Dr. Ertan Beyatlı

What is Melanoma? How is it treated?

(Update: ) - Skin and soft tissue diseases

Melanoma is the fifth most common cancer diagnosed in the United States. The number of cases has been increasing steadily since 1990.

Melanoma is less common than some other skin cancers, but more likely to grow and spread.

Causes | Types | Symptoms | Diagnostic | Treatment

What is Melanoma?

Melanoma, in the pigment cells of the skin (melanocyte) is a type of cancer that develops. Melanocytes, to protect the skin from ultraviolet (UV) radiation, i.e. sunlight melanin produces. Most moles (Nevus) are benign, but sometimes there may be malignant and uncontrolled melanocyte movements in a benign appearing mol.

what is melanocyte
melanocyte

What is the cause of melanoma?

Melanoma develops when pigment-producing cells known as melanocytes mutate. Although most melanocytes are found in the skin, some are found in the eyes and other parts of the body. While the exact cause of the disease is not always clear, the primary risk factor is exposure to ultraviolet (UV) radiation from the sun or tanning beds. People who have frequent sunburn, especially as a child, are at higher risk.

Risk factors

Understanding risk factors can help you take preventative measures to reduce the likelihood of developing the disease. Reducing these factors will reduce the risk of melanoma or other skin cancers. For uncontrollable factors, regular skin exams are very important for early diagnosis. These risk factors are as follows:

  • General - Ultraviolet (UV) exposure: People who work outdoors during the day or choose to spend most of their free time outdoors and are exposed to UV light are at greater risk. People who choose to use tanning beds increase their risk of skin cancer. Frequent sunburn increases the risk of developing the disease, especially when they occur in childhood.
  • Age: As with many cancers, the risk of melanoma increases as you age. About half of its new cases are diagnosed in patients aged 55 to 74 years. However, this disease can affect people of all ages. In fact, it is the most common type of cancer among women aged 25 to 29.
  • Immune suppression: Conditions that weaken the immune system, such as organ transplant-related viruses, diseases, or immunosuppressive therapy, can increase the risks for all skin cancers.
  • Body - Skin toneCaucasians are more likely to develop skin cancer than non-whites. The risk is also higher for people with blond or red hair, blue or green eyes, or skin that can burn easily or have freckles.
  • Moles (Nevus): Most moles are harmless and never turn into cancer, but having a large number of moles can increase the risk of developing melanoma. Dysplastic nevus (moles that may resemble melanoma) can also increase the risk by 10 percent. Although dysplastic nevi will not develop into melanoma, there may be a small percentage, and individuals with this type of moles should see a dermatologist regularly for comprehensive skin exams. (Dermatology is the branch of medicine that deals with skin diseases and its treatment. The physician interested is called a Dermatologist.)
  • Genetic - Family and / or personal history: The risk increases if the mother, father and siblings have this disease. Individuals who have been previously diagnosed with the disease are also at risk of developing the disease again.
  • Hereditary conditions: An inherited disease that affects the skin's ability to repair UV damage Xeroderma pigmentosum Conditions such as melanoma increase the risk of developing melanoma and may develop at an earlier age.

Types of Melanoma

The most common type of melanoma is the cutaneous type that develops on the skin. While most melanomas develop on skin exposed to the sun, the disease can also be found in unexposed areas such as the groin or bottom of the feet.

Superficial spreading melanoma

Superficial spreading melanoma

Superficial spreading melanoma most common species (70%). This form of the disease can grow over the outer layer of the skin for several years. Superficial spreading melanomas can rise and have irregular borders. They can be brown with black or pink edging. According to the National Cancer Institute (NCI), seventy percent of cases diagnosed are of the superficial spreading type.

Nodular melanoma

Nodular melanoma

After appearing on the skin's surface for the first time, nodular melanoma can rapidly develop into deeper layers of the skin. This form of the disease may appear as a lump or growth. Nodular melanomas account for 15 percent of all cases.

