How does melanoma manifest? What is melanoma

Melanoma of the skin is a malignant formation that develops from moles (very rarely appears on clean skin). Most often it occurs in open areas, but can even develop on the mucous membranes. Characterized by high aggressiveness. Daughter cells quickly spread throughout the body. The diagnosis is based on the results of histological examination, blood and urine tests for tumor markers. The tactics of treatment depends on the stage of the oncological process. The most effective surgical removal and targeted (targeted) chemotherapy. Radiation methods, classical cytostatics are used for palliative care.

What is melanoma: the mechanism of occurrence

Where melanoma comes from, no scientist knows. Increased risk of skin tumors in people with skin type I-II. In dark-skinned and dark-skinned people, the likelihood of developing the disease is very low.

An important role is played by heredity, since pigmented malignant neoplasms appear in people with a genetic defect. The risk of developing melanoma is higher in people who received sunburn in childhood or in adulthood. The substrate for the tumor is melanin, which contains melanocyte pigment cells. This cell population forms nevi (moles). Cancer can also develop on clean skin.

Most melanoblastomas develop from pigmented nevi, which include:

• giant;
• blue;
• nevus of Ota;
• difficult;
• borderline.

Quite often, atypical cells appear in the areas of xeroderma pigmentosa and Dubrey's melanosis. There is a malignancy of tissues, that is, their malignant degeneration. Provoking factors are injuries, radiation or internal failures of cellular regulation.

Internal and external risk factors

The risk of developing malignant tumors in people with fair skin color is high. According to the international classification, there are 4 Fitzpatrick skin phototypes. Classes I and II belong to the highest risk group.

The first phototype is Celtic. People in this category have fair skin, gray-blue eyes, freckles, red or light straw hair. They have a hard time with exposure to sunlight. Even after a slight insolation (exposure to ultraviolet rays), burns appear on their skin.

The second type includes European people who have fair skin and hair. Their eyes can be blue, green or grey. The skin also reacts poorly to the sun, but burns appear only after prolonged insolation. The proof that ultraviolet rays negatively affect the skin is melanoma on the face, since this anatomical region is located in constant contact with sunlight.

This is what melanoma looks like, not every person can visually distinguish it from an ordinary mole.

Diseases are intrinsic factors. endocrine system, violations of cellular transport and genetic failures.

Why is melanoma dangerous?

Melanoma is considered the most aggressive tumor. Even a small neoplasm gives large distant metastases. Often patients do not understand how quickly melanoma develops, and therefore seek medical help in the later stages.

Pigment tumors are characterized by endophytic (internal) growth. When ingrown into a circulatory or lymphatic vessel they immediately metastasize. Daughter cells spread throughout the body. Most often they are localized in the brain, lungs, liver, bones. After the appearance of metastases, surgical treatment is ineffective. Such patients are prescribed expensive targeted therapy.

The course of the disease is lightning fast. To save a life, you need to see a doctor before the onset of metastasis.

Types and stages

Treatment tactics depend on the clinical form.

Morphological variants of pigmented neoplasms:

• surface form. It often occurs, mainly in women. Characterized by horizontal growth. It has a favorable course, as it does not affect the vessels.
• Nodular (nodular) melanoblastoma. Grows deep into the dermis. The most malignant form.
• Acrolentigious melanocarcinoma is typical for representatives of the Negroid race. Affects the skin of the palms.
• Melanosis Dubrey. It develops from a pigmented spot (freckle) on the face. It most often affects women. Dubrey's melanosis is characterized by a slow, favorable course.

The symptoms of melanoma are quite specific. Knowing them, a person will be able to independently suspect the malignancy of a nevus and seek medical help.

Tumors most often develop from pigmented nevi. The development of neoplasms is preceded by mechanical or chemical traumatization of moles.

The first signs of melanoma according to the international ABCDE system:

• asymmetry. Asymmetry of the mole.
• border. The pigment spot has clear edges, and the malignant neoplasm is blurry, curved. Its borders are sometimes scalloped.
• color. Changes in color or shade indicate malignancy of the mole.
• Diameter. An increase in education over 6 mm.
• evolution. A change in shape, shape, color is an external sign of malignancy.

On the territory of the CIS countries, they also use the "chord classification":

• A is asymmetry.
• K - the edges are uneven.
• K - bleeding.
• O - the color is heterogeneous.
• R - large size.
• D - dynamics of changes in the structure.

The initial stage of cancer is curable. It is necessary to understand how skin oncology manifests itself:

1. If the moles look like fried eggs (light diameter with a dark center), they must be removed.
2. Nevuses that are heterogeneous in structure are more often malignant.
3. A healthy mole does not hurt. Pain syndrome can manifest any skin cancer.
4. Hair loss from a mole is another unfavorable symptom.

Melanoma on the skin is classified according to the stage and clinical course. The TNM classification of melanoma is accepted worldwide. T is the size of the primary tumor, N is metastases to regional lymph nodes, M is distant metastases. An accurate diagnosis can be determined only after a full laboratory, instrumental and histological examination.

How to Diagnose Melanoma

The first question of patients who suspect they have skin cancer is which doctor to contact. Skin problems are dealt with by a dermatologist. But skin cancer can only be treated by a dermatologist-oncologist.

During the examination, the doctor evaluates the boundaries, density, adhesion of the formation with the surrounding tissues. Be sure to conduct dermatoscopy - examination with a magnifying device. The doctor palpates regional lymph nodes to detect metastases.

The diagnosis of melanoma is histological. It is possible to distinguish a malignant tumor from a benign one only after a biopsy. Under a microscope, a smear-imprint is examined. It is forbidden to carry out an invasive biopsy (taking a piece of tissue), as it can stimulate the growth of cancer formation. After excision of the neoplasm, it is sent for detailed morphological diagnostics.

Additionally, computed, positron emission tomography, radionuclide research is carried out. Instrumental methods allow to detect metastases in other organs.

Treatment

How to treat skin melanoma depends on the stage of development. Melanoma is curable with early treatment. A horizontal tumor without metastases is sensitive to therapy. In this case, surgical intervention is sufficient.

With the germination of cancer deep into the tissues and the appearance of metastases, immunotherapy with α-interferon is performed simultaneously with surgical excision. If the foci affect regional lymph nodes, radical removal of the nodes is indicated.

When distant metastases appear, targeted chemotherapy is used. Zelboraf and Erivedge are registered in the Russian Federation. Before prescribing drugs of this group, a molecular genetic study should be carried out. Targeted therapy often helps to completely get rid of skin cancer on the body and internal organs. The main disadvantage of this treatment is its cost. The price for 1 can of the drug is 5-10 thousand dollars. Treatment of melanoma in Russia is identical to treatment abroad. Domestic oncologists work according to international standards.

With the spread of oncological foci beyond the regional lymph nodes, patients are provided with palliative care. Radiation therapy, excision of large metastases are shown.

Forecast

It is not always possible to completely cure melanoma, even with the use of modern medical technologies. The five-year survival rate reaches 48%. Disappointing statistics are associated with late treatment of patients. To achieve stable remission in the absence of metastases, you can use surgical treatment. If the lymph nodes are affected, targeted chemotherapy should be performed.

Prevention

Specific prevention of skin cancer has not been developed. However, careful attention to your health will help diagnose cancer in the early stages or prevent its development. Moles with signs of malignancy should be removed by an oncosurgeon. On sunny days, products with protective factors (UV filters) are applied to the skin. People of 1-2 phototypes should use cosmetics with at least 20 SPF (Sun protecting factor). It is forbidden to remove nevi yourself or in beauty salons.

Myths and truth about melanomas

Let's try to dispel a few common myths about melanomas:

• Myth 1: Melanoma is contagious. The etiology of the disease is unknown. The most reliable cause of the disease is a molecular genetic mutation. The relationship of pathology with infection has not been established.
• Myth 2: A healthy mole cannot develop a tumor. Malignant degeneration appears even in visually unchanged tissue.
• Myth 3: There is no cure for skin cancer. With timely treatment, tumors are curable.
• Myth 4: Melanomas only appear on the skin. This type of neoplasm appears in all organs where there is melanin.
• Myth 5: The sun is safer than a tanning bed. The source of rays does not play an important role in oncogenesis.

To protect yourself and your loved ones, you should regularly medical checkup, including cancer. In summer, the skin must be protected from direct sunlight. The American Cancer Association prohibits sunbathing from 12:00 to 15:00.

