Melanoma signs and symptoms of the disease in women. The most dangerous malignant skin tumor - Melanoma, its first signs and methods of treatment

Which develops from pigment cells (melanocytes) producing melanin (natural pigment or dye, determining skin color, hair and eyes).

Statistics

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

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

It is noteworthy that from all cancer skin diseases only 4% accounted for melanoma, but in 73% of cases it quickly comes a fatal outcome. Therefore, melanoma is called "queen" tumors.

At the place of the location of Melanoma, in 50% of cases, there arises on the legs, 10-15% - hand, 20-30% - torso, 15-20% - face and neck. At the same time, 50-80% of patients with melanoma is formed on the place of the moles.

In 86% of cases, the development of melanoma is associated with the effects of ultraviolet radiation (solar or solarium). Moreover, the risk of melanoma is 75% higher in persons who have begun to receive tan in solarium to 35 years.

• In 1960, the Mumi of Peruvian Incans, who revealed signs of melanoma. With the help of a radiocarbon method (it is used to determine the age of biological remains) it was proved that the age of mummies is about 2400 years.
• The first mentions about melanoma are found in John Hunter (Scottish Surgeon). But not knowing what it deals with, he described melanoma in 1787 as "cancer fungal growths".
• However, only in 1804, Rene Laennek (French doctor and Anatom) made a definition and described melanoma as a disease.
• American scientists have developed an interesting and unique technique to identify melanoma tumor cells. Researchers argue that under the influence of laser radiation, melanoma cells publish ultrasound fluctuations, which allows them to be detected in the blood long before they are rooted in other organs and systems.

Skin structure

It has three layers:

• Epidermis- Outer layer of skin having five cell rows: basal (lower), hipgy, grainy, shiny and horny. Normably melanocytes are only in the epidermis.
• Dermis- Actually skin, consisting of two words: mesh and papillary. They contain nerve endings, lymphatic and blood vessels, hair bulbs.
• Subcutaneous fat fiberit consists of connective tissue and fat cells, which are permeated with blood and lymphatic vessels, and also - nerve endings.

What are melanocytes?

During the intrauterine development, they occur from the nervous ridge, and then move into the skin, located in the epidermis randomly. Therefore, melanocytes, accumulating, sometimes forming moles - benign neoplasms.

However, melanocytes are still located in the iris (contains pigment cells that determine the color of the eyes), the brain (black substance) and in the internal organs.

Melanocytes have processes due to which they move in the epidermis. Also, through the prohibits the coloring peem to other cells of the epidermis - so the color of the skin and hair is attached. Whereas when reborn melanocytes into cancer cells, the process disappear.

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

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

Melanin value for man

• Determines eye color, nipples, hair and leatherwhich depends on the distribution and combination of different types of pigments.
• Absorbs ultraviolet rays (UV rays), Protecting the body from their malicious influence. Moreover, under the influence of UV rays, melanin generation increases - a protective reaction. Externally manifested in the tan.
• Acts as an antioxidant. What's happening? Free radicals (formed under the influence of UV rays) - unstable molecules, taking the missing electron in full cell molecules, which then become unstable - chain reaction. While Melanin gives an unstable molecule, the missing electron (the smallest particle), breaking the chain reaction.

What are ultraviolet rays?

Ultraviolet radiation, reaching the surface of the Earth, is divided into two main types:

• UVB rays - short waves penetrating into the skin shallow skin, so they become the cause of sunburn. In a remote future, they can lead to the development of skin cancer.
• UVA rays - long waves capable of penetrating the skin deep, without causing burns and painful sensations. Therefore, a person, without experiencing pain, can get a high dose of irradiation, exceeding the natural protective ability of the skin to the tan. While it was on the UVA-rays that "wines" for the development of melanoma lies, because in large doses they damage pigment cells.

It is noteworthy that UVA-rays are used in solariums, so their visit increases the likelihood of melanoma's development.

Causes and Risk Factors The occurrence of melanoma

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

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

Moreover, melanoma can develop from any person, regardless of the color of the skin and racial. However, some people are more susceptible to the emergence of this disease.

Risk factors

Mechanoma formation mechanism

The impact of UV rays on the skin is the most frequent factor leading to the development of melanoma, so it is most studied.

What's happening?

UV rays cause "breakdown" in the melanocyte DNA molecule, so he mutters and begins to multiply strongly.

However B. the norm works as a protective mechanism:in melanocyte there is a MC1R protein. It contributes to the production of melanin by pigment cells, and also involved in the restoration of the melanocite DNA molecule, damaged by UV rays.

How is melanoma formed?

Bright people have a genetic MC1R protein defect. Therefore, pigment cells are not produced in sufficient melanin.

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

However, the question arises: why can Melanoma develop in those places that were never exposed to UV rays?

Scientists have given an answer: it turns out that melanocytes have a very limited ability to restore damaged DNA by any factor. Therefore, they are often subject to mutations and without the impact of UV rays.

Skin melanoma stage

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

However, for easier perception of stages of melanoma skin, they use the systematization of two American scientists:

• In Clark - the basis of the penetration of the tumor into the skin layers is based on
• On Bereloou - when the thickness of the tumor is measured

Types of melanoma

Most often (in 70% of cases) Melanoma develops on the spot of non-units (moles, birthplace) or unchanged skin.

However, melanocytes are present in other organs. Therefore, the tumor can also affect them: eyes, head and spinal cord, straight intestine, mucous membranes, liver, adrenal fabric.

Clinical forms of melanoma

Within the course of melanoma there are two phases:

• Radial growth: Melanoma grows on the skin surface, spreading horizontally
• Vertical growth: Tumor germinates in deep skin layers

The most commonly found five varieties of melanoma skin.

Symptoms of melanoma skin

They have differences of dependence on the shape of the tumor and stage of development.

Surface-propagating melanoma

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

Metastases take place in 35-75% of cases, so the forecast is not very favorable.

What's happening?

In the radial growth phase The skin is located slightly towering pigment formation of up to 1 cm, which has an irregular shape and fuzzy edges. Its color is brown, black or blue (depending on the skin layer in which the pigment is located), and it sometimes appears black or gray-pink points (enclosures).

As they grow, the pigment education is compacted, turning into a black plaque with a shiny surface, and in its middle a section of enlightenment appears (pigment disappears).

In the vertical growth phasethe plaque turns into a node whose skin is thinned. Therefore, even with a slight injury (for example, friction of clothing), the node begins to bleed. Next, on the node there are ulcers, of which the succulent discharge (yellow liquid, sometimes containing a blood flow) appear.

Nodular melanoma

The disease proceeds rapidly: on average - from 6 to 18 months. Moreover, metastases are quickly distributed, and 50% of patients die for meekly time. Therefore, this form of melanoma is the most unfavorable forecast in terms of forecast.

What's happening?

The stage of horizontal growth is absent, and in the vertical growth phase, the skin of the node is thinned, therefore even a light injury leads to the appearance of bleeding. In the future, the node forms ulcers, of which the yellowish liquid is distinguished sometimes with an admixture of blood (Sukrovitsa).

The node itself has a dark brown or black color, and often a bluish shade. However, sometimes the pigment in the tumor node is absent, so it can be pink or bright red.

Lentginal Melanoma (Hutchinson's freckles, malignant lento)

Most often develops against the background of an old dark brown spot (Melanose Dycerea), against the background of the nevus (the godded stain, moles) - less often.

Mainly melanoma is located in areas of leather, which are constantly subjected to solar radiation (face, neck, ear shells, brushes).

The development of melanoma is long: in time it can take from 2-3 to 20-30 years. And as pigment education increases, it can reach 10 cm and more in diameter.

Moreover, metastases with this form of melanoma are developing late. In addition, with the timely inclusion of immune protection mechanisms, it can be partially spontaneously dissolved. Therefore, the lentiginal melanoma is considered the most favorable form.

What's happening?

In radial phase The boundaries of dark brown education become blurred and uneven, reminding the geographical map. At the same time, black splashes appear on its surface.

In vertical phase Against the background of the spots, a node occurs, which can bleed or highlight serous fluid. The node itself is sometimes deprived of color, and peels are formed on its surface.

Acral Lentginal Melanoma

People with dark skin color are most often sick. The tumor can be located on the skin of the palms, soles and genital organs, as well as on the border of the mucous membrane and skin (for example, centuries). However, this form is most often affecting the nail bed - the subnumber melanoma (most often - thumbs and legs, because they are susceptible to injuries).

The disease develops rapidly, and metastases extend quickly. therefore
The forecast is unfavorable.

What's happening?

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

In vertical phase Often ulcers appear on the surface of the tumor, and the tumor itself acquires the type of mushroom growth.

With a subnogle melanoma, the nail is destroyed, and suction discretions appear from under it.

