As with other types of skin tumours, sun exposure is a major risk factor in the development of melanoma. Melanoma kills. Of all skin tumours, it is the most aggressive due to its great capacity to develop metastases. Moreover, these metastases develop early and are often the cause of death of patients. Currently, around 160,000 cases are diagnosed each year worldwide. We at The Ante-operative Theatre will never tire of repeating this. PREVENTION. SKIN CARE. SUN PROTECTION. The sun has a cumulative effect on our body. At the moment, the best weapon we have to prevent this terrible pathology is prevention.
What is melanoma?
Melanoma is a tumour derived from melanocytes, skin cells that produce and contain melanin, the natural pigment responsible for skin and hair colour. The function of melanin is to absorb ultraviolet radiation. Melanomas grow in two phases: first in a transverse ↔️ direction (radial phase) and then in a vertical direction ↕️.
1️⃣ Family history of melanoma. Some genetic mutations determine an increased risk of developing the disease. If someone in your family has had melanoma, you should check your skin more frequently and, if in doubt, consult your doctor
2️⃣ Fair skin, freckles, light eyes and hair
3️⃣ Patients with melanocytic proliferations such as giant congenital nevus and disilabial nevus
4️⃣ Being female. Melanoma is more common in women.
5️⃣ SUN EXPOSURE!!!!
Types of melanoma
Lentigo maligna melanoma
It accounts for approximately 10% of melanomas and has the best prognosis. It usually manifests as a blackish-brown, dichromatic, extensive and irregularly bordered spot (most often on the face) that grows over several years (radial phase) and eventually deepens. It is related to chronic exposure to the sun and therefore usually affects older people.
Superficial spreading melanoma
The most common (approximately 70%). It usually appears as a macule with a mosaic of colours (most frequently on the legs of women and on the back of men) that grows for 4-5 years (radial phase) and then deepens to form a nodule. Ulcerations and haemorrhagic phenomena usually appear on the lesion at this time. This type of melanoma is associated with acute, intermittent sun exposure and mainly affects adults between the ages of 20 and 60.
This has the worst prognosis. In this case, melanoma usually manifests itself as a uniform black nodule that appears more frequently in middle-aged men, on any area of the body (although more frequently on the head or trunk), on healthy skin and suddenly. What characterises this clinical form is that there is no transverse growth phase. The nodule grows rapidly vertically and is therefore extremely invasive.
Acral lentiginous melanoma
This is the least frequent. It usually appears as a spot that grows on the soles of the feet, hands, mucous membranes and nail beds. This type is not related to sun exposure and most often affects elderly males.
Factors and prognosis
1️⃣ The depth of the lesion. This is the most important prognostic factor and the Breslow Index (which measures the depth in millimetres from the stratum granulosum to the deepest tumour cell) and the Clark Levels (which measures the depth of the tumour according to the dermoepidermal level affected) are often used to get an idea of the depth
2️⃣ Tumour location. If the tumour is located in a relatively hidden area, it is more likely to go unnoticed, thus delaying diagnosis and worsening the prognosis.
3️⃣ Number of lymph nodes affected at the time of diagnosis
4️⃣ Type of melanoma. Nodular melanoma has the worst prognosis
5️⃣ Age and sex of the patient. Although more common in females, the chances of survival are lower in young males
As mentioned in the introduction, the best way to combat it is to prevent it
Treatment is based on three pillars
📌 S urgical treatment. Early surgical removal is the mainstay of treatment. Surgery is usually accompanied by the search for the sentinel node (first lymph node draining the territory where the tumour is located; if it is positive we can deduce that the tumour has spread to the rest of the lymph node chain)
immunotherapy. It is indicated in some cases
radiotherapy and chemotherapy. These have poor results and are often used more as palliative treatment
The most important thing is to focus on prevention. SUNBATHE RESPONSIBLY. ALWAYS PROTECT YOUR SKIN. CHECK FOR LESIONS WITH STRANGE OR NEWLY APPEARING SHAPES. IF IN DOUBT, CONSULT YOUR DOCTOR. Early diagnosis is essential to get the right results
Films related to melanoma
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