Melanoma in the initial steps of: photo, symptoms, treatment

Melanoma is considered one of the most insidious of human cancers, the incidence and mortality of which has been steadily increasing from year to year. To talk about it on TV, write in journals and on the Internet. The interest of the inhabitants due to the fact that the tumor has become increasingly detected among residents of different countries, and the number of deaths is still high, despite intensive treatment.

As the prevalence of melanoma lags behind epithelial skin tumors (squamous cell carcinoma, basal cell carcinoma, etc.), Accounting for different data from 1.5 to 3% of cases, but it is much more dangerous. During the 50 years of the last century, the incidence has increased by 600%. This figure is enough to seriously fear of the disease and to look for reasons and ways to treat it.

What it is?

Melanoma - a malignant tumor that develops from melanocytes - pigment cells that produce melanin. Along with squamous and basal cell skin cancer refers to malignant tumors of the skin. Advantageously localized to the skin, at least - the retina, the mucous membranes (oral cavity, vagina, rectum).

One of the most dangerous human cancers, often recurrent and metastatic lymphogenous and hematogenous by almost all organs. A special feature is the weak response of the body, or its absence, which is why melanoma is often rapidly progresses.

Causes of

We will understand the underlying causes of causing the development of melanoma:

1. Prolonged and frequent exposure to ultraviolet radiation on the skin. Especially dangerous is the sun, which is in the zenith. This includes exposure to artificial sources of UV light (solarium, germicidal lamps and other).
2. Traumatic lesions of age spots, nevi, especially in those places where there is constant contact with their clothing and other environmental factors.
3. Traumatic lesions of moles.

Of moles, or nevi, melanoma develops in 60% of cases. This is quite a lot. The main places in which developing melanoma are those parts of the body, as the head; neck; hands; legs; back; chest; palm; soles; scrotum.

Most prone to the emergence of melanoma people who have more of the risk factors below:

1. A history of sunburn.
2. The presence in a sort of skin diseases, skin cancer, melanoma.
3. Genetically caused red hair, freckles, and also the presence of light skin.
4. Light, almost white skin caused by genetic characteristics, low content of melanin pigment in the skin.
5. The presence on the body of pigment spots, nevi. But if nevus hair grows, this skin can not degenerate into a malignant form.
6. The large number of moles on the body. It is believed that if more than 50 pieces of moles, it could already be dangerous.
7. Old age, but is more common among young people in recent melanomas.
8. The presence of skin diseases that can trigger the development of melanoma. This illnesses such as melasma Dyubreya, xeroderma pigmentosum, and others.

If a person belongs to a group from the list, then he has to be very careful to sun and attentive to their health, as it has a fairly high probability of melanoma.

Statistics

According to WHO, in 2000 worldwide were diagnosed with more than 200 000 cases of melanoma and was 65 000 melanoma-associated deaths.

In the period from 1998 to 2008 increase in the incidence of melanoma in Russia amounted to 38.17% and the standardized incidence rate increased from 4.04 to 5.46 per 100,000 population. In 2008 in Russia the number of new cases of melanoma was 7744 person. Deaths from melanoma in the Russian Federation in 2008 It amounted to 3159 people, and the standardized mortality rate of 2.23 per 100,000 person population. The average age of patients with melanoma with the first ever diagnosis in 2008 in Russia was 58.7 years [3]. The highest incidence was noted in the age of 75-84 years.

In 2005, the US registered 59580 new cases of melanoma and 7,700 deaths due to this tumor. The program SEER (The Surveillance, Epidemiology, and End Results) noted that the incidence of melanoma has increased by 600% from 1950 to 2000.

clinical types

In fact, found a considerable number of melanomas, including blood melanoma, melanoma of the nail, melanoma, lung, melanoma, choroidal melanoma and amelanotic Other that develop over time, in different parts of the human body due to disease progression and metastasis, but in medicine are the following, the main types of melanomas:

1. Superfitsialnaya or superficial melanoma. It is more common type tumors (70%). The disease is characterized by a long relatively benign growth in the outer layer of skin. In this type of melanoma appears spot with uneven edges, the color of which may vary: turn brown like a tan, red, black, blue or white.
2. Nodal (noduryanaya) melanoma is the second-highest number of diagnosed patients (15-30% of cases). The most common in people older than 50 years. It can be formed anywhere on the body. But as a rule, these tumors occur in women - in the lower extremities, men - on the body. Often nodular melanoma forms on the background of the nevus. Characterized by vertical growth and aggressive development. It develops over 6-18 months. This type of tumor is roundish or oval shape. Patients often go to the doctor when the melanoma has taken the form of plaques of black or black-blue color, which has clear boundaries and raised edges. In some cases, nodular melanoma grows to a large size, or takes the form of a polyp that has characterized by ulceration and hyperactivity.
3. Lentiginous melanoma. This disease is also known as malignant lentigo or freckle of Hutchinson. Most often it formed from senile pigment spots, birthmark, at least from an ordinary mole. This type of tumor tends to form on the parts of the body that are most exposed to solar ultraviolet radiation, is the face, ears, neck, hands. Melanoma develops this in the majority of people suffering from very slow, sometimes up to the last stage of its development may take up to 30 years. Metastasis is rare, there is evidence of resorption and formation of the so lentiginous melanoma is considered the most favorable in terms of prognosis from cancer of the skin.
4. Lentigo malignant melanoma seems on the surface. The development of a long, in the upper layers of the skin. In this case, the affected skin area flat or slightly raised, unevenly colored. Color similar spots patterned with brown and dark brown components. This melanoma is often found in the elderly due to a permanent location in the sun. Foci appear on the face, ears, arms, and upper torso.