Acral-lentiginous melanoma

Acral-lentiginous melanoma

Acral-lentiginous melanoma is most common in people with dark skin. This type of melanoma represents 70 percent of the disease in African Americans and 46 percent of all cases in Asians, according to the NCI. Acral-lentiginous melanoma can be found on the palms, soles, and under the nails.

Lentigo malignant melanoma

Lentigo malignant melanoma

Lentingo malignant melanomas are mostly found on the arms, legs, face, neck and other sun-exposed areas. The risk of this type of melanoma may increase with age due to prolonged sun exposure. Lentingo maligna is the most common species in Hawaii, according to the Skin Cancer Foundation.

Amelanotic and desmoplastic melanomas

Amelanotic and desmoplastic melanomas

These two similar and rare forms of melanoma can be aggressive and difficult to diagnose. Amelanotic melanoma can be difficult to detect due to the lack of pigment. Desmoplastic melanoma can be found on the head and neck of elderly patients.

Ocular melanoma

Ocular melanoma on the eye

Ocular melanoma develops in melanocytes that give color to the eyes. It accounts for about 3 percent of all cases. More than 2.000 cases are diagnosed each year.

Metastatic Melanoma

It is a type of melanoma that spreads to distant organs. The disease often spreads to the lungs, liver, bone and / or brain.

What are the symptoms of melanoma?

Most melanomas develop on the skin and can be detected early. Self-examination or regular skin exams by a doctor can help detect suspicious moles or changes in the skin that could be early signs.

Other symptoms include:

  • Wounds that do not heal
  • Redness, swelling, or sensitive skin
  • Growth, misshapen, discoloration or bleeding in moles
  • Dark spots in the eyes, loss of vision or blurred vision

Early warning signs of melanoma

The first sign is typically a new spot on the skin or a change in the size, shape, or color of an existing spot or mole.

  • Asymmetry: the stain or mole has an irregular shape.
  • Border: The edge is not smooth, it is uneven or notched.
  • Color: I have uneven shading or dark spots.
  • Diameter: I is larger than the size of a pencil eraser.
  • Height: I am changing in size, shape or texture.

Melanoma Stages

Melanoma can be staged prior to surgery (clinical staging) based on physical examination and imaging results. In addition, it will be staged after surgery (pathological staging), where clinical information will be combined with information obtained from biopsies. Pathological cancer staging is most accurate as it uses more information.

Melanoma Stages:

  • Stage 0: Cancer cells are in the upper layer of the skin (epidermis) and have not spread. At this stage, cancer is usually treated with surgery alone.
  • Stage I: Cancer cells have grown deep in the skin but have not spread to lymph nodes or other parts of the body.
  • Stage II: Cancer cells go deep into the skin or have higher-risk features, but have not spread to the lymph nodes or beyond.
  • Stage III: Cancer cells have spread to nearby lymph nodes, but not to distant organs.
  • Stage IV: Also known as metastatic melanoma, it means that cancer cells have spread beyond the skin and regional lymph nodes to distant organs such as the liver, lungs, or brain, or to distant lymph nodes and regions.

Diagnosis

Melanoma diagnosis usually begins with a visual examination. Monthly self-exams and annual doctor check-ups are important.

The only way to be sure if a spot or mole is melanoma is to have it examined by a doctor.

Some tests to diagnose melanoma:

Biopsy

Local anesthesia It can be sent to pathology by taking a piece from the area underneath. Various biopsy methods are used in the diagnosis of skin cancers, but in suspicious cases, doctors usually remove the entire growth. excisional biopsy they prefer to use.

If you are diagnosed with melanoma, your doctor may do some tests to determine if the cancer has spread beyond the skin. Usually the first place to spread is melanomas with nearby lymph nodes, so your doctor can examine the armpits, head, neck, and groin area to determine if any lymph nodes are enlarged. The doctor may also take a biopsy of the suspected lymph nodes. During the procedure, the surgeon may perform a sentinel lymph node biopsy.

views

Melanoma is more likely than other skin cancers to metastasize or spread to distant bones or distant organs. Various medical imaging procedures, including CT scan, MRI, PET / CT scan, or X-ray, can be used to detect cancer cells or tumors in the body.

