Whether melanoma benign. What is melanoma, causes, symptoms and treatment

Melanoma or melanoblastoma is a malignant neoplasm (skin cancer) that develops from melanocytes. What is it and what functions does it perform?

Melanocytes are specialized cells that produce melanin, which determines the color of human skin and its ability to tan. Melanocytes also perform a protective function, preventing the harmful effects of ultraviolet radiation.

Skin melanoma is considered the most aggressive type of cancer. The tumor process develops very rapidly. It is a mistake to think that melanoma appears only from moles.

The percentage of development of this type of cancer from moles is only 30%, the rest falls on clean areas of the skin. Melanoma can form even under the nails.

Despite the fact that for the most part melanoma develops on the skin, it can occur in the rectum, vagina, various structures of the eye, and oral cavity.

Causes of melanoma

There are many theories about the origin of cancer. Science has not yet decided on the causes of the development of the tumor process, however, for each type of tumor, there are prerequisites and risk factors. For melanoma it is:

• systematic prolonged exposure to ultraviolet radiation on the skin (sunlight, artificial light in solariums);
• chronic burns;
• regular repetitive mechanical trauma to moles, age spots, nevi;
• ionizing radiation;
• chronic electromagnetic radiation;
• predisposition of the skin - low pigmentation (white skin, abundant freckles);
• heredity (the risk of the disease increases if someone in the family has had this type of skin cancer);
• immunodeficiency states;
• hormonal disorders (increased levels of sex and melanocyte-stimulating hormones);
• late pregnancy (after 30);
• usage oral contraceptives.

melanoma symptoms

Early stages of melanoma

On the photo melanoma on the scalp

Acrolentigious melanoma

Skin cancer on the lip

Skin cancer most often occurs on the lower extremities or back, but localization can be very diverse. As it was said, it can occur at the site of a mole, at the site of injury skin or on normal uninjured clean skin (see photo above).

A malignant neoplasm changes the melanocyte, but it continues to produce melanin pigment, so the neoplasm acquires a black, brown color.

There are also colorless melanomas.

One of the symptoms of melanoma is a black rim around the edge of the tumor on the skin.

A characteristic feature of melanoma is the asymmetry of the formation and its big size. At first, skin changes are often not perceived by a person as cancer.

At first, melanoma looks like a mole, but unusual appearance.

Symptoms of melanoblastoma are divided into early and late:

• Early (first) signs of the disease:
  • elevation of previously flat moles;
  • itching, burning, bleeding, ulceration;
  • change in density (previously hard mole becomes soft);
  • hyperemia and edema of adjacent tissues;
  • growth of the primary focus of the neoplasm;
  • new areas of pigmentation around the primary focus of the neoplasm;
  • crust formation;
  • discoloration of the nail plate on the hands and feet;
  • darkening of the skin, not associated with prolonged exposure to the sun;
• Melanoma from a nevus ( benign tumor skin) can be distinguished by the following features:
  • a nevus is a flat formation on the skin;
  • the nevus has a symmetrical shape and smooth, even outlines;
  • the nevus does not have the ability to increase in size.
• Late symptoms of melanoma are:
  • bleeding from the formation and other pigmented areas of the skin;
  • pain syndrome that occurs on the affected skin;
  • violation of the integrity of the skin.

Stages of development of melanoma

The doctor determines the stage of development of melanoma according to the thickness of the neoplasm:

1. Zero stage- "cancer in situ" - at this stage, melanoma has not yet grown into the thickness of the epidermis;
2. initial stage– the size of the tumor is less than one millimeter with skin damage or up to two millimeters without damage (see how it looks in the photo below);
3. Second stage- the thickness of the formation is up to two millimeters with a damaged skin surface or more than two millimeters without damage;
4. Third stage- the presence of metastasis in one of the regional lymph nodes (lymphatic vessels);
5. fourth stage- tumor growth and germination of underlying tissues, the presence of metastases throughout the body.

Melanoma metastases occur most frequently in the skin, subcutaneous tissues, brain, and bones (spine, ribs, cranial and pelvic bones).

Classification

• Superficial spreading melanoma. This type of melanoma usually develops on a mole or intact area of ​​the skin.

Lentigo maligna (superficial spreading melanoma)

• nodular melanoma is a more malignant type of the disease.

• Lentiginous melanoma(Hutchinson's freckle) develops more often on the face, ears, neck, hands. It is considered the most favorable form of this pathology (slow growth combined with a low risk of metastasis);

How diagnostics is carried out

Dermatoscope

First of all, a specialist doctor examines the affected area of ​​the skin.

A thorough visual examination is carried out using a special device - a dermatoscope.

This is an apparatus instrumental research which allows to carry out examination of a skin neoplasm without surgical intervention.

Dermatoscope shot

The dermatoscope allows you to see signs of a malignant course of education that are not visible to the naked eye. Scientific progress has contributed to the creation of a digital dermatoscope, thanks to which you can see a three-dimensional image of the pathology on the screen.

Without fail, a patient with suspected skin cancer donates blood to detect tumor markers . Tumor markers are specific substances that are secreted by a malignant tumor.

A biopsy is a mandatory diagnostic method for suspected cancerous pathology.

The material undergoes histological and morphological examination, which allows determining the degree of malignancy of the tumor, the stage and clinical form of melanoma.

Additional research methods are:

• CT scan;
• scintigraphy;
• Ultrasound of the regional lymph node and internal organs.

These methods are used to detect tumor metastases.

Melanoma treatment

On early stages disease is carried out surgery which is the most efficient. Application possible drug therapy. In the later stages of melanoblastoma development, radiation treatments are used.

Medical therapy for melanoma

For melanoma of the skin, three drug treatment regimens are used:

• before surgical excision of the tumor to reduce the size of the melanoma and the defect that remains after (non-adjuvant therapy);
• basic therapy when surgical intervention does not seem possible;
• after surgical removal of the neoplasm in order to prevent recurrence (adjuvant therapy).

Medical treatment for melanoma includes immunotherapy, radiotherapy, and chemotherapy.

Melanoma immunotherapy is carried out using biological preparations created in the laboratory, but similar to the proteins of the human body's immunity.

Used medicines:

• Interferon-alpha used in adjuvant therapy, preventing recurrence of the excised tumor;
• Interleukin-2 used to prevent metastasis;
• Peginterferon-alpha-2b provides effective anti-relapse prevention;
• ipilimumab- a drug created on the basis of monoclonal antibodies; specifically affects the body, increasing the immune response to malignant processes;

Chemotherapy and radiotherapy

In the chemotherapy of melanoma, drugs are carried through the blood vessels, penetrate into all organs, tissues and have a systemic effect.

This type of therapy for melanoma is not effective enough, moreover, healthy cells of the body are destroyed, which makes chemotherapy drugs undesirable for use.

Chemotherapy is carried out in combination with immunotherapy in order to reduce the possibility of side effects.

Drugs used in this type of therapy: Dacarbazine, Paclitaxel, Carboplatin.

Chemotherapy causes a number of side effects:

• baldness;
• weakness, loss of appetite;
• increased bleeding;
• nausea, vomiting, diarrhea.

Radiotherapy is a method of treatment using strong radiation, which has a lethal effect on tumor-damaged cells. The method is not applicable for primary melanoma.

Radiotherapy is prescribed after lymph node dissection as a way to prevent recurrence.

Accompanied by this type of therapy side effects(hair loss, nausea, vomiting, skin manifestations), but all unwanted effects from radiotherapy pass at the end of treatment.

Surgery

Surgery followed by removal of the tumor is the main treatment for melanoma, especially at the initial stage of the disease.

There are the following surgical methods tumor removal:

• Simple excision- this method is suitable for flat melanomas and involves minimally invasive intervention. Together with the damaged areas, healthy tissues around are also removed to prevent relapse;
• Wide tissue excision- performed after a biopsy, the results of which showed the presence of a tumor process;
• Amputation- it is used if melanoma is localized on the finger;
• Lymph node dissection- removal of lymph nodes located in the immediate vicinity of the tumor.
• Surgery for metastatic melanoma- does not allow the patient to be cured of the tumor, but improves the quality of his life by removing the symptoms that a metastasis in any organ gives.

Complementary therapies

Must be indicated for melanoma diet, which involves proper nutrition to reduce the effects of chemotherapy.

With melanoma, you must follow these rules:

• Reduce the amount of fat intake and focus on proteins and carbohydrates;
• It is necessary to cook food exclusively by steaming or in the oven;
• It is strictly forbidden for a patient with melanoma to go on various diets for weight loss;
• It is necessary to eat every two to three hours in small portions;
• Exclude from the use of alcoholic beverages;
• Increase the amount of foods in the diet, which include vitamins E and A and folic acid;
• Increase the intake of foods with antioxidants (broccoli, carrots, pumpkin).

It is forbidden to eat:

• Pork and beef;
• Butter;
• Fast food;
• pastries;
• Ice cream;
• Chocolate;
• Seeds;
• Pine nuts.

The following products will have a beneficial effect on the condition of a patient with melanoma:

• Green tea;
• Fish;
• Vegetables, both raw and boiled (especially pumpkin, radish, tomatoes);
• Fruits or freshly squeezed juices;
• poultry meat;
• Seafood.

