How does melanoma manifest itself? Skin melanoma - symptoms and exact signs. Indications for biopsy

The diagnosis of melanoma often sounds like a death sentence, frightening not only the patient himself, but also his loved ones. It is no secret that the predisposition to the development of this type of malignant tumors is hereditary.

The success of treating this disease (as well as many others) greatly depends on the stage of development of the disease at which the diagnosis was made. This means that each of us needs to clearly understand how to recognize melanoma at the initial stage in order to prevent its dangerous growth.

What is melanoma

Melanoma is a type It is considered the most aggressive, since it actively metastasizes to all human organs with the flow of lymph. Moreover, the process can develop quite rapidly, literally in a matter of days, and even a minor injury can provoke it.

Melanoma is formed from melanin-producing skin pigment cells called melanocytes. It is diagnosed in 4% of cancer patients, but it is perhaps the only tumor whose development can be noticed at an early stage.

By the way, when thinking about how to recognize melanoma (a photo of which you can see in this article), remember that these neoplasms only in 30% of cases begin to develop from existing moles (nevi). And in 70% of cases it appears on the part of the skin where there were no spots. In addition, be aware that melanoma can also occur on the mucous membrane and even under the nails.

Factors that can trigger the development of melanoma

Speaking about how to recognize melanoma and what it is, first of all, it should be said that it is either a nodule or a spot that has dark color(although there are also non-pigmented species) and irregular shape.

Risk factors that can accelerate or provoke the development of melanoma include the following:

• the effect of ultraviolet radiation on the skin (this applies to both sunlight and artificial sources - solariums or bactericidal lamps);
• previously existing precedents for the occurrence of melanomas, both in the patient himself and in his close relatives;
• the presence of a large number of moles on the human body ( we're talking about fifty or more);
• female;
• old age (although melanomas also occur in young people);
• red hair and big number quickly appearing freckles.

The first signs of melanoma

Additional signs that will tell you how to recognize melanoma will be changes that occur with the mole. If the nevus thickens, rises above the skin, increases in size and at the same time changes pigmentation, then it should be shown to a dermatologist.

Particularly obvious signs of a dangerous situation are redness of the tissue around the nevus, the appearance of cracks, crusty ulcers, and bleeding. In such cases, the mole causes concern - it itches or burns. In this case, the patient's lymph nodes may become enlarged.

How does melanoma grow?

Most often, melanoma develops on the lower extremities, torso and arms; in only 10% of patients it can occur on the head or neck.

The described tumor, as a rule, grows in three directions - into the deep layers of the skin, along its surface, or through the skin into nearby tissues. By the way, the deeper the tumor spreads, the worse the prognosis of specialists.

Answering questions about how to recognize melanoma and how it manifests itself, oncologists note its rapid metastasis and damage to nearby lymph nodes. It spreads not only through the skin, but also by hematogenous or, as already mentioned, lymphogenous route. By the way, hematogenous metastases have the ability to penetrate any organ, but most often they affect the kidneys, adrenal glands, liver, brain and lungs.

They look like peculiar small rashes that rise slightly above it and are brown or black in color.

How to recognize melanoma: signs and symptoms of disease development

The first sign that a person is developing melanoma at the site of a mole is, as a rule, changes that suddenly begin in it. Take a closer look at your birthmarks.

1. Ordinary moles are always symmetrical. If you mentally draw a line through their middle, then both halves of a normal mole will completely match in shape and size. Any violation of this symmetry should raise your suspicions.
2. Pay attention to the borders of the mole. If they are uneven, blurry, unclear, then it should be checked.
3. A change in the color of your tumor should also alert you. If the mole is colored in more than one color or has several shades, check it.
4. Symptoms of melanoma development include an increase in size birthmark. Even if your spot has no other deviations (even color, clear boundaries, symmetrical shape), but its diameter exceeds 6 mm (this is about the same as the eraser on the tip of a pencil) - this can be considered alarming symptoms.

From the above, we can draw an unambiguous conclusion regarding how to recognize melanoma at an early stage. But you should remember that you don’t have to wait for everyone listed symptoms- one of them is enough for you to have a serious reason to consult a dermatologist.

Once again about whether you should worry if a mole grows

All of the above signs of the development of the disease will probably make you look at your body with fear. But we also want to warn you that when thinking about how to recognize melanoma and not miss its symptoms, do not immediately start sounding the alarm as soon as you notice that the mole has enlarged. After all, an ordinary nevus can change, just as we change with age. It may be flat at first and then become convex - that's not a big deal. But if such changes occur, as they say, right before your eyes, you should not delay going to the doctor.

By the way, the presence of hairs on a mole confirms that it is healthy!

Diagnosis of the disease

And yet, if you have doubts about the condition of your mole, do not guess about how to recognize melanoma yourself, but consult a doctor. He will clarify the symptoms, find out all the risk factors, and conduct an examination.

Due to the fact that, as stated earlier, melanoma is very aggressive, and its development can be triggered by even a minor injury, an invasive method of examining it is highly undesirable (by this we mean scraping or histology, when not the entire formation is taken for analysis, but a small part of it) ). Therefore, most often the doctor performs an external examination of the nevus.

He will definitely check the condition of the lymph nodes under the arms, neck and groin, and will also conduct a radioisotope study, which uses phosphorus. Its increased accumulation in the tumor is used to determine the presence of melanoma.

It is also used in which, if there are ulcerations on the suspected melanoma, an imprint is taken from the surface of the tumor and then sent for analysis.

To determine the presence of metastases, ultrasound of internal organs, x-rays and tomography are also performed.

How is melanoma treated?

If the patient managed to contact an oncologist in time, then at an early stage of development the melanoma is simply excised. Depending on how deeply it has penetrated, it is removed and a small amount of healthy skin. The doctor may also prescribe additional therapy in the form of medications that will help reduce the likelihood of relapse.

If damage to the lymph nodes is suspected, then after a biopsy of one of them and a positive result, they are supposed to be removed.

Immunotherapy has been proven to have significant benefits. This is a relatively new treatment method that is performed immediately after surgery to remove the tumor.

On late stages development of the disease resort to radiation and chemotherapy, which, by the way, at the fourth stage of development cancerous tumor turn out to be ineffective, allowing only to reduce it to some extent.

A few words in conclusion

In this article, we tried to talk in detail about how to recognize skin melanoma. The photos posted in it also probably helped you navigate the situation.

But finally, I would like to add that it is not at all necessary, upon discovering a birthmark of an unusual shape, to immediately fall into despair. Not every modified mole will turn out to be a cancerous neoplasm; it can be an atypical pigment spot or a benign dysplastic nevus.

But still, going to the doctor should not be postponed, since in this case it is better to be excessively vigilant, which can subsequently save not only your health, but also your life.

Cancer is the scourge of our time. Every year the number of patients is growing, and the statistics scare not only the average person, but also doctors. It is known that oncological diseases are insidious, as they affect a person quickly and unexpectedly. But melanoma is considered the most “tricky” cancer process. According to World Organization healthcare, over the past 50 years the number of cases has increased by 600%. The number is truly frightening, and it is better to know everything about the disease in order to react in time if you ever have to face it.

Interpretation of the term

Skin melanoma is a malignant disease that originates from melanocytes. These are cells that produce pigment that colors and protects the skin. It is believed that the disease begins only from the degeneration of moles, but in fact this is not entirely true. No more than 30% of cases were recorded in which melanoblastoma was associated with nevi. In other cases, clean areas of the skin, as well as mucous membranes and the retina of the eye were affected. Often the first formations appear on the hand or face.

The tumor is scary because it has an aggressive course; its cells quickly spread through the bloodstream and lymphatic system, thereby worsening the prognosis and significantly reducing the likelihood of achieving recovery for the patient.

Experts give the worst prognosis for melanosarcoma.

It is also worth noting that the onset of the disease is difficult to track, so the patient often seeks help when the process is neglected. In this situation, doctors have to urgently develop treatment tactics to help the patient.

