What is melanoma?

Melanoma is an aggressive form of skin cancer that develops from melanocytes, the cells responsible for producing the skin pigment, melanin. Melanocytes are located in the epidermis and their main function is to protect the skin from the harmful effects of ultraviolet (UV) radiation by producing melanin. Although melanoma accounts for only about 1% of all skin cancers, it is responsible for the majority of skin cancer-related deaths. The incidence of melanoma has increased in recent decades, largely due to increased exposure to sunlight and the use of ultraviolet (UV) rays in tanning beds.

Melanoma can develop anywhere on the body, but it most often appears in areas of the body that are regularly exposed to sunlight, such as the face, arms, and back. Melanoma can also develop in unexpected places, such as under the nails, in the eyes, and even on internal organs. Ocular melanoma, for example, is a rare but dangerous form that can affect vision and spread to other organs.

Early detection of melanoma is critical, as melanoma diagnosed at an early stage is often curable with surgery. However, if detected at a late stage, melanoma can metastasize and spread to other parts of the body, greatly reducing the chances of survival. Knowledge of melanoma symptoms and risk factors is therefore essential to promote early diagnosis and successful treatment.

Melanoma causes and risk factors

Genetic factors

Heredity and genetic predisposition play an important role in the development of melanoma. Research shows that people with a family history of melanoma have an increased risk of developing the disease. Specific mutations, such as those in the CDKN2A and BRAF genes, are associated with an increased risk of developing melanoma. These mutations can affect the control of cell division and growth, contributing to tumorigenesis. CDKN2A mutations can affect proteins that regulate the cell cycle, while BRAF mutations often result in persistent cell proliferation.

Genetic tests can help identify individuals at high risk of developing melanoma, allowing for early diagnosis and preventive measures. However, not all family members with a history of melanoma will necessarily develop the disease because the interaction between genes and environmental factors is complex and multifactorial. Family and genetic counseling can help better understand individual risks and appropriate prevention steps. It is also important to note that there are other genetic syndromes, such as Li-Fraumeni syndrome, that can increase the risk of melanoma.

Environmental factors

Environmental factors, especially ultraviolet (UV) radiation, are major risk factors for melanoma. Prolonged and intense exposure to sunlight, especially during childhood and adolescence, increases the risk of developing melanoma. UV radiation damages the DNA of skin cells, causing mutations that can contribute to cancer. The effects of UV radiation are cumulative, meaning that damage from sun exposure accumulates over a lifetime, increasing the risk of cancer.

In addition to the sun, artificial UV sources such as tanning beds also significantly increase the risk of melanoma. Using tanning beds before the age of 30 can significantly increase the chance of developing melanoma later in life. Studies show that tanning bed use can increase the risk of melanoma by up to 75%, especially when used at an early age. Therefore, it is essential to avoid excessive sun exposure and the use of tanning beds, as well as to use protective measures such as sunscreens and protective clothing. It is also worth mentioning that the risk of melanoma may be increased in high-altitude areas, where solar radiation is more intense.

Symptoms of melanoma

Symptoms of melanoma can vary, and early recognition is essential for successful treatment. One of the most well-known methods for early detection of melanoma is the ABCDE rule, which helps to identify suspicious skin lesions:

• A (Asymmetry): one side of the birthmark is different from the other. Asymmetry may indicate uncontrolled cell growth.
• B (Robain edges): the mole has uneven, jagged, or unclear edges, which may indicate the invasive nature of the tumor.
• C (Colour): a birthmark contains several colors or shades, such as black, brown, red, white, or blue. Heterogeneous color may indicate different populations of melanoma cells.
• D (Diameter): the diameter of the birthmark exceeds 6 mm, which is about the size of a pencil eraser. Larger moles are often more suspicious.
• E (Development): the mole changes in size, shape or color. Any change over time can be a signal of a malignant process.

In addition to these criteria, any appearance of a new birthmark or change in an existing birthmark should be taken seriously. Melanoma can also present as soreness, itching or bleeding in the mole area. Itching and bleeding may indicate tumor invasion of the dermis. Consultation with a doctor as soon as possible is important in order to perform the necessary diagnostic tests and start treatment.

Diagnostic methods

Clinical examination

Clinical examination is the first step in the diagnosis of melanoma. The doctor performs a physical examination of the skin, paying attention to suspicious birthmarks and skin lesions. Dermatologists can use dermatoscopy, a non-invasive method to look at the surface of the skin in detail and determine if further investigation is needed. Dermatoscopy allows you to see the structures and colors of the skin, which can help determine more accurately whether a lesion is malignant.

