What is melanoma? Melanoma symptoms, causes, types, stages, diagnosis. Internal and external risk factors

The first mentions of melanoma in history begin in the 17th century, when the first doctors began to talk about strange growths on the skin, which subsequently grew and led to quick death.

Scientists have noticed that in this century this disease has become more common in many patients, and every year the number of those diagnosed is increasing. Perhaps this is due to the polluted environment and the destruction of the ozone layer, or perhaps due to the rhythm of life of modern people.

Definition

What is skin melanoma? Melanoma (melanoblastoma) is a malignant neoplasm that develops from melanocyte cells that produce melanin. The disease develops rapidly and is aggressive towards nearby tissues and lymph nodes.

Found on covers:

Skin (the most common form).
In the oral cavity.
Larynx.
Mucous membrane of a diseased eye.
Leather ear canal.
Female internal genital organs - body, cervix.

If we take skin oncology, it is men and older women who suffer more often due to hormonal effects. In this case, mostly young people from 15 to 40 years old suffer. Girls, not men, are more often susceptible to the disease.

The danger of the most malignant disease is precisely that, despite the fact that cancer develops on the outside of the body, the tumor is disguised as ordinary pigment spots or birthmarks that a person has had for a long time. Therefore, he practically does not notice anything at the very beginning.

At the same time, the cancer itself is the most aggressive and fastest. In one year, it can fully develop and damage nearby tissues and mucous membranes, as well as metastasize to the nearest lymph nodes, and after a short time to all organs through the blood.

Why is melanoma dangerous? It is dangerous due to rapid damage to nearby tissues and metastases to nearby organs - when cancer tissue begins to spread to other parts and grow there. At the same time, the tumor itself interferes with the functioning of the organ and releases waste products into the blood, which also poison the person.

Causes

Like other types of cancer, melanoma occurs when healthy cells mutate under the influence of external and sometimes internal factors. Then the structure of the DNA at the chromosomal level changes and the cells begin to change. In this case, the cell loses its program configured by the body and begins to endlessly divide and multiply.

Most often, it is the causes and risk factors of an exogenous nature that influence, and the endogenous, in turn, can simply feed the neoplasm itself and worsen the condition. Let's consider all the risk factors for the development of malignancy.

External factors

Every day our skin protects us from all types of influences, from chemical, biological and other attacks. Therefore, when protecting, the skin itself can become damaged and hurt. It is from this that internal changes in tissues can occur. skin.

Ultra-violet rays. A person not involved in medicine has probably heard that you should not stay in the sun for a long time, and it is especially dangerous to do this without sunscreen. Many scientists argue that exposure to sunlight and ultraviolet radiation affects skin cells. Because of which tissues can mutate and turn into cancer. The more intense and powerful the radiation, the greater the likelihood of pathology. Doctors point to a historical factor, when a child could have severe sunburn in childhood, and get the disease in adulthood after a long time.
Radiation is one of the most common reasons any oncology. All types of rays when exposed to radiation cause changes at the molecular level and change chromosomes in DNA.
Electromagnetic radiation. People who work more often in the electronics industry and related to these factors are more likely to get melanoma than others.
Injuries and wounds on moles. Doctors have long been keeping statistics that include patients who mechanically damaged their mole, and later it turned into cancer.

Chemical exposure

Workers chemical industry associated with oil and other flammable substances. In the production of rubber, paint, plastic. Any chemical that comes into contact with the skin almost immediately begins to affect the tissue.

Nutrition

This type of cancer is practically no different from others, and people who often consume food of animal origin have a greater risk. Any red meat, as well as animal fats, can contribute to skin cancer.

Doctors recommend eating more berries, vegetables, fresh fruits (Not canned), and various green foods. This may be due to the fact that the large cattle and in pigs cancer- this is a very common occurrence. And they sell exactly this kind of meat to us in stores. However, there is no direct evidence yet that cancerous animal meat causes tumors in humans.

Of course, alcohol and cigarettes also have an impact here. You must understand that all these chemicals have mutagenic properties for cells. And the risk of developing melanoma in an alcoholic and a smoker doubles.

Internal factors

People with red hair often get sick blue eyes, light white skin with freckles. Such people have very little melanin and the risk of getting sick is higher.
Genetic predisposition - gives strong factor for cancer if the mother or more than two immediate relatives were ill in the family. Then the risk of disease is 40-45% higher.
For those who are full, tall people with a large area of skin.
Various hormonal disorders that lead to increased estrogen or melanostimulating hormone lead to an increased chance of getting sick.
Any cancer most often occurs in a weakened body with a poor immune system. Since it is she who first begins to destroy mutant cells.

Birthmarks

Most often, cancer occurs and grows directly from a mole or so-called birthmark. In general, almost every inhabitant of the planet has this benign formation and is located everywhere on the body.

The most dangerous moles:

Dubreuil's melanosis is a mole that has a curved shape and non-rounded features; every year the mole itself grows and increases in size.
Very dark, even black in color with a large size of 1.5 cm.
When there are a large number of dark-colored moles on the body.

Symptoms

Since cancer is usually hidden in the tissues of a birthmark or any other benign growth on the skin, the signs in the early stages are quite weak. But we will look at exactly what characteristics moles must have in order to identify cancerous ones.

Normal mole

It has a symmetrical shape.
Smooth and clear outlines.
Even color from yellow to dark brown and black.
The mole is flat and does not have a convexity; it is flush with the skin.
Small size. It can grow, but very slowly over a very long time (several years).