Prevention

People who are predisposed to developing melanoma need to follow some rules that will reduce the risk of the disease:

• Reducing sun exposure is the main prevention against melanoma;
• It is necessary to protect exposed skin from direct sunlight (wear sweatshirts with sleeves, hats or caps and pants);
• The use of sunscreen is recommended;
• Knowledge about the first signs and symptoms of melanoma is necessary so that if one of them is detected, immediately consult a doctor and begin treatment;
• It is necessary to examine the skin for the presence of new formations or changes in old ones, so as not to miss the transformation of a mole into melanoma;

How long will the patient live after diagnosis?

The prognosis for this cancer depends on several factors, one of which is tumor metastasis.

If melanoma has metastasized, then the life of the patient depends on the number of affected organs:

• one - seven months;
• two - up to four months;
• more than two organs - less than two months.

One of the factors affecting the patient's life expectancy is the localization of the tumor process. The prognosis is more favorable when melanoma is located on the forearm and lower leg, less on the scalp, hand, foot and mucous membranes.

Melanoma often recurs. Scientists have found that the malignant process can start again even ten years after a complete cure.

However, when melanoma of the first stage is detected, with the timely removal of this formation, the prognosis is more than favorable (97% of patients survive).

For patients who were able to survive skin cancer, there is a list of mandatory rules that must be followed in order to avoid or timely detect the recurrence of the disease.

First of all, every month the patient should independently or with the help of relatives inspect their skin for the presence of suspicious formations and the first alarming symptoms of relapse.

The patient must follow the schedule of visiting a specialist for consultation and examinations (if indicated).

Patients with a cured first stage of the disease are advised to visit a doctor once every three months for the next few years. With the second, third and fourth stages - once a month for four years.

It is also very important to avoid sunlight, stop visiting solariums if the patient used these services before the illness.

Such patients should qualitatively change their lifestyle. Sports are encouraged, proper sleep duration, correct and balanced diet. Rejection bad habits(alcohol, nicotine) is an important measure in the prevention of relapse.

Sports activities do not imply strong physical exertion. It can be hiking, aerobics, fitness.

This disease is the strongest stress for the psyche. And even if the disease was defeated, unpleasant memories can still haunt the mind of such a person. Therefore, it is important to apply stress prevention methods (meditation, relaxation). Visits to a psychotherapist are recommended if the patient cannot independently cope with the negative emotional background from the disease.

The participation of the family and close people in rehabilitation after melanoma treatment is also important. Regular communication, support, spending time together will only have a beneficial effect on psychological state sick.

Related video

Interesting

Malignant melanoma is a disease that develops from normal cells in the body that produce the pigment melanin. These cells are called melanocytes, they are in the skin, hair follicles, in the membranes of the brain, the iris of the eye. Sometimes a small part of the melanocyte cells fuse together, forming nevi - benign neoplasms or malformations of the skin.

Melanoma disease begins at the moment when failures occur in the division of melanocytes, which is why they acquire atypical signs. Atypicality of cells is manifested in a change in the composition of the cell, its division and growth, a tendency to spread to nearby tissues of the body and distant organs.

The occurrence of malignant melanoma

The atypical changes described above can occur both with those melanocyte cells that are located within the mole (nevus) already existing in a person, and with those that are in a diffuse state in unaltered skin. It has been established that more than half of malignant melanomas appear on an unaltered area of ​​the skin, and only a smaller part develops within the boundaries. When atypical cells occur within a nevus, such a nevus is considered atypical, in medicine it is called "melanocytic dysplasia". Since very often the development of malignant melanoma comes from a new pigmented formation that has appeared on smooth skin, all people need to carefully monitor changes not only in existing moles, but also in the appearance of new ones.

Forms of malignant melanoma

To date, four forms of malignant melanoma are known to medicine:

• superficially spreading melanoma is the most common form of this disease (more than 70% of the total number of cases). It appears in the form age spots on the skin, slightly protruding above its surface. The color of superficial melanoma varies from light brown to blue-black. With this form of the disease, cancer cells accumulate in the upper layers of the dermis, while spreading laterally (that is, along the surface of the skin, and not deep into it);
• nodular melanoma is a form diagnosed in approximately 15% of patients. Nodular melanoma usually appears as a thick plaque or nodule protruding from the surface of the skin. The color of such formation varies from dark blue to blue-black. Pathological cells spread vertically (deep into the skin).
• acral lentiginous melanoma. This form of the disease, which occurs much less frequently than the previous ones (in about 10% of cases). It is a dark-colored formation with uneven edges, most often localized in the upper layers of the dermis on the palms, soles, fingertips or under the nails. Spreads radially (surface).
• Lentigo maligna is one of the rarest forms of melanoma. It manifests itself in the form of light brown spots, similar in appearance to ordinary freckles. Most often, this form of melanoma affects older people. The path of distribution is superficial.

Classification of malignant melanoma

Depending on the stage of growth of melanoma, there are:

1. Tumors that do not have a radial growth stage:
   nodular melanoma.
2. Tumors with a stage of radial growth:
   superficial spreading melanoma;
   malignant lentigo;
   acral lentiginous melanoma;
   melanomas with unclassified radial growth stage.
3. Unclassifiable forms of melanoma:
   neurotropic;
   desmoplastic;
   melanomas with minimal deviation;
   blue nevus in a malignant form;
   unclassified melanomas with a vertical growth phase.

Stages of development of malignant melanoma

Determination of the phase of development of malignant melanoma is of clinical importance for the prognosis of the disease.

There are two of them:

1. phase of radial growth. In this context, the term "radial" is used to refer to the clinical stage of the development of a malignant process, and not as a geometric concept. In the radial phase of development, the growth of a cancerous tumor occurs due to the penetration of pathological cells into the lower layers of the epidermis (basal and spiny), and their spread there, in a horizontal direction.
   The main diagnostic features of melanoma in the radial growth phase, which allow it to be distinguished from benign neoplasms, are: asymmetry of form - while the formation has an irregular shape, resembling a geographical map;uneven coloring classical development melanoma, the color of the tumor is combined, including areas of reddish, blue, white. The main background can also vary from light brown to blue-black;big sizes(on average, not less than 1 cm) is a characteristic sign of melanomas in the phase of radial growth. Usually such formations are much larger than melanocytic nevi;elevation above the skin. Infiltration of the tumor with atypical cells usually causes thickening of the neoplasm, so very often tumors in the radial growth phase rise slightly above the skin surface.
2. F the basis of vertical growth. At this phase of melanoma development, in contrast to the stage of radial growth, the process of metastasis begins. The clinical manifestations of melanoma in the vertical growth phase are the elevation of the formation above the skin surface and the appearance of a node in it. In the phase of vertical growth, melanoma can pass both from the radial stage and bypassing it (arising as a new formation). In addition to this, to clinical signs vertical growth are:

• the previous stage of radial growth (in 90% of cases);
• the formation of a node ranging in size from 1 mm to several cm;
• the appearance of sores on the part of the epidermis covering melanoma, as well as its compression;
• the phenomenon of hyperkeratosis (keratinization) of the epidermis above the node.

Complications of malignant melanoma

The main complication of melanoma is the spread of this disease and its damage to other organs and tissues of the body, that is, metastasis.

(load position melanoma)

Spreading by the hematogenous route (through the blood vessels), metastases can settle in any organ: the liver, lungs, bones, brain, and others, and the spread of the disease through the lymphatic system leads to damage to the lymph nodes.

To prevent malignancy of the nevus, especially located in the place of constant risk of injury with his clothes, it is better to remove it. An attempt at self-treatment in the form of tying it with a thread, cutting it with a razor or scissors can also lead to complications of melanoma.

The consequences of such actions are unpredictable.

Doctors about melanoma (video)

Treatment of malignant melanoma

The main method of treatment of malignant melanoma is its removal by surgical excision with the capture of the skin surrounding the tumor (the size of the capture depends on the size of the tumor itself, but in general, the larger the tumor, the greater the capture), as well as subcutaneous fat and muscle area. Also used for the treatment of melanoma: radiation therapy, immunotherapy, laser destruction, cryodestruction.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

What is melanoma?

Melanoma is a type of malignant tumor that develops from pigment cells. In turn, pigment cells are cells containing pigment ( coloring) substance - melatonin. They are mainly found in connective tissue epidermis ( i.e. in the skin) and in the iris, giving these organs a characteristic shade. In the cells of the tumor, a large amount of melanin accumulates, which gives it a characteristic color. However, there are, albeit extremely rare, non-pigmented or achromatic tumors.
In the structure of cancer incidence, melanoma accounts for about 4 percent.
Caucasians are most at risk, in particular those with fair skin. This is due to several factors. One of the main ones is the reduction of the ozone layer in the atmosphere. Thus, it is known that the ozone layer located in the stratosphere ( upper atmosphere), blocks most UV rays. Ultraviolet radiation is a type of electromagnetic radiation, the main source of which is the Sun. It is with this type of radiation that the development of skin melanoma is associated. However, since the end of the last century, the ozone layer has decreased by 3 to 7 percent and continues to decrease annually. Researchers in this field suggest that every percent loss of the ozone layer is accompanied by an increase in the incidence of melanoma by one to two percent.

statistics on melanoma

Unfortunately, in recent decades there has been an increase in the incidence of this pathology. An analysis of the state of diagnosis of malignant skin diseases in the Russian Federation indicates a big problem of early diagnosis. So, at the first stage of the disease, only 30 percent of patients are detected. Every fourth ( 25 percent) a patient with melanoma is detected in advanced stages (third and fourth). This leads to the fact that the first-year mortality remains at a very high level. Thus, 10 to 15 percent of patients die within the first year of diagnosis.

