Melanomas of the mucous membranes. Causes of the appearance of melanomas on the mucous membranes. Causes of cancer of the nasal mucosa

One type of skin cancer is mucosal melanoma. At the initial stage, melanoma looks like a mole. The main characteristics of these malignant tumors are rapid growth and rapid metastasis to any other human organs. The origin of such tumors depends on the appearance of abnormalities in the body's pigment cells containing melanin. The spread of melanoma throughout the body occurs with blood flow or intercellular fluid to the lymph nodes, individual tissues and organs. Timely diagnosis and treatment of such a disease is difficult due to its accelerated development, which endangers human life.

Melanomas on the mucous membranes are a malignant formation that has a great threat to human life.

What is melanoma?

The process of development of this malignant tumor originates in cells - melanocytes. They are located in the lower layer of the epidermis, which borders on the dermis. These cells produce a dark pigment - melanin, which is responsible for skin tone, hair color, eyes, and the presence of birthmarks on the body. If there is no accumulation of pigment, the growth of melanoma proceeds without the appearance of symptoms of the disease. The boundaries of tissue damage are indistinguishable from healthy mucosal tissue. With the accumulation of melanin, the tumor begins to rise above the level of the mucosa in the form of a dark brown node. The tumor can be asymmetrical, change its color, borders, and even secrete blood. The size of malignant tumors can vary from a few millimeters to 3 centimeters.

Mucosal melanoma is the most common cancer in people over the age of 30.

Types and localization of melanoma

Most of these formations are located on the human skin or organs of vision, and only in 5% of cases such a tumor develops on the mucous membranes. Melanomas on the mucous membrane occur in people of both sexes, do not depend on geographical and individual living conditions. Types of tumor are determined by the area of its location.

vulvovaginal - develops on the walls of the genital organs, vagina or vulva;
nasopharyngeal - affects the mucous membrane of the nose, pharynx, oral cavity, lips;
rectal - located on the walls of the anus, rectum.

Reasons for education

The appearance of melanoma is promoted by the transformation of melanocyte into a cancer cell. The main reasons for the appearance of such a transformation are still unknown. Causes of melanoma include:

prolonged exposure to ultraviolet rays on the skin;
weakening of the human immune system;
heredity or genetic predisposition;
malignant transformation of pigmented nevi, moles, birthmarks;
a combination of negative environmental factors;
the use of hormonal drugs;
presence of chronic injury.

Symptoms of melanoma formation

The presence of melanoma on the mucous membranes is accompanied by the formation of spots, vesicles, wounds.

the presence of a birthmark, moles that begin to change parameters and their color;
the appearance of a painful wound on the mucous membrane, which begins to itch and bleed;
the formation of a smooth unevenly colored spot;
the emergence and spread of scaly flat spots on the mucosa;
the occurrence of a painful seal on the skin;
swollen lymph nodes in the groin;
the appearance of a volumetric neoplasm on the vulva.

Diagnostic measures

It is difficult to diagnose such formations due to the location of melanoma in a hard-to-reach place. Self-examination of moles and other formations on the skin is of great importance in determining the initial stage of the appearance of melanoma. With the appearance of asymmetry, a change in the size, number, color of such formations, it is urgent to check with a dermatologist. There are several methods for diagnosing the disease. The main ones are summarized in the table:

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What is insidious melanoma of the oral cavity?

Informed means armed. In order to stop the course of the disease in time, you need to contact a specialized doctor at the first symptoms or manifestations. Even small ulcers or swellings that appear in the mouth require close attention to themselves.

They can be the first signs of a very insidious disease - oral melanoma. This type of cancer is relatively rare, but it is extremely life-threatening to underestimate it.

What is oral melanoma?
Primary oral mucosal melanoma is extremely rare. Statistical data show that of all tumors of a malignant nature, it occupies 1-2%. Most often, melanomas are localized on the gums of the upper jaw or on the palate. If the formation occurs on the lip, then the risk of metastases increases. Initially, it manifests itself as an ulcer, or a formation that looks like a crack or papilloma.

As the disease progresses, the patient begins to suffer from toothache, swelling, ulcers, and bleeding appear. This type of melanoma develops very quickly and actively metastasizes. In a quarter of cases, metastases are localized in the lymph nodes.

