What is melanoma? Malignant melanoma: forms and phases of development, complications, treatment, prevention Melanoma signs treatment

Melanoma is a very aggressive malignant tumor that occurs as a result of the degeneration of pigment cells (melanocytes and melanoblasts) that produce the pigment melanin. The cells of such a tumor contain a large amount of melanin, which causes them to be dark in color, but there are also non-pigmented variants (in a small percentage of cases).

Epidemiology

Morbidity. Melanoma is approximately 10 times less common than skin cancer. It accounts for about 1% of the total number of malignant tumors. In European countries, this tumor occurs in 2-4 people per 100,000 population during the year. The incidence of melanoma has been increasing recently.

Age and gender characteristics. Melanoma occurs more often in women than in men. The differences are minor, but melanomas of the lower leg, dorsum of the foot and forearm are observed 3 times more often in women than in men. The incidence of melanoma increases sharply in the age group of 30-39 years, then there is a gradual, slow increase in the incidence of the tumor until old age.

Epidemiological patterns. Melanoma has the same geographic distribution patterns as skin cancer. The incidence is higher in southern countries and regions. More often, people with fair skin get sick. In the United States, melanoma occurs 7-10 times more often in whites than in blacks. In Kazakhstan and Kyrgyzstan, the incidence of the disease in the visiting population is 3-4 times higher than in the indigenous population. The likelihood of a tumor increases in direct proportion to the time spent outdoors in the sun.

Etiology

Pre-existing diseases

Melanoma usually develops from acquired and congenital nevi and Dubreuil's melanosis. Pigmented nevi occur in 90% of people. Depending on the layer of skin from which they develop, epidermal-dermal, or borderline, intradermal and mixed nevi are distinguished. Borderline nevi are the most dangerous. They are a clearly defined nodule of black-brown, black-gray or black color with a smooth, dry surface on which there is no hair. The nodule is flat or slightly raised above the surface of the skin, painless, and has a soft-elastic consistency. Dimensions vary from a few millimeters to 1 cm. Borderline nevus is usually localized on the head, neck, palms and feet, and torso. The incidence of malignancy (malignancy) of mixed nevi is much lower, and melanoma develops from dermal nevi in ​​isolated cases.

Surgery for nevi was previously considered dangerous. This idea turned out to be wrong. It is currently believed that excision of any and even borderline nevus within healthy tissue (0.5 cm from the edges) guarantees recovery and is a reliable measure for the prevention of melanoma. It is especially recommended to remove nevi located on the sole, foot, nail bed, and perianal area, which are almost always borderline in their structure and are often subject to injury.

Predisposing factors

The transformation of pigmented nevi into melanoma is facilitated by trauma, ultraviolet radiation and hormonal changes in the body. The last two factors may also influence the occurrence of melanoma on intact skin.

The role of trauma is beyond doubt. In approximately 40% of melanoma patients, signs of malignancy appear soon after accidental or intentional trauma to the pigmented nevus. Sometimes it is enough to bandage a nevus with a thread or cut it off with a razor to cause rapid growth and malignancy of the tumor. Insolation is associated with a high incidence of melanomas in southern countries and regions, as well as the frequent occurrence of tumors on exposed parts of the body.

The conclusion about the role of endocrine influences is speculative, it is made on the basis that melanomas rarely occur before puberty, and during puberty, pregnancy and menopause, accelerated tumor growth is sometimes observed. It is also confirmed that in some cases, changes in hormonal status lead to inhibition and even regression of the tumor.

Pathological characteristics

Localization

Unlike skin cancer, melanoma is not predominantly located on the face. In almost half of patients, the tumor occurs on the lower extremities, somewhat less frequently on the trunk (20-30%) and upper extremities (10-15%), and only in 10-20% - in the head and neck area.

Growth and spread

The growth and spread of melanoma occurs through germination of surrounding tissues, lymphogenous and hematogenous metastasis. Melanoma grows in three directions: above the skin, along its surface and deep, successively growing through layers of skin and underlying tissue. The deeper the strands of tumor cells spread, the worse the prognosis. Germination of skin layers is detected by microscopic examination of the removed area. Depending on the depth of damage to the layers, according to the classification proposed by Clark, 5 levels of invasion are distinguished. At levels 4-5 of invasion, the prognosis is worse.

The thickness of the tumor is of great prognostic significance. Melanomas with a thickness of less than 0.76 mm have the most favorable course. As the thickness of the tumor increases, the prognosis worsens.

Metastasis

Melanoma is characterized by rapid and early metastasis. Most often, regional lymph nodes are affected by metastases. Metastases to distant lymph nodes are less common. The affected lymph nodes are dark in color and have a dense elastic consistency; their size varies from 1-2 cm to large tumor conglomerates.

Skin metastases are common. They look like small, multiple, brown or black rashes that slightly rise above the skin level. Metastases are located near the primary site, and therefore are called satellites. Metastasis to the skin can occur in the form of diffuse infiltration of the skin by melanoma cells. In such cases, the skin becomes slightly swollen, painful, and acquires a bluish-red tint.

Hematogenous metastases can occur in any organ, but the lungs, liver, brain and adrenal glands are most often affected. Typically, metastases are multiple and may be accompanied by the appearance of free melanin (chalk) in the blood and excretion in the urine.

Classification

Classification according to the TNM system

• Primary tumor (T)
  • T is - melanoma in situ
  • T 1a - melanoma ≤ 1 millimeter thick, Clark level II-III, without ulceration
  • T 1b - melanoma ≤ 1 millimeter thick, Clark level IV-V or with ulceration
  • T 2a - melanoma 1.01 - 2.0 millimeters thick without ulceration
  • T 2b - melanoma 1.01 - 2.0 millimeters thick with ulceration
  • T 3a - melanoma 2.01 - 4.0 millimeters thick without ulceration
  • T 3b - melanoma 2.01 - 4.0 millimeters thick with ulceration
  • T 4a - melanoma > 4.0 millimeters thick without ulceration
  • T 4b - melanoma > 4.0 millimeters thick with ulceration
• Regional lymph nodes (N)
  • N 0 - no metastases to regional lymph nodes
  • N 1 - metastasis to 1 lymph node
  • N 1a - determined only microscopically
  • N 1b - visible to the naked eye
  • N 2 - metastases in 2 - 3 lymph nodes
  • N 2a - determined only microscopically
  • N 2b - visible to the naked eye
  • N 2c - satellite (these are small foci 0.05 mm in diameter that form in the dermis around the main tumor) or transient metastases
  • N 3 - metastases to 4 lymph nodes, transient or satellite metastases
• Distant metastases
  • M 0 - no distant metastases
  • M 1a - metastases to the skin, surrounding tissues or distant lymph nodes
  • M 1b - metastases of melanoma to the lungs
  • M 1c - distant metastases with an increase in LDH (Lactate dehydrogenase)
• R 0 - no relapse
• R 1 - microscopic recurrence
• R 2 - macroscopic recurrence

Stages of melanoma

In clinical practice, a relatively simple classification is used:

• Stage I - melanoma up to 2 cm in maximum diameter, growing only in the skin, without metastases to the lymph nodes;
• Stage II - pigmented tumors larger than 2 cm with infiltration of the underlying tissue;
  - IIa - without enlargement of regional lymph nodes;
  - IIb - with enlarged lymph nodes, suspicious for the presence of metastases;
• Stage III - tumors of various sizes and shapes, growing into the subcutaneous tissue and aponeurosis, limited displacement;
  - IIIa - without metastases to the lymph nodes;
  - IIIb - with metastases to regional lymph nodes;
• Stage IV - a tumor of any size with satellites, or with multiple metastases to regional lymph nodes, or with distant metastases.

Symptoms

Melanoma initially appears as a dark spot that rises slightly above the surface of the skin. As it grows, it takes on the appearance of an exophytic tumor, which can subsequently ulcerate. The tumor is usually solitary; Primary multiple lesions are very rare. Depending on the growth rate and the time of contacting a doctor, the size of melanoma varies from a barely noticeable point to large nodes, reaching an average size of 1.0-2.5 cm.

The consistency of the neoplasm is elastic, sometimes moderately dense. The surface is often smooth, but can be lumpy with papillary growths in the form of cauliflower. The shape is round or oval, and in the presence of papillary growths it becomes irregular. An exophytic tumor is usually located on a broad base, less often on a narrow stalk, in these cases acquiring a mushroom shape.

Three characteristic features play a role in the recognition of melanoma: dark color, shiny surface and tendency to decay. These features are due to the processes occurring in the tumor: accumulation of pigment, damage to the epidermal layer, and fragility of the tumor.

The dark color makes it relatively easy to distinguish melanoma from other malignant tumors, but it also leads to great difficulties in differential diagnosis with pigmented nevi. The intensity of the color depends on the amount of melanin in the tumor. Typically, melanomas have a rich, dark color with varying shades from dark brown or bluish black to slate black. Less common are tumors that are light brown or red-purple in color. In some cases, unpainted neoplasms, so-called non-pigmented melanomas, are observed.

When viewed with the naked eye, the color of the tumor seems uniform, but sometimes the pigmentation is more pronounced in the center, or, conversely, the relatively light central part may be surrounded by an intensely pigmented rim at the base. Finally, in some patients, the pigment is scattered over the entire surface in the form of isolated grains. When examined under magnification, a network-like surface pattern and variegated heterogeneous pigmentation of varying intensity with a bluish, brown or black tint to the grains are almost always revealed.

The disappearance of the skin pattern and the shiny nature of the surface are the second distinguishing feature of melanoma. The epidermis above the tumor is thinned, as if stretched; unlike nevi, there is no skin pattern, due to this the surface of the melanoma appears smooth, mirror-like. This feature is also observed in non-pigmented neoplasms, which sometimes facilitates their recognition.

Destruction of the tumor occurs in late stages. Loose and not very dense melanoma tissue is easily injured and disintegrates. Minor injuries lead to disruption of the integrity of the tumor and are accompanied by bleeding. A careless movement, friction of clothing, or an accidental, not very rough touch is enough to damage the tumor and cause bleeding. A crust forms at the site of damage. Sometimes patients take it off. The crust is easily removed, but bleeding occurs again.

As a result of trauma or without any intervention, an area of ​​decay or ulceration occasionally appears on the surface of the melanoma. Its surface is covered with crusts, from under which bloody or purulent discharge may be released.

