Melanoma: symptoms, early onset, treatment, prognosis
Melanoma is considered one of the most insidious of human malignancies, morbidity and mortality is steadily increasing from year to year. Talk about it on TV, write in journals and the Internet. The interest of the townsfolk is that the tumor is being increasingly detected among residents of different countries, and the number of deaths remains high, despite intensive treatment.
As the prevalence of melanoma lags behind the epithelial skin tumors (squamous cell carcinoma, basal cell carcinoma etc.), accounting for 1.5 to 3% of cases, but it is much more dangerous. 50 years of the last century, the incidence increased by 600%. This figure is enough to seriously fear of the disease and look for causes and its treatment.
Melanoma is more susceptible to white-skinned people of advanced age (55-70 years), but in young individuals after 30 there’s also the risk of its occurrence. In almost all cases, the tumor preceded changes in the form of age spots, moles, dermatitis and other precancerous lesions. Often melanoma is detected at the stage of metastasis, but even a timely diagnosis often leaves no chances for a favorable outcome due to the extreme malignancy of the tumor.
The skin is the largest and very important organ that protects the internal environment from the many adverse external influences. Experiencing the influence of solar radiation and various carcinogens, subjected to injuries, it often becomes a target for melanoma.
Cells that produce melanin (melanocytes) are mostly concentrated in the basal (deepest) layer of the epidermis. Melanin is the pigment that can reflect UV rays, thus protecting us from sunburn. The more melanin in the skin, the darker its color. The inhabitants of the African continent genetically determined high activity of the melanocytes to protect the skin from the scorching sun. Conversely, the Northern peoples have pale skin because they do not experience the action of the sun almost all year round, and therefore an excess of melanin they do not need. Some studies indicate that the number of melanocytes is approximately the same peoples with different skin colors, but their activity and the amount of produced pigment vary greatly.
In addition to the skin, there are melanocytes in the retina of the eye, soft meninges, rectum, inner ear. These cells carry a specific protein – protein S100, which allows to refer them to neuroectodermal elements. In other words, the melanocytes do not originate from the surface epithelium and Bud of nerve tissue. Although very often referred to as melanoma and skin cancer, but, nevertheless, it does not belong to him and are excluded from this group of tumors. Melanoma is a malignant melanocytic tumor, neuroectodermal origin.
The most often neoplasms melaminovaya tissue detected in the skin, but it is also possible to detect them in the eyes and even internal organs. Below will be discussed primarily about melanoma as the most frequent variant of the tumor.
What to be afraid of?
Like any other malignant tumor, melanoma does not occur suddenly. It is always preceded by certain changes, and in almost all cases there is a connection with exposure to ultraviolet radiation. The insidiousness of the tumor is that it may appearance after so many years and even decades after a sunburn. There is evidence that a single excessive sun exposure can cause tumors in the future, so it is important from childhood to follow the skin and to avoid burns.
Potentially dangerous factors that increase the risk of melanoma, can be considered:
- Solar radiation or ultraviolet radiation from artificial light sources.
- White skin, light hair and eyes, lots of freckles.
- Past sunburns.
- The presence of nevi, age spots, especially when a large number of them.
- Xeroderma pigmentosum.
- Age and sex factor.
Ultraviolet radiation occupies the first place in the list of possible causes of melanoma. The increase in the intensity of sunlight, as well as the stay of the person under them has led to increased incidence of the tumor. The fashion for tanned body dictates the need for beach long time, and in the winter come to the aid of the Solarium. Meanwhile, the desire to acquire an skin the color of chocolate may be too expensive.
With the increase of time spent under the sun, and increases the risk of disease. Moreover, the adverse effect of short duration but high intensity radiation, than a long but low-dose, even if the total number of doses in the same way. Trying to get a dark tan, escaping to the coast, pale inhabitants of the Nordic countries is ready to spend hours lying under the scorching sun even in the most dangerous time – from noon to 4-5 PM. Immediate effects can be sunburn, and distant – the development of melanoma.