symptoms of melanoma

In the initial stage of development of malignant tumors on healthy skin, and even more so against the background of a nevus, clear visual difference between them is small. Benign moles are characterized by:

• Symmetrical shape.
• Smooth smooth contours.
• Uniform pigmentation, formation of which imparts color from yellow to brown and sometimes black.
• A flat surface located flush with the surrounding surface of the skin or slightly above it uniformly rising.
• No increase in the amounts or in a slight increase over time.

The main symptoms of melanoma are:

• Hair loss from the surface of the nevus is caused by degeneration of the melanocytes in the tumor cells and the destruction of hair follicles.
• Itching, burning and tingling in the area of ​​the pigment formation is caused by enhanced cell division within it.
• Sores and / or cracks, bleeding, or releasing moisture due to the fact that destroys tumor normal skin cells. Therefore, the upper layer bursts, exposing lower layers of the skin. As a result, at the slightest trauma swelling "explodes" and its contents poured out. In this case, the cancer cells reach a healthy skin, penetrating into it.
• The increase in size speaks about enhanced cell division in the pigment formation.
• Rough edges and seal moles - a sign of enhanced tumor cell division, as well as their germination in healthy skin.
• The appearance of "daughter" of birthmarks or "satellites" near the main pigment formation - a sign of local metastasis of tumor cells.
• The appearance of redness around the pigment formation in the form of a corolla - inflammation, indicating that the immune system to recognize the tumor cells. Therefore, it is sent to the tumor foci special substances (interleukins, interferons, and others), which are designed to fight cancer cells.
• The disappearance of the skin pattern is caused by that destroys tumor normal skin cells, forming a dermal pattern.
• Signs of eye damage: the appearance of dark blotches on the iris of the eye visual impairment and signs of inflammation (redness), there is pain in the affected eye.
• Color change:

1) Amplification or the appearance of darker areas on pigment formation is caused by the fact that the melanocyte, in the process of changing the tumor cell loses its appendages. Therefore, the pigment having no escape from the cells accumulated.

2) Awakening due to the fact that the pigment cell loses its ability to produce melanin.

Each "birthmark" spot passes through the following stages:

• Edge nevus, which is a patchy formation, jacks which cells are placed in the epidermal layer.
• Compound nevus - cell nest migrate into the dermis of the entire area of ​​the spot; clinically represents an element papular formation.
• Intradermal nevus - formation of cells disappear completely from the epidermal layer and stay only in the dermis; gradually loses pigmentation and the formation of regress (involution).

stage

Melanoma defined within a particular stage, which corresponds to a specific point in the patient's condition, a total of five: zero phase, I, II, III and IV stage. Zero stage allows tumor cells to determine solely within the outer cell layer, germination them to deep-tissue at this stage does not occur.

1. Melanoma in the initial stage. Treatment consists of local excision of the tumor within the normal, healthy tissue. Total number of healthy skin, which is to be removed depends on the depth of penetration of the disease. Removal of lymph nodes near a melanoma does not increase the survival of infected people with stage I melanoma;
2. Step 2. biopsies of regional lymph nodes is performed in addition to the excision of education. If during sample analysis confirmed malignant process, then the entire group is removed lymph nodes in the area. In addition, for the purpose of prevention can be assigned alpha interferons.
3. Step 3. In addition to all the tumors were resected lymph nodes, which are located nearby. If you have multiple melanoma - all of them are subject to removal. In the lesion radiation therapy, immunotherapy well appointed and chemotherapy. As we have already noted, are not eliminated and recurrence of the disease, even if the true definition and treatment. Back pathological process may be in an area previously subjected to shock, and formed in a part of the body, which had no relationship to the old downstream process.
4. Step 4. At this stage melanoma patients can not be cured completely. With the help of surgery remove large tumors, causing very unpleasant symptoms. Extremely rare metastases are removed from the bodies, but it depends on their location and symptoms. Often in this case applied chemotherapy, immunotherapy. Predictions at this stage of the disease is extremely disappointing and, on average, up to six months of life of people who become ill with melanoma and have reached this stage. In rare cases, people who have revealed stage 4 melanoma and live a few more years.