Unmanned melanoma

It is rare (5%). It is deprived of color, since changed melanocytes lost the ability to produce a pigment.

therefore unmanned melanoma It is a formation of a bodily or pink color. It happens a variety of nodular shape of melanoma or the result of metastase of any form of melanoma into the skin.

Melanoma Eye.

It is found most often after melanoma of the skin. Moreover, melanoma eyes leaks less aggressive: the tumor grows slower and later gives metastases.

Symptoms depend on the place of lesion: iris (contains pigment cells that determine the color of the eyes), conjunctiva, a lacrimal bag, eyelids.

However, there are signs that should alert:

• One or more stains appear on the eye roset
• Visual acuity does not suffer for a long time, but gradually it worsens on the side of the patient's eye
• Over time, peripheral vision (items that are badly visible)
• Appear in the eyes of the flash, stains or glare
• Initially, there are pain in a sore eye (by increasing the eye pressure), then they subside - a sign of the yield of a tumor outside the eyeball
• On the eyeball appears redness (inflammation), and the vessels become visible
• A dark spot will appear on the protein shell of the eyeball

How does Melanoma manifest?

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

In addition, changes are available both at the site of melanoma (primary focus) and in other organs - when distributed metastasis.

Moreover, sometimes the primary tumor with the appearance of metastasis either ceases to grow, or is subjected to reverse development. At the same time, the diagnosis itself is exhibited only with after the defeat of other metastases. Therefore, the manifestations of melanoma need to know.

Symptoms of melanoma

1. Itching, burning and tingling In the field of pigment formation due to reinforced cell division inside it.
2. Hair loss from the surface of the nevus due to the rebirth of melanocytes in tumor cells and the destruction of hair follicles.
3. Color change:
   • Strengthening or the appearance of darker areas A pigment education is due to the fact that melanocytes, reborn into the tumor cell, loses its processes. Therefore, the pigment, without having the possibility of exiting the cell, accumulates.
   • Enlightenmentit is associated with the fact that the pigment cell loses the ability to produce melanin.
   And the pigment education changes the color unevenly: brighten or darkens from one edge, and sometimes in the middle.
4. Increase in sizespeaks about reinforced cell division within pigment education.
5. The appearance of ulcers and / or cracks, bleeding or moisture is duethe fact that the tumor destroys normal skin cells. Therefore, the upper layer bursts, exposing the lower layers of the skin. As a result, with the slightest injury, the tumor "explodes", and its content is poured. In this case, cancer cells fall on healthy skin, embedded in it.
6. The emergence of "subsidiaries" of moles or "satellites" near the main pigment education - a sign of local metastasis of tumor cells.
7. Rights of the edges and the seal of the mole - a sign of enhanced division of tumor cells, as well as their germination into a healthy skin.
8. Disappearance of skin pattern caused by the fact that the tumor destroys normal skin cells that form skin pattern.
9. Appearance around pigment education redness In the form of a whip - inflammation, indicating that the immune system recognized tumor cells. Therefore, she sent special substances in tumor focus (interleukins, interferons and others), which are designed to fight cancer cells.
10. Signs of eye defeat: Dark splasions appear on the eye iris impairment and signs of inflammation (redness), there are pain in the affected eye.

Diagnosis of melanoma

Includes several stages:

• Inspection at the doctor (oncologist or dermatologist)
• Study of pigment education with optical devices without damaging skin
• Fence from a suspicious piece of fabric, followed by its study under the microscope

Depending on the results of research, further treatment is determined.

Survey at the doctor

The doctor draws attention to the changed moles or education that appeared on the skin lately.

There are criteria for which you can pre-distinguish a benign education from melanoma. Moreover, knowing them, everyone can check their skin alone.

What are the signs of malignant rebirth?

Asymmetry- When pigment education is asymmetrically. That is, if you hold an imaginary line through its middle, both halves are different. And when the mole is benign, both halves are the same.

The border.With melanoma, the edge of pigment education or moles have the wrong, and sometimes toothed shape. While the benign formations of the edge are clear.

Color Moles or formations during reincarnation in a malignant tumor inhomogeneous having several different shades. While normal moles have one color, but they may include brighter or dark shades of the same color.

Diameterin a normal mole or a godded spot - about 6 mm (the size of the rubber band at the end of the pencil). All other moles must necessarily be examined by a doctor. If there are no deviations from the norm, in the future, such formations need to be observed, regularly visiting the doctor.

Change In the numbers, borders and symmetry of the birthmarks or moles - a sign of their rebirth in melanoma.

On a note

Melanoma is not always different from the normal mole or the birthmark of all these criteria. Only one change is enough to consult a doctor.

If an oncologist education will seem suspicious, he will conduct the necessary research.

When do you need a biopsy and pigment education microscopy?

To distinguish dangerous pigment formations on the skin from non-hazardous, three main research techniques are conducted: dermatoscopy, confocal microscopy and biopsy (fence a piece of fabric from the hearth, followed by study under the microscope).

Dermatokskopia

The examination during which the doctor explores the skin area without damaging it.

To do this, use a special tool - a dermatoscope that makes the transparent horny layer of the epidermis and gives an increase of 10 times. Therefore, the doctor can carefully consider symmetry, borders and heterogeneity of pigment education.

There are no contraindications to the procedure. However, its use is non-informative with unmanned and nodal melanomes. Therefore, it is necessary to conduct a more careful study.

Confocal Laser Scanning Microscopy (CLSM)

The method, with which the images of the layers of the skin are obtained, without damaging them to take a sample of fabric from the hearth. Moreover, images are as close as possible to the smears obtained by biopsy.

According to statistics, the diagnosis of 88-97% in the early stages of melanoma with the help of CLSM is set correctly.

Methodology

A series of optical sections (photographs) in vertical and horizontal planes is carried out on a special installation. Then they are transmitted to the computer where they are already investigated in a three-dimensional image (in 3D - when the image is transmitted in full). Thus, the condition of the layers of the skin and its cells is estimated, as well as - vessels.

Indications for holding

• Primary diagnostics of skin tumors: melanoma, flat-stacked cancer and others.
• Detection of recurrence melanoma after removal. Since due to the lack of pigment, the initial changes are minor.
• Observation in the dynamics of the precancerous skin diseases (for example, melanosis dfi).
• Study of the skin of the face with the appearance of non-welltic spots.

Contraindications There are no procedures.

However, if we are talking about melanoma, the final diagnosis is exhibited only on the basis of the study of the sample of fabric from the hearth.

Biopsy

The technique, during which a piece of fabric is taken from the pigment formation section, and then it is examined under the microscope. Fabric fence is carried out under local or general anesthesia.

However, the procedure is hidden with certain risks. Since if it is wrong to "disturb" melanoma, it is possible to provoke its rapid growth and the spread of metastasis. Therefore, the fence of tissues from the focus of the proposed tumor is performed in compliance.

Entries for biopsy

• If all possible diagnostic methods are used, and the diagnosis remains unexplained.
• Pigment education is located on areas unfavorable to remove (a large fabric defect is formed): brush and foot, head and neck.
• The patient is planned to carry out a leg, hands, breast removal together with regional (nearby) lymph nodes.

Conditions for biopsy

• The patient must be fully examined.
• The procedure is as close as possible to the next treatment session (operation or chemotherapy).
• If a pigment education has ulcers and mocking erosion, fragrance fragrances are taken. For this, several skimmed slide glasses are applied to the surface of the tumor (glass plastic on which the material being examined), trying to get several tissue samples from different sections.

There are several ways to fear fabrics with melanoma.

Excision biopsy - Removal of a tumor focus

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

The doctor is a surgical knife (scalpel) removes melanoma, surrounding the skin for its entire depth with the capture of 2-4 mm healthy skin.

Incision biopsy - Regional excision

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

Therefore, the most suspicious part of the tumor is removed with the seizure of the area of \u200b\u200bunchanged skin.

If the diagnosis is confirmed (regardless of the method of biopsy), tissues are excised into the corresponders with a depth of penetration of the tumor. The operation is carried out on the same day or no more than one or two weeks, if the laboratory prescription is hampered with an urgent answer.

Thin game or puncture biopsy (Obtaining a sample of the tissue by a puncture) during the primary melanoma is not carried out. However, it is used in suspected relapse or the presence of metastasis, as well as to study regional (nearby) lymphatic nodes.

Biopsy "Watchman" lymphatic nodes

Lymphatic nodes (LU) - a filter through which Lymph passes together with the cells that broke away from the primary tumor.

"Watching" or regional lu is closest to the tumor, becoming a "trap" for cancer cells.

Tumor cells for some time are delayed in LU. However, then with a current of lymph and blood, they spread throughout the body (metastases), hitting and violating the work of vital organs and tissues.

Therefore, to assess the condition and determination of the further tactics of treatment, a fence of a tissue sample from the "watchman" LU is carried out.