Melanoma treatments

Melanoma treatment may include surgery alone or in combination, radiation therapy, chemotherapy, immunotherapy, or targeted therapy. Your treatment plan usually depends on how early the disease was diagnosed and whether it has spread.

Chemotherapy

Chemotherapy may be recommended for patients who have spread (metastatic) to distant parts of the body. It can be used in combination with other cancer treatments, including chemotherapy, immunotherapy, and surgery.

isolated limb infusion
isolated limb infusion

In some cases of melanoma affected by the limb when a tumor is found in one extremity, such as the leg or arm, regional chemotherapy or isolated limb infusion can be suggested. In these cases, the isolated limb infusion administers chemotherapy directly to the affected limb to treat the tumor and help prevent the chemotherapy from going elsewhere in the body. By concentrating the chemotherapy on the affected area, this technique can cause fewer side effects than systemic chemotherapy. In this procedure, a tourniquet is placed in the arm or leg, then high doses of chemotherapy are administered.

Immunotherapy

Immunotherapy drugs can be used as first-line therapy for melanoma and some other cancers, or in combination with other treatments such as chemotherapy and surgery. For example: Checkpoint inhibitors, Cytokines, Oncolytic virus therapy.

Radiation therapy

Radiation therapy can be used for advanced disease. Specific treatments used include:

External beam radiation therapy is a painless outpatient procedure that carries none of the standard risks or complications associated with surgery and does not pose a risk of radioactivity to you or others you come into contact with.

Intensity-modulated radiation therapy can help patients reduce the risk of recurrence and finish treatments faster.

TomoTherapy® targets hard-to-reach melanoma tumors and helps reduce damage to nearby healthy tissue, thereby reducing treatment-related side effects.

Operation

Surgery is the primary treatment for localized melanoma. It may be a treatment option for metastasized disease. Surgery may be the only treatment required for some localized melanomas. However, if nearby lymph nodes are enlarged and the doctor suspects cancer cells have spread, they may require more extensive surgery.

Surgical procedures for melanoma include:

Excision: The surgeon cuts off the growth of the skin by performing an excision with a scalpel under local anesthesia. A wide excision is typically used in melanomas. In a wide excision, the skin tumor and a larger area of ​​healthy tissue are removed. A wide excision can extend from a simple excision to a much deeper skin (see Fig. Excisional Biopsy)

Reconstructive surgery: Skin cancer surgeries can cause scarring or deformity, especially when a large excision or other extensive surgery is required to remove skin cancer, or when surgery is performed on the face, head, neck, or hands. Consult your doctor about your reconstructive surgery options.

Lymph node biopsy and removal: In this procedure, your doctor will remove one or more lymph nodes known as sentinel lymph nodes, which take the lymph fluid draining directly from the tumor. If there are no signs of cancer in the lymph node or nodes, no additional lymph node surgery is required. If melanoma cells are found in one or more of the sentinel lymph nodes, the remaining lymph nodes in the area may be removed.

Sentinel lymph node biopsy: In patients with melanoma, a special type of lymph node biopsy known as the sentinel lymph node is often performed. In this procedure, your doctor will remove one or more specific lymph nodes known as sentinel lymph nodes, which are likely to extract lymph fluid draining from the tumor. If the sentinel lymph node shows no signs of cancer, no additional lymph node surgery is required. If melanoma cells are found in one or more of the sentinel lymph nodes, the remaining lymph nodes in the area are usually removed. Sentinel lymph node biopsy is a less invasive procedure than traditional lymph node dissection and is typically lymphedema such as associated with less side effects.

Surgery for metastatic melanoma: Melanoma can spread to the brain, bones, liver, and lungs. When this occurs, surgery can be done to remove the tumors from these locations. It can be combined with other treatments such as surgery, immunotherapy or chemotherapy. In some cases, metastatic melanoma surgery may be recommended to alleviate the symptoms of the disease (Palliative Surgery).

Targeted therapy

The FDA has approved several targeted therapy drugs to treat advanced metastatic melanoma that cannot be surgically removed. Some targeted therapy drugs are used in situations that cannot be treated with surgery.

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