Melanoma is a specific type of tumor malignant formation that forms on the skin, this formation develops from melanin-synthesizing melanocytes of skin cells. Melanoma, the symptoms of which can occur in patients at any age (from adolescence), in Lately has become a fairly common disease, in frequent cases leading to death, however, its detection in the early stages does not exclude the possibility of a cure.

general description

Melanoma is just one of the varieties of existing oncological skin pathologies. The epidemiology of this disease in the countries of Central Europe, as part of the consideration of annual indicators, corresponds to a ratio of 10 cases of its occurrence per 100,000 inhabitants. For the same number of people in the southern states of America and in Austria, the incidence is slightly higher and is about 37-45 cases.

The data of one of the Berlin clinics indicate that on average about 14 thousand cases of this disease are diagnosed annually in Germany, and the ratio of the incidence of cases indicates that here women are more susceptible to it - 6 thousand cases occur in men, 8 thousand - on women. Mortality from melanoma in this case is determined by 2 thousand cases of the disease, which, in turn, determines approximately 1% of the total consideration of mortality from cancer.

Patients over 70 years of age are most affected by melanoma. As we initially noted, recently melanoma has become a fairly common disease, in particular, there is information that over the past fifty years, global incidence rates have increased by 600%.

Predominantly, melanoma is concentrated in the region of the trunk and extremities in persons whose skin type belongs to Eastern European. Signs of melanoma are mostly observed in fair-haired and red-haired patients with green, gray or blue eyes and also with pink freckles. In addition to the genotype, the presence of atypical moles and nevi (congenital age spots) is distinguished as predisposing factors. In particular, nevi become a background predisposing to the development of melanoma when they are re-injured, as well as located in the back, foot, shoulder girdle and open areas of the body. Much more dangerous are those melanomas that develop against the background of acquired pigmentation, that is, when spots appear in patients of the mature age group. Exposure is also considered as a risk factor ultraviolet radiation, Dubreu's melanosis, heredity and pigment xeroderma, the presence of more than 50 moles, a significant number of freckles (including their rapid formation).

Despite the previously noted predisposition to the development of melanoma in white-skinned people, it should be borne in mind that this disease can develop in a person belonging to any race and with any skin color, that is, melanoma is not limited to the defeat of people with white skin color.

It should also be noted that hairy nevi never become malignant, respectively, if hair growth is detected when examining a pigmented tumor formation, then it should not be classified as a malignant formation.

Melanoma appears not only on previously formed age spots, but also on healthy skin. Melanoma in women predominantly focuses on the lower extremities, while in men there is a tendency to develop melanoma mainly on the trunk (especially often on the back). Typical areas for the appearance of a tumor formation are those areas that are most susceptible to ultraviolet radiation. However, at the same time, such areas are not excluded, which practically cannot get ultraviolet radiation, in particular, these are the interdigital spaces, the esophagus, the soles of the feet. The incidence of melanoma in infants and children is possible only as the rarest exception; in this case, their previous exposure to sunburn becomes a predisposing factor for the development of the pathological process.

There are also certain differences in the degree of "malignancy" of the disease we are considering, here we mean the rapid development of melanoma. Accordingly, a rapid disease is considered if it develops within a period of several months according to the “diagnosis-lethal outcome” scheme, and a long-term disease is considered when it occurs in combination with appropriate therapy within a period of 5 years or more.

As a very insidious manifestation of melanoma, the early formation of metastases is determined, which occurs in certain organs in the body, due to which a fatal outcome for the patient can subsequently occur. Most often, the heart, skin, lungs, liver, brain and bones of the skeleton are affected by metastases. Melanomas that have not spread beyond the basement membrane in the skin cells (that is, the layer located between the epidermal layer and the dermis layer) determine the practical elimination of the risk of metastases.

As for the types of melanoma, as well as the frequency of their occurrence, here their classification is as follows:

• - is characterized by its slow growth, the frequency of occurrence is the highest, is 47%;
• Melanoma nodular (nodular)- characterized by its own rapid growth, in terms of frequency of occurrence it is somewhat inferior to the previous form, determining an indicator of 39%;
• peripheral lentigo- the frequency of occurrence is 6%, this form of the disease is defined as precancerosis (or precancer, that is, such a pathological condition in which tissue changes, like the course of processes itself, naturally precede cancer, and the long-term existence of the disease in this form is most likely leads to its transition to cancer).
• Amelanotic melanoma (acral melanoma)- is diagnosed extremely rarely, the area of ​​​​concentration in this case is concentrated within the plantar and palmar surfaces.

Skin melanoma: symptoms

Before we move on to a more detailed consideration of the processes and symptoms associated with the course of the disease, we highlight the main signs of melanoma, which provide the possibility of its early recognition, there are five in total:

• asymmetry of education (irregularity of its shape);
• heterogeneity of the color of the formation: in some places the tumor is dark, in some it is light, and in some cases it can be combined with almost black areas;
• the edge of the tumor formation is arcuate and uneven, indistinct, there may be notches;
• the diameter of the tumor formation is 5 mm or more;
• the peculiarity of the location of the tumor formation is that it is in a somewhat elevated position compared to the level of the surface of the skin (more than 1 mm).

In about 70% of cases, melanoma develops from a nevus (mole), mainly, as we have already noted, it focuses on the extremities, neck and head. In men, the chest and back, as well as the upper limbs, are more likely to develop this type of tumor; in women, the lower limbs and chest. The greatest danger is the epidermal (or borderline) nevus, which mainly occurs in men in the skin of the scrotum, soles or palms. As the main signs that a malignant process is occurring, there is an increase in size, a change in color (weakening or intensification of color), the appearance of bleeding and skin infiltration (impregnation with a certain substance) surrounded by a nevus and under its base.

Outwardly, melanoma resembles a tumor nodule of a dense type, its color can be black or slate, in some cases with a bluish tint. Somewhat less often, non-pigmented melanomas are formed, according to the definition, it can be understood that they are devoid of pigment, they have a pinkish tint. Regarding the size, a diameter in the range of 0.5-3 cm can be distinguished. In frequent cases, the tumor formation has a bleeding eroded surface and a somewhat compacted base. Any of these signs allow you to make a primary self-diagnosis through a routine examination (but you need to use a magnifying glass for it).

As part of the course of the early stages of the disease, a malignant formation is outwardly more harmless than in later stages, therefore it is possible to distinguish it from a benign pigment nevus only with sufficient experience for this.

Let us dwell on the three main common forms of melanoma that we have identified earlier, or rather, on their features. In particular, we are interested in the superficially advanced form of melanoma, nodular (nodular) melanoma, as well as malignant lentigo.

Malignant lentigo characterized by the duration of the course of the phase of its own horizontal growth, determined in a time interval ranging from 5 to 20 years, and in some cases even more. Typical cases of the course are noted in elderly people in the open areas of the skin of the neck and face, on which plaques or spots of brown-black color appear.

Melanoma, superficially advanced develops in patients with more young age(in this case, their average age is 44 years). As for the area of ​​development of a tumor formation, the same frequency of its appearance is noted here both in open areas of the skin and in closed areas. In women, the lower extremities are mainly affected, and in men - top part back. The emerging plaque has an irregular configuration, the contour is scalloped, there are foci of discoloration and regression, the color is mosaic, keratosis appears on the surface (a condition of thickening of the epidermis layer). A few years later (about 4-5 years) a node is formed on the plaque, which indicates the transition of the process from horizontal to vertical growth.

Melanoma nodular acts as the most aggressive variant of tumor development in terms of the type of manifestation. The age of patients subject to this type of formation is on average 53 years, with respect to predisposition in accordance with gender, the ratio of 60:40 (men / women) is indicated. Most often, the localization of the process is concentrated in the area of ​​​​the skin of the back, head and neck, as well as limbs. The node increases quickly enough, patients notice such changes in it within a period of several months, accompanied by an increase in the formation of ulcers and its general bleeding.

As a direct consequence of the use of non-radical measures in the treatment of melanoma, its relapses are. Such cases are often accompanied by the detection of a distant type of metastasis, which occurs in parallel with the detection of recurrence, and sometimes even before the moment of its occurrence. Exclusively chemotherapeutic treatment is used in situations with widespread forms of the disease, with the relevance of distant metastases. In particular, combined treatment options with the use of anticancer drugs are used, which determines the possibility of tumor regression in about 40% of cases.

Melanoma: metastasis

Malignant melanoma is prone to fairly pronounced metastasis, not only by the lymphogenous route, but also by the hematogenous route. Predominantly affected, as we have already noted, are the brain, liver, lungs, heart. In addition, dissemination (spread) of tumor nodes along the skin of the trunk or limb often occurs.

The option is not excluded, in which the patient seeks the help of a specialist solely on the basis of an actual increase in the lymph nodes of any area. Meanwhile, a thorough questioning in such a case can determine that a certain time ago, for example, he, as an achievement of an appropriate cosmetic effect, removed the wart. Such a “wart” actually turned out to be melanoma, which is subsequently confirmed by the results of a histological examination of the lymph nodes.