Who is most at risk?
Statistics show that men get sick 5-7 times more often than women. The main risk group is people aged 60-70 years. The incidence of oral melanoma is increased among people over 40 years of age. After the age of 80, the risks decrease significantly. Rarely, but children also get sick.

Predisposing factors for oral melanoma:
frequent use of alcoholic beverages, addiction to tobacco products, extremely risky - a combination of these two bad habits;
sometimes there is one mechanical injury in the medical history - damage to the mucous membrane during a dental procedure and even biting of the cheek or tongue;
in many cases, the role of harmful production conditions, such as hot shops, a humid environment at low temperatures, etc., has been noted;
constant consumption of very hot food;
untimely dental treatment, etc.
Doctors noted that in 20-50% of cases, other diseases occur before the development of a malignant tumor. They affect the tongue in 70% of cases and the buccal mucosa in 20% of cases.

Symptoms of oral melanoma
The symptoms of the disease include the following phenomena:

a mole or birthmark begins to change in color and parameters;
a wound appears on the mucous membrane, it hurts, itches and bleeds;
a smooth colored spot with uneven contours is formed;
flat spots spread, which at the same time peel off;
possible compaction on the skin, accompanied by pain, etc.
If a person finds at least one of the symptoms on his body, he needs to urgently visit a doctor. Time is of the essence in this disease. Melanoma of the oral cavity is insidious in that it is difficult to treat. The 5-year survival rate is only 15-20

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 genitalia) - 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 surface - 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, stage III, 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 indicated 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 a 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, the 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 lower 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 formation.

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?

The rapid growth of the tumor: an increase of several times in a few months.
Heterogeneous pigmentation: usually melanoma is characterized by a mosaic color.
Asymmetric shape of the tumor with ragged fuzzy edges.
Painful sensations.
Bleeding and ulceration of the mole.
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:

asymmetry;
fuzzy borders;
mosaic coloring;
elevation of the tumor above the skin;
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 coloration 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 changes, 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 ensure 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;
.

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;
.

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 often.

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 performed by the Eastern Cooperative Oncology Group (ECOG) showed that the use of interferon-alpha-2b at the 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 usually 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 parts 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 basal cell carcinoma, 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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Melanomas on the mucous membranes are a malignant formation that has a great threat to human life.

What is melanoma?

Mucosal melanoma is the most common cancer in people over the age of 30.

Types and localization of melanoma

vulvovaginal? develops on the walls of the genital organs, vagina or vulva;

nasopharyngeal? affects the nasal mucosa, pharynx, oral cavity, lips;

rectal? located on the walls of the anus, rectum.

Reasons for education

prolonged exposure to ultraviolet rays on the skin;

weakening of the human immune system;

heredity or genetic predisposition;

malignant transformation of pigmented nevi, moles, birthmarks;

a combination of negative environmental factors;

the use of hormonal drugs;

presence of chronic injury.

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Symptoms of melanoma formation

The presence of melanoma on the mucous membranes is accompanied by the formation of spots, vesicles, wounds.

the presence of a birthmark, moles that begin to change parameters and their color;

the appearance of a painful wound on the mucous membrane, which begins to itch and bleed;

the formation of a smooth unevenly colored spot;

the emergence and spread of scaly flat spots on the mucosa;

the occurrence of a painful seal on the skin;

swollen lymph nodes in the groin;

the appearance of a volumetric neoplasm on the vulva.

Diagnostic measures

Malignant tumors of the nasal cavity and paranasal sinuses treatment stage 1, 2, 3. Symptoms, signs, metastases, prognosis.

The nasal cavity consists of two halves due to the separation of the nasal septum. The nasal cavity is lined with a mucous membrane. The function of this cavity is that the air passing through it is moistened and warmed before it enters the lungs.

Malignant neoplasms of the nasal mucosa account for 1.8% of neoplasms of the head and neck. They are equally common among men and women. They develop mainly in people over 50 years of age.

Risk factors

Background processes that precede the development of tumors (chronic inflammatory changes in the nasal mucosa).

Neoplasms of the nasal cavity with a tendency to malignancy (transitional cell papilloma and adenoma).

Occupational hazards (nickel cleaning, wood processing, leather processing).

Bad habits (smoking, alcohol abuse).

The main morphological forms of cancer:

squamous keratinizing;

squamous non-keratinizing.

In addition to cancer (tumor of the epithelium), other malignant tumors can also occur in the nasal cavity, such as melanoma (pigment tumor) and sarcoma (tumor of connective tissue).