What does melanoma look like?

When describing melanoma, it is necessary to take into account the features of its possible localization. Melanoma is a tumor characterized by the highest variability of the clinical picture, which, in turn, determines its diverse course. Since the skin is the largest organ in the human body its area is about 2 square meters ) and it covers all the external organs, then the localization of the tumor can be anywhere. Nevertheless, there are also favorite places of localization - for women this is the place of the lower leg, for men it is the back and face. In more than half of the cases, melanoma develops at the site of congenital moles.

If melanoma develops from previous pigmentation ( moles, nevus), then it can be located either in its center, or come from the periphery ( edges).

Variants of the appearance of melanoma are:

• flat pigment spot;
• mushroom-shaped, while it can be located on a leg or a wide base;
• slight protrusion;
• papillomatous growth.

However, single tumors of a round or oval shape are more common. Additional foci may form near the primary lesion ( also malignant), which either merge with the primary formation, or are located next to it.

Initially, the surface of melanoma is smooth and shiny, sometimes even as if it were a mirror. As the disease progresses, bumps, ulcerations appear on it ( small sores on the surface). The danger at this stage is that it starts to bleed at the slightest injury. Further, the tumor node can disintegrate with infiltration of the underlying tissues, as a result of which a formation resembling a cauliflower is formed on the surface of the skin. In rare cases, melanoma does not change and remains in the form of limited hyperemia ( redness) or a long-term non-healing ulcer.

melanoma consistency
The consistency of melanoma depends on its type and can vary from soft to firm and hard. At the same time, the consistency may be uneven - in this case, melanoma contains both soft and hard areas.

melanoma color
The color of melanoma depends on the amount of melanin in it ( pigment), with the exception of non-pigmented tumors. So, they can be brown, purple, purple or black, like ink.

Pigmentation may be uniform ( all melanoma is the same color) or uneven. In the second case, the tumor is more pigmented in the center, has a black rim around its circumference typical of melanoma. Often, melanoma has a variegated color, combining different shades.

A change in the color of an already existing melanoma is an alarming sign indicating an unfavorable and malignant course of the disease. In this case, a change in color can manifest itself in the form of darkening or, conversely, enlightenment. Moreover, pigmented melanomas can turn into non-pigmented melanomas and vice versa.

Nail melanoma and subungual melanoma

Nail melanoma is a type of melanoma that is localized near the nail bed or directly under the nail. It affects the nails on both fingers and toes. Today it is found in all age groups. Depending on the nature of growth, melanoma is divided into several types.

Types of nail melanoma are:

• melanoma growing from the skin, next to the nail plate;
• melanoma growing directly from the nail plate itself;
• melanoma growing from the nail.

Subungual melanoma can be suspected in several cases. The first symptom indicating a tumor may be a change in the usual color of the nail plate. Although it should be noted that at this stage, nail melanoma is diagnosed extremely rarely. Also, under the nail, an initially small dark spot may form, which gradually increases in size. The spot may look like a longitudinal strip or have a rounded shape. Sometimes the color of melanoma can merge with the surrounding tissues. In this case, the raised shape of the nail may indicate the growth of melanoma. This is explained by the fact that as the melanoma grows, it pushes back the nail plate. In advanced cases, melanoma may be indicated by the formation of a nodule near the nail fold. Further, ulcers and erosion form on it. Like all types of melanomas, subungual melanoma is also prone to aggressive growth and rapid metastasis.

Melanoma of the eye

Melanoma of the eye is one of the most common malignant tumors accompanied by decreased vision. It has a very aggressive and malignant course. Melanoma most often develops from choroid eyes, but melanoma and other elements of the eye also occur.

Types of melanoma of the eye include:

• conjunctival melanoma;
• eyelid melanoma;
• choroid melanoma;
• iris melanoma.

The most rare species are conjunctival and eyelid melanoma. Unfortunately, early detection of melanoma is extremely rare. Indeed, in the early stages, the patient does not make any complaints. The main manifestation is small opacities on the retina. However, this can only be detected by ophthalmoscopic examination. That is, if the patient is periodically observed by an ophthalmologist, then during routine studies, it is possible to detect melanoma in the first stage. In the second stage, complications already appear, such as pain in the eyes, swelling and redness of the eyelids. During the third stage, melanoma goes beyond eyeball. Due to the ever-increasing size of the melanoma, the eye is displaced anteriorly. This phenomenon in medicine is called exophthalmos, and in the people "bulging eyes". The walls of the orbit are destroyed by a growing tumor, the integrity of the sclera is violated. In the fourth stage, bleeding into the vitreous body, clouding of the lens and other intraocular symptoms develop along with metastasis to the internal organs.

The main treatment is surgical removal of melanoma.

Melanoma on the face

The most malignant forms of melanoma appear on the face. In this case, they may have the form of a pigmented ( painted) or non-pigmented flat formation of various shapes. On early stages it can be round or oval, sometimes even symmetrical. However, the more malignant the melanoma, the more uneven and blurred its outlines become. The same thing happens with color - in the initial stages, a uniform color is observed, but as it progresses, it becomes variegated. The shape can be flat, dome-shaped, in the form of a knot or a mushroom on a leg.

melanoma on the back

In its course, melanoma on the back is no different from melanoma on other areas of the skin. The shape can also vary from round to domed, the color from dark blue to red. The disadvantage of such localization is that, due to the inaccessibility of the gaze, such melanoma is diagnosed at later stages. Unlike melanoma on the face, which causes a visible aesthetic defect, patients with melanoma on the back go to the doctor much later.

Symptoms ( signs) melanoma

The main sign of malignant melanoma is considered to be the growth of a pre-existing nevus or mole along the plane, a change in its edges and color, as well as the appearance of itching. If melanoma developed independently, then the main symptom will be the appearance of a pigment spot on the skin that has certain characteristics.

Symptoms of malignant melanoma are:

• an increase in size or change in color of a nevus or mole;
• itching and bleeding of a nevus or mole;
• the appearance of a spot on the skin that bleeds slightly.

The earliest diagnosis of melanoma is noted when it is localized on the face. The presence of a cosmetic defect on the visible part of the body forces patients, especially women, to see a doctor as soon as possible.

skin melanoma

So, melanoma can develop in all organs and tissues of the body ( oral mucosa, rectum, or eyes), but the most malignant are melanomas of the skin. They can have a different size, shape, texture and color. Initially, the size of melanoma can be negligible - in the initial stages, the diameter usually does not exceed one centimeter. However, the tumor can grow very quickly and in the final stages reach large tumor nodes.

Melanoma can begin its development both from the previous nevus and independently. In the first case, a birthmark ( mole or nevus) begins to increase, change color and turns into a tumor. The growth of a mole into a tumor can begin with a previous injury ( it could be the slightest damage to the clothes) or after prolonged exposure to the sun. However, also the process of malignancy ( malignancy) may start spontaneously. There is a so-called malignancy rule, which includes four criteria. It is abbreviated as ABCD - an abbreviation made up of the first letters of the symptoms in English.

Signs of malignancy include:

• asymmetry ( asymmetry) - a previously symmetrical mole begins to lose symmetry and its edges become different and unlike each other;
• the edges ( border) - become uneven and intermittent;
• color ( color) - the color changes, a previously light or brown mole becomes black, while its color often becomes uneven - with inclusions of red and blue;
• diameter ( diameter) - the size of the mole increases, a diameter of more than 6 - 7 millimeters is considered to be potentially malignant.

Causes of melanoma development

Like most cancers, the causes of melanoma are still not well understood. Among the main risk factors, exposure to ultraviolet radiation on the skin and heredity predominates.

Causes of melanoma include:

• ultraviolet radiation;
• hormonal imbalance;
• genetic predisposition.

Ultraviolet radiation
To date, exposure to ultraviolet radiation ( spectrum of solar radiation) is recognized as the main cause contributing to the development of melanoma of the skin. However, it is important to understand here that not constant exposure to the sun is crucial ( i.e. chronic damage to the skin by ultraviolet rays) but a sharp, sometimes single, but intense effect of solar radiation.

Studies have confirmed that melanoma of the skin is more likely to occur in those individuals who spend most of their time indoors, and rest, staying under the sun for a long time. At the same time, exposure to ultraviolet rays is closely related to skin type. According to most researchers, the incidence of skin melanoma is equally affected by ultraviolet radiation and ethnic factors. So, the fact that the tumor develops in people with fair skin is reliable. Statistical data indicate a rarer incidence of melanoma among people of the black race ( despite the fact that they have the same number of melanocytes in the epidermis as people with white skin). The main role in the pathogenesis of melanoma is played by a violation of the pigmentation of the body. The result is an abnormal reaction of the skin to solar radiation.

A violation of skin pigmentation can be judged on the basis of its color, as well as on the basis of the color of the hair and eyes. The presence on the skin can also indicate the level of pigmentation. a large number age spots ( scientifically nevi) and freckles. In such people, the usual short exposure to the sun is accompanied by burns. The classic patient with melanoma is the owner of a light ( sour cream colors) skin, with many age spots and freckles, having straw-colored hair and blue eyes. Redheads are 3 times more likely to develop melanoma than fair-haired people.