Melanoma

The mole itself has a slight elevation.
Oval or irregular asymmetrical shape and size.
The diameter is greater than 6 mm in diameter.
At the slightest impact, injuries occur and blood flows.
The presence of ulcerations after a short time.
In the area of melanoma pigmentation, an uneven brown color appears and may have a rim of light or, conversely, dark pigment. At the same time, the color does not look like an ordinary mole.
The cancer itself does not always grow from a mole and can appear on a normal area of skin in the form of a pigment spot, which then grows and turns into an ulcer.

What does melanoma look like?

As you can see, the affected area begins to affect the pigment spot or mole itself, which is why it changes its shape and becomes deformed. Pay attention also to the color of moles - it is not uniform and torn at the edges.

Stages

Determining the phase of any cancer is the key to correct prognosis and treatment. The doctor first needs to know what he is dealing with: the size of the tumor, stage, aggressiveness of the cells, as well as the nature of the tumor itself. Let's consider and analyze all the stages of melanoma.

Stage 1

On initial stage Usually the tumor itself does not manifest itself in any way and the course of the disease is asymptomatic. Even with a magnifying glass it is very difficult to recognize it on the surface of the skin in a separate birthmark.

First, stage 0 occurs, when melanoma has the “in situ” stage, or translated as “In place”. The tumor itself is located within the epidermis. Then it grows in size up to 1 mm and enters the initial phase.

Stage 2

The tumor has already grown a little, but still does not go beyond the birthmark. there are no metastases yet, and the formation has not spread to the nearest lymph nodes. Red melanoma has a thickness of 1 to 5 mm. This stage is painless and has no characteristic features bleeding or sudden change in color of the mole.

Stage 3

Education already has quite big sizes, abscesses and bleeding may appear on the nevus of the mole. The doctor takes tissue for a biopsy from the lymph nodes to determine the stage, since it is at the third stage that pigmented melanoma begins to penetrate into nearby tissues and lymph nodes. General health deteriorates greatly, fever, nausea and vomiting may appear.

Stage 4

Caused by metastases to all organs of the body. The lungs are affected first, then the liver, brain, bones and stomach with intestines. At this stage, the main thing for doctors is not to cure the patient, since this is impossible, but to make his life simpler and painless.

How does a mole turn into cancer?

It is this stage of the transition of a benign formation to a malignant one that is determined by the transition of stage 0 to stage 1. If cancer is detected at this stage, then the treatment will pass with great success.

If the mole was flat, and later on it slowly becomes convex. In this case, the formation may simply grow slowly over a short period of time.
The primary lesion may appear darker in color.
When cancer begins to grow in a large mole, you may feel a small lump when you press on it with your finger. The birthmark becomes asymmetrical.
Uniform color changes color. In some places the color changes and a dark spot appears.
The color may become lighter or darker.
In a malignant neoplasm appear discomfort itching, tingling or burning. Melanoma hurts a little.
In later stages, redness appears around the birthmark, which increases over time.
If there was hair in the mole, it will fall out.
At the third, fourth stage, bleeding from the mole appears. The skin nearby peels off, and jams appear.

NOTE! If you notice at least one of the symptoms on your body, you should immediately consult a dermatologist. Additionally, take clinical and biochemical blood tests. All this is necessary to detect cancer at earlier stages.

Diagnostics

First, the doctor performs a visual examination and listens to all the patient’s complaints. At this point, it is better to explain in detail about the mole or formation on the skin that bothers you. The doctor will check other birthmarks and note the most suspicious and dangerous ones.
Next, the patient submits tests, blood and, just in case, stool for examination. Perhaps the doctor will additionally prescribe tests for tumor markers.
Hardware dermatoscopy is performed - when the entire tissue cover around the neoplasm is checked. This way you can see not only the extent of the damage, but also the size of the tumor.
A lymph node puncture is performed to identify stage 3. Sometimes this method helps diagnose cancer, even if it is not visually visible. A tissue sample is taken from the enlarged nodes and tested for biopsy.
If the doctor determines the tumor itself and there are metastases to the nearest lymph nodes, then it is further necessary to determine stage 4, when metastasis occurs to all organs. Ultrasound examination of organs and tissues is performed abdominal cavity, Ultrasound of the head and, spinal cord and radiography
There is another way to detect skin cancer if other research methods are not suitable. The doctor excises part of the skin formation and sends the tissue for histological examination.

Varieties

There are quite a large number of melanomas, and each differs in character and aggressiveness. At the diagnostic stage, it is important for the doctor to find out the type of tumor itself in order to choose further treatment.

View	Description
Achromatic, non-pigmented melanoma	A rather rare type of skin cancer, which in the early stages is practically invisible because it has the same color as the skin. The main symptoms are: peeling and thickening at the site of the tumor, hair loss, and in the last stages ulcers appear. Enough serious disease, which is growing and developing very quickly. Even at stages 2 and 3, there is a small survival rate, since in almost 90% of cases there is a relapse into the skin.
Spindle cell melanoma	It is very difficult to diagnose even on a tissue biopsy, since the cells themselves are very similar to healthy ones. The difference is only in size and shape, and sometimes even in the number of nuclei in the cells. They can be oval, elongated or even binuclear. There is melanoma of the skin of the back, when only loved ones can see and examine it. It is usually diagnosed very late.
Nodular, nodular melanoma	It is a very fast cancer and reaches the last final stage in 1-1.5 years. Quite common in women on the lower extremities.
Subungual melanoma	Melanoma is located on the patient’s leg or arm, in particular on the palms and soles. The tumor itself grows quite slowly and later affects the patient’s nails, making them darker. At the very beginning, the node itself has no color or pigmentation, so it is very difficult to diagnose it. The danger of the disease is that it is detected at a late stage.

Therapy

At stages 1 and 2 of melanoma development, when there are no metastases to organs yet, surgical intervention is mainly used, when the tumor itself is removed along with the affected nearby lymph nodes. Treatment of melanoma in the last stages occurs using immunotherapy and chemotherapy.