Indications for biopsy

• The thickness of melanoma is from 1 to 2 mm.
• Patients older than 50 years, because they have a bad survival forecast.
• Melanoma, located on the head, neck or face, because Lou is close to the tumor. Therefore, the probability of propagation of cancer cells from the primary hearth is higher.
• The presence of ulcers and moaning erosions on the surface of melanoma is a sign of germination of the tumor in the deep layers of the skin.

Method of execution

A special coloring agent with an isotope of phosphorus is introduced around Lu in the skin, which is moving along the lymphatic vessels towards Lou, accumulating into them. After two hours, lymphoscintigraphy is carried out - with a special installation, the Lou is obtained.

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

Sign	Displastic Neva	Melanoma in the radial growth phase	Melanoma in the vertical growth phase
Size of pigment education	Usually have 6 mm, rare -10 mm in diameter	Have more than 6-10 mm in diameter	From 1 to several centimeters
Symmetry	Pretty symmetric	Sharply asymmetric	Sharply asymmetric
Cytological features detected under the microscope
Shape and size of melanocytes	Symmetric, roughly the same size.	Asymmetric and different sizes.	Asymmetric and different sizes, and their processes are smoothed or absent.
The location of melanocyte	Uniform on the edge of the defeat, but they sometimes form a few clusters in the epidermis.	It is unevenly located in the epidermis for a single, forming a cluster ("sockets"), which can have different sizes and forms. At the same time in the dermis they are missing.	It is unevenly located in the epidermis, forming "nests", which have different sizes and shapes. Also, one and more "sockets" is available in the dermis. Moreover, they are much larger in size than those in the epidermis.
Changes of the horn (surface) leather layer	No changes	There is hyperkeratosis (excessive thickening of the surface layer of the skin), so scales appear	Ulcers occur, the surface of the node will mock, there is an increased bleeding
The presence of infiltration (clusters) of lymphocytes - the reaction of the immune system	Lymphocytes are small, they form small foci	Lymphocytes form large clusters around the pigment cells - tanning infiltration	Compared with the radial phase of lymphocyte less, they are arranged asymmetry
Spreading pigment cells	Usually they are not in the dermis. However, if they are present, then single, and size less than in the epidermis.	There are both in the derma and the epidermis. Size the same. In addition, pigment cells can spread along skin appendages (hair).	There are in all layers of the skin. Moreover, the cells in the dermis are larger in size than - in the epidermis.
Pigmental cell division	Absent	Meets in third cases in the epidermis, and there is no dermis	Usually available in all layers of skin - evidence of metastasis
Pigment content in melanocytes	There are single cells with an elevated melanin content - "Random Atiphy"	In most cells, elevated - "monotony"	Compared with the radial phase, the pigment content is reduced, and the pigment itself is unevenly distributed in melanocytes
Compression of "nests" of surrounding tissues	Not	Usually not sakes	Yes
Modified skin cells (non-pigment) having light color, greater oval shape and large kernel	No or exist in minor quantities, located in the epidermis symmetrically around the mature nevus	There are many of them in the epidermis, and they are asymmetrically around the nevus	Present in large quantities both in the epidermis and in the dermis

Laboratory tests for the diagnosis of melanoma

It is carried out to determine the presence of metastasis in the liver, the degree of differentiation of cells (the remoteness of tumor cells from normal), progression or the reverse development of melanoma.

Laboratory indicators

The content of some factors in venous blood is investigated:

• LDH (lactate dehydrogenase) - Enzyme rising in the presence of metastasis melanoma in the liver. However, this indicator also increases with myocardial infarction, viral hepatitis and muscle injuries. Since it is contained in almost all tissues of the body. Therefore, focusing only on the level of LDH is not an eligible diagnosis.
• CD44STD (melanoma marker)- receptor located on the surface of the skin cells for hyaluronate (skin component that moisturizes it).

  The indicator increases during damage to the skin cells and the distribution of metastasis. Therefore, CD44STD helps in the early diagnosis of melanoma and gives an idea of \u200b\u200ba further forecast of the disease.

• S100 protein Posted in nervous tissue, liver and muscles. The level of its increase in blood speaks of the number and degrees of organs affected by metastases. Approximately 80% of patients with unsuccessful treatment this indicator is high. Whereas in 95% of patients who have effective treatment, it decreases.
• Fibroblast growth factor (BFGF)increases when moving melanoma from the surface to the vertical phase of growth. Especially this indicator is high at the last stages of the disease, therefore evidence of a bad forecast.
• Vessel Growth Factor (VEGF) Speaks about the enhanced growth of the vessels and melanoma itself. This indicator is high in patients on the III and IV stages of the disease, which indicates a bad disease forecast.

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

Treatment of melanoma

Objectives - removal of primary tumor, prevention of development or control of metastases, increase the life expectancy of patients.

There is a surgical and conservative treatment of melanoma, including various techniques. Moreover, their use depends on the stage of the malignant tumor and the presence of metastases.

When do you need an operation to remove skin melanoma?

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

The goal is to remove the tumor with the capture of healthy tissues to prevent the distribution of metastasis.

Moreover, at the I and II stages of melanoma, surgical removal remains the only method of treatment. However, patients with the II stage of the tumor should be supervised with periodic control of the state of "guarding" lymphatic nodes.

Rules for removal of melanoma

• Under general anesthesia, since the local anesthesia has a risk of propagation of tumor cells (needle injury).
• Careful attitude towards healthy tissues.
• Without affecting melanoma to prevent the propagation of cancer cells. Therefore, the incision on the torso is carried out by recovering 8 cm from the edges of the tumor, on the limbs - 5 cm.
• The contact of the tumor with healthy cells is eliminated.
• Removal is carried out with the capture of a certain section of healthy tissue (wide excision) to eliminate the relapse. Moreover, the tumor is removed by capturing not only the surrounding skin, but also - subcutaneous tissue, muscles and ligaments.
• The operation is usually carried out using a surgical knife or electron-like.
• Cryodestruction (the use of liquid nitrogen) is not recommended. Since with this method, you cannot determine the tumor thickness, and the tissues are not always removed in full. Therefore, cancer cells can remain.
• Before the operation on the skin, the contours of the intended cut is planned.

Indications and volume of operation

Since the first removal of melanoma has passed more than 140 years, but there is no single opinion about the boundaries of excision. Therefore, WHO has developed criteria.

Removal borders of healthy fabric according to WHO recommendations

It is believed that it is impractical to remove a larger volume of healthy tissues. Since the survival of patients does not affect this, but worsens the restoration of tissues after the operation.

However, in practice, it is difficult to adhere to such recommendations, so the decision takes the doctor in each particular case individually.

Also, much depends on the location of the tumor itself:

• On the fingers, the brushes and foot are resorted to the amputation of the fingers or part of the limb.
• On the urine of the ear, it is possible only to remove her lower third
• On the face, neck and head at large melanoma sizes are captured by no more than 2 cm healthy fabrics, regardless of the thickness of melanoma

With such an aggressive tactic removal of melanoma, large tissue defects are formed. They are closed at the power of various techniques of skin-plastic operations: autotransplantation, combined skin transplant and others.

Removal of "watchman" lymphatic nodes

According to this issue, the opinions of scientists were divided: some believe that the preventive removal of Lu is reasonable, others that - such tactics does not affect survival.

However, numerous studies have shown that the preventive removal of the "watchman" LU significantly improves the survival of patients.

Therefore, it is advisable to conduct a biopsy of the "watchdog" node, and when there is cancer cells in it, delete.

However, unfortunately, sometimes micrometastases remain not detected. Therefore, with certain situations, the prophylactic removal of regional Lou is justified. Therefore, the doctor accepts an individual decision.

Meanoma Treatment with Medicinal Products

Several main techniques are used:

• Chemotherapy:medicinal preparations are prescribed, which act on the quick-acting cancer cells of melanoma.
• Immunotherapy:preparations are used to improve the work of the immune system.
• Hormonal therapy (Tamoxifen), the overwhelming reproduction of tumor cells. However, this approach is controversial, although there are cases of remission.

The techniques can be applied both independently (monotherapy) and combinations with each other.

At the I and II stages of melanoma, as a rule, sufficiently surgical intervention. However, only if the removal of melanoma was correct, and the aggravating factors were absent (for example, diseases of the immune system). In addition, immunotherapy is sometimes prescribed at stage II. Therefore, the decision does not accept individually in each case.

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

Chemotherapy with melanoma

The preparations used suppress the growth and division of cancer cells, causing the inverse development of tumors.

However, melanoma cells grow rapidly and divided, and also rapidly spread throughout the body (metastasis). Therefore, there is still no uniform developed scheme for the purpose of chemotherapy products for its treatment.

The most frequently used chemotherapy products for the treatment of melanoma:

• Ankilant means: Cisplastine and Dakarbazin
• Derivatives of not randomoise: Photosemustein, Lomustin and Karmostein
• Vincaalkaloids (Funds of Plant Origin): Winneristine, Vinorlebin

Preparations are prescribed both independently (monotherapy) and in combination, but depending on the melanoma stage, the presence of metastasis and the depth of tumor germination.

