Melanoma rates as one of the most common malignant tumours affecting young adults under the age of 30. The rate of this disease is constantly growing worldwide. The number of patients with melanoma doubles every 10 years.
Though this tumour is responsible for about 1% of skin diseases, mortality of the patients is much higher than other types of skin cancer.
Melanoma develops from pigment cells called melanocytes. Primary tumour grows on the skin in 90% of cases and on the mucous membranes, ligaments or aponeuroses in 10% of cases. If melanoma develops on the skin then it grows from melanocytes like moles or nevi. 30% of patients can have melanoma on visually unchanged skin.
Main risk factors of the illness are:
Disease affects women under the age of 30, more so than men. However, most patients are over 50 even though the disease can develop at any age.
Every person who suspects melanoma should consult with a doctor. Dermatologists use the ABCDE rule to classify the melanoma :
Melanoma symptoms are identified visually. They depend on the clinical from of the disease. More often than others the following clinical forms can seen:
Other melanoma forms are rare. All together they make up 1-2% of all cases with this illness.
Before you diagnose melanoma you need to suspect it first. Often, melanoma doesn’t differ from the usual mole or nevus. That’s why a person’s medical history is key for the primary diagnostics.
7 criteria are given below that are characteristic of skin malformation:
1 – size change (mole’s growth)
2 – form or borders change
3 – colour change
4 – inflammatory process (swelling, redness)
5 – bleeding or scab formation
6 – sensitivity change (soreness of the mole or numbness in its area)
7 – formation’s diameter is more than 7 mm
Additional clinical signs that help a doctor to diagnose melanoma are:
Instrumental research methods help to provide diagnostics like:
Surgery is often considered as main form of treatment. Excisional biopsy is performed during the diagnostics stage, with 0,5 – 1 cm of healthy tissue completely removed. Histological analysis is immediately done to confirm the diagnosis, then the extent of the surgery is determined.
Melanoma is removed along with the healthy tissue (3-5 cm on the limbs or body, 2-3 cm on the face), subcutaneous tissue, and fascia or aponeurosis subject. If there are major defects that cannot be fixed by contraction of the wound edges, then microsurgical autoplasty is done using the patient’s own skin flaps. If melanoma is located on the protruding part of the body , for instance the finger or ear, it will be removed completely.
Additionally chemotherapy, immune therapy and targeted therapy are used. The type of treatment depends on the stage of the illness.
Radiation therapy is rarely used unless the disease is at an advanced stage and palliative treatment is required.
New treatment techniques are constantly being developed that significantly increase the patient’s life expectancy.
Among the latest techniques are:
Immunotherapy with dendritic cells. Dendritic cells are taken from the patient’s own blood. These are the basic antigen-presenting cells of the body. They are being stimulated by the tumour cells under laboratory conditions and then they put back. The immune system reacts to the malformation’s cells more actively as a result of treatment.
Melanoma vaccine is a method of immunotherapy when the substance introduced into the body causes the immune system to fight melanoma more actively. Nowadays, vaccines are being clinically tested that includes antigens received from melanoma cells. This however is not yet implemented into practice.
Targeted therapy. There are medication for melanoma treatment that selectively influence tumour cells but don’t damage healthy tissues.
The following medicines are used:
Control points inhibitors. The tumour protects itself from the immune system thanks to the signalling molecules on the cell surface called control points. Substances that “turn off” these points are introduced into the patient’s body and thus, enables the person’s immune system a chance to attack the tumour. Pembrolizumab, Nivolumab, Ipilimumab are used to achieve this goal.
Negative prognostic factors are:
Positive prognostic factors are normal level of lactic dehydrogenase and absence of metastases into the internal organs.
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