Melanoma - a malignant and very aggressive tumor of the skin that is caused by the fact that regenerate and melanoblast melanocytes - pigment cells that produce the pigment melanin. The tumor contains in its cells a large number of melanin - and this is caused by the dark color. But sometimes there are options without pigment.
Of all skin tumors only 10% accounted for melanoma. Recently, the art continuously marked increase in the incidence. The number of diagnoses of skin melanoma in the past decade has grown significantly.
It is noted that at the age of sixty years, and women and men fall ill with the same frequency.
In the age range from thirty to fifty years, the peak incidence. For those who already have melanoma, the risk of new - about twelve percent. This disease prognosis is extremely poor - in the structure of mortality of melanoma of the skin is in ninth place (melanoma kills 1% of patients with malignant tumors).
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Causes of melanoma
For the main cause of melanoma - the impact of ultraviolet radiation on open exposed skin.
Ultraviolet radiation is carcinogenic in nature, especially traces squamous and basal cell skin cancer.
For the development of melanoma will mean a lot of intensity. Melanoma occurs most often as a direct result of single ultraviolet irradiation with a high intensity. It can develop in those patients that received in childhood or adolescence sunburn, it is often the appearance of the people who spend most of their time indoors, and leave to rest in the tropical countries.
In the development of melanoma can play a significant role trauma existing pigmented nevi. But it is possible that due to an injury the tumor begins to grow, but only accelerates the development, since there long before. These may be one-off effects on nevi - a bruise, cut, abrasion - or chronic exposure: chafing chain, rigid parts, seams of clothes, etc.
Many scientific research devoted to the study of heredity in the etiology of cancer. For example, found that in families where there is a dysplastic nevus syndrome, there is an increased ill melanoma. Those who have this syndrome, throughout life may develop a set of dysplastic nevi - their number may be more than 50 to a very high risk of transformation into melanoma. This syndrome type of autosomal dominant inheritance. Therefore, the diagnosis should be sent to the oncologist to inspect all took place in close relationship. It is desirable that such patients are treated to an oncologist for a follow-up visit twice a year, to quickly identify the signs of disease.
Increasingly, a lot of attention in the development of diseases such as melanoma of the skin, has been given immune factors. Immunosuppression as immunodeficiency states - these are the factors that contribute to this disease.
It was also established influence on the development of melanoma hormonal status, in particular, this can be seen in relation to women. In giving malignancy available pigmented nevi may have a stimulating effect puberty, climacteric reconstruction of pregnancy.
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Classification melanoma step
In the development of melanoma are four stages:
first step: Melanoma thickness of 2 mm, regional and distant metastases are absent.
the second stage - melanoma thicker than 2 mm, regional and distant metastases no.
third stage - put it where noted regional lymph nodes.
The fourth stage is exposed, if detected distant metastases.
Melanoma often metastasizes to the liver and lungs. Perhaps the skin lesions of bones, brain. When visceral metastases prognosis can be extremely unfavorable, life expectancy could reach an average of six months.
As the prevalence and histological types of melanoma can be divided into three basic forms:
Melanoma propagating surface; most common is this form. With the same frequency can develop on the background of existing nevi, and clean areas of the skin. It is a differently colored plaque rough contour with a long period of growth changes. After about 4-5 years begins a rapid degeneration - the transition to the horizontal to the vertical growth form. So begins the growth in the deeper layers of the skin, and it is an extremely negative impact on the prognosis of the disease. In most cases, localized on the legs of women, men on the back.
10-30% of all melanomas of nodular melanoma. It is considered the most aggressive, can change in a shorter period of time. It occurs most often in the same skin. It looks like a papule or nodule dark. Ill say rapid growth - for several months sizes are doubled. On papule may appear ulcer, it bleeds. The forecast is considered to be extremely unfavorable.
10-13% of cases of melanoma - a tumor, which is called lentigo-melanoma. It arises as a rule, quite elderly - in the seventh decade of life. It appears on exposed skin in the form of spots of dark brown color, diameter 2-4 mm. Characteristic for them is a long-term phase of horizontal growth, rather than due to a favorable prognosis.
In addition, you should know that in addition to the surface of the skin melanoma is able to occur in the choroid under the nail plate, in the mucous membranes (nasal cavity, conjunctiva, the mucous rectum, vagina), on the scalp. Such localization, however, is very rare.
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Diagnosis of the disease
Despite the availability of melanoma for inspection, the correct diagnosis can be difficult. Sometimes it is impossible to distinguish melanoma from nevus pigment, and attention to the conversation with the patient may be important for correct diagnosis.
