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Melanoma. Causes, symptoms, signs, diagnosis and treatment of the disease. The most dangerous malignant skin tumor is melanoma, its first signs and treatment methods

Melanoma is one of the most malignant human tumors with the highest mortality rate, occurring at any age. This is a type of skin cancer that originates from epidermal melanocytes of both normal skin and pigmented nevi, and, rapidly developing, affects not only the skin, but can also spread to other organs and bones. Melanoma appears as a flat, brown or black mole with jagged edges. Melanomas usually have an irregular and asymmetrical shape. This means that one half of the mole is different from the other half. Melanoma moles or spots can be 6 mm in diameter or larger.

Melanoma occurs approximately 10 times less frequently than skin cancer, accounting for about 1% of the total number of malignant neoplasms. The incidence of melanoma has been increasing recently, although it occurs slightly more often in women than in men.
The incidence of melanoma increases sharply in the age group of 30–39 years, but even small children can be affected.

Causes of melanoma

Melanoma can develop if you spend too much time in the sun. This leads to normal cells skin becomes atypical. Atypical cells grow quickly and uncontrollably and attack surrounding tissues.

Melanoma tends to occur in blood relatives. Other circumstances also increase the chance of illness. For example, you may have atypical moles. Atypical moles may gradually fade into the skin; their flat part may be flush with the skin. They may be smooth or slightly scaly, or appear rough or shagreened. These moles themselves do not cause cancer. But if you have a lot of these moles, it's a sign that melanoma may run in your family.

The background for the occurrence of melanoma is often congenital pigment spots - nevi, especially those that are repeatedly injured when they are located on the back, in the area of the shoulder girdle, on the foot or open parts of the body.

Pigmented nevi occur in 90% of people. And depending on the layer of skin from which they develop, they are distinguished as epidermal-dermal, or borderline, intradermal and mixed. Borderline nevi are the most dangerous. They are a clearly defined nodule of black-brown, black-gray or black color with a smooth, dry surface on which there is no hair. The nodule is flat or slightly raised above the surface of the skin, painless. It has a soft-elastic consistency. Dimensions vary from a few millimeters to 1 cm.

Borderline nevus is usually localized on the head, neck, palms and feet, as well as on the trunk. The incidence of malignancy in mixed nevi is significantly lower. And melanoma develops from dermal nevi in isolated cases.

Surgical intervention for nevi was previously considered dangerous. But this idea turned out to be erroneous. It is currently believed that excision of any and even borderline nevus within healthy tissue guarantees recovery and is a reliable measure for the prevention of melanoma. It is especially recommended to remove nevi located on the sole, foot, nail bed and in the perianal area, which are almost always borderline in their structure and are often subject to injury.
By the way, melanomas that develop against the background of acquired age spots, found in patients in adulthood, are also very dangerous.

Risk factors include significant doses of ultraviolet radiation, trauma, hormonal changes in the body, a family predisposition to melanoma, xeroderma pigmentosum and Dubreuil's melanosis.

Melanoma symptoms

The first signs that indicate malignancy of pigmented nevi are:

increase in size, compaction, bulging of one of the areas or uniform growth of pigment formation above the surface of the skin;
strengthening, and occasionally weakening of nevus pigmentation;
bleeding, cracking, or superficial ulceration with crusting;
redness, pigmented or non-pigmented cords, infiltrated tissue surrounded by nevus;
the appearance of itching, burning;
formation of satellites, enlargement of lymph nodes.

In other words, any nevus that protrudes above the surface, changes color, becomes weeping, bleeds, or causes unpleasant subjective sensations is suspicious for melanoma and in any case requires consultation with an oncologist.

Localization, growth and spread of melanoma

Unlike skin cancer, melanoma is not predominantly located on the face. In almost half of patients, the tumor occurs on the lower extremities, somewhat less frequently on the trunk (20–30%) and upper extremities (10–15%), and only in 10–20% in the head and neck area.
The growth and spread of melanoma occurs through germination of surrounding tissues, lymphogenous and hematogenous metastasis.

Melanoma grows in three directions: above the skin, along its surface and deep, successively growing through the layers of the skin and underlying tissues. The deeper the strands of tumor cells spread, the worse the prognosis.

Melanoma metastasis

Melanoma is characterized by rapid and early metastasis. Most often, metastases affect regional The lymph nodes. Metastases to distant lymph nodes are less common.

Skin metastases are common. They look like small, multiple, brown or black rashes that slightly rise above the skin level.
Hematogenous metastases can occur in any organ, but the lungs, liver, brain and adrenal glands are most often affected.

Can melanoma be prevented?

The best way to prevent all types of skin cancer, including melanoma, is to protect yourself during sun exposure. It is important to avoid exposure to ultraviolet radiation.

Try to avoid being in the sun in the middle of the day (from 10.00 to 16.00).

When outdoors, wear protective clothing, a hat that shades your face, a long-sleeved shirt, and long pants.

Daily use of sunscreen should become a habit. Your sunscreen should have a sun protection factor (SPF) of at least 15. Choose a sunscreen that protects against both types of ultraviolet radiation from the sun (UVA and UVB).

Use a product with a higher SPF if you are at higher elevations.

Avoid sunbathing and artificial tanning.

Check your skin monthly for unusual spots, moles, or sores that won't heal. Pay attention Special attention areas that are most exposed to the sun, such as the palms, arms and back. Ask your doctor during regular checkups. See your doctor at least once a year. Although the main cause of melanoma is excessive sun exposure, it can be found in areas of the body that are not exposed to it.

What increases the risk of melanoma?

Risk factors for melanoma include:

Heavy exposure to ultraviolet radiation in the past.

Sun exposure is the most important risk factor. Other factors, such as a family history of melanoma, increase your risk, but sun exposure is the factor that is best controlled. A person can be exposed to intense sun exposure in childhood, at work that requires being outside and during active rest on open air.

Exposure to UV rays in a tanning bed can be just as risky as sunbathing.
Sunburn, especially in childhood.
History of melanoma or other skin cancer.
Family history of melanoma or familial atypical mole and melanoma syndrome.
Atypical moles (dysplastic nevi).
50 or more moles with a diameter of at least 3 mm.
Caucasian, especially people with fair skin that burns rather than tans, freckles, red hair and blue eyes.
Weakened immune system.
Moles that were present at birth, especially if their size exceeds 20 cm (giant congenital melanocytic nevi).
Rare hereditary disease, which is called xeroderma pigmentosum. This is a disease in which the body is unable to repair cells damaged by ultraviolet radiation from the sun.
Treatment with a combination of psoralen and ultraviolet A light, which is used for skin conditions such as psoriasis

Initial treatment for melanoma

Melanoma can be cured if it is detected and treatment is started promptly. early stages when only the skin is affected. If melanoma is found only in the skin (primary melanoma), surgery to remove the affected area of skin is most effective. If the melanoma is thin and has not spread to surrounding tissue, removal can be cured. In later stages, melanoma can spread, or metastasize, to other organs and bones, reducing the chances of recovery.

Treatment for melanoma that occurs in other parts of the body depends on where it occurs. Such places include:

Eye (ocular melanoma). In the past, treatment for ocular melanoma often required removal of the eyeball (enucleation). Sometimes it is still necessary to remove the eye, but there are now alternative treatments available in some cases. Treatment may include radiation, laser therapy known as photocoagulation to cut off the cancer's blood supply, and surgery that does not remove the entire eye.
The skin of a finger or toe or under a nail. Melanoma in these areas is treated by removing the affected tissue. Often the entire finger needs to be removed.

Subsequent treatment for melanoma

After surgery to remove melanoma, you must visit your doctor every 3 to 6 months for 5 years, then annually.

Visit a doctor every 3 to 6 months in case of:

Atypical moles (dysplastic nevi). These moles are not cancerous, but their presence is a warning sign of a hereditary tendency to develop melanoma.
Familial atypical mole and melanoma syndrome, that is, a hereditary tendency to develop melanoma.

Dermatovenerologist S. V. Ponomarenko

The first mentions of melanoma in history begin in the 17th century, when the first doctors began to talk about strange growths on the skin, which subsequently grew and led to quick death.

Scientists have noticed that in this century this disease has become more common in many patients, and every year the number of those diagnosed is increasing. Perhaps this is due to the polluted environment and the destruction of the ozone layer, or perhaps due to the rhythm of life of modern people.

Definition

What is skin melanoma? Melanoma (melanoblastoma) is a malignant neoplasm that develops from melanocyte cells that produce melanin. The disease develops rapidly and is aggressive towards nearby tissues and lymph nodes.

Found on covers:

Skin (the most common form).
In the oral cavity.
Larynx.
Mucous membrane of a diseased eye.
Skin of the ear canal.
Female internal genital organs - body, cervix.

If we take skin oncology, it is men and older women who suffer more often due to hormonal effects. In this case, mostly young people from 15 to 40 years old suffer. Girls, not men, are more often susceptible to the disease.

The danger of the most malignant disease is precisely that, despite the fact that cancer develops on the outside of the body, the tumor is disguised as ordinary pigment spots or birthmarks that a person has had for a long time. Therefore, he practically does not notice anything at the very beginning.

At the same time, the cancer itself is the most aggressive and fastest. In one year, it can fully develop and damage nearby tissues and mucous membranes, as well as metastasize to the nearest lymph nodes, and after a short time to all organs through the blood.

Why is melanoma dangerous? It is dangerous due to rapid damage to nearby tissues and metastases to nearby organs - when cancer tissue begins to spread to other parts and grow there. At the same time, the tumor itself interferes with the functioning of the organ and releases waste products into the blood, which also poison the person.

