Melanoma

Dermatology Center

Moscow, Shchepkina, 35

•

+7 495 933 66 55

About the disease

Stages of melanoma

Symptoms

Diagnostics

Treatment

Observation and forecasts

About the disease

Melanoma (melanoblastoma)It is a malignant tumor with a high risk of metastasis that develops from melanocytes.

Melanocytes produce the pigment melanin, which is responsible for the color of skin, eyes, and hair. With disorders in melanocytes, new cells can grow uncontrollably and turn into a tumor. Melanoma ranks fifth in terms of prevalence among all types of cancer. In the early stages, the 5-year survival rate is at least 97%. The EMC clinic performs early diagnosis at the pre-symptomatic stages and uses modern methods of treating melanoma.

Types of melanoma

According to clinical and morphological characteristics, there are 4 types of skin melanoma:

Surface-spreading

This category includes up to 60% of all types of melanomas. The neoplasm manifests itself in the form of a small mole. Gradually, it increases, thickens, and uneven coloration and layers form, and the surface can ulcerate and bleed. It can develop for a long time without metastasis.

Malignant lentigo

This is a rare type of neoplasm, which accounts for about 5% of cases. The tumor also develops slowly — it can take 10-20 years to the stage of metastasis, it looks like a brown spot or a large freckle. It is usually localized in open areas of the body: hands, face, neck, and scalp.

Acral lentiginal

This form of melanoma is less common in the Caucasian race — its frequency in this group does not exceed 2-3%. The neoplasm is localized on the plantar part of the feet, palms, in the area of the wrist joints, under the nail. It looks like a dark growing spot, with subcutaneous localization — like a vertical strip under the nail, sometimes involving the nail roller. This tumor grows rapidly, metastasizes early, and is usually diagnosed at an invasive stage.

Nodal

This neoplasm accounts for from 14 to 20% of all types of melanoma. The prognosis for this type of cancer is the most unfavorable, since nodular melanomas do not have a horizontal growth phase. The neoplasm looks like a nodule of uniform dark color, regular shape and with clear boundaries, grows rapidly, penetrates into the deep layers of the skin, and the surface of the tumor often bleeds.

Stages of melanoma

As with many other types of cancer, the staging of skin melanoma is carried out according to the combined classification of TNM/UICC/AJCC. Currently, doctors are guided by the updated 2017 staging system (8th edition).

The exact determination of the stage is carried out after surgery based on a histological examination of the material. The staging is based on three characteristics of TNM. T refers to the prevalence of the primary tumor, N refers to the presence or absence of metastases in the lymph nodes, M refers to the presence or absence of metastases in distant organs. The stage is determined based on the gradations of each characteristic.

Stage 0 (tumor in situ).

Tis tumor prevalence, no metastases. This is the most initial stage of a malignant tumor with the most favorable prognosis.

Stage I.

There are also no metastases at this stage, but the melanoma has already reached the dermis (invasive). The thickness of the tumor is up to 1 mm (with or without ulceration).

Stage II.

Tumors with a thickness of more than 1 mm belong to this stage. They are predicted to have a higher risk of metastasis.

Stage III.

It is called locally widespread, regional lymph nodes are affected, metastases to the skin or subcutaneous tissue are possible. A genetic analysis is indicated before treatment.

Stage IV.

At this stage, distant metastases are diagnosed: in soft tissues, lungs, internal organs, and the central nervous system.

Risk factors

Doctors still don't know the exact reasons why and how melanoma begins. But there are risk factors that increase the likelihood of developing it. These include:

Ultraviolet radiation
The incidence is affected by prolonged exposure to the sun in the summer and winter months, as well as exposure to UV rays in a solarium. A person's exposure to sunlight is also important: sunburn in the past increases the risk of developing melanoma.
Phenotype
Thin fair skin with freckles and poor susceptibility to sunburn, easily burned in the sun, is a risk factor. The risk of melanoma in such people is above average.
Number of moles

It has been proven that up to 30% of melanomas have histological confirmation of a pre-existing nevus. Thus, the presence of a large number of moles is a risk factor for the development of melanoma. Especially moles with uneven and indistinct borders, uneven coloring, spotted or papular components.
Genetic predisposition

