As the Dermatologist - Venereologist Dr. Amalia Tsiatoura explains "melanoma comes from the melanin cells of the skin and it is possible to appear either in a pre-existing mole, or "de novo", i.e. in an area that was previously healthy. Although it has a lower incidence rate than other forms of skin cancer, it is extremely dangerous because it most often metastasises to other organs or tissues.
Most often, it occurs in areas that have been chronically exposed to the sun, as it has been observed that in almost half of the cases melanoma is found in the upper or lower limbs. Several times it is also found on the head, mainly on the face or ears. However, melanoma can also occur in non-exposed areas such as the palms, soles and perineum.
Melanoma looks like a nevus or papule with a different morphology than usual. Its colour can vary from black, blue, dark brown or grey and in more advanced lesions it may start to swell and become thicker. Symptoms that may accompany it are itching, bleeding and epithelialisation (crusting).
Melanoma of the skin can occur at any age, with a higher incidence in people aged 40-60 years. However, in recent years there has been an increase in cases in younger people. As the factors that favour its development are skin type and exposure to sunlight, people with fair skin, freckles, nevus, a family history of melanoma and people who are frequently exposed to the sun or have received radiation therapy are at increased risk of developing it.
The incidence of melanoma is particularly high in countries with increased solar radiation, such as Greece. Often, melanoma occurs in people with immunodeficiency or people who have undergone chemotherapy.
Λόγω της επιθετικότητας και γρήγορης ανάπτυξης του νεοπλάσματος αυτού, είναι πολύ σημαντικό να εντοπίζεται το συντομότερο δυνατό. Για αυτό το λόγο, οι σπίλοι (ελιές) θα πρέπει να εξετάζονται από εξειδικευμένο Δερματολόγο τουλάχιστον μία φορά το χρόνο και εκείνος θα κρίνει αν απαιτείται Δερματοσκόπηση ή Χαρτογράφηση Σπίλων, προκειμένου να υπάρχει λεπτομερής παρακολούθηση.
Η διάγνωση του μελανώματος μπορεί να γίνει με την αφαίρεση τμήματος ή ολόκληρης της δερματικής αλλοίωσης και εξέτασης των κυττάρων της στο μικροσκόπιο (βιοψία). Συχνά για την ιστολογική διαφοροδιάγνωση της βλάβης απαιτείται ανοσοϊστοχημεία με ειδικές χρώσεις που εφαρμόζει ο παθολογοανατόμος για να διακρίνει τα νεοπλασματικά κύτταρα. Η ιστολογική εξέταση αποτελεί τη βάση για τη διάγνωση και τη θεραπεία του μελανώματος.
Intraepidermal Epidermotropic Metastatic Melanoma: It usually appears as a melanotic spot on the skin of the body. It occurs mainly in young people and the face is the most common site. It is considered an early form of in situ melanoma.
Lentigo Maligna Melanoma: Its occurrence is more common in older people and in places that have been exposed to sunlight for years. It appears as a flat melanchromatic lesion, which increases in size over time. Initially it extends horizontally, and at a later stage it begins to extend vertically. At this stage it forms the malignant invasive melanoma. It can take on colourations from white or grey, to dark brown or black.
Superficial Spreading Melanoma: The initial appearance of this melanoma is a flat spot that slowly turns into a papule. It is characterised by the formation of nodules as it expands into the deeper layers of the skin and the appearance of a brown, black, grey or white colour. It has an irregular periphery and extends horizontally.
Nodular Melanoma: It starts as a papule and turns into a nodule and subsequently, it progresses and bleeds. It appears on the skin in the form of a shiny, usually black lump and mainly affects men. It should be diagnosed quickly because in the nodule stage, it already starts to metastasize.
Malignant melanoma of the extremities: It is seen on the feet (mainly the soles), on the palms or under the nails (subcutaneous melanoma). The clinical picture is characterised by the appearance of a black irregular line under the nail and redness and swelling near the skin (Hutchinson's sign). On the palms and soles it looks like a nevus. During the progression of this melanoma, the person may experience pain, or notice ulceration and bleeding.
Desmoplastic Melanoma: It is the rarest form of melanoma and occurs mostly in older people. It occurs due to the formation and accumulation of nodules or plaque. It mainly affects the face and neck. Unfortunately, it is the most difficult form of melanoma to treat, as most of the time, once it appears, it cannot be cured.
Amelanotic Malignant Melanoma: It may resemble a scar, pyogenic granuloma or hemangioma and is usually colorless, although in some cases it shows a characteristic pinkish tint.
By staging we mean the process that is followed to determine the extent of the disease and is a crucial stage in the treatment of the disease. According to Clark's classification, melanomas are divided into five levels of infiltration, depending on the depth of the skin to which the melanoma has spread. These stages are as follows:
Melanomas that are in stage 1 are almost always curable by surgical removal. At stage 2, the chance of recurrence is 60%, while melanomas detected at stage 3 or 4 have been shown to recur in 85% of cases. The treatment of melanoma is mainly surgical. Treatment should be immediate as it expands relatively quickly and metastasizes in a short time. Surgical removal of melanoma should include removal of at least 2 cm of healthy tissue peripherally.
If melanoma is suspected, the lesion should be surgically removed as soon as possible and then examined under a microscope (biopsy).
These lesions should not be treated with laser or other destructive methods (e.g. transthermal coagulation or cryotherapy) because this way the tissue is destroyed and valuable information for the diagnosis of the neoplasm, its depth and staging is lost.In addition to surgical removal of the melanoma, sometimes the following are also indicated:
If the result of the biopsy is positive, there is an additional wider surgical resection of the neoplasm, lymph node examination and staging of the tumor. In some cases, radiotherapy and chemotherapy may be required.
Superficial Spreading Melanoma and Nodular Melanoma are the most aggressive types of melanoma. Early diagnosis of small superficial lesions may also lead to complete cure, while advanced tumors with metastases may limit the average survival time to 6-9 months.
The treatment of melanoma depends on the stage it is in. In the early stages of melanoma, surgical removal has a fairly high rate of complete cure, up to 98%. However, once the melanoma has reached a depth or has spread sufficiently, there is a risk that it will recur. For this reason, after surgery, the patient is given chemotherapy drugs.
In any case, people who have developed melanoma have an increased risk of developing another melanoma. For this reason, regular monitoring by a dermatologist is recommended.
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