How to recognize melanoma at an early stage? Signs and symptoms of skin melanoma (photo). Used for diagnostic purposes. These procedures are carried out in the following clinics

Description of clinical cases

Clinical case 1

Clinical case 2

Clinical case 3

Case 4

During the X-ray examination, no significant changes were found.

Discussion

Conclusion

Ajay Kumar

Ruchi Bindal

Devi C. Shetty

Harkanwal P.Singh

Primary melanoma in the oral cavity is a rare neoplasm with aggressive growth and developing from malignantly degenerated melanocytes of the oral mucosa. The World Health Organization defines this disease as a malignant neoplasm of melanocytes or their precursors. Melanoma is formed due to the proliferation of atypical melanocytes at the site of contact between the epithelium and connective tissue. The disease is also accompanied by an upward migration of cells into the layers of the epithelium and the introduction of the underlying connective tissue. Melanoma is usually found on the skin, but its localization on the oral mucosa is also possible. Over the past decades, the incidence of melanoma in the population has greatly increased (3-8% per year). In 1960, it was believed that melanoma occurs in 1:500 cases, then in 1992 a frequency of 1:600 ​​was obtained, in 1996 1:105, in 1998 1:88 and by 2000 1:75 cases.

Localization of melanoma in the oral cavity is 0.2-8% of all cases of tumor development and 0.5% of the total number of all oral cavity neoplasms. Melanoma usually develops between the ages of 30 and 90 (most often around the age of 60) and affects men somewhat more often than women. The main sites of localization include the hard palate and gums (affecting the upper jaw in 80% of cases). Somewhat less frequently than the primary process, secondary melanoma occurs as a metastasis of a distant tumor. In such cases, the typical localization is the tongue, parotid salivary gland and palatine tonsils. Melanoma of the oral mucosa is characterized by greater aggressiveness and is clinically manifested mainly at the stage of nodule formation. Histologically, this tumor is defined as invasive, in situ, or a combination of invasive and in situ. About 85% of all melanomas that occur belong to the latter class.

No specific etiology has been identified for this disease. It is also still difficult to identify risk factors for the development of melanoma. Like skin neoplasms, primary melanoma of the oral mucosa is more often formed from a nevus, age spots, or de novo (about 30% of cases). In this article, we propose four clinical cases of primary melanoma with different localization for consideration.

Description of clinical cases

Clinical case 1

A 70-year-old woman came to the clinic with complaints of a rapidly growing dark-colored mass located in the anterior part of the oral cavity on the upper jaw, which appeared about 4 months ago. Approximately two months before the visit, the patient found in the anterior part of the oral cavity on the upper jaw a dark dense formation of small sizes, which constantly increased to the present state. The patient has a bad habit: she has been using chewing tobacco since the age of 20.

An external examination revealed a localized swelling in the area of ​​the upper lip, the skin over the formation was not changed. Firm swelling lifts the upper lip (Photo 1). Lymphadenopathy of the cervical lymph nodes was not detected.

Photo 1: External and intraoral view showing a pigmented lobular swelling in the region of the upper lip.

An intraoral examination revealed a lobular elevated pigmented swelling. The neoplasm was firm, inelastic, incompressible, incontractible, without fluctuation or pulsation, with well-defined margins, and occupied the anterior part of the maxilla from the mesial margin of tooth 13 to the distal margin of 24 (Figure 1).

An orthopantomogram revealed partial absence of teeth and a large radiolucent area with weakly defined boundaries in the anterior region of the upper jaw, which extended from tooth 13 to tooth 23 (Figure 2).

Photo 2: Orthopantomogram showing a large radiolucent area of ​​irregular shape.

Under local anesthesia, a biopsy of the neoplasm was performed, which showed the presence of layers of atrophic squamous epithelium with large round and oval melanocytes with vertical and radial growth. Modified proliferating round and oval melanocytes and chronic inflammation cells were diffusely distributed in the connective tissue stroma (Photo 3).

Photo 3: Clinical case 1. Micrograph (10x and 40x). Round and oval melanocytes and melanin pigmentation distributed in the connective tissue stroma.

The combination of data obtained from clinical, radiological and histological examinations gives the right to make a diagnosis of malignant invasive melanoma with a density of 0.90 mm. This conclusion was further confirmed using the immunohistochemical marker HMB-45 and Melan-A (Photo 4).

Photo 4: Clinical case 1. Immunohistochemical marker with HMB-45 antibody staining the cytoplasm of epithelial cells.

Due to the large size of the tumor, surgical treatment was not possible. The decision was made to administer radiotherapy. Subsequent examinations revealed partial regression of the neoplasm. Further, a surgical intervention was planned, but the woman did not go to the clinic anymore. Ten months later, the patient was hospitalized, but refused the proposed immunotherapy and took only painkillers. The patient died fifteen months later. An autopsy was not performed, so the exact cause of death remained unclear.

Clinical case 2

A 42-year-old man came to the clinic with complaints of a rapidly growing exophytic mass in the region of his left cheek.

Three months ago, the patient did not report any symptoms, then noticed a sore the size of a coin on the buccal mucosa. Education gradually increased to its present size.

An external examination revealed a single large dense palpable lymph node not soldered to tissues in the left submandibular region. A diffuse, dense, pliable swelling was also determined, located from the left corner of the mouth and from the lower edge of the lower jaw to the middle of the buccal region. Deviations of the angle of the mouth to the side were visually noted (Photo 5).

Photo 5: Photograph of the patient's appearance. Distortion of the face with a shift to the right side and enlarged submandibular lymph nodes.

An intraoral examination revealed two exophytic formations, black-brown in color, 3 x 4 cm and 2 x 2 cm in size, with a bumpy surface and a dense texture, localized on the mucous membrane of the left cheek from the corner of the mouth to the area of ​​tooth 38 (front-to-back) and from the vestibule of the oral cavity to 1 cm above the occlusal plane (top-down). An area of ​​hyperpigmentation was noted in the retromolar area (Figure 6).

Photo 6: Intraoral X-ray showing an exophytic lesion extending from the corner of the mouth to the region of tooth 38.

A biopsy of the neoplasm was performed, which showed the presence of dysplastic oval and fusiform melanocytes in the lamina propria, interspersed with melanin pigmentation (Figure 7).

Photo 7: Case 2. Micrograph (10x) showing invasive tumor growth, atypical melanocytes and melanophages.

The totality of data obtained from clinical, radiological and histological studies gives the right to make a diagnosis of malignant invasive and in situ melanoma. This conclusion was further confirmed using the immunohistochemical marker HMB-45 and Melan-A (Photo 4).

As a therapy, a wide excision of the formation was performed. Histopathological examination confirmed melanoma with a maximum density of 1.10 mm, which had infiltrated the superficial layers of the underlying tissues and metastasized to the regional lymph node.

Clinical case 3

A 65-year-old man was admitted to the clinic with complaints of painful swelling in the oral cavity on the left side, which began to disturb about 15 days ago. Two weeks prior to presentation, the patient discovered a small, firm mass on the upper gum on the left.

During the X-ray examination, no significant changes were found.

An external examination revealed submandibular lymph nodes palpable on both sides, 2 x 2 cm in size, dense, mobile and soldered to the lower edge of the lower jaw.

An intraoral examination revealed a dense raised pigmented swelling on the upper gum, 0.5 x 1.5 cm in size, located near teeth 21, 22, 23 and 24. The change in the color of the gum affected the area from tooth 21 to 28 and on the palatal side from 21, 22, 23 to 26, 27 and 28. Pigmented areas were observed bilaterally on the mucous membrane of the cheeks and palate.