Depending on the receptivity of the skin to the sun, identified several phototypes determining risk of a tumor:
Thus, individuals with fair skin, always burn in the sun without getting a sunburn, or those who are hard to reach it, are to I and II phototypes, when the risk of melanoma is very high. Conversely, dark or black residents of the southern latitudes almost no risk, but still a large amount of melanin does not guarantee the impossibility of tumor growth from them.
We should also mention the Solarium, the popularity of which came to us relatively recently. The use of even high-quality UV lamps creates a great risk of damage to the skin, and be underneath no special protective cream not quite. Treatment time should be 5-6 minutes, or sunburn and photodermatitis inevitable. Today, in many countries, tanning is banned for use due to the high carcinogenic activity obtained by this sun exposure.
Before be long in the sun or frequenting the Solarium, you should think twice whether to get the beauty of the victim in a possible loss of health.
White skin, light eyes and hair, lots of freckles predefined low amount of melanin that can reflect the sun’s rays, therefore, these people should be very careful and always use sunscreen.
Past thermal injury of the skin and sunburn can cause melanoma, even after many years, so it is important to avoid them not only for adults but especially for children and adolescents, are often affected by the sun with a long stay in the open air when walking.
One of the important risk factors for melanoma are considered to be nevi, commonly often called a nevus, and skin pigmentation. Nevi represent a tumor-like formation, mainly located in the skin and composed of clusters of melanocytes. Besides the skin, they can be found in the tissues of the eye.
Nevi may be congenital and acquired, which appear in children or adolescence. Congenital moles are more dangerous in terms of malignancy.
Microscopically nevus composed of melanocytes located in the epidermis, the dermis or at the border, and in some cases can capture all layers of the skin, accumulate and produce a large amount of pigment. The structure of such entities involves the allocation of different types, which can indicate the risk of tumors:
In addition to these, there are other forms of nevi, and of particular danger are congenital forms, giant pigmentary, dysplastic, complex and border nevi. More than half of melanoma patients have local tumors of a particular type of the precancerous process, and if you have more than 50 moles on the body should take special precautions.
The causes that can lead to transformation of nevus to melanoma is quite simple: insolation and traumas, disorders of the endocrine metabolism and a genetic predisposition. People who have many moles, especially in the neck and head, to avoid being in the sun, preferring the shade and use protective cosmetics and clothes. If the nevus is in a place frequently exposed to mechanical stress (e.g. parts of clothing), he will inevitably be injured, and, therefore, cells will be superfluous to multiply, which greatly increases the risk of melanoma, so these nevi is recommended to remove for the purpose of prevention of the tumor.
Xeroderma pigmentosum is considered to be a precancerous condition in relation to malignant tumors of the skin, so melanoma in these patients may occur with high probability. When exposure to the sun in retinitis pigmentosum appears the dermatitis and burns that will inevitably lead to cancer.
Hereditary factor plays a big role, as evidenced by the occurrence of tumors among members of the same family. The likelihood of melanoma when there are two or more relatives with such a diagnosis, increases several times. Moreover, 9 and 12 chromosomes found genes that determine the development of the tumor.
Gender and age also contribute to neoplastic potential of any cells, including melanocytes. Men suffer from melanoma more often than women, and older patients among patients much more than the young.
Melanoma can be represented by quite diverse forms of growth, in the early stages of its development «masquerading» under a nevus or lentigo. Over time the tumor increases in size and becomes obvious features of malignancy with characteristic ulceration, bleeding, metastasis, etc.
The tumor may have a predominantly horizontal distribution characteristic of the initial stages of the diseases in which the pathological process extends over the surface of the skin, increasing in size and within the epithelial layer. This increase can last for several years, and in some cases of melanoma – even a decade. Tumor for a long time, looks like a dark brown flat spot, not bringing significant anxiety.
Vertical growth is accompanied by the implantation of tumor tissue in the underlying layers through the basal membrane and is characteristic of nodular melanoma. At this stage there is a rapid increase in the size of the neoplasm, it rises above the surface of the skin in the form of a node or a polyp, and provide the ability to metastasize. Most often, the vertical growth phase is replaced by horizontal progression of the tumor.
It is accepted to allocate and clinical forms of the melanoma:
- Superficial spreading.