Moreover, Dakarbazin is considered the "golden" standard in the treatment of melanoma, since no other drug has exceeded its effectiveness. As a result, all combined treatment schemes are based on its reception.

Indications for chemotherapy

• The main blood indicators are within the normal range: hemoglobin, hematocrit, platelets, granulocytes
• Satisfactory work kidney, liver, lungs and hearts
• Lack of diseases that may interfere with chemotherapy (for example, chronic renal failure)
• Defeat by tumor "Watchman" lymphatic nodes
• Prevention of metastases
• Supplement in the surgical method of treatment

Contraindications for chemotherapy

They are divided into two groups: absolute and relative.

Absolute- When chemotherapy is not held:

• Chronic liver and kidney diseases with pronounced function impairment (chronic renal failure, liver cirrhosis)
• Complete violation of the outflow of bile (blocking of the biliary tract)
• The presence of mental diseases in the stage of aggravation
• When it is known that chemotherapy will be ineffective
• Pronounced insufficient body weight (cachexia)

Relative- Chemotherapy code is possible, but the decision does the doctor takes in each case individually:

• Autoimmune diseases (for example, rheumatoid arthritis) and immunodeficiency states (for example, AIDS)
• Old age
therefore the risk of developing infectious diseases is raised at times

Chemotherapy efficiency

Depends on the stage of the disease and the method of destination (independently or in combination).

So, with monotherapy of the common melanoma (lesion of LU or the presence of metastasis), effectiveness (full regression for 3 years or more) does not exceed 20-25%. With a combined appointment according to different authors, overall efficiency ranges from 16 to 55%.

Immunotherapy melanoma

Under certain conditions, the immune system is able to struggle with tumor cells of melanoma - antitumor immune response.

As a result, the primary melanoma can independently regress (develop back). In this case, pronounced redness appears around the tumor (immune cells are struggling with cancer), and then vitiligo appears on the site of the tumor (skin enlightenment section).

Therefore, immunological preparations are used to treat melanomes:Interferon-alpha, Interleukin-2, Refaferon, Ipilimumab (the preparation of the last generation).

Moreover, they can be used both independently and in combination with chemotherapy. Since their appointment even in the later stages improves the disease forecast by 15-20%. In addition, positive results are available in patients who have previously received chemotherapy products.

Efficiency of immunotherapy

If a positive result is achieved from immunotherapy, then there are high chances of a good forecast.

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

However, it should be remembered that the use of immunoprerators causes the development of a large number of complications: toxic effect on the liver and kidney, the development of sepsis (distribution throughout the infection body) and others.

New methods of treating melanoma

Bleomycin (antibiotic) is used in Israeli clinics. It is introduced using electricity directly to tumor cells - electrochemistry.

According to the statements of Israeli scientists with this method of treating melanoma, a good effect is quite quickly achieved. However, time will show how effective its remote results will be (the duration of remission, the emergence of relapses).

Recovery at melanoma

Radioactive radiation is used (radiation therapy) - phenomenon, under the influence of which the spontaneous decomposition of cell structures occurs. Therefore, cells either die or cease to share.

Moreover, cancer cells are more sensitive to ionizing radiation, since faster is divided than healthy cells of the body.

However, ionizing radiation is not used "on the eyes", because healthy cells are also damaged. Therefore, it is important to focus a beam by sending it to a tumor with an accuracy of a millimeter. With such a task, only modern devices can cope.

Methodology

Special installations are used that emit electronic bundles or X-rays with high energy.

First, the device makes a simple X-ray, which is displayed on the monitor screen. The doctor then makes the tumor markup using the manipulator, pointing its boundaries and sets the radiation load.

• Moves the patient
• Turns the radiating head
• Sets up the colummer curtains (device for producing ionizing radiation) so that the tumor is under the sight

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

Indications

• Recurner melanoma for irradiation Metastasis
• Treatment of melanoma, located in places where it is difficult to surround the tumor (for example, the skin of the eyelid or nose)
• Treatment of melanoma eyes when ledging iris and protein shell
• After the operation to remove lymph nodes to prevent the development of recurrence of melanoma
• Pain relief in metastasis in the head and / or bone marrow

Contraindications

• Autoimmune diseases: systemic red lupus, psoriatic arthritis and others
• Pronounced body weight failure (cachexia)
• Through blood platelets and leukocytes are sharply lowered
• Heavy kidney diseases, liver and lungs, accompanied by deficiency of their work (cirrhosis, renal failure and others)

Adverse reactions

• Total weakness, increased irritability, headache
• Elevated dry oral cavity and skin, nausea, belching, liquid chair
• Pronounced decrease in leukocyte and hemoglobin
• When irradiation of the area of \u200b\u200bthe head and neck - hair loss

Efficiency

Skin melanoma cells are small sensitive to conventional doses of radioactive radiation. Therefore, for a long time, radiation therapy was not used to treat melanoma.

However, it is now proved that when using high doses of ionizing radiation, a melanoma forecast is improved.

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

Whereas with a combination of radiation therapy with chemotherapy, overall efficiency approaches 60-80% (depending on the melanoma stage).

In the treatment of the initial stages of the melanoma of the eye (the thickness of the tumor is up to 1.5 mm, the diameter is up to 10 mm) the efficiency of radiation therapy is equal to enucleation (removal) of the eye. That is, coming is coming.

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

Forecast with melanoma

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

Valery Zolotov

Reading time: 6 minutes

A.

This pathology is a malignant tumor affecting the skin. This disease develops from melanocytes. For this reason, most often dark. Many people underestimate the danger of this disease and do not guess how many people in a year she takes. Most live and do not even suspect the presence of a malignant tumor.

According to statistics, this disease occurs only in 1% of cases of cancer. The skin is most often affected, but there were cases when this pathology was detected on, rectum and even the vagina. Tumor hair can both be present and missing.

The neoplasm may be located on any part of the body, even on the lip. Therefore, it is not necessary to think that since you have a new formation on some rare place is not melanoma. Tumors are growing both quickly and slowly, it depends on the type of disease.

Types of melanoma

Currently, 3 types of melanoma discovered.

1. malignant Lentgie - this type of disease, as a rule, strikes open areas of leather, such as neck or face. Less often closed, body or back. Development occurs quite a long period (5-20 years). Has a brown and black shade;
2. aklen pathology usually appears on the palms, feet, between your fingers, on nail spoons. From 50 to 70 percent of cases of occurrence comes from the representatives of blacks and Asians. This species is confused with the plantar wart and do not turn to the doctor on time;
3. nodular melanoma is the most aggressive and dangerous, occurs, as a rule, on the back, less often on the neck or skin of the head. Most often occurs in the elderly.

Diagnosis of melanoma

Currently, it is quite simple to detect it, you need to know the first signs of melanoma. When examining a medical specialist draws attention to the following details:

• size, education can be from 50 to 300 millimeters in diameter;
• bloodfaction, attention is paid to whether the surface does not bleed;
• appearance of the mole, borders, symmetry, color, density, structure;
• a special feature is to redness of the skin near the pigment spot or mole;
• rebirth of cells, the symptom to this can serve as a itch in the field of the mole;
• blood from Molenia is also a signal to what is required to contact a specialist.

If you have pigment spots or moles on your body, you should check their condition daily, as well as carry out medical examinations in order to prevent melanoma development to critical stages. Almost any disease is much easier to treat early stages of development, this disease is no exception. The weakening of bones can also serve as a signal to the appearance of malignant tumor.

Oncomarkers are used to diagnose the tumor, which make it possible to identify the presence of cancer cells in urine or blood. The presence of oncomarcresses allows you to suspect the presence of a tumor in the human body at an early stage.

Competent and experienced doctors can distinguish a malignant tumor from the mole or benign only in appearance, but in order to obtain the maximum accurate diagnosis, the tests are always assigned.

If you have a neoplasm hurt, we strongly recommend that you immediately consult a doctor.

Causes of disease development

This pathology has its own risk group, it includes people who have the following differences.

1. presence in the genus of diseases, melan;
2. light skin shade, which is caused by genetic features, small melanin content in the skin;
3. red hair color, which is due to genetically, as well as the presence of freckles;
4. a large number of moles on the human body can also adversely affect the human body;
5. the presence of diseases that can provoke the appearance of pathology. For example, either pigment kservoirma;
6. the presence of sunburn;
7. an elderly age is explained by this weakness of the body in this segment of life.

If you have at least one of these risk factors, you should be more careful and attentive to your body. Since you have quite large chances of the development of melanoma.

The physical impact, as well as the traumatic damage to the mole increases the risk of melanoma, especially in places that constantly contact with clothing.