Causes

Like other types of cancer, melanoma occurs when healthy cells mutate under the influence of external and sometimes internal factors. Then the structure of the DNA at the chromosomal level changes and the cells begin to change. In this case, the cell loses its program configured by the body and begins to endlessly divide and multiply.

Most often, it is the causes and risk factors of an exogenous nature that influence, and the endogenous, in turn, can simply feed the neoplasm itself and worsen the condition. Let's consider all the risk factors for the development of malignancy.

External factors

Every day our skin protects us from all types of influences, from chemical, biological and other attacks. Therefore, when protecting, the skin itself can become damaged and hurt. It is from this that internal changes in the tissues of the skin can occur.

Ultra-violet rays. A person not involved in medicine has probably heard that you should not stay in the sun for a long time, and it is especially dangerous to do this without sunscreen. Many scientists argue that exposure to sunlight and ultraviolet radiation affects skin cells. Because of which tissues can mutate and turn into cancer. The more intense and powerful the radiation, the greater the likelihood of pathology. Doctors point to a historical factor, when a child could have severe sunburn in childhood, and get the disease in adulthood after a long time.
Radiation is one of the most common reasons any oncology. All types of rays when exposed to radiation cause changes at the molecular level and change chromosomes in DNA.
Electromagnetic radiation. People who work more often in the electronics industry and related to these factors are more likely to get melanoma than others.
Injuries and wounds on moles. Doctors have long been keeping statistics that include patients who mechanically damaged their mole, and later it turned into cancer.

Chemical exposure

Chemical industry workers associated with oil and other flammable substances. In the production of rubber, paint, plastic. Any chemical that comes into contact with the skin almost immediately begins to affect the tissue.

Nutrition

This type of cancer is practically no different from others, and people who often consume food of animal origin have a greater risk. Any red meat, as well as animal fats, can contribute to skin cancer.

Doctors recommend eating more berries, vegetables, fresh fruits (Not canned), and various green foods. This may be due to the fact that the large cattle And in pigs, cancer is a very common occurrence. And they sell exactly this kind of meat to us in stores. However, there is no direct evidence yet that cancerous animal meat causes tumors in humans.

Of course, alcohol and cigarettes also have an impact here. You have to understand that this is it chemical substances have mutagenic properties for cells. And the risk of developing melanoma in an alcoholic and a smoker doubles.

Internal factors

People with red hair, blue eyes, and fair white skin with freckles often get sick. Such people have very little melanin and the risk of getting sick is higher.
Genetic predisposition - provides a strong factor for cancer if the mother or more than two immediate relatives are ill in the family. Then the risk of disease is 40-45% higher.
In plump, tall people with a large area of skin.
Various hormonal disorders that lead to increased estrogen or melanostimulating hormone lead to an increased chance of getting sick.
Any cancer most often occurs in a weakened body with a poor immune system. Since it is she who first begins to destroy mutant cells.

Birthmarks

Most often, cancer occurs and grows directly from a mole or so-called birthmark. In general, almost every inhabitant of the planet has this benign formation and is located everywhere on the body.

The most dangerous moles:

Dubreuil's melanosis is a mole that has a curved shape and non-rounded features; every year the mole itself grows and increases in size.
Very dark, even black in color with a large size of 1.5 cm.
When there are a large number of dark-colored moles on the body.

Symptoms

Since cancer is usually hidden in the tissues of a birthmark or any other benign neoplasms on the skin, the signs in the early stages are quite weak. But we will look at exactly what characteristics moles must have in order to identify cancerous ones.

Normal mole

It has a symmetrical shape.
Smooth and clear outlines.
Even color from yellow to dark brown and black.
The mole is flat and does not have a convexity; it is flush with the skin.
Small size. It can grow, but very slowly over a very long time (several years).

Melanoma

The mole itself has a slight elevation.
Oval or irregular asymmetrical shape and size.
The diameter is greater than 6 mm in diameter.
At the slightest impact, injuries occur and blood flows.
The presence of ulcerations after a short time.
Melanoma pigmentation appears unevenly in the area Brown color, may have a rim of light or, conversely, dark pigment. At the same time, the color does not look like an ordinary mole.
The cancer itself does not always grow from a mole and can appear on a normal area of skin in the form of a pigment spot, which then grows and turns into an ulcer.

What does melanoma look like?

As you can see, the affected area begins to affect the pigment spot or mole itself, which is why it changes its shape and becomes deformed. Pay attention also to the color of moles - it is not uniform and torn at the edges.

Stages

Determining the phase of any cancer is the key to correct prognosis and treatment. The doctor first needs to know what he is dealing with: the size of the tumor, stage, aggressiveness of the cells, as well as the nature of the tumor itself. Let's consider and analyze all the stages of melanoma.

Stage 1

At the initial stage, the tumor itself usually does not manifest itself in any way and the course of the disease is asymptomatic. Even with a magnifying glass it is very difficult to recognize it on the surface of the skin in a separate birthmark.

First, stage 0 occurs, when melanoma has the “in situ” stage, or translated as “In place”. The tumor itself is located within the epidermis. Then it grows in size up to 1 mm and enters the initial phase.

Stage 2

The tumor has already grown a little, but still does not go beyond the birthmark. there are no metastases yet, and the formation has not spread to the nearest lymph nodes. Red melanoma has a thickness of 1 to 5 mm. This stage is painless and has no characteristic features bleeding or sudden change in color of the mole.

Stage 3

The formation is already quite large in size; abscesses and bleeding may appear on the nevus of the mole. The doctor takes tissue for a biopsy from the lymph nodes to determine the stage, since it is at the third stage that pigmented melanoma begins to penetrate into nearby tissues and lymph nodes. General health deteriorates greatly, fever, nausea and vomiting may appear.

Stage 4

Caused by metastases to all organs of the body. The lungs are affected first, then the liver, brain, bones and stomach with intestines. At this stage, the main thing for doctors is not to cure the patient, since this is impossible, but to make his life simpler and painless.

How does a mole turn into cancer?

It is this stage of the transition of a benign formation to a malignant one that is determined by the transition of stage 0 to stage 1. If cancer is detected at this stage, then the treatment will pass with great success.

If the mole was flat and later started slowly becomes convex. In this case, the formation may simply grow slowly over a short period of time.
The primary lesion may appear darker in color.
When cancer begins to grow in a large mole, you may feel a small lump when you press on it with your finger. The birthmark becomes asymmetrical.
Uniform color changes color. In some places the color changes and a dark spot appears.
The color may become lighter or darker.
In a malignant neoplasm, unpleasant sensations of itching, tingling or burning appear. Melanoma hurts a little.
In later stages, redness appears around the birthmark, which increases over time.
If there was hair in the mole, it will fall out.
At the third, fourth stage, bleeding from the mole appears. The skin nearby peels off, and jams appear.

NOTE! If you notice at least one of the symptoms on your body, you should immediately consult a dermatologist. Additionally, take clinical and biochemical blood tests. All this is necessary to detect cancer at earlier stages.

Diagnostics

First, the doctor performs a visual examination and listens to all the patient’s complaints. At this point, it is better to explain in detail about the mole or formation on the skin that bothers you. The doctor will check other birthmarks and note the most suspicious and dangerous ones.
Next, the patient submits tests, blood and, just in case, stool for examination. Perhaps the doctor will additionally prescribe tests for tumor markers.
Hardware dermatoscopy is performed - when the entire tissue cover around the neoplasm is checked. This way you can see not only the extent of the damage, but also the size of the tumor.
A lymph node puncture is performed to identify stage 3. Sometimes this method helps diagnose cancer, even if it is not visually visible. A tissue sample is taken from the enlarged nodes and tested for biopsy.
If the doctor determines the tumor itself and there are metastases to the nearest lymph nodes, then it is further necessary to determine stage 4, when metastasis occurs to all organs. Ultrasound examination of organs and tissues is performed abdominal cavity, Ultrasound of the brain and spinal cord and radiography
There is another way to detect skin cancer if other research methods are not suitable. The doctor excises part of the skin formation and sends the tissue for histological examination.

Varieties

There are quite a large number of melanomas, and each differs in character and aggressiveness. At the diagnostic stage, it is important for the doctor to find out the type of tumor itself in order to choose further treatment.

View	Description
Achromatic, non-pigmented melanoma	Enough rare view skin cancer, which in the early stages is practically invisible because it has the same color as the skin. The main symptoms are: peeling and thickening at the site of the tumor, hair loss, and in the last stages ulcers appear. A rather serious disease that grows and develops very quickly. Even at stages 2 and 3, there is a small survival rate, since in almost 90% of cases there is a relapse into the skin.
Spindle cell melanoma	It is very difficult to diagnose even on a tissue biopsy, since the cells themselves are very similar to healthy ones. The difference is only in size and shape, and sometimes even in the number of nuclei in the cells. They can be oval, elongated or even binuclear. There is melanoma of the skin of the back, when only loved ones can see and examine it. It is usually diagnosed very late.
Nodular, nodular melanoma	It is a very fast cancer and reaches the last final stage in 1-1.5 years. Quite common in women on the lower extremities.
Subungual melanoma	Melanoma is located on the patient’s leg or arm, in particular on the palms and soles. The tumor itself grows quite slowly and later affects the patient’s nails, making them darker. At the very beginning, the node itself has no color or pigmentation, so it is very difficult to diagnose it. The danger of the disease is that it is detected at a late stage.