Hormonal imbalance
Often the development of melanoma falls on periods accompanied by hormonal changes. This may be puberty in adolescents and menopause among women. So, under the influence of hormones, existing moles begin to regenerate - they increase in size, change shape and color.

genetic predisposition
The genetic factor is also one of the main reasons for the development of melanoma. It has been established that the risk of developing this pathology is increased in families suffering from atypical birthmark syndrome ( AMS - Atypical Mole Syndrome). This syndrome is characterized by the presence on the skin of a large amount ( more than 50) atypical moles. Already initially, these moles have features characteristic of malignant melanoma ( e.g. uneven edges, intensive growth). They are characterized by malignant degeneration, that is, the transition to malignant melanoma. Therefore, this syndrome is considered one of the main risk factors contributing to the development of skin melanoma.

Nevus, moles and other risk factors for melanoma

A nevus is a benign neoplasm that tends to become malignant. In the people, the nevus is called a mole or birthmark, which is not true. A nevus differs from a mole primarily in its size. It can be both congenital and acquired, appearing at certain life stages.
A nevus is a dark lesion on the skin that can range in color from dark brown to purple. However, its color and size may change throughout life. Moles are subject to maximum changes during puberty. So, under the influence of hormones, they can increase in size, change shape and color.

Although a nevus is a benign and often harmless lesion, it is a risk factor for the development of melanoma. In people with multiple nevi, the risk of developing skin cancer is several times higher. Therefore, dermatologists advise monitoring the growth and number of nevi on the skin. Particular importance is attached to trauma to the nevi. So, cases of melanoma of the skin after their injury are described. It can be a single bruise, a cut or an elementary abrasion. Nevi can be chronically traumatized by clothes or shoes, which should also be taken into account.

Unfortunately, more than half of all primary melanomas of the skin develop against the background of nevi. This allows us to regard them as a precancerous condition. In this case, the frequency of malignancy ( malignancy) of nevi correlates with their size. For example, with a nevus larger than two centimeters, the risk of going into cancer is up to 20 percent. There are two main types of nevi - dysplastic and congenital. The former are part of the atypical syndrome and turn into malignant melanoma in 100 percent of cases. Congenital nevi occur in one percent of newborns. From acquired nevi, they differ in significant size and darker color.

Signs of dysplastic nevi are:

• more than half a centimeter in diameter;
• wrong shape;
• lack of clear boundaries and unclear outlines;
• flat surface;
• various shades - black, red, pink, red;
• uneven pigmentation ( the center can be one color, the edges - another).

As already mentioned, a dysplastic nevus is part of an atypical syndrome, which, in turn, has a hereditary predisposition. The malignancy of such a nevus is 10 cases out of 10, that is, 100 percent. Therefore, patients with this syndrome should be observed by an oncologist and dermatologist every six months throughout their lives.

Another risk factor for melanoma is Dubreu's melanosis. This syndrome is characterized by areas of skin pigmentation in middle-aged and elderly people. It is most often localized on the skin of the face, but can also develop in other areas of the body. The main signs of melanosis are uneven coloration and uneven edges. The contours of the pigment formation often resemble a geographical map. Dubrey's melanosis is distinguished by its scale - spots can reach up to 10 centimeters in diameter. Today, melanosis and nevus are usually regarded as a precancerous condition.

Types of melanoma

There are several types of melanoma classification. The main one is the TNM classification, which takes into account the stages of melanoma development and divides it into stages - from the first to the fourth. However, in addition to this, there is also a clinical classification, according to which there are four main types of melanomas.

The types of melanomas according to the clinical classification include:

• superficial spreading melanoma;
• nodal ( nodular) melanoma;
• lentigo melanoma;
• peripheral lentigo.

Superficial spreading melanoma

The most common type of melanoma is superficially spreading melanoma, which occurs in 70 to 75 percent of cases. As a rule, it develops against the background of previous nevi and moles. Superficial melanoma is characterized by a gradual increase in changes over several years, followed by a sharp transformation. Thus, its course is long and, relative to other forms of melanoma, is non-malignant. It is more common in middle-aged people and affects both men and women equally. Favorite places of localization are the back, the surface of the lower leg. Superficially spreading melanoma is not characterized by large sizes.

The characteristics of superficially spreading melanoma are:

• small sizes;
• wrong shape;
• uneven edges;
• polymorphic coloration interspersed with brown, red and bluish;
• is often ulcerated and bleeds.

Compared with other subspecies, the prognosis for superficial melanoma is generally favorable.

Nodal ( nodular) melanoma

Unlike the previous tumor, the nodular ( synonymous with nodular) melanoma is less common, in about 15 to 30 percent of lesions. But, at the same time, it is characterized by a more malignant and aggressive course. It is not characterized by a long period of increase in symptoms - the disease proceeds at lightning speed. Most often, nodular melanoma develops on intact skin, that is, without previous nevi and moles. Initially, a dome-shaped dark blue nodule forms on the skin. Then it quickly ulcerates and begins to bleed. Nodular melanoma is characterized by vertical growth, that is, with damage to the underlying layers. Pigmentless nodular melanomas occur in 5 percent of cases. The prognosis for this disease is extremely unfavorable, affecting mainly the elderly.

Lentigo melanoma or malignant lentigo

Lentigo melanoma ( synonym for melanotic freckles) occurs in 10 percent of cases, like the previous tumor, develops in old age ( most often in the seventh decade of life). Lentigo is often confused with freckles, which is not true. Initially, small nodules appear on the skin in the form of dark blue, dark or light brown spots, with a diameter of one and a half to three millimeters. Most often they affect the face, neck and other exposed areas of the body. Also, this type of melanoma can develop from benign Hutchinson's freckles. Melanoma grows very slowly in the superficial layers of the dermis. Until the moment of its penetration into the deeper layers of the skin, more than 20 years can pass. The prognosis is favorable.

peripheral lentigo

Peripheral lentigo also accounts for about 10 percent of cases. It is more common in people of the Negroid race. The favorite localization of the tumor is the palms, soles and nail bed. The tumor is dark in color ( due to the presence of pigment), jagged edges. However, non-pigmented tumors can also occur. Peripheral lentigo grows slowly in the radial direction, as a rule, in the superficial layers of the skin without invasion ( germination) to the inner layers. Rarely, the tumor can penetrate into the deeper layers of the skin up to the subcutaneous fat layer. The prognosis depends on the degree of germination deep into the tumor.

Pigmentary melanoma

In most cases, melanoma contains a coloring pigment - melatonin - which gives it a characteristic color. In this case, it is called pigment. The advantage of pigmentary melanoma is that it is easier to visualize ( that is to notice) and it brings a big cosmetic defect. This forces patients to see a doctor earlier.

The color of pigmentary melanoma can vary and include a wide variety of shades - from pink to blue-black. The color scheme may change as the disease progresses. Moreover, the color may become inhomogeneous, which is an unfavorable sign. So, previously homogeneous melanoma in the third and fourth stages becomes variegated and contains various shades. Pigmentary melanoma can become pigmentless and lose its characteristic shade.

Non-pigmented melanoma

Pigmentless or amelanotic melanoma is the most dangerous tumor. It is called so because of the absence in it of the same coloring pigment that gives it color. The danger of non-pigmented melanoma lies not only in the fact that it is noticed late ( for a long time the tumor is not visible), but also in its aggressive growth. This type of tumor, regardless of stage, has a worse prognosis compared to a pigmented tumor. The tumor is a small tubercle that rises above the surface of the skin, the color of which does not differ from the rest of the skin. Amelanotic melanoma quickly grows deep and metastasizes in all known ways ( with the flow of lymph and blood). At the same time, as the demon grows pigmentary melanoma can turn into pigment and acquire a dark shade. It should also be noted that the opposite happens when a pigmented tumor becomes pigmentless.

Diagnosis of this type of tumor is a very difficult task. Diagnosis is difficult, especially when there are already nevi on the skin. Main diagnostic symptom is fast growth and discoloration of the neoplasm. However, the diagnosis is made on the basis of dermoscopic examination.

malignant melanoma

Initially, melanoma is a malignant tumor. Benign melanoma does not exist. A malignant tumor differs from a benign one in a number of ways.

Signs of malignancy are:

• Rapid and uncontrolled growth. Tumor growth can be so intense that it leads to compression of surrounding tissues and organs.
• Tendency to invade germination) to neighboring organs and tissues and the formation of local metastases in them.
• The ability to metastasize- movement of tumor particles to distant organs with blood or lymph flow.
• The development of a powerful syndrome of intoxication ( "cancer poisoning"). This syndrome is characteristic of the later stages of the disease and is manifested by the penetration into the general bloodstream of dead tissues of the body.
• The ability to avoid immunological control of the body.
• Very low differentiation ( division) cells compared to healthy cells.
• Angiogenesis- the ability to form their own circulatory system. So, at the later stages, the phenomenon of “vascularization” of the tumor occurs, which is characterized by the formation of new vessels inside the tumor.
• A large number of mutations within the tumor.

Stages of melanoma

In the development of melanoma, like other diseases, there are several stages. However, there are several options for classifying staging. Adherence to a particular classification often varies by country or region. However, there is a basic international classification that all specialists in this field use.

Types of melanoma classifications include:

• international TNM classification- characterizes the size of the tumor, the presence of metastases;
• 5 stage classification- common in the west
• clinical classification- unlike the previous classifications, it describes only three stages.

The most common is the international classification - TNM. This classification takes into account the main criteria - T - the degree of invasion ( How deep has the melanoma grown?), N - damage to the lymph nodes, M - the presence of metastases. Abroad, the most popular is the 5-stage classification and the 3-stage clinical classification.