The main complication is the spread of melanoma disease process via metastasis.

Among the post-operative complications can be isolated signs of infection, postoperative change section (edema, hemorrhage, allocation), and pain. On-site or remote melanoma on healthy skin may develop a new mole or discoloration occur covers.

metastasis

Malignant melanoma prone to metastasize sufficiently expressed, not only by lymphogenous but also by hematogenous. Primary lesion, as we have noted, are subjected to the brain, liver, lungs, heart. Besides this often occurs dissemination (distribution) of the tumor nodes along the skin of the trunk or limb.

Variant is not excluded in which the patient recourse skilled occurs exclusively on the basis of the actual increase in the lymph nodes of any area. Meanwhile, careful questioning may then determine that a certain time ago, for example, it is as to achieve an appropriate cosmetic effect, wart removed. Such a "wart" in fact turned out to be a melanoma, which later confirmed by histological examination with respect to lymph nodes.

What is melanoma, photos

The photo shows how the disease is manifested in humans and other initial stages.

Melanoma can have the form of flat unpigmented or pigmented spots with a small elevation, rounded, polygonal, oval or irregular shape with a size of 6 mm in diameter. She is a long time can save a smooth glossy surface on which later there are small ulcers, bumps, bleeding with minor trauma.

Pigmentation usually is uneven, but it is more intense in the central part, sometimes with a characteristic black color rim around the base. Coating of all neoplasms may be brown, black with a bluish tinge, purple, variegated as separate unevenly distributed spots.

Diagnostics

Suspected melanoma, the doctor may have on the patient's complaints and inspected visually modified skin. To confirm the diagnosis is carried out:

1. Dermatoscopes - examination of the area of ​​skin under special device. This survey helps to consider the edge of the spot, its germination in the epidermis, the internal switching.
2. Biopsy - taking a tumor sample for histological examination.
3. Ultrasonography and computed tomography are assigned for detection of metastases and to determine the stage of cancer formation.

If necessary, to the exclusion of other diseases of the skin doctor may prescribe a number of diagnostic procedures and blood tests. The accuracy of the diagnosis of malignant melanoma and the effectiveness of their removal depends largely.

How to treat melanoma?

In the initial stage of melanoma necessarily carried out surgical excision of the tumor. It may be economical, the removal of no more than 2 cm from the edge of the skin melanoma or broad skin resection to 5 cm border around the neoplasm. A unified standard in the surgical treatment of melanoma stage I and II in this regard no. Wide excision of melanoma ensures a more complete removal of the tumor focus, but at the same time can be a cause of cancer recurrence at the site of the formed scar or transplanted skin flap. Type of surgical treatment of melanoma depends on the type and location of the tumor and the patient's decision.

Part of the combined treatment of melanoma is ppedopepatsionnaya radiation tepapii. It is indicated for the presence of ulcers in the tumor, bleeding and inflammation in the region of tumors. Local radiation therapy inhibits the biological activity of cancerous cells and creates favorable conditions for the surgical treatment of melanoma.

As an independent method of treatment of melanoma Radiation therapy is rarely used. In the preoperative period, the treatment of melanoma its use has become common practice, since excision can be performed on the very next day after the completion of radiation therapy. The interval for recovery between the two types of treatment for symptoms of melanoma are usually not maintained.

Forecast for life

The prognosis for melanoma detection depends on the time and extent of progression of the tumor. When detected early, most melanomas are treated well.

Deep sprouted melanoma, or spread to the lymph nodes, increasing the risk of re-development after treatment. If the depth of lesions greater than 4 mm, or there is a lesion in a lymph node, there is a high probability of metastasis to other organs and tissues. When the secondary foci (step 3 and 4) melanoma treatment becomes ineffective.

1. The degree of survival of melanoma varies widely depending on the stage of the disease and the treatment. In the initial stage of the cure is most likely. Also, healing can occur in almost all cases of melanoma of the second stage. Patients who have undergone treatment in the first stage, 95 percent have a five-year survival rate of 88 percent and ten. For the second step, these figures are respectively 79% and 64%.
2. 3 and 4 stages of cancer spread to distant organs, which leads to a significant reduction in survival. Five-year survival rate of patients with stage 3 melanoma is (according to various data) from 29% to 69%. Ten-year survival rate is only guaranteed 15 percent of patients. If the disease has passed in step 4, the five-year survival chance is reduced to 7-19%. Decadal statistics survival for patients with stage 4 no.

The risk of recurrence of melanoma is increased in patients with a tumor of great thickness, as well as the presence of ulcerated melanoma and surrounding metastatic lesions. Re-melanoma can occur in the vicinity of the previous place of localization, and at a considerable distance from him.