Therapy

At stages 1 and 2 of melanoma development, when there are no metastases to organs yet, surgical intervention is mainly used, when the tumor itself is removed along with the affected nearby lymph nodes. Treatment of melanoma in the last stages occurs using immunotherapy and chemotherapy.

Tumor removal

Surgical intervention at the primary stage has good prognosis. From the skin, 2 to 5 cm of skin tissue is usually removed, along with the fat layer and muscles, and the fiber itself is separated. Afterwards the muscles are bandaged with healthy ends. If the lymph nodes of the cervical spine are affected, the Crail operation is performed.

It all depends on the stage of the melanoma itself, and the deeper into the forest, the more difficult the operation will be. If the cancer cell is located on the phalanges of the arm or legs, then the last phalange is amputated, even at the first stage. If melanoma is on the face, then 1 to 3 centimeters of skin and subcutaneous fat are removed.

The fact is that skin cancer is a very nasty disease in terms of relapses, so they try to remove more - just to be sure! At stage 3, if the nearest lymph nodes are affected, the nearest one is completely removed lymphatic collector regional zone.

How to treat melanoma at home? Do not do this under any circumstances and do not undergo treatment. folk remedies and herbs, since they primarily remove symptoms, but not the disease. Contact your doctor immediately and act according to his recommendations.

Is melanoma curable or not? It all depends on the type and stage of cancer.

Immuno- and chemotherapy

Chemotherapy can be used both before surgery to reduce the aggressiveness of cutaneous adecorcinoma and shrink the tumor itself, and after it to kill the last lesions and small cancer cells.

Immunotherapy is also used to improve and enhance the patient’s immunity. So that the body cells themselves begin to fight and attack cancerous tissue. Oddly enough, radiotherapy is not effective for this oncology, and malignant melanoma copes well with radiation. But sometimes this method is used before surgery to reduce the tumor itself.

Forecast

Like any cancer, melanoma has a large number of aggressive and non-invasive aggressive species, which can contribute to both favorable and less favorable prognosis in treatment and recovery.

Of course, early detection of the problem is a big factor, and the earlier, the more favorable the prognosis will be. Often, at stages 1 and 2, the tumor is well treated and quietly removed without severe consequences for the patient.

1st degree cancer is usually associated with a high five-year survival rate of up to 90%.
2 Degree already has a lower chance of up to 65%, since this affects most of the tissues, and there is a risk of relapse.
3 Degree In some species, Melanoma has already metastasized to the nearest tissues of the fatty layer and muscles. Because of this, the operation and subsequent therapy are greatly aggravated. Additionally, some lymph nodes are removed. The percentage varies from 20 to 40.
4 Degree has a low probability of 5 to 15% 5-year survival. If the cancer is very aggressive, then everything depends on the level of treatment. But cancer in advanced stages is usually not curable.

What to do after treatment?

First of all, you need to constantly and regularly undergo examinations, take blood, urine and stool tests. Please contact your oncologist for advice. Sticking to the right diet will help you recover faster, speed up your metabolism, improve and strengthen your immune system, which is the main defender against cancer.

Until about 40 years ago, cutaneous melanoma was a relatively rare disease. However, in recent decades its frequency has increased significantly, and the annual growth rate is up to 5%. Why is melanoma dangerous?

Causes of development and risk factors

Melanoma is one of the types of skin malignant neoplasms that develops from pigment cells - melanocytes that produce melanins, and is characterized by an aggressive, often unpredictable and variable clinical course.

Its most common localization is the skin, much less often - the mucous membrane of the eyes, nasal cavity, mouth, larynx, skin of the external auditory canal, anal opening, female external genitalia. This tumor is one of the most severe forms cancer, which disproportionately often affects young people (15-40 years old), and ranks 6th among all malignant tumors in men and 2nd place in women (after cervical cancer).

It can develop independently, but more often it is “masked” against the background of birthmarks, which does not cause concern for people and creates significant difficulties for doctors in terms of its earliest possible diagnosis. The way this neoplasm develops quickly and is difficult to detect in the initial stages is another danger that often interferes with timely diagnosis. Within 1 year it spreads (metastasizes) to the lymph nodes, and soon through the lymphatic and blood vessels, to almost all organs - bones, brain, liver, lungs.

Causes

The main modern theory of the occurrence and mechanism of development of melanoma is molecular genetic. In accordance with it, in normal cells DNA damage occurs in the form of gene mutations, changes in the number of genes, chromosomal rearrangements (aberrations), violations of chromosomal integrity, and the DNA enzyme system. Such cells become capable of tumor growth, unlimited reproduction and rapid metastasis.

Such disorders are caused or provoked by damaging risk factors of an exogenous or endogenous nature, as well as their combined effects.

Exogenous risk factors

These include chemical, physical or biological agents external environment that have a direct effect on the skin.

Physical risk factors:

Ultraviolet spectrum of solar radiation. Its connection with the occurrence of melanoma is paradoxical: the latter occurs mainly in areas of the body covered by clothing. This indicates the development of the neoplasm not so much as a result of the direct, but rather the indirect effect of ultraviolet radiation on the body as a whole. In addition, it is not so much the duration that matters, but the intensity of irradiation. In recent years, the scientific literature has drawn attention to the particularly high danger of sunburn - even those received in childhood and adolescence, in older age they can play a significant role in the development of the disease.
Increased background of ionizing radiation.
Electromagnetic radiation - tumor occurs more often among people professionally associated with telecommunications equipment and the electronics industry.
Mechanical trauma to birthmarks, regardless of its frequency, is a high risk. It is not entirely clear whether it is the cause or the trigger, but this factor accompanies 30-85% of melanoma cases.

Chemical factors

They are important mainly among those working in the petrochemical, coal or pharmaceutical industries, as well as in the production of rubber, plastics, vinyl and polyvinyl chloride, and aromatic dyes.

From biological factors highest value have:

Nutritional features. High level daily use in food proteins and fats of animal origin, low consumption of fresh fruits and vegetables with a high content of vitamins “A” and “C” and some other bioactive substances are a risk in terms of the development of superficial spreading and nodular (nodular) forms of melanoma, as well as tumors of an unclassified type growth.
With regard to the systematic consumption of alcoholic beverages, it is theoretically assumed that they can provoke the growth of melanomas, but there is no practical evidence of this. It has been precisely proven that there is no connection between the consumption of drinks containing caffeine (strong tea, coffee) and malignant neoplasms. Therefore, nutrition for skin melanoma should be balanced mainly with products of plant origin, especially fruits and vegetables, and contain a rich amount of vitamins and antioxidants (blueberries, green tea, apricots, etc.).
Taking oral contraceptives, as well as estrogen drugs prescribed for the treatment of disorders menstrual cycle And autonomic disorders accompanying the menopause period. Their influence on the development of melanoma remains only a guess, since no clear relationship can be traced.

How does melanoma develop?

Endogenous risk factors

They are divided into two groups, one of which consists of factors that are a biological feature of the organism:

low degree of pigmentation - white skin, blue and light eyes, red or blond hair, a large number of freckles, especially pink ones, or a tendency to have them;
hereditary (family) predisposition - what matters is mainly the disease of melanoma in the parents; the risk increases if the mother was ill or there were more than two people with melanoma in the family;
anthropometric data - a higher risk of its development in people with a skin area of more than 1.86 m2;
endocrine disorders - high levels of sex hormones, especially estrogens, and melanostimulating hormone (melatonin), produced in the middle and intermediate lobes of the pituitary gland; the decrease in their production after the age of 50 coincides with a decrease in the incidence of melanoma, although some authors, on the contrary, indicate an increase in its frequency in older age;
immunodeficiency states;
pregnancy and lactation, which stimulate the transformation of pigmented nevi into melanoma; this is typical mainly for women with a late first pregnancy (after the age of 31), and pregnancy with a large fetus.

The second group is nevi, which are skin changes pathological in nature and characterized by a maximum degree of probability of degeneration into melanoma, as well as being its predecessors. These are benign formations consisting of pigment cells (melanocytes) varying degrees maturity (differentiation), located in varying quantities in different layers of the skin. A congenital nevus is called a birthmark, but in everyday life all formations of this type (congenital and acquired) are called birthmarks. The greatest risks are:

black or dark brown pigmented nevi measuring 15 mm or more;
the presence of 50 or more of these formations of any size;
Dubreuil's melanosis - is a small brown spot with irregular contours that slowly increases over the years, which is usually localized on the face, hands, on the skin of the chest, and less often on the mucous membrane of the oral cavity;
cutaneous xeroderma pigmentosa, characterized by high sensitivity to sunlight; this is a hereditary disease that is passed on to children only if there are specific DNA changes in both parents; These changes result in cells being unable to recover from damage from ultraviolet radiation.

How to distinguish a mole from melanoma?

The actual incidence of the latter from nevus has not been clarified. The types of nevus with the highest risk have been established: complex type - 45%, borderline - 34%, intradermal - 16%, blue nevus - 3.2%; giant pigmented - 2-13%. In this case, congenital formations account for 70%, acquired - 30%.

Melanoma symptoms

At the initial stages of the development of a malignant tumor on healthy skin, and even more so against the background of a nevus, there are few obvious visual differences between them. Benign birthmarks are characterized by:

Symmetrical shape.
Smooth, even outlines.
Uniform pigmentation, giving the formation a color ranging from yellow to brown and even sometimes black.
A flat surface that is flush with the surface of the surrounding skin or slightly evenly raised above it.
No increase in size or slight growth over a long period of time.

