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Treatment of melanoma abroad

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 treatment

 

Causes of melanoma

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:

  • Exposure to UV rays. The younger the patient is, the greater the correlation between the UV exposure and risk of melanoma. Intensity is more important than frequency of ultraviolet impact. According to the risk of melanoma, sun tanning is more dangerous for children than for adults.
  • Heredity. Almost 10% of patients with melanoma have relatives who have also suffered from this illness. 
  • Pigment spots. Moles and nevi can also increase the risk of skin disorder and the more spots a person has the higher the risk. 
  •  Race. People of African origin have the lowest risk of melanoma. Europeans have the highest risk of this illness and it is 10 times higher than for Africans. The main reason of this is a low resistance to UV radiation.
  • Skin type. Pale skin and red hair is also a melanoma risk factor. Such skin is least protected form UV-radiation. 

 

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. 

 

Symptoms of melanoma

Every person who suspects melanoma should consult with a doctor. Dermatologists use the ABCDE rule to classify the melanoma :

  • A – asymmetry. Mole doesn’t have a round shape, one of its parts differs from the other. 
  • B – borders. Melanoma doesn’t have clear limits, its edges are indistinct, broken or sharp. 
  • C – colour. It is anisochromatic or not natural. Colour includes different shades of brown or black. Melanoma can be stained in pink, red, white or blue colours.
  • D – diameter. If a mole’s size is more than 6 mm is cause for suspicion. 
  • E – evolving. Formation on the skin can change sizes, shape or colour. 

 

melanoma symptoms

 

Melanoma symptoms are identified visually. They depend on the clinical from of the disease. More often than others the following clinical forms can seen:

  • Superficially spreading melanoma is found in 70% of cases and has the most favourable prognosis. Most common location among women are lower limbs and upper part of the back among men. It looks like a plaque with a horizontal growth and uneven edges. It has a mosaic painting, foci of depigmentation (no staining). Usually, such melanoma grows over several years and then a nodule appears on it which is evidence of vertical growth of the tumour. 
  • Nodular melanoma is diagnosed among 15% of patients. It is the most aggressive tumour with a negative prognosis. Visually, it reminds a nodule or polyp, grows fast and has ulcers. Volume of the formation can double within several months. Tumour can bleed. 
  • Malignant lentigo is found in 8% of patients. It occurs more often among elderly people on opened wounds. Visually, plaques or patches of black or brown colour can appear. Tumour growth is horizontal and slow. 
  • Acral melanoma is common among 6% of patients. A dark stain appears under the nail and usually, a person treats it as a hematoma (a bruise suffered as a consequence of injury). Normally, nobody pays attention to such stains which results in a late consult with a doctor. 

 

Other melanoma forms are rare. All together they make up 1-2% of all cases with this illness. 

 

melanoma diagnostics

 

Diagnostics of melanoma

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:

  • Disappearance of skin picture in the area of pigment spot
  • Skin peeling
  • Hair loss
  • Thickening
  • Enlargement of the regional lymph nodes

 

melanoma instrumental research methods

 

Instrumental research methods help to provide diagnostics like: 

  • Dermatoscopy means that a formation is analysed while enlarged several times. Method doesn’t give a chance to confirm the diagnosis. 
  • Cytology is rarely used. Fine-needle aspiration biopsy of the malformation is not performed at all as it can contribute to the spread of tumour. Cytology is only done if there are ulcers on melanoma (smears). Also, biopsy sample of the enlarged lymph node can be analysed. 
  • Histological examination is mainly used to confirm the diagnosis. An excisional biopsy is performed and the suspicious growth is completely removed. This is followed by a histological analysis. Thus, diagnosis of melanoma is confirmed and a type of tumour is identified. 
  • Optical biopsy is the latest diagnostics method that diagnoses melanoma without intervention. This is greatly beneficial for the patients with a big number of suspicious formations on their skin. Method of reflective confocal microscopy enables tissue examination without their separation from the body.
  • Visualisation methods are used to identify metastases. Chest radiography, ultrasound of the abdominal cavity organs, CT and MRI, bone scan etc. are some of the techniques used to identify the tumour.  

 

melanoma treatment abroad

 

Treatment of melanoma abroad

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.

 

melanoma latest treatment methods

 

Latest treatment methods of melanoma

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:

  • “Zelboraf” and “Tafinlar” are drugs that influence cells with BRAF-genes mutations (this gene is mutated among 50% of patients)
  • “Mekinist” and “Cotellic” are medicines that are directed at the MRP proteins (they are located on melanoma surface)
  • Imatinib, Dasatinib, Nilotinib influence cells with mutations in C-KIT genes (these melanomas are usually developed under the nails, on the hands and feet)

 

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.

 

melanoma prognosis

 

Melanoma - Prognosis

 

 

Negative prognostic factors are:

  • Old age
  • Negroid race
  • immunodeficiency (HIV, transferred organ transplantation, immunosuppressive treatment)

 

Positive prognostic factors are normal level of lactic dehydrogenase and absence of metastases into the internal organs.

 


 

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