A biopsy of the neoplasm was performed, which showed the presence of atypical melanocytes interspersed with melanin pigmentation and located deep in the connective tissue stroma.

The combination of data obtained from clinical, radiological and histological examinations gives the right to make a diagnosis of malignant invasive melanoma. This conclusion was further confirmed using the immunohistochemical marker HMB-45 and Melan-A (Photo 8).

Photo 8: Case 3. Immunohistochemical examination with Melan-A staining the cytoplasm of cells.

As a therapy, a resection of the upper jaw was performed with the removal of the affected lymph nodes. Histopathological examination confirmed a 3.20 mm thick gingival melanoma with lymph node involvement (II).

Case 4

A 40-year-old woman came to the clinic with complaints of painful swelling in the area of ​​the right anterior gingiva on the upper jaw and discoloration of the mucosa on the palatal side. The disease began 4-5 months ago, when the patient noticed swelling in the area of ​​the right anterior gum area on the upper jaw and turned to the doctor for help. At the reception, the specialist also revealed pigmentation of the mucous membrane from the side of the sky.

During the X-ray examination, no significant changes were found.

External examination revealed a single dense palpable submandibular lymph node measuring 5 x 5 cm on the right side.

An intraoral examination revealed dark pigmentation between teeth 21, 22, 23 and a pigmented dense flat swelling on the palatal side in areas 11 and 12, measuring 1 x 1 cm, with irregularly shaped edges (Photo 9).

Photo 9: Intraoral photographs. Black pigmentation of gums and palate.

A biopsy of the neoplasm was performed, which showed the presence of oval and fusiform mutated melanocytes in the connective tissue stroma (Photo 10).

Photo 10: Case 4. Micrograph (10 x) showing atypical melanocytes in the connective tissue stroma.

The combination of data obtained from clinical, radiological and histological examinations gives the right to make a diagnosis of malignant invasive melanoma. This conclusion was further confirmed by the use of immunohistochemical markers.

After the diagnosis of primary gingival melanoma was made, the treatment was resection of the left part of the alveolar process of the upper jaw with removal of the neoplasm on the gum. The defect was restored using a cheek flap, the postoperative period passed without complications. Histopathological examination confirmed a 1.5 mm melanoma with lymph node involvement (I). The recovery period was uneventful.

Discussion

Melanoma in the oral cavity can show considerable variability in morphological terms, the process of its development and clinical presentation.

Studies show that from 20.41% to 34.4% of all melanomas are on the surface of the mucous membranes and 16% of them are inside the oral cavity. Scientists also report on the most susceptible age group: 56 - 77 years. The average age of a patient with melanoma is 69.2 years. According to different sources, by gender (men:women), the distribution varies from 1:1 to 2:1.

Most often, melanoma develops on the upper jaw, in most cases affecting the palate (32%), followed by affecting the gums in the upper jaw (16%) and, less often, formation on the buccal mucosa, gums on the lower jaw, lips, tongue and floor of the mouth. Our article describes three cases of a tumor on the gums of the upper jaw and one case on the buccal mucosa, the ratio of men and women is 1:1, which corresponds to the literature data (Table 1).

Table 1: Clinical and pathological findings of patients with primary oral mucosal melanoma.

Melanoma can be classified as a primary tumor of the oral mucosa only if it meets the criteria described by GREEN in 1953: the presence of melanoma on the oral mucosa, the presence of proliferative activity, and the absence of primary melanoma outside the oral cavity. In the cases described by us, all the above criteria are met, so we can talk about the primary melanoma that has arisen in the oral cavity.

To confirm the diagnosis, it is necessary to establish the presence of melanin pigment. This procedure is performed using Fontana-Masson stain and suitable immunohistochemical markers such as HMB-45, Melan-A, Tyrosinase and Antimicropthalmia transcription factor. Also, the analysis for the presence of the S-100 protein in melanoma is always positive. In the above clinical cases, the diagnosis was confirmed using HMB-45 and Melan-A markers.

For the development of primary melanoma in the oral cavity, the geographical sign does not matter, as, for example, for melanoma of the skin, in which the degree of ultraviolet radiation is of particular importance. Primary melanoma of the oral cavity is a rather aggressive disease, and at the beginning of its development requires careful differential diagnosis with conditions such as Addison's disease, Kaposi's sarcoma and Peutz-Jeghers syndrome. Also, melanoma must be differentiated from melanin pigmentation (both racially and due to irritation), nevus, melanoacanthoma, and other pigmentation of exogenous origin, such as discoloration of the gums under the influence of amalgam.

Delgado Azanero and others have proposed a practical and easy way to diagnose oral melanoma and also to differentiate this tumor from other pigmented lesions.

The clinical test is as follows: a piece of bandage is rubbed on the surface of the formation, and if it turns dark, the test is considered positive. Staining is explained by the presence of melanin pigment in the surface layers of the tissue. The authors report that in 84.6% of cases the test was positive, however, a negative result does not exclude the presence of this tumor, since sometimes malignant cells do not invade the surface layers of the epithelium. Melanoma on the oral mucosa, which is characterized as nodular and has a vertical growth with penetration into the submucosal layer, is considered even more aggressive. The prognosis in such cases is usually unfavorable and depends on the histological type of the tumor, the depth of its penetration and localization. According to the literature, mucosal melanoma most often occurs in areas where tissue covers bone formations, for example, on the hard palate or on the gums. Such localization worsens the prognosis of the disease even more, since the tumor begins to invade the bone tissue very quickly.

The precursors of the disease have not yet been fully identified, however, some scientists talk about the initial melanocytic hyperplasia, which can be considered the beginning of the disease. Other researchers point to the important role of various kinds of pigmentation, which initially have a horizontal growth and only then acquire an invasive - vertical type of growth. Ordinary nevi are also of some importance, which, interestingly, in the oral cavity are most often located precisely on the hard palate, like melanomas. For the first time, primary melanoma in the oral cavity was described by Weber in 1859, however, there were no clear diagnostic criteria for melanoma of the skin for a long time. Subsequently, many classifications of this disease were put forward, but none of them was accepted as universal.

Melanoma in the oral cavity must be distinguished from melanoma of the skin and divided into two histological types: invasive and in situ, as well as a combined variant of an invasive tumor with an in situ component. If the result of a cytological examination of a neoplasm is doubtful, then the concept of "atypical melanocytic proliferation" should be used. This term is taken as a preliminary diagnosis, while the final one is made only after a clinical, post-mortem examination, repeated biopsy and constant monitoring. The diagnostic criteria used to detect melanoma of the skin (asymmetry, irregular contours, discoloration, diameter greater than 6 mm, and elevation above the surface) may also be useful for diagnosing melanoma in the oral cavity.

The scientific institute studied 50 cases of malignant melanomas, 15% of which were defined as tumors in situ, 30% of the invasive form and 55% were mixed. In our article, 3 clinical cases describe invasive melanoma and one case describes mixed melanoma (Table 1). Since all patients were treated at the late stages of the disease, it is rather difficult to assume which of the components, invasive or in situ, appeared earlier. However, there is an opinion that the combined type of melanoma is often preceded by pigmentation, which is located exactly at the site of the future development of the tumor.

Localization on the mucous membrane significantly complicates the detection of the formation by the patients themselves, which leads to delayed diagnosis and, ultimately, a large percentage of deaths. According to statistics, from 13 to 19% of all patients have metastases in the lymph nodes, and in 16-20% metastasis develops in a very short period of time. The aggressive clinical course of primary melanoma in the oral cavity causes even more problems. Malignant melanoma on the mucosa accounts for 0.2-8.0% of all melanomas and has a much worse prognosis for recovery than a similar disease on the skin. The five-year survival rate of patients affected by this tumor varies from 5.2 to 20%. However, the chances of recovery and recovery from melanoma are greatly increased if diagnosis and treatment can be carried out in the early stages of the disease.