Treatment

Fight with this type of malignant tumor most often in two ways.

The first is a combined, which includes radiation therapy and operation. This method is the most effective and prudent, since melanoma rather quickly give metastases to nearby lymph nodes and for quickly successful treatment it is very important to immediately stop their growth. Special medical preparations are also used, for example, Dakarbazin.

The second is surgical. Includes surgical removal of malignant tumor.

Surface-propagating melanoma

Superficially propagating melanoma is one of the most popular types of this pathology. It accounts for about 70 percent of all Melan. In this case, the diseases of cancer cells apply to the body slowly.

At the initial stage, the superficially propagating melanoma has such characteristic signs as a change in the color and shade of the mole. Also a sign that helps to diagnose this type of melanoma is a small convexity of brown with splashes of pinkish gray or black.

The next stage of the development of the disease is invasive. During the passage of this stage, melanoma penetration begins inside the body, and ultimately develops malignant education. The presence of a large number of moles on the body speaks of the increased risk of developing this type of malignant tumor.

Recurd

The recurrence of melanoma occurs for various reasons, remote metastases, inflammation of lymph nodes, local recurrence. The cause of recurrence depends on the treatment method.

As a rule, about half of all metastases during melanoma are located in lymph nodes. An important role in relapse has the thickness of the primary malignant tumor. The smaller the thickness, the less risk of re-tumor.

Also affects the occurrence of a tumor, with melanoma on the limbs registered extremely few recurrences. In the case of the body and head, the worst forecast is marked.

That is why it is very important to keep track of benign tumors, as well as for their moles. We strongly recommend at least once every six months undergo a complete medical examination in order to detect diseases of this type at the initial stages.

The well-known fact is that the earlier the disease was detected, it is possible to cure it easier and faster.

Epithelioid cell melanoma

This type of malignant tumor is somewhat aggressive than others. There is an appearance of seals in the epidermis near the plaques. Otherwise, signs of the disease are the same - a change in size, color, shade, asymmetry.

The main feature of this type of pathology is spontaneous aggression, metastases appear early, the growth is very fast, but there are cases when the growth of a benign tumor is slow.

Most often, metastasis is observed in regional lymph nodes, as well as in tissue near the primary hearth. Such areas are called satellites.

In 2 percent there are patients with metastasis, but without a tumor. Very rarely observed full spontaneous aggression, so most often this type of disease can be detected in the early stages.

Melanoma liver

This type of pathology is one of the most dangerous among malignant tumors. Most often arises in other organs and later spreads to the liver. Detect this type of diseases is fairly easy with biopsy. As a rule, it is very difficult to treat, so the forecast is most often disappointing.

There are similar cases quite rarely, even less often diagnose the sarcoma of the liver, the course of the disease is passed rather quickly. In the case of metastasis, secondary liver cancer may occur.

Disseminated melanoma

A rather dangerous type of disease, from symptoms worth noting the following.

1. fast fatiguability;
2. vomiting;
3. headache;
4. fast weight loss;
5. temperature up to 37.5 degrees;
6. burning;
7. bad state of health.

A feature of the disseminated tumor is rapid metastasis. Most often, this type of pathology is detected on the skin of the neck and back. Develops towards lungs, spleen, brain.

This type of disease occurs not so often, in 4-12% of cases. The forecast in this case is disappointing, the average five-year survival is less than 5 percent. But with competent treatment and in case of detection of the disease at the initial stages, the percentage of survival rises to 33-47%.

Roshetocellular melanoma

The characteristic feature of this type of pathology can be considered the cells of the spindle-shaped form, as well as pink or dark brown. Most often no hair, in shape resembles the dome, surface or wart, or smooth.

Roshetocellic education most often found extremities, necks, heads. The course of the disease is quite favorable, death occurs in rare cases.

Prevention of the disease

The prevention of melanoma is an annual passage of a full medical examination in order to detect malignant tumors in the early stages.

It's important to know! You should also know how to determine melanoma.

To do this, it is necessary to know its symptoms. Remember - malignant education is not a sentence. Everything succumbes to treatment.

Symptoms and treatment of subnogle melanoma (Read in 5 minutes)

In this article you will learn what Melanoma is, as it looks like and how to detect it. We have prepared for you detailed information about skin cancer and signs of melanoma, how to understand that you or your loved ones are predisposed to melanoma and how to prevent the disease.

What is melanoma?

Melanoma- This is a malignant education, which develops from pigment cells of the skin - melanocytes. They are located preferably in the skin and pigmented epithelium of the retina. The accumulations of melanocytes form moles.

Highlighting Pigment melaninMelanocytes protect the body from the effect of ultraviolet radiation. So it turns out the tan.

The mechanism of the occurrence of the tumor is not fully established. Like other types of cancer, it arises due to spontaneous changes in the genetic code, the effects of harmful substances and adverse factors. Also, the development of the disease leads injury to moles.

The division of pigment cells and their growth becomes uncontrollable. Unlike benign formations, melanoma can germinate in deep layers of leather, and together with a current lymph or blood - migrate through the body, thus struck by vital organs, that is,. metastasis.

Melanoma is a malignant tumor of the skin, which arises due to the uncontrolled growth of melanocytes and is characterized by extremely rapid development.

Every hour in the world, one person dies from this disease. Scientists believe that the number of patients with such a diagnosis will increase in the coming years, which means that each of us needs to pay special attention to their moles.

May 17 - World Melanoma Day. On this day, the day of open doors, the doctors hold lectures to raise the public awareness of a dangerous disease. Often on May 17, everyone can check their moles with a dermatoscope for free.

To get the consultation

Types of skin cancer

Alone with melanoma allocate othermalignant Skin Education, among them basal cell Cancer (Basaloma) andflake carcation cancer. They are found in 88% of cases of all types of cancer.

Why melanoma is not cancer?

It should be remembered that skin cancer and melanoma is not the same thing. Cancer is formed from epithelial cells (skin cover), while melanoma is made of pigment (melanocytes).

• What types of skin cancer are most often found?
• What are the features of basal cell and flat-belling skin cancer?
• What modern method of treatment allows you to save healthy fabrics?
• How do skin cancer in later stages?

Answers - in video from BookImed.

To get the consultation

Types of skin cancer	Basaloma, basal cell Cancer Cancer	PlateLock Cancer Cancer, Cell Calcinoma	Melanoma
Features	Develops from the basal layer of the skin; Leads to local tissue destruction; Does not metastasis.	Develops from the cells of the spinged layer of the epidermis; Grows quickly; Metastasis.	Develops from pigment cells - melanocytes; Characterized by extremely rapid growth; Actively metastasizes; Very malignant view of skin cancer.
Frequency	Very common.	Less common.	It meets less frequently, but among the types of skin cancer - the most dangerous.
Appearance (signs)	A knot, similar to a furuncle, which does not ripen for a long time; Over time is ulcerated, destroying the skin.	A tumor that can go deep into or tower over the skin; It is ulcerated and becomes painful.	Looks like as a asymmetric mole with an uneven contour, in size, more ordinary; Painful, it can get it, swelling, bleeding.
Photos

To get the consultation

Melanoma and Mountain - what's the difference?

According to various oncological communities, in 30-40% of cases of Melanoma develops from the already existing moles, non-residents and pigment spots.

Moles, Netures are accumulations of pigment cells that every person has. We are not born with them: they appear in early childhood and can disappear in more mature age. Often, new moles are formed on the body up to 40 years. Normal moles do not change throughout life, they are clear and homogeneous. For melanoma is characteristicdynamics: If the mole is growing and changing, it is likely malignant.

How do Displastic Neva and Melanoma correlate?

Displastic Necess is an atypical mole, which has a high risk of malignancy (transformation into malignant education). This is a brown tumor, which rises above the skin surface. In the amount of such neutres are from 1 mm to 20 and more see

Forecast of the rebirth of the dysplastic nevus in melanoma

The more nonsense on the body, the higher the risk of melanoma. In people who have 10 or more atypical moles, the likelihood of the development of the disease increases 12 times. Netures are subject to observation and timely surgical removal. After the operation, patients undergo regular annual control.

In the photo Melanoma in comparison with ordinary moles.

How does Melanoma develop?

Melanoma develops in this way: pigment cells begin to share intensively and grow rapidly. They turn into cancer and distributed in the epidermis, and then germinate into a deep layer of skin.- Derma, where blood and lymphatic vessels are located.

So the cells fall into vessels and may apply to organs. The process of propagation of cancer cells is called metastasis, and remote tumors that are formed from melanoma cells - metastasami. First, skin cancer gives metastases in the closest lymph nodes, and then to the long organs - light, brain, liver and bones.

How is melanoma grow rapidly?

This disease is developing quickly: from the moment of the detection of the first symptoms of melanoma to the development of metastases can pass 6-8 months. Therefore, it is very important to follow the moles and contact the dermatologist in a timely manner.