Tumor removal

Surgical intervention at the primary stage has a good prognosis. From the skin, 2 to 5 cm of skin tissue is usually removed, along with the fat layer and muscles, and the fiber itself is separated. Afterwards the muscles are bandaged with healthy ends. When lymph nodes are affected cervical region Crail's operation is performed.

It all depends on the stage of the melanoma itself, and the deeper into the forest, the more difficult the operation will be. If cancer cell located on the phalanges of the arm or legs, then the last phalanx is amputated, even at the first stage. If melanoma is on the face, then 1 to 3 centimeters of skin and subcutaneous fat are removed.

The fact is that skin cancer is a very nasty disease in terms of relapses, so they try to remove more - just to be sure! At stage 3, if the nearest lymph nodes are affected, the nearest lymphatic collector of the regional zone is completely removed.

How to treat melanoma at home? Do not do this under any circumstances and do not treat yourself with folk remedies and herbs, as they primarily remove the symptoms, but not the disease. Contact your doctor immediately and act according to his recommendations.

Is melanoma curable or not? It all depends on the type and stage of cancer.

Immuno- and chemotherapy

Chemotherapy can be used both before surgery to reduce the aggressiveness of cutaneous adecorcinoma and shrink the tumor itself, and after it to kill the last lesions and small cancer cells.

Immunotherapy is also used to improve and enhance the patient’s immunity. So that the body cells themselves begin to fight and attack cancerous tissue. Oddly enough, radiotherapy is not effective for this oncology, and malignant melanoma copes well with radiation. But sometimes this method is used before surgery to reduce the tumor itself.

Forecast

Like any cancer, melanoma has a large number of aggressive and non-aggressive types, which can contribute to both a favorable and less favorable prognosis in treatment and recovery.

Of course, early detection of the problem is a big factor, and the earlier, the more favorable the prognosis will be. Often, at stages 1 and 2, the tumor is well treated and quietly removed without severe consequences for the patient.

1st degree cancer is usually associated with a high five-year survival rate of up to 90%.
2 Degree already has a lower chance of up to 65%, since this affects most of the tissues, and there is a risk of relapse.
3 Degree In some species, Melanoma has already metastasized to the nearest tissues of the fatty layer and muscle. Because of this, the operation and subsequent therapy are greatly aggravated. Additionally, some lymph nodes are removed. The percentage varies from 20 to 40.
4 Degree has a low probability of 5 to 15% 5-year survival. If the cancer is very aggressive, then everything depends on the level of treatment. But cancer in advanced stages is usually not curable.

What to do after treatment?

First of all, you need to constantly and regularly undergo examinations, take blood, urine and stool tests. Please contact your oncologist for advice. Sticking to the right diet will help you recover faster, speed up your metabolism, improve and strengthen your immune system, which is the main defender against cancer.

Until about 40 years ago, cutaneous melanoma was a relatively rare disease. However, in recent decades its frequency has increased significantly, and the annual growth rate is up to 5%. Why is melanoma dangerous?

Causes of development and risk factors

Melanoma is one of the types of skin malignant neoplasms, which develops from pigment cells - melanocytes, producing melanins, and is characterized by an aggressive, often unpredictable and variable clinical course.

Its most common localization is the skin, much less often - the mucous membrane of the eyes, nasal cavity, mouth, larynx, skin of the external auditory canal, anus, and female external genitalia. This tumor is one of the most severe forms of cancer, disproportionately affecting young people (15-40 years of age), and ranking 6th among all malignant tumors in men and 2nd in women (after cervical cancer) .

It can develop independently, but more often it is “masked” against the background of birthmarks, which does not cause concern for people and creates significant difficulties for doctors in terms of its earliest possible diagnosis. The way this neoplasm develops quickly and is difficult to detect in the initial stages is another danger that often interferes with timely diagnosis. Within 1 year it spreads (metastasizes) to the lymph nodes, and soon through the lymphatic and blood vessels, to almost all organs - bones, brain, liver, lungs.

Video: The simplest test for skin cancer

Causes

The main modern theory of the occurrence and mechanism of development of melanoma is molecular genetic. In accordance with it, in normal cells DNA damage occurs in the form of gene mutations, changes in the number of genes, chromosomal rearrangements (aberrations), violations of chromosomal integrity, and the DNA enzyme system. Such cells become capable of tumor growth, unlimited reproduction and rapid metastasis.

Such disorders are caused or provoked by damaging risk factors of an exogenous or endogenous nature, as well as their combined effects.

Exogenous risk factors

These include chemical, physical or biological agents external environment that have a direct effect on the skin.

Physical risk factors:

Ultraviolet spectrum of solar radiation. Its connection with the occurrence of melanoma is paradoxical: the latter occurs mainly in areas of the body covered by clothing. This indicates the development of the neoplasm not so much as a result of the direct, but rather the indirect effect of ultraviolet radiation on the body as a whole. In addition, it is not so much the duration that matters, but the intensity of irradiation. IN last years The scientific literature draws attention to especially high danger sunburn- even received in childhood and adolescence, at an older age they can play a significant role in the development of the disease.
Increased background of ionizing radiation.
Electromagnetic radiation - tumor occurs more often among people professionally associated with telecommunications equipment and the electronics industry.
Mechanical trauma to birthmarks, regardless of its frequency, is a high risk. It is not entirely clear whether it is the cause or the trigger, but this factor accompanies 30-85% of melanoma cases.

Chemical factors

They are important mainly among those working in the petrochemical, coal or pharmaceutical industry, as well as in the production of rubber, plastics, vinyl and polyvinyl chloride, aromatic dyes.