Melanoma of the eye: symptoms

Melanoma, in addition to skin lesions, is also a fairly common eye pathology, in which it manifests itself as a primary tumor formation. The main symptoms of melanoma of the eye are the appearance of photopsies, progressive scotomas and visual impairment.

Photopsies in particular are a pathological condition in which flickering sparks, luminous dots, “light flashes” and color spots appear in the field of view. As for such a manifestation as a scotoma, it is a blind area of ​​a limited type that occurs in the field of view, subjectively it is perceived by patients as a dark spot (in this case, it is a positive scotoma), or not perceived at all (negative scotoma). Identification of scotoma in a negative variant is possible only when carrying out special research techniques.

Often, small melanoma determines the difficulty in differentiation from a pigmented nevus, which is concentrated in the region of the choroid.

To determine the growth of the tumor formation, repeated studies are necessary. As for the generally accepted tactics in treatment, it does not exist for melanoma of the eye. Ocular enucleation and local resection are performed, as well as radiation therapy.

Melanoma: stages

The course of melanoma is determined by a specific stage, which corresponds to the patient's condition at a particular moment, there are five in total: stage zero, stages I, II, III and IV. The zero stage makes it possible to identify tumor cells exclusively within the outer cell layer; their germination to deep-lying tissues does not occur at this stage.

I stage determines the size of the thickness of the tumor formation within the limits not exceeding one millimeter, the epidermis (that is, the skin on the outside) is often covered with ulcerations. Meanwhile, ulceration may also not appear, the thickness of the tumor formation can reach about two millimeters, and the lymph nodes that are in close proximity to the pathological process are not affected by melanoma cells.

II stage tumor formation in melanoma determines for it the size of at least a millimeter in thickness or 1-2 mm in thickness with the appearance of characteristic ulcerations. This stage also includes tumor formations, the thickness of which exceeds two millimeters, with possible ulceration of their surface or with a surface without ulcers. At this stage, melanoma in any of these options does not spread to the lymph nodes located in close proximity to it.

next, III stage , accompanied by damage to the pathological process of nearby tissues, in addition, the study reveals the presence of tumor cells in one lymph node or in more of them, the affected lymph nodes are also located in close proximity to the affected area of ​​the skin. The possibility of melanoma cells leaving the borders of the primary focus is not excluded, however, the lymph nodes are not affected.

For IV stage The progression of the disease is characterized by the spread of tumor cells to the lymph nodes, as well as to neighboring organs and those areas of the skin that are located further outside the melanoma.

As we have already noted, relapses of the disease are not excluded even with correctly defined and carried out treatment. The pathological process can return both to the area that was previously affected, and form in that part of the body that was not related to the previous course of the process.

Melanoma: prognosis by stages

In this case, the clinical stage corresponding to the course of melanoma at the time of diagnosis is considered as the most important factor. Regarding survival within the framework of stages I and II, in which the localization of the tumor is concentrated within the boundaries of the primary focus, the survival rate for the next five years is approximately 85%. In the case of stage III of the course of the disease, in which metastasis occurs to regional lymph nodes, the survival rate for the specified 5-year period is reduced to 50% if the process affects one lymph node and about 20% if several lymph nodes are affected. As part of the consideration of stage IV, accompanied by distant metastasis, survival for the next five years is no more than 5%.

A positive aspect in the overall picture of the disease, directly related to its prognosis, is that in most cases melanoma is detected during stages I and II. The prognosis in this case is determined based on the thickness of the tumor formation, because it is the thickness that indicates the mass that is relevant for the tumor, while the mass of the tumor determines the likelihood of subsequent possible metastasis.

With a thickness of the tumor formation within the limits of no more than 0.75 mm, the prognosis of successful cure due to surgical intervention is determined, as for survival within the standard considered period of 5 years, here it is relevant in 96-99% of cases. Approximately today, it can be indicated that in approximately 40% of cases of morbidity in patients, a tumor formation is detected within its thickness of up to 1 mm, while the patients themselves in this case are identified in the so-called low-risk group. In those patients who develop metastases, a histological examination of the primary tumor formation determines either its vertical growth or spontaneous regression.

With a melanoma thickness of more than 3.64 mm, metastasis occurs in almost 60% of cases, such a course entails a fatal outcome for the patient. In most cases, tumors of similar size stand out significantly against the general background of the skin, rising noticeably above it.

In general, the prognosis directly depends on where exactly the tumor is located. Thus, the most favorable prognosis is determined by the localization of the tumor formation in the region of the legs and forearms, not favorable prognosis, in turn, is determined by its localization in the feet, hands, scalp, and mucous membranes.

There is also a certain trend in terms of gender in this respect. Thus, stages I and II are characterized by a better prognosis for women than for men. To some extent, this trend is due to the fact that the tumor in women is predominantly localized in the area of ​​​​the legs, where it is easier to detect it during self-examination, which, in turn, makes possible subsequent treatment in the early stages, in which the prognosis is so favorable. .

When considering the prognosis for melanoma for elderly patients, it can be noted that here it is less favorable, due to the late detection of the tumor, as well as the high susceptibility of older men to acral lentiginous melanoma.

The prognosis for the recurrence of the disease is based on general statistics, according to which about 15% of cases of relapse appear more than five years after the removal of the tumor. The main pattern here is as follows: the thicker the size of the tumor, the faster it is subject to subsequent recurrence.

As unfavorable factors for the prognosis during the period I and II stages, such factors as ulceration of the tumor formation, increased mitotic activity, and the formation of satellites (peculiar islands of tumor cells, reaching sizes from 0.05 mm or more) are distinguished. The latter are concentrated outside the main focus of the tumor, within the reticular layer of the dermis or in the subcutaneous tissue. Also, satellites in most cases of melanoma occur together with micrometastases directed to regional lymph nodes.

Stage I and II melanoma can also be predicted in its course and by using another method - the Clarke histological criteria comparison method. I level of invasion, in accordance with the system of Clark criteria, determines the location of the tumor formation within the epidermis layer, II level of invasion indicates the germination of the tumor into the dermis (papillary layer), III level determines the achievement of the tumor border between the reticular and papillary dermis, IV indicates its germination into the reticular layer, V determines its penetration directly into the subcutaneous tissue. Accordingly, for each of the listed levels, the survival rate is 100 and 95%, 82 and 71%, and 49% (for the last option).

Diagnosis

In the diagnosis of melanoma, in addition to the standard examination by using a magnifying glass for this purpose, a radioisotope study is also used, in which the detection of an increased amount of phosphorus in the tumor formation indicates that it is malignant. In case of skin cancer, a biopsy or puncture method is usually used in the diagnosis of this disease, however, with melanoma, such an intervention must be excluded, because even the slightest impact can determine an injury, and this, in turn, can lead to a rapid generalization of the pathological course of the process.

Given these conditions, the only method for clarifying the diagnosis is a cytological examination, in which an imprint from the surface of the tumor is studied in the case of ulceration that is relevant to it. The remaining cases of the course of the pathological process imply the diagnosis of the disease only on the basis of clinical manifestations.

In the collection of anamnesis, special interest is directed to the symptoms characteristic of metastases (general malaise, joint pain, blurred vision, headache, weight loss). Additionally, to exclude or confirm the presence of metastases to internal organs allows the use of such methods as ultrasound, CT and radiography. Having completed a general examination for the relevance of melanoma, they proceed to determine its stage and appropriate treatment.

Melanoma treatment

In the treatment of melanoma, two variants of methods are used, this is only a surgical method and a combined method. The combined method is considered to be the most reasonable, because after the irradiation, the tumor formation is removed ablastically. As part of the first stage of such treatment, the method of close-focus X-ray exposure to the tumor is used, after which, until the onset of the radiation reaction (2-3 days after the end of the exposure) or after it subsides, its broadband excision is performed when several centimeters of healthy skin are captured. The wound defect that occurs in this case is subject to skin plastic surgery.

Considering that malignant melanoma is characterized by its rapid transition to metastasis to nearby lymph nodes, it is necessary to remove regional lymph nodes even in the absence of their increase as such. If the lymph nodes are enlarged and there is a suspicion of metastasis, then they are pre-irradiated by applying measures of the remote type of gamma therapy. In recent years, it has become quite common to use A complex approach to treatment based on the addition of radiation and surgical methods with chemotherapy procedures.

It should be borne in mind that in the presence of nevi, and in particular with any changes associated with them, be it a change in color, the appearance of ulceration, an increase in size or bleeding, it is important to immediately take measures, which in this case come down to surgical intervention. We also note that today III and IV stages of melanoma are incurable, therefore, given this, the main measures in the fight against it are prevention and early diagnosis. In the event of symptoms indicating melanoma, it is necessary to contact an oncologist and a dermatologist.