Each “birthmark” goes through the following stages of development:

Borderline nevus, which is a spotty formation, the nests of cells of which are located in the epidermal layer.
Mixed nevus - cell nests migrate into the dermis over the entire area of the spot; clinically, such an element is a papular formation.
Intradermal nevus - the formation cells completely disappear from the epidermal layer and remain only in the dermis; gradually the formation loses pigmentation and undergoes reverse development (involution).

What does melanoma look like?

It may take the form of a flat pigmented or non-pigmented spot with a slight elevation, round, polygonal, oval or irregular in shape with a diameter of more than 6 mm. It can maintain a smooth shiny surface for a long time, on which small ulcerations, unevenness, and bleeding subsequently occur with minor trauma.

Pigmentation is often uneven, but more intense in the central part, sometimes with a characteristic rim of black color around the base. The color of the entire neoplasm can be brown, black with a bluish tint, purple, variegated in the form of individual unevenly distributed spots.

In some cases, it takes on the appearance of overgrown papillomas, resembling a “cauliflower”, or the shape of a mushroom on a wide base or on a stalk. Near the melanoma, additional separate lesions (“satellites”) sometimes appear or merge with the main tumor. Occasionally, the tumor manifests itself as limited redness, which turns into a permanent ulcer, the bottom of which is filled with growths. When developing against the background of a birthmark, a malignant tumor can develop on its periphery, forming an asymmetric formation.

A sufficient understanding of the population about what initial signs melanoma, significantly contributes to its timely (in the initial stages) and effective treatment.

Stages of development of a malignant tumor:

Initial, or local (in situ), limited;
I - melanoma 1 mm thick with a damaged surface (ulceration) or 2 mm - with an intact surface;
II - thickness up to 2 mm with a damaged surface or more than 2 mm (up to 4 mm) with a smooth surface;
III - a tumor with any surface and thickness, but with nearby foci or metastases to at least one “duty” (closely located) lymph node;
IV - tumor growth into underlying tissues, distant skin areas, metastases to distant lymph nodes, lungs or other organs - brain, bones, liver, etc.

Of great importance is knowledge of reliable and significant symptoms transition benign formations into an active state. How to recognize malignancy and the moment of transformation of the birthmark into it? Early signs the following:

An increase in the planar dimensions of a previously unchanged or very slowly enlarging mole, or the rapid growth of a newly emerging nevus.
Changing the shape or outline of a pre-existing formation. The appearance of compactions or asymmetry of contours in any part of it.
Change in color or disappearance of uniform coloring of an existing or acquired birthmark.
Change in intensity (increase or decrease) of pigmentation.
The appearance of unusual sensations - itching, tingling, burning, “bloating.”
The appearance of redness around the birthmark in the form of a corolla.
Disappearance of hair from the surface of the formation, if any, disappearance of the skin pattern.
The appearance of cracks, peeling and bleeding with minor injuries (light friction with clothing) or even without them, as well as growths of the type.

The presence of one of these symptoms, and even more so their combination, is a reason for the patient to contact a specialized oncological treatment and prevention institution for differential diagnosis and deciding how to treat melanoma, which depends on its type and stage of development.

Diagnostics

Diagnosis of a malignant tumor is carried out mainly through:

Familiarization with the patient’s complaints, clarification of the nature of changes in the “suspicious” formation, its visual examination, examination of the entire patient in order to count the number of birthmarks, identify those that are different among them and further study them.
Conducting general clinical examinations of blood and urine.
, which makes it possible to examine the neoplasm in the skin layers, magnified several tens of times (from 10 to 40), and make a fairly accurate conclusion about its nature and boundaries according to the relevant diagnostic criteria.
Ultrasound examination of the abdominal organs, computed and magnetic resonance imaging of the spinal cord and brain, radiography of the chest organs, allowing to determine the spread and presence of metastases in other organs.
Cytological examination of a smear (in the presence of ulcerations) and/or material obtained by puncture of a lymph node (in in rare cases). Sometimes examination of punctate from an enlarged lymph node allows one to diagnose the presence of the disease in the apparent absence of a primary tumor.
Excisional biopsy, the meaning of which is to excise a formation “suspicious” of a malignant tumor (within 0.2-1 cm outward from the edges) followed by urgent histological examination. If the diagnosis of melanoma is confirmed, further treatment is immediately carried out. radical removal. Such a diagnosis is carried out in cases where all other results of preliminary studies remain doubtful.

Some types of melanomas

There are many types of melanoma, depending on the cellular composition and growth pattern. This classification is explained by the fact that different shapes have a different tendency to local spread and rate of metastasis. It allows the oncologist to navigate the choice of treatment tactics.

Achromatic or non-pigmented melanoma

It is found much less frequently than other species and is difficult to diagnose due to the fact that it has the color of normal skin and is noticed by patients already in the later stages of development. Its formation begins with a small compaction, which, as it grows, becomes covered with fine lamellar epithelial scales and acquires a rough surface.

Sometimes this neoplasm has the appearance of a scar with uneven edges, sometimes scalloped, pink or whitish in color. The appearance of an inflammatory corolla is accompanied by swelling, itching, sometimes hair loss and ulcers. Can non-pigmented melanoma be cured? This form of the disease is very dangerous due to its late detection, tendency to aggressive growth and very rapid metastasis in the early stages. Therefore, at stage I, effective treatment is still possible; at later stages of the disease, even after intensive radical treatment, tumor recurrence or the development of metastases occurs.

Spindle cell melanoma

Received this name in connection with the characteristic shape of the cells, determined by histological or cytological examination. They look like a spindle and are located separately from each other. Intertwined with cytoplasmic processes of various lengths, which sometimes extend over considerable distances, tumor cells form strands, clusters, and bundles.

The shape of the nuclei and their number in different cells are not the same: there may be cells with two or more elongated, oval, round nuclei. Melanin is concentrated mainly in the processes, due to which they acquire a granular, speckled appearance, which distinguishes them from a sarcoma or tumor of nervous tissue (neurinoma).

Due to the significant similarity with the cells of moles, cytological diagnosis often presents considerable difficulties.

Nodular or nodular melanoma

Among those diagnosed, it ranks 2nd and ranges from 15 to 30%. It occurs more often after the age of 50 on any part of the body, but usually on the lower extremities in women and on the torso in men, often against the background of a nevus. Due to vertical growth, it is one of the most aggressive and is characterized by a rapid course - 0.5-1.5 years.

This tumor has an oval or round shape and by the time the patient consults a doctor, as a rule, it has already taken on the appearance of a plaque with clear boundaries and raised edges, black or unusually blue-black in color. Sometimes nodular melanoma reaches a significant size or has the form of a polyp with a hyperkeratotic or ulcerating surface.

Subungual melanoma

A form of acral-lentiginous tumor affecting the skin of the palms and soles. It accounts for 8-15% of all melanomas and is most often localized on the first finger or toe. The tumor often lacks a radial growth phase, making diagnosis in the early stages difficult. Over the course of 1-2 years, it spreads to the nail matrix and part or all of the nail plate, which becomes brown or black in color. The appearing papules and nodes are often devoid of pigment, so the disease initially does not attract the attention of the patient and lasts for months. Subsequently, ulcerations and mushroom-type growths occur.

Melanoma metastases

Many people have heard about a disease such as melanoma. Its appearance is provoked by the cells responsible for the production of skin pigment. Very often older people get sick with the disease. But similar cases also occur among young people.

Melanoma can occur at any age

Is melanoma dangerous for human health?

People who are afraid of melanoma are worried about only one question: is it dangerous for humans. Like any other disease, cancerous growths on the skin cause serious harm to health. But this disease does not always lead to death. Statistics show that at the first stage of melanoma, patients are cured in 90% of cases. People whose disease has reached the fourth stage have fewer chances. Only a few manage to fully recover.

People with early melanoma have a much better chance of survival. It is not difficult to understand whether it is dangerous. After all, any malignant formation on the human body can cause serious harm to his health.

Timely contact with a specialist increases the chances of a full recovery several times. A disease that is treated at an early stage is almost always eliminated. To recover, a person will have to agree to surgery. For melanoma it is required surgical removal malignant mole. The doctor must also capture part of the healthy tissue that could be infected. Patients are often prescribed chemotherapy. It is also used in the later stages of the disease.

The earlier melanoma is detected, the better a person's chance of survival

When to start worrying

In most cases, people have an unreasonable fear of melanoma. They only need to read an article on this topic or hear a story about a skin cancer patient to begin to fear the disease. Because of this it is completely healthy man suspects he has signs of melanoma, although in fact there are none.

A real cause for concern should appear only if a person begins to notice the main symptoms of melanoma. In the early stages, the disease is recognized by the following signs:

the mole has become asymmetrical, its edges are uneven and undefined;
the diameter of the neoplasm exceeds 5 mm;
the mole has changed its original color;
the nevus began to bleed or fester;
When you touch a mole, pain and burning occurs.

In later stages, malignant nevus has the following symptoms:

pigment spots appeared around the neoplasm;
observed constant bleeding from a mole;
felt severe itching in the area of the mole.

A malignant mole can metastasize. Then the person will begin to complain of persistent headaches, swollen lymph nodes, sudden cramps and sudden weight loss. His skin will turn gray and small lumps will begin to appear underneath. Such symptoms should never be ignored.