Of the biological factors, the most important are:

Nutritional features. High level daily consumption of proteins and fats of animal origin, low consumption of fresh fruits and vegetables with a high content of vitamins “A” and “C” and some other bioactive substances are a risk in terms of the development of superficial spreading and nodular (nodular) forms of melanoma, as well as tumors unclassifiable type of growth.
With regard to the systematic consumption of alcoholic beverages, it is theoretically assumed that they can provoke the growth of melanomas, but there is no practical evidence of this. It has been precisely proven that there is no connection between the consumption of drinks containing caffeine (strong tea, coffee) and malignant neoplasms. Therefore, nutrition for skin melanoma should be balanced mainly with products of plant origin, especially fruits and vegetables, and contain rich quantity vitamins and antioxidants (blueberries, green tea, apricots, etc.).
Taking oral contraceptives, as well as estrogen drugs prescribed to treat disorders menstrual cycle and vegetative disorders accompanying menopause. Their influence on the development of melanoma remains only a guess, since no clear relationship can be traced.

Video: How melanoma develops

Endogenous risk factors

They are divided into two groups, one of which consists of factors that are a biological feature of the organism:

low degree of pigmentation - White skin, blue and light eyes, red or blond hair color, a large number of freckles, especially pink ones, or a tendency to have them;
hereditary (family) predisposition - what matters is mainly the disease of melanoma in the parents; the risk increases if the mother was ill or there were more than two people with melanoma in the family;
anthropometric data - a higher risk of its development in people with a skin area of more than 1.86 m2;
endocrine disorders - high content sex hormones, especially estrogens, and melanostimulating hormone (melatonin), produced in the middle and intermediate lobes of the pituitary gland; the decrease in their production after the age of 50 coincides with a decrease in the incidence of melanoma, although some authors, on the contrary, indicate an increase in its frequency in older age;
immunodeficiency states;
pregnancy and lactation, which stimulate the transformation of pigmented nevi into melanoma; this is typical mainly for women with a late first pregnancy (after the age of 31), and pregnancy with a large fetus.

The second group is nevi, which are skin changes of a pathological nature and are characterized by the highest degree of probability of degeneration into melanoma, and are also its predecessors. These are benign formations consisting of pigment cells (melanocytes) varying degrees maturity (differentiation), located in varying quantities in different layers of the skin. A congenital nevus is called a birthmark, but in everyday life all formations of this type (congenital and acquired) are called birthmarks. The greatest risks are:

black or dark brown pigmented nevi measuring 15 mm or more;
the presence of 50 or more of these formations of any size;
Dubreuil's melanosis is a small, slowly enlarging brown spot with irregular contours over the years, which is usually localized on the face, hands, and skin chest, less often - on the oral mucosa;
cutaneous xeroderma pigmentosum, characteristic high sensitivity to the sun's rays; this is a hereditary disease that is passed on to children only if there are specific DNA changes in both parents; These changes result in cells being unable to recover from damage from ultraviolet radiation.

How to distinguish a mole from melanoma?

The actual incidence of the latter from nevus has not been clarified. The types of nevus with the highest risk have been established: complex type - 45%, borderline - 34%, intradermal - 16%, blue nevus - 3.2%; giant pigmented - 2-13%. In this case, congenital formations account for 70%, acquired - 30%.

Melanoma symptoms

At the initial stages of development of a malignant tumor on healthy skin, and even more so against the background of a nevus, there are few obvious visual differences between them. Benign birthmarks are characterized by:

Symmetrical shape.
Smooth, even outlines.
Uniform pigmentation, giving the formation a color ranging from yellow to brown and even sometimes black.
A flat surface that is flush with the surface of the surrounding skin or slightly evenly raised above it.
No increase in size or slight growth over a long period of time.

Each “birthmark” goes through the following stages of development:

Borderline nevus, which is a spotty formation, the nests of cells of which are located in the epidermal layer.
Mixed nevus - cell nests migrate into the dermis over the entire area of the spot; clinically, such an element is a papular formation.
Intradermal nevus - the formation cells completely disappear from the epidermal layer and remain only in the dermis; gradually the formation loses pigmentation and undergoes reverse development (involution).

What does melanoma look like?

It may look like a flat pigmented or non-pigmented spot with a slight elevation, round, polygonal, oval or irregular shape with a diameter greater than 6 mm. It can maintain a smooth shiny surface for a long time, on which small ulcerations, unevenness, and bleeding subsequently occur with minor trauma.

Pigmentation is often uneven, but more intense in the central part, sometimes with a characteristic rim of black color around the base. The color of the entire neoplasm can be brown, black or bluish tint, purple, mottled in the form of separate unevenly distributed spots.

In some cases, it takes on the appearance of overgrown papillomas, resembling a “cauliflower”, or the shape of a mushroom on a wide base or on a stalk. Near the melanoma, additional separate lesions (“satellites”) sometimes appear or merge with the main tumor. Occasionally, the tumor manifests itself as limited redness, which turns into a permanent ulcer, the bottom of which is filled with growths. When developing against the background of a birthmark, a malignant tumor can develop on its periphery, forming an asymmetric formation.

A sufficient understanding of the population about what initial signs melanoma, significantly contributes to its timely (in the initial stages) and effective treatment.

Video: How to recognize melanoma?

Stages of development of a malignant tumor:

Initial, or local (in situ), limited;
I - melanoma 1 mm thick with a damaged surface (ulceration) or 2 mm - with an intact surface;
II - thickness up to 2 mm with a damaged surface or more than 2 mm (up to 4 mm) with a smooth surface;
III - a tumor with any surface and thickness, but with nearby foci or metastases to at least one “duty” (closely located) lymph node;
IV - tumor growth into underlying tissues, distant skin areas, metastases to distant lymph nodes, lungs or other organs - brain, bones, liver, etc.

