Types of benign and malignant melanoma. The most dangerous malignant skin tumor is melanoma, its first signs and treatment methods Melanoma types and signs

Melanoma is a specific type of malignant tumor formation that forms on the skin; this formation develops from melanin-synthesizing melanocytes of skin cells. Melanoma, the symptoms of which can appear in patients at any age (from adolescence), has recently become a fairly common disease, often leading to death, however, its detection in the early stages does not exclude the possibility of cure.

general description

Melanoma is just one of the types of existing skin pathologies of an oncological nature. The epidemiology of this disease in the countries of Central Europe, when considering annual indicators, corresponds to the ratio of 10 cases of its occurrence per 100,000 inhabitants. For the same number of people in the southern states of America and Austria, the incidence is slightly higher and is about 37-45 cases.

Data from one of the Berlin clinics indicate that on average in Germany about 14 thousand cases of this disease are diagnosed annually, and the incidence rate ratio indicates that here women are more susceptible to it - 6 thousand cases occur in men, 8 thousand - for women. Mortality from melanoma in this case is determined per 2 thousand cases of the disease, this, in turn, determines approximately 1% of the total mortality rate for cancer.

Patients over 70 years of age are most susceptible to melanoma. As we initially noted, melanoma has recently become a fairly common disease; in particular, there is information that over the past fifty years, global incidence rates have increased by 600%.

Melanoma is predominantly concentrated in the area of ​​the trunk and limbs in people whose skin type is Eastern European. Signs of melanoma are generally observed in patients with fair or red hair, green, gray or blue eyes, as well as pink freckles. In addition to the genotype, the presence of atypical moles and nevi (congenital pigment spots) are identified as predisposing factors. In particular, nevi become a predisposing background to the development of melanoma when they are repeatedly injured, as well as when they are located in the back, foot, shoulder girdle and open areas of the body. Much more dangerous are those melanomas that develop against the background of acquired pigmentation, that is, when spots appear in patients of the mature age group. Exposure to ultraviolet radiation, Dubreuil's melanosis, heredity and xeroderma pigmentosum, the presence of more than 50 moles, a significant number of freckles (including their rapid formation) are also considered risk factors.

Despite the previously noted predisposition to the development of melanoma in white-skinned people, it should be borne in mind that this disease can develop in a person belonging to any race and with any skin color, that is, melanoma is not limited to affecting people with white skin color.

It should also be noted that hairy nevi never become malignant; therefore, if hair growth is detected when examining a pigmented tumor formation, then it should not be classified as malignant.

Melanoma appears not only on previously formed pigment spots, but also on healthy skin. Melanoma in women is predominantly concentrated in the lower extremities, while in men there is a tendency for melanoma to develop mainly on the torso (especially often on the back). Typical areas for tumor formation are those areas that are most exposed to ultraviolet radiation. However, at the same time, such areas cannot be excluded that ultraviolet radiation practically cannot reach, in particular the interdigital spaces, the esophagus, and the soles of the feet. The incidence of melanoma in infants and children is possible only as a rare exception; in this case, a predisposing factor for the development of the pathological process is their previous exposure to sunburn.

There are also certain differences in the degree of “malignancy” of the disease we are considering, here we mean the speed of development of melanoma. Accordingly, a disease is considered rapid if it develops within a period of several months according to the “diagnosis – death” scheme, and long-term if it develops in combination with appropriate therapy over a period of 5 years or more.

An inherently insidious manifestation of melanoma is the early formation of metastases, which occurs in certain organs in the body, which can subsequently lead to death for the patient. Most often, the heart, skin, lungs, liver, brain and skeletal bones are affected by metastases. Melanomas that have not spread beyond the basement membrane in the skin cells (that is, the layer located between the epidermis layer and the dermis layer) determine the practical elimination of the risk of metastases.

As for the types of melanoma, as well as the frequency of their occurrence, their classification is as follows:

• – characterized by its slow growth, the frequency of occurrence is the highest, 47%;
• Melanoma nodular (nodular)– characterized by its own rapid growth, in terms of frequency of occurrence it is somewhat inferior to the previous form, determining the figure at 39%;
• Peripheral lentigo– the frequency of occurrence is 6%, this form of the disease is defined as precancerosis (or precancer, that is, a pathological condition in which tissue changes, like the course of the processes themselves, naturally precede cancer, and the long-term existence of the disease in this form is most likely leads to its transition to cancer).
• Amelanotic melanoma (acral melanoma)– diagnosed extremely rarely; the area of ​​concentration in this case is concentrated within the plantar and palmar surfaces.

Skin melanoma: symptoms

Before we move on to a more detailed consideration of the processes and symptoms accompanying the course of the disease, we will highlight the main signs of melanoma that make it possible to recognize it early, there are five in total:

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

In about 70% of cases, melanoma develops from a nevus (mole), mainly, as we have already noted, it is concentrated in the area of ​​​​the extremities, neck and head. In men, this type of tumor is more likely to occur in the chest and back, as well as the upper limbs; in women, it is the lower limbs and chest. The greatest danger is epidermal (or borderline) nevus, which mainly occurs in men in the skin of the scrotum, soles or palms. The main signs that the process is becoming malignant include an increase in size, a change in color (weakening or intensifying of color), the appearance of bleeding and skin infiltration (impregnation with a certain substance) in the environment of the nevus and under its base.

Externally, melanoma resembles a dense tumor nodule; its color can be black or slate, in some cases with a bluish tint. Pigmentless melanomas are formed somewhat less frequently; according to the definition, it can be understood that they are devoid of pigment and have a pinkish tint. Regarding the size, a diameter in the range of 0.5-3 cm can be distinguished. In frequent cases, the tumor formation has a bleeding, eroded surface and a somewhat compacted base. Any of the listed signs allow you to make an initial independent diagnosis through a routine examination (but this requires the use of a magnifying glass).

During the early stages of the disease, the malignant formation is outwardly more harmless than in further stages, therefore it can be distinguished from a benign pigmented nevus only with sufficient experience.

Let us dwell on the three main common forms of melanoma that we identified earlier, or rather, on their characteristics. In particular, we are interested in the superficially widespread form of melanoma, nodular (nodular) melanoma, as well as lentigo maligna.

Lentigo maligna characterized by the duration of the phase of its own horizontal growth, determined in a time interval ranging from 5 to 20 years, and in some cases more. Typical cases of the disease are observed in elderly people in the area of ​​open areas of the skin of the neck and face, on which plaques or brown-black spots appear.

Superficially widespread melanoma develops in patients of a younger age group (in this case, their age is on average 44 years). As for the area of ​​​​development of tumor formation, the same frequency of its appearance is noted both in open areas of the skin and in closed areas. In women, the lower extremities are mainly affected, and in men, the upper back. The developing plaque has an irregular configuration, the contour is scalloped, there are areas of discoloration and regression, the color is mosaic, and keratosis appears on the surface (a condition of thickening of the epidermal layer). After a few years (about 4-5), a node forms on the plaque, which indicates a transition of the process from horizontal to vertical growth.

Melanoma nodular acts as the most aggressive variant of tumor development in terms of the type of manifestation. The average age of patients exposed to this type of education is 53 years; the ratio according to gender is 60:40 (men/women). Most often, the localization of the process is concentrated in the skin of the back, head and neck, as well as limbs. The node grows quite quickly; patients note such changes in it over a period of several months; the growth is accompanied by the formation of ulcerations and its general bleeding.