To get the consultation

Signs of non-safeness of moles

1. Asymmetric form

A normal, not threatening your life, the mole must be symmetric, that is, round or oval, its parts should be equal to each other. Its edges are clear, smooth and bright. Dangerous Mountain has an arbitrary shape, torn, fuzzy, blurred edges. If your body has such a burning spot, urgently consult a specialist. Only he can accurately determine the birthmark is or melanoma.

2. Color

The non-hazardous mole has a smooth brown or dark brown, it is evenly painted, does not have stains or impurities of other colors. Potentially cancer mole is uneven in color, has stains and impurities of different colors. Check the color of the moles on your body, also ask your relatives to inspect pigment entities that are in the places inaccessible to your eyes.

Size 3

All pigment formations on the skin, which exceed 6 mm, should examine the doctor. Moles in the amount of more lasty Pencil can be malignant.

4. Transformation of moles

Pay attention to whether the change does not occur with your mole. A sharp change of color, form, increase - evidence of potential danger.

5. Unprotected leather

If you are often visited by the beach or solarium, without using sunscreen, you risk your health. Proved that ultraviolet rays increase the likelihood of the rebirth of a healthy mole in malignant by 74%.

How to distinguish the birthplace from melanoma?

At the initial stages, it is not easy to distinguish a cancer mole from ordinary. Therefore, it is necessary to remember that any formations that are minimally different from other present on your body are subject to control.

The table contains a list of orientation symptoms of melanoma. It will help in determining the safety of your moles.

Symptom	Benign Mountains	Melanoma (malignant mole)
Education on the skin	symmetric	asymmetric
Circuit	smooth and clear contour, smooth outlines	uneven, fuzzy contour, with a toothed or blurry edge
Color	homogeneous, more often brown	uneven coloring, black or red formation, attacking another color
The size	no more heads	size more than 6 mm in diameter
Change	not subject to change; with age can disappear	growing and changing
Symptoms	no unpleasant symptoms	peeling, itching, swelling, redness, ulcers, bleeding

What does a malignant mole look like?

The appearance is determined by the type and stage of development.

As a rule, the skin melanoma looks like a flat spot, a bump or knot towering over its surface. Education color can be rich black or dark brown. Because of this feature, it is also called "black skin cancer".

Sometimes malignant moles are completely different from the skin or have white, red.

To get the consultation

Why is melanoma so dangerous?

• What is dangerous for the disease?
• Why does she arise?
• How common is the disease?
• How to suspect the disease?
• How is it diagnosed?

Watch video from BookImed:

What does melanoma look like and how to determine it at an early stage?

At the early stage, melanoma is hard to distinguish from the usual mole. It manifests itself as a stain or nodules on the skin, mucous membrane or iris eye. If you have noticed a birthday in the amount of more than 6 mm, and it delivers inconvenience (growing, changes color, hurts or itches), you should contact the doctor to establish malignancy of education. At a later stage, nearby lymph nodes are involved in the oncological process.

Lymph nodes act as a filter that protects the body from harmful factors, including microbes, viruses, poisonous substances and malignant cells. That is why, with inflammatory processes and various diseases, lymph nodes increase in size.

General well-being in a metastatic melanoma worsens. The patient notices weight loss and weakness, which indicates a violation of the normal life of all organism systems. It must be remembered that the sooner the diagnosis is made, the higher the healing of this disease.

How to suspect melanoma in symptoms?

• Do you or your relatives diagnosed with Melanoma or other types of cancer?
• Did you have new moles since the last inspection?
• Molenaya has an uneven contour?
• Isymmetric mole?
• Old mole increased in size since the last inspection?
• Mountain Zudit, peeling or bleeding?
• Molenia changed the color or became heterogeneous in color?

If you responded at least one question approved, you should consult with a dermatologist.

To get the consultation

Causes of melanoma

Today Melanoma is considered one of the most dangerous types of oncological diseases in the world, the number of patients with such a diagnosis is growing rapidly. Today, it was not yet possible to finally determine the specific reason for development, but the factors that significantly increase the risk are known. Knowing about such factors, you can limit them, and thus reduce the risk.

Risk factors in the development of melanoma:

• Genetic predisposition

If someone in your family was discovered melanoma, the probability of the case increases. It is necessary to regularly examine the skin and with the slightest suspicion of Melanoma to consult a doctor.

• Ultraviolet radiation (sun, solar lamps, solarium)

Uncontrolled in the sun and frequent visits to the solarium lead to excessive insolation (UV irradiation) of the body and burns. The latter are especially dangerous in childhood, because they can lead to the development of melanoma in adulthood.

• Multiple and / or atypical moles

The larger on the body of the moles, the higher the likelihood that they can be reborn in malignant education. Timely control will allow you to reveal suspicious elements on the skin and spend treatment on time.

• Light phototype skin

The skin of people with light or red hair is poorly protected from the effects of ultraviolet. They are more prone to the appearance of sunburn, and they are statistically melanoma occurs more often.

• Reducing immunity

The immune system protects us not only from viruses and bacteria, but also from the formation of malignant cells in the body. Immunity activity can decrease in chronic infections, as well as against the background of receiving some medicines.

• Pigment Keroderma

This is a rather rare hereditary disease in which the skin is not able to recover after exposure to sunlight. It is easily burning, and it increases the risk of developing melanoma and other types of skin cancer.

To get the consultation

Prevention of melanoma

Healthy lifestyle, timely treatment of infections is the first step in the prevention of oncological pathologies. These factors cannot fully protect against cancer, but reduce the risk of getting sick. For prophylaxis is necessary dosing to stay in the sun, use sunscreen with a high degree of protection and periodically pass inspections from a dermatologist.

In order to determine the melanoma, it is very important using an inspection to notice any changes on the skin. It should be inspected in front of a mirror in full growth, a mirror can be used to inspect the back sections. You can also ask you a loved one to help in the inspection of hard-to-reach areas of the skin.

With the help of a special algorithm you can promptly notice suspicious education on the skin at home.

Inspection of the Moles at home

1. Determine for yourself regular inspection time: It can be done once in the season. But if you are subject to any of the listed risk factors, inspect the skin more often.

2. Get diaryand make a note about the date of the inspection, moles that recently appeared and cause suspicion.

3. For visual fixation of the changes that occurred make photos of the moles.

4. Find a place for inspection - it should be a bright room with a large mirror; For inspection of hard-to-reach places, use a small manual mirror. Also in the inspection you can help you have a close person.

5. Inspect the entire surface of the skin, in all. Persons, ears, neck, armpits, chest, sides, palms, fingers, front and back surface of legs, genitals. Pay attention to the nails and interpal sites; Visually examine the reflection of your eyes and the skin in places that come into contact with clothing and shoes (for example, with underwear, glasses, belt). Women should explore the skin under the breast.

Melanoma - malignant rebirth of skin cellsa certain species. The disease is extremely aggressive, can be inheritedand nazable asymptomatic. Provoke cancer Skin of this type can even one-time stay in the sun, if the insolation was particularly intense.

What is melanoma

Melanoma (or melanoblastoma) is melanocytic skin cancer. From Greek her name can be translated as " black tumor».

Malignant disease Amazes skin cells (melanocytes, melanocytes), which are responsible for its pigmentation. Approximately 80% of cases of melanoma develops independently, on intact skin. Only in every 5th case of pigmented skin cancer malignant reincarnation, cells are subjected to patient neous (moles or birthplace).

Photo 1. Melanoma at the initial stage may look like an ordinary mole. It is preferably from time to time to check the neules from the doctor. Source: Flickr (Melanoma Research Foundation MRF).

Melanoblastoma Looks like a mole or a birthmark. From a benign nevus, cancer education is distinguished by a number of signs. Localizes most often in open areas of the body, but may occur on other parts of the body and even under the nail, in the eye or on the mucous membranes (for example, in the vagina). The internal localization of melanoma is rarely fixed.

Also rarely, but perhaps the appearance of unpainted melanoblastoma.

The disease does not have pronounced age or genital "preferences". However, the explicit dependence of the risk of skin cancer from the human phototype is traced. The less patient is tanningthe lighter skin (eyes, hair), the greater the risk of melanoma.

Melanocytic skin cancer is an aggressive disease with fast growth of metastasis throughout the body. The lymph nodes and any internal organs and fabrics (lungs, liver, bone) are striking.

Note! The incidence of melanoma around the world has increased dramatically in the 21st century. Scientists associate this with the possibility of long-range travel, when "Northern" people go to rest in Asia and North Africa countries, where they are exposed to massive solar radiation.

Causes of development

The main reason for the malignant rebirth of melanocytes is considered Ultraviolet irradiation both natural and artificial. Melanin is a substance that is "responsible" for the color of the eyes, hair and human skin. Melting melanin is closely related to the action of UV rays and the work of the hormonal system.