Symptoms of the disease

difficulty in nasal breathing;

release of purulent exudate;

ulceration of the nasal mucosa;

recurrent spontaneous nosebleeds;

inflammation of the middle ear.

pain in the nasal cavity;

heaviness in the head, headaches or pain in the face of a neuralgic nature;

deformation of the external nose and facial asymmetry;

noise in the ear and hearing loss;

pain in the teeth of the upper jaw.

Diagnostics

Examination of the nasal cavity (rhinoscopy);

Biopsy, i.e. excision of a small piece of tissue for subsequent examination under a microscope; X-ray of the head and chest;

Computed tomography or, if necessary, magnetic resonance imaging of the facial region of the skull and neck.

These research methods allow you to get much more information about the state of organs and tissues.

CT scan allows you to get, as it were, pictures of the "layers" of tissues and organs, which are further processed by a computer.

Magnetic resonance scanning does not use x-rays. For its implementation, the patient is placed in a special chamber in an electromagnetic field. This method allows you to identify an increase in lymph nodes;

Ultrasound procedure. It is a safe and painless method for examining soft tissues. It also allows you to identify changes in tissues adjacent to the tumor, an increase in lymph nodes.

Treatment of malignant tumors of the nasal cavity and paranasal sinuses

Mostly combined (tumor removal + radiation therapy).

With a significant spread of the tumor, treatment is supplemented with chemotherapy.

The type of treatment used depends on many factors:

general condition of the patient;
the size of the tumor and the degree of its germination in neighboring organs and tissues;
stage of tumor development;
the presence of regional and separated metastases.

All types of surgical interventions are performed in the oncological department of head and neck tumors of the National Research and Practical Center for OMR named after N.N. Aleksandrov for tumors of the nasal cavity, as well as the lymphatic apparatus of the neck in case of tumor metastasis.

Prevention

Timely and adequate treatment of chronic inflammatory diseases and benign neoplasms of the nasal cavity.
Use of personal protective equipment when working in hazardous industries.
Rejection of bad habits.
Seek immediate medical attention if early symptoms of the disease appear.

Melanoma- a common malignant disease of melanocytes (pigment cells of the skin), most often occurs in the skin, less often mucous membranes. In recent years, the incidence of melanoma has been on the rise. Melanoma accounts for 4% of all malignant neoplasms in men and 3% in women. It should also be noted that the disease is “getting younger”, i.e. if earlier the disease was more common in people over the age of 50, now the boundaries have shifted to a younger age. Currently, this disease is the second most common malignant disease among women aged 25-29 years, in the first place is breast cancer in women aged 30-35 years. The incidence of melanoma continues to grow faster than any other cancer, in terms of mortality, this disease ranks second after lung cancer.

General information about melanoma

Melanoma is a common malignancy. The disease itself is potentially treatable if detected and treated early. It should be noted that as soon as the fashion for a tanned body went up, the incidence also went up, especially with regard to the passion for solarium. Of course, it is clear that in our climate zone there is not enough sun. but remember that everything should be in moderation. This is especially true for people with skin types 1 and 2 (these are people with light eyes, hair, redheads, with freckles). There are the following types of melanomas:

Superficially spreading melanoma (70% of cases) - more often affects women, is characterized by horizontal growth and generally has a favorable prognosis;

Nodular melanoma (15%) - affects both men and women equally. It is characterized by growth in the thickness of the skin, is considered the most unfavorable in terms of prognosis;

Acral lentiginous (10%) is also known as subungual melanoma. It also grows on fingertips and palms. fast growing;

Malignant lentigo (5-10%) - equally affects both men and women, usually in the elderly. It develops in areas of open skin, i.e. face, neck, hands;

Amelanotic melanoma (7%) is pigmentless (colorless) melanoma. Appears as a harmless, enlarging pink-red papule (nodule), like the site of an insect bite.

Types of melanoma

retinal melanoma

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

30 % melanoma 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:

BUT asymmetry - one half is not similar to the other, perhaps on the one hand growth is faster.

B disordered outlines - jagged, uneven, patterned borders.

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

D diameter greater 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.

Causes and risk factors for melanoma

Cause melanoma not exactly established.