Melanoma stages according to TNM

Criterion		Description
T - degree of invasion(germination)melanoma in depth, the thickness of the melanoma itself is also taken into account		melanoma thickness less than one millimeter
		melanoma thickness from one to two millimeters
		melanoma thickness from two to four millimeters
		melanoma thickness more than four millimeters
N - damage to the lymph nodes		one lymph node affected
		two to three lymph nodes affected
		more than four lymph nodes affected
M - localization of metastases		metastases in the skin, subcutaneous fat and lymph nodes
		metastases in the lungs
		metastases in internal organs

Early stages of melanoma

The initial or zero stage of melanoma is called melanoma in situ. At this stage, the tumor does not grow, being in the same place. It looks like a small mole of black color, it may contain blotches of red.

first stage melanoma

According to international classification TNM stage 1 melanomas are classified as T1-2N0M0, which means that the thickness of stage 1 melanoma varies from one to two millimeters, and there are no metastases. According to the 5-stage classification, melanoma of the first degree is localized at the level of the epidermis and / or dermis, but does not metastasize through the lymphatic vessels in The lymph nodes. The thickness of the tumor is up to one and a half millimeters. According to the clinical classification, the first stage is a local stage.

The characteristics of the first stage according to the clinical classification are as follows:

• a single primary neoplasm;
• satellites are allowed ( related to basic education) tumors within a radius of five centimeters from the primary tumor;
• the presence of metastases at a distance of more than five centimeters from melanoma.

second stage melanoma

According to the international TNM classification, melanomas of the T3N0M0 category belong to the second stage. This means that the thickness of melanoma in the second stage is from two to four millimeters, there are no metastases in the lymph nodes and internal organs. According to the Western 5-stage classification, the thickness of melanoma of the second stage varies from one and a half to four millimeters. At the same time, it extends to the entire dermis ( that is, on the thickest layer of the skin), but does not penetrate into the subcutaneous fat layer and into the lymph nodes. Clinical classification adds to all this also the defeat of regional ( local) lymph nodes.

The third stage of melanoma

The third stage of melanoma is the categories T4N0M0 or T1-3N1-2M0. The first option describes a melanoma more than 4 millimeters thick, but without metastasis. The second option describes melanoma with a depth of one to four millimeters, with damage to two to three lymph nodes, without damage to internal organs.

The characteristics of stage III melanoma according to the Western classification include:

• thickness more than 4 millimeters;
• germination of the tumor already in the subcutaneous fat layer;
• the presence of satellite additional) tumors within 2 to 3 centimeters of the primary tumor;
• metastasis to regional lymph nodes.

The clinical classification adds to this a generalized lesion of the internal organs.

Fourth stage

The fourth stage of melanoma corresponds to the category T1-4N0-2M1, which means a tumor with a thickness of more than 4 millimeters, the presence of metastases in the lymph nodes and internal organs.

melanoma in children

Unfortunately, one of the most malignant tumors occurs in childhood. At the same time, melanoma is observed among all age groups, but is most often recorded at the age of 4 to 6 years and from 11 to 15 years. It affects both boys and girls equally. Favorite localization is the neck, upper and lower limbs.

Causes of melanoma in children

In more than 70 percent of cases in children, melanoma develops on altered skin, that is, against the background of existing nevi and moles. The most severe are melanomas that have developed against the background of large congenital nevi. In 10 percent of cases, melanoma is hereditary.

Symptoms of melanoma in children

Symptoms of melanoma in children are polymorphic ( variable) and depends, first of all, on the form and stage of melanoma, as well as on its localization. Tumors in childhood are characterized by rapid and invasive ( germinating) height.

Signs of melanoma in children are:

• discoloration of a previous nevus or mole;
• proliferation of a previously “calm” nevus;
• elevation of education above the skin;
• the appearance of cracks;
• the appearance of a burning sensation and tingling;
• formation of ulcers ulceration phenomenon) followed by repeated bleeding;
• hair loss on the nevus and adjacent skin area.

Late signs of the disease include metastases to the lymph nodes, the appearance of satellites ( subsidiaries cancerous tumors ), symptoms of intoxication. The disease can proceed both rapidly and lightning fast, and in waves with periods of remission ( periods of subsidence of the disease). A feature of melanoma in children is early metastasis ( metastases appear already in the first year of the disease) and the predominance of the lymphogenous pathway of spread of metastases. So, the rate of appearance of metastases in the lymph nodes is not affected by the size of the tumor and the degree of its germination. Even very small tumors can metastasize. Another feature is the predominance of the nodular form of melanoma, one of the most aggressive.

The biological feature is resistance ( sustainability) tumors to chemotherapy and radiotherapy . So, despite the fact that there have long been standard chemotherapy regimens for the treatment of melanoma in adults, they are not applicable to children. Although recently new regimens have been developed for the treatment of malignant melanoma among children, despite this, the main method of treatment has been and remains the surgical method.

Prognosis for melanoma

The main condition for successful remission in melanoma is its early diagnosis. Early detection of malignant melanoma depends primarily on the level of medical care and on the knowledge of the doctor. At the same time, patient awareness is important. All persons with precancerous conditions ( nevi, melanosis) should periodically undergo preventive examinations by a family doctor and a dermatologist. In Australia ( where is the highest incidence of melanoma) a program was adopted, according to which the signs of malignant skin tumors and malignant moles are studied in a comprehensive school. Thus, a simple resident with a mole or nevus is able to notice the first signs of a transition to cancer. During this program, it was possible to increase the 5-year survival rate ( main criterion for remission) in melanoma. This was achieved by the fact that patients themselves sought advice from a dermatologist at the slightest change in moles. Thus, an early diagnosis of melanoma was achieved.

Metastases in melanoma to the brain and lymph nodes

The lymphatic system is unique protective system an organism that has representation at every level. It is represented by three components - lymphoid tissue, lymphatic vessels and the lymphatic fluid they contain lymph). Lymphatic tissue is distributed throughout the body, being in almost every organ, in the form of lymph nodes. That is why the lymph nodes become the main target for metastasis ( dissemination) tumors and melanoma are no exception in this case.

Wherever melanoma is located, as it progresses, it always metastasizes to the lymph nodes. This happens already at the second stage, when the melanoma begins to ulcerate and becomes loose, as a result of which the tumor cells enter the lymphatic capillaries ( that are everywhere). From the capillaries, along with the liquid, cancer cells enter the nearest lymph nodes. In it, the cells settle and begin to multiply, forming a secondary focus in the lymph node. During this period, the tumor process is suspended for a while. However, the lymph node damaged by cancer cells continues to grow up to a certain stage. Then it becomes loose again, and the tumor particles from it through the lymphatic capillaries reach another, more distant lymph node. The farther from the primary focus, the more neglected the disease is considered.

With melanoma, the cervical, axillary and intrathoracic nodes are most often affected. Symptoms of the lesion are polymorphic ( diverse) and depends on the number of affected nodes, the degree of their compression.

Metastases in the cervical lymph nodes
At healthy person this group of lymph nodes is outwardly not noticeable and not palpable. But due to the enlargement of the lymph nodes in the neck, round or oval formations are visually determined ( the number of formations depends on the number of affected lymph nodes). The skin above them is not changed, which is an important diagnostic sign. To the touch they are dense, motionless, often painless. If deep cervical nodes are affected by metastases, then visually they are not marked in any way. At the same time, an asymmetric thickening of the neck appears.

Metastases in the axillary lymph nodes
Patients with metastases in the axillary lymph nodes complain of a feeling of a foreign body in the armpit, as if something is interfering with them. IN armpit lymph nodes are located along the vessels and nerves. If the lymph node is located near the nerve, pain, numbness of the arm, or tingling of the skin may occur. When squeezing the blood vessels, swelling of the hand develops.

Metastases in intrathoracic lymph nodes
In the cavity of the chest is a large number of lymph nodes, which are called intrathoracic. Symptoms of the defeat of these lymph nodes depend on their location and size.

Symptoms of metastases in the intrathoracic lymph nodes include:

• persistent cough;
• difficulty in swallowing;
• violations of the rhythm and conduction of the heart;
• hoarseness of voice.

This symptomatology is explained by squeezing the vessels and nerves located in the chest cavity.

Metastases in the lymph nodes of the abdominal cavity
The clinical picture of abdominal metastases, as in the cases described above, will depend on which lymph nodes were affected. So, metastases in the mesentery of the intestine are accompanied by intestinal colic, constipation, and in severe cases, intestinal obstruction. Metastases in the liver are accompanied by stagnation of venous blood in the organs, with the development of edema and ascites ( accumulation of fluid in the abdominal cavity).

Metastases to the brain
Unfortunately, brain metastases are not uncommon. Today, more than 30 percent of cancer patients have brain metastases. About one fifth of all intracranial metastases are melanoma ( lung and breast cancer are the first in brain metastasis). Penetrating into the brain metastases give a specific clinical picture.

Symptoms of brain metastases are:

• Nausea. It can be a sign of both intoxication and intracranial pressure. In the second case, as the pressure increases, vomiting also joins. Nausea combined with headache is an unfavorable symptom.
• Bursting headaches. Initially, headaches are mild and resolve with analgesics. Then they become permanent and do not respond to pain medication. Headaches are often accompanied by dizziness and visual disturbances. Often this is the first symptom that speaks of brain damage.
• convulsive syndrome, which is manifested by large and small seizures of the type of epileptic. Typical for patients over 45 years of age.
• Focal symptoms, which is individual and depends on the location of metastases. So, metastases in the right hemisphere are manifested by disorders of the sensitivity of the left arm and leg. Metastases in the temporal region are accompanied by hearing impairment, in the occipital region - visual impairment.