A direct consequence of the use of non-radical measures in the treatment of melanoma is its relapse. Such cases are often accompanied by the identification of a distant type of metastasis, which occurs in parallel with the detection of relapse, and sometimes even before its occurrence. Exclusively chemotherapy treatment is used in situations with common forms of the disease, when distant metastases are relevant. In particular, combined treatment options using antitumor drugs are used, which determines the possibility of tumor regression in up to 40% of cases.

Melanoma: metastasis

Malignant melanoma is prone to fairly pronounced metastasis, not only through the lymphogenous route, but also through the hematogenous route. The brain, liver, lungs, and heart are predominantly affected, as we have already noted. In addition, dissemination (spread) of tumor nodes along the skin of the torso or limb often occurs.

The option cannot be ruled out in which the patient seeks the help of a specialist solely on the basis of actual enlargement of the lymph nodes in any area. Meanwhile, a thorough survey in this case can determine that a certain time ago, for example, he, in order to achieve the appropriate cosmetic effect, removed a wart. This “wart” actually turned out to be melanoma, which was subsequently confirmed by the results of histological examination of the lymph nodes.

Melanoma of the eye: symptoms

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 ocular melanoma are the appearance of photopsia, progressive scotoma and deterioration of vision.

Photopsia, in particular, is a pathological condition in which flickering sparks, luminous points, “flashes of light” and spots of color appear in the field of vision. As for such a manifestation as scotoma, it is a blind area of ​​​​a limited type that appears in the field of vision; it is subjectively perceived by patients as a dark spot (in this case it is a positive scotoma), or is not perceived at all (negative scotoma). Detection of scotoma in the negative version is possible only through special research techniques.

Often small melanoma makes it difficult to differentiate from a pigmented nevus, concentrated in the area of ​​the choroid.

To determine the growth of a tumor formation, repeated studies are necessary. As for generally accepted treatment tactics, there is no such treatment for ocular melanoma. Ocular enucleation and local resection are performed, as well as radiation therapy.

Melanoma: stages

The course of melanoma is determined by the specific stage to which the patient’s condition corresponds at a particular moment; there are five of them in total: stage zero, stages I, II, III and IV. Stage zero allows you 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 limits not exceeding one millimeter; the epidermis (that is, the skin on the outside) is often covered with ulcerations. Meanwhile, ulcerations may also not appear, the thickness of the tumor formation can reach about two millimeters, and the lymph nodes located in close proximity to the pathological process are not affected by melanoma cells.

Stage II tumor formation in melanoma determines its size to be at least a millimeter in thickness or 1-2 millimeters in thickness when characteristic ulcerations appear. This stage also includes tumor formations whose thickness exceeds two millimeters, with possible ulceration of their surface or with a surface without ulcers. At this stage, melanoma in any of these variants does not spread to the lymph nodes located in close proximity to it.

Next, Stage III , is accompanied by damage to nearby tissues by a pathological process; in addition, the study reveals the presence of tumor cells in one lymph node or in a greater number of them; the affected lymph nodes are also located in close proximity to the affected area of ​​the skin. The possibility of melanoma cells spreading beyond the boundaries of the primary lesion cannot be ruled out, but the lymph nodes are not affected.

For Stage IV The progression of the disease is characterized by 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.

As we have already noted, relapses of the disease cannot be ruled out even with correctly defined and administered treatment. A pathological process can return either to an area that was previously damaged or to form in a part of the body that was not related to the previous course of the process.

Melanoma: prognosis by stage

The most important factor in this case is the clinical stage corresponding to the course of melanoma at the time of diagnosis. Regarding survival within stages I and II, in which the tumor localization is concentrated within the boundaries of the primary focus, survival rate for the next five years is approximately 85%. In the case of stage III of the disease, in which metastasis occurs to regional lymph nodes, survival for the specified 5-year period is reduced to 50% when the process affects one lymph node and about 20% when several lymph nodes are affected. When considering stage IV, accompanied by distant metastasis, survival for the next five years is no more than 5%.

A positive point 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 the thickness indicates the mass relevant to the tumor, while the mass of the tumor determines the likelihood of subsequent possible metastasis.

When the thickness of the tumor formation is no more than 0.75 mm, the prognosis for successful cure through surgical intervention is determined; as for survival within the standard period of 5 years considered, here it is relevant in 96-99% of cases. Approximately today, it can be indicated that in approximately 40% of cases of morbidity, patients are diagnosed with a tumor formation within its thickness of up to 1 mm, while the patients themselves are in this case identified in the so-called low-risk group. In those patients who develop metastases, histological examination of the primary tumor formation determines either its vertical growth or spontaneous regression.

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

In general, the prognosis directly depends on where exactly the tumor is located. Thus, the most favorable prognosis is determined when the tumor formation is localized in the area of ​​the legs and forearms; an unfavorable prognosis, in turn, is determined when it is localized in the area of ​​the feet, hands, scalp, and mucous membranes.

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

The prognosis regarding recurrence of the disease is based on general statistics, according to which about 15% of cases of relapse appear more than five years after the removal of the tumor. The main pattern here is the following: the thicker the size of the tumor, the faster it is subject to subsequent recurrence.

Unfavorable factors for prognosis during stages I and II include such factors as ulceration of tumor formation, increased mitotic activity, as well as the formation of satellites (peculiar islands of tumor cells, reaching sizes of 0.05 mm or more in diameter). The latter are concentrated outside the main tumor focus, within the reticular layer of the dermis or in the subcutaneous tissue. Also, satellites in most cases of melanoma occur together with micrometastases directed to regional lymph nodes.

Melanoma of stages I and II can also be predicted in its course by using another method - the method of comparing Clark's histological criteria. I level of invasion in accordance with the system of Clark criteria determines the location of the tumor formation within the layer of the epidermis, II level of invasion indicates tumor germination into the dermis (papillary layer), III level determines whether the tumor has reached the border between the reticular and papillary layers of the dermis, IV indicates its germination into the reticular layer, V determines its penetration directly into the subcutaneous tissue. According to each of the listed levels, survival rate is 100 and 95%, 82 and 71%, and 49% (for the last option).

Diagnosis

In diagnosing melanoma, in addition to the standard examination through the use of a magnifying glass for this purpose, radioisotope research is also used, in which the detection of an increased amount of phosphorus in the tumor indicates that it is malignant. In case of skin cancer, the method of biopsy or puncture is usually used to diagnose this disease, however, in case of melanoma, such intervention must be excluded, because even the slightest impact can result in injury, and this, in turn, can lead to rapid generalization of the pathological course of the process.

Taking into account these conditions, the only method for clarifying the diagnosis is a cytological examination, in which the imprint from the surface of the tumor is studied in the case of actual ulceration. Other cases of the pathological process involve diagnosing the disease only on the basis of clinical manifestations.

When collecting an anamnesis, special interest is aimed at symptoms characteristic of metastases (general malaise, joint pain, blurred vision, headache, weight loss). Additionally, the use of methods such as ultrasound, CT and radiography allows you to exclude or confirm the presence of metastases to internal organs. Having completed a general examination to determine the relevance of melanoma, we move on to determining its stage and appropriate treatment.