Symptoms and signs of melanoma are easy to recognize if you know what to look for. Melanoblastoma is always a pigment spot on the body. You need to be careful and monitor any changes that occur on the skin. A large number of moles on the body is a risk factor, so it is worth monitoring nevi and conducting independent monitoring. Signs of melanoma at an early stage consider:

When found similar symptoms you need to go to the hospital where you live, the therapist will give a referral to an oncologist, who will determine whether the formations are dangerous and what to do with them next. If you put off visiting a doctor, other symptoms of skin melanoma will increase:

• damage by pigmentation to healthy tissues adjacent to the formation;
• bloody discharge and opening of a mole;
• pain and discomfort at the site of the lesion.

Such manifestations indicate that the disease is already advanced. In this case, you cannot hesitate, because melanoma begins to spread throughout the body, which means there is a high risk of metastases. Metastatic melanoblastoma of the skin gives other signals:

Usually this condition appears in the last stage, general health deteriorates sharply.

The examination reveals the widespread prevalence of the process. Forecasts are assessed as negative.

Causes of the disease

The occurrence of pigmented melanoma is associated with many factors that provoke the degeneration of melanocytes into malignant, mutational cells. Experts often associate melanoma with a gene mutation that occurs in human DNA. It causes cells to change their appearance and internal structure, as well as to multiply uncontrollably, thereby starting the oncological process. But the "program" needs to run, The trigger mechanism can be:

It is known that women get sick somewhat more often than men, and this must be taken into account.

Especially for representatives of the fair sex who are over 50 years old and have other risk factors. But men suffer the disease more severely, so you need to monitor your health without focusing on gender.

Like any other oncological disease, melanoblastoma also has stages, which makes it possible to predict the further course of the disease and select the necessary treatment tactics. Stages of melanoma:

• First. A formation is detected that is more than 5 mm in diameter and rises above the skin within 1-2 mm. With or without damage to the nevus membrane.
• Second. The tumor is larger, thickness within 4 mm. Often with signs of opening of the upper layer, which means bleeding or other discharge.
• Third. Spread to nearby tissues is detected, pigmentation increases, regional lymph nodes are affected.
• Fourth. The process spread to distant organs. Metastases affect internal organs.

As the stage and prevalence of the disease increases, the general state patient, prognosis and responsiveness to treatment.

In cases where metastases are detected in vital important organs, reversing the process can be extremely difficult. Targeted therapy is often used.

Diagnostic measures

The earlier the disease is detected, the better the prognosis. But diagnosis often causes a number of difficulties, because only a person can determine the presence of melanoma. experienced specialist. Active work is currently underway aimed at familiarizing the population with the problem of skin cancer. Experts encourage self-examination of the skin for changes. This facilitates early diagnosis. The diagnosis is made based on the following:

All studies are an important part of the diagnostic process; they allow a comprehensive study of the patient’s condition and determine the diagnosis, as well as establish the stage of melanoma.

Based on the collected history, a program is developed to help the patient. In every special case Treatment tactics are selected individually.

Treatment tactics

If any primary signs of degeneration or other dubious manifestations are detected, it is recommended to remove the mole or age spot. And only then find out the causes similar situation, as well as continue further study of the obtained material.

As already mentioned, treatment directly depends on the neglect of the process. The more difficult the situation, the more A complex approach required. Surgical methods are used to remove suspicious nevi:

• scalpel;
• laser;
• radio waves.

All options are effective, but if further study is required, it is better to use a scalpel, it will help preserve the material.

Considering the stages, The doctor’s tactics will look like this:

To maintain the patient's life and normal functioning of the body, targeted therapy is prescribed. It is aimed at mitigating associated symptoms. Unfortunately, such tactics do not bring recovery, but they can save a person from pain and discomfort.

Treatment largely depends on the area of ​​the body where the melanoma appears, for example, cryo-freezing is often used on the face, neck and eyes. It destroys tissue but only affects the affected area, thereby reducing the likelihood of large scars after surgery.

Chemotherapy has a positive effect on recurrent tumors and generally slows down the process, while radiation is not prescribed as often. The reason is the resistance of skin cancer cells to such radiation. After all, it is the harmful rays that turn out to be the trigger for starting the process.

It is also possible to use immunotherapy; it will serve as a prevention of relapses of melanoblastoma; it is often used together with chemotherapy. In addition, the specialist will give instructions on nutrition, physical activity and other preventive measures.

Forecast based on various factors

Treatment results and prognosis later life depend on the prevalence of the process and characteristics of the cancer. It is clear that the earlier the disease is detected, the higher the chances of staying alive and healthy. But experts also note the dependence of this factor on the form of the disease:

• Thus, superficial melanoma is found in more than 70% of patients. It is less aggressive, since it does not grow deep into the tissue, which means the prognosis is positive in most cases.
• The nodular form occurs in 15% of patients. It is more serious and occurs more often in men. With such a course, the prognosis is negative.
• Subungual. On average, about 15% suffer from this form, but it carries minimal negative consequences.

The latter type is typical of the African-American races. Among Europeans, the first two are more common. But there are also cases of acrolentiginous tumor (neoplasm under the nail).

Effect of stages

The first stage is the easiest, therefore, treatment does not cause difficulties, which predicts a survival rate tending to 100%. Usually quite enough surgical intervention with wide excision and supportive care.

Things are a little worse in the second stage, especially when regional lymph nodes are affected, but even in this case, complete recovery can be achieved if measures are taken on time.

The third stage threatens with deep growth of melanoma into the dermis and the presence of metastases or multiple foci. But even in this case, the survival rate is quite high - from 24 to 68%.

With the fourth degree of severity, 15−20% survive the first five-year period, and 10−15% survive the second. This means that you should not give up in any situation, but should fight together with your doctor to the end.

Primary metastasis of melanoma is usually noted in the lungs, but lesions of the bones, brain, and liver are possible. At the same time, the fight against the disease becomes significantly more difficult. But even in this case, specialists will try to help prolong life as much as possible and improve its quality.

You won’t be able to protect yourself completely, but accept possible measures costs. Because the skin is the biggest human organ, you also need to monitor him as closely as possible. Will help with this:

Skin cancer - complex disease, requiring an urgent response from the patient and the doctor, timely diagnosis and positive attitude. It is only thanks to these factors that many sick people continue to live and enjoy their successes. But the main thing is to have as much information as possible. It will give you an understanding of what to expect next and how to deal with the disease.

There is no consensus on the cause of skin cancer. Moving forward different versions. IN Lately, there was even a statement about the fungal and helminthic origin of the tumor, which originated in the embryonic period.

Almost all photos of the initial stage of skin melanoma are obtained as a result of excessive exposure to ultraviolet radiation. With increased doses of ultraviolet radiation, melanocyte cells responsible for skin pigmentation begin to divide more actively, and, as a result, cancer develops.

A reliable cause for the development of melanoma has not been established. But doctors point to the existence of risk groups, among which skin cancer is more common. This category includes people with the following characteristics:

Types of oncology

The main types of malignant skin lesions and their presentation include:

1. Superficial distribution. This type accounts for about 70% of all cases of melanoma skin lesions. Peculiarities:

Symptoms of skin cancer can vary significantly depending on the specific type of tumor you are talking about. Moreover, the symptoms of the initial stage of melanoma, as seen in the photo, can differ very significantly:

Nodular melanoma

The formation of the neoplasm occurs at the epidermal junction, from where it spreads in the vertical direction. Intraepithelial tumor cells are localized in small groups. Basically, the disease affects the male half of humanity.

Creeping, superficial form. The formation has an irregular shape, slightly raised above the epidermis.

Localization of melanocytes can be located in all layers of the epidermis and in the subcutaneous tissue, located singly, in nests or in the form of nodular formations, mainly on the back.

It develops slowly, growing in any direction.

What does melanoma look like? Skin melanoma (the prognosis for life with early diagnosis is favorable) has the appearance of a non-pigmented or pigmented spot. The formation is slightly convex and has an irregular shape. The diameter of melanoma is about 0.6 cm.

The insidiousness of the disease is that it can maintain a smooth and shiny surface for a long time. As the formation progresses, it begins to bleed at the slightest injury and acquire uneven contours.

Sometimes a black outline forms around the spot. Melanoma itself is brown, sometimes dark gray, black, blue or red.

It can form in the form of many small spots unevenly spaced from each other.