Of great importance is knowledge of reliable and significant symptoms transition benign formations V active state. How to recognize a malignant formation and the moment of transformation of a birthmark into it? Early signs the following:

An increase in the plane size of a previously unchanged or very slowly enlarging mole, or fast growth newly emerging nevus.
Changing the shape or outline of a pre-existing formation. The appearance of compactions or asymmetry of contours in any part of it.
Change in color or disappearance of uniform coloring of an existing or acquired birthmark.
Change in intensity (increase or decrease) of pigmentation.
The appearance of unusual sensations - itching, tingling, burning, “bloating.”
The appearance of redness around the birthmark in the form of a corolla.
Disappearance of hair from the surface of the formation, if any, disappearance of the skin pattern.
The appearance of cracks, peeling and bleeding with minor injuries (light friction with clothing) or even without them, as well as growths of the type.

The presence of one of these symptoms, and even more so their combination, is a reason for the patient to contact a specialized oncological treatment and prevention institution for differential diagnosis and deciding how to treat melanoma, which depends on its type and stage of development.

Diagnostics

Diagnosis of a malignant tumor is carried out mainly through:

Familiarization with the patient’s complaints, clarification of the nature of changes in the “suspicious” formation, its visual examination, examination of the entire patient in order to count the number of birthmarks, identify those that are different among them and further study them.
Carrying out general clinical studies blood and urine.
, which makes it possible to examine the neoplasm in the skin layers, magnified several tens of times (from 10 to 40), and make a fairly accurate conclusion about its nature and boundaries according to the relevant diagnostic criteria.
Ultrasound examination of the abdominal organs, computed and magnetic resonance imaging of the spinal cord and brain, radiography of the chest organs, allowing to determine the spread and presence of metastases in other organs.
Cytological examination of a smear (in the presence of ulcerations) and/or material obtained by puncture of a lymph node (in rare cases). Sometimes examination of punctate from an enlarged lymph node allows one to diagnose the presence of the disease in the apparent absence of a primary tumor.
Excisional biopsy, the meaning of which is to excise a formation “suspicious” of a malignant tumor (within 0.2-1 cm outward from the edges) followed by urgent histological examination. If the diagnosis of melanoma is confirmed, further radical removal is immediately carried out. Such a diagnosis is carried out in cases where all other results of preliminary studies remain doubtful.

Some types of melanomas

There are many types of melanoma, depending on the cellular composition and growth pattern. This classification is explained by the fact that different shapes have a different tendency to local spread and rate of metastasis. It allows the oncologist to navigate the choice of treatment tactics.

Achromatic or non-pigmented melanoma

It is found much less frequently than other species and is difficult to diagnose due to the fact that it has the color of normal skin and is noticed by patients already at late stages development. Its formation begins with a small compaction, which, as it grows, becomes covered with fine lamellar epithelial scales and acquires a rough surface.

Sometimes this neoplasm has the appearance of a scar with uneven edges, sometimes scalloped, pink or whitish in color. Appearance of the corolla inflammatory in nature accompanied by swelling, itching, sometimes hair loss and ulcers. Can non-pigmented melanoma be cured? This form of the disease is very dangerous due to its late detection, tendency to aggressive growth and very rapid metastasis in the early stages. Therefore, at stage I it is still possible effective treatment, in later stages of the disease even after intensive radical treatment tumor relapse or metastases develop.

Spindle cell melanoma

Received this name due to characteristic shape cells determined by histological or cytological examination. They look like a spindle and are located separately from each other. Intertwined with cytoplasmic processes of various lengths, which sometimes extend over considerable distances, tumor cells form strands, clusters, and bundles.

The shape of the nuclei and their number in different cells are not the same: there may be cells with two or more elongated, oval, round nuclei. Melanin is concentrated mainly in the processes, due to which they acquire a granular, speckled appearance, which distinguishes them from a sarcoma or tumor of nervous tissue (neurinoma).

Due to the significant similarity with the cells of moles, cytological diagnosis often presents considerable difficulties.

Nodular or nodular melanoma

Among those diagnosed, it ranks 2nd and ranges from 15 to 30%. It occurs more often after the age of 50 on any part of the body, but usually on the lower extremities in women and on the torso in men, often against the background of a nevus. Due to vertical growth, it is one of the most aggressive and is characterized by a rapid course - 0.5-1.5 years.

This tumor has an oval or round shape and by the time the patient consults a doctor, as a rule, it has already taken on the appearance of a plaque with clear boundaries and raised edges, black or unusually blue-black in color. Sometimes nodular melanoma reaches a significant size or has the form of a polyp with a hyperkeratotic or ulcerating surface.

Subungual melanoma

A form of acral-lentiginous tumor affecting the skin of the palms and soles. It accounts for 8-15% of all melanomas and is most often localized on the first finger or toe. The tumor often lacks a radial growth phase, making diagnosis in the early stages difficult. Over the course of 1-2 years, it spreads to the nail matrix and part or all of the nail plate, which becomes brown or black in color. The appearing papules and nodes are often devoid of pigment, so the disease initially does not attract the attention of the patient and lasts for months. Subsequently, ulcerations and mushroom-type growths occur.

Melanoma metastases

Melanoma is a malignant tumor of the skin, mucous membranes and uveal tract ( choroid) eyes. It grows from pigment cells of the skin, the so-called melanocytes, has a high tendency to early metastasis and low sensitivity to treatment.

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

Localization and prevalence

More than 90 percent of all melanomas develop on the skin, but this type of cancer can attack any tissue where there are melanocytes (pigment cells) - the eyes, the mucous membrane of the genitals, mouth, larynx, esophagus, intestines, stomach. Most often it occurs at the site of age spots and moles (nevi), but it can also develop on unchanged skin.