Treatment of melanoma

In the treatment of melanomas, two types of methods are used: only a surgical method and a combined method. The combined method is considered to be the most justified, because after irradiation the tumor formation is removed ablastically. As part of the first stage of this treatment, the method of close-focus X-ray exposure to the tumor is used, after which, until the onset of the radiation reaction (2-3 days after completion of the exposure) or after it subsides, its wide-band excision is performed, capturing several centimeters of healthy skin. The wound defect that occurs in this case is subject to skin grafting.

Considering that malignant melanoma is characterized by its rapid transition to metastasis to nearby lymph nodes, it is necessary to remove regional lymph nodes even in the absence of their enlargement as such. If the lymph nodes are enlarged and there is a suspicion of metastasis, then they are pre-irradiated through the use of remote measures such as gamma therapy. In recent years, an integrated approach to treatment has been used quite often, based on the addition of radiation and surgery to chemotherapy procedures.

It should be borne in mind that in the presence of nevi and in particular in case of any changes associated with them, be it a change in color, the appearance of ulcerations, an increase in size or bleeding, it is important to immediately take measures, which in this case boil down to surgical intervention. We also note that stages III and IV melanoma today are incurable, therefore, taking this into account, the main measures in the fight against it are prevention and early diagnosis. If symptoms indicating melanoma appear, you should contact an oncologist and dermatologist.

Myopia is a pathological condition, with the progression of which the sick person begins to have difficulty distinguishing objects located far from him. He can hardly read signs, make out license plates, and may not even recognize his friend from a distance of several meters. Medical statistics are such that myopia is the most common visual impairment, which occurs in both adults and children (children's myopia is not uncommon). This disease can progress and have varying degrees of severity.

Skin melanoma is a malignant disease that develops from the pigment cells of melanocytes. Cancer of this type manifests itself regardless of the person’s age and country of origin, and the number of deaths from the disease is statistically high, despite intensive therapy. Melanoma of the skin is diagnosed in 3% of cases of all epithelial tumors.

The appearance of melanoma is explained by a defect in the DNA molecule that the pigment cell contains. In medical practice, the following causes are identified for the occurrence of one of the most dangerous human cancers, characterized by constant relapses and lymphogenous and hematogenous metastases to all organs:

1. Abuse of ultraviolet rays, exposure to the sun at its zenith is especially dangerous. A malignant tumor can also appear as a result of prolonged exposure to artificial sources of ultraviolet radiation, which include solariums and bactericidal lamps. Statistically, melanoma is most common among residents of countries with high sun exposure, such as Florida, Australia and Hawaii.
2. Skin cancer often manifests itself as a recurrence.
3. Outgrowing moles is a common phenomenon in medical practice. In 60% of cases, skin cancer develops from nevi and atypical moles. The main places of localization are the head, legs, arms, back, neck, palms, scrotum, sole and chest area. The more moles throughout the body, the higher the risk of their degeneration into a malignant tumor.
4. Skin diseases that are precancerous in nature. Similar diseases include xeroderma pigmentosa and Dubreuil's melanosis.

In addition to the direct causes of skin cancer, there are so-called risk factors:

• weakened immunity, unable to independently destroy cells with altered DNA;
• overweight;
• predominance of fats and proteins in the daily diet;
• age – the older the person, the higher the risk of getting sick;
• genetic inheritance;
• fair skin, presence of freckles and red hair pigment;
• history of sunburn.

A person belonging to one of the risk groups must carefully monitor their health in order to prevent the development of the disease at the initial stage.

Melanoma symptoms

Melanoma often occurs on unchanged skin, but tumor manifestations from moles and against the background of a skin disease that are precancerous are common. The main symptoms of tumor lesions of the skin include changes in the color and shape of existing moles, as well as the occurrence of unpleasant sensations in this area. Melanoma is often perceived as a new mole with an unpleasant appearance, but only a doctor can recognize it during examination.

Primary signs

What the initial stage looks like can only be understood by the changes and sensations that appear in the area of ​​the mole:

• burning sensation;
• bleeding;
• itching of the skin;
• change in the appearance of the mole, its thickening and elevation;
• change in consistency, the mole becomes soft;
• severe swelling and redness of nearby tissues;
• the appearance of discharge;
• the main tumor focus is surrounded by new pigmentation.

Late symptoms

Rapidly developing melanoma is characterized by the following symptoms:

• constant bleeding of the mole;
• noticeable pain discomfort in the affected area;
• noticeable violation of the integrity of the skin;
• the appearance of blood from pigmented areas located elsewhere.

Symptoms of metastases

When cancer cells enter the blood and spread to other organs, signs of metastatic melanoma are observed:

• palpable thickening under the skin;
• the skin acquires a grayish tint;
• an unreasonable chronic cough appears;
• severe headaches accompanied by cramps throughout the body;
• weight loss or complete exhaustion;
• lymph nodes become clearly enlarged.

Immediate medical attention is required if severe bleeding from pigment spots appears, if there is a strong change in skin color, if moles are asymmetrical and if they increase in diameter by more than 6 mm.

Medical practice recognizes different types of melanomas that develop in different areas of the body.

The most common types of cancerous lesions are:

1. Noduryanaya, better known as nodal. It ranks second in popularity among diagnosed melanomas; according to statistics, this is 15-30% of cases. The average age of formation is from 50 years and older, the localization of the nodule does not have clear locations, it can be found throughout the body: from the scalp to formations on the foot or palm. It is noteworthy that this type of tumor in men occurs on any part of the skin, and in women mainly on the lower extremities. The appearance of nodura melanoma is characterized by aggressive development and vertical growth of the nevus. The average duration of tumor development is from six months to one and a half years. Diagnosis of nodular type formation at an early stage is extremely rare; patients usually seek help when the tumor takes the form of a dark-colored plaque with high edges and clear dimensions. In advanced stages, melanoma can take the form of an aggressively developing polyp.
2. Superficial, called in medical practice as superficial. This type of skin tumor occurs in 70% of cancerous lesions. The source of development is previous moles and nevi. Growth begins with a benign tumor located in the subcutaneous layer. The development of the superficial type occurs over a long period of time. Characteristic signs are the appearance of a spot with uneven edges, which is distinguished by a change in color pigment. The mole can take on various shades from tan to black or white. Superficial melanoma is usually treatable and has a favorable prognosis when compared with other types of skin cancer.
3. Melanoma lentigiosum, also called lentigo maligna and melatonic freckles. Appears mainly in old age against the background of senile pigmentation of the skin; in rare cases, it may appear from a simple mole. The average incidence rate is 10% of the total number of skin cancers. Lentigo maligna is diagnosed in those areas of the body that are most exposed to ultraviolet radiation - ears, face, neck. Development occurs slowly, the period between its initial manifestation and the final stage can be up to 30 years. Lentigo maligna has a fairly favorable prognosis: metastasis occurs rarely. There are cases when the disease resolved on its own without consequences for the patient.
4. Lentigo is peripheral, the proportion of the disease is about 10%, mainly in representatives of the Negroid race. The main location of peripheral melanoma is the palms and nail beds. Often, skin lesions in the form of a dark spot with jagged edges are diagnosed on the foot. The growth of lentigo occurs very slowly, the tumor grows in the upper layers of the skin, without spreading inside. The prognosis depends on the depth of tumor penetration.
5. Pigmented melanoma. It is distinguished by the presence of melatonin pigment, which gives the tumor a specific color. The main advantage is a clear cosmetic manifestation, since the cosmetic effect is noticeable immediately, which forces patients to seek medical help on time. A peculiarity of pigmented melanoma is the presence of colors unusual for a simple mole. The range of shades can change from pink to black as the disease spreads. In this case, one tumor can gradually change from monochromatic to variegated. Over time, pigmented melanoma loses its color and becomes colorless.
6. Amelanotic, is colorless and the most dangerous. The main risk of such a tumor lies not only in its invisibility at the initial stage, but also in its rapid growth rate. With this diagnosis, the prognosis is the worst compared to other types. There may be cases of transition of a non-pigmented neoplasm into a pigmented one.

