Malignant Melanoma

Melanoma is a skin cancer that develops in the pigment-producing skin cells (melanocytes).

• Melanomas can develop on normal skin or in existing birthmarks .
• They can appear as irregular, flat or raised brown skin spots with dots of different colors or as solid, black or gray knots.
• A biopsy is performed to diagnose melanoma.
• Melanomas are removed.
• If you have sprinkled, chemotherapy and radiation therapy are used. However, healing is difficult.

(See also skin cancer – an overview .)

Melanocytes are the pigment-producing cells that give the skin its typical color. Sunlight stimulates them to produce more melanin (the pigment that tans the skin); this stimulation increases the risk of melanoma.

Every year, more than 76,000 people are diagnosed with melanoma in the United States, and about 10,000 people die from it. Although melanoma accounts for less than 5% of all skin cancer cases diagnosed in the United States, it causes most skin cancer- related deaths. One person dies of melanoma every hour in the United States.

Melanoma initially manifests itself as a new, small, pigmented growth on normal skin, mostly in areas that are exposed to the sun. About one in three melanomas develops from an existing birthmark . Melanomas can also occur on and inside the eyes, mouth, genitals and rectal areas, as well as in the brain and nail beds.

Melanomas like to spread to distant parts of the body (metastasize), where they continue to grow and destroy tissue.

The two most common types of melanoma are:

• Superficial spreading melanoma, which accounts for about 70% of melanoma cases. It mainly occurs on the legs of women and the torso of men and usually has mutations in the BRAF gene.
• Nodular melanoma, which accounts for about 15 to 30% of melanoma cases. It can appear anywhere on the body and grows quickly.

risk factors

Risk factors for melanoma include:

• Sun exposure (mainly repeated blistering sunburns)
• Repeated tanning with UV-A radiation or treatment with psoralen and UV-A radiation (PUVA)
• Skin cancer (other melanoma or skin cancer)
• Melanoma in family members
• Light skin, freckles
• Large number of atypical birthmarks (especially if there are more than 5) or pigmented birthmarks (especially if there are more than 20; depending on the family history)
• Weakened immune system

People who have previously had melanoma are at greater risk of developing melanoma again.

Melanomas are less common in dark-skinned people. If melanomas nevertheless occur in dark-skinned people, these often arise in the nail beds, on the palms of the hands and the soles of the feet.

Melanomas are very rare in children.

Although melanoma can occur during pregnancy, pregnancy does not increase the likelihood that a birthmark will develop melanoma. Birthmarks often change size or become darker during pregnancy. Pregnant women should know the melanoma ABCDE so that they can examine their birthmarks for malignant (cancerous) changes.

symptoms

Melanomas can vary in appearance. Some are flat, irregular, brown spots with little black dots in them. Others appear as raised spots with red, white, black, or blue dots. Sometimes melanoma also appears as a solid red, black, or brown lump.

Less than 10% of melanomas do not produce pigments. These so-called amelanotic melanomas can be pink, red or slightly light brown and look like benign growths or a form of white skin cancer.Superficial melanoma that spreads

DR.’S PICTURE MED. GREGORY L. WELLS.melanoma

PHOTO COURTESY OF GREGORY L. WELLS, MD.

diagnosis

• biopsy

A new birthmark or changes in a birthmark – such as enlargement (especially with irregular margins), darkening, inflammation, occasional color changes, bleeding, itching, tenderness and pain – as well as the ABCDE of the melanoma can be warning signs of a possible melanoma. If these or other findings suspect melanoma, the doctor will perform a biopsy.

If the growth is small, the biopsy is completely removed. If the growth is large, only a part is removed. The tissue is then examined under the microscope to determine whether it is melanoma and, if so, whether the entire tumor has been removed. If the biopsy confirms that the tissue is melanoma and has not been completely removed, it will be removed completely.

Most dark pigmented growths that are removed for a biopsy are not melanomas, but rather simple birthmarks . Nevertheless, the removal of harmless birthmarks is preferable to the growth of a single tumor. Some growths are neither simple birthmarks nor melanomas, but something in between. These atypical males (dysplastic nevi) sometimes turn into melanoma later. Additional tools are available to doctors to distinguish a striking mark from melanoma. These include polarized light and dermatoscopy, which are helpful in determining the mark more precisely.