Surgery remains the most effective treatment for malignant melanoma. It is important to note that surgical intervention should be radical and be accompanied by a long postoperative observation period. However, a wide excision of cutaneous melanoma involving 20-50 mm of healthy tissue, which is considered sufficient, is not always applicable for melanoma in the oral cavity.

Conclusion

It is very important to include an examination of the oral cavity in the general preventive examination of the skin. To prevent the development of melanoma of the oral mucosa, any dense pigmented areas that cannot be explained should be biopsied. Morphological variability, asymptomatic course, rarity of occurrence, poor prognosis, need for specialized treatment are all factors that must be taken into account when diagnosing and choosing therapy for this malignant neoplasm.

Vigilance, a thorough analysis of these and other clinical cases can be very useful to create a clear classification, early diagnosis, as well as contribute to timely treatment and improve the prognosis of this rare pathology.

Ajay Kumar, Department of Dental and Maxillofacial Pathology with Microbiology, I.T.S. Dental Research Center, Muradnagar, Ghaziabad, Uttar Pradesh

Ruchi Bindal, Department of Dentistry and Radiology, I.T.S. Dental Research Center, Muradnagar, Ghaziabad, Uttar Pradesh

Devi C. Shetty, Department of Dental and Maxillofacial Pathology with Microbiology, I.T.S. center for scientific research in the field of dentistry

Harkanwal P.Singh, Department of Dental Pathology and Microbiology, Swami Devi Dyal Dental College and Hospital, Pranchkula, Haryana, India

Melanoma is usually called malignant neoplasms that appear on the human skin. In this case, melanoma is formed not only on the skin, but also in the oral cavity, on the gums. Such a tumor is characterized by its causes, symptoms and, accordingly, treatment.

Description of the disease

Gingival melanoma is a cancerous tumor that most often occurs in the alveolar region of the mandible. But in case of not timely treatment, the growth is able to spread cancer cells to other parts of the body and internal organs.

Gum cancer is most common in people over 55 who have a history of other oral diseases.

Symptoms

Depending on the stage of development, gum cancer is accompanied by various symptoms. At the same time, the symptoms of the initial stage of such a disease are similar to the usual flux.

Bleeding

One of the earliest signs of cancer. The affected area of ​​​​the oral cavity begins to bleed at the slightest touch.

puffiness

Develops in later stages of cancer. Moreover, not only the area affected by the tumor swells, but also nearby soft tissues.

This symptom is accompanied by discomfort inside the mouth (feeling of internal bursting) and increasing pain. In this regard, it becomes problematic for the patient to chew food and smile.

Pain syndrome

At the first stage of a cancerous growth, pain is felt directly at the site of its localization. But with the growth of the tumor, the pain syndrome also covers other adjacent parts of the oral cavity, up to half of the face.

At the same time, the sensations are so strong that moving any muscle of the face becomes difficult for a person. In this regard, the patient begins to limit himself in talking and eating, which is due to a further decline in strength and a violation of the central nervous system.

Color change

In most cases, melanoma is characterized by a change in color. In this case, the damaged area of ​​the gum becomes a rich red color with pronounced vessels. Also, white blotches and point erosion appear at the site of the neoplasm.

Changing the size of the lymph nodes

Gingival melanoma is characterized by an increase in the parotid or submandibular lymph nodes. This symptom is usually accompanied by cough, shortness of breath and pain in the neck. This is due to the fact that the mutated cells have already spread to the lymph nodes and began to affect other closely located organs (larynx, lungs, bronchi).

hyperthermia

If the patient does not have any inflammatory and infectious processes, then elevated body temperature is considered a clear sign of malignancy. In this case, hyperthermia is often accompanied by drowsiness, general weakness, significant weight loss, nausea and vomiting.

In the early stages of cancer, body temperature varies from 37 to 38 degrees. At stages 3-4, hyperthermia exceeds 38.5 degrees.

There are cases when the above symptoms do not appear until metastases begin to affect other nearby soft tissues and internal organs.

Provoking factors

The direct causes that affect the formation of gingival melanoma have not been established. However, there are various factors that have a negative effect on soft tissues, as a result of which a favorable environment is created for the development of tumor cells on the gums.

Diseases

Chronic and inflammatory diseases of the gums (periodontitis, papilloma and others) with untimely treatment can give rise to malignant neoplasms.

Damage

People whose gums are regularly exposed to mechanical damage are more likely to get melanoma. Such damage is often caused by crowns, prostheses and piercings. In addition, unprofessional tooth extraction also damages the gums and can lead to inflammation and further development of a cancerous tumor.

Wrong way of life

Smoking, drug addiction and alcoholism are considered provocateurs of various diseases, including gum melanoma.

Improper nutrition

The soft tissues of the gums are very sensitive. Eating too hot or spicy food makes them more vulnerable over time.

If a person has a combination of the above reasons, then the risk of getting gingival melanoma increases at least twice.

Diagnostics

To distinguish ordinary dental pathology from gum cancer, the examination should be carried out by a qualified specialist. For diagnosis, various research methods are used.

First, the doctor conducts a visual examination of the oral cavity. If cancer is suspected during such an examination, the doctor directs the patient for additional laboratory tests.

These include fluorescent examination, biopsy and puncture from the lymph nodes. It should be borne in mind that these analyzes are effective only at the initial stage.

At later stages, a study is carried out for biomarkers, x-rays of the facial bones and magnetic resonance therapy. All these diagnostic methods make it possible to determine the size of the growth, its stage, and the depth of spread of mutated cells.

Treatment

Depending on the stage and size of the neoplasm, the prescribed therapy depends.

Surgical intervention

It implies excision of the tumor, regardless of the stage of its development. In this case, a certain tumor-like area of ​​\u200b\u200bthe gum, the affected area of ​​\u200b\u200bthe jawbone, lymph nodes and cervical soft tissues are subject to removal.

Chemotherapy

This method of treatment is carried out with inoperable growths. It is characterized by the introduction of special medicines into the human body. However, they can be administered orally (tablets) or intravenously (injections).

Radiation therapy

The affected part of the gum is exposed to radiation, which can destroy cancer cells. It should be borne in mind that this method stops the spread of metastases, but does not heal a person from cancer.

Complications

The main and most dangerous complication is the spread of metastases to other parts of the body and internal organs. In addition, malignant tumors in the last stages may be accompanied by severe bleeding, which is life-threatening for the patient.

Forecast

Timely detection of gingival melanoma and proper treatment favors the speedy recovery of the patient and avoids relapses.

The mortality rate from this disease is very low.

Prevention

Preventive measures include regular medical examinations, maintaining a healthy lifestyle and performing oral hygiene procedures. In addition, proper nutrition and avoiding smoking will reduce the risk of gingival melanoma.

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

The success of the treatment of this disease (as well as many others) is highly dependent on the stage at which the disease was diagnosed. This means that each of us needs to clearly understand how to recognize melanoma at an early stage in order to prevent its dangerous growth.

What is melanoma

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

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

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

Factors that can trigger the development of melanoma

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

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

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

The first signs of melanoma

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

Especially obvious signs of a dangerous situation are reddening of the tissues around the nevus, the appearance of cracks on it, sores covered with a crust, and bleeding. In such cases, the mole causes concern - it itches or burns. In this case, the patient may have enlarged lymph nodes.

How does melanoma grow?

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

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

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

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

How to recognize melanoma: signs and symptoms of the disease

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

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

From the above, we can draw an unambiguous conclusion regarding how to recognize melanoma at an early stage. But at the same time, you should remember that you do not need to wait for all of the listed symptoms - just one of them is enough for you to have a serious reason to contact a dermatologist.