Diagnosis of melanoma

Diagnosis of melanoma, like other diseases, is to collect an anamnesis ( medical history), inspection and appointment of additional studies.
The collection of anamnesis in the diagnosis of malignant melanoma occupies an important place. So, during the survey, the doctor is interested in when the changes appeared, how they started, how quickly the mole grew and whether it changed color. Family history ( hereditary diseases) is no less important. Today obligate ( compulsory) precancerous disease is considered atypical birthmark syndrome. In families where family members suffer from this syndrome, the risk of developing melanoma is increased several dozen times. Data on previous trauma, prolonged exposure to the sun are important.

Melanoma checkup

Next, the doctor proceeds to the examination. Particular attention is paid not only to melanoma, but also to adjacent areas of the skin. There are certain signs of malignant melanoma on which the diagnosis is based.

Diagnostic criteria for malignant melanoma are as follows:

• neoplasm unevenly protrudes above the surface of the skin;
• numerous erosions and bleeding sores;
• maceration ( softening);
• ulceration of melanoma;
• development of associated nodules ( is a sign of metastasis);
• melanoma color variation - includes areas of red, white and blue on a brown or black background;
• color enhancement along the periphery of the melanoma, resulting in a ring of coal-black merging nodules;
• an inflammatory corolla can also form around the contour of the melanoma;
• in the area of ​​​​melanoma, the skin pattern completely disappears;
• uneven edge with corners and notches;
• blurred outline borders.

Currently, dermatologists and oncologists use a questionnaire containing 7 basic questions regarding the evolution of previous skin lesions.

Questions that a dermatologist asks during a consultation may include:

• Has the size changed? This takes into account the rapid growth of an old or newly formed mole. Formations larger than 7 millimeters are subject to special examination.
• Has the form changed? A previously rounded mole acquires irregular contours.
• Has the color changed? The appearance of various brown, red and blue shades on an old or new mole.
• Have there been signs of inflammation before? Zones of hyperemia appear around the contour of the mole ( redness).
• Is the release of moisture and bleeding characteristic?
• Is there itching and peeling?

What tests and studies are prescribed for melanoma?

Despite the fact that the diagnosis sometimes lies on the surface, the attending physician, as a rule, prescribes additional tests and research. This is done to exclude or confirm, first of all, metastases to regional lymph nodes and systemic metastases ( i.e. metastases to internal organs). This requires an additional general examination of the patient, as well as studies such as a chest x-ray and a scan of the bones of the skeleton.

Additional studies in the diagnosis of melanoma are:

• general inspection- during a general examination, the doctor palpates the patient's lymph nodes, determines their soreness, density, adhesion to tissues;
• chest x-ray ( enroll) - in order to determine if there are metastases in the intrathoracic lymph nodes;
• skeletal bone scan- to exclude the same metastases;
• blood chemistry with determination of lactate dehydrogenase activity ( LDH) and alkaline phosphatase - an increase in the level of these enzymes indicates melanoma metastasis, it can also indicate resistance ( sustainability) tumors for treatment;
• ultrasonography ( ultrasound) abdominal organs ( enroll) carried out to analyze the state of internal organs and lymph nodes, it is recommended for patients with melanoma thicker than one millimeter;
• dermatoscopy ( enroll) - a method that allows using a special device ( on a device similar to a microscope and connected to a computer) increase the suspicious formation hundreds of times and examine it in detail.

Melanoma ICD10

According to the international classification of diseases of the tenth revision ( ICD-10) malignant melanoma of the skin is coded C 43. The localization of the tumor is further explained by an additional figure, for example, malignant melanoma of the eyelid - C43.1.

ICD-10 code	Localization of melanoma
C43.0	Malignant melanoma of the lip
C43.1	Malignant melanoma of the eyelid
C43.2	Malignant melanoma of the ear and external auditory canal
C43.3	Malignant melanoma of other parts of the face
C43.4	Malignant melanoma of the scalp and neck
C43.5	Malignant melanoma of the trunk
C43.6	Malignant melanoma of the upper extremities
C43.7	Malignant melanoma of the lower extremities
C43.8	Malignant melanoma of other parts of the body
C43.9	Unspecified malignant melanoma of the skin

How to distinguish melanoma?

In order to correctly distinguish melanoma and notice the first signs of malignancy, it is necessary to distinguish between skin formations, that is, to know the difference between freckles, moles, nevi. Unfortunately, even many experts confuse these definitions with each other.

Characteristics of Common Skin Lesions

Name	Definition
Freckles	Flat light brown round spots on the skin, darkening in the sun and turning pale in winter.
Moles	Oval or rounded formations, dark brown or flesh-colored. The diameter of moles varies from 0.2 to 1 cm. As a rule, moles are flat, but sometimes they can rise above the level of the skin.
Atypical or dysplastic nevi	Larger moles, with jagged edges and uneven coloring.
malignant melanoma	Pigmented and non-pigmented formations on the skin that occur both independently ( de novo), and on altered skin ( i.e. from previous moles). Melanoma develops from pigment cells ( melanocytes) skin. Further, growing deeper, the tumor acquires the ability to metastasize through the lymphatic and blood vessels to any part of the body.

Each pigment formation, whether it is an old mole or a new nevus, in people older than 20-30 years should be examined with suspicion of melanoma. In addition to periodic examinations by a dermatologist and oncologist, additional studies should be carried out.

Melanoma research methods are:

• tumor indication by radioactive phosphorus;
• cytological examination;
• thermal differential test;
• biopsy ( enroll) .

Tumor indication with radioactive phosphorus
The method is based on the intensive accumulation of radioactive phosphorus by the tissues of a growing malignant melanoma.

Cytological examination
This method is simple and highly effective in determining the nature of melanoma and its metastases. Cytology involves the study of tissue for cell morphology. This examines the structure of the cells that make up the melanoma. The reliability of the study is more than 95 percent. Pieces of lymph nodes should also be taken for cytological examination in order to determine metastases in them.

Thermal differential test
This test is based on the temperature difference between a melanoma site and a symmetrical area of ​​healthy skin. It is carried out by measuring the temperature of each affected area with a thermometer. If the average temperature difference is more than 1 degree, then the test is considered positive.

Biopsy
As a diagnostic method, biopsy today deserves special attention. For a long time it was believed that due to the high risk of metastasis, this method is not applicable in the diagnosis of melanoma. However, recent studies have shown that biopsy is a very valuable method in identifying early forms of melanoma.

The principles of a biopsy are as follows:

• the excision is made in the form of an ellipse, since with a circular excision the thickness of the tumor may be incorrectly estimated;
• when performing a biopsy, the injection needle should not be inserted into the melanoma itself;
• melanoma is excised, departing from the edge by two millimeters.

Which doctor treats melanoma?

The main specialist in diagnosing and subsequently treating melanoma is oncologist ( enroll) . Since melanoma is a tumor, it is treated by a doctor who treats tumor diseases. However, melanoma may initially be suspected dermatologist ( enroll) or family doctor ( therapist) (enroll) . Consultation may be needed to confirm hereditary atypical spot syndrome genetics ( enroll) .

Melanoma treatment

Treatment of melanoma, like any tumor, involves surgery, radiotherapy and chemotherapy. However, the choice of treatment method depends solely on the characteristics of melanoma and its stage. At the same time, it should be noted that melanoma is poorly sensitive to radiotherapy and does not always respond to chemotherapy.

Melanoma treatments are as follows:

• surgical treatment, which involves excision of the tumor;
• chemotherapy;
• radiation therapy;
• biological therapy ( immunotherapy).

The choice of treatment depending on the stage of melanoma

Stage	Treatment method
initial stage(0 )	It involves excision of the tumor with the capture of up to one centimeter of healthy tissue. Further, only observation by an oncologist in dynamics is recommended.
Stage I	Initially, a biopsy is performed, followed by excision of the tumor. In this case, the capture of healthy tissue is already 2 centimeters. If there are metastases in the lymph nodes, then they are also removed.
Stage II	Surgical treatment and chemotherapy are used. Initially, a study is carried out on the defeat of lymph nodes by metastases. Next, a wide excision of the melanoma is performed ( capture of healthy tissue by more than 2 centimeters), followed by removal of the lymph nodes. At the same time, the removal of melanoma and lymph nodes can take place in one or two stages. After removal, chemotherapy follows.
Stage III	Chemotherapy, immunotherapy, tumor excision are carried out. A wide excision of melanoma is also performed, in which healthy tissue is captured by more than 3 centimeters. This is followed by regional lymphadenectomy - removal of lymph nodes located near the primary focus. Treatment ends with chemotherapy. For the resulting defect after the removal of melanoma and adjacent tissue, plastic surgery is used.
Stage IV	There is no standard treatment. Radiation therapy and chemotherapy are used. Operational ( surgical) treatment is rarely used.

Chemotherapy for melanoma

In the treatment of melanoma, polychemotherapy is often used, which is based on the use of several drugs at the same time. The most commonly used drugs are bleomycin, vincristine, and cisplatin. So, for each type of melanoma, their own schemes have been developed.