Diagnostics

Diagnosis of melanoma in many patients presents significant difficulties. To make a diagnosis, it is necessary to take into account complaints, the dynamics of the disease and objective research data. Valuable information can sometimes be obtained using special research methods.

Survey

Patients with melanoma complain of the appearance or increase in pigment formation, its weeping, bleeding, slight burning, itching or dull pain in the tumor area.

When collecting anamnesis, the doctor is faced with the task of assessing the dynamics of the disease. To do this you need to find out:

1. whether the pigment formation is congenital or acquired;
2. what form it had at the beginning, what changes occurred and over what period of time;
3. whether the changes that have occurred are associated with accidental injury or prolonged exposure to the sun;
4. whether treatment was previously carried out and what its nature was. The assumption of melanoma arises when a pigmented formation has recently appeared and is increasing in size, or when a long-standing pigmented nevus has accelerated growth or changed color.

Physical examination

Inspection of the pigment formation is crucial. It should be done very carefully, using a magnifying glass when necessary. Serious difficulties are encountered in recognizing melanomas arising from congenital or acquired pigmented nevi. In such cases, it is important to catch the malignancy of the nevus in a timely manner.

“Alarm signals” are signs indicating the possible malignancy of pigmented nevi. They are usually caused by rapid proliferation of tumor cells. These include:

1. increase in size, compaction, bulging of one of the areas or uniform growth of pigment formation above the surface of the skin;
2. strengthening, and occasionally weakening of nevus pigmentation;
3. bleeding, cracking, or superficial ulceration with crusting;
4. redness, pigmented or non-pigmented strands, infiltrated tissue around the nevus;
5. the appearance of itching, burning;
6. formation of satellites, enlargement of lymph nodes.

Experts identify five main signs of melanoma called “ACORD of melanoma.” This name is formed by capital letters of 5 main features:
A - Asymmetry. An axis of symmetry can be drawn through a “good” mole, but not through a tumor. In specialized clinics there is a special apparatus that allows you to evaluate a mole along 12 axes.
TO - edge. A mole has smooth edges, while a melanoma has jagged or scalloped edges.
ABOUT - Coloring. If a mole has changed color or is unevenly colored, this is a bad sign.
R - Size. The larger the mole, the higher the likelihood of its degeneration. A size of 6 mm is considered critical, but there are also small melanomas with a diameter of 1 mm.
D - Dynamics. This refers to any external changes: the growth of a mole, the appearance of crusts, cracks, inflammation, peeling, bleeding or the sudden disappearance of a mole.

You should take it as a rule: Any nevus that protrudes above the surface, has changed color, is weeping, bleeding, or causes unpleasant subjective sensations is suspicious for melanoma. Patients with such nevi need consultation with a specialist - an oncologist.

Special examination methods

Examination of patients with suspected melanoma is usually performed on an outpatient basis. General clinical examinations include a general blood test, which sometimes reveals an increase in ESR, and a chest x-ray, which is necessary to identify possible metastases to the lungs. Special research methods used to diagnose melanoma are radioisotope diagnostics, thermography, Yaksha reaction, cytological and histological examination.

Radioisotope diagnostics. Radioactive phosphorus (32P) is used as an isotope, which is a source of radiation. Dibasic sodium phosphate, labeled with radioactive phosphorus, is dissolved in 30 ml of water and given to the patient by mouth. Using special probes, the level of isotope accumulation in the pigment formation and the symmetrical point of the opposite side is examined 2, 24 and 48 hours after taking the drug. Phosphorus is more easily incorporated into tissues whose cells are in a state of active division. Therefore, melanomas accumulate it in quantities 3-4 times greater than healthy skin. Excessive accumulation of the isotope is also observed in hematomas, pigmented nevi and other benign neoplasms. This reduces the diagnostic value of a technically simple and safe method.

Thermography is widely used in the detection of melanoma. An increase in metabolic processes in melanoma is accompanied by an increase in local temperature and the appearance of a so-called hot spot, which looks like a light spot on the thermogram.

Yaksha reaction. In melanomas, the content of colorless intermediate products of melanin synthesis, melanogens, which are excreted in the urine (melanuria), increases. Under the influence of oxygen, they oxidize, turning into melanin, and the urine becomes dark in color. "Spontaneous" melanuria is rare in the early stages. It is usually observed in disseminated, advanced tumors. Even more common is “radiation” melanuria—the release of melanogens in the urine during radiation treatment. When producing the reaction, a 5% solution of ferric chloride is used as an oxidizing agent. A solution in an amount of 0.5 ml is added drops into a test tube filled 3/4 with warm, freshly collected urine. If the reaction is positive, a gray or dark gray cloud appears in the urine, slowly settling to the bottom of the tube. The success of the reaction depends on the scrupulous implementation of technical rules. For 3 days before the study, the intake of salicylates, tannin and their derivatives is prohibited; canned food (contains salicylic acid) and wine (contains tannin) are excluded from the diet. The test tube must be thoroughly cleaned and viewed against a white background in natural light in the first minutes after administration of the reagent.

Morphological study allows you to establish an accurate diagnosis, but is rarely used in clinical practice due to the risk of tumor dissemination. Material for cytological examination can be easily obtained only from disintegrating ulcerated neoplasms. It is enough to apply a glass slide to the wet area or very carefully scrape the surface.

Tumor puncture, suspicious for melanoma, is permissible only in case of exophytic formation, if all other diagnostic possibilities have been exhausted. A prerequisite is an urgent cytological examination of the punctate. Puncture is contraindicated in cases of rapid growth of a pigmented neoplasm and severe inflammatory infiltration. It is not done if there is no exophytic component and the tumor is small. The puncture is performed after a thorough examination of the patient to determine the possibility of surgery under anesthesia. The puncture technique for suspected melanoma has its own characteristics. The skin is treated with alcohol. A thin needle is directed parallel to the surface so that its end enters the epidermal layer without damaging the dermis. No additional movements of the needle should be made. Once the diagnosis is confirmed, radical surgery should be performed as quickly as possible, preferably 20-30 minutes, but no more than 1 day after puncture. In exceptional cases, if radical surgery cannot be performed within this period, radiation treatment should be started immediately.

Puncture of lymph nodes They are rarely performed if it is impossible to establish the nature of the pigment formation in any other way. There is no doubt that puncture of lymph nodes affected by melanoma is dangerous, but its harm is not too noticeable, since dissemination of the process has already occurred.

Biopsy of pigmented formations performed when it is impossible to establish a diagnosis in any other way. A biopsy is performed only by completely removing the tumor. Partial excision of a tumor suspicious for melanoma is unacceptable. The biopsy is always performed under general anesthesia. The neoplasm is excised at a distance of 1.0-1.5 cm from the visible boundaries. Urgent histological and cytological examinations are performed. If melanoma is detected, radical surgery is immediately performed, the volume of which depends on the location of the tumor.

Treatment of melanoma

Treatment of melanomas is a difficult task due to rapid, early-onset dissemination. It should only be carried out in a specialized institution.

Treatment of the primary lesion

The most common method is surgical excision of the tumor; combined treatment, radiation and complex, is used somewhat less frequently.

Surgical treatment is indicated for stage I and II melanoma. The operation must be performed under anesthesia. The skin with the tumor is widely excised with a scalpel or electric knife. You should step back at least 5 cm from the visible edge, and even 7-8 cm or more in the direction of lymph drainage. For cosmetic reasons, this cannot be performed on the face. Facial melanoma usually has to be excised, leaving only 3 cm from the edge of the tumor.

The skin flap must be removed deeply. Most oncologists consider it mandatory to remove not only the skin and subcutaneous tissue, but also the underlying fascia. Removal of the fascia itself is a controversial issue and is not accepted by some authors.

An extensive defect after excision of melanoma cannot be closed without skin grafting. On the trunk and in the proximal extremities, the defect is closed by moving local tissues. Free skin grafting should be used on the extremities. It is conventionally believed that if the defect after removal of the melanoma was able to be sutured without resorting to skin grafting, then the operation was not done radically enough. If melanoma is located on the fingers or toes, amputation or disarticulation of the fingers is performed. For other tumor locations, amputation is undesirable.

During the operation, it is necessary to strictly follow the rules of ablastics. For this purpose, the tumor is covered with a napkin soaked in iodine, suturing it to the skin within the limits of the removed preparation. To avoid dissemination, try not to injure the melanoma and surrounding tissues, and not touch the tumor with fingers or instruments.

There is also microscopically controlled surgery to increase the effectiveness of operations for skin tumors - Mohs surgery (Frederick Mohs).

Treatment of metastases to lymph nodes

In the past, there was an attitude that regional lymph nodes in melanoma should be removed regardless of the presence of metastases. The rationale was the frequent (25-30%) detection of malignant neoplasm cells in non-palpable lymph nodes. Randomized trials have shown that prophylactic removal of regional lymph nodes does not improve long-term treatment outcomes. Currently, lymphadenectomy is performed only in the presence of palpable metastases to the lymph nodes. As a rule, it is not performed for prophylactic purposes, but some authors resort to lymphadenectomy when melanoma grows deep into the dermis (levels 4-5 of invasion).

Indications for regional lymphadenectomy for primary cutaneous melanoma: table

Radiation treatment

Despite the low sensitivity of melanomas to ionizing radiation, radiation therapy as an independent treatment has previously been widely used. Close-focus radiotherapy was administered at 3-5 Gy with a total dose of up to 120-200 Gy. A wide field was irradiated, covering the skin 4-5 cm outside the tumor. Under the influence of irradiation in melanoma, even at a dose of 100 Gy, more or less deep cell damage occurred. However, without histological confirmation of the diagnosis, there was no certainty that it was melanoma and not a pigmented nevus that was irradiated. Because of this, radiation therapy has ceased to be used as an independent method of treatment.

Combined treatment

It is used in the presence of a large exophytic component, very rapid growth or ulceration of melanoma, the appearance of satellites, and also when the tumor is located in an area where the possibility of wide excision is limited (face, palms, soles). Treatment begins with close-focus radiotherapy with a single dose of 5 Gy. Irradiation is carried out daily 5 times a week. The total dose ranges from 60 to 120 Gy. Surgery is performed after the inflammatory reaction has subsided.

Chemotherapy

Melanoma is insensitive to chemotherapy. However, drugs are widely used for disseminated forms, and in combination with surgery they are sometimes used for localized tumors and local recurrences located on the extremities. In such cases, chemotherapy is administered by intra-arterial perfusion, followed by surgery. The operation is performed immediately after perfusion or several days later.