But known risk factors:

fair skin, blue eyes, freckles, blond or red hair;
sunburn (especially in childhood or adolescence);
age over 50 years, although it may occur earlier;
heredity (melanoma in close relatives);
excessive exposure to ultraviolet rays, including a solarium;
borderline nevi (flat and slightly raised spots). If they are located on the palms, genitals and mucous membranes, then they are dangerous (borderline), because. can progress to melanoma.

Prevention of melanoma

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:

the optimal and harmless time to sunbathe is before 11 am and after 4 pm;
use a sunscreen (especially in hot countries), apply such a cream every 2 hours, whether you swim or not. It is recommended to apply the cream 30 minutes before. before bathing;
it is not advisable to use perfumes, tk. some components may cause burns;
drink plenty of water, because. in the heat, the body is severely dehydrated;
it is not advisable to sleep while sunbathing;
you can eat something salty;
remember. that some drugs have a photosensitizing effect (i.e. sensitivity to sunlight increases, a burn may occur), eg. tetracyclines (antibiotics).

Complications of melanoma

The main complication in melanoma- this is metastasis (i.e., 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!

Diagnosis of melanoma

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).

Melanoma treatment

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.

Cancer of the nasal mucosa

Cancer of the nasal mucosa occurs in 1% of all malignant tumors. It occurs in the same proportion in both women and men. Nasal cancer usually occurs in people over the age of fifty. The level of this disease is quite high in China and Asian countries. No one notices nose cancer in its early stages, as the symptoms can be similar to a cold. Already at a later stage of tumor development, severe bleeding from the nose is observed, and catarrh of the Eustachian tube and inflammation of the middle ear may also begin.

The mucous membrane, which consists of epithelium, lines the nasal cavity and paranasal sinuses. Cancers are formed from epithelial cells. They are isolated as the most common tumors of the nasal mucosa. In addition to malignant neoplasms, there are also benign ones, such as papilloma. which must be removed in time.

Causes of cancer of the nasal mucosa

Among the causes and risk factors for cancer of the nasal mucosa, the specifics of some hazardous professions are distinguished. This can be nickel refining, leather processing, wood processing, metallurgy and flour milling. Habits such as smoking, alcohol, especially smoking are also at great risk. Cancer of the nasal mucosa can be caused by chronic inflammation in the mucosa and paranasal sinuses.

Symptoms of cancer of the nasal mucosa

The symptoms of mucosal cancer are quite similar to colds and infectious diseases. Among the symptoms of cancer of the nasal mucosa are the following:

nasal congestion for a long period;
pain under or above the eyes;
obstruction of the nasal passage on one side;
nosebleeds;
pus in the nasal passage;
deterioration of the sense of smell;
facial pain or numbness;
the occurrence of swelling on the face, nose or palate;
bulging or decreased vision;
enlargement of the cervical lymph nodes;
pressure in the ears.

Many of these symptoms can occur in other diseases, as a result of infectious diseases of the nasal cavity and sinuses. Only a doctor can detect a tumor in the nose, so you should immediately contact him. In the early stages, a mucosal tumor is treated much easier.

Diagnosis of cancer of the nasal mucosa

Diagnosis of cancer of the nasal mucosa is carried out in the clinic by a specialist who takes into account all risk factors, including professional ones. Then the doctor examines the patient, probing the area of the paranasal sinuses, as well as the lymph nodes. If they are enlarged, there is a possibility of formation of regional metastases. Then a rhinoscopy is performed - an examination of the nasal cavity. It is the introduction of a metal or plastic rhinoscope into each nostril, which expands the nasal cavity in order to examine it well.

To conduct a more detailed examination of tumors, endoscopic equipment is used. To do this, a flexible thin tube is inserted into the openings of the nose, at the end of which there is a video camera and a light bulb. The doctor can see the image itself on the monitor screen. This research method allows you to conduct a biopsy - this is the excision of a small piece of tissue for examination under a microscope. In addition, the following methods for studying cancer of the nasal mucosa can be used: X-ray of the nose and paranasal sinuses, MRI and CT.

Cancer of the nasal mucosa treatment

Treatment of cancer of the nasal mucosa is carried out using a combination of several methods. Operative and radiation methods are used for limited exophytic tumors in the nasal cavity. At the first stage of therapy, remote gamma therapy is performed with a focal dose of 40-45. Such irradiation occurs from 2 fields, anterior and lateral, the dimensions of which are determined by the place and direction of growth of the cancer. In addition to the main tissues, the pharyngeal lymph nodes are also irradiated. In the case of metastases, the submandibular and cervical lymph nodes are also irradiated. Three or four weeks after radiation therapy, the patient undergoes surgery to remove the tumor.