Once again about whether to worry if a mole grows

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

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

Diagnosis of the disease

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

Due to the fact that, as already mentioned earlier, melanoma is very aggressive, and even a minor injury can provoke its development, an invasive method of examining it is highly undesirable (it means scraping or histology, when not all of the formation is taken for analysis, but a small part of it ). Therefore, most often the doctor conducts an external examination of the nevus.

He will definitely check the condition of the lymph nodes under the arms, on the neck and in the groin, and will also conduct a radioisotope study, in which phosphorus is used. By its increased accumulation in the tumor, the presence of melanoma is judged.

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

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

How is melanoma treated?

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

If lymph nodes are suspected, then after a biopsy of one of them and a positive result, their removal is supposed.

With proven significant benefit of immunotherapy. This is a relatively new method of treatment, which is carried out immediately after surgery to remove the tumor.

In the later stages of the development of the disease, they resort to radiation and chemotherapy, which, by the way, in the fourth stage of the development of a cancerous tumor are ineffective, allowing only to some extent to reduce it.

A few words in conclusion

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

But in the end, I would like to add that it is not at all necessary, having discovered a birthmark of an unusual shape, to immediately fall into despair. Not every mutated mole will turn out to be a cancerous neoplasm, it can be an atypical pigment spot or a benign dysplastic nevus.

But still, a trip to the doctor should not be postponed, since in this case it is better to exercise excessive vigilance, which can subsequently save not only health, but also life.

Most often, women from 30 to 40 years old are affected. Melanoma may cause the spread of metastases. If it is not treated in time, the outcome can be sad.

Symptoms of the disease

Signs of melanoma

• it can be more than 6 mm wide, if the melanoma becomes even larger - this is a clear sign of its growth inside;
• it has an irregular shape;
• color change.

Causes of the disease

• intradermal;
• epidermal-modermal;
• mixed.

The main causes of melanoma on the lip are:

1. Influence of ultraviolet rays;
2. Injury;
3. Hormonal disbalance;
4. Violation in the work of the body.

Lip disease

• smoking cigarettes;
• infection with viruses and infections;
• sun;
• constant chewing of tobacco;
• temperature changes;
• drinking strong coffee;
• strong alcohol;
• and of course the lack of hygiene.

Video: "Lip cancer first symptoms"

Melanoma is a skin cancer that develops from melanin-producing pigment cells. Pigment cells are present in each of us. The color of the skin, the presence or absence of nevi, moles, freckles depends on them.

Melanoma is thought to be a collection of atypical pigment cells. They begin to divide uncontrollably, which is why the tumor grows. At the initial stage, the tumor is easily treated - it is removed surgically.

The longer the patient delays and avoids surgery, the worse his condition will be. At the 4th stage, skin oncology actively metastasizes, which often leads to death.

Metastases are called secondary foci of cancer. The initial focus in the course of growth throws out cancer cells that enter the lymph flow, and then spread throughout the body with lymph and blood.

In some places they linger and accumulate. This process is called metastasis. Metastases can be multiple or single. First, they are located in the lymph nodes, and then attack the internal organs that are vital to humans.

Proper and timely treatment can prevent the above process. If you remove the tumor in the early stages, you can ensure a long and carefree life. However, it doesn't always happen that way. Melanoma can relapse - come back again.

One type of malignant skin disease is called melanoma. What is this pathology? This is a disease that develops from melanocytes, that is, special pigment cells that produce melanins.

The pathology has an aggressive, often unpredictable and variable clinical course.

Most often, melanoma is found on the skin. Much less often, it affects the mucous membrane of the larynx, eyes, mouth and nose. Sometimes melanoma is found on the skin of the anus, external auditory canal, as well as on the female external genitalia.

If a person has melanoma, what does this mean? The presence of this neoplasm suggests that the patient is affected by one of the most severe types of cancer, which is in sixth place in terms of the incidence of malignant tumors in men and in second place in women.

Most often, melanoma affects quite young people, whose age ranges from 15 to 40 years.

THE REASONS

One factor cannot provoke the appearance of a malignant tumor. This requires a combination of factors.

Over the entire period of treatment of melanoma, oncology has revealed a significant number of provocateur factors, but they have not recognized one of them as the main, absolute and mandatory.

Melanoma differs from other types of skin cancer in that it often recurs. The reasons for relapse can be very different:

• poorly removed tumor (if cancer cells remain);
• metastases;
• depressed state of immunity;
• the patient's age;
• disease complications.

The cause of melanoma has not been precisely determined.

But known risk factors:

The cause of the disease, as we have already said, experts call damage to the DNA of the cell, which occurs under the influence of various risk factors. In addition to the main reasons that we have already named, people with very fair skin and red hair often have a tendency to develop the disease, that is, those who have someone close to them in the family suffered from this disease, as well as people with a large number of moles on their bodies or exposed to excessive sun exposure.

Melanoma is a skin cancer that develops in pigment cells called melanocytes. The course of the disease is variable.

Often the disease is located on the skin, less often - in the oral cavity, nose, larynx, mucous membranes of the eyes, skin of the anus, ear canals, genital female organs.

Speaking about what skin melanoma is, such a tumor is considered one of the most severe forms of cancer. It often develops in people between the ages of 15 and 40, ranking sixth among all cancers in men and second in women after cervical cancer.

The reason for the formation of melanoma is the degeneration of melanocytes into malignant cells. The main theory that explains this process is the molecular genetic one. 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, a violation of the integrity of chromosomes or their rearrangement. Altered cells acquire the ability to divide indefinitely, as a result of which the tumor increases in size and metastasizes. These violations can occur under the influence of adverse factors of internal and external properties, or their combination.

Causes and risk factors:

Melanoma (Latin melanoma) is a type of skin malignancy. It is formed from pigment cells - melanocytes. These cells produce melamines. The clinical course of the disease is characterized by unpredictability, aggression and frequent changes.

As a rule, melanoma affects the skin. But in some cases, it can manifest itself in the mouth, larynx, on the mucous membrane of the eyes, nasal cavities, anus, the surface of the external auditory cover, or on the female genital organs.
Melanoma is considered one of the most severe forms of cancer. It occurs in both children and adults. The age range of patients varies from 15 to 40 years. It ranks 2nd among all malignant tumors in women (1st place is cervical cancer) and 6th among malignant tumors in men.

Types of melanoma

TNM classification

retinal melanoma

Lentiginous melanoma of the mucous membranes of the nasal cavity, mouth, perianal (anus area) and vulvovaginal region (external genital organs) - 1% of the total number of melanomas. It manifests itself in the form of uneven pigmentation.

Malignant soft tissue melanoma - grows on ligaments and aponeuroses. It occurs in all age groups, including children and adolescents.

Speaking about the treatment of melanoma, first of all it should be noted the presence of several types of education. They differ from each other depending on the nature of growth and cellular composition.

The classification can be explained by the fact that different forms have different trends in the rate of metastasis and local spread. Having determined the type of formation, the doctor will be able to prescribe treatment in a particular case.

Pigmentless (achromatic) melanoma

Speaking about the symptoms and treatment of this type of education, it should be noted that it is very rare and difficult to diagnose. The reason is that the skin does not change its usual color, and the patient may not even suspect that he has cancer.

It manifests itself in the form of a small seal, which later begins to grow, covered with epithelial small-lamellar scales, and the surface of the formation itself becomes rough.

The disease varies in form.