For disseminated tumors, imidazole carboxamide (DTIC) is most effective, with its help it is possible to obtain clinical remission in 20-30% of patients. Nitrosourea, procarbazine, dactinomycin, etc. are less effective. The effectiveness of drug treatment can be increased by using a combination of chemotherapy drugs. One such combination, containing methylnitrosourea (MNU), vincristine and dactinomycin, has become widespread and is as effective as imidazolecarboxamide. Drugs such as dacarbazine (DTIC), carmustine (BCNU), lomustine (CCNU), cisplatin, tamoxifen, cyclophosphamide, etc. are also used.

Immunotherapy

Immunotherapy has sometimes been used in recent years to treat recurrent and cutaneous melanoma metastases. It is often used in combination with chemotherapy treatment.

Typically, the BCG vaccine is used, which is injected directly into tumor nodes or into the skin next to the tumor. Such treatment in some patients leads to the resorption of nodes, but is often accompanied by a general reaction, which prevents the widespread use of immunotherapy in clinical practice.

Interferon-alpha (IFN-A), interleukin-2 (IL-2) and granulocyte-macrophage colony-stimulating factor (GM-CSF) are also used. A study performed by the Eastern Cooperative Oncology Group (ECOG) showed that the use of interferon-alpha-2b at maximum tolerated doses provides a significant prolongation of disease-free interval and overall survival compared with no adjuvant therapy. One of the latest developments is the treatment of melanoma with the drug Yervoy (Ipilimumab).

Ipilimumab (MDX-010, MDX-101) is a melanoma drug that was approved by the US Food and Drug Administration (FDA) in March 2011 for the treatment of advanced melanoma under the market name Yervoy ( Yervoy). Yervoy was developed by the pharmaceutical company Bristol-Myers Squibb and is a monoclonal antibody that activates the human immune system. Yervoy is also supposed to be used to treat certain forms of lung cancer and prostate cancer. Mechanism of action: Ipilimumab is a human antibody that binds cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), a cytotoxic T lymphocyte molecule that likely plays an important role in regulating natural immune responses.

In addition to interferon-alpha (IFN-A) therapy, virotherapy is used to treat melanoma - treatment of ECHO 7 virus-containing drug Rigvir, which is registered for the prevention of metastases and relapses of melanoma, as well as for local therapy of skin and subcutaneous metastases.

Treatment results (prognosis)

Five-year recovery is observed on average in 50-65% of patients. Relatively favorable results are due to the fact that in the majority (80-85%) of patients the tumor is recognized in stage I. The prognosis is much worse for melanoma in stage II and subsequent stages, especially when the lymph nodes are affected.

In the absence of metastases to the lymph nodes, tumor thickness and the degree of skin invasion are of decisive prognostic importance. In addition, the gender of the patient, the presence of ulceration, and the location of the tumor are important. All other things being equal, long-term treatment results are better in women than in men. Melanomas of the extremities (with the exception of subunguals) have a more favorable course than melanomas of the trunk.

Clinical examination of cured patients is carried out according to general rules. During follow-up examinations, the skin, lymph nodes, and liver are examined, a blood test is performed, and an X-ray examination of the lungs is performed.

Photo materials

Remember

• Melanoma is usually a dark-colored spot or tumor of a round shape, elastic consistency with a smooth or bumpy surface.
• Characteristic features of melanoma are dark color, shiny surface and the tendency of the tumor to disintegrate.
• Suspicion of melanoma arises when an increasing pigment formation appears or when a pre-existing one grows rapidly.
• Nevi that are discolored, weeping, bleeding, or causing itching, burning, or pain are suspicious for melanoma.
• If melanoma is suspected, a puncture is performed in exceptional cases, with strict adherence to technical rules and mandatory urgent histological examination.

Melanoma is a skin cancer that develops from a mole very quickly and metastasizes to the lymph nodes and other organs and systems. It is not easy to detect melanoma at the initial stage; the tumor is almost invisible and, nevertheless, very dangerous.

Modern medicine faces many diseases. Some of them have been known to mankind for a long time, and some have not even been explored yet. This is why problems with diagnosis and treatment often arise. One of the most dangerous diseases is cancer. They pose a great danger to human life, and there is currently no medicine that guarantees a 100% cure. Today's article will focus on melanoma. Let's find out what kind of disease this is, what statistics know about it, and look at treatment and diagnosis. Be sure to study all the information provided. Today's pace of life requires such awareness not only from specialized specialists, but also from the person himself.

What is melanoma

Melanocytes are certain cells found in human skin that produce melanin (the so-called color pigment). Melanoma is a skin cancer that arises and develops from these cells (melanocytes). This tumor disease is now very common everywhere. Unfortunately, people of different ages, genders and nationalities are susceptible to it. The first stages of the disease in question in most cases have a positive dynamics of treatment, while advanced forms very often do not respond to intervention and, as a result, lead to death.

Modern medicine knows many skin pathologies of an oncological nature, and melanoma is one of them. According to statistics, in the countries of central Europe there are 10 cases per 100,000 people annually. Austria and America have 37-45 cases per year for a similar number of residents of the country, which makes melanoma the most dangerous cancer even in developed countries, let alone those where the level of medicine is not so developed.

Berlin scientists have concluded that women experience this disease much more often than men. Statistics show that 6 thousand men and 8 thousand women are affected by the disease. Mortality due to melanoma is determined by 2 thousand men and women. From official data it is clear that about 14 thousand Germans fall ill with this type of cancer every year. It is also worth knowing that of all the deaths in the world from cancer, 1% of them are due to melanoma.

The disease is considered to be of different ages, but the majority of patients are elderly people, after 70 years. Over the past half century, the incidence of the disease has increased by 600%. However, you should not relax if this age is still very far away. Unfortunately, melanoma is often diagnosed in middle-aged people, young people and even children.

Many moles: could it be melanoma?

Since melanoma develops from a mole, it would be logical to ask: are people with many moles on their body susceptible to cancer? Oncologists answer: yes. People with nevi, papillomas and skin tendencies to pigmentation need to be careful not to expose the skin to solar radiation and mechanical damage.

Many years of medical research have shown that people with Eastern European skin type have melanoma on the limbs and torso. Persons with blond, red hair, eyes of green, gray, blue shades are more susceptible to it. The risk group consists primarily of people with pink freckles, congenital age spots (nevi) and atypical moles located on open areas of the body, forearm, foot and back. Trauma to the nevus in some cases leads to skin cancer. In older people, age-related pigmentation on the skin is a signal of concern, which in no case should be ignored, since melanoma develops well against this background. The appearance of this pathology is influenced by the following factors:

• hereditary predisposition;
• regular exposure to ultraviolet rays;
• Dubreuil's melanosis;
• xeroderma pigmentosum;
• the presence of a large number of moles (more than 50 pieces) and freckles on the body.

Thus, if there was at least one case of cancer in a family, then all subsequent generations automatically fall into the risk group, and if a person is constantly exposed to ultraviolet rays, and additionally has light skin covered with freckles, then he needs to be especially careful relates to your health. These people should also be aware of factors that can provoke the rapid development of cancer cells (which are present in the body of every person, but only lie dormant for the time being). In addition to environmental influences, severe stress, prolonged illness, alcohol, smoking, and drugs can also provoke the development of cancer.

The rapid formation of moles and freckles on the skin is also a cause for concern.

Where does melanoma grow?

However, melanoma occurs in people of all skin colors. People in different countries encounter this skin pathology.

The tumor will not be considered malignant if hair growth is detected on the skin. This does not happen in the area affected by melanoma. However, even if there is no hair on the neoplasm, do not panic, remember - if you take appropriate measures in time, the disease can be defeated.

Melanoma develops on age spots and healthy skin as well. In women it is found, most often, in the area of ​​the lower extremities, and in men on the entire surface of the body. Parts of the body exposed to ultraviolet rays are more likely to be affected by this formation. However, areas of the body where the rays penetrate little or not at all are not excluded. This tumor also occurs in people between the fingers, on the soles of the feet, even on internal organs. Infant morbidity is extremely rare. It's scary, but even the slightest sunburn or heatstroke can lead to illness.

Everyone develops the disease differently

The disease progresses at different rates in different patients. There is a period of several months when the disease progresses very rapidly and leads to death. Some people survive melanoma for more than 5 years with ongoing maintenance therapy.

Another danger is that metastases appear very early; a person may not even be aware of the disease for a long time. Damage occurs to the bones, brain, liver, lungs, skin, heart. Metastases may not appear if the melanoma has not spread shallowly, that is, no further than the basement membrane.

Types of melanoma and symptoms

Modern medicine differentiates the disease discussed in today's article into types and defines in this distinction a set of symptoms that arise with this disease. The symptoms of melanoma are quite varied. Thanks to it and high-quality diagnosis, it is possible to detect the disease at an early stage.

The types of this tumor are as follows:

This formation grows very slowly, but is considered the most common and occurs, according to statistics, in 47% of cases. It grows horizontally, has an uneven shape and is slightly convex to the touch. Reaching its peak, it begins to resemble in appearance a black glossy plaque. Only then does it gradually grow vertically and then grow deep into the skin;

2. Nodular or nodular melanoma is growing quite rapidly and is the second most common, according to statistics, it occurs in 39% of cases. This type is more aggressive and quite swift;

3. Peripheral or malignant lentigo changes the tissues of the skin, which later turn into cancer, and this type occurs in 6% of cases. It is considered a precancerous condition. The skin lesion is flat, not convex;

4. Amelanotic melanoma or acral melanoma occurs on the soles of the feet and palms of the hands. It occurs extremely rarely in medical practice.

Early stage melanoma: how to determine

Very often, people with an already advanced stage of melanoma turn to an oncologist, when the tumor has already begun to metastasize to various organs. Due to the painlessness of this type of skin cancer and the speed of its development, it is imperative to know the symptoms of melanoma. A person can be saved if melanoma is detected at its very initial stage. Melanoma can be identified by:

1. The appearance of a skin formation with an irregular shape;

2. The distinctive color of the formation;

3. The edges of the tumor have a jagged or arched shape;

4. Dark spot measuring 5 mm or more;

5. A spot similar to a mole, which is located above the skin level.

From all of the above, we can draw the following conclusion: it could be melanoma if a mole suddenly appears that was not there before. At the same time, it is irregular and heterogeneous in shape, and has blurred edges. It may itch and hurt. She is completely hairless. There may be ulcers on it, oozing blood or ichor (but this only happens in some cases).

