribed – that is, the removal of a skin area along with melanoma.

— In stages I and II, when the tumor is a mass on the skin and has not spread to nearby lymph nodes or other organs, surgical treatment of melanoma is used. It begins immediately after the excisional biopsy. The tumor itself is removed with a scalpel. 1 or 2 cm horizontally recede from its edge, removed along with the underlying subcutaneous tissue, and then sutured, explains dermatologist-oncologist Dmitry Beinusov.

adjuvant treatment of melanoma

The term “adjuvant treatment” refers to those additional treatments that are prescribed after surgery. As a rule, adjuvant treatment is required at stage III, after the removal of lymph nodes affected by metastases. About the drugs that are used, we will talk further.

Chemotherapy

Chemotherapy for melanoma of the skin was used earlier, but today this method of treatment is almost abandoned.

— Chemotherapy for melanoma (dacarbazine, temozolamide, lomustine) in its traditional sense is now rarely used. It can be used as a treatment when immunotherapeutic and targeted drugs have already exhausted their capabilities,” notes the dermato-oncologist.

Melanoma drugs

The use of medications for melanoma is indicated when the tumor has already metastasized and its removal will not be enough.

– At stages III and IV, when there are already metastases, drug treatment of melanoma is carried out. The most commonly prescribed drugs at these stages are BRAF inhibitors (dabrafenib), MEK inhibitors (trametinib), and anti-PD1 therapy (nivolumab, pembrolizumab), the expert notes.

To prescribe medications for melanoma, the doctor must be sure that the disease has reached the lymph nodes.

— Here, one should especially note an important diagnostic procedure — a biopsy of the sentinel lymph node (SLN). It helps to determine the stage most accurately, i.e. distinguish stages I and II from III. Unfortunately, it is still often neglected in many oncological institutions of the Russian Federation, but it is SLNB that helps answer the question of whether there are metastases in the nearest lymph nodes. If yes, then it is stage III and drug treatment is required. If not, then this is stage I or II, and surgery is enough, the expert emphasizes4.

Radiation therapy

In some cases, radiation therapy may be used to treat distant metastases (eg, in the brain). 

Popular questions and answers

So what causes melanoma of the skin, who is at risk and how quickly the tumor develops, is responsible PhD, member of the European Society of Surgical Oncology, dermato-oncologist Dmitry Beinusov.

Why does skin melanoma occur?

– The most well-known and well-proven risk factors are sunburn and solarium. Freckles, light skin and hair, blue or green eyes – all this suggests that a person is more prone to developing melanoma.

In addition, a large number of moles (nevi) on the skin, as well as the presence of flat moles larger than 5 mm, can indicate an increased risk of a tumor.

Heredity also matters. The risk is increased if melanoma was in first-line relatives (mother, father, brother, sister, son, daughter).

How quickly does skin melanoma develop?

– Not as fast as anonymous people write about it on the Internet. Most melanomas have two growth phases, one after the other. Horizontal, when the tumor grows along the plane of the skin and vertical, when it grows into the deeper layers. According to studies, the horizontal phase of growth can last for years.

Very often, people who find out they have melanoma think that their days are numbered anyway. After all, they write on the Internet that this tumor is “the most malignant and the fastest growing.” Fortunately, this is not the case. Like any other oncological disease, melanoma obeys the law – the smaller the stage, the more favorably it proceeds. At stages 0, I, II and often III, melanoma in the vast majority of cases can be successfully treated.

Does melanoma hurt?

– In the early stages, when the process is limited to a focus on the skin, there is no pain. It can appear when a tumor metastasizes to nearby lymph nodes or internal organs. It is very important to note that in stages I and II, melanoma does not manifest itself in any way, except for a changing lesion on the skin. At these stages, there are no changes in blood tests. The now extremely popular “tumor markers” are also uninformative in the initial diagnosis.

Can melanoma be treated with folk remedies?

– Absolutely not, however, like any other malignant tumor. Means without proven effectiveness can be used in consultation with the attending physician, as an addition to the main treatment, but should never replace it. The effectiveness of currently available methods of treating melanoma has been proven in numerous international studies conducted on thousands of patients. Yes, official medicine will not be able to completely cure a person at stage IV, however, trusting means like “my second cousin’s neighbor helped”, in my opinion, is the height of frivolity.

Sources:

  1. Chen ST, Geller AC, Tsao H. Update on the Epidemiology of Melanoma. Curr Dermatol Rep. 2013 Mar 1;2(1):24-34. doi: 10.1007/s13671-012-0035-5.
  2. Malignant neoplasms in Russia in 2018 (incidence 

    and mortality). Edited by A.D. Kaprina, V.V. Starinsky, G.V. Petrova. M., 2019, MNIOI them. P.A. Herzen – branch of the Federal State Budgetary Institution “NMIRTs” of the Ministry of Health of Russia

  3. Kittler H, Pehamberger H, Wolff K, Binder M. Diagnostic accuracy of dermoscopy. Lancet Oncol. 2002 Mar;3(3):159-65.
  4. Clinical recommendations of the Ministry of Health of the Russian Federation “Melanoma of the skin and mucous membranes”, 2020. (cr.minzdrav.gov.ru/recomend/546_1)
  5. Roma P, Savarese I, Martino A, et al. Slow-growing melanoma: Report of five cases. J Dermatol Case Rep. 2007;1(1):1-3. doi:10.3315/jdcr.2007.1.1001
  6. Argenziano G, Kittler H, Ferrara G, Rubegni P, Malvehy J, Puig S, Cowell L, Stanganelli I, De Giorgi V, Thomas L, Bahadoran P, Menzies SW, Piccolo D, Marghoob AA, Zalaudek I. Slow-growing melanoma: a dermoscopy follow-up study. Br J Dermatol. 2010 Feb 1;162(2):267-73.
  7. Vrbić S, Filipović S, Pejić I, Vrbić M, Filipović A. Sensitivity, specificity, positive and negative predictive value of serum S-100 beta protein in patients with malignant melanoma. J BUON. 2003 Apr-Jun;8(2):139-41.

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