Clinical forms of the disease:

If we talk about the varieties of melanomas, then there are a large number of them. Classification is carried out according to the nature of growth and cellular composition. The classification according to these features is explained by the fact that different forms of melanoma are characterized by different rates of spread of metastases and a different tendency to local spread.
Pigmentless (achromatic) melanoma is extremely rare. This type of tumor is difficult to diagnose. This is due to the fact that it has a color similar to the color of the skin, so patients notice it only in the later stages of development. Such a tumor begins with a small induration. As the seal increases, it becomes covered with small-lamellar scales of the epithelium, its surface becomes rough. In some cases, it may be in the form of a scar with uneven edges, or in the form of a white or pink scallop. When a red corolla of inflammation appears, itching and swelling begin, sometimes hair may begin to fall out or small sores may appear. This form of melanoma is extremely dangerous, as it is characterized by the rapid development and spread of metastases in the earliest stages. At the 1st stage of achromatic melanoma, effective treatment is possible. If the disease is detected at a later stage, then even after radical and intensive treatment, relapse and the spread of new metastases often occur.

Stages of development

The stages of melanoma of the skin are based on the cytological examination of the removed tumor. Melanoma has the following stages of development:

Zero stage. Melanoma is a non-invasive malignant lesion.

First stage. In this case, melanoma without ulceration has a thickness of at least 1 mm, and with ulceration no more than 2 mm.

Second stage. Melanoma without ulcers with a thickness of more than 2, without ulcers with a thickness of up to 2 mm

The above stages are not characterized by the formation of foci of metastasis of internal organs. In the next two, these foci are already present.

The third stage is characterized by the presence of metastases in the regional lymph nodes.

The fourth stage is characterized by the presence of metastases in distant organs and tissues of the body.

A malignant tumor goes through the following stages:

• initial, or local;
• I, when the spot has a thickness of 1 mm with ulceration or 2 mm without them (a photo of melanoma at this stage is presented below);

• II, in which neoplasms with a damaged surface have a diameter of up to 2 mm, and with a smooth one - up to 4 mm;
• III - this is the stage, which is characterized by any size and thickness of a tumor that has nearby foci or metastases;
• IV, the last stage is characterized by the germination of the neoplasm in distant lymph nodes and in many organs.

If treatment is not carried out, then all the stages described above pass through melanoma. See photo of the neoplasm below.

Speaking about the symptoms of melanoma, it should be noted that, like any cancerous tumor, it also has its own stages of development:

• local or initial stage, limited;
• Stage 1 melanoma - thickness 1 mm with ulceration (damaged surface) or 2 mm, but without damage;
• Stage 2 - thickness not more than 2 mm with damage on the surface or up to 4 mm but without damage;
• Stage 3 - the formation of any thickness and surface, but with at least one metastasis to nearby lymph nodes or nearby foci;
• Stage 4 - the tumor begins to grow into tissues located nearby, separate areas of the skin, metastases are observed in separate lymph nodes, lungs and other organs - the liver, bones, brain.

Of great importance in this case are reliable and significant signs of melanoma, which turns from a benign formation into cancer. So it is possible to determine that a benign formation begins to gradually degenerate into oncology? If there is melanoma of the skin, the symptoms at an early stage are:

The course of melanoma is determined by a specific stage, which corresponds to the patient's condition at a particular moment, there are five in total: stage zero, stages I, II, III and IV. The zero stage makes it possible 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 the limits not exceeding one millimeter, the epidermis (that is, the skin on the outside) is often covered with ulcerations.

Meanwhile, ulceration may also not appear, the thickness of the tumor formation can reach about two millimeters, and the lymph nodes that are in close proximity to the pathological process are not affected by melanoma cells.

Stage II of the tumor formation in melanoma determines for it the dimensions of at least a millimeter in thickness or 1-2 mm in thickness with the appearance of characteristic ulcerations.

This stage also includes tumor formations, the thickness of which exceeds two millimeters, with possible ulceration of their surface or with a surface without ulcers.

At this stage, melanoma in any of these options does not spread to the lymph nodes located in close proximity to it.

The next, III stage, is accompanied by damage to the pathological process of nearby tissues, in addition, the study reveals the presence of tumor cells in one lymph node or more of them, the affected lymph nodes are also located in close proximity to the affected area of ​​the skin.

The possibility of melanoma cells leaving the borders of the primary focus is not excluded, however, the lymph nodes are not affected.

For stage IV of the progression of the disease, 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, is characteristic.

As we have already noted, relapses of the disease are not excluded even with correctly defined and carried out treatment. The pathological process can return both to the area that was previously affected, and form in that part of the body that was not related to the previous course of the process.

In this case, the clinical stage corresponding to the course of melanoma at the time of diagnosis is considered as the most important factor. Regarding survival within the framework of stages I and II, in which the localization of the tumor is concentrated within the boundaries of the primary focus, the survival rate for the next five years is approximately 85%.

In the case of stage III of the course of the disease, in which metastasis occurs to regional lymph nodes, the survival rate for the specified 5-year period is reduced to 50% if the process affects one lymph node and about 20% if several lymph nodes are affected.

As part of the consideration of stage IV, accompanied by distant metastasis, survival for the next five years is no more than 5%.

A positive aspect 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 it is the thickness that indicates the mass that is relevant for the tumor, while the mass of the tumor determines the likelihood of subsequent possible metastasis.

With a thickness of the tumor formation within the limits of no more than 0.75 mm, the prognosis of successful cure due to surgical intervention is determined, as for survival within the standard considered period of 5 years, here it is relevant in 96-99% of cases.

Approximately today, it can be indicated that in approximately 40% of cases of morbidity in patients, a tumor formation is detected within its thickness of up to 1 mm, while the patients themselves in this case are identified in the so-called low-risk group.

In those patients who develop metastases, a histological examination of the primary tumor formation determines either its vertical growth or spontaneous regression.

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

In general, the prognosis directly depends on where exactly the tumor is located. Thus, the most favorable prognosis is determined by the localization of the tumor formation in the region of the legs and forearms, the unfavorable prognosis, in turn, is determined by its localization in the area of ​​the feet, hands, scalp, and mucous membranes.

There is also a certain trend in terms of gender in this regard. 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 area of ​​​​the legs, where it is easier to detect it during self-examination, which, in turn, makes possible subsequent treatment in 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, due to the late detection of the tumor, as well as the high susceptibility of older men to acral lentiginous melanoma.

The prognosis for the 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 as follows: the thicker the size of the tumor, the faster it is subject to subsequent recurrence.

Symptoms

Although each form of melanoma has its own specific symptoms, there are a number of common symptoms that are common to all forms of melanoma. What are the symptoms of melanoma?

1. The rapid growth of the tumor: an increase of several times in a few months.
2. Heterogeneous pigmentation: usually melanoma is characterized by a mosaic color.
3. Asymmetric shape of the tumor with ragged fuzzy edges.
4. Painful sensations.
5. Bleeding and ulceration of the mole.
6. Loss of hair, if hair has grown on it before.

When examining a neoplasm on the skin, you can use the "ABCDE rule", which allows you to diagnose melanoma at an early stage of development:

1. asymmetry;
2. fuzzy borders;
3. mosaic coloring;
4. elevation of the tumor above the skin;
5. change in symptoms: a mole changes its characteristics.

Attention! If you find one or more of the "ABCDE rules" in yourself, you need to urgently seek advice from a dermatologist.

Melanoma is initially a dark spot that rises slightly above the surface of the skin. In the process of growth, it takes the form of an exophytic tumor, which can ulcerate in the future.

The tumor is usually solitary; primary-multiple foci are very rare. Depending on the growth rate and the time of visiting 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 may be bumpy with papillary growths in the form of cauliflower.