Asymmetry, bleeding and discoloration are the first signs of melanoma

Common myths that cause fear of cancer

Fear of melanoma often arises in people due to common myths about this disease. Debunking them or a scientific explanation will help you get rid of this phobia:

A malignant neoplasm appears due to the degeneration of an existing mole on the body. Therefore, her injury will not significantly affect this process. In rare cases, it may even help a person prevent illness. For example, he seriously damaged a nevus and now it is causing him a lot of inconvenience.

To correct the situation, the person goes to see a doctor to remove the skin growth. This way he protects himself from the possible degeneration of the nevus, getting rid of it even before this process begins.

It just so happens that the fear of melanoma appears in many people who mistakenly injured their mole. To get rid of fear and unnecessary unpleasant thoughts, they should simply contact a specialist. He will examine the skin growth, conduct a study and tell you exactly whether the damaged growth is dangerous or not.

Melanoma and tanning are not as closely related as the myth says

How to get rid of the fear of melanoma

It is normal to be afraid of cancer. Every person experiences anxiety when they think about the possibility of getting melanoma. But sometimes these thoughts become too intrusive and do not let you live in peace. In such situations, the problem cannot be ignored. Especially considering that in most cases, fear of melanoma occurs in healthy people.

If a person cannot cope with his problem on his own, then it will be difficult for him to cope without the help of a specialist. Now we're talking about about the psychotherapist. For most this option is the best way out from an unpleasant situation.

Few people are ready to admit their problem and turn to a psychotherapist. People simply don't want to believe what they need qualified assistance. However, it is worth overcoming yourself and doing the right thing. After all, constant exposure to stress negatively affects a person’s performance, keeps him tense and reduces immunity. All this leads to illness.

To cope with the fear of a malignant mole, a person will have to undergo a course of psychotherapy. Depending on the situation, the specialist may suggest that the patient take medications that will reduce the level of anxiety, thereby speeding up the recovery process. With proper treatment, unnecessary fears about one’s health will cease to bother a person after the end of the first cycle of sessions with a psychotherapist.

If the patient is sure that melanoma is fatal, then the doctor may offer him hypnosis or neurolinguistic reprogramming. 3-4 sessions are enough to solve this problem and free a person from the obsession of getting seriously ill with skin cancer.

Psychotherapy will help with obsessive fear of melanoma

A person can try to rid himself of fear on his own, even without the help of a specialist. But for this he needs great willpower and a great desire to get negative thoughts about melanoma out of his head.

The first thing you need to understand is why the fear of getting cancer appeared. Experts believe that a person is not afraid of illness, but of death, which it can lead to. Therefore, you need to fight precisely with thoughts about fatal outcome, not about melanoma. A person must realize the fact that all people will die one day. This cannot be avoided. And cancer is just one of the reasons.

A person who suffers from a panic attack caused by fear of melanoma must learn to get rid of negative feelings and emotions. Doctors have repeatedly said that they are the causes of development dangerous illnesses. Therefore, unnecessary worries will only worsen the situation and may even cause cancer.

It is important to free yourself from negative feelings and thoughts about melanoma to reduce your risk of developing cancer. You need to recharge yourself with positive emotions, surround yourself with pleasant objects and people in order to stop thinking about the bad, thereby protecting your own health from great danger. How fewer people imagine bad things, the less often it happens to them.

If a person cannot escape the thought that he may have melanoma, then he should simply make an appointment with a doctor. He alone is able to confirm or dispel the fears of a patient who is haunted by this problem.

As a rule, after receiving reassuring results, a person stops worrying. To once again make sure of his condition and finally calm down, he can additionally visit another specialist.

Do not panic if the doctor, after conducting preliminary tests, discovers the disease. In the early stages, melanoma is quite easy to cure. The main thing in this matter is to tune in to recovery and not give in to negative emotions. A pleasant atmosphere around and close people will help a patient who has been diagnosed with a malignant tumor on the skin to quickly recover. It also wouldn’t hurt to enlist the support of a psychotherapist who will tell you how to behave correctly in such a difficult situation. The patient’s relatives should also consult with him so that they can, if necessary, help him overcome melanoma.

Which develops from pigment cells (melanocytes) that produce melanin (a natural pigment or dye that determines the color of the skin, hair and eyes).

Statistics

More than 200,000 cases of melanoma are diagnosed annually in the world, and about 65,000 people die from it per year.

Moreover, the increase in the incidence of melanoma in Russia over the past 10 years has amounted to 38%.

It is noteworthy that of all cancer diseases Of the skin, only 4% is melanoma, but in 73% of cases it quickly progresses fatal outcome. Therefore, melanoma is called the “queen” of tumors.

By location, melanoma in 50% of cases occurs on the legs, 10-15% on the arms, 20-30% on the torso, 15-20% on the face and neck. Moreover, in 50-80% of patients, melanoma forms at the site of moles.

In 86% of cases, the development of melanoma is associated with exposure to ultraviolet radiation (sun or tanning beds). Moreover, the risk of melanoma is 75% higher in people who began tanning in a solarium before the age of 35.

In 1960, Peruvian Incas mummies were examined and found to have signs of melanoma. Using radiocarbon dating (used to determine the age of biological remains), it was proven that the age of the mummies was about 2400 years.
The first mention of melanoma is found in the works of John Hunter (Scottish surgeon). But not knowing what he was dealing with, in 1787 he described melanoma as “cancerous fungal growths.”
However, it was not until 1804 that Rene Laennec (a French physician and anatomist) defined and described melanoma as a disease.
American scientists have developed an interesting and unique technique to detect melanoma tumor cells. Researchers say that when exposed to laser radiation, melanoma cells emit ultrasonic vibrations, which allows them to be detected in the blood long before they take root in other organs and systems.

Skin structure

Has three layers:

Epidermis- outer layer skin, having five rows of cells: basal (lower), spinous, granular, shiny and horny. Normally, melanocytes are found only in the epidermis.
Dermis- the skin itself, consisting of two words: reticular and papillary. They contain nerve endings, lymphatic and blood vessels, and hair follicles.
Subcutaneous fat consists of connective tissue and fat cells, which are penetrated by blood and lymphatic vessels, as well as nerve endings.

What are melanocytes?

During fetal development, they originate from the neural crest and then move into the skin, settling randomly in the epidermis. Therefore, melanocytes, accumulating, sometimes form moles - benign neoplasms.

However, melanocytes are also located in the iris (contains pigment cells that determine eye color), the brain (substantia nigra) and in the internal organs.

Melanocytes have processes that allow them to move through the epidermis. Also, through the processes, the coloring pymentum is transmitted to other cells of the epidermis - this is how color is imparted to the skin and hair. Whereas when melanocytes degenerate into cancer cells, the processes disappear.

It is noteworthy that there are several varieties of melanin: black, brown and yellow. Moreover, the amount of pigment produced depends on the race.

In addition, internal and/or external factors can affect melanin synthesis (reduce or increase): during pregnancy, when taking certain medications (for example, glucocorticoids) and others.

The value of melanin for humans

Determines the color of eyes, nipples, hair and skin, which depends on the distribution and combination different types pigments.
Absorbs ultraviolet rays (UV rays), protecting the body from their harmful influences. Moreover, under the influence of UV rays, the production of melanin increases - defensive reaction. Externally it appears as a tan.
Acts as an antioxidant. What's happening? Free radicals (formed under the influence of UV rays) are unstable molecules that take the missing electron from full-fledged cell molecules, which then themselves become unstable - a chain reaction. Whereas melanin gives the unstable molecule the missing electron (the smallest particle), breaking the chain reaction.

What are the types of ultraviolet rays?

Ultraviolet radiation reaching the earth's surface is divided into two main types:

UVB rays are short waves that penetrate the skin shallowly and therefore cause sunburn. In the distant future, they can lead to the development of skin cancer.
UVA rays are long waves that can penetrate deeply into the skin without causing burns and painful sensations. Therefore, a person, without experiencing pain, can receive a high dose of radiation that exceeds the skin's natural protective ability to tan. Then how exactly is UVA rays to blame for the development of melanoma, since in large doses they damage pigment cells.

It is noteworthy that tanning salons use UVA rays, so visiting them increases the likelihood of developing melanoma significantly.

Causes and risk factors for melanoma

Melanoma is formed due to the degeneration of a melanocyte into a cancer cell.

Cause- the appearance of a defect in the DNA molecule of a pigment cell, which ensures the storage and transmission of genetic information from generation to generation. Therefore, if, under the influence of certain factors, a “breakdown” occurs in the melanocyte, it mutates (changes).

Moreover, melanoma can develop in any person, regardless of skin color and race. However, some people are more susceptible to developing this disease.

Risk factors

Mechanism of melanoma formation

Exposure to UV rays on the skin is the most common factor leading to the development of melanoma, so it is the most studied.

What's happening?

UV rays cause “breakage” in the melanocyte DNA molecule, so it mutates and begins to multiply intensively.

However, in The protective mechanism works normally: MC1R protein is present in melanocytes. It promotes the production of melanin by pigment cells, and is also involved in the restoration of the DNA molecule of melanocytes damaged by UV rays.

How does melanoma form?

Fair-haired people have a genetic defect in the MC1R protein. Therefore, pigment cells do not produce enough melanin.

In addition, under the influence of UV rays, a defect occurs in the MC1R protein itself. As a result, it no longer transmits information to the cell about the need to repair damaged DNA, leading to the development of mutations.

However, the question arises: why can melanoma develop in areas that have never been exposed to UV rays?

Scientists have given the answer: it turns out that melanocytes have very limited opportunity to restore damaged DNA by any factor. Therefore, they are often susceptible to mutation even without exposure to UV rays.

Stages of skin melanoma

There is a clinical classification of melanoma stages, but it is quite complex, so specialists use it.