One of the causes of melanoma is a mutation in the BRAF V600E gene. This mutation is detected in 30-70% of patients and in 59% of melanomas without signs of UV damage. The presence of such a mutation allows the use of targeted drugs for the treatment of melanoma. Melanoma has also been linked to some other genetic damages, for example, in the NRAS gene.
Family history
Approximately 10% of patients with melanoma have the same disease in close relatives. If your family has already encountered such a diagnosis, it is recommended to visit a dermatologist regularly. If there are many cases, the doctor can send for a genetic analysis to identify mutations, in particular, the P16/CDKN2A gene. And with other types of cancer in the family, a multigenesis analysis is possible.
Other factors
These include, for example, hereditary syndromes associated with breast and ovarian cancer, previous skin tumors (basal cell or squamous cell carcinoma, melanoma), race and ethnic origin — melanoma is most often diagnosed in people of Caucasian race. In addition, age and gender are affected — the maximum risk for men over 60 years of age. People with weakened immune systems, for example, with HIV or after organ transplantation, will also have a higher risk.

Symptoms

In most cases, melanoma is a neoplasm on the skin, so it manifests itself as a nevus or pigmented skin formation that does not look like other moles. It is difficult to notice in time how melanoma begins and when a mole becomes dangerous. The principle of the "ugly duckling" is recommended — the search for a nevus that is different from others. If new moles or unusual symptoms from pre-existing nevi appear, consult a doctor.

Classical ABCDE technology is used in clinical practice and self-diagnosis:

(A, asymmetry)

The two halves of the oncological mole are asymmetrical relative to the central axis;

(B, borders)

A malignant tumor has uneven, "geographical" edges, whereas an ordinary mole has a rounded shape.;

(C, color)

The skin color within the borders of one mole may vary, there are dark and light areas;

(D, diameter)

Melanoma is usually much larger than the average mole;

(E, evolving)

The size, shape, and color of a malignant nevus change over time.

Diagnostics

The diagnosis of melanoma is made by a doctor primarily based on a skin biopsy. But before that, a number of other examinations are needed. At the initial diagnosis, the doctor collects the patient's medical history: interviews about health problems, symptoms, medications and dietary supplements, and cases of cancer in the family. A physical examination is performed: a complete examination of the skin is mandatory, including on the scalp using a dermatoscope.

The EMC clinic uses the latest FotoFinder system for the prevention and early diagnosis of melanoma. Its advantages:

Early diagnosis of melanoma with 99% accuracy.
The possibility of 140x optical magnification.
A complete skin map will be created in 4 minutes.
Images of each cm of skin are saved with fixation of neoplasms.

Other ways to diagnose melanoma

Biopsy

If suspicious formations were found during the examination, they are removed under local anesthesia and the tissues are sent to The EMC Histological Laboratory. To confirm or refute the diagnosis of melanoma, an excision (with complete removal of the formation) biopsy is preferable. If there are grounds (test results, physical examination), a lymph node biopsy is performed: by needle method or with removal of the lymph node at the discretion of the doctor.
Computed tomography (CT)

CT allows you to obtain a detailed image of the internal structures of the body using X-rays and computer technology. It is most often performed with contrast, a substance that improves image quality and allows for better differentiation of anatomical structures. CT allows you to determine the exact size of the melanoma, to identify metastases in soft tissues and organs.
Magnetic resonance imaging (MRI)

This method allows you to assess the depth of tumor penetration, identify distant metastatic foci, even small ones, including in the brain and spinal cord. Sometimes an MRI scan introduces contrast to reveal the vascular structures of the neoplasm and its aggressiveness.
Positron emission tomography (PET)

During PET scanning, a radiopharmaceutical drug (RFP) is injected intravenously into the patient. It serves as a radioactive label: in a malignant tumor, cells grow very quickly and actively absorb RFP, so they look like bright spots in the image. PET scans are often performed together with CT scans to increase the resolution of the images. The method may be uninformative in the early stages of melanoma, it is used to find foci of metastasis.
Biomarker tests

The tissue sample taken during the biopsy is analyzed for biomarkers. This is necessary to identify mutations and proteins that are important to consider when choosing a treatment. Immunohistochemical analysis (IHC) is performed by staining cells with antibodies and a chemical marker. It helps to understand how far the tumor has spread, to find gene mutations (the BRAF mutation is most common) and to identify the PD-L1 protein (it suppresses the body's immune response to the tumor).
Blood tests

By themselves, blood tests do not allow to diagnose melanoma. But they are prescribed by doctors if they want to check the patient's body condition before and during therapy. Among them: a general blood test (UAC), a biochemical one, as well as a lactate dehydrogenase (LDH) test. The latter is used for stage IV melanoma, if the LDH level is high, it means that the cancer has spread through the body.