The shape is round or oval, in the presence of papillary growths becomes irregular. An exophytic tumor is usually located on a wide 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 coloration, a shiny surface, and a tendency to decay. These features are due to the processes occurring in the tumor: the accumulation of pigment, the defeat of the epidermal layer, the fragility of the neoplasm.

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 color intensity depends on the amount of melanin in the tumor. Usually, melanomas are a rich dark color with varying shades from dark brown or bluish black to slate black.

Less common tumors are light brown or reddish-purple. In some cases, unstained neoplasms, the so-called pigmentless melanomas, are observed.

When viewed with the naked eye, the color of the tumor seems to be uniform, but sometimes the pigmentation is more pronounced in the center, or vice versa, 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 viewed under magnification, a network-like surface pattern and variegated heterogeneous pigmentation of varying intensity with a bluish, brown or black tint of grains are almost always found.

The disappearance of the skin pattern and the shiny nature of the surface are the second hallmark of melanoma. The epidermis over 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.

1. Particular attention should be paid to the color of moles. Alertness should cause blackening of the mole or any other change in its color.2. Changing the shape and size of a mole.3. Redness of the skin around the mole, itching.4. Bleeding from a mole.

30% of melanomas develop within the previously existing nevus (pigment formation), the remaining 70% are formed in a new place. You should be alerted by the following changes in the nevus and / or a newly formed formation:

And asymmetry - one half is not like the other, perhaps on the one hand growth is faster.

B disorderly outlines - jagged, uneven, patterned borders.

With color variations - blotches of various colors and white, and pink, and brown, and black, and bluish.

D diameter is more than 6 mm. measured along the longest axis of the focus.

An early but rare symptom is itching, but most cases are asymptomatic.

Late symptoms include soreness, bleeding, and ulceration.

Of course, a specialist will instantly distinguish an ordinary mole from a dangerous malignant neoplasm. But it is also important for each of us to know the main signs of melanoma in order to recognize a dangerous disease in time and not start the disease.

So, let's see what are the first symptoms of such a serious disease as melanoma.
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First of all, the alarm must be sounded if an ordinary mole suddenly began to “reborn”. That is, if you notice that the nevus began to increase in size or grow rapidly above the surface of the skin, get wet, if its color has changed, redness, itching, burning and bleeding appear, if the lymph nodes are swollen or you experience discomfort in this place, this most likely nothing more than symptoms of melanoma.
In more detail, you should be alerted by the asymmetric, as if jagged, edges of the neoplasm - in an ordinary mole they are usually even. The unusual color of a birthmark, as a rule, also speaks eloquently about the disease: the color can change both to gray and black, and to bright red and even blue.

By the way, it is important to know that absolutely any change in the color of a birthmark should not go unnoticed. In this situation, it is necessary to be examined and consult an oncologist.

As for the size, any neoplasm with a diameter of more than 6 mm should also cause you concern - since these are characteristic signs of melanoma.

Later on this place may appear bleeding ulcers.
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What does melanoma look like in the initial stages of its development? At this stage, it is not much different from a birthmark.

What does melanoma look like in this case (photo - initial stage - presented below)?

A malignant neoplasm may be a flat pigmented or non-pigmented spot, characterized by a slight elevation. At the same time, melanoma has an oval, irregular or rounded polygonal shape with a diameter of more than 6 mm.

The initial stage of this pathology lasts a certain time. At the same time, the stain retains its shiny and smooth surface.

But in the future, the appearance of this neoplasm becomes different from that which the mole has. Melanoma becomes a patch with small ulcerations and bumps.

In addition, it bleeds even with the slightest injury. Pigmentation in this pathology is uneven.

However, it has a more intense color in the central part of the spot. Below you can see what melanoma looks like (photo).

Symptoms, in addition to more intense pigmentation, are characteristic black rims located around the base. In general, melanoma can be black with blue, brown, purplish or variegated, looking like unevenly distributed individual spots.

In some cases, the neoplasm looks like overgrown papillomas (see a photo of this type of melanoma below).

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 also develop on healthy skin.

In women, symptoms often appear on the chest and legs, in men - on the arms, chest, back.

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

Before we move on to a more detailed consideration of the processes and symptoms associated with the course of the disease, we highlight the main signs of melanoma, which provide the possibility of its early recognition, there are five in total:

• asymmetry of education (irregularity of its shape);
• heterogeneity of the color of the formation: in some places the tumor is dark, in some it is light, and in some cases it can be combined with almost black areas;
• the edge of the tumor formation is arcuate and uneven, indistinct, there may be notches;
• 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 somewhat elevated position compared to the level of the surface of the skin (more than 1 mm).

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 melanoma of the eye are the appearance of photopsies, progressive scotomas and visual impairment.

Melanoma develops from melanocytes, the cells that produce the pigment melanin. The amount of this pigment determines the color of the skin. The color of melanomas is usually dark, but can be different, for example, gray, blue, black, pink-red.

Differences between melanoma and a normal mole:

• The tumor has an asymmetrical shape, the mole is round.
• The edges of the melanoma are irregular.
• The color is uneven.
• Large size (from 6 mm).

If there are doubts, a mole or melanoma has appeared on the body, you should definitely visit a dermatologist. If necessary, he will recommend contacting an oncologist for a consultation.

During the examination, the specialist pays attention to the presence of symptoms:

• Characteristic color, appearance, structure, shape, density of the spot. A bad symptom is a change in the color, shape or structure of the mole.
• Mole size.
• Bleeding, ulceration.
• Redness of the skin in the area of ​​the mole, pigmentation.

Diagnostics

Usually, the diagnosis of melanoma is established on the basis of a morphological examination of tissue sections under a microscope. In other words, a biopsy of the removed tissue is performed.

In the presence of a tumor manifestation, a histological examination is performed to accurately diagnose melanoma before surgery.

A smear glass is applied to the expressed tumor, on which a trace of the wound is imprinted. The smear-imprint is microscopically and determine the exact diagnosis.

Also, an inflamed enlarged lymph node is punctured in conjunction with an ultrasound scan to determine the spread of the process (development of metastases).

The 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 development of the disease and the data of an objective study. Valuable information can sometimes be obtained using special research methods.

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

You should be alerted if the following changes occur with a mole:

• the shape is convex - raised above the level of the skin, it is better seen with side lighting.
• resizing, growth acceleration is one of the most important signs.
• the borders are irregular, "jagged" edges.
• asymmetry - the halves of the mole are not similar to each other.
• large size - the diameter of the tumor is larger than the diameter of the handle.
• color uneven blotches of brown, gray, black, pink, white areas.

With the help of a dermatoscope (a special microscope that makes the stratum corneum (i.e. the most superficial) transparent, and you can see if the mole is malignant.

But the final diagnosis is made only after a histological examination (when a suspicious mole with a healthy skin area is cut out and tissue sections are examined under a microscope).

Various research methods are used in the diagnosis of melanoma. One of the earliest diagnostic methods is dermatoscopy, it is carried out using a magnifying glass or dermatoscope.

In this case, the doctor can determine whether the nevus is dangerous or not. For this, a special system is used, which takes into account the asymmetry of the mole, the presence of uneven edges, the diameter and variability of the mole, and the unequal color of individual sections of the mole.

The final diagnosis is made only after receiving the results of histological examination. As a rule, in this case, the mole or nevus is completely removed along with part of the surrounding healthy tissues. Permissible for other types of tumors, preoperative tumor biopsy is contraindicated in this case, in order to exclude the spread of melanoma. Histological examination determines the depth of tumor germination and mitotic index.

To diagnose metastases, the level of lactate dehydrogenase (LDH) is determined, which makes it possible to determine metastases in the liver, computed tomography, MRI and scintigraphy are also used, these studies allow determining the presence of metastases in the lymph nodes and other organs.