However, to make it easier to understand the stages of skin melanoma, they use the systematization of two American pathologists:

According to Clark, it is based on the penetration of the tumor into the layers of the skin
According to Breslow - when the thickness of the tumor is measured

Types of melanomas

Most often (in 70% of cases) melanoma develops at the site of nevi (moles, birthmarks) or unchanged skin.

However, melanocytes are also present in other organs. Therefore, the tumor can also affect them: eyes, brain and spinal cord, rectum, mucous membranes, liver, adrenal tissue.

Clinical forms of melanoma

There are two phases during the course of melanoma:

Radial growth: Melanoma grows on the surface of the skin, spreading horizontally
Vertical growth: the tumor grows into the deeper layers of the skin

There are five most common types of skin melanoma.

Signs of skin melanoma

They differ depending on the shape of the tumor and stage of development.

Superficial spreading melanoma

Appear on unchanged skin or on the background of a nevus. Moreover, women get sick somewhat more often than men.

Metastases occur in 35-75% of cases, so the prognosis is not very favorable.

What's happening?

In the radial growth phase on the skin there is a slightly raised pigment formation up to 1 cm in size, which has an irregular shape and unclear edges. Its color can be brown, black or blue (depending on the layer of skin in which the pigment is located), and sometimes black or grayish-pink dots (blotches) appear on it.

As the pigment formation grows, it thickens, turning into a black plaque with a shiny surface, and a clearing area appears in its middle (the pigment disappears).

In the vertical growth phase the plaque turns into a knot, the skin of which becomes thinner. Therefore, even with minor trauma (for example, friction with clothing), the node begins to bleed. Next, ulcers appear on the node, from which a bloody discharge appears (yellow liquid, sometimes containing an admixture of blood).

Nodular melanoma

The disease progresses rapidly: on average, from 6 to 18 months. Moreover, metastases spread quickly, and 50% of patients die in a short time. Therefore, this form of melanoma is the most unfavorable in terms of prognosis.

What's happening?

There is no horizontal growth stage, and in the vertical growth phase, the skin of the node becomes thinner, so even a slight injury leads to bleeding. Subsequently, ulcers form on the node, from which a yellowish liquid is released, sometimes mixed with blood (ichor).

The node itself has a dark brown or black color, and often a bluish tint. However, sometimes there is no pigment in the tumor node, so it can be pink or bright red.

Lentiginous melanoma (Hutchinson's freckle, lentigo maligna)

It most often develops against the background of an senile dark brown spot (Dyurey's melanosis), and less often against the background of a nevus (birthmark, mole).

Melanoma is mainly located in areas of the skin that are constantly exposed to sunlight (face, neck, ears, hands).

The development of melanoma is long: it can take from 2-3 to 20-30 years. And as it grows, the pigment formation can reach 10 cm or more in diameter.

Moreover, metastases in this form of melanoma develop late. In addition, with the timely activation of immune defense mechanisms, it can partially resolve spontaneously. Therefore, lentiginous melanoma is considered the most favorable form.

What's happening?

In the radial phase the boundaries of the dark brown formation become blurred and uneven, resembling a geographical map. At the same time, black inclusions appear on its surface.

In vertical phase against the background of the spot, a node appears that can bleed or secrete serous fluid. The node itself is sometimes discolored, and crusts form on its surface.

Acral lentiginous melanoma

People with dark color skin. The tumor can be located on the skin of the palms, soles and genitals, as well as at the border of the mucous membrane and skin (for example, the eyelids). However, most often this form affects the nail beds - subungual melanoma (most often - thumbs arms and legs, as they are susceptible to injury).

The disease develops rapidly, and metastases spread quickly. That's why
the prognosis is unfavorable.

What's happening?

In the radial phase the tumor formation is a spot, the color of which on the skin can be brownish-black or reddish-brown, under the nail - bluish-red, bluish-black or purple.

In vertical phase Often ulcers appear on the surface of the tumor, and the tumor itself takes on the appearance of mushroom-shaped growths.

With subungual melanoma, the nail is destroyed, and bloody discharge appears from underneath it.

Amelanotic melanoma

Occurs rarely (5%). It is devoid of color because the altered melanocytes have lost the ability to produce color pigment.

That's why amelanoma represents the formation of a bodily or Pink colour. It comes in a variety nodal shape melanoma or the result of metastasis of any form of melanoma to the skin.

Melanoma of the eye

It occurs most often after skin melanoma. Moreover, ocular melanoma is less aggressive: the tumor grows more slowly and later metastasizes.

Symptoms depend on the location of the lesion: the iris (contains pigment cells that determine eye color), conjunctiva, lacrimal sac, eyelids.

However, there are signs that should alert you:

One or more spots appear on the iris of the eye
Visual acuity does not suffer for a long time, but gradually it worsens on the side of the diseased eye
Over time, peripheral vision decreases (objects located to the side are difficult to see)
Flashes, spots or glare appear in the eyes
Initially, there is pain in the diseased eye (due to increased eye pressure), then they subside - a sign of the tumor spreading beyond the eyeball
On eyeball redness (inflammation) occurs and blood vessels become visible
A dark spot may appear on the white of the eyeball

How does melanoma manifest?

Melanoma is an aggressive malignant tumor that can affect not only the skin, but also other organs: eyes, brain and spinal cord, and internal organs.

In addition, changes are present both at the site of melanoma origin (the primary focus) and in other organs - with the spread of metastases.

Moreover, sometimes the primary tumor with the appearance of metastases either stops growing or undergoes reverse development. In this case, the diagnosis itself is made only after damage to other organs by metastases. Therefore, it is necessary to know about the manifestations of melanoma.

Melanoma symptoms

Itching, burning and tingling in the area of pigment formation is due to increased cell division within it.
Hair loss from the surface of the nevus caused by the degeneration of melanocytes into tumor cells and destruction hair follicles.
Color change:
- Increased or appearance of darker areas on pigment formation is due to the fact that the melanocyte, degenerating into a tumor cell, loses its processes. Therefore, the pigment, unable to leave the cell, accumulates.
- Enlightenment due to the fact that the pigment cell loses its ability to produce melanin.
Moreover, the pigment formation changes color unevenly: it becomes lighter or darker at one edge, and sometimes in the middle.
Increase in size speaks of increased cell division within the pigment formation.
The appearance of ulcers and/or cracks, bleeding or moisture is caused by because the tumor destroys normal skin cells. Therefore, the top layer bursts, exposing the lower layers of skin. As a result, at the slightest injury, the tumor “explodes” and its contents pour out. In this case, cancer cells enter healthy skin, penetrating into it.
The appearance of “daughter” moles or “satellites” near the main pigment formation- a sign of local metastasis of tumor cells.
Uneven edges and thickening of the mole- a sign of increased division of tumor cells, as well as their germination into healthy skin.
Disappearance of skin pattern is caused by the tumor destroying the normal skin cells that form the skin's pattern.
The appearance of redness around the pigment formation in the form of a corolla - inflammation, indicating that the immune system has recognized tumor cells. Therefore, she sent special substances (interleukins, interferons and others) to the tumor site, which are designed to fight cancer cells.
Signs of eye damage: dark spots appear on the iris of the eye, visual disturbances and signs of inflammation (redness), there is pain in the affected eye.

Diagnosis of melanomas

Includes several stages:

Examination by a doctor (oncologist or dermatologist)
Study of pigment formation using optical instruments without damaging the skin
Sampling from a suspicious area of tissue, followed by its examination under a microscope

Depending on the research results, further treatment is determined.

Examination by a doctor

The doctor pays attention to changing moles or formations that have appeared on the skin recently.

There are criteria by which a benign tumor can be preliminarily distinguished from melanoma. Moreover, knowing them, everyone can check their skin on their own.

What are the signs of malignant transformation?

Asymmetry- when the pigment formation is asymmetrical. That is, if you draw an imaginary line through its middle, both halves are different. And when a mole is benign, then both halves are the same.

Border. In melanoma, the edges of the pigment formation or mole have an irregular and sometimes jagged shape. Whereas benign formations have clear edges.

Color moles or formations that degenerate into a malignant tumor are heterogeneous, having several different shades. Whereas normal moles are one color but may include lighter or darker shades of the same color.

Diameter for a normal mole or birthmark - about 6 mm (the size of an eraser at the end of a pencil). All other moles must be examined by a doctor. If no deviations from the norm are noted, such formations should be monitored in the future by regularly visiting a doctor.

Changes the number, boundaries and symmetry of birthmarks or moles is a sign of their degeneration into melanoma.

On a note

Melanoma does not always differ from a normal mole or birthmark in all of these ways. Just one change is enough to see a doctor.

If the oncologist finds the formation suspicious, he will conduct the necessary studies.

When is a biopsy and microscopy of a pigment formation needed?

To distinguish dangerous pigmented formations on the skin from non-dangerous ones, three main research methods are used: dermatoscopy, confocal microscopy and biopsy (sampling a piece of tissue from the lesion followed by examination under a microscope).

Dermatoscopy

An examination during which a doctor examines an area of skin without damaging it.

For this, a special instrument is used - a dermatoscope, which makes the stratum corneum of the epidermis transparent and gives a 10-fold magnification. Therefore, the doctor can carefully consider the symmetry, boundaries and heterogeneity of the pigment formation.

There are no contraindications to the procedure. However, its use is not informative in non-pigmented and nodular melanomas. Therefore, more thorough research is needed.