Sometimes melanoma looks like several papillomas that resemble a mushroom. Additional foci often form around the malignant tumor, merging with each other into one whole. In medicine they are called “satellites”.

Melanoma of the skin, the symptoms of which are varied, can also manifest itself in the form of ordinary redness, which subsequently turns into an ulcer with multiple growths.

Stages of melanoma - photo

To find out what the initial stage of melanoma looks like and more, we suggest that you familiarize yourself with the photo.

The photo above shows what melanoma looks like at the initial stage of development. At first, it is very difficult to distinguish a malignant neoplasm from a harmless mole.

We have discussed in detail what melanoma is. Let's talk about the stages of its development:

1. First stage. Formation no more than 1-2 mm thick, the surface may or may not be damaged
2. Second. The formation has a size of 2 - 4 mm with a damaged or smooth surface
3. Third: A tumor with a damaged or smooth surface. Foci form next to the mole. Possible spread of metastases to neighboring lymph nodes
4. Fourth: Cancer invades nearby cells. Metastases appear in distant lymph nodes and other organs

The presence of moles and age spots requires a person to regularly monitor their condition. If abnormal changes are detected in the structure of the nevus, you must immediately consult an oncologist.

In oncological practice, two main methods of therapy are used to treat melanoma in the early stages:

1. A surgical operation during which all cancerous tissue is removed.
2. A complex technique including surgery and radiation therapy. The combination of surgical excision of the tumor and radiological techniques gives the most favorable results and chances of survival from cancer. Radiation exposure through the use of highly active x-ray radiation allows you to destroy possible cancer cells in the lymph nodes.

Radiological treatment is used in the form of external beam irradiation of the tumor before surgery. This is necessary to stabilize the malignant process and prevent relapse of the disease.

Stage melanoma – photo:

In oncological practice, malignant tumors are divided depending on the volume of pathological tissues, the extent of the process and the presence of metastatic lesions.

The tumor size does not exceed 2 mm and there are no metastases in the regional lymph nodes.

Melanoma is more than 2 mm in diameter and is also absent secondary lesions defeats.

A typical manifestation of this stage is metastases in the lymph nodes.

A cancer tumor metastasizes to distant organs and systems.

By clinical picture Melanoma is classified as follows:

• Surface spreading form:

The fundamental method of anticancer therapy is surgery. Even with the formation of single metastases in regional lymph nodes, surgeons recommend excising both the focus of the mutation and the secondary cancerous tumor.

Photo of early stage melanoma:

Radiation therapy and chemotherapy are used to diagnose metastases in distant organs.

• Treatment of the first and second stages of melanoma:

It consists of radical excision of the tumor and part of nearby healthy tissue, which has a favorable effect on long-term treatment results.

• Therapy for the third stage of damage:

Implies except surgery radiological impact on regional The lymph nodes. Radiation irradiation causes the death of metastatic elements of the tumor.

It consists of a complex effect on the tumor using surgery, radiology and chemotherapy. Despite the extensive medical measures, melanoma at the fourth stage of malignant growth has an unfavorable prognosis of the disease and the average life expectancy of such cancer patients does not exceed six months from the final diagnosis.

NOTE: Melanoma is the initial stage. Description, photo

The photographs below show various types of age spots with the presence of melanoma formed at an early stage. Let’s take a closer look at how you can discern the disease during a self-examination.

The disease has 5 stages, where zero stage the easiest. Cancer cells are still present only at the cellular level. Sprouting deeper malignant tumor hasn't happened yet.

Stage I has a tumor formation no more than 1-2 mm in thickness, above the skin level. There may be ulceration, but this is not necessary. The lymph nodes located next to the affected area of ​​the skin are not subject to negative effects from the tumor.

Stage II has tumor formations from 2 mm thick and characteristic lesions. There are no distant or regional metastases.

At stage III, pathological changes in the skin appear, and a nearby lymph node is affected by cancer cells. Sometimes at this stage, melanoma cells spread further through the lymph system.

Stage IV always has cancer cells in the lymph system and the disease has already spread to other areas of the skin, organs and tissues of the body. Lethal outcome in 100% of cases.

Practice shows that relapses occur even with properly selected treatment; in addition, the disease returns not only to the places where it was before, but also to those areas of tissue that were not exposed to melanoma.

Signs of imminent danger

The Cancer Institute uses the international designations ABCDE to describe skin cancers. The symbols indicate the main conditions by which the sign of the “ugly duckling” (modified lesion) is determined:

• A (asymmetry). The person should carefully examine each pigmented (dark) area. The sign is based on identifying a discrepancy between the two halves of one birthmark;
• B (from English - border): if the edges of any darkening of the epidermis are uneven, seemingly torn, jagged, this indicates a malignant transformation;
• C (color) is another warning sign. A person must find out whether the pigment spot is different in color or includes several colors at the same time;
• D (diameter): melanoma is usually larger than the size of a pencil eraser, i.e. greater than 6 mm. But sometimes, upon initial detection, the size of the tumor is insignificant;
• E (evolution): any education requires careful monitoring of changes, including the identification of any of the described signs.

Important to know: Melanoma is the initial stage. PHOTO, description

Other signs of melanoma

Some cancer processes do not comply with the rules, so you need to carefully evaluate the following conditions:

• long-term painful sensations;
• wounds and ulcers on the skin that do not heal for a long time;
• spread of pigmentation beyond the boundaries of the original spot to the surrounding tissue;
• redness of the integument and severe swelling;
• surface change: roughness, purulent discharge, the appearance of compaction;
• the presence of a large brown spot with dark specks.

The first signs of the disease are asymmetry and ulceration of the mole. If your mole does not consist of equal halves in size, this may mean that this mole may well be melanoma

If you see that small papillomatous elements with foci of necrosis have formed at the base of the mole, this could be skin cancer. Symptoms of the disease:

• tension at the base of the nevus;
• burning;
• tingling;
• bleeding;
• presence of cracks;
• ulcerations.

Above is another photo of what melanoma looks like at an early stage. You can see that the edges of the pigment spot are blurred, and an inflammatory halo may appear around it. The nevus itself is asymmetrical and has inclusions of a different color.

Melanoma symptoms

Common moles have the following characteristics:

• they can vary in color from light to brown and black. They are also prone to discoloration, but always consist of only one shade;
• the difference is in appearance and shape: from flat and small to convex, from oval to round;
• clear boundaries and small diameter.

When pigmentation does not meet the described characteristics, you should definitely consult a dermatologist.

Important aspects:

An experienced specialist can immediately distinguish malignancy from an ordinary mole according to some basic characteristics:

• Asymmetrical form of education. Melanoma usually has sharp, irregular edges. Sometimes it looks like an asterisk.
• Unhealthy color. The color of melanoma is usually quite different from the color of a regular mole. It is dominated by black, gray, bluish, red shades. A special prevention of the disease is daily inspection of birthmarks on the skin. If they have changed their usual color, you should immediately contact a specialist.
• Size changes. Melanoma grows quite quickly. Its diameter is usually at least 6 millimeters. However, you should know that the disease can develop even from a millimeter mole.
• Bleeding or wetting of the neoplasm also indicates an irreversible process occurring in the skin cells.
• Secondary signs are: general malaise, rapid weight loss, blurred vision, aches and bone pain.

Often the initial stage of the disease may occur without any specific symptoms. At first, melanoma is a rapidly growing birthmark-like formation that rises slightly above the surface of the skin.

Then it takes on the appearance of an exophilic tumor and can be expressed.

The initial stage of development of the disease can be recognized by three main features:

1. Shiny surface.
2. Dark color.
3. Tendency to decay.

The most common locations for melanoma are the face, neck, back and extremities.

Manifests:

• itching, soreness and loss of hair in the area of ​​the mole;
• change in pigmentation color;
• intensive growth of the nevus and the appearance of nodular formations on or near the mole;
• nevus bleeding when damaged and changes in pigmentation around age spots;
• changes in shapes and outlines;
• ulcerative manifestations on the surface of the nevus;
• the appearance of compactions of the mole and nearby lymph nodes;
• structural changes in the surface of the nevus;
• the presence of asymmetry in the surface layer of the mole;
• focal pigmentation around the perimeter of the mole;

The symptoms of melanoma in the initial stage may be minor, but even they are significant reason for immediate medical examination.