Sometimes melanoma develops from an existing mole. Be careful if:

• there used to be hair on the mole, but now it has fallen out;
• the mole has increased in size;
• the mole has changed color (for example, it used to be light brown, but now it has become very dark, almost black);
• the nevus has increased in volume - it has noticeably risen above the skin;
• keratosis became noticeable on the nevus - dark, dry pimples appeared;
• dark spots appeared around the mole.

Melanoma symptoms

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, 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. The average age is 53 years. It occurs slightly more often in men than in women. The upper and lower limbs, cervical spine, head and back are affected. The node forms quickly, the skin undergoes changes, reaches the peak of development in a few months and already has bleeding.

Incorrectly selected treatment threatens repeated relapse. Against this background, distant metastases occur. In most cases, chemotherapy is used. Treatment can be prescribed in combination, in which case the patient takes antitumor drugs, which gives a chance of recovery in 40% of cases.

Forms of manifestation of melanoma

Malignant melanoma often metastasizes to the brain, heart, lungs, and liver in a hematogenous and lymphogenous manner. The nodes begin to spread and are located along the limb, skin or torso.

It happens that a person goes to the doctor with a complaint of enlarged lymph nodes. A competent doctor will ask many clarifying questions to the patient to draw up a complete picture of the disease. For example, it may turn out that the patient recently had a wart removed that was a melanoma.

Symptoms of eye melanoma

Melanoma damages tissue not only on the skin, but also on the visual organ, the 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);

2. Negative scotoma (the blind area is not perceived by a person in any way).

Negative scotoma is determined using certain techniques.

Small melanoma can be confused with a pigmented nevus, which is located in the eye shell. A positive scotoma should be differentiated by an experienced ophthalmic oncologist, since glaucoma has similar symptoms.

The growth rate of ocular melanoma can only be determined through certain studies. The treatment tactics are chosen by the doctor after a detailed study. Radiation therapy, local resection or ocular enucleation are prescribed.

Stages of melanoma

The disease has 5 stages, with stage zero being the mildest. Cancer cells are still present only at the cellular level. The malignant tumor has not yet grown deeper.

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.

Diagnosis of melanoma

A number of manipulations help diagnose melanoma. The doctor uses a special magnifying glass for examination. 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 of melanoma

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 the skin to its usual appearance, it is necessary 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. In recent years, such combined methods of fighting cancer have been used quite often, which indicates the positive effect of the combination of these procedures.

Melanoma prognosis: is it possible to survive?

Melanoma is an extremely dangerous and fast-growing cancer disease. The main importance is the clinical stage, which was relevant at the time of diagnosis when contacting an oncologist. After all, the earlier the disease is detected, the greater the chances of a favorable outcome. Approximately 85% of patients survive a five-year period in stages I and II, when the tumor has not yet spread beyond the cancer site. Since at stage III metastases spread throughout the lymph system, the survival rate is 50% over a five-year period when only one lymph node is affected. If several lymph nodes are affected by the disease, then the possibility of recovery is reduced to 20%. As stated earlier, stage four or final stage melanoma has distant metastases, so the five-year survival rate is only 5%.

As a rule, the diagnosis is made at stage I or II, which significantly increases the chances of defeating the disease. The thickness of the tumor plays an important role in determining the prognosis, because... its mass indicates the presence of metastases.

Survival rates of 96-99% at five years are due to surgery unless the tumor thickness is 0.75 mm or less. Patients with a thickness of no more than 1 mm are at low risk and account for about 40%. A sharp regression or vertical increase in the tumor indicates the appearance of metastases, but the final answer will only be given by histological examination.

In 60% of cases, metastases spread if the melanoma has grown to 3.64 mm or higher. Such dimensions are very dangerous because they lead the patient to death. But the tumor can be noticed much earlier, because it rises above the level of the skin and significantly changes its color.

The location of the tumor on the body affects the prognosis. Skin lesions on the forearm or lower leg give a better chance of recovery than the presence of cancer cells in the area of ​​the hands, feet, mucous membranes and scalp.

Forecasting, in some way, is determined by belonging to one gender or another. The first two stages often have a better prognosis for women than for men. This is due to the fact that in women the disease develops on the lower extremities, therefore, it is easier to see it there at an early stage, and timely detection of the tumor gives greater hope for recovery.

A less favorable prognosis is determined for elderly patients. This is due to the fact that tumors are detected quite late and older men more often suffer from another form of melanoma, namely acral lentiginous melanoma.

Statistics show that after 5 or more years the tumor returns in 15% of cases after its removal. The fact is that the likelihood of relapse depends on the thickness of the cancer. Accordingly, the thicker the removed tumor, the greater the chance that it will return in a few years.

In the first two stages, unfavorable prognosis is sometimes encountered. There is a high risk of increased mitotic activity and satellites (small areas of tumor cells measuring at least 0.05 mm or even larger), which begin to form in the subcutaneous tissue or reticular layer of the dermis. Melanoma often spreads satellites and micrometastases simultaneously.

Using the method of comparing Clark's histological criteria, a prognosis is made for stages I and II of the disease. The location of the tumor in the epidermis determines the first stage of invasion in accordance with the Clark system. Penetration of a malignant tumor into the layers of the epidermis determines the second stage of invasion. When the tumor reaches the space between the papillary and reticular layers of the dermis, this indicates stage III of invasion. Stage IV is characterized by penetration of the formation into the reticular layer of the dermis. Germination occurs in the subcutaneous tissue at stage V according to Clark’s criteria. Survival rate for each individual criterion is 100% at stage I, 95% at stage II, 82% at stage III, 71% at stage IV and 49% at stage V.

Every person should understand that timely access to the clinic makes it possible to prevent the serious consequences of illness. Any changes in the nevus are a reason for a thorough examination. It is necessary to pay attention to changes in its color, size and shape. Ulcerations and bleeding cannot be left to chance, because stages III and IV cannot be treated with modern medicine. Even the most advanced technologies and the latest equipment have not yet learned to cope with advanced forms of cancer. Prevention and early diagnosis of the disease help prevent severe illness and its consequences. Don’t forget to inspect your skin yourself. If you have the slightest suspicion of melanoma, contact your doctor immediately.

Melanoma is a type of cancer that affects melanocytes—pigment cells located in human skin.

Melanoma has a high risk of rapid metastasis, which leads to the development of severe complications and, in severe cases, death of the patient. Every year, about 50 thousand new cases of melanoma are registered in the United States.

The first link in the timely diagnosis of the disease is the patients themselves, since melanomas usually occur on open, visible areas of the skin. This is important because early detection and diagnosis of melanoma ensures rapid cure with minimal surgery.

Disease statistics

Skin cancer is the most common cancer in the United States and Australia. In other countries, this group of diseases is in the top three. Melanoma is the leader among skin cancers in terms of the number of deaths. Every hour in the world one person dies from this disease. In 2013, there were 77 thousand confirmed melanoma diagnoses and 9,500 deaths from it. The share of melanoma in the structure of cancer is only 2.3%, while at the same time being the cause of 75% of deaths from skin cancer.

This form of cancer is not exclusively skin cancer and can affect the eyes, scalp, nails, feet, and oral mucosa (regardless of gender and age). The risk of developing melanoma among Caucasians is 2%, 0.5% among Europeans and 0.1% among Africans.

Causes

• Prolonged exposure to the sun. Exposure to ultraviolet radiation, including solariums, can cause the development of melanoma. Excessive sun exposure in childhood significantly increases the risk of disease. Residents of regions with increased solar activity (Florida, Hawaii and Australia) are more susceptible to developing skin cancer.

Burns caused by prolonged exposure to the sun more than double the risk of developing melanoma. A visit to the solarium increases this indicator by 75%. The WHO Cancer Research Agency classifies tanning equipment as an "increased risk factor for skin cancer" and classifies tanning equipment as carcinogenic.

• Moles. There are two types of moles: normal and atypical. The presence of atypical (asymmetrical, raised above the skin) moles increases the risk of developing melanoma. Also, regardless of the type of moles, the more there are, the higher the risk of degeneration into a cancerous tumor;
• Skin type. People with more delicate skin (characterized by light hair and eye color) are at increased risk.
• Anamnesis. If you have previously had melanoma or another type of skin cancer and are cured, your risk of developing the disease again increases significantly.
• Weakened immunity. The negative impact of various factors on the immune system, including chemotherapy, organ transplantation, HIV/AIDS and other immunodeficiency conditions, increases the likelihood of developing melanoma.

Heredity plays an important role in the development of cancer, including melanoma. Approximately one in ten patients with melanoma has a close relative who has or has had the disease. A strong family history includes melanoma in parents, siblings, and children. In this case, the risk of melanoma increases by 50%.

Types of melanomas

Based on the type of melanoma, they are divided into 4 categories. Three of them are characterized by a gradual onset with the development of changes in only the superficial layer of the skin. Such forms very rarely become invasive. The fourth type is characterized by a tendency to quickly grow deep into the skin and spread to other parts of the body and internal organs of the patient.

Superficial (superficial) melanoma

is the most common variant of the disease (70% of cases). This is a melanoma of the skin, the symptoms of which are characterized by the long-term persistence of relatively benign growth in the upper (outer) layer of the skin. Only after a long period of time does superficial melanoma grow into deeper layers.

The first sign of this type of melanoma is the appearance of a flat, asymmetrical spot with uneven borders. The color of the affected area changes to brown (like a tan), black, red, blue, or white. Such melanomas can occur at the site of moles. Although the disease can occur anywhere on the skin, symptoms are more likely to develop on the torso (men) and legs (women), as well as the upper back (regardless of gender).

Lentigo maligna

its course is similar to superficial melanoma, since it develops in the upper layers of the skin for a long time. Visually, lentigo appears as a flat or slightly raised unevenly colored area of ​​skin. The color of the spot is variegated with brown and dark brown elements. This type of in situ melanoma is more common in older patients due to constant chronic exposure to sunlight and usually develops on the face, ears, arms and upper torso. This is the most common form of melanoma in Hawaii. When it enters the invasive stage, the disease is called lentigo melanoma.

Acral lentiginous melanoma

also develops superficially before continuing to grow deeper into the skin. This form differs from the others in that it appears as black or brown spots under the nails, on the palms of the hands or on the soles of the feet. The disease progresses faster than previous forms and is more likely to affect dark-skinned people. It is the most common form among Africans and Asians, while Caucasians and Europeans are least susceptible to it.