Any melanoma is initially malignant; a benign type of such a tumor does not exist in medical practice. Signs of oncological formation are rapid growth, a tendency to grow into the deeper layers of the skin and metastasis.

External presentation of melanoma

When describing the appearance of a skin tumor, one should take into account its type, stage of development and location. Melanoma is a neoplasm characterized by the greatest variability among other malignant phenomena. When a tumor develops from a mole, it is localized either in the center or at the edges. The following types of melanomas exist:

• proliferation of papillomatous type;
• flat-shaped pigment spot;
• minor protrusion;
• the form of a mushroom, the tumor is located either on a broad base or on a stalk.

Mostly single tumors of oval or round shape are found. Multiple melanoma often occurs, when several additional ones are located around the main focus. Gradually they can merge into one common one.

At the initial stage of development, melanoma has a smooth surface, but as the disease progresses, it becomes covered with small lesions and irregularities. The main danger of this stage of the disease is that it is highly traumatic; bleeding from the tumor can begin at the slightest impact.

When the tumor node disintegrates, the neoplasm may take on the appearance of a cauliflower with multiple formations on the surface. The consistency of melanoma can vary from fairly dense and hard to soft, or a combination of hard and soft areas.

The shade is always individual and depends on the amount of pigment present in it, unless there is a pigmentless tumor. The most common shades are brown, gray, purple, crimson and black.

The pigmentation of melanoma is most often heterogeneous with a greater concentration of color in the central part. An alarming signal is a change in the color of the tumor, which indicates the progression of the malignant disease.

Locations

Melanoma can appear on any part of the skin. According to statistics, the favorite places for its formation in women are the lower leg, in men - the face and back.

Face

The most dangerous malignant melanomas appear on the face. They are a pigment spot of various shapes, but in some cases the pigment may be absent. The primary stage of malignant lesions of the facial skin is characterized by a clear oval shape with possible symmetry. As the disease progresses, melanoma acquires blurry outlines and variegated colors. The shape itself gradually changes - it can become convex, take on the shape of a mushroom or a knot.

Back

Melanoma on the back does not differ in its course from tumors localized in other parts of the body. The shape of the neoplasm has rounded outlines, and the color range varies from dark blue to reddish. The main danger of melanoma that forms along the spine is its late detection.

An aesthetic defect on the face or leg will be noticed faster than on the back, which leads to too late seeking medical help.

Melanoma of the visual organs

A tumor of the eye is quite common and entails significant loss of vision. Development occurs most often from the ocular choroid and has an aggressive course. The following types of melanoma of the visual organs are distinguished:

• choroid;
• conjunctiva;
• iris;
• century.

The least common tumors are the eyelid and conjunctiva. It is not possible to detect this type of tumor at the initial stage due to insufficient symptomatic picture. The main primary symptom is a slight clouding in the retinal area. Only an ophthalmologist can accurately diagnose this stage.

The second stage is characterized by painful discomfort in the mucous membrane, redness of the eyelid and swelling. At the third stage, ocular melanoma extends beyond the apple, the eye begins to shift due to the growing tumor, at the fourth stage symptoms of bleeding and clouding of the lens are noticeable.

Nail

The neoplasm in this case is localized directly on the skin around the nail plate or the nail itself. Manifestation is possible at any age, and the tumor can grow on the fingernails and toenails.

The primary symptom of the disease is a change in the color of the nail plate, but at this stage it is not always possible to diagnose the disease. The dark spot formed under the nail begins to grow and increase in size. The nail begins to gradually lift, and a nodule with erosion forms near the nail plate.

Stages of the disease

The course of melanoma can be assessed and the chances of a favorable outcome can be predicted based on the stage at which the disease is located. In medical practice, it is customary to distinguish 5 main stages of the course of the disease:

1. Stage zero, the presence of cancer cells can be determined only on the outer cellular layer. This stage does not involve deep growth of the tumor inside.
2. The first stage, also called the initial stage. The thickness of the tumor during this period is from 1 to 2 mm, metastasis is not observed. Localization occurs at the dermal level, but spread to the lymph node level does not occur. According to the clinical classification of melanomas, this tumor formation is not yet dangerous, since it represents a local stage.
3. At the second stage, the thickness of melanoma is within 2-4 mm, but metastases in the lymph nodes and other organs are still not diagnosed. The tumor spreads to the thickest layer of the skin, the dermis.
4. The third stage is more than 4 mm in size, there are no metastases. Damage to 2-3 lymph nodes without spreading to other organs is diagnosed. Tumor growth occurs in the subcutaneous fat layer. According to the clinical classification, generalized damage to internal organs is added.
5. The fourth stage is characterized by metastasis of internal organs and lymph nodes. Melanoma grows deep into the subcutaneous layer and is more than 4 mm thick. A complete cure at this stage is almost impossible.

Pediatric melanoma

A malignant tumor of the skin can also manifest itself in childhood, mainly in the period from 4 to 6 years and from 11 to 15 years. It is most often located on the neck, head and limbs. In 70% of cases, the appearance of melanoma in a child is observed on unchanged skin against the background of already present moles and nevi. More than 10% of cases of malignant neoplasms are of a genetic hereditary nature. Main symptoms:

• enlargement and change in the shape of a previously quiet nevus;
• change in color of a mole;
• burning, cracking and tingling in the area of ​​skin formations;
• ulceration with bleeding;
• noticeable elevation of moles and age spots;
• loss of vegetation in the area of ​​the nevus and around it.

Childhood melanoma is characterized by unpredictability of development; it can occur either rapidly or gradually, when periods of remission give way to exacerbation. Treatment of childhood skin tumors is carried out without the use of conventional chemical therapy, since the main feature of such melanoma is resistance to radiation and chemical therapy. It is distinguished by the childhood version of the disease and rapid metastasis.

The study of melanoma involves a set of measures that are standard for all diseases. First, the doctor conducts a visual examination of the tumor and asks the patient about the nature and duration of the changes. An important point is the presence of heredity: whether other family members have cancerous lesions of the skin.

A general examination with palpation, during which the doctor determines the pain and density of the melanoma, as well as its fusion with other tissues. During the general examination, attention is also paid to the lymph nodes. Even with an obvious diagnostic picture, the doctor prescribes a series of studies that will confirm the diagnosis. This is necessary to exclude or confirm metastases in other organs. Main diagnostic measures for melanoma:

• bone scan and x-ray of chest organs to identify metastases;
• taking a blood test for a biochemical study, where the readings of LDH and alkaline phosphatase will be important; high values ​​of these indicators indicate the process of metastasis and the resistance of the tumor to the treatment already being carried out;
• Ultrasound of the abdominal cavity, which determines the condition of the lymph nodes and organs; the study is indicated if the thickness of the melanoma exceeds 1 mm;
• dermatoscopy, when using a special device with a magnification function, a close examination of melanoma is carried out.