Myopia is a pathological condition, during the progression of which a sick person begins to poorly distinguish objects located far from him. He can hardly read the signs, see the numbers of cars, he may not even recognize his friend from a distance of several meters. Medical statistics are such that it is myopia that is the most common violation. visual function, which occurs in both adults and children (children's myopia is not uncommon). This disease can progress and have varying degrees of severity.

Skin melanoma is a malignant disease that develops from melanocyte pigment cells. Cancer of this type manifests itself regardless of age and country of origin of a person, and the number of deaths of the disease is statistically high, despite intensive care. Melanoma skin is diagnosed in 3% of cases of all epithelial tumors.

The appearance of melanoma is due to a defect in the DNA molecule that contains the pigment cell. In medical practice, the following causes of one of the most dangerous oncological tumors a person characterized by constant relapses and lymphogenous and hematogenous metastases in all organs:

1. The abuse of ultraviolet rays, especially dangerous exposure to the sun at its zenith. A malignant tumor can also manifest itself as a result of prolonged exposure to artificial sources of ultraviolet radiation, which include a solarium and bactericidal lamps. According to statistics, melanoma is most common among residents of countries with increased solar activity, such as Florida, Australia and Hawaii.
2. Cancer of the skin often manifests itself in the form of a relapse.
3. Overgrowth of moles is a common occurrence in medical practice. In 60% of cases, skin cancer develops from nevi and atypical moles. The main localization sites are the head, legs, arms, back, neck, palms, scrotum, sole and chest area. The more moles all over the body, the higher the risk of their degeneration into a malignant tumor.
4. Skin diseases that are precancerous. Such diseases include pigmented xeroderma and Dubrey's melanosis.

In addition to the direct causes that provoke the appearance of skin cancer, there are so-called risk factors:

• weakened immunity, unable to independently destroy cells with altered DNA;
• overweight;
• the predominance of fats and proteins in the daily diet;
• age - the older the person, the higher the risk of getting sick;
• genetic inheritance;
• light skin, the presence of freckles and red hair pigment;
• history of sunburn.

A person belonging to one of the risk groups must carefully monitor their health in order to prevent the development of the disease at an early stage.

melanoma symptoms

Melanoma often occurs on intact skin, but tumor manifestations from moles and on the background of skin disease which is precancerous. The main symptoms of a tumor lesion of the skin include a modification of the color and shape of already existing moles, as well as the occurrence discomfort in this area. Often, melanoma is perceived as a new mole with an unpleasant appearance, but only a doctor can recognize it upon examination.

Primary signs

What the initial stage looks like can only be understood by the changes and sensations that appear in the area of ​​​​the mole:

• burning sensation;
• bleeding;
• itching of the skin;
• change in the type of mole, its thickening and elevation;
• change in consistency, the mole becomes soft;
• severe swelling and redness of nearby tissues;
• the appearance of secretions;
• the main focus of the tumor is surrounded by new pigmentation.

late symptoms

Rapidly developing melanoma is characterized by the following features:

• constant bleeding of a mole;
• tangible pain discomfort in the lesion;
• a noticeable violation of the integrity of the skin;
• the appearance of blood from pigmented areas located elsewhere.

Symptoms of metastases

When cancer cells enter the bloodstream and spread to other organs, signs of metastatic melanoma are observed:

• palpable induration under the skin;
• the skin acquires a grayish tint;
• there is an unreasonable cough of a chronic nature;
• severe headaches, accompanied by convulsions throughout the body;
• weight loss, or complete exhaustion;
• lymph nodes acquire a pronounced increase.

Immediate medical assistance required when severe bleeding from age spots appears, with big change skin color, asymmetry of moles and their increase in diameter of more than 6 mm.

Medical practice recognizes different types of melanomas that develop in different parts of the body.

The most common types of cancers are:

1. Noduryanaya, better known as nodular. It ranks second in popularity among diagnosed melanomas, according to statistics, this is 15-30% of cases. The average age of the formation is from 50 years and older, the localization of the nodular has no clear places, it can occur throughout the body: from the scalp to formations on the foot or palm. It is noteworthy that this type of tumor in men occurs on any part of the skin, and in women mainly on the lower extremities. The appearance of nodular melanoma is characterized by aggressive development and vertical growth of the nevus. Average duration tumor development is from six months to one and a half years. Diagnosis of nodular type formation at an early stage is extremely rare, usually patients seek help when the tumor takes the form of a dark-colored plaque with high edges and clear sizes. On the advanced stages melanoma can take the form of an aggressively developing polyp.
2. Superficial, called in medical practice as superficial. This variant of the tumor of the skin is found in 70% of cancerous lesions. The source of development are previous moles and nevi. Growth begins with a benign tumor located in the subcutaneous layer. The development of the superficial type takes place over a long period of time. Characteristic features - the appearance of a spot with uneven edges, which is characterized by a change in color pigment. A mole can take on various shades from tan to black or white. Superficial melanoma is usually treatable and has a favorable prognosis compared to other skin cancers.
3. Melanoma lentigo, also called malignant lentigo and melatonic freckles. It appears mainly in old age against the background of senile pigmentation of the skin, in rare cases it may appear from a simple mole. The average incidence rate is 10% of total cancerous skin lesions. Malignant lentigo is diagnosed in those parts of the body that are most exposed to ultraviolet radiation - ears, face, neck. Development is slow, the period between initial manifestation and the final stage can be up to 30 years. Malignant lentigo has a fairly favorable prognosis: metastasis is rare. There are cases when the disease resolved on its own without consequences for the patient.
4. Lentigo is peripheral, the proportion of the disease is about 10%, mainly in representatives of the Negroid race. The main sites of localization of peripheral melanoma are the palms and the nail bed. Often, skin lesions in the form of a dark spot with uneven edges are diagnosed on the foot. The growth of lentigo occurs very slowly, the tumor grows in the upper layers of the skin, without spreading inward. The prognosis depends on the depth of the introduction of the neoplasm.
5. Pigmentary melanoma. It is distinguished by the presence of the pigment melatonin, which gives the tumor a specific color. The main advantage is a clear cosmetic manifestation, since the cosmetic effect is immediately noticeable, which makes patients seek medical help in time. A feature of pigmentary melanoma is the presence of flowers unusual for a simple mole. The range of shades can change from pink to black as the disease spreads. In this case, one tumor can gradually become motley from a monotonous one. Over time, pigmentary melanoma loses its color and becomes colorless.
6. Amelanotic, is colorless and the most dangerous. The main risk of such a tumor lies not only in its invisibility at the initial stage, but also in its rapid growth rate. With this diagnosis, the prognosis is the worst, compared with other species. There may be cases of transition of a non-pigmented neoplasm to a pigmented one.

Any melanoma is initially malignant; a benign type of such a tumor does not exist in medical practice. Signs of oncological education are fast growth, a tendency to germinate into the deep layers of the skin and metastasize.

External view of melanoma

Giving a description appearance tumors of the skin, its type, stage of development and location should be taken into account. Melanoma is a neoplasm characterized by the greatest variability among other malignant phenomena. With the development of a tumor from a mole, it is localized either in the center or along the edges. There are the following variants of melanoma:

• proliferation of papillomatous type;
• pigment spot of a flat shape;
• protrusion of a minor nature;
• the shape of the fungus, the tumor is located either on a wide base or on a stalk.

Tumors are predominantly single oval or round in shape. Often there is multiple melanoma, when several additional ones are located around the main focus. Gradually, they can merge into one common.

At the initial stage of development, melanoma has a smooth surface, but as the disease progresses, it becomes covered with small manifestations and irregularities. The main danger of this stage of the disease is high trauma, bleeding from the tumor can begin at the slightest impact.

With the disintegration of the tumor node, the neoplasm may take the form of a cauliflower with multiple formations on the surface. By consistency, melanoma can vary from fairly dense and hard to soft, or combine hard and soft areas.

The shade is always individual and depends on the amount of pigment present in it, unless there is a pigmentless tumor. The most common shades are brown, grey, purple, purple and black.

The pigmentation of melanoma is most often heterogeneous with a greater concentration of color in the central part. An alarming signal is a change in the color of the neoplasm, which indicates the progression of a malignant disease.

Places of localization

Melanoma can appear anywhere on the skin. According to statistics, the favorite places for its formation in women are the lower leg, in men - the face and back.

Face

The most dangerous malignant melanomas appear on the face. They are pigment spots various shapes, however, in some cases, the pigment may be absent. The primary stage of a malignant lesion of the facial skin is characterized by a clear oval shape with possible symmetry. As the disease progresses, melanoma becomes blurred and variegated. Gradually, the shape itself also changes - it can become convex, take the form of a mushroom or a knot.

Back

Melanoma on the back does not differ in its course from tumors localized in other parts of the body. The shape of the neoplasm has a rounded outline, and the color range varies from dark blue to reddish. The main danger of melanoma, which forms along the spine, is its late detection.

An aesthetic defect on the face or leg will be noticed more quickly than on the back, resulting in too late seeking medical attention.

Melanoma of the organs of vision

A tumor of the eye is quite common and entails a significant loss of vision. Development occurs more often from the ocular choroid and has an aggressive course. There are the following types of melanoma of the organs of vision:

• choroid;
• conjunctiva;
• iris;
• century.

Less common tumors of the eyelid and conjunctiva. It is not possible to identify this type of tumor at the initial stage due to an insufficient symptomatic picture. The main primary symptom is a slight opacification in the retinal area. Spend accurate diagnosis Only an ophthalmologist can do this step.

The second stage is characterized by painful discomfort in the mucosal area, redness of the eyelid and swelling. In the third stage, ocular melanoma extends beyond the apple, the eye begins to shift due to a growing tumor, in the fourth, symptoms of bleeding and clouding of the lens are noticeable.

Nail

The neoplasm in this case is localized directly on the skin around the nail plate or the nail itself. The manifestation is possible at any age, and the tumor can grow on the nails of the hands and feet.

The primary symptom of the disease is a change in the color of the nail plate, but at this stage it is not always possible to diagnose the disease. The dark spot formed under the nail begins to grow and increase in size. The nail begins to gradually rise, and a nodule with erosion forms near the nail plate.

Stages of the disease

It is possible to assess the course of melanoma and predict the chances of a favorable outcome based on the stage at which the disease is located. In medical practice, it is customary to distinguish 5 main stages of the course of the disease:

1. Zero stage, to determine the presence of cancer cells, which is possible only on the outer cell layer. This stage does not have a deep growth of the tumor inside.
2. The first stage, also called the initial stage. The thickness of the tumor during this period is from 1 to 2 mm, metastasis is not observed. Localization occurs at the level of the dermis, but spread at the level of the lymph nodes does not occur. According to the clinical classification of melanomas, this tumor formation is not yet dangerous, since it is a local stage.
3. At the second stage, the thickness of melanoma is in the range of 2-4 mm, but metastases in the lymph nodes and other organs are still not diagnosed. The spread of the tumor occurs on the thickest skin layer - the dermis.
4. The third stage is more than 4 mm in size, there are no metastases. The defeat of 2-3 lymph nodes is diagnosed without spreading to other organs. The growth of the tumor occurs already in the subcutaneous fat layer. According to the clinical classification, a generalized lesion of the internal organs is added.
5. The fourth stage is characterized by metastasis of internal organs and lymph nodes. Melanoma grows deep into the subcutaneous layer and is more than 4 mm thick. Complete cure at this stage is almost impossible.

childhood melanoma

A malignant tumor of the skin can also manifest itself in childhood, mainly in the period from 4 to 6 years and from 11 to 15 years. It is located most often on the neck, head and limbs. In 70% of cases, the appearance of melanoma in a child is observed on unchanged skin against the background of already present moles and nevi. More than 10% of cases of malignant neoplasms are of a genetic hereditary nature. Main symptoms:

• increase and change in the shape of a previously calm nevus;
• change in the color of the mole;
• burning, the appearance of cracks and tingling in the area of ​​​​skin formations;
• expression with bleeding;
• noticeable elevation of moles and age spots;
• loss of vegetation in and around the nevus.

Childhood melanoma is characterized by unpredictable development, it can proceed both rapidly and gradually, when periods of remission are replaced by exacerbation. The treatment of a childhood tumor of the skin is carried out without the use of the usual means of chemical therapy, since the main feature of such melanoma is resistance to radiation and chemical therapy. Distinguishes the children's version of the disease and rapid metastasis.

The study of melanoma is a set of measures that are standard for all diseases. Previously, the doctor conducts a visual examination of the tumor and asks the patient about the nature and duration of the changes. An important point is the presence of heredity: whether other family members have cancerous lesions of the skin.

General examination with palpation, during which the doctor determines the soreness and density of melanoma, as well as its fusion with other tissues. During a general examination, attention is also paid to the lymph nodes. Even with a clear diagnostic picture, the doctor prescribes a series of studies that will confirm the diagnosis. This is necessary to exclude or confirm metastases in other organs. The main diagnostic measures for melanoma:

• bone scan and chest X-ray to detect metastases;
• taking a blood test for a biochemical study, where the indications of LDH and alkaline phosphatase will be important, high values ​​​​of these indicators indicate the process of metastasis and the resistance of the tumor to the ongoing treatment;
• ultrasound abdominal cavity, with the help of which the state of the lymph nodes and organs is determined, the study is indicated if the thickness of the melanoma exceeds 1 mm;
• dermatoscopy, when using a special device with a magnification function, a close study of melanoma is carried out.

Methods of therapy

Treatment of melanoma directly depends on the stage of development of the disease:

1. Zero stage - surgical excision of the tumor with the capture of tissue around the focus for 1 cm.
2. First stage. A biopsy is preliminarily performed, after which the tumor is removed with a tissue capture of 2 cm. If there are signs of metastases in the lymph nodes, they are also removed.
3. At the third stage, chemotherapy, raising immunity and removing the tumor are shown. The capture of healthy tissue during resection of melanoma reaches 3 cm. A mandatory continuation is the removal of lymph nodes and subsequent chemotherapy.
4. The fourth stage does not have a standard treatment regimen, usually therapy includes a complex effect chemicals and radiation medicine.

Chemotherapy

Treatment of melanoma involves the use of several drugs at once, the most common among them:

• Roncoleukin,
• cisplatin,
• Reaferon,
• Vincristine.

If there is a disseminated form, the drug Mustoforan is used, indicated for brain metastases. With standard therapy, Roncoleukin is used intravenously at 1.5 mg in combination with other drugs. The average duration of chemotherapeutic exposure is 6 cycles with 4-week intervals.

Radiation therapy

This method of influence is additional and is used in combination with others. therapeutic measures. Independent use of radiation treatment is possible only if the patient refuses surgery.

Cancer cells are markedly resistant to ionization, which is why this method is used as a recovery therapy after surgery or in combination with chemotherapy.

Operation

Method surgical treatment involves a wide excision of the tumor with the capture of nearby tissues. The main goal of surgery is to prevent metastases. The defect that appears as a result of surgery is eliminated with the help of plastics.

The area of ​​the removed site depends on the initial sizes of a tumor. With melanoma of the nodular type or superficial neoplasm, the indentation from the edge of the focus is no more than 1-2 cm. The excision is carried out in the form of an ellipse, and the block of excised tissues acquires an ellipsoidal shape.

Surgery is contraindicated in lentigo melanoma. This type of cancerous lesion of the skin is subjected to laser destruction or exposure using cryogenic technologies using low temperatures.

Prevention

Measures to prevent the development of cancerous lesions of the skin:

1. Limitation of exposure to ultraviolet radiation. This includes not only a ban on prolonged exposure to the sun at its zenith, but also visits to solariums. UV rays are dangerous even on a cloudy day. Sunscreen will help protect you.
2. Limit skin contact with chemicals as much as possible. This is especially true for workers in hazardous industries.
3. Necessary careful attitude to nevi and moles, prevent their injury and do not try to eliminate a cosmetic defect on your own, regardless of its location.
4. Compliance with a balanced diet and maintaining a proper lifestyle. It has been scientifically proven that people who prefer fatty junk food and have bad habits suffer from cancer skin more often than others.
5. Accept any medications only under the supervision of a physician in a strictly prescribed dosage.

Melanoma of the skin affects the skin of people regardless of age and gender. A timely visit to the doctor if there is a suspicion of the appearance of a cancerous tumor gives an excellent chance of getting rid of the disease.

About 40 years ago, melanoma of the skin was 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 frequent localization is the skin, much less often the mucous membrane of the eyes, nasal cavity, mouth, larynx, skin of the external auditory canal, anus, 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 in women (after cervical cancer).

It can develop on its own, but more often it “masks” against the background of birthmarks, which does not cause concern in people and creates significant difficulties for doctors in terms of its maximum early diagnosis. In how quickly this neoplasm develops and is difficult to detect in the initial stages, there is another danger that often interferes with timely diagnosis. Already within 1 year it spreads (metastasizes) to the lymph nodes, and soon to the lymphatic and blood vessels, practically, in all organs - bones, brain, liver, lungs.

Video: The simplest test for skin cancer

Causes

The main modern theory of the origin and mechanism of development of melanoma is molecular genetic. In accordance with it, DNA damage occurs in normal cells by the type 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 environmental agents that have a direct effect on the skin.