Also, in the treatment of cancer of the nasal mucosa, an operative method of treatment is used. It depends on how large the tumor is, at what stage of development it is. The tumor is completely removed along with the tissue. After surgery, additional radiation therapy and chemotherapy may be prescribed for more effective treatment. Malignant tumors of the nasal mucosa can have a different prognosis. It depends on the stage of tumor development, how quickly a person asked for help and the quality of the treatment provided. The prognosis may be unfavorable for sarcomas, in advanced cases of the disease, with cancer of the regional lymph nodes and metastases to neighboring organs. Cancer of the nasal mucosa can be cured, the main thing is to turn to the right specialists in time.

Melanoma of the oral mucosa

Clinical diagnosis:

Melanoma of the oral mucosa with metastases in the lymph nodes of the neck on both sides, in the lungs, liver. Ulceration of the tumor, bleeding from the ulcer.

The patient turned to the oncologist with complaints of general weakness, the presence of a bleeding tumor in the oral cavity, difficulty in eating, and bad breath. She has been sick for more than two years (she cannot accurately indicate the duration of the disease), she has not been treated.

At the time of treatment, the general condition of the patient was of moderate severity. On the neck on both sides are determined by multiple metastases in the lymph nodes (submandibular and deep cervical) 1.5 - 2 cm in diameter, displaceable. An ichorous odor is felt from the oral cavity. The tumor affects totally the alveolar processes of both upper jaws, the hard palate, the left half of the palatine curtain and extends to the left side wall of the oropharynx. There is a focus of ulceration up to 2.5 cm in diameter, the bottom of the ulcer bleeds.

The patient on urgent indications (stop bleeding) was made ligation of the external carotid artery on the left. At the same time, a biopsy of the Mts lymph node was performed. The result of a pathohistological study is a total replacement of the lymph node tissue with a metastasis of epithelioid cell melanoma.

Subsequently, the patient received symptomatic treatment.

What does skin melanoma look like, its types and methods of treatment

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

Causes of development and risk factors

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

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

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

The reasons

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

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

Exogenous risk factors

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

Physical risk factors:

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

Chemical Factors

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

Of the biological factors, the most important are:

Features of nutrition. High daily intake of animal proteins and fats, low consumption of fresh fruits and vegetables high in vitamins “A” and “C” and some other bioactive substances are a risk in terms of developing superficially spreading and nodular (nodular) forms of melanoma, and also tumors of unclassified type of growth.
With regard to the systematic use of alcoholic beverages, the possibility of provoking the growth of melanomas is theoretically assumed, but there is no practical evidence for this. The absence of a connection between the use of drinks containing caffeine (strong tea, coffee) and malignant neoplasms has been accurately proven. Therefore, nutrition for skin melanoma should be balanced mainly due to plant products, especially fruits and vegetables, and contain a rich amount of vitamins and antioxidants (blueberries, green tea, apricots, etc.).
Taking oral contraceptives, as well as estrogenic drugs prescribed to treat menstrual disorders and autonomic disorders associated with menopause. Their influence on the development of melanoma is still only an assumption, since there is no clear relationship.

How does melanoma develop?

Endogenous risk factors

They are divided into two groups, one of which is made up of factors that are a biological feature of the body:

low degree of pigmentation - white skin, blue and light eyes, red or light hair color, a large number of freckles, especially pink ones, or a tendency to their occurrence;
hereditary (family) predisposition - it is mainly the disease of melanoma in parents that matters; the risk increases if the mother was sick or there were more than two people with melanoma in the family;
anthropometric data - a higher risk of its development in people with a skin area of more than 1.86 m 2;
endocrine disorders - a high content of sex hormones, especially estrogen, and melanostimulating hormone (melatonin), produced in the middle and intermediate lobes of the pituitary gland; a decrease in their production after the age of 50 coincides with a decrease in the incidence of melanoma, although some authors, on the contrary, indicate an increase in its frequency at an older age;
state of immunodeficiency;
pregnancy and lactation, stimulating the transformation of pigmented nevi into melanoma; this is predominantly for women with a late first pregnancy (after the age of 31), and pregnancy with a large fetus.