Methods of therapy

Treatment of melanoma directly depends on the stage of development of the disease:

1. Stage zero – surgical excision of the tumor with tissue capture around the lesion for 1 cm.
2. First stage. A biopsy is first performed, after which the tumor is removed, covering 2 cm of tissue. If there are signs of metastases in the lymph nodes, they are also removed.
3. At the third stage, chemotherapy, boosting immunity and tumor removal are indicated. The capture of healthy tissue during resection of melanoma reaches 3 cm. A mandatory continuation is the removal of lymph nodes and subsequent chemotherapy.
4. The fourth stage does not have a standard treatment regimen; usually therapy includes the complex effects of chemicals and radiation medicine.

Chemotherapy

Treatment of melanoma involves the use of several drugs at once, the most common among them:

• Ronkoleikin,
• Cisplatin,
• Reaferon,
• Vincristine.

If there is a disseminated form, the drug Mustoforan is used, indicated for brain metastases. In standard therapy, Roncoleukin is used intravenously at a dose of 1.5 mg in combination with other drugs. The average duration of chemotherapy is 6 cycles at 4-week intervals.

Radiation therapy

This method of exposure is additional and is used in combination with other therapeutic measures. Independent use of radiation treatment is possible only if the patient refuses surgery.

Cancer cells are noticeably resistant to ionization, so this method is used as a restorative therapy after surgery or in combination with chemotherapy.

Operation

The method of surgical treatment involves wide excision of the tumor involving nearby tissues. The main goal of surgery is to prevent metastases. The defect that appears as a result of surgery is eliminated using plastic surgery.

The area of ​​the removed area depends on the initial size of the tumor. For melanoma of the nodular type or superficial neoplasm, the distance from the edge of the lesion is no more than 1-2 cm. Excision is carried out in the shape of an ellipse, and the block of excised tissue takes on an ellipsoidal shape.

Surgery is contraindicated for lentigo melanoma. This type of cancerous skin lesion is subjected to laser destruction or exposure using cryogenic technologies using low temperatures.

Prevention

Measures to prevent the development of cancerous lesions of the skin:

1. Limit exposure to ultraviolet radiation. This includes not only the ban on prolonged exposure to the sun at its zenith, but also visiting solariums. UV rays are dangerous even on a cloudy day. Sunscreen will help protect you.
2. Limit skin contact with chemicals as much as possible. This is especially true for workers in hazardous industries.
3. It is necessary to be careful with nevi and moles, to avoid injuring them and not to try to eliminate a cosmetic defect on your own, regardless of its location.
4. Maintaining a balanced diet and maintaining a healthy lifestyle. It has been scientifically proven that people who prefer fatty junk foods and have bad habits suffer from skin cancer more often than others.
5. Take any medications only under the supervision of a doctor in the dosage strictly prescribed by him.

Melanoma of the skin affects the skin of people regardless of age and gender. A timely visit to a doctor if you suspect a cancerous tumor gives an excellent chance of getting rid of the disease.

Melanoma is a malignant neoplasm, one of the most aggressive forms of skin cancer. The trouble is that the human immune system practically does not react to melanoma and does not try to fight it, so it can quickly progress and metastasize.

Cancer is the result of abnormal and uncontrolled proliferation of “crazy” cells. In the case of melanoma, trouble befalls the melanocyte cells that produce the pigment melanin, which is responsible for tanning, freckles, age spots, eye and hair color. These cells are located:

in the skin - in the epidermis and at the border with the dermis;

in mucous membranes (epithelium).

Melanoma is often called a “degenerated mole.” Indeed, most often it develops from an already existing mole, or, scientifically, a nevus. This is why nevi should be shown to a dermatologist annually to determine their condition.

© La Roche-Posay

Traditionally, Melanoma Day is held in May, on the initiative of the La Roche-Posay brand. Many clinics invite everyone to a free examination in order to promptly detect moles that require special monitoring.

“Melanoma can even occur in the mouth and on the back of the eyeball. She especially likes areas that are often exposed to the sun, as well as those where it is difficult to notice: between the fingers, on the scalp, in the folds of the skin. Doctors note that in recent decades, the number of cases of melanoma on the legs in men has increased sharply, which is explained by the fashion for Bermuda shorts.”

Risk factors

Melanoma has many risk factors.

1. 1

   Exposure to the sun without sunscreen or with insufficient protection.

2. 2

   Passion for solarium and sunbathing.

3. 3

   Light skin (I-II phototypes). This does not mean that representatives of other phototypes are guaranteed to be insured against melanoma. But pale skin is less protected from ultraviolet radiation.

4. 4

   An abundance of moles, as well as the presence of dark and raised moles. It is believed that if there are more than 50 moles in total, this is already an additional risk factor. According to the Research Institute of Oncology named after Academician Petrov, 70% of potentially dangerous nevi are congenital, and 30% are acquired.

5. 5

   Experienced (even in early childhood) sunburn.

6. 6

   Genetic predisposition. According to scientists, the main role is played by the “weak link” in the immune system, which makes it difficult to resist malignant neoplasms.

7. 7

   Age 50+. The average age of people diagnosed with melanoma is 57 years.

There is an opinion among dermatologists that at the entrance to a solarium there should be an inscription: “You are coming here for skin cancer.” © Getty Images

Types of melanoma

Superficial spreading melanoma

It accounts for about 70% of all cases. This form is somewhat more common in women aged 30 to 50 years. A suspicious mole, slightly protruding above the skin, begins to increase in size and gradually turns into a granular speck (and then a spot) with uneven edges and uneven color - from brown to black.

As the name suggests, this form of melanoma first grows in breadth over a long period of time. And only at the second stage does it move on to more dangerous growth in depth. Therefore, it is important to monitor moles.

Nodular melanoma

This is the so-called nodular melanoma. It accounts for about 15% of all cases and most often affects men. This form is considered the most unfavorable, since the malignant tumor quickly begins to grow deep into the skin, which accelerates the formation of metastases. It looks like a red-brown or black nodular bump on the surface of the skin. Hence the name.

Pigmentless

Pigmentless, or achromatic, melanoma develops quite rarely, literally in 1–2% of cases. However, it is especially insidious precisely because it is simply not visible. Just like nodular, it is a small nodular compaction on the skin that is rough to the touch, but it may not be colored in any way, which does not in any way prevent the tumor from progressing.

Lentigo-melanoma (lentiginous)

This form makes up about 5% of cases and usually develops after 55 years, it begins with a light, flat small spot, which quickly increases in size and turns out to be not just a pigment spot, but melanoma. This form is also called "Hutchinson's freckle". It is more common in women and mainly on the face. So watch out for pigmentation!

Acral lentiginous melanoma

Spindle cell melanoma

A rare form that usually (but not always) develops in childhood and adolescence. It got its name from the elongated shape of the cells that form the formation. It is a small convex tubercle, pinkish or flesh-colored, smooth or rough to the touch, which is quite difficult to mistake for a malignant tumor. This type of melanoma does not cause any pain, it only grows - this is the main alarming sign.

The first symptoms and signs of melanoma

How to determine the initial stage

“The ABCDE method is intended for self-diagnosis of skin growths (but does not replace regular visits to the doctor to monitor moles).

A - ASYMMETRY (asymmetry). A benign mole is always symmetrical. If the mole is not symmetrical, there is a risk of developing melanoma.

B - BORDERS (borders). A benign mole has smooth, clear boundaries. In melanoma, the borders are usually uneven, like a blot.