The ABCDE of melanoma

forecast

Melanomas can spread quickly and lead to death within a few months of diagnosis. The less a melanoma has grown into the skin, the greater the likelihood that it can be removed completely by surgery. Almost 100% of the flattest melanomas that are discovered in the early stages are treated by surgery. However, with melanoma that is deeper than overgrowth into the skin, the risk of metastasis to the lymph nodes and blood vessels is higher.

Once melanoma has metastasized to the lymph nodes, survival rates for the next 5 years will vary between 25 to 70%, depending on the degree of ulcer formation and the number of nodes affected.

If melanoma has metastasized to distant areas of the body, the survival rate is only 10% for the next 5 years. Some people live less than 9 months. However, the course of the disease is very different and is partly dependent on the strength of the body’s immune system. Some people survive for several years with apparently good health despite the spread of melanoma.

prevention

Since melanomas are often caused by long stays in the sun , the following measures can be taken to prevent them from early childhood:

• Avoid sun : stay between 10 and 16 O’clock (when the sun’s radiation is strongest) in the shade and restrict activities in the sun, avoid sunbathing and solariums (especially adolescents and young adults).
• Wear protective clothing : For example, long-sleeved shirts, pants and wide-brimmed hats.
• Use of sunscreens : Use a sunscreen with at least sun protection factor (SPF) 30 and UV-A and UV-B protection according to the instructions for use. Reapply every 2 hours and after swimming or sweating, but not to stay in the sun longer.

However, it has not been clearly established that these measures reduce the likelihood of developing melanoma and dying from it. However, these measures reduce well the risk of certain other cancers of the skin to develop ( basal cell carcinoma or squamous cell carcinoma ).

Someone who has had melanoma is at risk of getting melanoma again. Therefore, such people have to undergo regular skin examinations. If you have a lot of birthmarks or liver spots, you should have your skin examined at least once a year. Affected people can be trained to examine themselves , identify changes in existing birthmarks , and identify characteristics that indicate melanoma . For people without risk factors, it is unclear whether routine skin examinations would reduce the number of melanoma-related deaths.

treatment

• Removal of the tumor
• If necessary, imiquimod , cryotherapy or radiation therapy
• For tumors that have spread, immunotherapy, targeted therapy or radiation therapy

Melanomas are treated by cutting them out (sometimes using a method called microscopic surgery according to Mohs ), with a one-centimeter margin around the tumor being removed.

In people who have very flat melanomas (i.e. the melanomas have not yet affected the skin beyond the epidermis – called melanoma in situ) and for whom surgery is not an option (e.g. due to poor general condition) or who are If you decide against this (e.g. because your melanoma is located in cosmetically important areas), doctors can treat it with imiquimod cream or destroy the melanoma by freezing (cryosurgery).

Scattering melanoma

When melanoma has spread to different areas, surgery is usually not an option, but certain areas affected by cancer (such as the affected lymph nodes) can sometimes be surgically removed.

Chemotherapy is used to treat scattered melanoma, but healing may not be possible.

The new immunotherapy pembrolizumab and nivolumabare administered to support the body’s immune system in destroying the tumor. These medicines are called PD-1 inhibitors because they block the action of a protein on the surface of cancer cells called “programmed cell death protein 1”. This protein protects the cancer cells from the effects of the immune system. When PD-1 inhibitors block the protein, the immune system can attack and destroy the cancer cells. PD-1 inhibitors have been shown to be very effective in treating metastatic melanoma. Iipilimumab is another immunotherapeutic that supports the activation of certain white blood cells that attack cancer cells and thereby improve survival.

Other newer drugs that increase the likelihood of survival in spreading melanoma are dabrafenib and vemurafenib . These drugs can often attack the actual tumor cells more precisely than older chemotherapy drugs. They do this by recognizing abnormal genes that are only present in cancer cells. This is called targeted therapy.

Radiation therapy can be used in people whose cancer has spread to the brain.

Other treatments are still being researched, including other drugs and vaccines that stimulate the body to attack melanoma cells.