Melanoma is a very common problem. It accounts for 5%-7% of all human malignant skin tumors. About 130,000 cases of the disease are diagnosed annually. Most patients are Caucasians living in countries with high solar activity. The peak incidence occurs in the seventh and eighth decades of life; people under the age of 40 practically do not suffer from it.

Causes

The main factor generating malignant melanoma, is considered to be UV radiation. In melanocytes, as in most cells human body, genetic material is present in the form of DNA. Under the influence of negative factors, DNA undergoes irreversible damage (mutation). Under normal conditions, when mutations are detected, the mechanism of death of pathological cells (apoptosis) is triggered. However, if the genes responsible for this mechanism are damaged, the mutated cells do not die, but continue to divide. Normal melanocytes present in the tissues of every healthy person, degenerate into cancerous melanocytes.
A person with fair skin, blue eyes, and blond or red hair is predisposed to this process. However, there are other provoking factors:

prolonged exposure to sunlight - sunburn is especially dangerous in at a young age. The use of a solarium also causes enormous harm;
the patient's individual sensitivity to sunlight;
the presence of numerous age spots and moles;
xeroderma pigmentosum (hereditary disorder associated with the functioning of pigments);
conditions accompanied by decreased immunity - chronic use of immunosuppressive drugs in patients after organ transplantation, use of glucocorticoids by carriers of the human immunodeficiency virus (HIV), congenital immunodeficiency;
genetic factors (scientists have identified a family predisposition to this cancer);
hormonal factors - puberty, pregnancy and childbirth, long-term use oral contraceptives and hormone replacement therapy.

Varieties

There are 5 main types of skin melanomas:

lentiginous - a relatively mild type, which is localized mainly on the face and other open areas of the body, often in contact with sunlight; develops slowly over many years, has a favorable prognosis;
acrolentigiosus - a rare form that is located on the tips of the fingers and toes, develops slowly and can completely destroy the nail plate on the affected finger;
superficial spreading is the most common type of cancer that develops from pigmented moles, including atypical ones (that is, those that have shown a predisposition to oncology on microscopic examination). Neoplasms often occur in the middle and lower parts of the body (trunk and lower extremities) and develop relatively slowly;
nodular - a rare dangerous variety that is usually localized in the head, neck and back. The nodular form shows rapid growth and an abundance of metastases;
achromatic (pigmentless) is the most dangerous of all types of melanoma. It is characterized by a reduction in melanin production in cancer cells.

As for tumors of other organs, the following are found in medicine:

retinal melanoma;
lentiginous melanoma of the mucous membranes (vagina, anus, nasopharynx);
malignant soft tissue melanoma (localized on ligaments and aponeuroses).

Symptoms and stages

The tumor grows either on the site of an existing mole or on unchanged skin. Here are some features of malignant neoplasms:

change in the shape of the spot - the more it is characterized by asymmetry, the stronger the suspicion of cancer development;
uneven edges;
itching and burning;
uneven or atypical color - new, previously unnoticed areas with black, blue, brown, red or pink spots with possible inclusions of other colors;
an increase in the size of the changes - nevi with a diameter of more than 6 mm, or rapidly growing spots should be alerted;
the appearance of a red or pink rim around inflammatory changes - this indicates activity immune cells and the development of a local inflammatory reaction in response to contact with foreign antigens (derived from cancer cells);
the tumor and surrounding tissue may swell or harden.

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

stage I - pathological cells affect only upper layer(epidermis);
stage II – the papillary layer of the dermis is affected;
stage III: cancer has reached the border between the papillary and reticular layers;
stage IV: the reticular layer is affected;
stage V: changes have reached the fatty tissue.

In the last stages, the changes become covered with ulcers, from which serous-bloody contents flow.
Melanoma metastasizes to the lymph nodes, lungs, liver, brain, and bones. In this case, symptoms of damaged organs appear:

enlarged and painful lymph nodes;
hemoptysis, shortness of breath, symptoms of pneumonia;
gastrointestinal bleeding, bleeding disorders, swelling of the lower extremities, fluid in the abdominal cavity;
headache, nausea, vomiting, temporary disturbance of consciousness;
bone pain, frequent fractures.

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

Diagnostics

Most important elements diagnosis is an independent examination of the body - if you notice one of the signs described above, inform your doctor. Early diagnosis- the key to successful treatment.

The specialist makes a preliminary assessment using a dermatoscope - optical device, through which you can see deep changes in the mole. If there is a suspicion of malignancy, the doctor excises the entire tumor with a reserve of healthy skin, and sends part of the tissue for histopathological examination. This test allows you to determine the type and severity of the disease.

Since melanoma initially metastasizes only to the lymph nodes, the doctor will definitely prescribe an ultrasound of the regional absorption zone (closely located lymph nodes). It will show whether there are metastases. When the study does not give a clear answer, the doctor removes the so-called sentinel lymph node - the first lymph node along the way lymphatic vessels coming from the tumor.

At advanced stages of the disease, tests of internal organs are prescribed to assess the extent of their damage.

Treatment

Doctors use 3 main methods: surgery, chemotherapy and radiation therapy. In the early stages, you can only get by surgical resection(removal of pathological tissues with a reserve of healthy skin). This is done traditionally or laser. The surrounding lymph nodes must be removed.

In later stages and in the presence of metastases, chemotherapy is prescribed. This is the main method of treatment when there is diffuse growth that cannot be resected. For extensive and multiple metastases, treatment is limited only to alleviating symptoms and supporting the affected internal organs - painkillers (potent analgesics, morphine and its derivatives), metoclopramide, diuretics, and diet are prescribed.