Nodular melanoma

is an invasive variant of the course. Usually, by the time it is detected, it has already grown quite deeply into the skin. Outwardly, this melanoma resembles a lump. It is usually black in color, but there are other variations (blue, grey, white, brown, red or even unaltered skin colours). It is most often localized on the torso, legs and arms. Mainly affects older people. This is the most aggressive variant of melanoma. It is diagnosed in 10-15% of cases.

Melanoma symptoms

Melanoma can develop from an existing mole or as a result of another skin disease, but it often occurs on normal skin. The most common locations for melanoma are the legs and upper back. Due to the continued production of melanin by the altered cells, the tumor is black or brown, but colorless melanomas are also found.

Less commonly, melanomas occur on the palms, nails, and mucous membranes. In older people, melanomas are more likely to appear on the face, as well as on the neck, scalp and ears.

Early symptoms of melanoma

The main signs of melanoma are changes in the size, shape, color of existing moles or “birthmarks” or the appearance of discomfort in this area. The development of these symptoms may take a long time (several weeks or months). In addition, melanoma may initially be perceived as a new mole, but at the same time have an unpleasant appearance. The appearance of such a subjective symptom should serve as an alarming sign and a reason to visit a doctor.

Early signs of melanoma include:

• Bleeding
• Burning feeling
• Crust formation
• Change in the height of the spots (thickening or raising a mole that was previously flat above the skin)
• Ulceration
• Change in consistency (mole becomes soft)
• The appearance of any discharge in the tumor area
• Increase in the size of the altered lesion
• Redness or swelling of surrounding tissues
• The appearance of new small areas of pigmentation around the main lesion

Late symptoms of melanoma

Further development is characterized by the following symptoms of melanoma:

• Violation of the integrity of the skin
• Bleeding from a mole
• Bleeding from other pigmented areas of the skin
• Pain in the affected area

Symptoms of metastatic melanoma

These symptoms develop when melanoma cancer cells enter the bloodstream and spread to other organs:

• Chronic cough
• Lump under the skin
• Gray skin tone
• Constant headache
• Convulsions
• Enlarged lymph nodes
• Unexplained weight loss, exhaustion

You should immediately consult a doctor if you experience:

• Bleeding from moles or areas of pigmentation
• Discoloration of fingernails and toenails not caused by injury
• Asymmetry in the growth of moles or individual areas of skin
• Darkening of the skin not associated with tanning
• The appearance of areas of pigmentation with uneven edges
• The appearance of moles with areas of different colors (the spread of pigmentation from a mole to surrounding tissue is an early sign of melanoma)
• Increase in diameter more than 6mm

Stages of melanoma

According to the new approved international classification, when determining the stage of melanoma, diagnostic criteria are the thickness of the tumor (Breslow thickness), the presence of microscopic ulcerations and the rate of division of cancer cells. Thanks to the new system, it has become possible to make a more accurate diagnosis and plan the most effective treatment.

Breslow thickness is measured in millimeters and characterizes the distance from the upper layer of the epidermis to the deepest point of tumor invasion. The thinner the melanoma, the higher the chance of cure. This indicator is the most important aspect in predicting the course and effectiveness of treatment measures.

• Stages 1 and 2

melanomas are characterized by limited swelling. This means that cancer cells have not yet metastasized to lymph nodes or other organs. At this stage, the risk of recurrence of melanoma or further spread of the tumor is quite low.

Depending on the thickness there are:

• Melanoma “in situ” (“in place”). This is the initial stage, when the tumor has not yet grown deep into the epidermis. This form is still referred to as the zero stage;
• Thin tumors (less than 1 mm). The development of a tumor indicates the initial (first) stage of melanoma;
• Medium thickness (1 – 4 mm). From this moment on, the course of melanoma enters the second stage;
• Thick melanomas (more than 4 mm in thickness).

The presence of microscopic ulcerations aggravates the severity of the disease and means a transition to later stages. The rate of cell division is also an important criterion in determining the prognosis of the course. Even a single confirmed process of dividing a cancer cell culture by one square millimeter characterizes the transition to more severe stages of melanoma and increases the risk of metastasis. In this case, the method of choice is a more aggressive treatment tactic to achieve the desired effect. At the first and second stages, melanoma is characterized by an asymptomatic increase in the size of areas of pigmentation, their elevation above the skin level without bleeding or pain.

• Stage 3

At this stage, important changes in the course of the disease are observed. At this stage, the Breslow thickness is no longer taken into account, but the identification of ulcerations becomes indicative.

The third stage is characterized by the spread of tumor cells to the lymph nodes and surrounding areas of the skin. Any spread of the tumor beyond the boundaries of the primary focus is characterized. As a transition to the third stage. This is confirmed by a biopsy of the lymph node closest to the tumor. Now this diagnostic method is indicated when the tumor size increases by more than 1 mm or if there are signs of ulceration. The third stage is characterized by the late symptoms of melanoma described above (pain, bleeding, etc.).

• Stage 4

means that tumor cells metastasize to distant organs. Metastases in melanoma spread in (according to the time of involvement in the pathological process):

• Lungs
• Liver
• Bones
• Gastrointestinal tract

At this stage, symptoms of metastatic melanoma appear, which depend on the damage to a particular organ. At stage 4, melanoma has a very unfavorable prognosis, the effectiveness of treatment is only 10%.

What does melanoma look like - photo

Malignant melanoma is not always characterized by dark pigmentation. Because of this, it is often difficult to make a correct diagnosis.	Photographs taken at some time interval help to assess the degree of tumor growth and changes in the size of the lesion.
Left - Plain Right - Color changes within one element	Left - Smooth edges Right - No clear border
Left - Common mole Right - Change shape, size and color	Left - Normal mole (symmetrical) Right - Melanoma (asymmetric)
A brown or dark line along the nail should be considered malignant melanoma, especially if the edges become uneven and gradually thicken.

Diagnostics

Diagnosing melanoma is quite a difficult task even for an experienced dermatologist. Since characteristic symptoms do not always come first, it is necessary to pay great attention to self-diagnosis and notify the doctor immediately after discovering a suspicious mole or spot. This is especially important if your close relatives have had a similar disease. After an examination, your doctor may order a skin biopsy as well as a lymph node biopsy to confirm the diagnosis. The final diagnosis of melanoma is confirmed only after histological examination of the biopsy specimen. Obtained from a pathological focus.

Early detection of melanoma can save the patient's life. To do this, it is recommended to perform a monthly self-examination to detect skin changes in a timely manner. You don't need any special equipment for this. All you need is a bright lamp, a large mirror, a hand mirror, two chairs and a hairdryer.

• Examine the head and face using one or both mirrors. Use a hair dryer to check the scalp;
• Check the skin of your hands, including your nails. Using mirrors, examine your elbows, shoulders, and armpits;
• Carefully assess the condition of the skin on the neck, chest and torso. For women, it is mandatory to check the skin under the mammary glands;
• Using a mirror, examine your back, buttocks, and the back of your neck, shoulders, and legs;
• Carefully evaluate the condition of the skin on your legs and feet, including your nails. Be sure to examine your knees;
• Using a mirror, inspect the skin on the genitals.

If you find suspicious pigmentation elements, compare them with the photos of melanomas below.

Forecast

The prognosis of the disease depends on the time of detection and the degree of tumor progression. When detected early, most melanomas respond well to treatment.

Melanoma that has grown deeply or has spread to the lymph nodes increases the risk of recurrence after treatment. If the depth of the lesion exceeds 4 mm or there is a lesion in the lymph node, then there is a high probability of metastasis to other organs and tissues. When secondary lesions appear (stages 3 and 4), treatment of melanoma becomes ineffective.

If you have had melanoma and recovered, it is very important to conduct self-examination regularly, since for this category of patients the risk of recurrence of the disease is very high. Melanoma can recur even after several years.

Survival rates for melanoma vary widely depending on the stage of the disease and the treatment provided. In the first stage, cure is most likely. Also, cure can occur in almost all cases of stage 2 melanoma. Patients treated in the first stage have a 95 percent five-year survival rate and 88 percent ten-year survival rate. For the second stage, these figures are 79% and 64%, respectively.

In stages 3 and 4, the cancer has spread to distant organs, resulting in a significantly reduced survival rate. The five-year survival rate of patients with stage 3 melanoma ranges (according to various sources) from 29% to 69%. Ten-year survival is achieved in only 15 percent of patients.

If the disease has progressed to stage 4, then the chance of five-year survival is reduced to 7-19%. There are no 10-year survival statistics for patients with stage 4.

The risk of melanoma recurrence increases in patients with a large tumor thickness, as well as in the presence of ulcerations of melanoma and nearby metastatic skin lesions. Recurrent melanoma can occur either in close proximity to the previous site or at a considerable distance from it.

Despite the fact that this form of cancer looks frightening, the prognosis for its treatment is not always unfavorable. Even if it reoccurs, early treatment leads to cure and ensures long-term survival of patients.

Those who have many moles on their body should wash only with a soft sponge, not a hard washcloth, and especially not rub their back with a brush. Moles that protrude above the surface of the skin are best washed carefully by hand.

MELANOMA- a malignant human tumor that develops from epidermal pigment cells (melanocytes) of both normal skin and birthmarks (nevi). Melanoma makes up about 13% of skin cancers. The cause of melanoma has not been established.

Currently, there is a gradual spread of melanoma among young people and predominantly affects women. Melanoma can occur anywhere. Primary tumors most often appear on the trunk in men and on the lower extremities in women. The tumor usually grows in three directions: above the skin, along its surface and deep, successively growing through the layers of the skin and underlying tissue. The deeper the strands of tumor cells spread, the greater the likelihood of complications. In some cases, the tumor can metastasize through the lymphogenous and hematogenous route. Tumor cells, spreading through the lymphatic vessels, form the first metastases in the regional lymph nodes. Metastasis to the liver, lungs, bones, and brain can occur through the hematogenous route (through blood vessels).

Signs of melanoma may include:

Change in color (decrease or sharp increase in pigmentation - up to black).

Uneven coloring, disturbance or complete absence of skin pattern in the area of ​​the nevus, peeling.

The appearance of an inflammatory areola around the mole (redness in the form of a corolla).

Changing the configuration along the periphery, “blurring” the contour of the nevus.

Increase in the size of the nevus and its compaction.

The appearance at the base of the nevus of nodular small papillomatous elements with foci of necrosis.

