MELANOMA
– Melanoma is the most malignant form of epithelial tumors of the skin.
It is called so because it comes from the melanocytes of the deeper layers of the skin. The melanocytes produce melanin, the pigment that gives the skin its color.
Melanoma if it is in the initial stage and is treated correctly then we are talking about a 100% cure. However, it is an aggressive tumor and if not treated early it is often fatal. On an annual basis, approximately 200,000 new cases of melanoma are detected worldwide, while according to data from the World Health Organization, 55,000 people die each year from malignant melanoma.
It develops locally but also metastasizes to both the lymph nodes and distant organs.
It does not hurt at all and is generally an asymptomatic tumor.
– Melanoma usually “warns” with symptoms, making it a little easier to treat it early. It is also a form of cancer that can be prevented thanks to good information, regular self-examination and preventive visits to the doctor.
Melanoma – Frequency of occurrence
Of the cancers that appear on the skin:
I. 3 to 4% are melanoma
II. 85% are Basal Cell Carcinomas
II. 10% are Squamous cell carcinomas and
IV. 1 to 2% are unclassified tumors.
Melanoma – Causes
Melanoma is a radiation-dependent malignant tumor. This means that the longer and the younger a person has been exposed to solar radiation, the greater the risk of developing melanoma. If he also has many moles on his skin or suffers from dysplastic mole syndrome, so much the worse.
Since in the last 30-40 years tanned skin was considered aesthetically more beautiful, many children during summer vacations mainly at the sea, have stayed with their parents for many hours under the sun sunbathing. This has the result that today people are affected by skin cancer at a younger age than in the past and in areas of the body that were not foreseen.
People who tan artificially (solarium) can also develop melanoma.
Today we have evidence that there is a hereditary predisposition to the development of melanoma, as for example in the dysplastic mole syndrome.
Melanoma can develop in immunocompromised, superficial chronic irritation nevi as well as after malignant transformation of congenital nevi, malignant lenticule, or melanocytic nevi.
1.3. Risk Factors for Melanoma
Risk factors for melanoma include exposure to ultraviolet (UV) radiation, a history of sunburns, fair skin, a family history of melanoma, and having numerous moles or atypical moles. Other risk factors include having a weakened immune system, a personal history of nonmelanoma skin cancer, and certain inherited gene mutations. It is important to protect oneself from UV radiation by using sunscreen, wearing protective clothing, and avoiding indoor tanning. Regular self-examination of the skin and seeking medical attention for any suspicious changes are also essential for early detection and prompt treatment of melanoma. Avoiding risky behaviors, such as excessive sun exposure and indoor tanning, can significantly reduce the risk of developing this deadly form of skin cancer.
Melanoma – Who is it for?
People with red hair and fair skin are usually affected. Also people with blond hair and blue or gray eyes who have freckles belong to the high risk group.
Many times people who develop melanoma report that they had sunburns in their childhood.
It occurs more often in Caucasians than in blacks or Asians. It is most common between the ages of twenty and sixty and is very rare before puberty.
Superficial spreading melanoma is most common between the ages of forty and sixty while malignant nodular melanoma occurs between the ages of twenty and forty.
In a percentage of 30% it can appear as an evolution of a dysplastic nevus while in a percentage of 70% it appears as a new skin lesion on healthy skin.
Because there is heredity, children with a family history of melanoma should be examined from the age of 10.
Melanoma – Where does it appear?
The most common places where melanoma occurs are the legs and arms in women and the head, neck and trunk in men.
It can also appear on the palms and soles, on the hair follicles of the mouth and anus as well as under the nails and on the sclera of the eye. At these positions it is more common in blacks and less common in whites.
So if we have a pigmented nevus on the palms, soles or under the nails we must definitely remove it and send it for a biopsy because there is a high possibility that it is melanoma.
Melanoma can metastasize to almost any organ in the human body and is therefore an aggressive tumor and potentially fatal. It usually metastasizes to the lymph nodes, skin, brain and spinal canal, lungs, bones and liver.
Symptoms of melanoma
Any change in the texture, color and size of a skin mole (olive) should lead us to the doctor for a checkup. And although sometimes the changes may be innocent, others may be related to the development of melanoma.
In English-speaking countries, the “Melanoma Alphabet” (ABCDE) has been defined with the first 5 letters of the English alphabet providing an easy guide to the early warning signs of melanoma.
A for asymmetry (ASYMMETRY) – The good ones
benign moles are almost always symmetrical with a smooth shape and round or oval outline unlike malignant ones which are asymmetrical with jagged edges.
B for border (BORDER) – A benign nevus has a smooth and smooth border, as opposed to a malignant nevus which has indistinct and irregular borders.
C for COLOR – Most moles are uniform in color. If a nevus is two-color or multi-color or if it has a very black color then it is good to have it evaluated by the Doctor.
D for DIAMETER – A malignant mole usually has a larger diameter than most moles on the skin. It is often greater than 6mm.
E for evolution or change (EVOLVING) – If a mole starts to grow, change color or bleed, these are red flags and it is important not to delay the visit to the doctor.
Melanoma – Diagnosis
People with a history of heredity or with many “olives” on their body should be regularly monitored with mole mapping, a procedure that accurately records the moles on the skin, their location, shape and color so that the specialist can notice early any changes.
If the doctor suspects that an olive has developed into melanoma, in addition to the clinical examination, a biopsy will also need to be done to confirm the result and check for cancer cells. The biopsy can be done in the doctor’s office under local anesthesia or in a clinic if a larger tissue sample needs to be taken.
Melanoma – Treatment
The main way to treat melanoma is surgery.
Our aim is to remove the entire cancerous lesion with “clear margins” around it so that we can be sure that no cancer cells have remained in the area.
The surgical preparation is sent to the pathologist for biopsy who checks the adequacy of the surgical resection and directs us the further treatment.
If the melanoma is in an early stage then its surgical removal is enough and can provide a complete cure.
If the melanoma is at a more advanced stage, then we may need to check for lymph node metastases by performing an additional resection in the area of the primary focus and checking for “sentinel lymph nodes” by removing the neighboring lymph nodes.
After staging the disease and in collaboration with the oncologist, we will decide if chemotherapy, radiotherapy or immunotherapy, administration of interferon, etc. or any other form of treatment that will stop the progression of the cancer is needed.
Melanoma – Protective measures
If skin cancer is hereditary, self-examination and regular visits to the doctor for skin checks are important. However, some good habits can significantly reduce the chances of developing melanoma whether a person has a history of it or not. Protecting the skin from the sun by avoiding midday exposure, using sunscreen, a hat and sunglasses, and wearing sun-protective clothing can make a difference.
Melanoma – prognosis
Melanoma is a modern disease. Due to our lifestyle and excessive exposure to the sun’s harmful rays in the last 20-30 years there is an increase in the number of cases.
However, melanoma is a tumor on the surface of the skin. It looks. If we ignore the symptoms, the disease can become fatal. A few years ago patients with metastatic melanoma had a life expectancy of 6 months. Today, new treatments are being developed that, if started early, significantly increase survival. Early diagnosis, however, remains the “key” to good melanoma progression.