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

black or dark brown pigmented nevi measuring 15 mm or more;
the presence of 50 or more of these formations of any size;
Dubreuil's melanosis - is a small, slowly increasing over the years, brown spot with irregular contours, which is usually localized on the face, hands, on the skin of the chest, less often on the oral mucosa;
skin pigment xeroderma, characterized by high sensitivity to sunlight; this is a hereditary disease that is transmitted to children only if there are specific DNA changes in both parents; these changes lead to a lack of cells' ability to recover from damage by ultraviolet radiation.

How to distinguish a mole from melanoma?

The real frequency of development of the last of the nevus has not been elucidated. The types of nevus with the highest risk were established: complex type - 45%, borderline - 34%, intradermal - 16%, blue nevus - 3.2%; giant pigmented - 2-13%. At the same time, congenital formations account for 70%, acquired - 30%.

melanoma symptoms

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

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

Each "birthmark" goes through the following stages of development:

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

What does melanoma look like?

It may have the form of a flat pigmented or non-pigmented spot with a slight elevation, rounded, polygonal, oval or irregular in shape with a diameter of more than 6 mm. It can maintain a smooth, shiny surface for a long time, on which small ulcerations, irregularities, and bleeding occur in the future with minor trauma.

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

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

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

Stages of development of a malignant tumor:

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

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

An increase in planar dimensions to that unchanged or very slowly growing mole, or the rapid growth of a newly emerging nevus.
Changing the shape or outline of an already existing formation. The occurrence in any of its areas of seals or asymmetry of contours.
Change in color or the disappearance of the uniformity of color of an existing or acquired "birthmark" spot.
Change in intensity (increase or decrease) of pigmentation.
The appearance of unusual sensations - itching, tingling, burning, "bursting".
The appearance of redness around the birthmark in the form of a corolla.
The disappearance of hair from the surface of the formation, if any, the disappearance of the skin pattern.
The appearance of cracks, peeling and bleeding with minor injuries (light friction with clothing) or even without them, as well as growths like papilloma.

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

Diagnostics

Diagnosis of a malignant tumor is carried out mainly through:

Familiarization with the patient's complaints, clarification of the nature of the changes in the "suspicious" formation, its visual examination, examination of the entire patient in order to count the number of birthmarks, highlight the different ones among them and further study them.
Conducting general clinical blood and urine tests.
Hardware dermatoscopy. allowing to examine in the skin layers, increased by several tens of times (from 10 to 40), a neoplasm and make a fairly accurate conclusion about its nature and boundaries according to the relevant diagnostic criteria.
Ultrasound examination of the abdominal organs, computed and magnetic resonance imaging of the spinal cord and brain, X-ray of the chest organs, which allow to determine the spread and presence of metastases in other organs.
Cytological examination of a smear (in the presence of ulceration) and/or material obtained by puncture of the lymph node (in rare cases). Sometimes a study of punctate from an enlarged lymph node makes it possible to diagnose the presence of a disease in the apparent absence of a primary tumor.
Excisional biopsy, the meaning of which is to excise a formation that is "suspicious" for a malignant tumor (within 0.2-1 cm outward from the edges) with subsequent urgent histological examination. Upon confirmation of the diagnosis of melanoma, its further radical removal is immediately carried out. Such diagnosis is carried out in cases where all other results of preliminary studies have remained doubtful.

Some types of melanoma

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

Achromatic or pigmentless melanoma

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

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

Spindle cell melanoma

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

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

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

Nodular or nodular melanoma

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

This tumor is oval or round in shape and by the time the patient sees a doctor, as a rule, it already takes on the appearance of a plaque with clear boundaries and raised edges, black or unusually blue-black in color. Sometimes nodular melanoma reaches a considerable size or has the form of a polyp with a hyperkeratic or ulcerative surface.

subungual melanoma

A form of acral lentiginous tumor that affects the skin of the palms and feet. It accounts for 8-15% of all melanomas and is most often localized on the first finger or toe. The tumor often lacks a radial growth phase, which makes it difficult to diagnose in the early stages. Within 1-2 years, it spreads to the nail matrix and part or all of the nail plate, which becomes brown or black. Appearing papules and nodes are often devoid of pigment, so the disease at first does not attract the attention of the patient and lasts for months. In the future, ulcerations and growths of the mushroom type occur.

melanoma metastases

Skin melanoma treatment

The main method is surgical knife, laser or radio wave excision of the tumor. In the presence of metastatic foci, a combination of the surgical method with chemotherapy and immunotherapy is used.

How is a malignant neoplasm removed?

If tumor metastases are not detected, the affected area of the skin on the body and limbs is excised at a distance of 3-5 cm from its visible edge, along with subcutaneous adipose tissue, aponeurosis or muscle fascia. When localized on the skin of the face, hands and near the natural opening - at a distance of 2-3 cm, on the fingers (subungual form) - amputation or exarticulation is carried out, on the upper and middle parts of the auricle - removal of the latter.

In the presence of ulceration of a tumor that grows into the dermis, as well as the presence of metastases in the nearest ("on duty") lymph node, the entire "package" of lymph nodes with subcutaneous tissue is removed simultaneously.

Treatment after surgery

Therapy is carried out mainly in the presence of metastases, or at least if such a possibility is suspected. For these purposes, chemotherapy, immunotherapy, or a combination of both is used. The most common drugs for treatment are intravenous or intramuscular administration of Cyclophosphamide, Imidazolecarboxamide, Cisplatin, Dacarbamazine, Karmustine. More often, combined treatment with these drugs is carried out with Vinblastine and Metatrixate, as well as with immunopreparations - Interleukin-2 or Interferon-alpha. This combination helps prevent relapses.

Melanoma is characterized by low sensitivity to radioactive radiation. Therefore, radiation therapy is carried out only as a symptomatic or palliative effect, as well as in cases where the patient refuses radical surgery. In addition, it is sometimes used as a preoperative preparation and after surgery.

After radical treatment, all patients are subject to constant clinical examination for the timely detection and treatment of cancer recurrence.

Mucosal melanoma is a relatively rare disease, accounting for less than 1% of all melanomas.

These formations have a much more aggressive growth compared to skin forms, are prone to active metastasis to regional and distant sites, and often recur, which leads to high mortality rates. The prognosis for mucosal melanomas is poor, with a five-year survival rate of 10–15%.

Mucosal melanomas of the head and neck region account for half of all mucosal melanomas. They are mainly localized in the projection of the upper respiratory tract, oral cavity and pharynx. Other forms of mucous melanomas belong to the urogenital area. The distribution of tumors by localization is presented in the table.

According to scientists, unlike other dermatological cancers, mucosal melanoma does not depend on exposure to ultraviolet radiation. In addition, there are no obvious risk factors for this type of tumor, including family history.

Melanoma of the mucous membranes affects the following organs:

mouth and nose;
paranasal sinuses;
trachea and bronchi;
lips;
throat
esophagus;
stomach;
intestines;
gallbladder;
anorectal area;
vulva and vagina;
urethra and bladder;
conjunctiva of the eye.

For convenience, mucosal melanomas are sometimes divided into three subgroups:

melanoma of the gastrointestinal mucosa;
respiratory;
urogenital melanomas.

Given the tendency to early lymphogenous and hematogenous metastasis, it is sometimes difficult to establish whether the mucosal tumor is primary or metastatic. Depending on the localization, the tumor will have certain features. So, for example, primary melanomas of the oral cavity, nose, pharynx, as well as the anorectal and genital areas first develop in the radial direction, increase in area, taking the form of a spot; only then do they acquire volume, rising above the surface of the mucosa, and begin to infiltrate the underlying base.

Some mucosal melanomas develop from melanocyte cells that are present in the tissue structure of an organ (lips, nose, oral cavity, anorectal region, etc.). The development of primary melanomas on the mucosa of organs, where pigment cells are initially absent (trachea, bronchi), can be explained by violations of tissue embryonic development.

Symptoms of melanoma of the mucous membranes

Symptoms of mucosal melanoma vary significantly. This is primarily due to the localization of the pathological process.

The most common signs of pigmented tumors of the mucous membranes:

a suspicious spot in the mouth or nasal passages;
unexplained mucosal defects or ulcerative lesions that do not heal;
bleeding from the rectum or vagina of unknown etiology;
hemorrhoids that do not heal for a long time, despite treatment;
abdominal pain during intestinal motility.

If any of these symptoms appear, a specialist consultation is necessary. Mucosal melanomas can quickly spread to neighboring and distant organs.

Favorite localization for metastases are:

lungs;
liver;
brain;
The lymph nodes;
intestines.

Melanoma of the mouth

Oral melanoma is a rare tumor with an incidence of 0.2 per million. Oral melanomas originate from melanocytes normally present in the oral cavity. This form is most common among the elderly. It develops most often in a new place and only in 30% of cases is formed in the place of a pre-existing pigmented formation. Melanoma in the mouth is most often localized on the soft and hard palate, the mucous membrane of the gums of the upper jaw, less often on the tongue, tonsils and uvula. Initially, the tumor is asymptomatic, representing a flat spot. In the process of development, edema, ulceration, bleeding, and toothache occur.

Oral melanoma metastasizes to regional lymph nodes in 25% of patients.

Melanoma of the nose

Primary respiratory melanoma is most common in the nasal cavity, paranasal sinuses, and very rarely in the larynx and mucosa of the tracheobronchial tree. A tumor of the nasal mucosa, unlike melanoma of the skin of the nose, is a rare disease, its frequency is 0.3 per 1 million (for paranasal sinuses - 0.2 per 1 million). The favorite localization of melanoma on the nasal mucosa is the septum and side walls, and among the paranasal sinuses, the sinuses of the upper jaw and the ethmoid bone are most often involved in the process.

The disease is more common in older people. Common symptoms: unilateral nasal congestion, nosebleeds. Most tumors are presented as a polypoid, brown or black pigmented mass, often ulcerated, and non-pigmented forms are not uncommon.

Melanoma of the lips

Melanoma in the lip area often develops from an already existing pigment spot. Tumors that begin their growth with unchanged mucosa are less common. At first, melanoma on the lip is a pigment spot, which gradually increases in volume, becomes dense, and then infiltrates the underlying base.

Urogenital melanoma

Although rare, melanoma can occur in almost any part of the urogenital tract, including the vulva, vagina, uterus, urethra, and bladder. Pigmentary tumors of the mucous membranes of the urogenital area are more common among women. The genitals account for 18% of all melanomas of the mucous membranes, the urinary tract - 3%. Among the female genital tract, vulva tumors are the most susceptible, with a frequency of 0.1 per 1 million.

Melanoma predominantly develops on the labia majora and clitoris. Older women get sick more often. The most common symptoms are: bleeding, pain, itching, irritation, abnormal discharge.

Diagnosis of melanoma of the mucous membranes

In the diagnosis of mucosal melanoma, errors often occur. Due to its hidden position and lack of noticeable early signs, detection of mucosal melanoma is usually delayed.

When making a diagnosis of primary melanoma, especially if it is rare, it is important to exclude the possibility of a metastatic lesion from a primary cutaneous or ocular melanoma.

If mucosal melanoma is suspected, endoscopic examinations are performed:

tracheobronchial tree;
upper respiratory tract;
esophagus and stomach;
large intestine;
rectal segment.

During the diagnostic procedure, the doctor takes fragments of the altered mucosa for analysis. Biopsy of a sample of suspicious tissue and subsequent histopathological examination is the main point in the diagnosis of mucoid melanomas.

Amelanotic forms of tumors, which are often found among mucosal lesions, further complicate diagnosis. Immunohistochemical staining of the material to detect tumor protein (S-100, HMB-45, Melan-A, Mart-1) and tyrosinase enzyme helps in the diagnosis of non-pigmented tumors.

If the spread and metastasis of mucous melanomas is suspected, the body is scanned with visualization: CT, PET CT, MRI.

Treatment of mucosal melanoma

Today, surgical treatment is the main treatment option and can be combined with adjuvant radiotherapy. However, the prognosis for melanomas of the mucous membranes remains unsatisfactory. Local relapses occur in half of the cases. Radiation therapy for melanomas of the mucous membrane of the head and neck somewhat stabilizes the condition, but does not improve survival in common forms of the disease.

At the same time, due to the complex topography of some tumors, it is not always possible to perform a sentinel lymph node biopsy.

For urogenital melanomas, the most accessible is the surgical method. The combination of wide excision of the tumor after a course of radiation gives good results only in the initial stages of melanoma.

Immunotherapy and target therapy have good prospects for the treatment of common mucosal melanomas complicated by metastases to distant organs. Tumor genotyping, detection of BRAF mutations in melanoma make it possible to introduce a new generation into clinical practice