The normal process of dividing melanocytes is broken under the action:

• intensive UV irradiation,
• hormonal rearrangements of the body due to illness or natural reasons (pregnancy, menopausal period),
• immunodeficiency states. Melanoma does not cause an adequate immune response in the patient's body. Low immune status facilitates the development of malignant tumors;
• injury Nevusov.

Note! For the occurrence of melanoma, it is not critical is not the frequency or duration of stay under the sun, but the intensity of the insolation. Even one-time skin burning in childhood is able to initiate a malignant process in an adult under certain conditions.

Melanoma Risk Risk Factors

• Hereditary predisposition. Melanoma is inherited close relatives on dominant type. If in your family there were cases of skin cancer, then you are in the risk zone;
• The presence of a large number of moles or parental spots;
• Bright skin;
• Netures in places that are subject to regular mechanical exposure(squeezed, rubbed, succeed);
• Sunny burns In history.

Note! The exact reason for which the melanocyte DNA fails is impossible to determine. It is believed that a combination of several adverse factors leads to malignant processes.

Photo 2. The appearance of melanoma is primarily associated with elevated UV irradiation. Source: Flickr (Fábio Petry).

Types and types of tumor

According to the development of oncopathology and morphological signs, melanocytic cancer is divided into 5 specieswhich are distinguished by localization, in the way and speed of distribution, the forecast.

Surface-propagating melanoma

This kind of skin cancer it is commonHis share accounts for about 70% of all diseases. Surface-propagating cancer is called side, since growing a malignant tumor for a long time(from 2 to 5 years) happens exclusively around the perimeterwithout affecting deeper layers of dermis.

Looks like a surfactant melanoma as brown inhomogeneous stain with a clear hyperemic boundary. The stain is towers above the surface of the body, does not have a skin pattern. The main difference from a benign nevus is a change in time. Internal coloring, size, contours can change.

Over timesurface-propagating melanoma goes to the vertical growth phaseWhen the tumor begins to affect the deeper skin layers. With vertical growth, the forecast is worsening, the risks of metastasis increase sharply. The clinical picture is changing - apulification, bleeding, itching, burning.

Lentiginosna

Lentiginian melanoma meetrelatively rare in 10-12% of cases of diseases. Develops from Pre-Plan Lentigo. It is found in women who are poorly susceptible to the tan, have a large amount of freckles, pigment spots. This form of cancer it is considered the pathology of the elderly. It is localized on the face, a decollete zone, head, ears, less often in the open parts of the hands, legs.

Lentiginous cancer can resemble superficial melanoma, but spent slower development and best forecast. Externally, it is a large (from 4 to 20 cm) stain with sharply outlined, irregular shape, rugged boundaries. The surface of the stain is flaky, dim. The color is uneven with a darker-shaped inclusions.

AKLAL (amolanotic) melanoma

The acral tumor differs from other types of melanocytic cancer with its localization - it develops at the closed areas of the body, amazes thickened skin - Palms, feet, nail plates. Arises on clean areas from non-nonseaves. Rapidly growing I. able to metastasize in the early stages of development. It occurs in about 5% of cases.

The acral melanoma does not have age, sex or racial preferences, although until recently it was believed that she was more susceptible to representatives of the Negroid race.

The appearance of a tumor accompanied by an increased skin's energization. A visually acral malignant tumor is a dark color spot, evenly thickened over the entire surface. In further development, novels appear. The tumor on the nail lifts the nail plate, increases the lesion area, pain appear.

Note! In the emergence and development of acral melanoma, a clear dependence on UV insolation is not traced.

Nodular (nodular)

Nodular or nodular melanoma developspredominantly in men of middle and older. Cases of the disease with this type of skin cancer among the remaining are about 15%. Tumor is knot(Great protruding "Roda") more often dark color. Tumor shape Round or oval, with clear boundaries, the surface is smooth. The color depends on the number of melanocytes.

Rarely, but there are impudent irradiated tumors. They are large nodal formations of pink color. Diagnosed with special chemicals that allow melanocyte presence.

Nodular melanoma differs large aggressiveness and lack of phase of horizontal distribution. Vertical germination, early metastasis and late diagnosis determine the unfavorable forecast in the development of this type of cancer.

Photo 3. Developed stain indicates the progression of melanoma. Source: Flickr (Melanoma Research Foundation MRF).

Unmanned melanoma

An unmanned melanoma is an aggressive oncological disease that Characterized by early metastasis. It looks like a neoplasm very harmful - it painless pink knot on the skinthat does not cause any fears.

The development of pathology adds specific symptoms. Itching, burning, ulceration, vascular lesions, bleeding appear.

Note! Any formation on the skin, which appeared, steadically hold, increase or modify - reason to visit the dermatologist.

Stages of development of the tumor

Eliminate 4 stages of the development of melanoma. Depending on the degree of tumor growth, the specificity of therapy is determined. As with other oncopathology, the earlier the tumor is diagnosed, the more optimistic the forecast in its treatment.

The prejudition state is isolated as zero stage. This is the development of atypical melanocytic dysplasia on the basis of existing nonsense or the appearance of an unusual nevus in a pure skin.

Can be suspecting melanoma by the following signs:

• The existing or newly educated birthmark, the Mountains begin to undergo noticeable visual changes. Their color, size, thickness, surface structure is changing (for example, skin pattern disappears);
• There are ulcerations on the surface;
• There is a bleeding or any expiration of fluid;
• Neva is beginning to hurt (in the norm, its presence is not felt), itching, burn.

Note! Watch out your skin surface and your loved ones. With the slightest suspicion, the activation of the birthplace of spots, the moles visit the dermatologist. Timely diagnostics will save life.

First (initial) stage of development

The beginning of the development of melanocytic cancer is characterized by horizontal invasion, without germination of the tumor in the deep layers of the dermis. To the first stage relate malignant formations whose thickness up to 1 mm (may be an ulceration) or formation with a thickness of up to 2 mm withoutsigns of ulcerations, severe symptomatics. Metastasation is absent.

Surgical treatment, the forecast is very good. A tumor with adjacent tissues under general anesthesia is removed. Local anesthesia is not shown to avoid the transfer of atypical cells in the deeper layers of the skin or blood flow when piercing the adjacent needle tissues.

The forecast of survival in 5 years is more than 85%. If the melanoma is diagnosed and removed when its thickness did not reach 1 mm, then the survival forecast is up to 99%.

Second stage

The second stage of skin cancer is tumor from 1 to 2 mm thick without metastasis. Small ulcerations are allowed. Surgical treatment. Survival statistics are not different from the first stage. However, the forecast depends on the rate of propagation of the tumor and the type of melanoma.

Note! Statistics shows that women have a favorable forecast than men. This is due to localization of tumors in open areas of the body, where women are more concerned about, they earlier appeal for medical care.

Third stage

The third stage is the beginning of the distribution of metastatic tumors in regional lymph nodes and the appearance of pronounced symptoms. When localization of metastases in 1 lymph node the forecast of survival for 5 years is about half cases of melanoma. When diagnosing a metastatic lesion in 2 lymph nodes, the forecast deteriorates to 20%.

Treatment surgical + chemotherapy or irradiation for the destruction of metastases.

Fourth Stage

Any melanoma, which gives metastases to remote lymph nodes, organs and fabrics Reached the final stage of its development - the fourth. Treatmenthere symptomaticDiffers low efficiency. The forecast is extremely unfavorable, survival is about 5%. The forecast is the worse than the older patient, because with age, the disease has the own resistance of disease.

Treatment of melanoma in stages

Surgery

The first and second stage of development tumors requires immediate surgical excision Tompetions with adjacent fabrics. The removal of large areas of skin creates aesthetic and functional (for example, when removing a tumor on the limbs), a defect that is closed with flap of self-leather with other parts of the body.

In addition to the excision of the tumor itself, if there are metastases, regional lymph nodes remove. Here surgery are combined with immunotherapy and chemotherapy.

Chemotherapy

Chemotherapy is the main method of therapy in the treatment of 3-4 stagesWhen there are metastases or if it is impossible to make an operation. The course and medicines are selected individually in each case.

Immunotherapy

Immunotherapy for melanocytic cancer stimulates the body for the destruction of atypical cells. Apply local action preparations (creams) or central action medicines. Immunotherapy can be shown at any stage of development of the tumor. At 1-2, it avoids the propagation of cancer cells in the body, at 3-4 - to extend the patient's life.

Radiation therapy

The irradiation at melanoma is shown:

• with the general defeat of the body of malignant pathology to remove metastases in the brain, bones,
• to facilitate the state of the patient with the 4th stage of the disease,
• when recurring the disease
• after removing lymph nodes to prevent re-tumor.

For the treatment of primary focus, 1-2 stages of development of the disease are not applicable.

Prevention

Effective preventive measures include:

• protection against solar irradiation,
• refusal to artificial insolation,
• preventive skin inspections.