Itching, burning, tingling and tension in the mole area;

The appearance of cracks, ulcerations, bleeding.

Thus, if a dark, fast-growing formation of irregular shape appears on the skin, or if there is a change in the structure of one of the pigment formations that previously existed, it is necessary to seek advice from dermatologist-oncologist or surgeon-oncologist. Early stage and superficial melanomas usually respond well to treatment. However, sometimes in practice one has to deal with a common process complicated by metastatic damage to internal organs. In such cases, it is necessary to resort to combined treatment, including extensive surgery and long courses of chemotherapy and immunotherapy.

Self-examination easy to do:

Draw an axis mentally through the center of the mole. Normal moles are “divided” into equal halves. Asymmetry is a danger signal.

Examine the contours of the mole - with malignant degeneration, the edges become jagged.

Check to see if the mole changes color: there are no inclusions or veins.

Monitor the size of “suspicious” (especially large moles). Periodically measure their diameter with a ruler and record the readings.

Control any changes: size, volume, texture. If a mole suddenly begins to bleed or becomes painful, consult a doctor immediately!

Once a year, a “technical examination” by an oncodermatologist should also be done by those who have many moles and if they are large. It is advisable to see a doctor even after vacationing in hot regions.

Most often, the degeneration of moles is provoked by insolation (stay in the sun). It is useless to protect moles from the ubiquitous sun's rays with a towel, a Panama hat, and even more so by covering them with a band-aid - the greenhouse effect deals a double blow. Solarium is no less dangerous; it is absolutely contraindicated for those who have many moles on their body.

Comparison of ordinary moles and malignant ones:

Melanoma comes in different shapes, colors and sizes

and can be placed anywhere

And, as you know, a disease is easier to prevent than to treat.

1. Get regular examinations from a dermatologist (if you have regular moles - once a year, if atypical nevi are identified - on the doctor’s recommendation)

2. Do not injure moles and papillomas, do not try to get rid of formations on the skin yourself, since any irritating factor can provoke the growth of tumor cells on a predisposed background.

3. Follow a sun exposure regime (regardless of your skin phototype, time in the open sun is allowed before 10 a.m. and after 5 p.m. using sunscreen).

4. Do not overuse the solarium. Just 20 minutes of tanning in a solarium is equivalent to approximately 4 hours of sun exposure. In the absence of medical contraindications, it is recommended to sunbathe no more than once a week, being sure to protect your eyes, hair and mammary glands.

Cotton clothing blocks the sun's rays by only 20%. Polyester provides the greatest protection from the sun. Darker clothing provides better protection from the sun's rays than light-colored clothing, and knitted clothing provides better protection than fabric clothing. Two-layer materials almost double their protective properties, while for wet fabric they are reduced by a third. In hot weather, it is better to wear loose clothing made of thick fabric. The folds of such clothing provide a double layer of material, almost doubling its sun protection capabilities. But the best protection from the bright sun is to stay in the shade.

Main risk factors for melanoma– this is light skin (I - II phototypes), a tendency to freckles, numerous moles, melanoma in close relatives, severe sunburn suffered in childhood (one or more), age (over 30 years), exposure to strong solar radiation for many years, changes in the structure of nevi.

If a dark, fast-growing formation of irregular shape appears on the skin, or if there is a change in the structure of one of the pigment formations that previously existed, you should seek advice from dermatologist-oncologist or surgeon-oncologist. Early stage and superficial melanomas usually respond well to treatment.

P.S. a real example of dealing with this problem can be seen in.

MELANOMA

Melanoma is a malignant tumor(cancer) originating from epithelial cells of the skin. Melanoma is the most aggressive of all known malignant tumors; it quickly forms metastases, after which it is considered practically incurable.

At the same time, it is easier to prevent the development of melanoma than other types of cancer. To do this, you just need to carefully monitor moles and age spots on the skin and know what signs you can use to identify melanoma. What is melanoma, which groups of people are at risk of developing this type of skin cancer, and how can melanoma be recognized in the early stages of its development?

What is melanoma

Melanoma is a particularly aggressive type of skin cancer. Typically, melanoma originates from skin cells that produce the pigment that colors tanned skin, birthmarks, or freckles. These cells are called melanocytes, hence the name melanoma.

The incidence of melanoma is about 8 cases per 100 thousand population among men and about 12 cases per 100 thousand population among women. Unlike other forms of cancer (malignant diseases), melanoma most often affects young people (15-40 years old). In the structure of mortality from cancer among women, melanoma ranks second (in first place is cervical cancer), and among men - sixth (after lung cancer, prostate cancer, stomach cancer, colon cancer, pancreatic cancer).

Is melanoma dangerous?

Melanoma is the most aggressive form of cancer known today. This tumor quickly metastasizes (even at very small sizes) which within a few months can affect the main vital organs (brain, lungs, bones). Once metastases are detected, melanoma is considered virtually incurable.

How does melanoma form?

The source of melanoma development are pigment cells that synthesize the biological pigment melanin, which colors the skin and age spots on the skin. There are a lot of such cells (melanocytes) in birthmarks, freckles, and nevi. For early diagnosis of melanoma, it is very important to know the characteristics of the structure and all pigment formations of the skin. Very often, when visiting a doctor, it turns out that the patient does not know what a healthy mole should look like and how it differs from an atypical nevus or a malignant melanoma tumor. Below we give brief descriptions of skin pigment formations:

Freckles– pigment spots of small size, usually round or oval in shape, not protruding above the surface of the skin. Most often, freckles cover the skin of the face, but they can appear on almost the entire surface of the skin. Freckles fade in winter and reappear in spring and summer.

Moles(birthmarks, nevi) - medium-sized pigmented formations (up to 1 cm in diameter), usually dark and evenly colored; however, lightly colored flesh-colored moles are also found. The surface of the mole may only rise slightly above the surface of the skin. The edges of moles are smooth.

Atypical nevi– large pigmented skin formations with uneven edges and uneven coloring. Some atypical nevi can be considered precancerous formations.

Malignant melanoma– a pigmented skin formation that arises from moles or on “clean skin” with uneven edges, a bumpy surface, and uneven color of varying intensity. The edges of melanoma are often surrounded by an inflammatory rim (a bright red stripe).

By what signs can you distinguish melanoma?

Nowadays, to diagnose melanoma, as a form of skin cancer, a number of criteria are used that make it possible to distinguish melanoma from other pigmented skin formations or from benign skin tumors.

The main features that distinguish melanoma This:

1. Rapid growth of a new mole or the beginning of rapid growth of an old mole that has remained unchanged until now.

2. A change in the contour line of an old mole (uneven, broken edges) or the appearance of a new mole with fuzzy edges.

3. Uneven coloring (various shades of brown, black blotches, colorless areas) of a new fast-growing mole, or the appearance of these signs in an old mole.

Additional signs for diagnosing melanoma This:

An increase in the size of the mole is more than 7 mm;

The appearance of a zone of inflammation along the edges of pigmented skin formations;

Bleeding and itching of pigmented skin formations.

When diagnosing melanoma, it is important to take into account the fact that in men this tumor is most often located on the back, and in women on the lower leg. Regardless, all areas of the skin should be checked, including the scalp and nail beds (melanoma may appear as a black spot under the nail).

If these signs are detected, you should immediately consult a dermatologist. The earlier melanoma is detected, the greater the chance of successful treatment.

Types of melanomas .

From a clinical point of view, there are several types of melanoma:

Superficial melanoma This is the most common type of skin cancer. Superficial melanoma is located in the upper layers of the skin, and its surface does not protrude much above the surface of healthy skin. This type of melanoma is most easily confused with a regular mole or an atypical nevus.

Nodular melanoma occurs in a quarter of all patients with melanoma. This is the most aggressive form of skin cancer. Nodular melanoma has the appearance of a dark-colored nodule of various sizes, raised above the surface of the skin.

Lentigo melanoma– found on the head and neck of older people. The surface of this tumor is slightly raised above the surface of the skin.

Subungual melanoma occurs in every tenth patient with melanoma. Most often, the tumor forms under the nails of the big toes.

What is the Breslow index?

The Breslow index (Breslow thickness) determines the thickness to which melanoma cells have penetrated deep into the skin. The Breslow index is determined during histological examination of a tissue sample taken from the suspected tumor. If the Breslow index value is less than 0.5 mm, then the tumor is not malignant and it is not necessary to remove the pigment spot. If the Breslow index is more than 0.5 mm, the patient must be referred to a dermatologist for removal of the formation.

Who is at risk of getting melanoma?

There is now a proven connection between various types of skin cancer and solar radiation. This principle also applies to melanoma. Solar radiation is the main cause of the development of this type of tumor. In some people, however, the sensitivity of the skin to solar radiation is higher due to the presence of certain predisposing factors: a large number of freckles on the body, the presence of benign skin tumors, the presence of atypical nevi, light skin sensitive to the sun, working in open sunlight.

How to protect yourself from melanoma?

Because melanoma is extremely dangerous, people who are at high risk of developing the disease (such as people who spend a lot of time outdoors) are advised to take certain precautions to prevent melanoma and other skin cancers. To protect yourself from skin cancer:

Try to limit your time in the sun as much as possible, especially during lunch hours. If sun exposure is unavoidable, protect exposed skin from direct sunlight: wear a long-sleeved T-shirt, a wide-brimmed hat, and pants.

When exposed to direct sunlight, be sure to use sunscreen. The protection factor of the cream must be at least 15.

Learn all the major and minor signs of melanoma and, if possible, discuss them with your doctor. Make sure you know exactly what melanoma can look like and how to distinguish it from a regular mole.

Check the entire surface of your skin regularly. Your back and scalp should be examined by a friend or relative.

Consult a doctor if you notice any skin element that makes you suspicious.

Melanoma and other skin cancers

In addition to melanoma, there are other types of skin cancer (squamous cell skin cancer, basal cell carcinoma), however, unlike melanoma, they are much less aggressive and are more treatable.

Basal cell carcinoma or squamous cell carcinoma of the skin appears as a long-term non-healing crack or wound, which is usually located on the face, neck, or back of the hand.

Treatment of melanoma and other skin cancers

The type of treatment for melanoma and its effectiveness depends on the stage of its development. The earlier melanoma is detected, the greater the chance of a full recovery. If the diagnosis of melanoma or another form of skin cancer is confirmed, surgical removal of the tumor is performed. Usually the operation is performed under local anesthesia. The surgical intervention itself does not pose any danger to the patient.