To recognize the disease at an early stage of development, you should learn everything about the primary signs:

Skin melanoma is formed from a mole (nevus) in 70% of cases and is located in the torso, limbs, head and cervical region. In women, as a rule, the lower limbs and chest are affected, and in men - the chest and back.

In addition, men are prone to epidermal nevus. The lesion occurs on the palms, soles and scrotum.

The skin changes its color, the structure appears and the area bleeds. These are the defining and most important signs in making a preliminary diagnosis.

Melanoma is black, sometimes with a blue tint, and looks like a nodule. There are non-pigmented melanomas, in which there is no specific color, and they are painted with a pink tint.

The size varies from 0.5 cm to 3 cm.

The affected surface may bleed and have a compacted structure. Using a magnifying glass during examination, you can make a preliminary diagnosis.

It is very difficult to identify this disease in the early stages. Stage I cancer may not attract attention. To determine the disease, the doctor must have extensive experience working with similar diseases.

Let's look at the most common types of melanomas in more detail. We will talk about superficially widespread, nodular (nodular), malignant lentigo.

Lentigo maligna has a long horizontal growth phase, which can last up to 20 years or more. In old age, the disease develops against the background of pigmentation on the neck and face.

Superficially widespread melanoma occurs in people with an average age of 44 years. Formation appears both on closed areas of the skin and on open ones.

The upper back is most often affected in men, while in women the lower extremities are affected. When formed, the plaque acquires a chaotic contour, in some places it becomes discolored and the color appears mosaic-like; the epidermis undergoes changes and thickens significantly.

After a few years, a node appears on the plaque, then the melanoma grows vertically.

Nodular melanoma is the most aggressive among other types. Average age is 53 years old.

It occurs slightly more often in men than in women. The upper and lower extremities are affected, cervical region, head and back.

The node forms quickly, the skin undergoes changes, reaches the peak of development in a few months and already has bleeding.

Melanoma tissue damage occurs not only on the skin, but also on visual organ, eye. The first symptoms include the appearance of a tumor, rapid deterioration of vision, the appearance of photopsia and progressive scotoma.

Photopsia is accompanied by the appearance of sparks, dots, spots in the field of view. There are two types of scotoma:

1. Positive scotoma (a blind area appears in the field of vision, which is perceived by a person as a black spot);

Diagnostic methods

The basis successful treatment melanoma is the correct diagnosis of this disease. If melanoma is suspected, doctors should conduct special examination and tests that allow a patient to be diagnosed with melanoma, distinguishing it from non-melanoma malignancies or other skin diseases.

Diagnostic methods used:

• CT scan;
• X-rays of light;
• position emission tomography;
• Ultrasound, blood test.

In order to prescribe adequate therapy, you must first make an appointment with an oncologist. Even after looking at the photo and finding out what melanoma looks like at the initial stage, it is impossible to accurately diagnose without the help of doctors. In addition to a visual examination, the doctor will prescribe a number of additional tests and studies that will help determine:

• type of pathology;
• number and size of lesions;
• the presence or absence of metastases in the internal skin structures and organs.

Despite the fact that most of the affected areas are in the public domain for medical examination, additional research is needed to make a final diagnosis.

Some patients think that they are prescribed so many procedures just to get more money, but this is not true at all. It is on the basis of the results obtained that the oncologist can make an informed decision regarding further therapy.

High-tech equipment allows doctors to study in detail the affected area and the general well-being of the patient in order to determine the optimal treatment option for him in the future.

The main examinations for patients with this diagnosis include a general and extensive blood test, biopsy, ultrasound, positron emission tomography, radiography and MRI.

Order a cost estimate for treatment in Israel

At the initial stage in mandatory Dermatoscopy is performed using special apparatus, enlarging the image. Using a dermatoscope, the doctor is able to examine in detail the skin under the keratinized particles - thanks to this method, the list of necessary instrumental studies can be significantly reduced.

In addition, a cytological analysis of a smear taken from the patient and a blood test for the presence of tumor markers are performed. Large oncology centers have their own laboratory, which allows them to obtain results in the shortest possible time.

However, it is possible to say for sure whether a person has skin cancer only after taking a biopsy. Histological examination is performed exclusively after the surgeon removes the neoplasm and nearby affected tissue.

Before surgery, the collection of biomaterial is contraindicated, since any impact can provoke active growth and transformation of the tumor, as well as activate the process of spread of infected cells throughout the body.

As for the treatment of skin cancer, the first stage is treated with surgical intervention(extraction of affected areas), radiotherapy, or a combination of these two methods.

By contacting doctors in a timely manner, patients have every chance of returning to normal life for a short period of time.

1. 1) First stage diagnostics consists of a visual examination of the patient’s skin to identify pathological manifestations on the skin - dermatoscopy using magnifying optics.
2. 2) The use of excisional biopsy is used to take a tissue sample directly from the tumor site.
3. 3) Incisional biopsy is used to collect material for histological studies.
4. 4) Computer and isotope scanning, magnetic resonance and positron emission tomography diagnose possible lesions in internal organs.
5. 5) Using confocal microscopy based on infrared radiation, all skin layers are examined to determine the depth of the lesion and the stage of tumor development.

The easiest way for a doctor to diagnose the initial stage of nodular melanoma shown in the photo above. In this case, 15 minutes is enough to make a diagnosis.

At unclear picture The subject is prescribed an ultrasound of the lymph nodes. If there is an ulceration on the surface, a cytological examination is performed. When the initial stage of melanoma is confirmed, as in the photo, treatment is prescribed.

As already noted, the success of therapy depends very much on the degree at which the disease is diagnosed. Having noticed the first signs, as described above, you should immediately contact an oncologist for professional diagnosis.

The oncologist examines the formation first visually, and then using a flaw detector (or dermatoscope) with high magnification and illumination. There is also more modern equipment - a digital flaw detector, with which you can get a three-dimensional picture of a suspicious formation.

If necessary, a biopsy is performed or part of the tumor is removed for histological analysis. This method is considered very accurate, but leads to mechanical damage nevus, which can cause cancer even if there was none before the biopsy.

A number of manipulations help diagnose melanoma. The doctor uses a special magnifying glass. Radioisotope testing helps make a diagnosis. Thanks to it, you can see a large amount of phosphorus in the tumor, which means that the tumor is malignant.

If skin cancer is suspected, a puncture or biopsy is used, but not for melanoma. The fact is that any damage to the skin can make the situation worse.

Cytological examination helps to make a final diagnosis. An imprint is taken from the surface of the formation along with the lesion.

A detailed conversation with the patient helps in diagnosing melanoma. It is necessary to pay attention to the symptoms that appear in the patient.

Weight loss, deterioration of visual acuity, joint pain, headache and general malaise are common. X-ray, CT and ultrasound help to accurately determine the presence or absence of metastases on a person’s internal organs.

Treatment plan

If the examination shows the malignant nature of the formation, excision of the mole and the affected skin around it is performed. Unfortunately, this method is not always effective.

Treatment of melanoma is very difficult due to its early decay and metastasis. A patient with a similar diagnosis should be hospitalized for long term, the entire treatment process must take place under strict medical supervision.

Getting rid of the disease is possible only through surgery and only at its initial stage. Practice shows that the use of postoperative chemotherapy usually does not produce positive results.

In addition, if melanoma appears once and is successfully removed, there is a high probability of its occurrence in the future.

The main criterion when drawing up a treatment plan for melanoma is determining the stage of development of the pathology.

The treatment regimen depends on many factors, not least the location of the tumor. Thus, the treatment of subungual melanoma, which is rarely seen in photographs in the initial stage, will in most cases differ from the treatment of skin cancer.

The main method is based on surgery. It is used at all stages of oncology.

The purpose of the operation is to remove the melanoma while affecting healthy areas of the skin. The intervention is carried out under general anesthesia, since with local treatment there is a possibility of cancer cells spreading to healthy areas of the skin.