For lesions located on the extremities, a special type of chemotherapy is used - isolated perfusion. It involves insertion into an artery high doses cytostatics when extremities are heated to 41/42 ºC. These two factors interact with each other, destroying mutated cells.

Radiation therapy is usually used in extreme cases, when there is no consent for treatment or when surgery is not possible.

In recent years, there have been breakthroughs in the treatment of melanoma. Scientists have identified a relationship between the BRAF gene mutation and disease progression. Such knowledge has helped develop molecularly targeted therapies that work by blocking the abnormal protein encoded by the mutated BRAF gene. This gene is present in more than half of melanoma patients. The effect of the new drug (vemurafenib) is that it blocks access to tumor cells - they do not receive nutrition, as a result of which they die (the tumor stops growing). This therapy is effective in 90% of patients.

Folk remedies

Naturopaths recommend treating growing moles with the juice of celandine, milkweed, Kalanchoe, oleoresin, or even burning them with matches. However, these techniques cause skepticism among doctors. Oncological diseases require immediate medical action, so it is better not to risk your own life and trust in the hands of a competent specialist.

Traditional medicine will be useful during rehabilitation after chemotherapy. Regular intake of teas made from rose hips, chamomile, lemon balm, prickly tartar and echinacea will help to quickly restore immunity and strengthen the body as a whole.

Prognosis and complications

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

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

Prevention

Prevention includes:

safe tanning (it is prohibited to stay on the beach between 10:00 and 15:00);
use of sunscreens;
regular examination of the skin to identify suspicious elements;
regular visits to a dermatologist (every six months).

Prevention is especially important for people who have many nevi on their bodies.

Photo

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

General information

Melanoma is a type of skin cancer. Melanoma accounts for 1-1.5% of all malignant neoplasms. According to WHO, about 48,000 people die from melanoma every year in the world and there is an increase in the incidence. Most often, melanoma is diagnosed in patients living in southern countries in conditions of increased natural insolation. People over 30 years of age are mainly susceptible to the disease, but isolated cases of melanoma also occur in children. In different countries of the world, the incidence of skin melanoma varies from 5 to 30 people per 100,000 population.

Causes of melanoma

The risk of developing melanoma is increased in individuals with skin phototypes I and II. People with dark skin and people of black race are most unlikely to develop the disease. The likelihood of melanoma is increased by a history of sunburn (even in early childhood), and excessive ultraviolet radiation, both natural and received in a solarium. Traceable hereditary predisposition- the occurrence of the disease in persons with a family history of melanoma. Scientists suggest that this is due to a genetically transmitted disorder in the functioning of suppressors that suppress tumor growth.

About 70% of cases of melanoma development occur as a result of malignant degeneration of pigmented nevi, which include: giant pigmented nevus, blue nevus, nevus of Ota, complex pigmented nevus, borderline nevus. Xeroderma pigmentosum and Dubreuil's melanosis are also highly likely to transform into melanoma. Factors that trigger the process of malignancy of a nevus or pigment formation include its trauma and increased insolation, hereditary and endocrine factors.

Melanoma classification

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

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

Treatment of melanoma

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

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

Melanoma prognosis and prevention

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

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

In recent decades, there has been a steady increase in the incidence of melanoma. Diseases people of any age are susceptible, starting in adolescence, but in people over 70 years of age, symptoms of melanoma are diagnosed more often. It is noteworthy that melanoma accounts for only 4% of all skin malignancies, but in 70% of cases the disease is fatal.

According to statistics, in European countries there are 10 cases of the disease per 1000 inhabitants, while in Australia the figure is much higher and amounts to 37-45 cases.

Melanoma can develop as an independent formation, but in 70% of episodes the background is a pigment spot. Nevi (moles) consist of melanocytes that synthesize the pigment melanin. Most often they are dark in color, but non-pigmented nevi are also found. Sometimes they are found on the lining of the eye, brain, nasal mucosa, in the oral cavity, in the vagina and in the rectum.

Acquired moles that have formed in adulthood are more dangerous. In 86% of patients, the development of the disease was provoked by the influence of ultraviolet radiation received in the sun or in solariums.

Melanoma cells do not have close connections with each other, so they easily break away from the general mass and migrate, forming metastases. At this stage, the disease is no longer treatable.

CAUSES

The cause of melanoma formation is the degeneration of melanocytes into malignant cells. The main theory that explains this process is molecular genetics. Defects appear in the DNA molecule of the pigment cell. Further, under the influence of provoking factors a gene mutation occurs associated with a change in the number of genes, violation of the integrity of chromosomes or their rearrangement. The changed cells acquire the ability to divide unlimitedly, as a result of which the tumor increases in size and metastasizes. These disorders can occur under the influence of unfavorable factors of internal and external properties or a combination of them.

Causes and risk factors:

Range susceptible to disease individuals is not limited to people with a low degree of pigmentation. Cases of melanoma are recorded in both light-skinned and dark-skinned people. The risk of developing it in Europeans is about 0.5%, in Africans - 0.1%, while in Caucasian peoples - 2%.

CLASSIFICATION

The disease varies in form.

