Melanoma is the most dangerous form of skin cancer, which originates from melanocytes , the cells that produce melanin, the skin’s natural pigment. In most cases, melanoma arises from a pre-existing mole or in general from any point of the epidermis , but it can also, in rare cases, form in the irises of the eyes and even in internal organs, such as the intestine.
The melanoma has never “benign”, but can be more or less aggressive . Furthermore, melanoma, among the skin cancers, is potentially the most dangerous because it usually produces metastases if it is not eliminated. In general, moles are benignless than half a centimeter wide , they have a rounded shape with defined contours . Their color ranges from pink to dark brown. Almost all of the benign nevi present on the skin are completely harmless, although a very small part of them can degenerate into a melanoma.
There are 4 main types of melanoma , each of which has a different degree of severity:
- Superficial spreading melanoma . It is the most common (70% of all melanomas) and least invasive form. It appears as a flat or slightly raised lesion that tends to spread superficially for a long time without infiltrating deeply or generating metastases;
- Lentigo maligna . It is the melanoma of “old age”, which arises from a senile spot and which progresses slowly and is not aggressive. It originates in areas exposed to the sun for a long time such as the face, the auricles, the arms. It is recognized as a flat and large, olive-colored lesion;
- Nodular melanoma . It is the most aggressive and dangerous type of melanoma (15% of all melanomas), because it is invasive and faster spreading than other cancers. It commonly arises on the back, chest, face (including scalp), and neck as a dark blue, sometimes pink or red, dome-shaped lump. The characteristic element of this tumor in the form of amelanotic melanoma (or achromic melanoma ) is color. Since it is – in fact – devoid of or almost melanin, it is pink or even the same color as healthy skin.
- Acral melanoma . Similar to a bruise, it is usually olive, brown, or black in color, with irregular edges. It forms in particular areas, for example under the nails or in the palms of the hands and feet, and has a hematoma- like appearance ; and it is the only form of melanoma not related to sun exposure. A particular form is subungual nail melanoma, which is easily recognized because it appears a black band straight and vertical to the nail, more frequently on the thumb. It is important to diagnose this type of cancer early, before ulcers appear in the vicinity, and before the tumor spreads to the lymph nodes. This form of cancer usually occurs after the age of 50. Then there is the acral melanomafreckle that appears predominantly from freckles on the hands and feet (including nails).
Although not all forms of melanoma are equally aggressive, it is in any case, as mentioned, a malignant tumor . It is important to recognize it promptly because the best prognosis is in the initial forms, when it is possible to eliminate it completely with a small surgery. Over the past 15 years, cases of melanoma , the skin cancer that hides under the guise of a mole, have more than doubled. More than 100,000 the Italians affected by the disease, with over 10,000 new diagnoses a year.
Consult the centers that have claimed to be specialized in Melanoma:
Specialized centers in Melanoma
Causes and risk factors of melanoma
There is still no absolute certainty about the causes that can favor the appearance of a melanoma, but certainly among the risk factors one of the main ones is represented by excessive exposure to UV rays from the sun or tanning lamps, and this is the reason for which the prevention of this form of cancer particularly widespread at a young age involves the necessary protection of the skin and a limitation to the hours in which one is exposed to sunlight, especially when ultraviolet radiation is more intense (spring-summer).
In fact, they produce alterations at the cellular DNA level which in the long run can lead to the abnormal proliferation of cancerous cells.
There are other risk factors to consider, namely:
- Having a very fair complexion (phototypes 1-2);
- Having a history of repeated sunburn and sunburn , especially in childhood
- Have a history of prolonged use of tanning lamps especially before the age of 30;
- Having many moles (between 50 and 100);
- Be familiar with melanoma
- Having a weakened immune system(this applies to almost all types of cancer)
- Be over 40 years old.
What is the difference between mole and melanoma
How to tell if the dark spot we just noticed is a new mole or something to worry about?
To understand if a mole of our skin is at risk of developing a melanoma or if the mutation is already in progress, it is necessary to start from the description of a healthy mole , a non-pathological mole.
Non-dangerous moles:
- Uniform color (usually hazel, brown or black);
- Edges distinctly separated from the rest of the skin;
- Round or oval shape;
- Dimensions not exceeding 6 mm in diameter (to be clear the size of the rubber of a pencil);
- Variable number between 10 and 50 . To consider that, after the age of 50, new moles can form and others disappear or shrink, and this is also part of normalcy.