C - COLOR (color). A mole that contains several colors at once (different shades of brown, black) is an alarming signal. Melanoma may also turn red, white, or blue.

D - DIAMETER (diameter). The diameter of the mole has become larger than the eraser on a pencil (6 mm). Benign moles are usually (but not always!) smaller.

E - EVOLUTION (change). Any change in size, shape, color, bleeding, itching, pain is a warning sign. You need to see a doctor urgently.”

At the initial stage of melanoma, all degenerated cells are located within the surface layer of the skin - the epidermis, so it is easier to get rid of it.

Moles that are at least voluminous should definitely be shown to a dermatologist every year. © Getty Images

For the initial examination, a dermatoscope is sufficient, but the final diagnosis of melanoma can only be made on the basis of a histological examination of the distant formation (nevus).

Now there are even mobile applications that help assess the condition of a mole. But an urgent request, or rather a requirement: do not get carried away with self-diagnosis. Only a doctor can competently analyze the symptoms and signs of melanoma.

At the second stage of melanoma, the mole continues to transform and may hurt, bleed, or itch. The tumor has already grown up to 4 mm in depth, penetrating into the dermis, while remaining externally within the same boundaries as before. But there are no metastases yet, since the malignant tumor has not yet reached the lymph nodes and large blood vessels.

Unfortunately, without regular screening, melanoma can go undetected and progress.

How to fight melanoma

If a diagnosis is made or even there is only a suspicion that the nevus is malignant, most often a decision is made to perform a surgical operation - complete removal of the formation, including part of the intact nearby tissue.

At-risk groups

To summarize, we would like to remind you that the risk group includes the following categories:

sunbathers;

light-skinned people;

people with a large number of moles and pronounced pigmentation;

people over 50 years old;

people with a family history of melanoma.

Not a single sunburn, even one received in childhood, goes away without leaving a trace on the skin. Protect children! © Getty Images

Which doctor should you contact?

You should contact a dermatologist, like a therapist, at least once a year for a general examination and consultation, without waiting for alarming symptoms.

A dermatologist will use a dermatoscope to examine the skin and moles, assess their condition and activity. Quite often, the doctor leaves himself a “memory photo” so that at the next visit he can assess the condition and development of a particular nevus.

Tools Overview

Despite the extreme seriousness of a disease such as melanoma, there is a simple way to prevent it. Scientists at the University of Oslo conducted a large-scale study and found that even using a cream with SPF 15 already reduces the risk of developing melanoma by 33%. For our pale skin, unspoiled by the sun, we need products with an SPF of at least 30, and if the skin is especially fair, or if you have moles and age spots, choose SPF 50. The choice is huge.

Sun protection moisturizing dry face spray “Expert Protection”, SPF 50 protects the skin from both types of rays (A and B), moisturizes. easy to use - can be applied directly to the face.

Sunscreen “Expert Protection”, SPF 50+, Garnier Suitable for face and body, contains vitamin E and a complex of chemical sunscreen filters that protect the skin from broad spectrum rays.

Sunscreen milk Sublime Sun “Extra protection”, SPF 50+, L’Oréal Paris enriched with antioxidants that neutralize the threat of ultraviolet damage to the skin.

Sun protection stick for sensitive areas of the skin and lips Capital Idéal Soleil, SPF 50+, Vichy, Convenient to keep on hand wherever you walk in the sun. With its help, you can easily protect your nose, cheekbones, ears and parting area, which quickly burn.

Sunscreen for face in compact format Anthelios XL, SPF 50+, La Roche-Posay allows you to quickly update your sun protection. Protects against broad spectrum rays. Intended also for sensitive skin.

Melting moisturizing sun milk Lait Solaire, SPF 50, Biotherm Suitable for both face and body. In addition to an effective sunscreen complex, it contains the antioxidant tocopherol, which helps cope with the damaging effects of ultraviolet radiation.

Sunscreen lotion for face and body Activated Sun Protector for Face and Body, SPF 50, Kiehl’s retains moisture in the skin, contains antioxidant vitamin E and soybean oil.

Makeup base Maestro UV, SPF 50, Giorgio Armani represents complete sunscreen. Just keep in mind that it is recommended to renew the UV protection every 2 hours - the foundation is suitable for morning makeup if the bulk of the day is spent indoors.

Cancer is a pathology that can affect any organs and tissues. The skin is also an exception. The appearance of small moles and pigmented spots can often represent a cancerous formation - melanoma.

Over the years, the number of people diagnosed with this type of cancer is constantly progressing, and today 40 people out of 100 thousand cancer patients suffer from this pathology.

Melanoma is a cancerous growth on the surface of the skin and is one of the aggressive forms. Without treatment, she metastasizes quickly involving adjacent organs and tissues in the pathological process.

Most often, the disease is diagnosed in people of the age category 30–50 years. Unlike other types of cancer, melanoma is easily diagnosed, even in the early stages of development.

Statistics

Melanoma is a fairly rare disease. Of the total number of cancer patients, only 2.3% are diagnosed with skin melanoma. If we consider this pathology among all cancerous skin diseases, then melanoma is detected in 13% of cases.

Treatment of melanoma in the early stages is characterized by a positive prognosis and stable remission in 95% of patients.

Causes

The reasons that provoke the development of skin melanoma differ in character and diversity:

• low melanin content in the body;
• people's predisposition has been noted with red hair and freckles;
• genetic predisposition;
• availability of large quantities pigment formations(more than 50 pieces throughout the body);
• skin dermatitis or precancerous pathologies;
• age over 50 years;
• regular sunburn or ultraviolet exposure;
• exposure to carcinogenic sources of training: solariums, quartz lamps;
• systematic injuries in the area of ​​moles or pigmented areas;
• expressed weakening of the immune system.

Symptoms

The peculiarity of skin melanoma is that at the first stages of its development, it practically does not reveal itself. In a separate area, in the basal layer of the skin appears little education, no more than 0.5 cm in diameter.

Depending on the form of formation, cancer can have different symptoms. You can distinguish a newly appeared malignant formation from an ordinary mole or mole by the following symptoms:

• most often, education has a dark heterogeneous color. But in isolated cases, a pigmentless formation is diagnosed;
• tumor surface is different uniform dense structure and shiny surface;
• in the affected area no vegetation;
• the edges of melanoma are often jagged and have no clear boundaries.

If a mole is affected by cancer, the following changes are observed:

• surface shade changes to darker;
• mole begins quickly increase in size and change its shape;
• noted hair loss from a nevus or mole, as well as in the surrounding area.

In addition to the listed signs, both the first and second forms are characterized by common symptoms:

• with time, the surface becomes “varnished”, acquiring an unnatural shine;
• noted tendency of the tumor to decay;
• in the center of the affected area ulcers form;
• slight mechanical impact leads to tumor bleeding;
• pathological formation begins to itch constantly;
• noted upon palpation severe pain;
• the growth of education occurs simultaneously both in depth and in width;
• tumor acquires complete asymmetry.

In this video, doctors named 5 main signs of melanoma that you should definitely pay attention to:

Diagnostics

Diagnosis of the initial stage of pathology development is carried out according to a standard plan, including the following research methods:

• visual inspection and collection of clinical data. It is used during initial treatment and allows you to form a general picture of the disease;

dermatoscopy– carried out using a special device equipped with magnifying optics. The device makes it possible, through magnification, to examine in detail the keratinized layer of the epidermis.