Confocal laser scanning microscopy (CLSM)

A method that produces images of layers of skin without damaging them to remove a tissue sample from the lesion. Moreover, the images are as close as possible to smears obtained using a biopsy.

According to statistics, the diagnosis in 88-97% of early stages of melanoma using CLSM is made correctly.

Methodology

A series of optical sections (photographs) are taken in vertical and horizontal planes using a special installation. Then they are transferred to a computer, where they are already examined in a three-dimensional image (in 3D - when the image is transmitted in full). In this way, the condition of the layers of the skin and its cells, as well as blood vessels, is assessed.

Indications for testing

Primary diagnosis of skin tumors: melanoma, squamous cell carcinoma and others.
Detection of melanoma recurrence after removal. Because due to lack of pigment, the initial changes are minor.
Dynamic monitoring of precancerous skin diseases (for example, Dubreuil's melanosis).
Examination of facial skin when unaesthetic spots appear.

Contraindications are not required for the procedure.

However, if we are talking about melanoma, then the final diagnosis is made only on the basis of examining a tissue sample from the lesion.

Biopsy

A technique during which a piece of tissue is taken from the area of pigment formation and then examined under a microscope. Tissue collection is carried out under local or general anesthesia.

However, the procedure carries certain risks. Because if you incorrectly “disturb” melanoma, you can provoke its rapid growth and spread of metastases. Therefore, tissue collection from the site of the suspected tumor is carried out with precautions.

Indications for biopsy

If all possible diagnostic methods have been used, but the diagnosis remains unclear.
The pigment formation is located in areas unfavorable for removal (a large tissue defect is formed): hand and foot, head and neck.
The patient is scheduled to undergo amputation of a leg, arm, and removal of the breast along with regional (nearby) lymph nodes.

Conditions for biopsy

The patient must be fully examined.
The procedure is carried out as close as possible to the next treatment session (surgery or chemotherapy).
If the pigment formation has ulcers and weeping erosions, fingerprint smears are taken. To do this, apply several fat-free glass slides (glass plastic on which the taken material will be examined) to the surface of the tumor, trying to obtain several tissue samples from different areas.

There are several ways to collect tissue for melanoma.

Excisional biopsy - removal of the tumor focus

It is performed when the tumor is less than 1.5-2.0 cm in diameter. And it is located in places where removal will not lead to the formation of cosmetic defects.

The doctor uses a surgical knife (scalpel) to remove the melanoma, excising the skin to its full depth, including 2-4 mm of healthy skin.

Incisional biopsy - marginal excision

It is used when it is impossible to immediately close the wound: the tumor is located on the face, neck, hand or foot.

Therefore, the most suspicious part of the tumor is removed, including an area of intact skin.

When the diagnosis is confirmed (regardless of the biopsy method), tissue is excised according to the depth of tumor penetration. The operation is performed on the same day or no more than one to two weeks later if the laboratory doctor finds it difficult to provide an urgent answer.

Fine-needle or puncture biopsy (obtaining a tissue sample by puncture) is not performed for primary melanoma. However, it is used when a relapse or the presence of metastases is suspected, and also for examining regional (nearby) lymph nodes.

Biopsy of sentinel lymph nodes

Lymph nodes (LN) are a filter through which lymph passes along with cells detached from the primary tumor.

“Sentinel” or regional lymph nodes are located closest to the tumor, becoming a “trap” for cancer cells.

Tumor cells remain in the lymph nodes for some time. However, then, with the flow of lymph and blood, they spread throughout the body (metastases), affecting and disrupting the functioning of vital organs and tissues.

Therefore, to assess the condition and determine further treatment tactics, a tissue sample is taken from the “sentinel” lymph nodes.

Indications for biopsy

The thickness of melanoma is from 1 to 2 mm.
Patients over 50 years of age because they have a poor survival prognosis.
Melanoma located on the head, neck or face because the lymph nodes are close to the tumor. Therefore, the likelihood of cancer cells spreading from the primary site is higher.
The presence of ulcers and weeping erosions on the surface of melanoma is a sign of tumor growth into the deeper layers of the skin.

Execution method

Around the lymph nodes, a special dye with a phosphorus isotope is injected into the skin, which moves through the lymphatic vessels towards the lymph nodes, accumulating in them. Then, two hours later, lymphoscintigraphy is performed - using a special installation, an image of the lymph node is obtained.

Distinctive features of dysplastic nevus and melanoma in the radial as well as vertical growth phase

Sign	Dysplastic nevus	Melanoma in the radial growth phase	Melanoma in the vertical growth phase
Size of pigment formation	Usually have 6 mm, rarely -10 mm in diameter	Have more than 6-10 mm in diameter	From 1 to several centimeters
Symmetry	Quite symmetrical	Sharply asymmetrical	Sharply asymmetrical
Cytological features revealed under a microscope
Shape and size of melanocytes	Symmetrical, approximately the same size.	Asymmetrical and different sizes.	Asymmetrical and of different sizes, and their processes are smoothed out or absent.
Location of melanocytes	Uniform along the edge of the lesion, but they sometimes form a few clusters in the epidermis.	They are unevenly located in the epidermis singly, forming clusters (“nests”) that can have different sizes and shapes. However, they are absent in the dermis.	They are unevenly located in the epidermis, forming “nests” that have different sizes and shapes. There are also one or more “nests” in the dermis. Moreover, they are much larger in size than those found in the epidermis.
Changes in the stratum corneum (superficial) layer of skin	No changes	There is hyperkeratosis (excessive thickening of the surface layer of the skin), so scales appear	Ulcers appear, the surface of the node becomes wet, there is increased bleeding
The presence of infiltration (accumulation) of lymphocytes - reaction of the immune system	There are few lymphocytes, they form small foci	Lymphocytes form large clusters around pigment cells - band-like infiltration	Compared to the radial phase, there are fewer lymphocytes, and they are located asymmetrically
Distribution of pigment cells	Usually they are not in the dermis. However, if they are present, they are single and smaller in size than in the epidermis.	Available in both the dermis and epidermis. The sizes are the same. In addition, pigment cells can spread along the skin appendages (hair).	Available in all layers of the skin. Moreover, the cells located in the dermis are larger in size than those in the epidermis.
Pigment cell division	Absent	Occurs in a third of cases in the epidermis, and is absent in the dermis	Usually present in all layers of the skin - evidence of metastases
Pigment content in melanocytes	There are single cells with increased content melanin - “random atypia”	In most cells it is increased - “uniform atypia”	Compared to the radial phase, the pigment content is reduced, and the pigment itself is unevenly distributed in melanocytes
Compression of surrounding tissues by “nests”	No	Usually does not squeeze	Yes
Modified skin cells (not pigmented), having a light color, large oval shape and large core	Absent or present in small quantities, located in the epidermis symmetrically around a mature nevus	There are many of them in the epidermis, and they are located asymmetrically around the nevus	Present in large quantities in both the epidermis and dermis

Laboratory tests to diagnose melanoma

They are carried out to determine the presence of metastases in the liver, the degree of cell differentiation (distance of tumor cells from normal ones), progression or reverse development of melanoma.

Laboratory indicators

The content of some factors in venous blood is studied:

LDH (lactate dehydrogenase)- an enzyme that increases in the presence of melanoma metastases to the liver. However, this figure also increases with myocardial infarction, viral hepatitis and muscle injuries. Because it is found in almost all tissues of the body. Therefore, focusing only on the LDH level does not make a valid diagnosis.
CD44std (melanoma marker)- a receptor located on the surface of skin cells for hyaluronate (a component of the skin that moisturizes it).
The indicator increases when skin cells are damaged and metastases spread. Therefore CD44std helps in early diagnosis melanoma and gives an idea of the further prognosis of the disease.
Protein S100 present in nervous tissue, liver and muscles. The level of its increase in the blood indicates the number and extent of organs affected by metastases. In approximately 80% of patients with unsuccessful treatment, this indicator is high. Whereas in 95% of patients in whom the treatment is effective, it decreases.
Fibroblast growth factor (bFGF) increases during the transition of melanoma from the superficial to the vertical growth phase. This indicator is especially high in the last stages of the disease, and therefore indicates a poor prognosis.
Vascular growth factor (VEGF) speaks of increased growth of blood vessels and melanoma itself. This indicator is high in patients at stages III and IV of the disease, which indicates a poor prognosis of the disease.

To detect metastases additional research methods are used in various organs and tissues: ultrasound, computed tomography (lungs, internal organs, brain), angiography (vascular examination) and others.

Treatment of melanoma

The goals are to remove the primary tumor, prevent the development or fight metastases, and increase the life expectancy of patients.

There are surgical and conservative treatments for melanoma, which include various techniques. Moreover, their use depends on the stage of the malignant tumor and the presence of metastases.

When is surgery needed to remove skin melanoma?

Surgical removal of the tumor is the main treatment method used at all stages of the disease. And the sooner it is carried out, the higher the chances of survival.

The goal is to remove the tumor while capturing healthy tissue to prevent the spread of metastases.

Moreover, at stages I and II of melanoma, surgical removal often remains the only treatment method. However, patients with stage II tumors should be monitored with periodic monitoring of the condition of the “sentinel” lymph nodes.