The moles that are “changing state” are recognized by 5 characteristics, which we can remember using the acronym ABCDE.
- Asymmetry . Beware of moles with asymmetrical shapes even in only a part of them;
- Irregular edges . Melanomas usually have jagged or jagged edges, not as smooth as normal moles;
- Color . The melanoma takes on particular shades, not typical of normal moles, ie bluish, pinkish shades, or the color appears unevenly distributed, with lighter and darker areas;
- Diameter . Greater than 6 mm of normal moles;
- Evolution . Observing a mole that undergoes sudden changes should prompt you to book an immediate dermatological check-up. When a mole itches, swells in no time, bleeds or changes color, there’s no time to waste.
It is important to understand that melanoma does not always originate from a mole , although it does happen in most cases. All skin can potentially become the site of skin cancer . It is also important to go to a dermatological examination if you find:
- A sudden development of a new mole or pigmented area on the skin
- A new and abnormal growth on the skin;
- An ulceration that does not heal.
Prevention of melanoma: sun protection
The first prevention tool against melanoma is protection from ultraviolet rays (UVB and UVA). The sun’s rays are divided into UVA and UVB rays: the latter are responsible for common sunburns or burns, while UVA rays, while not producing redness or burns, also act deeply on the immune system, and are responsible for the aging process of the skin due to the sun.
If you have never undergone a dermatological examination , it may also be useful to do it preventively, or following the appearance of manifestations with or without symptoms such as itching, burning or pain.
The simple golden rules to protect our skin from the damage of UV rays, and therefore also from the risk ofmelanoma :
- Know your phototype and use adequate sun protection. For the first sun, experts recommend maximum protection (ie 50+), for all skin types up to 4. The dosage is fundamental: the laboratory tests that are carried out to determine the effective protection of the product are carried out with a layer of cream of 2 milligrams per square centimeter of skin. It is therefore good to apply the protection every 2-3 hours, about 15 minutes before exposing ourselves to the sun, and after each bath;
- Minimize exposure to sunlight in the central hours of the day in spring-summer;
- Avoid using tanning lamps and sun beds;
- Wear clothing that protects the skin;
- Never expose babies under 6 months to direct sunlight ;
- Check your moles and go to the dermatologist at least once a year.
Consult the structures that carry out a dermatological examination:
Where to carry out a dermatological examination?
Prevention: mapping of moles
Preventing melanoma is also possible thanks to the mapping of your moles, a control program that is particularly recommended for those who have a high risk – due to the factors we have seen – of developing this form of skin cancer. How and where does the mapping of moles take place? To request it, you must go to a dermatological study, where you will undergo a first visit that includes:
- History and risk assessment. This first phase of the visit serves the specialist to get an idea of the patient in front of him. With appropriate questions, he will obtain important information such as medical history (including that of the family circle), any symptoms complained of, lifestyle habits and frequency and intensity of sun exposure over time;
- Physical examination of the skin. In the first meeting, the dermatologist, in addition to inspecting the skin to observe its characteristics, realizes on cardboard a real map of the moles and spots and / or lesions that are most at risk of turning into tumors, indicating their precise position and supporting them with photographic documentation. In this way it is easy, on subsequent visits, to immediately identify suspicious changes;
- Dermoscopy or dermatoscopy (or epiluminescence) of moles. It is a non-invasive technique which, using an optical instrument (dermatoscope), allows you to enlarge any portion of the skin to the maximum in order to observe it in all its smallest characteristics. Dermoscopy is essential for the early diagnosis of melanomas.
The cure of melanoma
The success of the treatment depends on the stage of the tumor. There are four stages (I to IV, while stage 0 indicates melanoma in situ, which affects only the top layer of the skin). The diagnosis system is the TNM, which is based on the characteristics of the tumor (T), on the possible involvement of the lymph nodes (N) and on the presence of any metastases (M).
There are many treatment options for skin melanoma. The first choice is usually surgery which is usually sufficient to permanently cure the disease at an early stage.