A doctor can make an accurate diagnosis of the presence of a malignant tumor based on the following:

• patient complaints about a suspicious mole and its visual examination;
• a general clinical analysis of urine and blood;
• the method of hardware dermatoscopy used, which allows you to examine the neoplasm in the skin layers and draw conclusions about its boundaries and nature;
• performing an ultrasound examination of the abdominal cavity, chest x-ray, magnetic resonance and computed tomography of the brain and spinal cord, which allow to determine the presence and spread of metastases in various organs;
• pathological examination of a smear or materials obtained as a result of a puncture;
• conducting an excisional biopsy, in which suspicious moles are excised, followed by a histological examination.

Speaking about whether it is possible to cure melanoma, first of all, it is necessary to conduct a timely diagnosis. You can determine the presence of the disease in this way:

Even for an experienced doctor, diagnosing melanoma is a challenge. Of great preventive importance in this matter is the early detection of signs of the disease. An important role is played by the coverage of 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, you should immediately seek advice from a dermatologist or oncologist.

Diagnostic steps:

• Visual examination of the patient's skin and detection of pathological changes using a dermascope or a 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 for tissue sampling for histological analysis.
• Cytological analysis of a puncture of an enlarged regional lymph node.
• Chest x-ray, isotropic CT scan, MRI, ultrasound to detect lesions of internal organs.
• Confocal microscopy - infrared irradiation of a layer of skin to determine the depth of melanoma germination.

A disease such as melanoma is diagnosed in the following ways and methods.

Listening to patients' complaints, clarifying how the neoplasm changed, which caused suspicion or concern, when the patient noticed it.

A visual examination of the patient is also carried out to determine the number of existing moles, the determination of those birthmarks that differ from others in order to conduct their further research;
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Conducting urine and blood tests (general clinical tests);

Ultrasound examination of the abdominal organs, chest X-ray, magnetic resonance and computed tomography of the brain and spinal cord. These studies make it possible to determine whether there are melanoma metastases in other organs;

Hardware dermatoscopy, which allows you to increase several tens of times (from 10 to 40 times) the skin layers and the neoplasm itself. Thanks to this study, it is possible to determine the nature of the development of the tumor and its boundaries;

Cytological examination of a smear or material obtained by puncture of a lymph node. A smear is taken if the tumor is ulcerated.

A puncture of the lymph node is taken only in special cases. Puncture helps to identify melanoma even in the absence of a primary tumor;
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excisional biopsy. In this study, excision of the formation is performed, which raises suspicions of malignancy. Excision is carried out outside 0.1-1 cm from the edge of the formation. After that, an urgent histological examination is carried out. In the event that the diagnosis is confirmed, a radical removal of the tumor is performed. This diagnostic method is used if all preliminary studies have shown a dubious result.

Treatment

Treatment for melanoma depends on the stage of the disease. In cases of melanoma with metastases only in the lymph nodes and melanoma without metastases, surgical treatment of the tumor is performed. In the treatment of metastatic stages of melanoma, the following treatment methods are used:

• surgical method;
• chemotherapeutic method;
• radiation therapy;
• immunotherapy;
• general hyperthermia;
• photodynamic therapy.

Surgery. Surgical removal of the tumor is the main treatment for melanoma. The tumor itself is removed along with the surrounding tissue and subcutaneous tissue. Lymph nodes are excised only if they are affected by metastases.

Radiation therapy. If it is impossible to remove metastases surgically, radiation therapy is performed, as well as after removal of large metastases to prevent relapses.

Chemotherapy and immunotherapy. Unfortunately, modern medicine does not have effective means to cure skin melanoma metastases, so chemotherapy is used to prevent recurrence.

Other methods are not dominant in the treatment of melanoma, but in some cases they are able to slow down its development, stop the growth of metastases and even reduce its size.

General hyperthermia (OGT). This method is used in the treatment of metastases of internal organs.

This method is not used for metastases located in the brain, head and neck. What is the essence of the method? The human body is heated by an electromagnetic field with the introduction of an anticancer drug.

In some cases, during the treatment of OHT, the malignant formation decreases in size and stops progressing. This phenomenon is observed even with the use of chemotherapy, to which she was previously insensitive.

Photodynamic therapy (PDT). The PDT method does not cure melanoma, but it provides local antitumor therapy. This method is used to treat intradermal metastases.

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

Treatment of the primary focus

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 melanoma stages I and II. The operation must be performed under anesthesia.

A scalpel or an electroknife is widely excised skin with a tumor. From the visible edge should be retreated by at least 5 cm, and in the direction of the lymph outflow even by 7-8 cm or more.

For cosmetic reasons, this cannot be done on the face. Facial melanoma usually has to be excised 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 controversial and is not recognized by some authors.

An extensive defect after excision of melanoma cannot be closed without skin grafting. On the trunk and in the proximal limbs, the defect is closed by moving local tissues.

Free skin grafting should be applied on the extremities. Conventionally, it is believed that if the defect after removal of melanoma was successfully sewn up without resorting to skin grafting, then the operation was not done radically enough.

In the case of melanoma located on the fingers of the hands or feet, amputation or disarticulation of the fingers is performed. At other localizations of the tumor, amputation is undesirable.

During the operation, it is necessary to strictly observe the rules of ablastics. For this purpose, the tumor is closed with a napkin soaked in iodine, stitching it to the skin within the limits of the removed preparation.

In order to avoid dissemination, they try not to injure the melanoma and surrounding tissues, do not touch the tumor with fingers and instruments.

There is also a surgical intervention under the control of a microscope to increase the effectiveness of operations for skin tumors - Mohs surgery (Frederick Mohs).

Treatment of metastases in the 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 outcomes. Currently, lymphadenectomy is performed only in the presence of palpable metastases in the lymph nodes.

As a rule, it is not performed for prophylactic purposes, but some authors resort to lymphadenectomy with deep germination of melanoma into the dermis (4-5th level of invasion).

Indications for regional lymphadenectomy in primary skin melanoma: table

Radiation treatment

Despite the low sensitivity of melanomas to ionizing radiation, radiation therapy as an independent treatment used to be widely used.

Conducted close-focus X-ray therapy 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 the melanoma, and not the pigment nevus, was subjected to irradiation.

Because of this, radiation therapy was no longer 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 X-ray therapy 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. Surgical intervention is performed after the inflammatory reaction subsides.

Chemotherapy

Melanoma is insensitive to chemotherapy. However, drugs are widely used in 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 carried out by intra-arterial perfusion, after which surgery is performed. The operation is performed immediately after perfusion or after a few days.

In disseminated tumors, imidazolecarboxamide (DTIC) is most effective, with the help of which it is possible to obtain clinical remission in 20-30% of patients.

Less effective are nitrosourea, procarbazine, dactinomycin, etc. The effectiveness of drug treatment can be increased by using a combination of chemotherapy drugs.

One such combination, containing methylnitrosourea (MNM), vincristine, and dactinomycin, has become widespread and is as effective as imidazolecarboxamide.

Also used drugs such as dacarbazine (DTIC), carmustine (BCNU), lomustine (CCNU), cisplatin, tamoxifen, cyclophosphamide, etc.

Immunotherapy

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

Usually, the BCG vaccine is used, which is injected directly into the tumor nodes or into the skin next to the neoplasm. Such treatment in some patients leads to resorption of the 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 by the Eastern Cooperative Oncology Group (ECOG) showed that the use of interferon-alpha-2b at maximum tolerated doses provides a significant increase in disease-free period and overall survival compared with no adjuvant therapy.