After melanoma is eliminated, noticeable defects remain on the body. They can be successfully eliminated using modern techniques- plastic surgery, skin grafting, autotransplantation

In some cases, removal of a nearby lymph node is required. Many studies have proven that this manipulation increases the chances of recovery. However, a biopsy should be performed to detect the presence of cancer cells in the lymph node.

Treatment of skin oncology with drugs is also effective in many situations.

IN in this case Several effective methods are used:

• immunotherapy (“Interferon-alpha”, “Ipilimumab”, “Reaferon”);
• chemotherapy - drugs are used that suppress the proliferation of cancer cells (Dacarbazine, Fotemustine, Vincristine, Carmustine);
• hormonal therapy.

Treatment methods can be used separately or in combination with each other.

In addition, the doctor sometimes decides to carry out radiation, which promotes the breakdown of cancer cells. As a result, they stop reproducing or die altogether. However, this method is not always justified, because healthy cells are also affected along with cancer cells.

Treatment of melanoma folk remedies is carried out only after its removal and consultation with a doctor. Self-therapy of the disease at any stage is excluded

When diagnosing standard method Treatment is removal by surgical excision. As a rule, simultaneously with the tumor, the skin within a radius of 2-5 cm is removed to prevent relapses.

After excision, the removed area is necessarily sent for histology to understand whether the tumor was only in the superficial layer of the skin or has grown more deeply.

In some cases, after removal surgery, the patient undergoes radiotherapy to the site where the formation was. This is required to destroy possible remnants of cancer cells, which are destroyed using radioactive irradiation.

If detected and removed promptly, the five-year survival rate reaches 85%, which effectively means full recovery. When the disease drags on, this figure is no more than 20%.

We hope that the photographs of the first signs of skin cancer given in this article will help you recognize the disease in time and help you maintain your health.

http://103med.ru/stati/onkologiya/foto-melanomy-nachalnoj-stadii

The disease is treated in two ways: surgery and combination treatment. With combined treatment, the tumor is removed after radiation.

Combined treatment occurs in two stages. Close-focus X-ray exposure is used in the first stage.

The radiation reaction occurs 2 or 3 days after exposure to the tumor. Therefore, the operation is carried out before or after this moment.

The malignant tumor is removed with a sufficient amount of healthy tissue around it. To return your skin to its normal appearance, you need to perform plastic surgery, because a wound defect accompanies this type of procedure.

A patient facing malignant melanoma must have regional lymph nodes removed, even if the disease is not detected in them, because melanoma tends to spread metastases to nearby lymph nodes.

Such caution affects the prognosis of the disease and gives a chance for a favorable outcome. Enlarged lymph nodes indicate possible metastasis to them.

The combined treatment method involves irradiating them with gamma therapy, after which the necessary lymph nodes are removed through surgery.

Recent years have been similar combined methods anti-cancer treatments are used quite often, which indicates the positive effect of the combination of these procedures.

Prevention of melanomas

To reduce the risk of developing skin melanoma, it is advisable to:

1. Avoid aggressive sun rays between 10:00 a.m. and 4:00 p.m. Moreover, you need to know that ultraviolet radiation accumulates in the body over time, causing damage in the form of pigmented spots on the skin. And in many cases they provoke cancer.
2. When going out in the sun, it is imperative to apply sunscreen with an SPF factor of at least 15 to exposed skin areas, and in the summer use waterproof protective creams with an SPF factor of 30.
3. Wear quality Sunglasses, blocking two types of radiation - UVA and UVB.
4. Wear light clothing that tightly covers the body, as well as wide-brimmed hats.
5. Avoid going to the solarium.

Early detection of signs and symptoms of melanoma has great importance for favorable treatment results, therefore, every person should regularly self-diagnose their skin condition at home, and also visit a dermatologist without fail.

It must be remembered that photos of early and subsequent stages of melanoma are the result of receiving excessive doses of ultraviolet radiation. Protect yourself from ultraviolet radiation, and the risk of acquiring melanoma will be minimal.

To prevent malignant degeneration of moles and nevi, doctors recommend timely surgical intervention for acute injury pigment spot. Also, moles whose localization makes them more traumatic are subject to excision.

In addition, people of all age categories It is not recommended to be exposed to ultraviolet rays for a long time, or to be subjected to numerous sunburns.

It is extremely important to remember that only early diagnosis and complex therapy able to ensure complete recovery.

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A malignant tumor resulting from atypical degeneration and proliferation of pigment cells (melanocytes). It most often affects the skin, but can also occur on mucous membranes. Characterized by the rapid spread of tumor cells throughout the body. Melanoma is diagnosed by examining a smear-imprint made from its surface. Histological confirmation of the diagnosis is made after removal of the formation. Treatment depends on the stage of melanoma and may consist of surgical excision of the formation, removal of lymph nodes, immunotherapy, radiation therapy and chemotherapy.

When examining a formation, its edges, density, and displacement relative to surrounding tissues are assessed. Dermatoscopy of the formation and surrounding skin is performed. To identify melanoma metastases, other areas of the skin, as well as regional lymph nodes, are examined. It is possible to conduct radioisotope research. The patient takes the radiotherapy drug on an empty stomach. Then, using radiometry, the accumulation of the isotope in the area of ​​formation and on a healthy area of ​​the skin is assessed.

In diagnosing melanoma, a biopsy of a skin lesion is strictly not used, since it can cause tumor growth and metastasis. The main diagnostic method is the detection of atypical melanocytes during cytological examination a smear-imprint taken from the surface of the formation. However final diagnosis melanoma can be diagnosed only after histological examination removed tumor.

Treatment of melanoma

The choice of treatment for melanoma depends on the phase of its development, the extent of the process and the presence of metastasis. If treatment is started in the horizontal growth phase of melanoma, then surgical excision within healthy tissue is sufficient. If deep tumor invasion is detected, surgical treatment is combined with alpha-interferon immunochemotherapy to prevent relapse. Metastasis of melanoma to regional lymph nodes is an indication for their removal.

Detection of several melanomas requires removal of all of them and additional chemotherapy, irradiation of the affected areas of the skin, or a combination of these methods with immunotherapy. Patients with distant metastases of melanoma undergo palliative treatment: excision of large tumor foci that cause severe discomfort to the patient. In some cases, it is possible to perform operations to remove metastases from internal organs. Radiation and chemotherapy are also performed.

Melanoma prognosis and prevention

Unfortunately, even with modern level With the development of medicine, every third case of melanoma ends in rapid death. Approximately half of patients fail to live longer than 5 years.

Prevention of melanoma consists of avoiding exposure to provoking factors and oncological vigilance for existing pigmented nevi. People with fair skin, especially owners of phototypes I and II, need to avoid excessive insolation and sunburn. Important has limited exposure to ultraviolet rays on those areas of the skin where pigmented nevi are located. If sudden changes in the size, color or consistency of the nevus occur, you should consult a dermatologist or oncologist. Timely diagnosis and surgical excision of melanoma-dangerous skin formations and frequently injured nevi prevents their transformation into melanoma.

Which develops from pigment cells (melanocytes) that produce melanin (a natural pigment or dye that determines the color of the skin, hair and eyes).

Statistics

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

It is noteworthy that of all skin cancers, only 4% are melanoma, but in 73% of cases it is quickly fatal. Therefore, melanoma is called the “queen” of tumors.

By location, melanoma in 50% of cases occurs on the legs, 10-15% on the arms, 20-30% on the torso, 15-20% on the face and neck. Moreover, in 50-80% of patients, melanoma forms at the site of moles.

In 86% of cases, the development of melanoma is associated with exposure to ultraviolet radiation (sun or tanning beds). Moreover, the risk of melanoma is 75% higher in people who began tanning in a solarium before the age of 35.

• In 1960, Peruvian Incas mummies were examined and found to have signs of melanoma. Using radiocarbon dating (used to determine the age of biological remains), it was proven that the age of the mummies was about 2400 years.
• The first mention of melanoma is found in the works of John Hunter (Scottish surgeon). But not knowing what he was dealing with, in 1787 he described melanoma as “cancerous fungal growths.”
• However, it was not until 1804 that Rene Laennec (a French physician and anatomist) defined and described melanoma as a disease.
• American scientists have developed an interesting and unique technique for identifying melanoma tumor cells. Researchers say that under the influence laser radiation melanoma cells emit ultrasonic vibrations, which allows them to be detected in the blood long before they take root in other organs and systems.