In some cases, “sentinel” lymph nodes are also surgically removed, i.e. the first to receive lymph directly from the tumor. If these contain cancer cells, all those in the affected area are removed. Surgery can also be helpful in removing any metastases.
Radiation therapy is used in the presence of bone or brain metastases, in the case of multiple inoperable brain lesions or for which stereotaxic radiosurgery treatment is not indicated, pan-brain radiation treatment and palliative treatment is envisaged.
Chemotherapy for melanoma is indicated only after treatment with BRAF drugs and MEK inhibitors (in patients with tumor with BRAFV600 mutation) and with immunotherapy, or if these therapies are contraindicated.
The real revolution in the treatment of advanced stage melanoma is represented by immunotherapy . In recent years, the development of immunotherapy has allowed significant progress in the treatment of advanced stage melanoma, both to combat tumor metastases and as an adjuvant therapy to help prevent relapses.
Research presented in 2019 at the ESMO (European Society for Medical Oncology) conference showed that the latest drug combination developed (ipilimumab plus nivolumab) enabled 52% of people with metastatic melanoma to survive 5 years after diagnosis . Without these drugs, the average life expectancy for a patient with metastatic melanoma was 9 months.
The risk of relapse in patients with grade III melanoma , even if completely removed, is high (about 80% probability of a new melanoma within a few years). With the immunotherapy nivolumab as adjuvant therapy, the three-year relapse-free survival is 58%.
Questions and answers
HOW LONG DO YOU LIVE WITH MELANOMA?
When melanoma is identified and treated at an early stage, and surgically removed, the 5-10 year survival rate is 99-100%. In recent years, the development of immunotherapy has allowed significant progress in the treatment of advanced stage melanoma, both to combat tumor metastases and as an adjuvant therapy to help prevent relapses.
Research presented in 2019 at the ESMO (European Society for Medical Oncology) conference showed that the latest drug combination developed (ipilimumab plus nivolumab) enabled 52% of people with metastatic melanoma to survive 5 years after diagnosis. Without these drugs, the average life expectancy for a patient with metastatic melanoma was 9 months.
WHEN IS MELANOMA DANGEROUS?
Melanoma is always potentially dangerous if it is not identified and removed, because it can affect other organs. This is why it is important to undergo an annual dermatological examination and pay attention if you notice a new mole with particular characteristics or an old mole that changes shape.
WHERE DOES MELANOMA METASTASIZE?
The most frequent localizations of metastases are the lymph nodes, lungs, liver, bones, brain.
WHEN IS A MOLE A MELANOMA?
The moles that are “changing state” are recognized by 5 characteristics, which we can remember using the acronym ABCDE.
- Beware of moles with asymmetrical shapes even in only a part of them;
- Irregular edges. Melanomas usually have jagged or jagged edges, not as smooth as normal moles;
- The melanoma takes on particular shades, not typical of normal moles, ie bluish, pinkish shades, or the color appears unevenly distributed, with lighter and darker areas;
- Greater than 6 mm of normal moles;
- Observing a mole that undergoes sudden changes should prompt you to book an immediate dermatological check-up. When a mole itches, gets bigger in no time, bleeds or changes color, there’s no time to waste.
It is important to understand that melanoma does not always originate from a mole, although this happens in most cases. All skin can potentially become the site of skin cancer. It is also important to go to a dermatological examination if you find:
- A sudden development of a new mole or pigmented area on the skin.
- A new and abnormal growth on the skin.
- An ulceration that doesn’t heal.
HOW IS MALIGNANT MELANOMA TREATED?
The first choice is usually surgery which is usually sufficient to permanently cure the disease at an early stage. In some cases, the “sentinel” lymph nodes are also surgically removed, ie the first to receive lymph directly from the tumor. If these contain cancer cells, all those in the affected area are removed. Surgery can also be helpful in removing any metastases.
Radiation therapy is used in the presence of bone or brain metastases, in the case of multiple inoperable brain lesions or for which stereotaxic radiosurgery treatment is not indicated, pan-brain radiation treatment and palliative treatment is envisaged. The real revolution in the treatment of advanced melanoma is represented by immunotherapy. In recent years, the development of immunotherapy has allowed significant progress in the treatment of advanced stage melanoma, both to combat tumor metastases and as an adjuvant therapy to help prevent relapses.