One of the latest developments is the treatment of melanoma with the drug Yerva (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 expected to be used to treat certain forms of lung cancer and prostate cancer. Mechanism of action: ipilimumab is a human antibody that binds the cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) antigen, a cytotoxic T-lymphocyte molecule that probably plays an important role in the regulation of natural immune responses.

In addition to interferon-alpha (IFN-A) therapy for the treatment of melanoma, virotherapy is used - treatment of ECHO 7 with a 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.

A 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 the II and subsequent stages, especially with the defeat of the lymph nodes.

In the absence of lymph node metastases, the thickness of the tumor and the degree of skin invasion are of decisive prognostic value. In addition, the gender of the diseased, the presence of ulceration, and the localization of the tumor are important.

Other things being equal, the long-term results of treatment in women are better than in men. Melanomas of the extremities (with the exception of the subungual) proceed more favorably than melanomas of the trunk.

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

There are a number of treatments for melanoma. The most radical and most effective is the surgical removal of a malignant tumor. The method is used in 95% of cases and is performed under local anesthesia. With surgery, remission is quite high, especially in the early stages of melanoma.

Immunotherapy is one of the most recent treatments for melanoma. Usually used after surgery.

The following drugs are used: interferon-alpha, interleukin-2. These drugs not only help to increase the general tone of melanoma patients, but also help to reduce the number of metastases in the later stages of the disease.

Chemotherapy is the classic treatment for all cancers. Modern medicine uses drugs that are the so-called onco-cell blockers. They operate at the molecular level.

In advanced cases of melanoma, point radiation exposure is used. The latest treatment for the disease is gene therapy.

Prevention of melanoma is to reduce risk factors for the development of the disease. These include injury to birthmarks, as well as excessive exposure to ultraviolet radiation (both natural and artificial).

And of course, those who have a lot of moles on their bodies need to see an oncodermatologist once a year.

Melanoma is excised surgically, with the capture of healthy skin of about 2-3 cm, along with subcutaneous fat and muscle.

Other methods of treatment include: radiation therapy, immunotherapy, laser destruction, cryodestruction.

Remember that melanoma is potentially curable if detected and treated early.

After the surgical intervention, therapy is carried out only in the presence of metastases or suspicion of them. How is melanoma treated? With the use of courses of immuno- and chemotherapy, as well as their combinations.

Strengthening the body's defenses is, as a rule, an additional treatment. It is inevitable with existing metastases or with their high risk of formation.

The goal of immunology is to minimize the possibility of disease recurrence. And the combination of this method with chemotherapy allows you to exclude the spread of the tumor to other organs.

To completely eliminate the problem, it is important to recognize the disease at the earliest stages of its development. So, at the first and second stages of the disease, the tumor is localized only in the primary focus. This allows you to get a positive outcome when taking all the necessary measures in 99% of cases.

If melanoma has reached its third stage of development, then this means that metastases have already affected the lymph nodes. This development of the disease significantly aggravates the situation and gives a positive prognosis of only fifty percent.

Treatment success for melanomas that have reached their fourth stage is the least favorable. But it is still possible to overcome the disease. And this is confirmed by 40% of such patients.

Speaking about how to treat melanoma, first of all, it should be noted - radio wave, laser or surgical knife excision of the formation. If there are metastases, then after the operation, the patient is prescribed chemotherapy and stimulation of immunity.

Speaking about whether this type of cancer is treated, first of all, you need to determine the stage of the disease. If there is no metastasis, then the area affected by the formation must be excised at a distance of 3-5 centimeters from the visible edges of the melanoma.

Removal of the formation occurs along with the muscle fascia, aponeurosis and fatty tissue. If the formation is located on the skin of the hands, face, near natural openings - at a distance of 2-3 cm, on the fingers and toes (with the subungual type) - exarticulation or amputation is performed, on the middle and upper sections of the ear shells - their removal.

Melanoma treatment of the disease may depend on the presence of metastases, if they grow into the skin, as well as into nearby lymph nodes, then it is necessary to completely remove the “package” of lymph nodes along with the tissue under the skin.

Treatment of melanoma consists of its removal, chemotherapy or radiation, and immunotherapy. The choice of a specific tactic is determined by the stage of the tumor and its localization.

The most rational treatment for melanoma in the early stages is surgical removal of the tumor. Not only the neoplasia growth zone is excised, but also the surrounding healthy skin at a distance of up to three centimeters from the edge of the neoplasm.

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

The tumor is excised in several ways:

• knife;
• laser;
• radio wave.

In the case of a metastatic formation, the focus is removed by combining the 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:

• I stage. Surgical excision is performed with the capture of healthy tissue. The area of ​​intervention depends on the depth of germination of the formation.
• II stage. In addition to excision of the formation, a biopsy of regional lymph nodes is performed. If during the analysis of the sample a malignant process is confirmed, then the entire group of lymph nodes in this area is removed. Additionally, for the purpose of prevention, alpha-interferons can be prescribed.
• III stage. 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.
• IV stage. At this stage, a complete cure is no longer possible. Only those formations that cause inconvenience, as well as large neoplasms, are subject to removal. Sometimes it is possible to remove metastases from the internal organs, some patients are recommended a course of chemotherapy and radiation treatment.

Complications of melanoma

The main complication of melanoma is metastasis (that is, the spread and damage to other organs and tissues).

Melanoma spreads through the blood vessels (this is the hematogenous route), while metastases can settle in any organ, liver, lungs, bones, brain; as well as in the lymphatic system, while the lymph nodes are affected.

If the nevus is in a place of constant friction, and you constantly touch it, it can bleed, grow faster, ulcerate (it is better to remove them).

Self-treatment, in the form of threading, cutting with a razor or scissors, can lead to unpredictable results!

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

Postoperative complications include the appearance of signs of infection, changes in the postoperative incision (edema, bleeding, discharge) and pain. At the site of the removed melanoma or on healthy skin, a new mole may develop or discoloration of the integument may occur.

Prevention of melanoma

Unfortunately, this form of skin cancer is the most aggressive and has a poor prognosis. Even with a timely visit to the doctor and the behavior of adequate treatment, the disease does not always end in a favorable outcome.

In most cases, the outcome of the disease depends on the stage of melanoma development. The thicker the melanoma, the higher the risk of a terminal condition.

At an early stage of the disease, melanoma may well be curable.

Prevention of the disease consists in observing several rules:

• protect the skin from UV radiation with sunscreens with a high protection factor;
• avoid visiting the solarium, especially for people with multiple nevi on the skin;
• limit sun exposure: before 10 am and after 5 pm;
• avoid damage and injury to moles;
• use natural protection from the sun: relax in the shade of trees, wear light-colored light clothing that covers a large perimeter of the skin;
• use sunscreen even when you are in the sun for a short time.
• do not forget to wear hats, panamas and glasses;
• people at risk are systematically observed by a dermato-oncologist;
• independently monitor the condition of moles.

It should be remembered that tanned skin is far from a sign of beauty and health. The phrase "healthy tan" is an oxymoron, as a tan cannot be healthy.

Sunburn is our body's response to the harmful effects of ultraviolet radiation. Ultraviolet radiation is skin damage that causes photoaging at best and fatal diseases such as basalioma, adenocarcinoma, squamous cell carcinoma and skin melanoma at worst.

Remember the rule of ABSD and FIGARO. If you have any doubts, do not be shy, go to a dermato-oncologist.

Remember the simple rules of tanning:

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

Prolonged exposure to the sun is contraindicated. You need to get used to the influence of sunlight gradually, using sunscreen.

It is very important to protect children from sunburn. It is necessary to protect not only the skin, but also the eyes with the help of dark glasses with special filters.

It is also better to refuse tanning in the solarium.

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