Skin structure

• Epidermis- the outer layer of the skin, which has five rows of cells: basal (lower), spinous, granular, shiny and horny. Normally, melanocytes are found only in the epidermis.
• Dermis- the skin itself, consisting of two words: reticular and papillary. They contain nerve endings, lymphatic and blood vessels, hair follicles.
• Subcutaneous fat consists of connective tissue and fat cells, which are penetrated by blood and lymphatic vessels, as well as nerve endings.

What are melanocytes?

However, melanocytes are also located in the iris (contains pigment cells that determine eye color), the brain (substantia nigra) and in the internal organs.

Melanocytes have processes that allow them to move through the epidermis. Also, through the processes, the coloring pymentum is transmitted to other cells of the epidermis - this is how color is imparted to the skin and hair. Whereas when melanocytes degenerate into cancer cells, the processes disappear.

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

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

The value of melanin for humans

• Determines the color of eyes, nipples, hair and skin, which depends on the distribution and combination different types pigments.
• Absorbs ultraviolet rays(UV rays) protecting the body from their harmful influences. Moreover, under the influence of UV rays, the production of melanin increases - a protective reaction. Externally it appears as a tan.
• Acts as an antioxidant. What's happening? Free radicals(formed under the influence of UV rays) - unstable molecules that take the missing electron from full-fledged cell molecules, which then themselves become unstable - a chain reaction. Whereas melanin gives the unstable molecule the missing electron (the smallest particle), breaking the chain reaction.

Ultraviolet radiation reaching the earth's surface is divided into two main types:

• UVB rays are short waves that penetrate the skin shallowly and therefore cause sunburn. In the distant future, they can lead to the development of skin cancer.
• UVA rays are long waves that can penetrate deeply into the skin without causing burns or pain. Therefore, a person, without experiencing pain, can receive a high dose of radiation that exceeds the skin's natural protective ability to tan. Whereas it is UVA rays that are to blame for the development of melanoma, since in large doses they damage pigment cells.

Causes and risk factors for melanoma

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

Moreover, melanoma can develop in any person, regardless of skin color and race. However, some people are more susceptible to developing this disease.

Risk factors

Mechanism of melanoma formation

What's happening?

UV rays cause “breakage” in the DNA molecule of the melanocyte, so it mutates and begins to multiply intensively.

However, in The protective mechanism works normally: MC1R protein is present in melanocytes. It promotes the production of melanin by pigment cells, and is also involved in the restoration of the DNA molecule of melanocytes damaged by UV rays.

How does melanoma form?

U bright people there is a genetic defect in the MC1R protein. Therefore, pigment cells do not produce enough melanin.

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

However, the question arises: why can melanoma develop in areas that have never been exposed to UV rays?

Scientists have given an answer: it turns out that melanocytes have a very limited ability to repair damaged DNA by any factor. Therefore, they are often susceptible to mutation even without exposure to UV rays.

Stages of skin melanoma

However, to make it easier to understand the stages of skin melanoma, they use the systematization of two American pathologists:

• According to Clark, it is based on the penetration of the tumor into the layers of the skin
• According to Breslow - when the thickness of the tumor is measured

Types of melanomas

However, melanocytes are also present in other organs. Therefore, the tumor can also affect them: eyes, brain and spinal cord, rectum, mucous membranes, liver, adrenal tissue.

Clinical forms of melanoma

There are two phases during the course of melanoma:

• Radial growth: Melanoma grows on the surface of the skin, spreading horizontally
• Vertical growth: the tumor grows into the deeper layers of the skin

There are five most common types of skin melanoma.

Signs of skin melanoma

They differ depending on the shape of the tumor and stage of development.

Superficial spreading melanoma

Metastases occur in 35-75% of cases, so the prognosis is not very favorable.

What's happening?

In the radial growth phase on the skin there is a slightly raised pigment formation up to 1 cm in size, which has an irregular shape and unclear edges. Its color can be brown, black or blue (depending on the layer of skin in which the pigment is located), and sometimes black or grayish-pink dots (blotches) appear on it.

As the pigment formation grows, it thickens, turning into a black plaque with a shiny surface, and a clearing area appears in the middle of it (the pigment disappears).

In the vertical growth phase the plaque turns into a knot, the skin of which becomes thinner. Therefore, even with minor trauma (for example, friction with clothing), the node begins to bleed. Next, ulcers appear on the node, from which a bloody discharge appears (yellow liquid, sometimes containing an admixture of blood).

Nodular melanoma

What's happening?

There is no horizontal growth stage, and in the vertical growth phase, the skin of the node becomes thinner, so even a slight injury leads to bleeding. Subsequently, ulcers form on the node, from which a yellowish liquid is released, sometimes mixed with blood (ichor).

The node itself has a dark brown or black color, and often a bluish tint. However, sometimes there is no pigment in the tumor node, so it can be pink or bright red.

Lentiginous melanoma (Hutchinson's freckle, lentigo maligna)

Melanoma is mainly located in areas of the skin that are constantly exposed to sunlight (face, neck, ears, brushes).

The development of melanoma is long: it can take from 2-3 to 20-30 years. And as it grows, the pigment formation can reach 10 cm or more in diameter.

Moreover, metastases in this form of melanoma develop late. In addition, with the timely activation of immune defense mechanisms, it can partially resolve spontaneously. Therefore, lentiginous melanoma is considered the most favorable form.

What's happening?

In the radial phase the boundaries of the dark brown formation become blurred and uneven, resembling a geographical map. At the same time, black inclusions appear on its surface.

In vertical phase against the background of the spot, a node appears that can bleed or secrete serous fluid. The node itself is sometimes discolored, and crusts form on its surface.

Acral lentiginous melanoma

The disease develops rapidly, and metastases spread quickly. That's why
the prognosis is unfavorable.

What's happening?

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

In vertical phase Often ulcers appear on the surface of the tumor, and the tumor itself takes on the appearance of mushroom-shaped growths.

With subungual melanoma, the nail is destroyed, and bloody discharge appears from underneath it.

Amelanotic melanoma

That's why amelanoma represents the formation of a bodily or Pink colour. It can be a type of nodular melanoma or the result of metastasis of any form of melanoma to the skin.

Melanoma of the eye

Symptoms depend on the location of the lesion: iris (contains pigment cells that determine eye color), conjunctiva, lacrimal sac, eyelids.

However, there are signs that should alert you:

• One or more spots appear on the iris of the eye
• Visual acuity does not suffer for a long time, but gradually it worsens on the side of the diseased eye
• Over time, peripheral vision decreases (objects located to the side are difficult to see)
• Flashes, spots or glare appear in the eyes
• Initially, there is pain in the affected eye (due to increased eye pressure), then they subside - a sign of the tumor spreading beyond the eyeball
• On eyeball redness (inflammation) occurs and blood vessels become visible
• A dark spot may appear on the white of the eyeball

How does melanoma manifest?

In addition, changes are present both at the site of melanoma origin (the primary focus) and in other organs - with the spread of metastases.

Moreover, sometimes the primary tumor with the appearance of metastases either stops growing or undergoes reverse development. In this case, the diagnosis itself is made only after damage to other organs by metastases. Therefore, it is necessary to know about the manifestations of melanoma.

Melanoma symptoms

1. Itching, burning and tingling in the area of ​​pigment formation is due to increased cell division within it.
2. Hair loss from the surface of the nevus caused by the degeneration of melanocytes into tumor cells and the destruction of hair follicles.
3. Color change:
   • Increased or appearance of darker areas on pigment formation is due to the fact that the melanocyte, degenerating into a tumor cell, loses its processes. Therefore, the pigment, unable to leave the cell, accumulates.
   • Enlightenment due to the fact that the pigment cell loses its ability to produce melanin.
   Moreover, the pigment formation changes color unevenly: it becomes lighter or darker at one edge, and sometimes in the middle.
4. Increase in size speaks of increased cell division within the pigment formation.
5. The appearance of ulcers and/or cracks, bleeding or moisture is caused by because the tumor destroys normal skin cells. Therefore, the top layer bursts, exposing the lower layers of skin. As a result, at the slightest injury, the tumor “explodes” and its contents pour out. In this case, cancer cells enter healthy skin, penetrating into it.
6. The appearance of “daughter” moles or “satellites” near the main pigment formation- a sign of local metastasis of tumor cells.
7. Uneven edges and thickening of the mole- a sign of increased division of tumor cells, as well as their germination into healthy skin.
8. Disappearance of skin pattern is caused by the tumor destroying the normal skin cells that form the skin's pattern.
9. The appearance of redness around the pigment formation in the form of a corolla - inflammation, indicating that the immune system recognized tumor cells. Therefore, she sent special substances (interleukins, interferons and others) to the tumor site, which are designed to fight cancer cells.
10. Signs of eye damage: dark spots appear on the iris of the eye, visual disturbances and signs of inflammation (redness), there is pain in the affected eye.