In some cases, surgical treatment is combined with radiotherapy and chemotherapy. The appearance of metastases significantly reduces the patient’s chances of survival, however, recently there have been reports of the invention of new ways to combat cancer, in particular melanoma, for example, using monoclonal antibodies that can defeat the disease even at the stage of metastasis.

Bibliography:

1. Anisimov V.V. Skin melanoma, Russian Academy of Sciences, Institute of Oncology named after N.N. Petrov St. Petersburg. : Science, 1995-

2. G.K. Pavlovna Malignant melanoma and previous skin changes, Nauk.dumka, 1991

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TREATMENT of melanomas

Melanoma (melanoblastoma) is a malignant pigmented tumor that is characterized by great diversity and aggressive growth. In most cases, the problem begins with a mole (nevus), which, under the influence of the sun, radiation, injury and other irritating factors, begins to grow and change. Signs of a mole degenerating into a malignant tumor include: hair loss and disappearance of the skin pattern on its surface, peeling, inflammation, change in color and contour, burning, itching, weeping. The occurrence of small nodular elements with necrosis nodules at the base of the nevus is especially dangerous.

It is necessary to regularly examine suspicious moles, especially large ones (10-15 mm) that are dark brown or black in color. Congenital nevi often degenerate into cancer and are much more dangerous than acquired ones. If such changes are detected, you should immediately consult a doctor. If there is an ulcerated surface of the tumor, only impression smears are taken for cytological examination. If the rotting nevus is covered with crusts, then you can apply a napkin with lard on top until a smear is taken. When you remove the napkin in the place with pork fat, the outer crusts are easily removed. Taking a biopsy and curettage (scraping) of a nevus with intact skin is strictly contraindicated!

Treatment

The main method of treating melanoma is wide excision of the tumor, 1.5–3 cm from the edge of the tumor. They try to perform the operation under general anesthesia, since local anesthesia can promote tumor growth and metastasis. The determining factor in the prognosis of tumor treatment is not only the enlargement of the lymph nodes, but also the degree of their penetration. There are five stages of invasion (penetration), with 4 and 5 considered the most dangerous in terms of the spread of the disease, because in this case, the growth in depth can reach 4 mm or more. In older people, the primary tumor more often ulcerates, and non-pigmented or weakly pigmented melanomas of the skin, bright red or pink in color, can also form. These types of tumors, as well as tumors with ulcerations, are considered very aggressive and have a poor prognosis. Therefore, older people need to protect their face and feet from the sun, i.e. places where melanomas are more likely to occur after 60 years of age and older.

To dry reduce inflammation and ulceration of the tumor at the initial stage, in the first days you can apply the mole externally apply yarrow and plantain leaves (1:1) and juice from these leaves.

It is better to apply the leaves for 3-4 hours, then you should replace the raw material with fresh ones, without heavily bandaging the sore spot.

The best therapeutic results are obtained with a complex ointment.

Mix in a glass jar: 3 parts crushed poplar buds, 2 parts crushed pomegranate peels, 3 parts incense powder, 2 parts finely ground madder root, 2 parts hot red pepper (chili) powder. Pour 70% alcohol on top so that it covers all the ingredients well, with a small margin. Leave for 2 weeks in a warm place, shaking occasionally.

Attention: madder roots must be fresh, as they quickly lose their medicinal properties (the shelf life of the raw materials is no more than 3 months). This tincture is anti-cancer and can be used independently for wetting and applying napkins to the tumor.

You can mix this tincture with some fatty cream 1:1 and you will get an anti-cancer cream for nevi and open cancer ulcers.

In the initial stages, you can get rid of a festering mole by additionally lubricating the nevus Colchicum oil, as if burning it out.

Colchicum splendid oil is prepared at the rate of 10 g of colchicum seeds per 200 ml of vegetable oil (preferably corn). Leave in a dark place for 20 days, shaking occasionally. Keep refrigerated.

It must be remembered that the cream acts on the external tumor and is effective in treating only the external tumor (stage 1-2), and to remove possible metastases you need to add a tincture of Djungarian aconite with herbs (see below).

Let me remind you that melanoma metastasizes very quickly and therefore you should not calm down, hoping that surgical removal of the tumor will cure you. The primary focus of melanoma increases over time, and metastases spread throughout the circulatory and lymphatic systems. It must be said that the movement of metastases through the bloodstream is the fastest way for melanoma to penetrate internal organs. In this regard, the standard procedure for removing the “sentinel” node (the first enlarged lymph node) in oncology not only does not bring a therapeutic result, but, on the contrary, only enhances their growth. Excision of the primary tumor gives results only at the very initial stage, while in practice, metastasis is often observed within 4-6 months.

Melanoma is insidious and very resistant to most types of chemotherapy drugs. At the moment, the use of any type of therapy (chemo-, radiation, immuno-) poorly improves the condition of patients and practically does not prolong their life. The use of complex combined methods of treating patients with metastases has a temporary effect of reducing tumors by no more than 20-30%.

ethnoscience

It is known that any large-scale process in the body suppresses the immune system, and negative manifestations (stress, surgery, chemotherapy, sudden climate change, etc.), plus everything else, also provoke a large release of adrenal hormones that stimulate the growth of cancer cells. Don't forget about this, especially if you are having surgery to remove a nevus. In this situation, traditional medicine first of all recommends taking natural adaptogens: ginseng tincture or rosea radiola tincture(pharmaceuticals) 20-25 drops, Eleutherococcus tincture 30-35 drops 3 times a day with ¼ glass of water.

Let me remind you that the full effect of the tinctures begins only 7-8 days after the start of use. Any of the tinctures can be taken for about 2 months, then you should change to another.

Cancer patients should constantly take natural adaptogens, as they also have an anti-cancer effect. After burning out the nevus with colchicum oil, it is better to start taking lemongrass tinctures 30 drops 3 times a day for a month.

And immediately after surgery to remove a nevus, it is better to take it for 3-4 weeks Leuzea extract(liquid) 20-25 drops 3 times a day.

Has proven itself well tincture of aconite Djungarian as an anti-metastasis agent. Together with aconite, a whole complex of anti-cancer herbs is used, which not only supports the functioning of internal organs and systems, but also helps aconite work even stronger. The effectiveness of such a complex at stage 3 melanoma can reach 60-70%.

Let me give you an example of such a complex.

Tincture of Djungarian aconite.

The tincture is taken according to the standard “slide” method: from 1 drop to 10 and back, 3 times a day before meals, 60-90 minutes. Drop into 1/3 cup of whey at room temperature. After performing the “slide”, take a 7-day break to cleanse the body. Tincture of Djungarian aconite is prepared from the ratio of 20 g of dry crushed root per 1 liter of 70% alcohol. Leave for 3 weeks in a dark place, shaking occasionally. Accustoming to the tincture begins after 12-14 months.

Tincture of catharanthus rosea(prepared from fresh raw materials).

Fill a glass jar loosely with fresh catharanthus herb and fill it with 70% alcohol, leave for 2 weeks in the sun. The drug is quite toxic to the liver, so the dosage is selected based on the patient’s condition. Usually take 15 drops of tincture 3 times a day, gradually reaching this dosage. Take 2-3 months, then take a one-month break. Well-crushed fresh catharanthus root, mixed with melted lard in a ratio of 1:10, is an excellent remedy for the treatment of purulent cancer ulcers.

ASD fraction-2, is used in small doses as a means of enhancing the effect of herbs and stimulating the defenses. Take 30 minutes after taking tincture of aconite jungaris or tincture of catharanthus rosea. Reception begins with 3 to 15 drops 3 times a day with ¼ glass of water. Stop at 15 drops and drink until there is a break in the regimen of taking aconite. In this case, abruptly stop taking it (do not go downstairs!), take a break for 7 days, just like a break from aconite tincture. Then start taking aconite with 1 drop, and ASD with 3 drops 3 times a day. If lightheadedness or nausea occurs when taking ASD, then ASD can be dripped into 1/3 cup of kefir, without washing it down with water!

Belog foot tincture o on dry red wine, used more often for metastases to the lungs (the most common site of melanoma metastases), brain, liver, heart. Metastases in the heart often lead to arrhythmias and myocardial rupture. One can note the versatile positive effects of the foot tincture on the entire body, along with an anti-cancer and analgesic effect.

2 tbsp. spoons of crushed dry root of the foot, pour 0.7 liters of dry red wine, leave for 2 weeks in a glass container, shaking occasionally. Then place in a water bath for 15-20 minutes. Leave for another 3 days. Store at room temperature in a dark place. Take 3 tbsp 15 minutes before meals. spoons 3 times a day.

A mixture of different types of bark: elm, aspen, black elderberry, taken in a ratio of 2:2:1, is used in advanced stages of melanoma as an anticancer, anti-inflammatory, improves circulation, restores the mucous membranes of the gastrointestinal tract, anti-edematous, antiviral, antifungal agent.

It is better to collect bark from young trees by scraping off the top cork layer with a knife, cutting off the rest of the inner bark down to the wood itself. Finely chop the raw materials and dry in the sun. Brew at the rate of 2 tbsp. spoons of the collection per 0.5 liters of boiling water, simmer over low heat or a water bath for 15-20 minutes, leave until cool. Add 3 teaspoons of honey and store in the refrigerator. Take ¼ cup 3 times a day, 30 minutes after meals.

Aloe juice(pharmaceutical preparation) - enhances the effect of aconite on melanoma metastases. Take 1 teaspoon 3 times a day, on the days of taking Djungarian aconite tincture.

Turmeric Root Powder(sold in stores and at the market). It is used as an anticancer agent that enhances the effect of aconite, improving the condition of patients, especially in advanced stages of melanoma. Can be taken for a long time. Stir 1 teaspoon of turmeric powder into ½ cup of warm whey. Take 3 times a day 20 minutes after taking Djungarian aconite.

Collection of roots: burdock, bergenia, angelica, licorice, Baikal skullcap, rhubarb. Mix the roots in equal quantities, brew in a ratio of 2 tbsp. spoons per 0.5 liters of boiling water, simmer over low heat for 30 minutes, strain while warm. Take 1/3 cup 3 times a day.

If a person has a tendency to form nevi, then as they grow older their number may increase, reaching a maximum by the age of 30. Nevi can continue to grow further, especially in people who suddenly found themselves in an unusual climate and did not cover their bodies from the scorching rays of the sun. For residents of most regions of Russia, frequent trips to hot countries, especially during the cold season, are associated with a high risk of burns and the development of melanoma. It is known that the skin does not forgive burns. The risk group includes people with fair skin, blond and red hair, pregnant women, and those with more than two sunburns, especially if they were suffered in childhood and adolescence. Such people should not only constantly stay in the shade, but also regularly use sunscreen.