Superficial spreading melanoma 70% of all cases of tumor, more common in women and has a relatively favorable prognosis. The initial stages look like a horizontal brown or black spot, towering above the skin surface.
Nodular form of melanoma up to 20% of cases, more malignant and has a very poor prognosis. Among patients dominated by men, the tumor grows as a node or a polyp, growing into the thickness of the skin and lower tissues. This form is characteristic of early metastasis and rapid progression.
Lentiginous form is considered to be one of the most favorable variants of the tumor, which is characterized by a prolonged horizontal growth. Most of these melanoma detected at the face, formed on the place of moles and affects mainly women.
A distinct form of lentiginous melanoma can be considered subungual (melanoma «nail», ukrrentgen), which affects mainly the tips of the fingers, the nail beds, palms. The peculiarity of this form is that it occurs more often in dark-skinned individuals, the least prone to tumors melaminovaya tissue.
A very rare kind of tumor is considered to be pigmentless melanoma, which has a characteristic staining and forms a large number of melanin. This form is extremely difficult to diagnose, and therefore can be quite dangerous.
A separate form of disease is melanoma of the eye, mucous membranes and soft tissues.
Melanoma in the eye is able to hit the retina and iris, often giving no specific symptoms and viewsas by chance when visiting the ophthalmologist. Localizes on the mucous membranes, the tumor predominantly affects the tissues of the nose, oral cavity, anus, vulva or vagina in women. Melanoma of the soft tissues is characteristic of all ages and can be found in ligaments and aponeurosis.
Melanoma metastasis can occur with the flow of lymph – lymphokine, or blood – hematogenous, and, the preferential path is determined by a variety of tumors. Thus, the relatively favorable long-existing types can metastasize to regional lymph nodes and rapidly progressive nodular melanoma will metastasize not only limfopenia, but the bloodstream, affecting the liver, bones, lungs, brain. In General, melanoma is quite unpredictable, and metastases can occasionally be found in the most unexpected places, such as the cervix or the adrenal glands.
Feature of melanoma can be considered the emergence of the so-called skin metastases in the form of nodules, which may be located at different distances from the primary tumor and have the same coloring as her.
Manifestations of melanoma
Symptoms of melanoma are quite diverse. In the early stages of development, it can be difficult to distinguish from benign pigmented formations on the skin, so requires careful diagnosis.
The initial stage of melanoma is represented mainly by formations with horizontal type of growth. It is often a blur of brown, black, blue or purple flowers, towering above the skin surface, but gradually increasing in transverse size from a few millimetres to 1-3 cm tumors Form from round or oval to irregular, pitted or scalloped edges, the contour can be blurred.
The growth appear and other symptoms of melanoma: secondary neoplastic changes in the form of ulceration, a tendency to bleeding, itching, with the formation of crusts, the tumor thickens and begins a vertical rise, which you can see site either rising above the surface of the skin infiltration, there is tenderness at the site of tumor growth. The uneven deposition of pigment gives the melanoma multi-colored: black or dark brown to the plots of red-violet and gray. A reliable sign of malignancy is the discovery of the so-called skin metastases as the «child» of nodules at some distance from the primary.
Symptoms, combination of which can cause concern:
Because most melanomas develop from moles it is important to know the signs of incipient tumor growth in such formations:
Any of these symptoms should alert and to make appeal to an oncologist, to exclude tumor.
Melanoma of the eye is manifested by pain, blurring and loss of parts of visual fields, decreased acuity. Often this form of tumor for a long time does not give any severe symptoms, if the patient suffers from other eye pathology, the symptoms of a melanoma may not cause concern.
Pigmentless melanoma is quite rare, however, refers to a form in which the prognosis is often disappointing. The fact that the lack of melanin in tumor cells and the corresponding staining of tumors does not allow time to suspect the tumor and start treatment in time. Pigmentless melanoma can be detected at the stage of extensive metastasis, not giving chance for a cure.
When metastasis lymphogenous way possible detection of enlarged regional lymph nodes, wherein they are compacted, but not soldered between itself and accessible to probing.