Diagnosis of melanomas

• Examination by a doctor (oncologist or dermatologist)
• Study of pigment formation using optical instruments without damaging the skin
• Sampling from a suspicious area of ​​tissue, followed by its examination under a microscope

Examination by a doctor

There are criteria by which a benign tumor can be preliminarily distinguished from melanoma. Moreover, knowing them, everyone can check their skin on their own.

What are the signs of malignant transformation?

Asymmetry- when the pigment formation is asymmetrical. That is, if you draw an imaginary line through its middle, both halves are different. And when a mole is benign, then both halves are the same.

Border. In melanoma, the edges of the pigment formation or mole have an irregular and sometimes jagged shape. Whereas benign formations edges are clear.

Color moles or formations that degenerate into a malignant tumor are heterogeneous, having several different shades. Whereas normal moles are one color but may include lighter or darker shades of the same color.

Diameter for a normal mole or birthmark - about 6 mm (the size of an eraser at the end of a pencil). All other moles must be examined by a doctor. If no deviations from the norm are noted, such formations should be monitored in the future by regularly visiting a doctor.

Changes the number, boundaries and symmetry of birthmarks or moles is a sign of their degeneration into melanoma.

On a note

Melanoma does not always differ from a normal mole or birthmark in all of these ways. Just one change is enough to see a doctor.

If the oncologist finds the formation suspicious, he will conduct the necessary studies.

When is a biopsy and microscopy of a pigment formation needed?

To distinguish dangerous pigmented formations on the skin from non-dangerous ones, three main research methods are used: dermatoscopy, confocal microscopy and biopsy (sampling a piece of tissue from the lesion followed by examination under a microscope).

Dermatoscopy

For this, a special instrument is used - a dermatoscope, which makes the stratum corneum of the epidermis transparent and gives a 10-fold magnification. Therefore, the doctor can carefully consider the symmetry, boundaries and heterogeneity of the pigment formation.

There are no contraindications to the procedure. However, its use is not informative in non-pigmented and nodular melanomas. Therefore, more thorough research is needed.

Confocal laser scanning microscopy (CLSM)

According to statistics, the diagnosis in 88-97% of early stages of melanoma using CLSM is made correctly.

Methodology

A series of optical sections (photographs) are taken in vertical and horizontal planes using a special installation. Then they are transferred to a computer, where they are already examined in a three-dimensional image (in 3D - when the image is transmitted in full). In this way, the condition of the layers of the skin and its cells, as well as blood vessels, is assessed.

Indications for testing

• Primary diagnosis of skin tumors: melanoma, squamous cell carcinoma and others.
• Detection of melanoma recurrence after removal. Because due to lack of pigment, the initial changes are minor.
• Dynamic monitoring of precancerous skin diseases (for example, Dubreuil's melanosis).
• Examination of facial skin when unaesthetic spots appear.

However, if we are talking about melanoma, then the final diagnosis is made only on the basis of examining a tissue sample from the lesion.

Biopsy

However, the procedure carries certain risks. Because if you incorrectly “disturb” melanoma, you can provoke its rapid growth and spread of metastases. Therefore, tissue collection from the site of the suspected tumor is carried out with precautions.

Indications for biopsy

• If all possible diagnostic methods used, but the diagnosis remains unclear.
• The pigment formation is located in areas unfavorable for removal (a large tissue defect is formed): hand and foot, head and neck.
• The patient is scheduled to undergo amputation of a leg, arm, and removal of the breast along with regional (nearby) lymph nodes.

• The patient must be fully examined.
• The procedure is carried out as close as possible to the next treatment session (surgery or chemotherapy).
• If the pigment formation has ulcers and weeping erosions, fingerprint smears are taken. To do this, apply several fat-free glass slides (glass plastic on which the taken material will be examined) to the surface of the tumor, trying to obtain several tissue samples from different areas.

Excisional biopsy - removal of the tumor focus

It is performed when the tumor is 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 uses a surgical knife (scalpel) to remove the melanoma, excising the skin to its full depth, including 2-4 mm of healthy skin.

Incisional biopsy - marginal excision

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

Therefore, the most suspicious part of the tumor is removed, including an area of ​​intact skin.

When the diagnosis is confirmed (regardless of the biopsy method), tissue is excised according to the depth of tumor penetration. The operation is performed on the same day or no more than one to two weeks later if the laboratory doctor finds it difficult to provide an urgent answer.

Fine-needle or puncture biopsy (obtaining a tissue sample by puncture) is not performed for primary melanoma. However, it is used when a relapse or the presence of metastases is suspected, and also for examining regional (nearby) lymph nodes.

Biopsy of sentinel lymph nodes

“Sentinel” or regional lymph nodes are located closest to the tumor, becoming a “trap” for cancer cells.

Tumor cells remain in the lymph nodes for some time. However, then, with the flow of lymph and blood, they spread throughout the body (metastases), affecting and disrupting the functioning of vital organs and tissues.

Therefore, to assess the condition and determine further treatment tactics, a tissue sample is taken from the “sentinel” lymph nodes.

Indications for biopsy

• The thickness of melanoma is from 1 to 2 mm.
• Patients over 50 years of age because they have a poor survival prognosis.
• Melanoma located on the head, neck or face because the lymph nodes are close to the tumor. Therefore, the likelihood of cancer cells spreading from the primary site is higher.
• The presence of ulcers and weeping erosions on the surface of melanoma is a sign of tumor growth into the deeper layers of the skin.

Execution method

Around the lymph node, a special dye with a phosphorus isotope is injected into the skin, which moves along lymphatic vessels towards the lymph nodes, accumulating in them. Then, two hours later, lymphoscintigraphy is performed - using a special installation, an image of the lymph node is obtained.

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

Laboratory tests to diagnose melanoma

Laboratory indicators

The content of some factors in venous blood is studied:

• LDH (lactate dehydrogenase)- an enzyme that increases in the presence of melanoma metastases to the liver. However, this figure also increases with myocardial infarction, viral hepatitis and muscle injuries. Because it is found in almost all tissues of the body. Therefore, focusing only on LDH level a valid diagnosis is not made.
• CD44std (melanoma marker)- a receptor located on the surface of skin cells for hyaluronate (a component of the skin that moisturizes it).

  The indicator increases when skin cells are damaged and metastases spread. Therefore, CD44std helps in the early diagnosis of melanoma and provides insight into the further prognosis of the disease.

• Protein S100 present in nervous tissue, liver and muscles. The level of its increase in the blood indicates the number and extent of organs affected by metastases. In approximately 80% of patients with unsuccessful treatment, this indicator is high. Whereas in 95% of patients in whom the treatment is effective, it decreases.
• Fibroblast growth factor (bFGF) increases during the transition of melanoma from the superficial to the vertical growth phase. This indicator is especially high in the last stages of the disease, and therefore indicates a poor prognosis.
• Vascular growth factor (VEGF) speaks of increased growth of blood vessels and melanoma itself. This indicator is high in patients at stages III and IV of the disease, which indicates a poor prognosis of the disease.

Treatment of melanoma

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

When is surgery needed to remove skin melanoma?

The goal is to remove the tumor while capturing healthy tissue to prevent the spread of metastases.

Moreover, at stages I and II of melanoma surgical removal often remains the only method of treatment. However, patients with stage II tumors should be monitored with periodic monitoring of the condition of the “sentinel” lymph nodes.