Natural antioxidants

Scientific medicine says that drinking one or two cups of coffee a day reduces the risk of skin cancer. It is also recommended to drink green tea and apply it to the skin. I personally recommend that when vacationing in hot countries, you often eat local fruits and vegetables in large quantities: pineapples, mangoes, papaya, passion fruit, grapes (chew along with the seeds), tangerines, prunes, red beans, eggplants, etc. Fruits grown in hot climates, are intended for people in this climate, and these are natural antioxidants that protect not only the skin, but the entire body from free radicals formed during insolation (lighting from the sun's rays). Here we can also mention aggressive tanning beds, which cause melanoma much faster than natural sun. It’s not for nothing that solariums are banned in most developed countries. I strongly recommend avoiding animal fats, red meat and egg yolks, because... they contain arachidonic acid, which stimulates aggressive metastasis of melanoma.

In addition, it is better in advance, before traveling to the south, to start taking vitamin D3 450 IU per day for 2-3 months or calcitriol 0.00025 mg per day. This will restore the functions of lymphocytes and macrophages in case of immunodeficiency caused by a lack of vitamin D production, and will reduce the likelihood of melanoma.

In conclusion, I would like to note the possibility of maintaining health with the help of immunotherapy, because scientific medicine has long established a direct connection between patient survival and immunity, and practicing oncologists have changed their attitude towards immunorehabilitation from sharply negative to interested. Scientific research in relation to melanoma has so far only made it possible to restrain its development by 10-30%. The most effective immunodrug turned out to be IL-2 ( roncoleukin), which can be used either independently or in combination with reaferon(IFα), the treatment regimen is selected individually.

Mood: alarming

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

general description

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

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

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

Melanoma is predominantly concentrated in the area of ​​the trunk and limbs in people whose skin type is Eastern European. Signs of melanoma are generally observed in patients with fair or red hair, green, gray or blue eyes, as well as pink freckles. In addition to the genotype, the presence of atypical moles and nevi (congenital pigment spots) are identified as predisposing factors. In particular, nevi become a predisposing background to the development of melanoma when they are repeatedly injured, as well as when they are located in the back, foot, shoulder girdle and open areas of the body. Much more dangerous are those melanomas that develop against the background of acquired pigmentation, that is, when spots appear in patients of the mature age group. Exposure to ultraviolet radiation, Dubreuil's melanosis, heredity and xeroderma pigmentosum, the presence of more than 50 moles, a significant number of freckles (including their rapid formation) are also considered risk factors.

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

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

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

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

An inherently insidious manifestation of melanoma is the early formation of metastases, which occurs in certain organs in the body, which can subsequently lead to death for the patient. Most often, the heart, skin, lungs, liver, brain and skeletal bones are affected by metastases. Melanomas that have not spread beyond the basement membrane in the skin cells (that is, the layer located between the epidermis layer and the dermis layer) determine the practical elimination of the risk of metastases.

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

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

Skin melanoma: symptoms

Before we move on to a more detailed consideration of the processes and symptoms accompanying the course of the disease, we will highlight the main signs of melanoma that make it possible to recognize it early, there are five in total:

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

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

Externally, melanoma resembles a dense tumor nodule; its color can be black or slate, in some cases with a bluish tint. Pigmentless melanomas are formed somewhat less frequently; according to the definition, it can be understood that they are devoid of pigment and have a pinkish tint. Regarding the size, a diameter in the range of 0.5-3 cm can be distinguished. In frequent cases, the tumor formation has a bleeding, eroded surface and a somewhat compacted base. Any of the listed signs allow you to make an initial independent diagnosis through a routine examination (but this requires the use of a magnifying glass).

During the early stages of the disease, the malignant formation is outwardly more harmless than in further stages, therefore it can be distinguished from a benign pigmented nevus only with sufficient experience.

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

Lentigo maligna characterized by the duration of the phase of its own horizontal growth, determined in a time interval ranging from 5 to 20 years, and in some cases more. Typical cases of the disease are observed in elderly people in the area of ​​open areas of the skin of the neck and face, on which plaques or brown-black spots appear.

Superficially widespread melanoma develops in patients of a younger age group (in this case, their age is on average 44 years). As for the area of ​​​​development of tumor formation, the same frequency of its appearance is noted both in open areas of the skin and in closed areas. In women, the lower extremities are mainly affected, and in men, the upper back. The developing plaque has an irregular configuration, the contour is scalloped, there are areas of discoloration and regression, the color is mosaic, and keratosis appears on the surface (a condition of thickening of the epidermal layer). After a few years (about 4-5), a node forms on the plaque, which indicates a transition of the process from horizontal to vertical growth.

Melanoma nodular acts as the most aggressive variant of tumor development in terms of the type of manifestation. The average age of patients exposed to this type of education is 53 years; the ratio according to gender is 60:40 (men/women). Most often, the localization of the process is concentrated in the skin of the back, head and neck, as well as limbs. The node grows quite quickly; patients note such changes in it over a period of several months; the growth is accompanied by the formation of ulcerations and its general bleeding.

A direct consequence of the use of non-radical measures in the treatment of melanoma is its relapse. Such cases are often accompanied by the identification of a distant type of metastasis, which occurs in parallel with the detection of relapse, and sometimes even before its occurrence. Exclusively chemotherapy treatment is used in situations with common forms of the disease, when distant metastases are relevant. In particular, combined treatment options using antitumor drugs are used, which determines the possibility of tumor regression in up to 40% of cases.

Melanoma: metastasis

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

The option cannot be ruled out in which the patient seeks the help of a specialist solely on the basis of actual enlargement of the lymph nodes in any area. Meanwhile, a thorough survey in this case can determine that a certain time ago, for example, he, in order to achieve the appropriate cosmetic effect, removed a wart. This “wart” actually turned out to be melanoma, which was subsequently confirmed by the results of histological examination of the lymph nodes.

Melanoma of the eye: symptoms

Melanoma, in addition to skin lesions, is also a fairly common eye pathology, in which it manifests itself as a primary tumor formation. The main symptoms of ocular melanoma are the appearance of photopsia, progressive scotoma and deterioration of vision.

Photopsia, in particular, is a pathological condition in which flickering sparks, luminous points, “flashes of light” and spots of color appear in the field of vision. As for such a manifestation as scotoma, it is a blind area of ​​​​a limited type that appears in the field of vision; it is subjectively perceived by patients as a dark spot (in this case it is a positive scotoma), or is not perceived at all (negative scotoma). Detection of scotoma in the negative version is possible only through special research techniques.

Often small melanoma makes it difficult to differentiate from a pigmented nevus, concentrated in the area of ​​the choroid.

To determine the growth of a tumor formation, repeated studies are necessary. As for generally accepted treatment tactics, there is no such treatment for ocular melanoma. Ocular enucleation and local resection are performed, as well as radiation therapy.

Melanoma: stages

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

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

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

Next, Stage III , is accompanied by damage to nearby tissues by a pathological process; in addition, the study reveals the presence of tumor cells in one lymph node or in a greater number of them; the affected lymph nodes are also located in close proximity to the affected area of ​​the skin. The possibility of melanoma cells spreading beyond the boundaries of the primary lesion cannot be ruled out, but the lymph nodes are not affected.

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

As we have already noted, relapses of the disease cannot be ruled out even with correctly defined and administered treatment. A pathological process can return either to an area that was previously damaged or to form in a part of the body that was not related to the previous course of the process.

Melanoma: prognosis by stage

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

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

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

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

In general, the prognosis directly depends on where exactly the tumor is located. Thus, the most favorable prognosis is determined when the tumor formation is localized in the area of ​​the legs and forearms; an unfavorable prognosis, in turn, is determined when it is localized in the area of ​​the feet, hands, scalp, and mucous membranes.

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

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

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

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

Melanoma of stages I and II can also be predicted in its course by using another method - the method of comparing Clark's histological criteria. I level of invasion in accordance with the system of Clark criteria determines the location of the tumor formation within the layer of the epidermis, II level of invasion indicates tumor germination into the dermis (papillary layer), III level determines whether the tumor has reached the border between the reticular and papillary layers of the dermis, IV indicates its germination into the reticular layer, V determines its penetration directly into the subcutaneous tissue. According to each of the listed levels, survival rate is 100 and 95%, 82 and 71%, and 49% (for the last option).

Diagnosis

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

Taking into account these conditions, the only method for clarifying the diagnosis is a cytological examination, in which the imprint from the surface of the tumor is studied in the case of actual ulceration. Other cases of the pathological process involve diagnosing the disease only on the basis of clinical manifestations.

When collecting an anamnesis, special interest is aimed at symptoms characteristic of metastases (general malaise, joint pain, blurred vision, headache, weight loss). Additionally, the use of methods such as ultrasound, CT and radiography allows you to exclude or confirm the presence of metastases to internal organs. Having completed a general examination to determine the relevance of melanoma, we move on to determining its stage and appropriate treatment.

Treatment of melanoma

In the treatment of melanomas, two types of methods are used: only a surgical method and a combined method. The combined method is considered to be the most justified, because after irradiation the tumor formation is removed ablastically. As part of the first stage of this treatment, the method of close-focus X-ray exposure to the tumor is used, after which, until the onset of the radiation reaction (2-3 days after completion of the exposure) or after it subsides, its wide-band excision is performed, capturing several centimeters of healthy skin. The wound defect that occurs in this case is subject to skin grafting.

Considering that malignant melanoma is characterized by its rapid transition to metastasis to nearby lymph nodes, it is necessary to remove regional lymph nodes even in the absence of their enlargement as such. If the lymph nodes are enlarged and there is a suspicion of metastasis, then they are pre-irradiated through the use of remote measures such as gamma therapy. In recent years, an integrated approach to treatment has been used quite often, based on the addition of radiation and surgery to chemotherapy procedures.

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

Myopia is a pathological condition, with the progression of which the sick person begins to have difficulty distinguishing objects located far from him. He can hardly read signs, make out license plates, and may not even recognize his friend from a distance of several meters. Medical statistics are such that myopia is the most common visual impairment, which occurs in both adults and children (children's myopia is not uncommon). This disease can progress and have varying degrees of severity.