On the basis of the size of the tumor, the depth of its infiltration into the subcutaneous layers and about the presence of metastases (classified by the TNM system and microstudio Clark), determine the stage of the disease:
Thus, in the first stage, the tumor does not exceed 2 mm in thickness and not ulcerate, the second melanoma greater than 4 mm, but metastases are still lacking, the third is accompanied by metastasis to lymph node 4, and also apparent skin metastases, and stage 4 of the disease is determined when there are distant metastases regardless of the size of the primary tumor. Correctly identify each of the stages can oncologist, this is not gonna work.
How to detect a tumor?
The difficulty of early diagnosis of melanoma is associated mainly with the fact that there are no obvious signs of malignancy in the initial stages of tumor development. If the pathological process is difficult to access for inspection by the patient himself places the time can be missed. However, timely diagnosis is still possible, just need to be mindful of skin changes and the appearance of any symptoms do not hesitate to visit a doctor.
The important point for the first stage of diagnosis is self-examination. Preferably at least once a month to inspect the skin in the mirror in good lighting, and region of the back, back of the thighs and other hard to reach places you can ask to see a relative or friend. If you notice changes in moles, as described above, you will have to visit a dermatologist or oncologist.
Diagnostic methods used in medical facilities are few because the tumor localization of skin located superficially and is available for inspection eye. Apply:
- The morphological study.
- Radioisotope scanning.
- CT, MRI, ultrasound, determination of the level of LDH, chest x-ray, bone scintigraphy – when you suspect the presence of metastases.
The doctor in the primary treatment will examine the affected area using a magnifying glass or microscope epiluminescence (dermatoscopy), and determine the color, texture, dimensions of education, the condition of the skin in the area of presumed tumor and around it, then propellerom lymph nodes may be enlarged and sealed with a melanoma metastasis.
Morphological methods include Cytology, the accuracy of which can reach up to 97% (brushstrokes-prints from the surface of the tumor) and histological assessment of the nature of neoplasms. It is important to note that any kind of biopsy prior to surgery for melanoma is contraindicated because of high risk of hematogenous dissemination of tumor cells, and therefore the study is subject only to fully remote the tumor with enough surrounding tissue.
Intraocular melanoma is detected using ophthalmoscopy, ultrasound of the eyeball, angiography and other techniques.
Video: specialist about the symptoms and diagnosis of melanoma
Treatment of melanoma
Treatment of melanoma consists of its removal, chemotherapy or radiation, and immunotherapy. The choice of specific tactics is determined by the stage of the tumor and its localization.
The most rational method of treatment of melanoma in early stages is the surgical removal of the tumor. Excised not only the growth of neoplasias, but also the surrounding healthy skin at a distance of three inches from the edge of the tumor.
Cryosurgery and other gentle methods of tumor removal are not applied even at the initial stage because to determine the level of penetration of melanoma into the underlying tissues is impossible, and, therefore, it is possible to aggravate the process and provoke a relapse with the metastasis.
In the presence of melanoma metastases in addition to surgery to remove the primary tumor and the lymphatic apparatus of the assigned chemotherapy, radiation and immunotherapy. Among chemotherapeutic agents, the greatest effect of cisplatin, dacarbazine, lomustine, etc. Radiation therapy to a total dose of 4000-4500 rad is usually applied topically in the area of tumor growth.
Immunotherapy of tumors is a relatively new direction in Oncology. Apply interferon-alpha and monoclonal antibodies, which allows to reduce the size of tumors and increase life expectancy, even in patients with III-IV stage of the disease.
National treatment for melanoma is unacceptable! First, because the tumor is highly malignant and often has a poor prognosis even for conventional treatment. Secondly, the local application of various lotions, lubricating, compresses certainly lead to personal injury and violation of the integrity of the superficial parts of the tumor, than is possible not only to accelerate the pitting and increased invasive growth, but to provoke early metastasis.
The prognosis of melanoma is always serious, and it depends on many factors: the age and sex of the patient (women have it better), location of the tumor and depth of growing it in tissue, the presence or absence of metastases, and genetic defects. The detection of melanoma in the first stage the survival rate is 90 percent or more at a time begun treatment in the second – 75%, in the third stage, with the presence of metastases in regional lymph nodes does not exceed 45%, and fourth survive no more than 10% of patients.