Healthy life, a strong immune system, a reasonable attitude to the tan and attentive attitude towards itself is the best prevention of melanoma.

Melanoma is a malignant tumor of the skin, mucous membranes and an involuntary path (vascular shell) of the eye. It grows from pigment cells of the skin, so-called melanocytes, has a high tendency to early metastasis and low sensitivity to treatment.

There are several varieties of the disease, each of which has its own symptoms, development dynamics and forecast.

Localization and prevalence

More than 90 percent of all melanomes are developing on the skin, but this kind of cancer can attack any tissue where there are melanocytes (pigment cells) - eyes, mucous membrane of the genital organs, oral cavities, larynx, esophagus, intestines, stomach. Most often, it arises on the spot of pigment stains and moles (Nevids), but can also develop on unchanged skin.

Melanoma is a very common problem. It is 5% -7% of all malignant human skin neoplasms. About 130,000 cases of the disease are diagnosed annually. Most patients are representatives of the European-like race living in high solar countries. The peak of morbidity falls on the seventh and eighth decade of life, people under the age of 40 practically do not suffer.

The reasons

The main factor generates malignant melanoma is considered UV radiation. In melanocytes, as in most cells of the human body, there is a genetic material in the form of DNA. Under the influence of negative DNA factors is irreversible damage (mutation). Under normal conditions, the mechanism of death of pathological cells (apoptosis) is launched upon detection of mutations. Nevertheless, if the genes responsible for this mechanism are damaged, mutated cells are not dying, but continue to share. Normal melanocytes present in the tissues of each healthy person are reborn into cancer melanocytes.
The face with light skin, blue eyes, light or red hair is predisposed to this process. However, there are other provoking factors:

• long exposure to sunlight is especially dangerous solar burns at a young age. Huge harm also applies the use of solarium;
• individual patient sensitivity to sunlight;
• the presence of numerous pigment spots and moles;
• pigment Keroderma (hereditary disorder associated with the work of pigments);
• states accompanied by a decrease in immunity - chronic use of immunosuppressive drugs in patients after organ transplantation, receiving glucocorticoids by human immunodeficiency virus (HIV), congenital immunodeficiency;
• genetic factors (scientists revealed a family predisposition to this oncological disease);
• hormonal factors - a period of puberty, pregnancy and childbirth, long-term use of oral contraceptives and substitution hormone therapy.

Varieties

There are 5 main varieties of melanoma skin:

• lentigiosis is a relatively soft type that is localized mainly on the face and other open areas of the body, often in contact with sunlight; slowly develops for many years, has a favorable forecast;
• the acrolntigious is a rare shape that is placed on the tips of the fingers and legs, slowly develops and can completely destroy the nail plate on the affected finger;
• superficial-propagating is the most common type of cancer, which develops from pigment moles, including atypical (that is, those that on microscopic examination showed a predisposition to oncology). The neoplasms often occur in the middle and lower part of the body (torso and lower limbs), they are developing relatively slow;
• a nodal - a rare dangerous variety, which is usually localized in the area of \u200b\u200bthe head, neck and back. The nodal form shows the rapid growth and abundance of metastasis;
• achromatic (unmanned) is the most dangerous of all kinds of melan. It is characterized by a reduction in melanin production in cancer cells.

As for the tumors of other organs, it is found in medicine:

• melanoma retina eye;
• lentginal melanoma of the mucous membranes (vagina, anal opening, nasopharynk);
• meligated melanoma of soft tissues (localized on bundles and aponeurosis).

Symptoms and Stages

The tumor is growing either on the site of the already existing moles, or on unchanged skin. Here are some features of malignant neoplasms:

• changing the shape of the stain - the more it is characterized by asymmetry, the stronger the suspicion of cancer development;
• uneven edges;
• itching and burning;
• uneven or atypical color - new, previously unnoticed places with black, blue, brown, red or pink stains with possible intrinsic colors;
• increasing the size of the change - no avuses with a diameter of more than 6 mm should be alert, or rapidly growing stains;
• the appearance of a red or pink rim around inflammatory changes - this indicates the activity of immune cells and the development of a local inflammatory response in response to contact with alien antigens (obtained from cancer cells);
• the neoplasm and surrounding fabrics can be swollen or hardening.

There are 5 stages of melanoma, depending on the depth of her germination:

• stage I - Pathological cells tight only the upper layer (epidermis);
• stage II - the puffy layer of the dermis is affected;
• stage III: Cancer reached the border between the papillary and mesh layers;
• stage IV: The mesh layer is affected;
• stage V: Changes reached fatty fiber.

At the last stages, the changes are covered with ulcers from which serous-bloody contents flows.
Melanoma gives metastases in lymph nodes, lungs, liver, brain, bone. At the same time, symptoms appear by damaged organs:

• an increase and painfulness of lymph nodes;
• hemoptia, shortness of breath, symptoms of lung inflammation;
• gastrointestinal bleeding, blood coagulation disorders, swelling of the lower extremities, the liquid in the abdominal cavity;
• headache, nausea, vomiting, temporary violation of consciousness;
• pains in the bones, frequent fractures.

It should be noted that each of the above general symptoms may indicate other nosological problems.

Diagnostics

The most important elements of the diagnosis is an independent body inspection - if you noticed one of the above signs, let me know the doctor. Early diagnosis is the key to successful treatment.

The specialist makes a preliminary estimate using a dermatoscope - an optical device through which you can consider deep changes in the mole. If there is a suspicion of malignancy, the doctor cuts all the neoplasm with a reserve of healthy skin, and part of the fabric poisons to histopathological examination. This analysis allows you to determine the type and severity of the disease.

Since Melanoma initially gives metastases only into lymph nodes, the doctor will definitely assign an ultrasound of the regional absorption zone (closely located lymph nodes). It will show if there are metastases. When the study does not give a clear answer, the doctor removes the so-called trial lymph node - the first lymphatic assembly along the path of lymphatic vessels coming from the tumor.

In developed stages of the disease, analyzes of internal organs are appointed to assess the degree of damage.

Treatment

Doctors use 3 basic methods: surgery, chemotherapy and radiation therapy. In the early stages, it is possible to do only to surgical resection (removal of pathological tissues with a margin of healthy skin). This is done by the traditional or laser way. Be sure to remove the surrounding lymphatic nodes.

In later stages and in the presence of metastases, chemotherapy is assigned. This is the main method of treatment, when there is a diffuse expansion, not amenable to resection. With extensive and multiple metastases, treatment is limited only to the relief of the symptoms and support of the affected internal organs - painkillers are prescribed (potent analgesics, morphine and its derivatives), metoclopramide, diuretics, dietary food.

With lesions located on the limbs, a special type of chemotherapy is used - isolated perfusion. It includes an introduction to the artery of high doses of cytostatic when heating the limbs to 41/42 ºC. These two factors interact with each other, destroying mutated cells.

Radiation therapy is usually used in extreme cases, in the absence of consent to treat or impossibility to perform an operation.

In recent years, a breakthrough occurred in the treatment of melanoma. Scientists revealed the relationship between the BRAF gene mutation and the progression of the disease. Such knowledge helped to develop molecular targeting therapy, which operates by blocking anomalous protein encoded by a mutated BRAF genome. This gene is present in more than half of the patients with melanoma. The action of the new drug (VEMRAPENIB) is that it closes access to tumor cells - they do not receive food, resulting in dying (tumor ceases to grow). Such therapy is effective in 90% of patients.

Folk remedies

Naturopaths recommend to process growing moles with chilli juice, miluine, calangean, ghivitsa, or to catch up with matches. However, these techniques cause doctors skepticism. Oncological diseases require immediate medical actions, so it is better not to risk your own life and trust in the hands of a competent specialist.

Folk medicine will be useful during the rehabilitation after chemotherapy. Regular reception of teas from rosehip, chamomile, Melissa, Taricar, barley and Echinacea will help to restore immunity and strengthen the body as a whole.

Forecast and complications

If the disease is detected at an early stage, the chances of recovery are very high (95% of patients live longer than five years). The third and fourth stage is successfully healed in 40-60% of cases, but the chance for the treatment of the fifth stage is only 25%. The most favorable forecast has lentigiosis and superficial varieties. The most dangerous forms are nodal and achromatic, as well as neoplasms that develop during pregnancy and childbirth. Thus, the prevention and early diagnosis plays an extremely important role in the fight against melanoma.

Death occurs as a result of complications caused by metastases (liver failure, respiratory stop, internal hemorrhage, etc.).

Prevention

Prevention includes:

• safe tan (it is forbidden to stay on the beach between 10:00 and 15:00);
• use of sunscreen;
• regular inspection of skin cleanings for the identification of suspicious elements;
• regular visits to a dermatologist (every six months).

Especially important prevention for people who have a lot of non-love on the body.

Photo