Rules for removing melanoma

• Under general anesthesia, because local anesthesia there is a risk of tumor cells spreading (needle trauma).
• Careful treatment of healthy tissues.
• Without affecting melanoma to prevent the spread of cancer cells. Therefore, the incision on the torso is made 8 cm away from the edges of the tumor, on the extremities - 5 cm.
• Contact of the tumor with healthy cells is excluded.
• Removal is carried out with the capture of a certain area of ​​healthy tissue (wide excision) to exclude relapse. Moreover, the tumor is removed, capturing not only the surrounding skin, but also subcutaneous tissue, muscles and ligaments.
• The operation is usually performed using a surgical knife or an electric knife.
• Cryodestruction (use of liquid nitrogen) is not recommended. Because with this method it is impossible to determine the thickness of the tumor, and the tissue is not always completely removed. Therefore, cancer cells may remain.
• Before skin surgery dye outline the contours of the proposed cut.

More than 140 years have passed since the first removal of melanoma, but there is still no consensus on the boundaries of excision. Therefore, WHO developed criteria.

Limits of healthy tissue removal according to WHO recommendations

It is considered inappropriate to remove more healthy tissue. Since this does not affect the survival of patients, it does impair tissue restoration after surgery.

However, in practice it is difficult to adhere to such recommendations, so the decision is made by the doctor in each specific case individually.

Much also depends on the location of the tumor itself:

• On the fingers, hands and feet, amputation of fingers or part of a limb is resorted to.
• On the earlobe, it is only possible to remove the lower third of it
• On the face, neck and head, with large melanomas, they cover no more than 2 cm of healthy tissue, regardless of the thickness of the melanoma

Removal of sentinel lymph nodes

However, numerous studies have shown that prophylactic removal of sentinel lymph nodes significantly improves patient survival.

Therefore, it is advisable to perform a biopsy of the “sentinel” node, and if there are cancer cells in it, remove it.

However, unfortunately, sometimes micrometastases remain undetected. Therefore, in certain situations, prophylactic removal of regional lymph nodes is justified. Therefore, the doctor makes an individual decision.

Treatment of melanoma with drugs

• Chemotherapy: Medicines are prescribed that act on rapidly multiplying melanoma cancer cells.
• Immunotherapy: medications are used to improve the functioning of the immune system.
• Hormone therapy(Tamoxifen), which suppresses the proliferation of tumor cells. However, this approach is controversial, although there are cases of achieving remission.

At stages I and II of melanoma, surgical intervention is usually sufficient. However, only if the melanoma was removed correctly and there were no aggravating factors (for example, diseases of the immune system). In addition, immunotherapy is sometimes prescribed for stage II. Therefore, the doctor makes the decision individually in each case.

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

Chemotherapy for melanoma

However, melanoma cells quickly grow and divide, and also rapidly spread throughout the body (metastases). Therefore, there is still no single developed scheme for prescribing chemotherapy drugs for its treatment.

The most commonly used chemotherapy drugs for the treatment of melanoma are:

• Ankylation agents: Cisplastin and Dacarbazine
• Notrosourea derivatives: Fotemustine, Lomustine and Carmustine
• Vinkaalkaloids (herbal products): Vincristine, Vinorelbine

The drugs are prescribed either alone (monotherapy) or in combination, but depending on the stage of melanoma, the presence of metastases and the depth of tumor invasion.

Moreover, Dacarbazine is considered the “gold” standard in the treatment of melanoma, since no other drug has exceeded its effectiveness. As a result, everything combined schemes treatments are based on its intake.

Indications for chemotherapy

• Basic blood parameters are within normal limits: hemoglobin, hematocrit, platelets, granulocytes
• Satisfactory functioning of the kidneys, liver, lungs and heart
• Absence of diseases that may interfere with chemotherapy (for example, chronic renal failure)
• Tumor involvement of sentinel lymph nodes
• Prevention of the spread of metastases
• Supplement to surgical treatment

They are divided into two groups: absolute and relative.

Absolute- when chemotherapy is not performed:

• Chronic diseases of the liver and kidneys with severe dysfunction (chronic renal failure, cirrhosis of the liver)
• Complete disruption of the outflow of bile (blockage biliary tract)
• Availability mental illness in the acute stage
• When it is known that chemotherapy will be ineffective
• Severe underweight (cachexia)

• Autoimmune diseases (eg. rheumatoid arthritis) And immunodeficiency states(eg AIDS)
• Old age
, therefore the risk of developing infectious diseases increases significantly

Depends on the stage of the disease and the method of administration (alone or in combination).

Thus, with monotherapy for advanced melanoma (lytic lesions or the presence of metastases), the effectiveness (complete regression for 3 or more years) does not exceed 20-25%. With combined use according to different authors overall efficiency ranges from 16 to 55%.

Melanoma immunotherapy

As a result, primary melanoma can regress (grow back) on its own. In this case, pronounced redness appears around the tumor ( immune cells fight cancer), and then vitiligo (an area of ​​clearing of the skin) appears at the site of the tumor.

Therefore, immunological drugs are used to treat melanomas: Interferon-alpha, Interleukin-2, Reaferon, Ipilimumab (the latest generation drug).

Moreover, they can be used either alone or in combination with chemotherapy. Since their administration, even in late stages, improves the prognosis of the disease by 15-20%. In addition, positive results are observed in patients who have previously received chemotherapy.

The effectiveness of immunotherapy

If a positive result from immunotherapy is achieved, then there is a high chance of a good prognosis.

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

However, it should be remembered that the use of immunopreparatives causes the development of a large number of complications: toxic effects on the liver and kidneys, the development of sepsis (spread of infection throughout the body) and others.

New treatments for melanoma

IN Israeli clinics Bleomycin (antibiotic) is used. It is injected directly into tumor cells using electricity - electrochemotherapy.

According to Israeli scientists, this method of treating melanoma quickly achieves a good effect. However, time will tell how effective its long-term results will be (duration of remission, occurrence of relapses).

Radiation for melanoma

Moreover, cancer cells are more sensitive to ionizing radiation because they divide faster than healthy cells of the body.

However, ionizing radiation is not used “by eye”, since healthy cells are also damaged. Therefore, it is important to focus the beam, directing it to the tumor with millimeter precision. Only modern devices can cope with such a task.

Methodology

Special installations are used that emit electron beams or X-rays with great energy.

At first, the device makes it simple X-ray, which is displayed on the monitor screen. Then the doctor, using a manipulator, marks the tumor, indicating its boundaries and sets the radiation dose.

• Moves the patient
• Rotates the emitting head
• Adjusts the collimator curtains (a device for producing ionizing radiation) so that the tumor is in the crosshairs

Indications

• Recurrence of melanoma for irradiation of metastases
• Treatment of melanoma located in areas where it is difficult to excise the tumor (for example, the skin of the eyelid or nose)
• Treatment of eye melanoma with damage to the iris and protein membrane
• After surgery to remove lymph nodes to prevent recurrence of melanoma
• Pain relief from metastases to the brain and/or bone marrow

• Autoimmune diseases: systemic lupus erythematosus, psoriatic arthritis and others
• Severe underweight (cachexia)
• Platelets and leukocytes in the blood are sharply reduced
• Serious illnesses kidneys, liver and lungs, accompanied by insufficiency of their work (cirrhosis, renal failure and others)

• General weakness, increased irritability, headache
• Increased dryness in the mouth and skin, nausea, belching, loose stools
• Marked decrease in blood leukocytes and hemoglobin
• When irradiating the head and neck area - hair loss

Skin melanoma cells are insensitive to normal doses of radioactive radiation. That's why for a long time Radiation therapy has not been used to treat melanoma.

However, it has now been proven that the use of high doses of ionizing radiation improves the prognosis of melanoma.

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

Whereas when radiation therapy is combined with chemotherapy, the overall effectiveness approaches 60-80% (depending on the stage of melanoma).

When treating the initial stages of eye melanoma (tumor thickness - up to 1.5 mm, diameter - up to 10 mm), the effectiveness of radiation therapy is equivalent to enucleation (removal) of the eye. That is, complete recovery occurs.

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

Prognosis for melanoma