The most common treatment regimens are as follows:

• Roncoleukin 1.5 mg intravenously every other day in combination with bleomycin and vincristine. It is carried out in 6 cycles at intervals of 4 weeks.
• Roncoleukin 1.5 mg intravenously every other day in combination with cisplatin and reaferon. Similarly, 6 cycles at intervals of 4 weeks.

Mustoforan is widely used today for the treatment of disseminated forms of melanoma. This drug is able to penetrate the blood-brain barrier, which allows it to be used for brain metastases. Also, the drug is used in polychemotherapy of melanoma with metastases to the lymph nodes and internal organs.

Surgical treatment of melanoma

As already described, in the surgical treatment of melanoma, a wide excision is used. The purpose of this method is to prevent the development of local tumor metastases. For the resulting defect, plastic reconstruction is used.

The amount of tissue removed depends on the size and shape of the tumor. So, with superficially spreading and nodular melanoma, excision is performed, departing from its edge by 1 - 2 centimeters. Excision in this case is carried out along an ellipse, giving the block of excised tissues an ellipsoidal shape. The plasty of the resulting defect takes place in two stages. First with a synthetic absorbable material ( vicryl or polysorb) sutured the dermis. Then the second intradermal suture is adjusted, using non-absorbable threads ( e.g. nylon).

Wide excision is excluded in the treatment of lentigo melanoma. Instead, cryodestruction and laser destruction are used. In the first case, the tumor is destroyed when exposed to extremely low temperatures. In the second case, tumor cells are destroyed under the influence of a laser.

Radiation therapy

Radiation therapy or radiotherapy is not the primary treatment for patients with melanoma. This is explained by the low sensitivity of the tumor to ionizing radiation. Therefore, the application this method in the form of self-treatment of melanoma is possible only when the patient categorically refuses the operation. In other cases, radiation therapy is used in postoperative period or as a combination treatment.

Patient follow-up

Patients who have completed radical surgery should be followed up by an oncologist. Observation should be carried out according to the general rules - periodic examinations by a doctor, with the performance of control ultrasound examinations.

The rules for dispensary observation of patients with melanoma are as follows:

• during preventive examinations mandatory examination of the skin in the area of ​​the removed tumor;
• Skin diseases (face, head and other parts of the body) in children and adults - photos, names and classification, causes and symptoms, description of skin diseases and methods of their treatment

The first mention of melanoma in history dates back to the 17th century, when the first doctors began to talk about strange neoplasms on the skin, which later grew and led to imminent death.

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

Definition

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

Found on covers:

• Skin (the most common form).
• In the mouth.
• Larynx.
• The mucous membrane of the diseased eye.
• The skin of the ear canal.
• Female internal genital organs - body, cervix.

If we take skin oncology, then men and women of more advanced age suffer more often due to hormonal effects. In the same case, young people from 15 to 40 years old are mainly affected. The disease affects girls more often than men.

The danger of the malignant disease itself is precisely that, despite the fact that cancer develops on the outside of the body, the tumor disguises itself as ordinary pigment or birthmarks that have already been present in humans for a long time. Therefore, he practically does not notice anything at the very beginning.

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

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

Causes

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

Most often, it is the causes and risk factors of an exogenous nature that influence, and the endogenous one, in turn, can simply feed the neoplasm itself and worsen the condition. Consider all the risk factors for the development of malignant tumors.

External factors

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

1. Ultra-violet rays. A person who is not connected with medicine must have heard that it is not worth staying in the sun for a long time, it is especially dangerous to do this without sunscreen. Many scientists claim that exposure to sunlight and ultraviolet radiation affects skin cells. Because of what, tissues can mutate and turn into cancer. The more intense and stronger the radiation, the greater the likelihood of pathology. Doctors point to a factor of a historical nature, when a child could have severe sunburn in childhood, and get the disease already in adulthood after a long time.
2. Radiation is one of the most common causes of any cancer. All types of rays during exposure to radiation entail a change at the molecular level and change chromosomes in DNA.
3. Electromagnetic radiation. People who work more often in the electronics industry and are associated with these factors are more likely to get melanoma than others.
4. Injuries and wounds on moles. Doctors have been keeping statistics for a long time, which include patients who mechanically damaged their mole, and later it turned into cancer.

Chemical exposure

Chemical industry workers associated with oil and other combustible substances. In the production of rubber, paint, plastics. Any chemical reagent that enters the skin begins to affect the tissues almost immediately.

Nutrition

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

Doctors recommend eating more berries, vegetables, fresh fruits (not canned), various green foods. Perhaps this is due to the fact that the large cattle and in pigs, cancer is a very common occurrence. And we sell just such meat in stores. however, direct evidence that cancerous animal meat causes tumors in humans is not yet available.

Of course, there is also alcohol along with cigarettes. You must understand that these are all chemicals that have a mutagenic property for cells. And the risk of getting melanoma in an alcoholic and a smoker doubles.

Internal factors

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

birthmarks

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

The most dangerous moles:

• Dubreuil's melanosis is a mole that has a curved shape and not rounded features; every year the mole itself grows and increases in size.
• Very dark, even black in color with a large size of 1.5 cm.
• When there are a large number of dark-colored moles on the body.

Symptoms

Since cancer usually hides in the tissues of a birthmark or any other benign neoplasm on the skin, the signs in the early stages are rather weak. But we will consider exactly what characteristics moles should have in order to identify cancer.

Normal mole

• It has a symmetrical shape.
• Smooth and clear outlines.
• Even color from yellow to dark brown and black.
• The mole is flat and does not have a bulge, is on the same level with the skin.
• Small size. Can grow, but very slowly over a very long time (several years).

Melanoma

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

What does melanoma look like?

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

Stages

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

1 stage

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

First, it is stage 0, when melanoma has the “in situ” stage, or in translation - “In place”. The tumor itself is located within the epidermis. Further, it already grows in size up to 1 mm and passes into the initial phase.

2 stage

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

3 stage

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

4 stage

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

How does a mole turn into cancer?

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

1. If the mole was flat, and later on it slowly becomes convex. In this case, the formation can simply grow slowly over a short period of time.
2. The primary focus may be more brightly stained in a dark color.
3. When the cancer begins to grow in a mole that is large in diameter, then you may feel a small induration when you press on it with your finger. The birthmark becomes asymmetrical.
4. Uniform color changes its color. In some places, the color changes, a dark spot appears.
5. The color may become lighter or darker.
6. In a malignant neoplasm appear discomfort itching, stinging or burning. Melanoma hurts a little.
7. In the later stages, redness appears around the birthmark, which increases over time.
8. If there was hair in the mole, they fall out.
9. At the third, fourth stage, bleeding from a mole appears. The skin nearby is shelled, jams appear.

NOTE! If at least one of the symptoms is found on the body, you should immediately consult a dermatologist. In addition, hand over Clinical and biochemical blood tests. All this is necessary to detect cancer at an earlier stage.

Diagnostics

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

Varieties

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

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

Therapy

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

Removal of the tumor

Surgical intervention at the primary stage has a good prognosis. On the skin, usually from 2 to 5 cm of skin tissue is removed along with the fat layer and muscles, and the fiber itself is separated. After the muscle is tied with healthy ends. In case of damage to the lymph nodes of the cervical region, Crile's operation is performed.

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

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

How to treat melanoma at home? In no case do this and do not be treated with folk remedies and herbs, as they first of all remove the symptoms, but not the disease. Seek immediate medical attention and act according to his recommendations.

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

Immuno- and chemotherapy

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

Be sure to apply and immunotherapy to improve and raise the immunity of the patient. So that the cells of the body themselves begin to fight and attack cancerous tissues. Oddly enough, radiotherapy is not effective for this oncology, and malignant melanoma copes well with radiation. But sometimes this method is used before surgery to shrink the tumor itself.

Forecast

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

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

• 1 degree cancer is usually due to a large five-year survival up to 90%.
• 2 degree already has a lower chance of up to 65%, since most of the tissues are affected, and there is a risk of relapse.
• 3 degree in some species, melanoma already has metastases to the nearest tissues of the fatty layer and muscles. Because of this, the operation and subsequent therapy are greatly aggravated. Additionally, part of the lymph nodes is removed. The percentage varies from 20 to 40.
• 4 degree has a low probability - from 5 to 15% of 5-year survival. If the cancer is very aggressive, then it all depends on the level of treatment. But usually at high stages, cancer is not curable.

What to do after treatment?

First of all, you need to constantly and regularly undergo an examination, take blood, urine and feces tests. Seek advice from your oncologist. Stick to right diet- the way you eat will help you recover faster, speed up your metabolism, improve, strengthen your immune system, which is the main defender against cancer.

Melanoma is the most aggressive course. Signs of melanoma must be recognized at an early stage of their development, since in 73% of cases in advanced cases of this disease, a fatal outcome occurs.

What is skin melanoma?

This tumor develops from melanocyte pigment cells, which, under the influence of provoking factors, degenerate into cancerous ones. A neoplasm may well begin to form in fairly young people.

The main localization of melanoma is the skin, but this neoplasm can also grow in the mucous membranes - in the structures of the eye, in the vagina, rectum, and oral cavity. In most cases, a cancerous tumor of melanocytes is found on the limbs and face, and often it forms at the site of moles.

The picture shows the difference between melanoma and other benign neoplasms of the skin surface.