If there is suspicion of melanoma, it should be required to carry out a morphological study. A definitive diagnosis can be set precisely with it. Cytology performed in the presence of ulceration - from the surface of the tumor take swabs.
If in doubt in the diagnosis of the primary way to set the correct picture becomes excisional biopsy (it involves complete excision with a departure from the edges of 2-5 mm), whereupon be exposed histological conclusion. If the diagnosis is confirmed, it must be carried out immediately wide excision. A biopsy should be performed under general anesthesia, with the piercing needle zone melanoma is possible that tumor cells spread into the surrounding tissue.
To estimate the prevalence of tumor process, if melanoma is already installed, you must perform ultrasound to regional lymph nodes of the chest X-ray, ultrasound of the abdomen.
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Symptoms of melanoma
An experienced doctor is able to well understand the pathological cells and tumors on the skin surface, but the man in the street pigmentary changes for the most part seem ordinary mole. In order not to miss the appearance of melanoma, it is necessary to know some of the symptoms that are characteristic features of this disease.
Among the first symptoms and signs of melanoma include:
changes in tumor size from - slow growth.
tumor may become a convex shape.
color changes appear differently colored areas.
changing contours appear jagged, irregular edges.
itching, changes in the sensitivity of the tumor.
The most common complaints of patients the appearance of pigmented lesions or an increase in the size of existing, itching and burning in the area of the tumor, bleeding occurs.
In melanoma symptoms can be both basic and more. Additional features include the possible absence of the figure of the skin, loss of hair on this spot, peeling of the skin, the appearance of the seals on the surface of the tumor. May increase coming to a tumor lymph nodes.
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To prevent the appearance of melanoma, should limit exposure to the sun. If a person is at risk, you should use sunscreen, whose protection factor of at least 15, wearing light clothing, covered, be sure to wear a hat.
Some of the types of melanoma have a family history, so if their relatives had ever been diagnosed with melanoma, it is necessary to regularly undergo examination by a dermatologist.
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How to treat melanoma
Melanoma of the skin is mainly treated using surgical methods. This provision applies to the primary tumor, and in relation to metastasis to the lymph nodes regional. Other treatments, which include radiation therapy, chemotherapy, immunotherapy can not be considered an alternative for surgery. But these methods may find application in the case of neoplastic process, with the appearance of distant metastases.
Melanoma Treatment - Stage 1-2
Treatment of melanoma by surgery should be performed under general anesthesia in a specialized cancer ward. Early detection of melanoma and its timely excision - the basis for successful treatment, which may result in complete freedom from the dangerous disease. Radical intervention is understood as excision with grasping the surrounding skin, subcutaneous fat beneath it, fascia or aponeurosis. The smallest offset from the edge of the tumor at the same time can be 1 cm.
After excision of melanoma is not always possible to eliminate the defect, simply reducing injuries at the edge. May be made different types of plastic substitution - such as plastic, using a free skin graft, local tissue, it is possible to transplant grafts axial type of blood supply.
Treatment of melanoma: the third stage
After excision of melanoma disease often continues to progress. Most often it manifests itself metastatic regional lymph nodes, patients may find yourself or it becomes clear during an ultrasound. Lymph collectors are mostly located in the armpits, groin. To confirm the diagnosis, for enlarged lymph nodes perform fine-needle biopsy.
If melanoma cells are found, it removes the entire lymphatic system in this area, en bloc with the surrounding fiber. Operation refers to the traumatic, postoperative, it is often accompanied by lymphorrhea, ie the expiry of the lymph. In the cavity of the wound must be installed drainage - a hollow tube made of rubber, which will facilitate the outflow of lymph from the wound cavity.
In the postoperative period may conduct additional treatments - chemotherapy and radiation therapy.
Treatment of melanoma fourth step
Despite the poor prognosis for these patients may be treated with the aim of prolonging life, which use a variety of modern methods.
As the indications for surgery are:
removal of a single metastasis, if no other lesions, and the patient's general condition is good;
elimination of symptoms that significantly reduce quality of life or life-threatening.
tumor mass reduction to increase sensitivity to chemotherapy.
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Treatment of melanoma with the help of chemotherapy used in the presence of distant metastases in patients. To achieve the stabilization process using modern chemotherapy regimens possible only twenty percent of the cases, that is, the efficiency is quite low due to the low sensitivity of melanoma to the drugs.
In the case of neoplastic process may use radiation therapy. It is used mainly in the presence of brain metastases or localized bone diseases. The effectiveness of this method is inferior to surgery, so the indications for this method of treatment are limited.