Physical risk factors:

1. UV spectrum solar radiation. Its connection with the occurrence of melanoma is paradoxical: the latter occurs mainly on areas of the body covered by clothing. This indicates the development of a neoplasm not so much as a result of a direct, but rather an indirect effect of UV radiation on the body as a whole. In addition, it is not so much the duration as the intensity of exposure that matters. In recent years, the scientific literature has drawn attention to the particularly high risk of sunburn - even received in childhood and adolescence, at an older age they can play a significant role in the development of the disease.
2. Increased background of ionizing radiation.
3. Electromagnetic radiation - the tumor is more common among people professionally associated with telecommunications equipment and the electronics industry.
4. Mechanical trauma to birthmarks, regardless of its multiplicity, is a high risk. It is not completely 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, aromatic dyes.

From biological factors highest value have:

1. Features of nutrition. A high daily intake of animal proteins and fats, a low intake of fresh fruits and vegetables high in vitamins “A” and “C” and some other bioactive substances are a risk in terms of the development of superficially spreading and nodular (nodular) forms of melanoma, and also tumors of unclassified type of growth.

   Regarding the systematic use alcoholic beverages theoretically, it is assumed that they can provoke the growth of melanomas, but there is no practical evidence for this. It has been accurately proven that there is no relationship between the use of caffeinated drinks (strong tea, coffee) and malignant neoplasms. Therefore, nutrition for skin melanoma should be balanced mainly due to plant products, especially fruits and vegetables, and contain a rich amount of vitamins and antioxidants (blueberries, green tea, apricots, etc.).

2. Taking oral contraceptives, as well as estrogen drugs prescribed to treat disorders menstrual cycle and autonomic disorders associated with menopause. Their influence on the development of melanoma is still only an assumption, since there is no clear relationship.

Video: How melanoma develops

Endogenous risk factors

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

• low degree of pigmentation - white skin, blue and light eyes, red or light hair color, a large number of freckles, especially pink ones, or a tendency to their appearance;
• hereditary (family) predisposition - it is mainly the disease of melanoma in parents that matters; the risk increases if the mother was sick 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 m 2;
• endocrine disorders - a high content of sex hormones, especially estrogens, and melanostimulating hormone (melatonin), produced in the middle and intermediate lobes of the pituitary gland; a 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 at an older age;
• state of immunodeficiency;
• pregnancy and lactation, stimulating the transformation of pigmented nevi into melanoma; this is predominantly 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 of a pathological nature and are characterized by the maximum degree of probability of degeneration into melanoma, as well as being its precursors. These are benign formations, consisting of pigment cells (melanocytes) of varying degrees of maturity (differentiation), located in different numbers 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, slowly increasing over the years, brown spot with irregular contours, which is usually localized on the face, hands, on the skin of the chest, less often on the oral mucosa;
• skin pigment xeroderma, characterized by high sensitivity to sunlight; this is a hereditary disease that is transmitted to children only if there are specific DNA changes in both parents; these changes lead to a lack of cells' ability to recover from damage by ultraviolet radiation.

How to distinguish a mole from melanoma?

The real frequency of development of the last of the nevus has not been elucidated. The types of nevus with the highest risk were established: complex type - 45%, borderline - 34%, intradermal - 16%, blue nevus - 3.2%; giant pigmented - 2-13%. At the same time, 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:

1. Symmetrical shape.
2. Smooth smooth outlines.
3. Uniform pigmentation, giving the formation a color from yellow to brown and even sometimes black.
4. A flat surface that is flush with the surface of the surrounding skin or slightly evenly elevated above it.
5. No increase in size or little growth for a long time.

Each "birthmark" goes through the following stages of development:

1. Border nevus, which is a spotted formation, the nests of cells of which are located in the epidermal layer.
2. Mixed nevus - cell nests migrate into the dermis over the entire spot area; clinically, such an element is a papular formation.
3. Intradermal nevus - 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 have the form of a flat pigmented or non-pigmented spot with a slight elevation, rounded, polygonal, oval or irregular in shape with a diameter of more than 6 mm. She long time can maintain a smooth, shiny surface, on which small ulcerations, irregularities, and bleeding occur in the future with minor trauma.

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

In some cases, it takes the form of overgrown papillomas, resembling " cauliflower”, or the shape of a mushroom on a wide base or on a leg. Near the melanoma sometimes there are additional separate or merging with the main tumor foci (“satellites”). Occasionally, the tumor is manifested by 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.

Sufficient understanding of the population about what initial signs melanoma, greatly contributes to its timely (at the initial stages) and effective treatment.

Video: How to recognize melanoma?

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 undamaged one;
• 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 already with nearby foci or metastases to at least one "on duty" (closely located) lymph node;
• IV - germination of the tumor in the underlying tissues, distant skin areas, metastases to distant lymph nodes, lungs or other organs - the brain, bones, liver, etc.

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

1. An increase in planar dimensions to that unchanged or very slowly growing mole, or the rapid growth of a newly emerging nevus.
2. Changing the shape or outline of an already existing formation. The occurrence in any of its areas of seals or asymmetry of contours.
3. Change in color or the disappearance of the uniformity of color of an existing or acquired "birthmark" spot.
4. Change in intensity (increase or decrease) of pigmentation.
5. Appearance unusual sensations- itching, tingling, burning, "bursting".
6. The appearance of redness around the birthmark in the form of a corolla.
7. The disappearance of hair from the surface of the formation, if any, the disappearance of the skin pattern.
8. The appearance of cracks, peeling and bleeding with minor injuries (light friction with clothing) or even without them, as well as growths by 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 preventive 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:

1. Acquaintance with the patient's complaints, clarification of the nature of the changes in the "suspicious" formation, its visual examination, examination of the entire patient in order to count the number of birthmarks, highlight the different ones among them and further study them.
2. holding general clinical trials blood and urine.
3. , allowing to examine in the skin layers, enlarged several tens of times (from 10 to 40), a neoplasm and make a fairly accurate conclusion about its nature and boundaries according to the relevant diagnostic criteria.
4. Ultrasound examination of the abdominal organs, computed and magnetic resonance imaging of the spinal cord and brain, X-ray of the chest, which allow to determine the spread and presence of metastases in other organs.
5. Cytological examination of a smear (in the presence of ulceration) and / or material obtained by puncture of the lymph node (in rare cases). Sometimes a study of punctate from an enlarged lymph node makes it possible to diagnose the presence of a disease in the apparent absence of a primary tumor.
6. Excisional biopsy, the meaning of which is to excise a formation that is "suspicious" for a malignant tumor (within 0.2-1 cm outward from the edges) with subsequent urgent histological examination. Upon confirmation of the diagnosis of melanoma, its further radical removal is immediately carried out. Such diagnosis is carried out in cases where all other results of preliminary studies have remained doubtful.

Some types of melanoma

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

Achromatic or pigmentless melanoma

It occurs 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 increases, is covered with small-lamellar epithelial scales and acquires a rough surface.

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

Spindle cell melanoma

Received such a name in connection with the characteristic shape of 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, rounded nuclei. Melanin is concentrated mainly in the processes, due to which they acquire a granular, mottled appearance, which distinguishes them from a sarcoma or a tumor of the nervous tissue (neurinoma).

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

Nodular or nodular melanoma

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

This tumor is oval or round in shape and by the time the patient sees a doctor, as a rule, it already takes on the appearance of a plaque with clear boundaries and raised edges, black or unusually blue-black in color. Sometimes nodular melanoma reaches a considerable size or has the form of a polyp with a hyperkeratic or ulcerative surface.

subungual melanoma

A form of acral lentiginous tumor that affects the skin of the palms and feet. 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, which makes it difficult to diagnose in the early stages. Within 1-2 years, it spreads to the nail matrix and part or all of the nail plate, which becomes brown or black. Appearing papules and nodes are often devoid of pigment, so the disease at first does not attract the attention of the patient and lasts for months. In the future, ulcerations and growths of the mushroom type occur.

melanoma metastases

Melanoma is considered one of the most insidious human cancers. morbidity and mortality from which is steadily increasing from year to year. They talk about it on TV, write in magazines and the Internet. The interest of the townsfolk is due to the fact that the tumor is increasingly being detected in residents of the most different countries and the number of deaths is still high, even with intensive treatment.

In terms of prevalence, melanoma lags far behind epithelial skin tumors (squamous cell carcinoma, basal cell carcinoma, etc.), according to various sources, accounting for 1.5 to 3% of cases, but it is much more dangerous. Over 50 years of the last century, the incidence increased by 600%. This figure is enough to seriously fear the disease and look for the causes and methods of its treatment.

