35. MELANOMA Melanoma is a type of skin cancer which forms from melanocytes (pigment-containing cells in the skin). In women, the most common site is the legs, and melanomas in men are most common on the back. It is particularly common among Caucasians, especially northern Europeans and northwestern Europeans, living in sunny climates. There are higher rates in Oceania, North America, Europe, Southern Africa, and Latin America. This geographic pattern reflects the primary cause, ultraviolet light (UV) exposure in conjunction with the amount of skin pigmentation in the population. The treatment includes surgical removal of the tumor. If melanoma is found early, while it is still small and thin, and if it is completely removed, then the chance of cure is high. The likelihood that the melanoma will come back or spread depends on how deeply it has gone into the layers of the skin. Melanoma is less common than other skin cancers. However, it is much more dangerous if it is not found in the early stages. It causes the majority (75%) of deaths related to skin cancer Early signs of melanoma are changes to the shape or color of existing moles or, in the case of nodular melanoma, the appearance of a new lump anywhere on the skin (such lesions should be referred without delay to a dermatologist). At later stages, the mole may itch, ulcerate or bleed.[11] Early signs of melanoma are summarized by the mnemonic ABCDE: Asymmetry Borders (irregular) Color (variegated) Diameter (greater than 6 mm (0.24 in), about the size of a pencil eraser) Evolving over time Brain metastases are particularly common in patients with metastatic melanoma, It can also spread to the liver, bones, abdomen or distant lymph nodes. Melanomas are usually caused by DNA damage resulting from exposure to ultraviolet (UV) light from the sun. Diagnosis Asymmetrical skin lesion. Border of the lesion is irregular. Color: melanomas usually have multiple colors. Diameter: moles greater than 6 mm are more likely to be melanomas than smaller moles. Enlarging: Enlarging or evolving Following a visual examination and a dermatoscopic exam, or in vivo diagnostic tools such as a confocal microscope, the doctor may biopsy the suspicious mole. A skin biopsy performed under local anesthesia is often required to assist in making or confirming the diagnosis and in defining the severity of the melanoma. If the mole is malignant, the mole and an area around it need excision Total body photography, which involves photographic documentation of as much body surface as possible, is often used during follow-up of high-risk patients. The technique has been reported to enable early detection and provides a cost-effective approach (being possible with the use of any digital camera), but its efficacy has been questioned due to its inability to detect macroscopic changes.[30] The diagnosis method should be used in conjunction with (and not as a replacement for) dermoscopic imaging, with a combination of both methods appearing to give extremely high rates of detection. Treatment Confirmation of the clinical diagnosis is done with a skin biopsy. This is usually followed up with a wider excision of the scar or tumor. Depending on the stage, a sentinel lymph node biopsy is done, as well, although controversy exists around trial evidence for this procedure.Treatment of advanced malignant melanoma is performed from a multidisciplinary approach. Excisional biopsies may remove the tumor, but further surgery is often necessary to reduce the risk of recurrence. Complete surgical excision with adequate surgical margins and assessment for the presence of detectable metastatic disease along with short- and long-term followup is standard. Prognosis Features that affect prognosis are tumor thickness in millimeters (Breslows depth), depth related to skin structures (Clark level), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, presence of tumor-infiltrating lymphocytes (if present, prognosis is better), location of lesion, presence of satellite lesions, and presence of regional or distant metastasis (as opposed to a staged excision or punch/shave excision) since these recurrences tend to indicate lymphatic invasion. When melanomas have spread to the lymph nodes, one of the most important factors is the number of nodes with malignancy. When there is distant metastasis, the cancer is generally considered incurable. The five-year survival rate is less than 10%.The median survival is 6–12 months. Treatment is palliative, focusing on life extension and quality of life. In some cases, patients may live many months or even years with metastatic melanoma (depending on the aggressiveness of the treatment). Metastases to skin and lungs have a better prognosis. Metastases to brain, bone and liver are associated with a worse prognosis. So is important to consult a doctor when a mole change of size and become asymmetric , the color is not uniform, the borders become irregular. It could be a melanoma. If not early recognized is a potentially fatal cancer. Dimitri SCUFFI, M.D. Swiss Board of Surgery Royal Phnom Penh Hospital 888, Russian Confederation Blvd Phnom Penh 023 991 000 @drscuffi.ch facebook/DimitriScuffiMD
Posted on: Thu, 27 Nov 2014 09:05:09 +0000
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