16 symptoms of melanoma: should you worry if you find one of them?

Skin cancer melanoma. Photo

Melanoma develops from specialized melanocyte cells that produce the pigment melanin. Melanocytes are responsible for the color of eyes, hair, skin, and are responsible for protecting the body from ultraviolet rays. Most often, a malignant neoplasm is localized on the skin, less often in the mucous membranes of the rectum, vagina, oral cavity, and a tumor can also form on the retina. Melanoma is rare, but the mortality rate from melanoma is high - the tumor is prone to metastasis and the formation of secondary lesions.

In the oncology department of the Yusupov Hospital, patients will be able to receive qualified advice from a dermatologist, oncologist, be diagnosed with skin melanoma, and undergo treatment for the disease. The oncology department is equipped with modern equipment; the hospital treats malignant diseases using innovative methods using modern medications.

Sign 3 - “the appearance of asymmetry or irregularity in the outlines of the nevus.”

If the nevus has become asymmetrical along two axes, its entire edge has become scalloped

or begins to resemble
a coastline
on a geographical map - it’s time to go to the oncologist.

However, if you look closely at any mole on the body with a magnifying glass, even with low power, you will not find perfect circles or straight lines. In no nevus is the pigment distributed 100% evenly.

You can read more about moles with uneven edges here

Skin melanoma: symptoms and signs with photos

Photo of vertical melanoma on the back

Men most often develop melanoma of the skin of the back. Superficial and nodular melanoma develops on the back; superficial melanoma is more common. Superficial melanoma is located in the upper layer of the skin, has uneven tumor edges, and can have a different color. The prognosis is favorable in most cases. Nodular melanoma looks like a pedunculated polyp, the color of the tumor is dark - brown or black, the shape of the tumor is symmetrical, this type of tumor can ulcerate.

There are non-pigmented forms of melanoma; often melanoma on the back is a secondary focus of a cancerous tumor. Symptoms of skin melanoma are asymmetry of the sides of the mole, uneven color, diameter of the formation over 6 mm, changes in the size, color and shape of the nevus, unclear edges of the formation. The prognosis is unfavorable for the vertically growing type of skin melanoma indicated in the photo.

Signs 6 and 7 - “ulceration of the epidermis over the nevus”, “wetting on the surface of the nevus”

In my experience, ulceration appears mainly in melanomas in late stages, when there is no longer any doubt about the diagnosis. This symptom is more relevant, in my opinion, for basal cell skin cancer (basal cell carcinoma). This disease is much less formidable; people die from it extremely rarely.

For a benign mole, an ulcerated surface and weeping are also possible - immediately after trauma:

What to do if you injured a mole, is it really dangerous - read here

What does skin melanoma look like: photo

Melanoma at an early stage can go undetected. It attracts attention after a mole changes color to a darker color or due to tumor growth. There are various causes of skin melanoma:

Ultraviolet irradiation. Melanoma often forms in lovers of artificial and natural tanning, after a sunburn.
Nevi (moles), melanoform nevus.
Genetic predisposition to the development of melanoma, for which a specific gene is responsible.
I and II skin phenotype. The remaining skin phenotypes are less prone to the formation of malignant skin tumors. People with fair skin, light hair color, blue or gray eyes, and freckles are most susceptible to developing cancer.
Hereditary hypersensitivity to ultraviolet rays.
Skin injuries, moles.
Diseases of the endocrine system.
Age-related changes.
A predisposing factor is a history of treatment for skin cancer.

Expert opinion
Author:
Milana Khanlarovna Mustafaeva
Head of the oncology department, oncologist, chemotherapist
Melanoma is one of the malignant neoplasms characterized by an aggressive course. Mortality from skin cancer accounts for 40% of all cancer cases. Diagnosis of melanoma in the Russian Federation is carried out quite often. Every year, 9,000–10,000 onsets of the disease are detected. The trend towards an increase in severe forms due to late treatment, when doctors can only offer palliative therapy, is not encouraging.
Oncologists at the Yusupov Hospital pay careful attention to the diagnosis and treatment of melanoma. Doctors advise seeking medical help if suspicious lesions appear on the skin. In this way, the disease can be identified at the initial stages and appropriate treatment can be carried out. In addition, in the early stages, melanoma has a favorable prognosis for recovery.
At the Yusupov Hospital, doctors conduct a full course of examination, which is necessary to determine the stage of development of skin cancer and all related criteria. As a result of determining an accurate diagnosis, the effectiveness of the prescribed complex therapy increases. The drugs are selected according to the latest European recommendations for the treatment of skin tumors.