Melanoma is more susceptible to white-skinned older people (55-70 years old), but young people after 30 also have a risk of its occurrence. In almost all cases, tumors are preceded by changes in the form of age spots, moles, dermatitis and other precancerous conditions. Often, melanoma is detected at the stage of metastasis, but even timely diagnosis often leaves no chance for a favorable outcome due to the extreme malignancy of the neoplasm.

The skin is the largest and extremely important human organ that protects the internal environment from numerous external adverse effects. Being influenced by solar radiation and a variety of carcinogens, being injured, it most often becomes a target for melanoma.

Cells that produce melanin (melanocytes) are concentrated mainly in the basal (deepest) layer of the epidermis. Melanin is a pigment capable of reflecting ultraviolet rays, thus protecting us from sunburn. The more melanin in the skin, the darker its color. The inhabitants of the African continent are genetically determined by the high activity of melanocytes in order to protect the skin from the scorching sun. Conversely, northern peoples have light skin, because they do not experience the action of the sun almost all year round, and therefore they do not need an excess of melanin. Some studies indicate that the number of melanocytes is approximately the same in people with different color skin, but their activity and the amount of pigment produced vary significantly.

In addition to the skin, melanocytes are found in the retina, pia mater, rectum, and inner ear. These cells carry a special protein, protein S100, which allows them to be classified as neuroectodermal elements. In other words, melanocytes do not originate from the integumentary epithelium, but from the rudiment of nervous tissue. Although very often melanoma is called, but, nevertheless, it does not belong to it and is excluded from this group of tumors. Melanoma is a malignant tumor of melanocytic, neuroectodermal origin.

Most often, neoplasms of melanin-forming tissue are detected in the skin, but they can also be found in the eyes and even internal organs. Below we will talk mainly about melanoma of the skin as the most common variant of the tumor.

What should be afraid?

Like any other malignant tumor, melanoma does not appear suddenly. It is always preceded by certain changes, and in almost all cases there is a connection with exposure to ultraviolet radiation. The insidiousness of the tumor is that it may occur many years and even decades after sunburn. There is evidence that a single excessive solar exposure can cause a tumor in the future, so it is so important to monitor the skin from childhood and avoid burns.

Potentially dangerous factors that increase the risk of melanoma can be considered:

• Solar radiation or ultraviolet from artificial light sources.
• white skin type, blonde hair and eyes, an abundance of freckles.
• Past sunburns.
• The presence of nevi, age spots, especially with a large number of them.
• Heredity.
• Age and gender factor.

Ultraviolet radiation rightfully occupies the first place in the list of possible causes of melanoma. The increase in the intensity of sunlight, as well as the exposure of a person under them, has led to an increase in the incidence of tumors. The fashion for a tanned body dictates the need to spend a long time on the beach, and in winter, tanning beds come to the rescue. Meanwhile, the desire to acquire a chocolate skin color can be too expensive.

As time spent under the sun increases, so does the risk of disease. Moreover, the most unfavorable effect is produced by short-term, but high-intensity radiation, than long-term, but low-dose, even if the total dose is the same. In an effort to get a dark tan in a short time, having escaped to the sea coast, the pale-skinned inhabitants of the northern countries are ready to lie for hours under the scorching sun even at the most dangerous time - from noon to 4-5 pm. The immediate consequences can be sunburn, and the long-term - the development of melanoma.

Depending on the susceptibility of the skin to the sun, several phototypes have been identified that determine the risk of a tumor:

skin phototypes

Thus, fair-skinned persons who always burn in the sun without getting a tan, or those who hardly achieve it, belong to I and II phototypes, when the risk of melanoma is extremely high. Conversely, dark-skinned or black-skinned residents of the southern latitudes practically do not risk, but still a large amount of melanin does not guarantee the impossibility of tumor growth in them.

We should also mention the solarium, the popularity of which came to us relatively recently. The use of even high-quality ultraviolet radiation lamps creates a high risk of skin damage, and it is absolutely impossible to be under them without a special protective cream. The duration of the procedures should be 5-6 minutes, otherwise burns and photodermatitis are inevitable. Today, in many countries, solariums are prohibited for use due to the high carcinogenic activity of the radiation received during such a tan.

Before staying in the sun for a long time or often visiting a solarium, you should carefully consider whether the resulting beauty is worth the sacrifice in the form of a possible loss of health.

White skin color, light eyes and hair, lots of freckles predetermined by a low amount of melanin that can reflect the sun's rays, so such people should be very careful and always use sunscreen.

Past thermal injury to the skin and sunburn can cause melanoma even after many years, so it is important to avoid them not only for adults, but especially for children and adolescents, who are often exposed to the sun during prolonged exposure to the open air while walking.

One of the important risk factors for melanoma are nevi, in everyday life often called a mole, as well as skin pigmentation disorders. Nevi are tumor-like formations, mainly located in the skin and consisting of accumulations of melanocytes. In addition to the skin, they can also be found in the tissues of the eye.

Nevi are congenital and acquired, which appear in children or in adolescence. Congenital moles pose a great danger in terms of malignancy.

Microscopically, nevi consist of melanocytes located in the epidermis, dermis or at their border, and in some cases they can capture all layers of the skin, accumulate and produce a large amount of pigment. The structure of such formations implies the allocation of their various types, which may indicate the risk of developing a tumor:

1. Epidermal - melanocytes within the epidermis;
2. Intradermal - melanocytes are located only in the dermis;
3. Borderline - localized at the border of the epidermis and dermis;
4. Complex - captures both the epidermis and the dermis, has a high risk of malignancy;
5. Blue - has a bluish tint and is more often found on the face or buttocks;
6. Juvenile - typical for adolescents and children;
7. Dysplastic - cells bear signs of atypia, giving resemblance to a malignant tumor;
8. Giant pigmented.

In addition to those described, there are other forms of nevi, and congenital forms, giant pigmented, dysplastic, complex and borderline nevi are of particular danger. More than half of melanoma patients had one or another type of precancerous process at the site of the tumor, and if there are more than 50 moles on the body, special measures precautions.

The reasons that can lead to the transformation of a nevus into melanoma are quite simple: insolation and trauma, endocrine metabolism disorders and hereditary predisposition. People who have a lot of moles, especially in the neck and head, should avoid sun exposure, prefer shade, and use protective cosmetics and clothing. If the nevus is located in a place that is often subjected to mechanical stress (for example, parts of clothing), then it will inevitably be injured, which means that its cells will multiply excessively, which greatly increases the risk of melanoma, therefore, such nevi are recommended to be removed in order to prevent tumors.

Pigmentaryxeroderma It is considered a precancerous disease in relation to malignant tumors of the skin, therefore, melanoma in such patients may also occur with a high degree of probability. When exposed to the sun with xeroderma pigmentosum, dermatitis and burns appear, which inevitably leads to cancer.

hereditary factor plays an important role, as evidenced by cases of tumor occurrence in members of the same family. The likelihood of melanoma, when there are two or more relatives with such a diagnosis, increases several times. Moreover, genes that predetermine the development of a tumor were found on chromosomes 9 and 12.

Gender and age also contribute to the tumor potential of any cells, not excluding melanocytes. Men suffer from melanoma more often than women, and there are significantly more elderly patients among patients than young ones.

How does melanoma grow?

Melanoma can be represented by quite a variety of forms of growth, at the initial stages of its development, "masking" as a nevus or pigment spot. Over time, the tumor increases in size and acquires clear features of a malignant process with its characteristic ulceration, bleeding, metastasis, etc.

Melanoma, cancer and precancerous conditions of nevi (moles): 1 - normal, 2 - nevus dysplasia (moles), 3 - senile keratosis, 4 - squamous cell carcinoma, 5 - basal cell carcinoma, 6 - melanoma

The neoplasm may be predominantly horizontal distribution, characteristic of the initial stages of the disease, in which the pathological process spreads over the surface of the skin, increasing in area and not going beyond the epithelial layer. Such growth can last for several years, and with some variants of melanoma - even a decade. The tumor for a long time looks like a dark brown flat spot that does not bring significant concern.

Vertical growth is accompanied by the introduction of tumor tissue into the underlying layers through the basement membrane and is characteristic of nodular melanoma. At this stage, a rapid increase in the size of the neoplasm is observed, it rises above the surface of the skin in the form of a node or polyp, and the ability to metastasize also appears. Most often, the vertical growth phase replaces the horizontal one as the tumor progresses.

It is customary to highlight and clinical forms melanomas:

• Surface spreading.
• Nodal.
• Lentiginous.

Superficial spreading melanoma accounts for up to 70% of all tumor cases, is more common in women and has a relatively favorable prognosis. In this case, the initial stages look like a horizontal brown or black spot that does not rise above the surface of the skin.

superficially spreading (left) and nodular (right) forms of melanoma

nodalform melanoma accounts for up to 20% of cases, is more malignant in course and has a very unfavorable prognosis. Among patients, men predominate, the neoplasm grows in the form of a node or resembles a polyp that grows into the thickness of the skin and into deeper tissues. This form is characterized by early metastasis and rapid progression.