Rules for removing melanoma

Under general anesthesia, since with local anesthesia there is a risk of tumor cell spread (needle trauma).
Careful treatment of healthy tissues.
Without affecting melanoma to prevent the spread of cancer cells. Therefore, the incision on the torso is made 8 cm away from the edges of the tumor, on the extremities - 5 cm.
Contact of the tumor with healthy cells is excluded.
Removal is carried out with the capture of a certain area of healthy tissue (wide excision) to exclude relapse. Moreover, the tumor is removed, capturing not only the surrounding skin, but also subcutaneous tissue, muscles and ligaments.
The operation is usually performed using a surgical knife or an electric knife.
Cryodestruction (use of liquid nitrogen) is not recommended. Because with this method it is impossible to determine the thickness of the tumor, and the tissue is not always completely removed. Therefore, cancer cells may remain.
Before the operation, the contours of the proposed incision are marked on the skin with a dye.

Indications and scope of surgery

More than 140 years have passed since the first removal of melanoma, but there is still no consensus on the boundaries of excision. Therefore, WHO developed criteria.

Limits of healthy tissue removal according to WHO recommendations

It is considered inappropriate to remove more healthy tissue. Since this does not affect the survival of patients, it does impair tissue restoration after surgery.

However, in practice it is difficult to adhere to such recommendations, so the decision is made by the doctor in each specific case individually.

Much also depends on the location of the tumor itself:

On the fingers, hands and feet, amputation of fingers or part of a limb is resorted to.
On the earlobe, it is only possible to remove the lower third of it
On the face, neck and head, with large melanomas, they cover no more than 2 cm of healthy tissue, regardless of the thickness of the melanoma

With such aggressive tactics for removing melanoma, large tissue defects are formed. They are closed using various methods of skin plastic surgery: autotransplantation, combined skin transplantation and others.

Removal of sentinel lymph nodes

On this issue, the opinions of scientists are divided: some believe that prophylactic removal of lymph nodes is justified, others that such tactics do not affect survival.

However, numerous studies have shown that prophylactic removal of sentinel lymph nodes significantly improves patient survival.

Therefore, it is advisable to perform a biopsy of the “sentinel” node, and if there are cancer cells in it, remove it.

However, unfortunately, sometimes micrometastases remain undetected. Therefore, in certain situations, prophylactic removal of regional lymph nodes is justified. Therefore, the doctor makes an individual decision.

Treatment of melanoma with drugs

Several basic techniques are used:

Chemotherapy: are appointed medications, which act on rapidly proliferating melanoma cancer cells.
Immunotherapy: medications are used to improve the functioning of the immune system.
Hormone therapy (Tamoxifen), which suppresses the proliferation of tumor cells. However, this approach is controversial, although there are cases of achieving remission.

The techniques can be used either independently (monotherapy) or in combination with each other.

At stages I and II of melanoma, as a rule, there is enough surgical intervention. However, only if the melanoma was removed correctly and there were no aggravating factors (for example, diseases of the immune system). In addition, immunotherapy is sometimes prescribed for stage II. Therefore, the doctor makes the decision individually in each case.

A different approach to patients who have stage III or IV melanoma: they need chemotherapy and immunotherapy.

Chemotherapy for melanoma

The drugs used suppress the growth and division of cancer cells, causing the tumors to grow back.

However, melanoma cells quickly grow and divide, and also rapidly spread throughout the body (metastases). Therefore, there is still no single developed scheme for prescribing chemotherapy drugs for its treatment.

The most commonly used chemotherapy drugs for the treatment of melanoma are:

Ankylation agents: Cisplastin and Dacarbazine
Notrosourea derivatives: Fotemustine, Lomustine and Carmustine
Vinkaalkaloids (herbal products): Vincristine, Vinorelbine

The drugs are prescribed either alone (monotherapy) or in combination, but depending on the stage of melanoma, the presence of metastases and the depth of tumor invasion.

Moreover, Dacarbazine is considered the “gold” standard in the treatment of melanoma, since no other drug has exceeded its effectiveness. As a result, all combination treatment regimens are based on its use.

Indications for chemotherapy

Basic blood parameters are within normal limits: hemoglobin, hematocrit, platelets, granulocytes
Satisfactory functioning of the kidneys, liver, lungs and heart
Absence of diseases that may interfere with chemotherapy (for example, chronic renal failure)
Tumor involvement of sentinel lymph nodes
Prevention of the spread of metastases
Supplement surgical method treatment

Contraindications for chemotherapy

They are divided into two groups: absolute and relative.

Absolute- when chemotherapy is not performed:

Chronic diseases of the liver and kidneys with severe dysfunction (chronic renal failure, cirrhosis of the liver)
Complete disruption of the outflow of bile (blockage of the bile ducts)
Availability mental illness in the acute stage
When it is known that chemotherapy will be ineffective
Severe underweight (cachexia)

Relative- chemotherapy is possible, but the doctor makes a decision in each case individually:

Autoimmune diseases (eg, rheumatoid arthritis) and immunodeficiency conditions (eg, AIDS)
Old age

infectious diseases

Efficacy of chemotherapy

Depends on the stage of the disease and the method of administration (alone or in combination).

Thus, with monotherapy for advanced melanoma (lytic lesions or the presence of metastases), the effectiveness (complete regression for 3 or more years) does not exceed 20-25%. With combined administration, according to various authors, the overall effectiveness ranges from 16 to 55%.

Melanoma immunotherapy

Under certain conditions, the immune system itself is able to fight melanoma tumor cells - an antitumor immune response.

As a result, primary melanoma can regress (grow back) on its own. In this case, pronounced redness appears around the tumor (immune cells fight cancer cells), and then vitiligo (an area of clearing of the skin) appears at the site of the tumor.

Therefore, immunological drugs are used to treat melanomas: Interferon-alpha, Interleukin-2, Reaferon, Ipilimumab (the latest generation drug).

Moreover, they can be used either alone or in combination with chemotherapy. Since their administration, even in late stages, improves the prognosis of the disease by 15-20%. In addition, positive results are observed in patients who have previously received chemotherapy.

The effectiveness of immunotherapy

If a positive result from immunotherapy is achieved, then there is a high chance of a good prognosis.

Since in the first two years after treatment, 97% of patients experience a partial disappearance of signs of melanoma, and 41% experience a complete reversal of the symptoms of the disease (remission). Moreover, if remission lasts more than 30 months, the likelihood of relapse (new development of the disease) is reduced to almost zero.

However, it should be remembered that the use of immunopreparatives causes the development large quantity complications: toxic effects on the liver and kidneys, development of sepsis (spread of infection throughout the body) and others.

New treatments for melanoma

In Israeli clinics, Bleomycin (an antibiotic) is used. It is injected directly into tumor cells using electricity - electrochemotherapy.

According to Israeli scientists, this method of treating melanoma quickly achieves good effect. However, time will tell how effective its long-term results will be (duration of remission, occurrence of relapses).

Radiation for melanoma

Radioactive radiation (radiation therapy) is used - a phenomenon under the influence of which spontaneous decay of cell structures occurs. Therefore, the cells either die or stop dividing.

Moreover, cancer cells are more sensitive to ionizing radiation, since they divide faster than healthy cells body.

However, ionizing radiation is not used “by eye”, since healthy cells are also damaged. Therefore, it is important to focus the beam, directing it to the tumor with millimeter precision. Only modern devices can cope with such a task.

Methodology

Special installations are used that emit electron beams or x-rays with high energy.

At first, the device makes it simple X-ray, which is displayed on the monitor screen. Then the doctor, using a manipulator, marks the tumor, indicating its boundaries and sets the radiation dose.

Moves the patient
Rotates the emitting head
Adjusts the collimator curtains (a device for producing ionizing radiation) so that the tumor is in the crosshairs

The procedure is carried out in a specially equipped room and lasts from 1 to 5 minutes. The number of radiation therapy sessions depends on the stage and location of the melanoma. Moreover, during the session the patient does not experience pain or discomfort.

Indications

Recurrence of melanoma for irradiation of metastases
Treatment of melanoma located in areas where it is difficult to excise the tumor (for example, the skin of the eyelid or nose)
Treatment of eye melanoma with damage to the iris and protein membrane
After surgery to remove lymph nodes to prevent recurrence of melanoma
Pain relief from metastases to the brain and/or bone marrow

Contraindications

Autoimmune diseases: systemic lupus erythematosus, psoriatic arthritis and others
Severe deficiency body weight (cachexia)
Platelets and leukocytes in the blood are sharply reduced
Serious illnesses kidneys, liver and lungs, accompanied by insufficiency of their work (cirrhosis, renal failure and others)

Adverse reactions

General weakness, increased irritability, headache
Increased dryness in the mouth and skin, nausea, belching, loose stool
Marked decrease in blood leukocytes and hemoglobin
When irradiating the head and neck area - hair loss

Efficiency

Skin melanoma cells are insensitive to usual doses radioactive radiation. Therefore, for a long time, radiation therapy was not used to treat melanoma.

However, it has now been proven that the use of high doses of ionizing radiation improves the prognosis of melanoma.

For example, for metastases to the brain, the effectiveness is 67%, bones - 50%, lymph nodes and subcutaneous tissue - 40-50%.

Whereas when radiation therapy is combined with chemotherapy, the overall effectiveness approaches 60-80% (depending on the stage of melanoma).

During treatment initial stages melanoma of the eye (tumor thickness - up to 1.5 mm, diameter - up to 10 mm), the effectiveness of radiation therapy is equivalent to enucleation (removal) of the eye. That is, complete recovery occurs.

Whereas in the later stages (thickness - more than 1.5 mm, diameter - more than 10 mm), the volume of the tumor decreases by 50%.

Prognosis for melanoma

With stage I and II melanoma without relapse, cure is possible; with relapse, the five-year survival rate is approximately 85%, stage III - 50%, stage V - up to 5%.