Clinical forms of the disease:

Superficially spreading, or superficial. It is observed in 70% of patients, more often in women. This melanoma is characterized by a long period of benign growth. It grows into deeper layers after a long time and has a favorable prognosis.
Nodular (nodular). Invasive variant of the tumor. It quickly grows deep into the skin and looks like a convex round bump. The pigmentation of such a formation is usually black, less often than other dark shades, or is not changed at all. Often, nodular melanoma is detected in elderly people on the limbs and trunk.
Acrolentiginous. It develops on the surface of the skin and later grows deeper. A distinctive feature is the localization of symptoms - the tumor occurs on the palms, soles or under the nails. This melanoma appears more often in blacks and Asians.
Lentiginous, or malignant lentigo. The neoplasm in appearance resembles a large flat birthmark. Nests of melanocytes form in the epithelial layer, from where they penetrate inside. More common in older women over 70 years of age on the face, neck and back surface limbs.
Pigmentless (achromatic). It occurs quite rarely, in 5% of cases. Changed pigment cells lose the ability to synthesize pigment, so these formations are pink or flesh-colored. A non-pigmented tumor is considered as one of the varieties of the nodular form or is considered a manifestation of metastases on the skin.

SYMPTOMS OF MELANOMA

At the beginning of the development of the disease, it is difficult to visually trace any differences between a nevus and a malignant formation. But the symptoms of melanoma appear not only on moles, the disease can develop on healthy skin. In women, symptoms often appear on the chest and legs, in men - on the arms, chest, and back.

Melanoma has a number of characteristic symptoms, which doctors use to diagnose the disease. The main feature pathological process is change in shape, size, color of an existing nevus.

It should also be noted that moles with signs of hair growth never become malignant.

Symptoms in the early stages of development:

asymmetry of education;
uneven coloring (darkening or lightening);
diameter more than 5 mm;
the edges of the formation are uneven or unclear;
change in the height of the spots (previously flat, they begin to rise above the surface);
change in the density of the birthmark (it becomes soft);
discharge in the area of growth;
bleeding, burning, crust formation on the surface of the formation.

Symptoms in later stages of development::

the appearance of pigmentation around the nevus;
violation of the integrity of education;
bleeding from a nevus;
sensations of itching and pain in the area of tissue damage.

The malignant form of the disease can actively metastasize.

Symptoms of metastatic melanoma:

continuous headaches;
the appearance of subcutaneous seals;
gray color of the skin;
the appearance of chronic cough;
enlarged lymph nodes;
convulsions;
sudden weight loss for no apparent reason.

The patient's condition is determined by the stage of the disease.

Stages of development:

Stage I. A spot 1 mm thick with signs of damage to the surface integrity or intact 2 mm thick;
Stage II. Formation 2 mm thick with a damaged surface or 2 to 4 mm thick with an intact surface;
Stage III. The surface of the tumor may be damaged or intact; foci of spread of the pathological process to nearby tissues and lymph nodes appear.
Stage IV. Tumor cells spread to distant organs. The prognosis of the disease at this stage is unfavorable, the effectiveness of treatment is quite low and is only 10%.

DIAGNOSTICS

Even for an experienced doctor, diagnosing melanoma is somewhat difficult. Big preventive value in this matter has early detection signs of the disease. Important role plays a role in highlighting the problem of melanoma among the population for self-diagnosis. If any suspicious neoplasm appears on the skin or changes in birthmarks and age spots, it is necessary consult a dermatologist immediately or an oncologist.

Diagnostic stages:

Visual examination of the patient's skin and identification of pathological changes using a dermascope or magnifying glass.
General clinical blood and urine tests.
Excisional biopsy to remove a tissue sample from the tumor (complete removal of the tumor).
Incisional biopsy of a tumor site to collect tissue for histological analysis.
Cytological analysis of puncture of an enlarged regional lymph node.
Chest X-ray, isotropic computer scan, MRI, ultrasound to identify lesions of internal organs.
Confocal microscopy - infrared irradiation of a layer of skin to determine the depth of melanoma growth.

TREATMENT

Any changes that occur with the nevus (change in color, shape, bleeding) require immediate surgical intervention . Doctors prefer to remove suspicious tumors without waiting for them to degenerate.

The tumor is excised using several methods:

knife;
laser;
radio waves.

In the case of metastatic formation, the focus is removed using a combination of surgical method, immunotherapy and chemotherapy. Treatment of melanoma at different stages has its own characteristics.

Treatment depending on the stage of development of the disease:

Stage I. Surgical excision is performed to capture healthy tissue. The area of intervention depends on the depth of germination of the formation.
Stage II. In addition to excision of the formation, a biopsy of regional lymph nodes is performed. If a malignant process is confirmed during sample analysis, the entire group of lymph nodes in this area is removed. Additionally, alpha interferons can be prescribed for prevention purposes.
Stage III. In addition to the tumor, all lymph nodes that are located nearby are excised. If there are several melanomas, all of them must be removed. Radiation therapy is performed in the affected area, immunotherapy and chemotherapy are also prescribed.
Stage IV. At this stage, a complete cure is no longer possible. Only those formations that cause inconvenience, as well as large tumors, must be removed. Sometimes it is possible to remove metastases from internal organs; some patients are recommended to undergo chemotherapy and radiation treatment.

COMPLICATIONS

The main complication of melanoma is the spread of the pathological process through metastases.

Among postoperative complications can be distinguished signs of infection appear, changes in the postoperative incision (swelling, bleeding, discharge) and pain syndrome. Melanoma may develop at the site of removed melanoma or on healthy skin. new mole or discoloration of the integument may occur.

PREVENTION

Preventive measures involve early removal of any traumatic formations in specialized medical institutions.

Prolonged exposure to the sun is contraindicated. Get used to influence sun rays you need to gradually use sunscreen. It is very important to protect children from sunburn. You need to protect not only your skin, but also your eyes with dark glasses with special filters. It is also better to avoid tanning in a solarium.

PROGNOSIS FOR RECOVERY

The prognosis for melanoma depends on the degree of tumor development and the moment of its detection. In the early stages the disease responds well to treatment. The survival rate of patients for five years after treatment of stages I and II is 85%, while stage III with signs of metastasis gives a chance to live for half of the patients.

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