Some clinics use a digital version of this device. In addition to the appearance of the skin surface, it allows you to create a three-dimensional model of a malignant neoplasm;

• excisional– taken directly from the affected area to identify cancer cells;
• incisional biopsy. Designed for histological examination, for which not only affected but also healthy tissues are collected;
• CT or MRI allows you to determine the size of the tumor, the degree of damage to adjacent tissues, due to the layer-by-layer image of the formation;
• confocal microscopy. It is used to determine the stage of the disease using a special microscope.

Methods for self-diagnosis of the disease are described in this video:

Treatment

To treat melanoma in the early stages, certain methods or a combination of them are used.

The fundamental method used is surgery. To consolidate the result and reduce the likelihood of relapse, a complex is prescribed, including chemotherapy and radiation.

Surgery

Surgical removal of melanoma is indicated for small growths. This procedure can be performed even on an outpatient basis, as it does not require special equipment or general anesthesia.

The procedure is carried out step by step:

1. Before removal, the patient a local anesthetic is administered injection method, in the affected area.
2. Then, using a scalpel, a careful excision of malignant tissue with the capture of 1 or 2 cm of healthy skin located around the formation.
3. Next is carried out additional biopsy after which the wound is treated with a hemostatic and aseptic drug.
4. Finally, to the operated area a tight aseptic bandage is applied.

Conservative treatment methods

Conservative methods for skin cancer are used only in combination and, most often, act as methods that complement surgical treatment.

The following conservative methods are used:

Chemotherapy. This method is not used as an independent treatment due to its low effectiveness. Clinical observations showed that after chemotherapy, improvement occurred in only 2% of patients. Chemotherapy is the administration of certain drugs that are active against cancer cells.

The drugs are introduced into the general bloodstream or a localized area, due to which they have not only anti-inflammatory, but also a pronounced negative effect. To stop melanoma, drugs such as carmustine or dacarbazine are most often used.

Also, the use of cisplatin, tamoxifen, cyclophosphamide and lomustine is allowed. The procedure with these drugs can be carried out both regionally and systemically.

Radiation therapy. Involves impact on the formation of radiation rays. The dosage, scheme and number of irradiations are determined depending on the volume of growth, the age of the patient and the characteristics of his body.

Treatment can be carried out externally and internally. Internally, a small needle or catheter is inserted into the affected skin, through which radiation is delivered. With the external method, a radioactive beam from a special device is placed on the pathological area, which is pulsed.

Radiological treatment. Most often it is used only before surgery, as a therapy to reduce the size of the tumor. After surgery, it is prescribed only in combination with other methods.

This method involves exposure of the tumor to targeted radiological irradiation. It guarantees stabilization of the malignant process and is a good prevention of relapse of the pathology.

Forecast

At the initial stage of the disease, the tumor is only superficial, without penetration into the deep layers of the skin and metastasis. Treatment in this case is easy to predict.

As a rule, when the thickness of the formation is no more than 1 mm, treatment is positive results in 100% of cases.

Observation of pathology for 5 years shows complete recession in 97% of patients. If the tumor was about 1.5 mm in size, then treatment shows positive results in 95% of cases. Only 85% of them are in recession.

The rehabilitation period after surgery takes only a few days. After chemotherapy or radiation therapy, this period can be a month or more.

To reduce rehabilitation time and reduce the likelihood of relapse, it is recommended to adhere to the following rules:

• During the rehabilitation period, you should support your body immunotherapy. But it is worth considering that all drugs should be selected only by an oncologist. Most often, interferon-alpha, interleukin-2 and granulocyte-macrophage component of a colony-stimulating nature are prescribed;
• in the future, it is necessary avoid prolonged exposure to the sun and exposure to direct sunlight;
• do not do it visiting a solarium and ultraviolet irradiation, even for preventive purposes;
• necessary as much as possible protect moles and similar formations from chafing and permanent injury;
• at the slightest changes in formations, you need contact a doctor immediately.

Melanoma is a malignant degeneration of skin cells a certain type. The disease is extremely aggressive, can be inherited And begins asymptomatically. Trigger cancer skin of this type even a single exposure to the sun can, if the insolation was particularly intense.

What is melanoma

Melanoma (or melanoblastoma) is melanocytic skin cancer. From Greek its name can be translated as “ black tumor».

Malignant disease affects skin cells(melanocytes, melanoblasts), which are responsible for its pigmentation. In approximately 80% of cases, melanoma develops independently, on intact skin. Only in every 5 cases of pigmented skin cancer do the cells of nevi (moles or birthmarks) present on the patient’s body undergo malignant degeneration.

Photo 1. Melanoma at the initial stage may look like an ordinary mole. It is advisable to have nevi checked by a doctor from time to time. Source: Flickr (Melanoma Research Foundation MRF).

Melanoblastoma looks like a mole or birthmark. A cancerous formation differs from a benign nevus in a number of characteristics. It is most often localized on open areas of the body, but can occur on other parts of the body and even under the nail, in the eye or on mucous membranes (for example, in the vagina). Internal localizations of melanoma are rarely recorded.

Also rare, but possible, is the appearance of unstained melanoblastoma.

The disease has no pronounced age or gender “preferences”. However, there is a clear dependence of the risk of skin cancer on a person’s phototype. The less the patient is exposed to sunburn, the lighter his skin (eyes, hair), the greater the risk of melanoma.

Melanocytic skin cancer is an aggressive disease with rapid growth of metastases throughout the body. It affects the lymph nodes and any internal organs and tissues (lungs, liver, bones).

Note! The incidence of melanoma worldwide has increased dramatically in the 21st century. Scientists associate this with the possibility of long-distance travel, when “northern” people go on vacation to the countries of Asia and North Africa, where they are exposed to massive solar radiation.

Reasons for development

The main cause of malignant degeneration of melanocytes is considered ultraviolet irradiation both natural and artificial. Melanin is a substance that is “responsible” for the color of human eyes, hair and skin. The production of melanin is closely related to the action of UV rays and the functioning of the hormonal system.

The normal process of melanocyte division is disrupted by:

• intense UV irradiation,
• hormonal changes in the body due to illness or natural causes (pregnancy, menopause),
• immunodeficiency states. Melanoma does not provoke an adequate immune response in the patient's body. Low immune status facilitates the development of malignant tumors;
• injury to nevi.

Note! For the occurrence of melanoma, it is not the frequency or duration of exposure to the sun that is critical, but the intensity of insolation. Even a single burn of the skin in childhood can initiate a malignant process in an adult under certain conditions.

Risk factors for developing melanoma

• Hereditary predisposition. Melanoma is inherited by close relatives in a dominant manner. If there have been cases of skin cancer in your family, then you are at risk;
• The presence of a large number of moles or birthmarks;
• Bright skin;
• Nevi in ​​places that are subject to regular mechanical stress(squeezed, rubbed, prey);
• Sunburn in the anamnesis.

Note! The exact reason why a malfunction in the DNA of melanocytes occurs cannot be determined. It is believed that a combination of several unfavorable factors leads to malignant processes.

Photo 2. The appearance of melanoma is primarily associated with increased UV radiation. Source: Flickr (Fábio Petry).

Types and types of tumor

According to the type of development of oncopathology and morphological characteristics, melanocytic cancer is divided into 5 types, which differ in localization, method and speed of spread, and prognosis.