Treatment

The choice of therapy for patients with melanoma depends on the type of neoplasm, size, stage, location, and other factors. Important: treatment is always selected by the doctor individually, based on medical history and examination results. Not in all cases, only radical removal of melanoma is indicated.

Basic treatment methods

Surgical
(excision of the tumor)
Targeted therapy
suppresses melanoma-specific processes
Immunotherapy
activates the patient's immune system
Combination therapy
combination of targeted and immunotherapy
Radiation therapy
treatment with different types of radiation

Surgical treatment

The main method of treating melanoma is radical surgical excision of the neoplasm. Depending on the thickness of the neoplasm, the margins from the boundaries during removal of the melanoma can be up to 2 cm or even more. The procedure is performed under local anesthesia, with a deep or widespread tumor — under general anesthesia. Nearby lymphatic ducts are also removed — there is a risk that malignant cells will remain in them.

If the tumor is more than 1 mm thick, doctors recommend a sentinel lymph node biopsy. This is the lymph node closest to the neoplasm, the presence of pathological cells in which indicates the danger of metastasis. BSLU is often performed simultaneously with the removal of melanoma.

Adjuvant therapy

This is an additional treatment that is prescribed to the patient, including after the removal of the tumor, in order to prevent relapses. The choice of a specific method depends on the stage of melanoma, its prevalence, age and condition of the patient. Thus, radiation therapy can be prescribed before, during, and after tumor removal to patients at high risk of recurrence. Radiation can be directed only to a malignant tumor, to the entire skin or to specific lymph nodes. Targeted therapy is chosen, for example, when mutations in the BRAF or MEK genes are detected: tumor growth inhibitors block growth factors that cause tumor cells to grow and divide. Immunotherapy helps the body's immune system to find and destroy malignant cells on its own.

Observation and forecasts

The follow-up of patients after treatment and the prognosis of survival depend on the stage at which the disease was detected.

How surveillance is conducted

Stage 0–I
Regular self—diagnosis, once a year - a specialist consultation with a full examination of the skin. Depending on the symptoms, additional examinations may be performed: CT, MRI, PET/CT, ultrasound.
Stage II–IV
Follow-up examinations include a full body examination, CT scans of the chest and abdominal cavity, MRI or CT scans of the brain with contrast. During the first two years after treatment, examinations are carried out every 3-6 months. Further, until the age of 5, examinations are scheduled every 3-12 months, and after that at least once a year.

At the initial stage, almost 100% of patients can be cured. The prognosis for stage I patients is also favorable, with a recurrence risk of less than 15%. At stage II, the five-year survival rate is 80-87%. When the disease spreads to the lymph nodes (stage III), depending on the number of affected tissues, the five-year survival rate is estimated at 15-50%. The most serious prognosis is at stage IV: only 5-10% of patients manage to live more than 5 years after the diagnosis is confirmed.

Doctor's recommendations

To reduce the likelihood of developing melanoma, doctors recommend:

stop using tanning beds
spend less time outdoors with high solar activity
use sunscreen
mark the appearance of new moles or the modification of previously existing ones

Services

Why the EMS

The first and only clinic in Russia, created in the image of the world's leading clinics

EMC is a multidisciplinary center offering patients a high level of medical services and a personalized approach

600

world-renowned doctors

57

treatment directions

36

years taking care of your health

24/7

we work at any convenient time

World recognition and awards

Our achievements are confirmed by prestigious international awards

More details

World recognition and awards

We work according to international standards, we have licenses and certificates

Certificates and licenses

Specialists

Vardanyan Karine

Dermatovenerologist, Allergist, Dermatologist, Doctor of the highest category, Ph.D. of Medical Sciences

More than 20 years of work

71 review

Gaydaychuk Marina

Dermatovenerologist, Trichologist, Dermatologist

More than 20 years of work

Galieva Nadezhda

Dermatovenerologist, Podologist, Dermatologist, Ph.D. of Medical Sciences

More than 20 years of work

2 reviews

Zharinova Natalia

Dermatovenerologist, Mycologist, Dermatologist, Ph.D. of Medical Sciences

More than 20 years of work

12 reviews

Zavialova Aleksandra

Podologist, Dermatovenerologist, Dermatologist

More than 20 years of work

8 reviews

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Questions and answers

What is the danger of melanoma?