Lentiginous form It is considered one of the most favorable variants of the tumor, which is characterized by long horizontal growth. More often, such melanoma is detected on the face, formed at the site of a mole and affects mainly women.

A separate form of lentiginous melanoma can be considered subungual(melanoma of the "nail", acrolentiginous), in which the tips of the fingers, the nail bed, and the palms are mainly affected. A feature of this form is that it occurs more often in dark-skinned individuals who are least prone to tumors of the melanin-forming tissue.

A very rare type of tumor is pigmentless melanoma, which does not have a characteristic staining and does not form a large amount of melanin. This form is extremely difficult to diagnose, and therefore can be quite dangerous.

Some forms of the disease are melanoma of the eye, mucous membranes and soft tissues.

Melanoma in the eye can affect the retina and iris, often without any specific symptoms and being discovered incidentally when visiting an ophthalmologist. Localized on the mucous membranes, the tumor affects mainly the tissues of the nose, oral cavity, anus, vulva or vagina in women. Soft tissue melanoma is characteristic of all ages and can be found in ligaments and aponeuroses.

Metastasis melanoma can occur with lymph flow - lymphogenically, or blood hematogenously, moreover, the predominant path is determined by the type of neoplasm. So, long-term relatively favorable species can metastasize to regional lymph nodes, and rapidly progressing nodular melanoma will metastasize not only lymphogenously, but also through the bloodstream, affecting the liver, bones, lungs, and brain. In general, melanoma is quite unpredictable, and metastases can sometimes be found in the most unexpected places, such as the cervix or adrenal glands.

Manifestations of melanoma

The manifestations of melanoma are quite varied. In the early stages of development, it can be difficult to distinguish from benign pigmented lesions on the skin, and therefore requires careful diagnosis.

The initial stage of melanoma is represented mainly by formations with a horizontal type of growth. More often it is a spot of brown, black, blue or purple color, which does not rise above the surface of the skin, but gradually increasing in transverse size from a few millimeters to 1-3 cm. The shape of the tumor is from round or oval to irregular, with corroded or scalloped edges, the contour may be blurred.

As it grows, other symptoms of melanoma appear: secondary tumor changes in the form of ulceration, a tendency to bleeding, itching with the formation of crusts, the neoplasm thickens, and vertical growth begins, in which you can see a node or an infiltrate rising above the skin surface, pain appears at the site of tumor growth. Uneven deposition of pigment gives melanoma a variegated color: from black or dark brown to areas of red-violet and gray. A reliable sign of the malignancy of the process is the detection of so-called skin metastases in the form of "daughter" nodules at some distance from the primary one.

Signs that may be a cause for concern include:

healthy moles (top) and neoplastic/precancerous processes (bottom)

Since melanoma most often develops from a mole, then it is important to know the signs of incipient tumor growth in such formations:

1. Changing the color of the nevus, uneven pigment deposition.
2. An increase in the size of the formation, a change in contours with the appearance of pitting and unevenness.
3. Itching, burning, hardening, redness, bleeding or peeling of the mole.
4. Hair loss and loss of skin pattern.
5. The appearance of new similar elements on the skin.

Any of these signs should alert and make you turn to an oncologist to exclude a tumor.

Melanoma of the eye manifested by pain, blurring and loss of parts of the visual fields, a decrease in its sharpness. Often this form of tumor does not give any pronounced symptoms for a long time, and if the patient suffers from another ophthalmic pathology, then the symptoms of melanoma may not cause concern at all.

Non-pigmented melanoma is quite rare, but refers to forms in which the prognosis is often disappointing. The fact is that the absence of melanin in tumor cells and the corresponding staining of the neoplasm does not allow suspecting a tumor in time and starting treatment in a timely manner. Pigmentless melanoma can be detected at the stage of extensive metastasis, which does not give a chance for a cure.

When metastasizing by the lymphogenous route, it is possible to detect enlarged regional lymph nodes, while they are compacted, but do not solder to each other and are well accessible for palpation.

Based on data on the size of the tumor, the depth of its ingrowth into the subcutaneous layers, as well as the presence of metastases (classification according to the TNM system and Clark microstage), the stage of the disease is determined:

classification of melanoma degrees according to the TNM system (left) and Clarke stage (right)

So, in the first stage, the tumor does not exceed 2 mm in thickness and does not ulcerate, in the second - melanoma is more than 4 mm, but metastases are still absent, the third is accompanied by metastasis to 4 lymph nodes, and is also manifested by skin metastases, and the 4th stage of the disease is determined then, when there are distant metastases, regardless of the size of the primary tumor. An oncologist will be able to correctly determine each of the stages, it will not work on your own.

How to detect a tumor?

The difficulties of early diagnosis of melanoma are mainly due to the fact that there are no obvious signs of a malignant process at the initial stages of tumor development. If the pathological process is located in places that are difficult to access by the patient himself, then time may be lost. However, timely diagnosis is still possible, you just need to be attentive to skin changes and, if any symptoms appear, visit a doctor without delay.

An important point at the pre-medical stage of diagnosis is self-examination. It is advisable to examine the skin in a mirror at least once a month in good light, and you can ask a relative or friend to examine the area of ​​​​the back, back of the thighs and other hard-to-reach places. If the mole changes described above are found, you will have to visit a dermatologist or oncologist.

Diagnostic methods, used in medical institutions, are few, since the tumor of skin localization is located superficially and is accessible to eye examination. Apply:

• Dermatoscopy.
• Morphological studies.
• radioisotope scanning.
• CT, MRI, ultrasound, determination of LDH levels, lung radiography, bone scintigraphy - if metastases are suspected.

During the initial visit, the doctor will examine the affected area using a magnifying glass or an epiluminescent microscope (dermatoscopy), and determine the color, texture, size of the formation, the condition of the skin in the area of ​​​​the alleged tumor and around it, then palpate the lymph nodes, which can be enlarged and compacted during metastasis melanoma.

Morphological methods imply a cytological examination, the accuracy of which can reach 97% (smear-imprints from the surface of the tumor), and a histological assessment of the nature of the neoplasm. It is important to note that any type of biopsy before surgery for melanoma is contraindicated due to the high risk of hematogenous spread of tumor cells, therefore, only a completely removed neoplasm with a sufficient volume of surrounding tissues is subject to study.

Intraocular melanoma is detected using ophthalmoscopy, ultrasound eyeball, angiography and other methods.

Video: specialist on the signs and diagnosis of melanoma

Skin melanoma treatment

Treatment of melanoma consists of its removal, chemotherapy or radiation, and immunotherapy. The choice of a specific tactic is determined by the stage of the tumor and its localization.

The most rational treatment for early stage melanoma is surgical removal of the tumor. Not only the neoplasia growth zone is excised, but also the surrounding healthy skin at a distance of up to three centimeters from the edge of the neoplasm.

Cryodestruction and other sparing methods of tumor removal are not used even at the initial stage, since it is impossible to determine the level of penetration of melanoma into the underlying tissues, which means that the process can be aggravated and provoke a relapse with metastasis.

In the presence of melanoma metastases, in addition to surgery to remove the primary tumor and lymphatic apparatus, chemotherapy, radiation and immunotherapy are prescribed. Among chemotherapy drugs, cisplatin, dacarbazine, lomustine, etc. have the greatest effect. Radiation therapy in a total dose of 4000-4500 rad is usually applied topically in the area of ​​tumor growth.

Tumor immunotherapy is a relatively new direction in oncology. Interferon-alpha and monoclonal antibodies are used to achieve a reduction in tumor size and an increase in life expectancy even in patients with stage III-IV of the disease.

Alternative treatment for melanoma is unacceptable! First, because the tumor is extremely malignant and often has a poor prognosis even with traditional treatment. Secondly, the local application of various lotions, lubrication, compresses will certainly lead to injury and disruption of the integrity of the superficial sections of the tumor, which can not only accelerate its ulceration and increase invasive growth, but also provoke early metastasis.

The prognosis for melanoma is always serious, but it depends on many factors: the age and sex of the patient (in women it is better), the localization of the tumor and the depth of its ingrowth into the tissues, the presence or absence of metastases and genetic defects. If melanoma is detected in the first stage, the survival rate reaches 90 percent or more with timely treatment, in the second - 75%, in the third stage with the presence of metastases to regional lymph nodes does not exceed 45%, and in the fourth, no more than 10% of patients survive.

Video: melanoma in the program “Live healthy!”

The author selectively answers adequate questions from readers within his competence and only within the limits of the OncoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not currently provided.