Superficial spreading melanoma

This type of skin cancer most common, it accounts for about 70% of all cases of the disease. Superficial spreading cancer is called lateral cancer because the growth of a malignant tumor over a long period of time(from 2 to 5 years) occurs exclusively along the perimeter without affecting the deeper layers of the dermis.

Superficial spreading melanoma looks like brown heterogeneous spot with a clear hyperemic border. The spot rises above the surface of the body and has no skin pattern. Its main difference from a benign nevus is the change over time. The internal color, size, and contours may change.

Over time superficial spreading melanoma enters the vertical growth phase when the tumor begins to affect the deeper layers of the skin. With vertical growth, the prognosis worsens, the risks of metastasis increase sharply. The clinical picture changes - ulcerations, bleeding, itching, burning appear.

Lentiginous

Lentiginous melanoma meets relatively rare in 10-12% of cases of disease. Develops from precancerous lentigo. It occurs in women who are poorly susceptible to tanning and have a large number of freckles and age spots. This form of cancer considered a pathology of older people. It is localized on the face, décolleté, head, ears, and less often on the exposed parts of the arms and legs.

Lentiginous carcinoma may resemble superficial melanoma, but characterized by slower development and better prognosis. Externally, it is a large (from 4 to 20 cm) spot with sharply defined, irregularly shaped, jagged boundaries. The surface of the spot is flabby and dull. The coloring is uneven with blot-like inclusions of a dark color.

Acral (amelanotic) melanoma

Acral tumor differs from other types of melanocytic cancer in its localization - it develops in closed areas of the body, affects thickened skin– palms, soles, nail plates. Occurs in areas clear of nevi. Growing quickly and capable of metastasizing in the early stages of development. Occurs in approximately 5% of cases.

Acral melanoma does not have age, sex or race preferences, although until recently it was believed that representatives of the Negroid race are more susceptible to it.

Appearance of a tumor accompanied by increased keratinization of the skin. Visually, an acral malignant tumor is a dark-colored spot, evenly thickened over the entire surface. With further development, nodular formations appear. A tumor on the nail lifts the nail plate, the affected area increases, and pain appears.

Note! There is no clear dependence on UV insolation in the occurrence and development of acral melanoma.

Nodular (nodular)

Nodular or nodular melanoma develops mainly in middle-aged and older men. The incidence of this type of skin cancer among others is about 15%. The tumor is node(large protruding mole) more often dark color. The shape of the tumor is round or oval, with clear boundaries, the surface is smooth. The color depends on the number of melanocytes.

Rarely, nodular tumors without pigmentation occur. They are large nodular formations of pink color. Diagnosis is made using special chemicals that detect the presence of melanocytes.

Nodular melanoma characterized by great aggressiveness and the absence of a horizontal propagation phase. Vertical growth, early metastasis and late diagnosis determine an unfavorable prognosis for the development of this type of cancer.

Amelanotic melanoma

Amelanotic melanoma is an aggressive cancer that characterized by early metastasis. This neoplasm looks very harmless - it’s painless pink nodule on the skin, which does not cause any concern.

The development of pathology adds specific symptoms. Itching, burning, ulcerations, vascular lesions, and bleeding appear.

Note! Any formations on the skin that appear, persist, increase or change are a reason to visit a dermatologist.

Stages of tumor development

There are 4 stages of melanoma development. Depending on the degree of tumor growth, the specifics of therapy are determined. As with other oncological pathologies, the earlier a tumor is diagnosed, the more optimistic the prognosis for its treatment.

The precancerous condition is classified as stage zero. This is the development of atypical melanocytic dysplasia based on existing nevi or the appearance of an unusual nevus on a clean area of ​​skin.

You can suspect melanoma based on the following signs::

• An existing or newly formed birthmark or mole begins to undergo noticeable visual changes. Their color, size, thickness, surface structure changes (for example, the skin pattern disappears);
• Ulcerations appear on the surface;
• Bleeding or any leakage of fluid occurs;
• The nevus begins to hurt (normally its presence is not felt), itch, and burn.

Note! Examine the surface of your skin and that of your loved ones. At the slightest suspicion of activation of birthmarks or moles, visit a dermatologist. Timely diagnosis will save lives.

First (initial) stage of development

The onset of melanocytic cancer development is characterized by horizontal invasion, without tumor growth into the deep layers of the dermis. The first stage includes malignant formations, the thickness of which is up to 1 mm(ulceration may be present) or formations up to 2 mm thick without signs of ulceration, severe symptoms. There is no metastasis.

The treatment is surgical, the prognosis is very good. The tumor and adjacent tissues are removed under general anesthesia. Local anesthesia is not indicated to prevent the transfer of abnormal cells into deeper layers of the skin or bloodstream when the needle pierces adjacent tissue.

The 5-year survival rate is more than 85%. If melanoma is diagnosed and removed when its thickness has not reached 1 mm, then the survival rate is up to 99%.

Second stage

The second stage of skin cancer is tumor from 1 to 2 mm thick without metastases. Minor ulcerations are allowed. Treatment is surgical. Survival statistics are no different from the first stage. However, the prognosis depends on the speed of tumor spread and the type of melanoma.

Note! Statistics show that women have a better prognosis than men. This is explained by the localization of tumors in open areas of the body, where women are more concerned about them and seek medical help earlier.

Third stage

The third stage is the beginning of the spread of metastatic tumors to regional lymph nodes and the appearance of severe symptoms. When metastases are localized in 1 lymph node 5-year survival prognosis is about half of melanoma cases. When diagnosing metastatic lesions in 2 lymph nodes, the prognosis worsens to 20%.

Treatment is surgical + chemotherapy or radiation to destroy metastases.

Fourth stage

Any melanoma, which gives metastases to distant lymph nodes, organs and tissues has reached the final stage of its development - the fourth. Treatment Here symptomatic, is characterized by low efficiency. The prognosis is extremely unfavorable, survival rate is about 5%. The prognosis is worse the older the patient is, since one’s own resistance to disease decreases with age.

Treatment of melanoma by stages

Surgery

First and second stages of development tumors requires immediate surgical excision neoplasms with adjacent tissues. Removal of large areas of skin creates an aesthetic and functional (for example, when removing a tumor on the extremities) defect, which is covered with flaps of one’s own skin from other parts of the body.

In addition to excision of the tumor itself, in the presence of metastases, remove regional lymph nodes. Here surgery is combined with immunotherapy and chemotherapy.

Chemotherapy

Chemotherapy is the main method of therapy in the treatment of stages 3-4 when there are metastases or when it is impossible to perform surgery. The course and medications are selected individually in each case.

Immunotherapy

Immunotherapy for melanocytic cancer stimulates the body to destroy atypical cells. Use topical medications (creams) or centrally acting medications. Immunotherapy can be indicated at any stage of tumor development. At 1-2, it allows you to avoid the spread of cancer cells throughout the body, at 3-4, it prolongs the patient’s life.

Radiation therapy

Radiation for melanoma is indicated:

• in case of general damage to the body by malignant pathology to remove metastases in the brain, bones,
• to alleviate the condition of a patient with stage 4 disease,
• in case of relapse of the disease,
• after removal of lymph nodes to prevent recurrence of the tumor.

To treat the primary lesion, at stages 1-2 of the disease, irradiation is not used.

Prevention

Effective preventive measures include:

• protection from solar radiation,
• refusal of artificial insolation,
• preventive skin examinations.

A healthy life, a strong immune system, a reasonable attitude towards tanning and careful attention to yourself is the best prevention of melanoma.