Melanoma is characterized by rapid germination deep into the skin and the development of metastases. under the influence of the spread of cancer cells by the hematogenous and lymphogenous pathways. Due to these features, melanoma is an aggressive malignant skin neoplasm.

Clinical types

Oncologists distinguish five types of melanomas, of which four are most common.

• Surface-propagating melanoma. This type of tumor begins to form on a nevus (mole) or against the background of the skin that has not been changed before. You can pay attention to the towering pigmented area with uneven edges and mostly irregular shape. The color of this type of melanoma is from light brown to black and blue. Sometimes in the center you can see blotches that differ in color. Gradually, the tumor thickens, transforms into a plaque, and then into a node, on the surface of which ulcerations appear. More women are diagnosed with this form of the disease, metastasis occurs in almost half of the cases.
• nodal melanoma is characterized by the most aggressive growth, on average, this form of the disease lasts from six months to 18 months. There is no horizontal formation of melanoma, it immediately begins to grow vertically. The surface of the resulting node quickly becomes thinner, easily injured and bleeding occurs. Ulcers gradually appear on the node, from which a yellowish exudate comes out, sometimes blood may be present in it. The color of the node varies from light pink to dark blue.
• Lentiginous melanoma. This form of the disease is also known as lentigo maligna or Hutchinson's freckle. Most often it is formed from a senile pigment spot, a birthmark, less often from an ordinary mole. This type of tumor is prone to formation in those parts of the body that are most exposed to solar ultraviolet radiation, such as the face, ears, neck, and hands. This melanoma develops in most ill people very slowly, sometimes it can take up to 30 years to the last stage of its development. Metastasis is rare, there is evidence of resorption of this formation, so lentiginous melanoma is considered the most favorable in terms of prognosis. cancer skin.
• Acral-lentiginous melanoma occurs predominantly in people with a dark skin tone. The formation is located on the palms, genitals, feet, eyelids, nail beds. This form of melanoma develops very quickly, characterized by the rapid spread of metastases. The tumor at the beginning is a spot with a brownish color, under the nail such a spot has a purple or bluish-red color. As the neoplasm progresses, it ulcerates, and if the nail is touched, it collapses.
• Pigmentless type of melanoma is very rare. The formation received a similar name due to the lack of color in it, which is due to the fact that a pathological disorder in melanocytes also leads to the destruction of the pigment. The growing tumor is pinkish or flesh-colored.

Reasons for the appearance

The main reason for the development of melanoma is a defect that develops in melanocytes. This defect leads to a change in the structure of cells and to their cancerous degeneration.

A variety of factors can provoke such a pathology, they are divided into exogenous and endogenous.

Exogenous risk factors

Exogenous provocative causes include those that have a damaging effect on skin cells from the external environment.

Physical reasons

Physical triggers:

• The most likely causes in this group include ultraviolet solar radiation. And greater value has not the duration of the impact, but its intensity. There is evidence that even a sunburn received in childhood can later provoke a cancerous degeneration of melanocytes.
• Ionizing radiation.
• Electromagnetic radiation. It is noted that among patients with this disease there are many who, by virtue of their profession, are associated with electrical communications.
• Mechanical injury. Constant scratching, compression or other unfavorable change in moles contributes to their malignancy.

Chemical

The degeneration of melanocytes can be affected by external conditions detected in industries associated with the processing of oil, plastics, polyvinyl chloride, coal, dyes and paints. There is also an adverse effect of the pharmaceutical industry.

Biological

Biological triggers include:

• Certain diet. The risk of forming a melanocyte defect is increased in those people who constantly eat meals containing a large amount of animal fats and proteins. At the same time, the diet of such people is not enough. plant food, which reduces the intake of vitamin A, which is so necessary for the skin.
• Use of oral contraceptives and medications needed to normalize the menstrual cycle. This provoking factor is just an assumption, since the exact relationship between skin cancer and hormonal drugs has not yet been established.

Endogenous

Melanoma is most often diagnosed in people with certain biological features, they include:

• Racial affiliation. Representatives of the Negroid race practically do not suffer from melanoma.
• The amount of pigment in the skin. People with light eyes, hair and correspondingly fair skin are most susceptible to ultraviolet rays. Most often, melanoma occurs in redheads, followed by blondes, and in third place is just all other people with a light skin tone.
• immune factors. Immunodeficiency states increase the risk of malignancy.
• endocrine factors. Hormonal imbalance can provoke the degeneration of melanocytes. That is why malignancy of nevi is often noted during pregnancy.
• Gender and age. Among patients with melanoma, there are more females, the peak of the disease occurs between the ages of 40 and 50 years.
• Precancerous skin diseases- Dubreu's melanosis, xeroderma, blue or giant nevus.

There is also a hereditary predisposition to the disease and a large number of patients with melanoma, prone to overweight.

Symptoms

The symptoms of the disease depend on the type of melanoma and its stage.

In the last stages, in addition to external signs, symptoms of a violation of the general condition of the body are also added, which is associated with its intoxication.

What does a malignant tumor look like?

Melanoma of the skin can manifest itself as a spot, nodule, plaque. At first, this is a small area, which is alarming only for its formation and color.

Melanoma often begins with moles or nevi. Its locations are mainly legs, arms, face, then comes the surface of the body, back. Melanoma grows not only upwards, but also in depth, its external dimensions can be more than 10 cm in diameter in some types of neoplasms.

What are the first signs of malignant transformation?

It is possible to understand that an abnormal degeneration of cells occurs in a mole or nevus by self-examination. The following changes most often indicate a malignant process:

• Rapid growth of a mole.
• Discoloration, the nevus may become discolored or darken to black.
• Tingling, burning in the area of ​​pigmentation, internal itching. These signs are signs of increased cell division.
• The appearance of an inflamed (red) rim around the spot.
• Ulceration of the surface of the mole, the appearance of exudate in it.
• The formation next to the primary spot of daughters, which indicates metastasis.
• Compaction of the mole and the appearance of uneven, jagged edges.

The photo clearly shows what the initial stage of a cancerous tumor on the skin looks like - melanoma

Even the fixation of one of the listed types of changes should be the reason for a quick appeal to an oncologist. Currently, all examinations are carried out instantly, and therefore the treatment in the early stages of melanoma is very effective.

Skin cancer stages and life prognosis

The stages of melanoma are of great importance in predicting the outcome of treatment. In total, there are five stages of such an oncological formation:

• initial stage exhibited when the process is organic only by the epidermis.
• First stage it is a melanoma having a thickness of 1 mm and an ulcerated surface. This stage also includes melanoma 2 mm thick, but without ulcers on the surface.
• Second stage- a tumor up to 2 mm with ulcers, or a tumor from 2 to 4 mm without damage.
• Third stage Any melanoma with metastasis to a lymph node.
• At the fourth stage melanoma grows into distant parts of the body, metastasizes not only to the lymph nodes, but also to the lungs, brain, bones.

The photo shows the late stage of malignant melanoma of the skin.

A positive outcome of treatment is possible in almost 99% of cases if melanoma is established at stages 1-2. In the third stage, recovery is noted only in half of the cases.

Methods of diagnostic examination

A doctor can suspect melanoma based on the patient's complaints and visual examination of the altered skin. To confirm the diagnosis is carried out:

• - Examination of the area of ​​the skin under special device. This examination helps to examine the edges of the spot, its germination in the epidermis, internal inclusions.
• – taking a sample of the tumor for histological examination.
• Ultrasound and are prescribed to detect metastases and to determine the stage of cancer.

If necessary, and to exclude other skin diseases, the doctor may prescribe a number of diagnostic procedures and blood tests. The effectiveness of their elimination largely depends on the accuracy of diagnosing melanomas.

How is it treated?

Identified melanoma is removed surgically. The most effective treatment is where the operation is combined with radiation exposure, which is necessary to prevent further metastasis.

Initially, several sessions are usually prescribed. radiotherapy, then the operation is performed and after that several sessions are also used. During the operation, the tumor is removed with the capture of the surrounding tissue.

When melanoma is located on the fingers of the extremities, according to indications, their complete amputation is possible. With a generalized process, a systemic or regional one is assigned. Currently, immunotherapy is often additionally prescribed.

The most favorable outcome of combined treatment is observed if the patient seeks help in the early stages of the disease. Dispensary observation allows timely detection of recurrence of the disease and a new course of therapy.

Diet food

A certain importance in the recovery of a person and the absence of relapses of the disease is also given to nutrition. The diet must be complete with a large amount of proteins, vitamins, and with the lowest content of animal fats. Minimize the need for dishes with flavorings and food additives.

• Fish rich in omega acids.
• Vegetables, fruits and juices from them.
• Foods with selenium - turkey, chicken breast, lamb and pork kidneys, lobsters, mussels, squid, low-fat homemade cheese.
• natural dairy products.
• Of the additives, kelp, wasabi sauce, turmeric, saffron, rosemary are recommended.
• Fresh herbs and fresh tomato dishes.
• Green tea, coffee is not prohibited, but no more than two cups per day.

It is necessary to eat in small portions, but often, and it is definitely recommended to monitor the regularity of bowel movements.

Preventive actions

Preventive measures to prevent cancerous growths on the skin are the least stay under direct sunbeams especially for people with fair skin tones. It is also necessary to avoid injury to the skin and exposure to the body of chemicals, salts of heavy metals.

A healthy diet and the absence of bad habits are also of some importance in reducing the likelihood of cancerous tumors.

Video about the treatment of melanoma of the skin: