Melanoma is a tumor caused by a mutation in human pigment cells. Malignant tumors in this disease are most often formed on the skin, less often on the mucous membrane. Metastases can move to almost any organ and progress rapidly. Diagnosis in the early stages increases the chances of effective treatment and prolongs the life of the patient.
Melanoma is considered solely a skin disease, but this view is erroneous. Pigment cells are unevenly distributed almost throughout the body. Where they are, there may be melanoma. The tumor is formed on the internal organs, eyes, skin. According to the place of formation and the mode of growth, there are several types of melanomas.
Most often, the tumor is still formed on the skin. This is due to the fact that the most pigment cells are concentrated in the epithelium. The tumor is formed on clean skin, in places of moles and birthmarks. The disease is detected by the appearance of a dark uneven spot or nodule, you can accurately establish the diagnosis after a biopsy.
Melanoma of the skin (C43-C44 according to ICD10) summarizes several types of tumors. Neoplasms are classified according to the method of growth in the layers of the skin. The tumor can spread over the surface, covering an increasing area. And it can grow vertically, penetrating deep into tissues. There are forms in which a lesion occurs on the surface and in depth.
This is the most commonly diagnosed form of the disease - almost 75% of all cases. Melanoblastoma grows from a small spot, can appear anywhere on the body. A small speck eventually takes on a larger diameter. The surface of education is uneven, convex. The color can be from light brown to black.
In the initial stages it grows over the surface and is best treated in this phase. In the absence of therapy goes into vertical growth, and goes deep into the lower layers. Metastases spread moderately. Diagnosis in the final stages reduces the chances of effective treatment. In men, most spots appear on the body, in women - on the legs. In most cases, found in people aged 30-50 years.
15-30% of patients experience nodular or nodular melanoma. The tumor, like the other forms, is formed on clean skin and in the place of other formations. Externally, it looks like a dark plaque with jagged edges and a bulge on the surface. Color - dark blue, black, dark red. It grows rapidly above the skin surface. Usually in the center is a growth that looks like a mole that surrounds a dark spot.
This form has its own characteristics:
- grows on the surface without going deep into the tissue;
- more common in people over the age of 50;
- the formation may be colorless due to the absence of melanin;
- ulcers may be present in the tumor area.
In men, this disease occurs 2 times more often than in girls. Most often, melanoma is formed on the body, rarely on the head and limbs. The tumor progresses very quickly, so early diagnosis is extremely important for successful treatment of the patient.
According to the WHO, in 2015, acroliginous melanoma accounts for approximately 5% of all cases of this type of tumor. But from this it does not become less dangerous: the transition to the phase of rapid growth occurs in 2-3 years. Unlike other types of melanoblastoma, this one most often appears on clean skin. At the same time, unlike other forms, the characteristic place of appearance is closed skin. It can be feet, palms, nail plates. This location eliminates the dependence on the action of sunlight. Acrolentigious type of melanoma is more common in people with dark skin.
Lentigo - a spot on the skin of a reddish or dark brown shade. In the initial stages it resembles a freckle or a small mole. With the progress of the disease, the lesion area increases. This form of melanoma may not turn into vertical growth, not spread metastases. The risk of transformation into a malignant tumor increases if lentigo is permanently injured. This occurs when rubbing against the fabric of clothing or a belt, in the folds of the skin. In open areas that are not injured lentigo can remain benign for many years.
A stain is formed on any part of the body. At risk - people with fair skin, the elderly and those who spend much time in the solarium or in the sun. Lentigo features:
- fuzzy boundaries;
- uneven color with dark patches;
- no pain;
- grows very slowly.
Metastases spread through the blood and lymph, so they can affect absolutely any organs. If the new spot is scratched - this is the first reason to contact an oncologist or a dermatologist.
The rarest type of tumor, but also one of the most dangerous. It occurs in 2-4% of cases of melanoma more often in light-skinned children and adults. A distinctive feature of the achromatic form is the lack of color. The spots are white or with a light pinkish and brown tint. Externally, it looks like a slight elevation above the skin. This elevation may be with the scalp, maybe without it. In this case, the second case is more dangerous, since it speaks of a malignant nature.
Metastases also pass through the blood and lymphatic pathways. The danger of the disease is that in the first phases of growth the patient is unaware of the problem. The state of health does not change, and the colorless stain often goes unnoticed. Because of this, the tumor is already diagnosed in the latter stages, which greatly reduces the chances of effective therapy. Melanoblastoma progresses rapidly, pain and bleeding appear in the phase of active growth. There are two symptoms in which you need to contact a dermatologist, these are enlarged lymph nodes and the appearance of a spot on any part of the skin or mucous membrane.
Melanoma other localization
Since the tumors appear in different parts of the body, they are distinguished by the place of formation. Melanoma of the retina, soft tissue and mucous membrane occurs. In symptomatology and diagnosis, they differ little from skin cancer. There are differences in treatment methods and clinic.
Lentigo appears most often in the eye area. Accompanied by discomfort, then bleeding and loss of vision. In the area of the lesion spots appear, which eventually turn into nodules. Older people aged 70 years and older are at risk, although young people sometimes diagnose such a tumor. Early detection and treatment ensures almost 100% patient survival. If the formation was detected in the vertical growth stage, 15–20% of patients survive.
Progressing slowly, due to discomfort, patients in most cases on time seek help. The treatment consists of an operation of radiotherapy or chemotherapy therapy, if there are already metastases.
Malignant melanoma affects the aponeurosis and ligaments. The aponeurosis is a layer of dense collagen and elastic fibers covering the abdominal cavity, lower back, palms, etc. Melanoma of the ligaments and aponeuroses, like other types of cancer, is more often found in the elderly. But there are cases when babies and teenagers died from this form of cancer. In the early stages of development, it can be confused with an allergic reaction, the symptoms are as follows:
- spots on the skin;
- muscle pain;
Unlike allergies, these symptoms do not go away after taking antihistamines. It is easy to notice in the first stages, as the patient feels constant pain and calls for help. If the tumor gives metastases, they affect the muscle tissue and the central nervous system.
Any form of melanoma may appear on the mucosa, it occurs in about 5% of cases. According to the localization, vulvovaginal, nasopharyngeal and rectal are distinguished. The first is formed on the shell of the genital organs in women. Nasopharyngeal - in the mouth, nose, throat. Rectal affects the walls of the rectum and anus. Symptomatology is the same as with other types of melanoblastoma. These are: the appearance of a spot or elevation above the mucous membrane, itching, bleeding.
Diagnosis is complicated by the location of education, so patients themselves can not always detect the problem in the early stages of development. Such cancer also develops and gives metastases, worsening the prognosis for the patient. But both treatment and prolongation of life is possible.
This is not to say that we have studied this pathology well. Dozens of questions remain open, for example, because of what appears a tumor. Scientists have put forward a number of assumptions, some of which are accepted by the medical community, some are waiting for confirmation. It is well established that the main cause is a mutation in the DNA of melanocytes. But in order for a tumor to form, a trigger must be attached to this factor.
Heredity, abnormalities in the endocrine system, and misuse of sunbathing act as a trigger. If a person has reduced immunity, if several factors coincide, the risk increases even more. In addition to white-skinned people, in a special risk group are those who have already treated melanoma. Education may appear again in the same place or on another part of the body.
Melanoblastoma occurs when melanocytes are transformed into cancer cells. The reason for this phenomenon is in the defects of the DNA molecules of pigment cells. Under the influence of certain factors, such as sunburn, there is a "breakdown". Cells mutate and form an accumulation of colored particles. They can not move, because they have lost shoots.
In understanding the growth of melanoma, two factors are important: vertical growth and radial growth. It all starts with the fact that the former pigment cells spread in the thickness of the epidermis and the upper layers of the dermis. Outwardly, it looks like an increasing spot. Then comes the stage of vertical growth, when the tumor penetrates into the deeper layers of the skin. At the first stage, the cells are not capable of metastasis, and during invasion into the lower layers, they produce metastases.
Metastases spread through the body in two ways: with the bloodstream and lymph flow. Given that the circulatory and lymphatic systems cover the entire body, a tumor can appear on any organ. The spread of metastasis leads to death.
A single mutation in the DNA is not enough for the development of a tumor; an instigator should join this factor. Risk factors identified as disease triggers are:
- Bright skin. It has been found that people with fair skin and bright eyes are most often affected by this disease. Conversely, people with dark skin and the face of the Negroid race are least affected by this problem.
- Sunburn Even those that were received in early childhood are taken into account. Exposure to ultraviolet rays is considered the main cause of the disease. In this case, both natural sunlight and tanning beds are dangerous.
- Heredity. Traced predisposition in persons whose family history were / are relatives with melanoma.
- Damage to moles and birthmarks. Almost 70% of cases fall on the degeneration of nevi in the tumor. Triggers are: damage, exposure to tanning beds and the sun, disorders in the endocrine system, hereditary factors.
These factors can be attributed to age, as older people suffer most from melanoma. It is believed that this is due to the accumulation of triggers over the decades. But the coincidence of several triggers does not "work" if there is no defect in the genome.
Heredity of the disease
In Sweden, an independent study was conducted, involving 79,060 people with melanoma. Of these, only 9% were hereditary. Despite such a low rate, the tumor is considered hereditary. It is assumed that a person inherits the violation of suppressors, which are responsible for the suppression of oncological processes. Of the subjects with hereditary cancer, 92% were from those families that already had 2 cases of melanoma. Another 8% fell on those who have 3 or more cases in the family history. Scientists also found that in families with melanoma, the risk of other types of cancer is significantly higher in the history of diseases.
Psychosomatics is a science that classifies all diseases as psychological. She regards melanoma as a way of protection. Melanin is used by the body to protect against the harmful effects of ultraviolet rays. But the "shield" may be needed in other cases: during attacks, injuries, even a sense of shame. For example, moles and blemishes may appear near scars. Psychosomatics explains this by saying that the body is trying to prevent a recurrence of the injury. Therefore, uses to protect what he has - pigment cells.
If a person has experienced shame or embarrassment, pigment spots may appear on the face. That is, once a person really did not want to be looked at, but now the body protects the face. So according to psychosomatics, moles and pigmented spots appear. And they turn into melanoma in case of a strong conflict inside and outside the person. It appears when the need for protection rises. For example, if a person continues to experience fear, shame, guilt. For the treatment of psychosomatics offers getting rid of fears and study with a psychologist of children's injuries.
Is the disease contagious?
No type of cancer, including melanoma, is transferred from the patient to the healthy. Only genetic predisposition in the family is transmitted.
The first sign remains unchanged - this is the appearance on the body of a dark zone or "mole." If a tumor forms at the site of a birthmark or nevus, external and internal changes occur. Common symptoms of the disease:
- Itching. Education itches because of the formation of new cancer cells in it.
- Uneven color. When melanocytes turn into cancer cells, the processes disappear, with the help of which the melanocyte used to move. Without a process, the cell cannot divide the pigment and accumulates it. So coloring becomes uneven, with dark impregnations.
- No hair on the surface of the nevus.
- The roughness of the edges of the formation is a sign of the appearance of new cancer cells and their germination in healthy skin.
- "Child" moles around the nevus.
- The appearance of blood, bleeding and discharge of pus - due to the destruction of healthy cells. The top layer is broken, the deeper layers are exposed.
Signs of eye damage are dark blotches on the iris, pain and redness. In some cases, an increase in lymph nodes is added to the symptoms listed.
Stages, phases of tumor development
In medicine, a complex classification scheme for the stages of melanoma is used. For easier perception, use the rules of two American scientists: Breslow and Clark. Also the progress phase is explained by the TNM system.
The Clark distribution reflects how deeply the tumor has penetrated the vertical growth. There are 5 steps to grow when cancer cells invade:
- only in the epidermis (on the surface);
- papillary dermis (under the epidermis);
- reticular dermis (papillary);
- deep dermis;
- subcutaneous fat layer.
The more skin layers are affected by the formation, the worse the prognosis of the disease.
The second popular systematization shows the thickness of the tumor. This indicator determines the overall risk of a tumor. The wider the education, the higher the risk of metastasis. The Breslow distribution produces a thin melanoma (0.75 mm), intermediate (0.76-3.99 mm), deep (more than 4 mm).
The TNM classification was developed by the American Joint Cancer Research Committee. Such a scheme is more developed and complex compared to the Breslow and Clark systems. The tumor includes three categories: T, N and M. They imply:
- T - describes the destruction of tissue inland. This category is expressed by a number from 0 to 4. The higher the indicator, the more difficult the situation. The letters “a” or “b”, which indicate the presence of mitosis, can also be attributed to the number.
- N - describes the spread of tumor particles in the lymph flow, where they fall in the first place. It is expressed as a number from 0 to 3.
- M - determines the spread of metastasis to the internal organs.
Set the category of education alone is impossible. To do this, conduct a diagnosis with a biopsy.
Like any disease, melanoblastoma appears and develops gradually. It has a phase of primary signs, active growth, irreversible effects. The study of pathogenesis helps to determine the stage and choose the strategy of therapy.
In the “nucleation” stage, the cancer is poorly diagnosed, since it has practically no tangible symptoms. At this moment, the cells are just beginning to turn into tumor cells, lose shoots, accumulate melanin. Gradually, hair falls out of this place, the formation itches. On the skin or mucous membrane may already be a stain without or with elevation. If a mole is transformed, a birthmark - dark blotches appear on it, the area increases.
Suspicion should also cause a pinkish halo around the spot, a sign of an inflammatory process and the destruction of healthy cells. In the early stages, the appearance of one or several dark patches on the iris is characteristic of the eye. The eye is watering, sore, red. There are no special changes in the patient's state of health. This phase can last from several months to several years.
The duration of the course depends on the type of melanoma and the action of the triggers. Acrolifegious for several months can give metastases, and lentigeous - a dozen years to remain in hibernation. If the provoking factors continue to affect the body, the pathology develops faster.
Average or exact indicators from the moment of appearance of cancer to mitosis are not published. New growth gives metastases in vertical growth, up to this point - no. Metastases affect any organs and systems. Most often they are found in the brain, adrenal glands, lungs. Chemotherapy and radiation therapy does not always give an effective result. Therefore, it is important to contact the specialists in time for any changes on the skin.
Setting a clear diagnosis takes place in several stages. The first one is a medical examination, you can contact a dermatologist or oncologist. The doctor needs to show moles or spots that are suspicious. Already at the examination stage, it is possible to determine whether the patient is benign or malignant. If by color, diameter or shape it causes suspicion of a doctor, the person should undergo an additional examination.
Diagnostic methods in dermatology
To establish the nature of the tumor and differentiation from other diseases, three methods are used: CLSM, dermatoscopy, biopsy. Confocal laser scanning microscopy (CLSM) is a technique that shows layers of skin in an image. At the same time, the integrity of the epithelium is not violated. Statistics show that correct diagnosis using CLSM is established in 88-97% of cases. The survey is effective even at the initial stage.
Dermatoscopy also does not violate the layers of the skin. It is used in conjunction with CLSM or biopsy. For the procedure, the doctor uses a dermatoscope - a device for repeated magnification. With it, you can clearly consider the symmetry and the surface of education. But the depth of the defeat can not be seen in this way.
The final diagnosis can be made after a biopsy. This is a study in which a piece of tissue is taken from the focus of the disease. The material is examined under a microscope, establish the nature of the tumor. But taking tissue from melanoma can aggravate the situation, so a biopsy is prescribed only if other diagnostic methods do not give a definitive answer.
To obtain a complete picture, general analyzes of urine and blood, chest x-ray, abdominal ultrasound, MRI of the brain and spinal cord are prescribed. This is necessary to exclude the likelihood of other diseases or metastases and to establish the general condition of the patient.
Treatment involves the surgical removal of the affected area. A complex of procedures and medications is added to the operation. To combat metastases, radiation and chemotherapy are needed. Remove melanoma only under general anesthesia, healthy tissues try not to affect. This allows the skin to recover faster and prevents metastasis. The operation also removes deeper layers. The use of plastics preserves the appearance and functions of the operated areas to the maximum.
From drugs prescribed immunosuppressants for the prevention of relapse. Also, hormone therapy helps well to fight cancer. Chemotherapy is among medications.
In the early stages of the disease enough surgery. Sometimes immunomodulators are prescribed to prevent recurrence. From the third stage, we need an integrated approach using chemotherapy. No methods of dealing with melanoma at home can not be taken without the knowledge of the doctor.
What is dangerous disease
The only danger of melanoma is metastasis. The defeat of the internal organs leads to multiple melanoma, affects the brain, liver, lungs. Tumor cells divide very quickly - this is another danger of pathology. To get into the lymph flow, cancer needs to overcome an obstacle of just three millimeters. Also this type of oncology is called insidious, since the first stages are rarely suspicious. And in the last phases, the probability of successful treatment is very low.
Life expectancy and survival statistics
Survival depends on the stage of the cancer, its location and race. In the African race, the five-year survival rate is 63%, in the white - 93%. Also, women are almost twice as likely to die from the effects of melanoma than men. At the first stage, ten-year survival is 86-95%, at the second - 40-67%, at the third - 24-43%. At the same time, in stage III A, the probability of survival is higher than on II. At the last stage, 10–20% of patients survive.
It is impossible to say exactly about life expectancy, since it depends on many factors. It may be 6 months, or maybe 10 years. But we can say for sure that timely treatment to the doctor and treatment from the first stage ensures almost 100% survival.
Specialty: pediatrician, infectious diseases specialist, allergist-immunologist.
Total experience: 7 years.
Education: 2010, SSMU, pediatric, pediatrics.
Experience infectious diseases more than 3 years.
He has a patent on the topic “A method for predicting the high risk of the formation of a chronic pathology of the adeno-tonsillar system in frequently ill children”. As well as the author of publications in the journals of the Higher Attestation Commission.