MyKerkyra

Melanoma is a malignant tumor of melanocytes (also known as skin melanoma, malignant melanoma).

Melanoma is a very serious disease because it can lead to metastasis to other organs of the body mainly through the lymphatic system. This system consists of thin arteries which create a network just like coronary arteries in all tissues of the body. Tumor cells are detached from the primary tumor and reach lymph nodes through the lymph (the fluid in the lymphatic arteries). Lymph nodes are mainly located in the underarm, neck, groin and belly areas. Surgeons usually remove lymph nodes to see if they include tumor cells.

Melanoma can also lead to metastasis through the blood (hematogenous dissemination).

Causes and Prevention

Melanoma rates keep increasing and melanoma affects all ages. Researchers have been trying to determine who is more likely to be affected and the exact causes. Research has focused on work conditions, heredity and skin sensitivity when exposed to solar radiation.

We know that ultraviolet (UV) solar radiation is a risk factor that increases the possibility of melanoma. People with red or blond hair, blue eyes and generally people with fair skin are more likely to be affected. Dark-skinned people are affected less often, possibly because their skin produces more melanin which acts protectively. The risk of melanoma is higher for people with dysplastic nevus or a family history of melanoma, or for people who have sizeable moles. Location also plays a significant role. Risk is higher in places with increased solar radiation. As a result, the highest melanoma percentage globally is found in Australia.

Signs

Usually, the first sign of melanoma is the change in size, shape or colour of a mole. In normal circumstances, a mole is a brown, dark or black spot on the skin. It can be flat or elevated and its shape can be round or oval. Moles are usually small, less than half centimeter in diameter. You can have a mole since birth or a mole may appear later on, usually during the first ten years. Many moles appear later in life, however. Most people carry 10 to 30 moles on their skin. The vast majority of moles is completely harmless. However, a change in a mole is a sign that you should see your dermatologist. Of course, melanoma can appear as a new mole.

Early diagnosis

Melanoma in men usually occurs on the body, head and neck. In women, it usually occurs on the arms and legs. Fair-skinned people are particularly susceptible. Dark-skinned people most often get melanoma on their palms and soles.

Early diagnosis and swift treatment is essential in all types of medical cases and this also applies to melanoma cases. An early diagnosis makes an effective treatment more probable. You should check your skin regularly and you should see your doctor for any change on a mole or the appearance of a new one.

Especially people with a history of melanoma should be checked regularly (every 3 to 6 months) to prevent any recurrence.

In some families, members have a certain category of moles known as dysplastic nevus. These kinds of moles can turn into melanoma more often. They occur in large numbers (more than fifty) and some have diameter longer than half centimeter.

Diagnosis

Since melanoma can lead to metastasis, early diagnosis from a dermatologist is very important. A biopsy will lead to the final diagnosis. The tumor is removed and examined using a microscope by a pathologist. The next step is to determine the extent and level of the tumor and this is done through the measurement of its thickness, how deep in the body and whether there is metastasis in the lymph nodes or other organs of the body. When the stage is determined, the treatment is planned taking into account the age and health of the patient.

Ways of treatment

Most cases are treated surgically. The melanoma and a part of the healthy skin around it are removed. Sometimes an implant (part of skin from another area of the body to cover the are of surgery) is used. Although doctors try to do a good job, surgical removal sometimes can lead to scars.

Patients with melanoma which is deep or spread have a high risk or recurrence despite its removal. In this case, patients can undergo the additional treatment of chemotherapy (antitumor medicine).

As the existing medicines are not very effective in advanced stages, research continues and new treatments are studied. A new treatment is called biotherapy and it uses natural substances produced by the body. The aim of this treatment is to enforce or recover the immune system so it can fight the disease more effectively. Two such substances – medicines are interleukin-2 and interferon.

Sometimes there is the need of high power x-rays radiation which destroys the ability of tumor cells to increase and multiply. Radiotherapy is mainly used to relieve pain.

Treatment side-effects

Anorexia can be a major problem for some patients. This is why people who undergo treatments should eat well. This means that they should calculate how many calories they should consume to make up for weight-loss and consume protein to maintain good skin condition, hair, muscles and organs.

There are more side effects which are fortunately temporary. Consult a doctor for further details.

After the treatment

As patients with melanoma face an increased risk of a new melanoma, they should be examined by their doctor regularly. The examination can include x-rays depending on the size and extend of the first tumor.

When people have cancer, life can change dramatically for them and the people around them. These changes can be very difficult.

Sometimes patients and family members feel fear, anger or depression. Their feelings vary between hope and disappointment or courage and despair. Patients feel better if they can speak freely with their relatives and friends about their disease and feelings.

Worries about the future (as well as medical examinations, treatments, hospital stays, expenses) are common. Discussions with doctors, nurses and other members of the medical treatment group can help them to get over some of their worries. Patients can ask about their disease and treatment and take an active part in their cure. They should ask their doctor to repeat or explain everything they don’t understand. They may have important questions concerning their disease so the doctor is the most appropriate person to answer them. Many people ask what kind of cancer they have, how it can be cured and what success percentages these treatments have.

Living with a serous disease is hard and a real challenge. Quite often, the social services of the hospital can significantly help in terms of support and information.

By Alexandros Poulis, MD/Physician (Internal Medicine Specialist)