Although melanoma accounts for less than 5% of skin malignancies, this oncopathology causes more than 80% of deaths in its group. The danger of melanoma lies in its prolonged asymptomatic course. If the neoplasm is detected late, the risk of metastasis to distant organs increases.

Does melanoma hurt?

In most cases, melanoma does not hurt in the early stages. However, as the oncopathology develops, the patient may complain of itching, burning, subjective discomfort in the area of the neoplasm, and skin inflammation at its borders.

Which organs are affected by melanoma?

Melanoma can occur in almost any organs and tissues. Melanoma of the skin is the most common (over 90%). Melanoma of the eye and its appendage is in the second place in terms of prevalence (6.8% of cases). Less often, the neoplasm is localized in other organs, for example, in the rectum, genital or respiratory organs, meninges, etc.

How long does melanoma develop over time?

The time of development depends on the stage and type of melanoma. On average, the situation is as follows. The first stage is the slowest, lasting from 1 to 5 years. The second one is faster and develops within a few months. The third and fourth ranges from 1-3 months to several weeks.

How many people live with the first stage of melanoma?

With timely diagnosis and high-quality treatment, the five-year survival rate in patients with skin melanoma exceeds 97%.

How to understand that melanoma has metastasized?

Most often, the tumor metastasizes to the lymph nodes, which may become enlarged and painful when squeezed. When metastases appear in distant organs, symptoms from the affected organ are noted, for example, headaches, sensitivity disorders (brain), back pain (spine), the appearance of new growths next to the primary (skin), etc.

Melanoma

Dermatology Center

About the disease

Melanoma (melanoblastoma)It is a malignant tumor with a high risk of metastasis that develops from melanocytes.

Types of melanoma

Surface-spreading

Malignant lentigo

Acral lentiginal

Nodal

Stages of melanoma

Stage 0 (tumor in situ).

Tis tumor prevalence, no metastases. This is the most initial stage of a malignant tumor with the most favorable prognosis.

Stage I.

There are also no metastases at this stage, but the melanoma has already reached the dermis (invasive). The thickness of the tumor is up to 1 mm (with or without ulceration).

Stage II.

Tumors with a thickness of more than 1 mm belong to this stage. They are predicted to have a higher risk of metastasis.

Stage III.

It is called locally widespread, regional lymph nodes are affected, metastases to the skin or subcutaneous tissue are possible. A genetic analysis is indicated before treatment.

Stage IV.

At this stage, distant metastases are diagnosed: in soft tissues, lungs, internal organs, and the central nervous system.

Risk factors

Ultraviolet radiation

Phenotype

Number of moles

Genetic predisposition

Family history

Other factors

Symptoms

(A, asymmetry)

(B, borders)

(C, color)

(D, diameter)

(E, evolving)

Diagnostics

Other ways to diagnose melanoma

Biopsy

Computed tomography (CT)

Magnetic resonance imaging (MRI)

Positron emission tomography (PET)

Biomarker tests

Blood tests

Treatment

Basic treatment methods

Surgical

Targeted therapy

Immunotherapy

Combination therapy

Radiation therapy

Surgical treatment

Adjuvant therapy

Observation and forecasts

How surveillance is conducted

Stage 0–I

Stage II–IV

Doctor's recommendations

Services

Why the EMS

The first and only clinic in Russia, created in the image of the world's leading clinics

EMC is a multidisciplinary center offering patients a high level of medical services and a personalized approach

World recognition and awards

World recognition and awards

Specialists

Make an appointment for a consultation

Specify your contacts and we will contact you to clarify the details.

Questions and answers

What is the danger of melanoma?

Does melanoma hurt?

Which organs are affected by melanoma?

How long does melanoma develop over time?

How many people live with the first stage of melanoma?

How to understand that melanoma has metastasized?

Contacts