During the clinical examination, the doctor may ask questions about the patient's and his family's medical history, as well as about previous sun exposure and other risk factors. This information will help determine if additional diagnostic tests are needed. In addition, your doctor may recommend regular skin exams to monitor for suspicious lesions.

Biopsies and laboratory tests

If the clinical examination indicates a suspicious skin lesion, a biopsy is performed to determine whether it is malignant. During the biopsy, a small skin sample is taken from the suspicious area and sent to the laboratory for histopathological analysis. Histopathology is the gold standard in the diagnosis of melanoma, as it allows the identification of cancer cells and the determination of tumor thickness and degree of invasion.

A biopsy is essential to confirm the diagnosis of melanoma and determine its stage. Staging is determined using the TNM system (tumor size, lymph node involvement and metastases). Additional laboratory tests, such as molecular tests, can help identify specific gene mutations that can affect the treatment plan and prognosis. Molecular tests can identify BRAF, NRAS and c-KIT mutations, which are important for the selection of targeted therapy.

Treatment options for melanoma

Surgical intervention

Surgery is the main treatment for melanoma, especially in the early stages. Surgical removal involves resection of the tumor and surrounding healthy skin to ensure that all cancer cells are removed. This procedure is often enough to cure localized melanoma. The depth of resection depends on the thickness of the tumor, which is determined by the Breslow scale.

In some cases, especially if the melanoma has spread to the lymph nodes, more extensive surgery, including removal of the lymph nodes, may be necessary. A lymphadenectomy can help prevent cancer from spreading to other organs. The effectiveness of surgical treatment depends on the stage of the melanoma and its spread at the time it is detected.

Prevention and early detection

Prevention and early detection are essential steps in reducing the risk and successful treatment of melanoma. To reduce the risk of melanoma, it is recommended to:

• Avoid excessive sun exposure, especially between 10:00 AM and 4:00 PM, when UV radiation is most intense. UV radiation is most dangerous during these hours because the sun's rays are more direct.
• Use a broad-spectrum sunscreen with SPF 30 or higher, even on cloudy days. SPF indicates the cream's ability to protect against UVB rays, which are responsible for sunburn.
• Wear protective clothing, hats and sunglasses to protect your skin from UV rays. Clothing with a UV protection factor (UPF) can provide additional protection.
• Perform regular skin self-exams to detect new or changing birthmarks. Self-exams can help identify suspicious lesions early.
• Visit a dermatologist at least once a year or more often if there is an increased risk. Regular dermatological examinations can help detect melanoma early.
• Eat a balanced diet, exercise regularly and avoid smoking to improve overall health. A healthy lifestyle can strengthen the immune system and reduce the risk of cancer.

Early detection is important because it increases the chances of successful treatment. Regular dermatological examinations and education about the symptoms of melanoma can help detect the disease at an early stage and initiate timely treatment. Early intervention often means less surgery and a better prognosis.

Life with melanoma

Psychological aspects

Living with melanoma can be emotionally and psychologically challenging, and patients often need support to cope with diagnosis and treatment. Psychological support groups and therapy can help patients cope with the anxiety, depression, and stress associated with cancer. Psychological support is important to help patients cope with the emotional and practical challenges of cancer treatment.

Emotional support from family and friends is also essential to help patients adjust to the new reality and maintain a positive attitude during treatment. Sometimes talking to other patients who have experienced similar situations also helps. Peer support can provide practical advice and emotional support.

Patient experience

Liga, a 45-year-old woman, shares her experience with melanoma: "When I was diagnosed with melanoma, I was very scared at first. I didn't know what to expect. However, thanks to my doctor and support group, I was able to overcome my fear. The surgery was successful and I now check my skin regularly. I have learned to value each day and take care of my health."

Such stories show how important support and knowledge are during illness, and also emphasize the importance of prevention and regular check-ups. Patient experience shows the importance of early diagnosis and timely treatment.

Recent research and development perspectives

Recent research in the field of melanoma focuses on developing new treatments and improving the effectiveness of existing therapies. Genomic studies have revealed several new mutations that may be potential targets for future therapies. For example, the development of new targeted therapy drugs that might be effective against less common mutations is a critical step in the treatment of melanoma.

In the field of immunotherapy, research is being done to develop vaccines that could help the immune system fight melanoma more effectively. In addition, research is underway to identify biomarkers that could help predict response to therapy and monitor treatment progress. Biomarkers could help personalize treatment, making it more effective and less toxic.

The use of artificial intelligence in diagnostics is also becoming more and more popular, allowing more accurate and faster detection of melanoma signs. Artificial intelligence algorithms can analyze images and identify suspicious moles with high accuracy, which could facilitate early diagnosis and improve treatment outcomes. These developments provide hope for improving melanoma treatment outcomes and quality of life for patients in the future.