Sign 8 - “bleeding from the surface of the nevus.”

Yes, indeed, one of the common features of melanoma is spontaneous bleeding without previous trauma to the mole.
Even this sign alone
will make any oncologist seriously doubt the benignity of the mole.

However, in my practice several times I came across a rather rare type of skin tumor - pyogenic granuloma. These formations appear very quickly, bleed, however, they are 100% benign:

Classification

Superficial spreading melanoma. Typically, this type of melanoma develops on a mole or intact area of skin.

Lentigo maligna (superficial spreading melanoma)

Nodular melanoma is a more malignant type of the disease.

Lentiginous melanoma (Hutchinson's freckle) develops more often on the face, ears, neck, and hands. It is considered the most favorable form of this pathology (slow growth combined with a low risk of metastasis);

Acral lentiginous melanoma characterized by rapid development and growth, often metastasizes. Mostly diagnosed in people with dark skin;
acral lentiginous melanoma
Pigmentless skin cancer is quite rare.

Sign 9 - “hair loss on the surface of the nevus.”

This sign may indicate that the mole has become malignant. If the mole is 5 mm or more and several hairs have disappeared from its surface at the same time and they do not appear. Moreover, if the same mole began to grow and doubled in size in 2 months, these are already 2 alarming signals at the same time and such a mole should be shown to an oncologist without delay. In addition, I should note that in my practice once

I encountered a melanoma, the surface of which was covered with hair.

At the same time, there are a huge number of moles, the surface of which is not covered with hair and at the same time they are completely benign. People also often panic if one hair grew from a mole and it suddenly fell out. Please do not despair - it should appear no later than in 2-3 weeks.

I wrote this article about hair on moles.

Skin melanoma: photo of the initial stage

Photo of skin melanoma at an early stage

The initial stage of melanoma is characterized by horizontal growth of the tumor, which does not extend beyond the epithelium and does not affect the deeper layers of the skin. If you pay close attention to your own health, the patient may notice a change in moles - color or size. The exception is moles located on the back. Symptoms of trouble are itching, soreness or an increase in the size of the mole. If such symptoms appear, you should urgently visit a dermatologist or oncologist.

Sign 10 - “inflammation in the area of the nevus and surrounding tissues”

Redness and swelling of the tissue around the mole may be a consequence of melanoma cells growing into the surrounding skin.

However, it must be remembered that in case of inflammation of the sebaceous gland, which is located under or next to the mole, “pimples” may form. If such a focus of inflammation is located next to a mole, you will see symptoms of inflammation - redness and soreness. How to distinguish a “pimple” from a sign of melanoma? It’s very simple - wait 1-2 weeks and it should go away on its own.

Inflammation of a mole is a common occurrence. I analyze it in this article

Skin melanoma ICD 10

Skin melanoma ICD 10 is coded C43-C44. Codes include:

Malignant melanoma of the lip (red border of the lips is excluded) (C43.0).
Malignant melanoma of the eyelid (C43.1).
Malignant melanoma of the external auditory canal and ear (C43.2).
Malignant melanoma of unspecified other parts of the face (C43.3).
Malignant melanoma of the neck and scalp (C43.4).
Malignant melanoma of the trunk (C43.5).
Malignant melanoma of the upper limb + shoulder joint area (C43.6).
Malignant melanoma of the lower extremity + hip joint area (43.7).
Malignant melanoma extending beyond one or more of the sites listed above (C43.8).
Unspecified malignant melanoma (C43.9).

Sign 11 - “peeling on the surface of the nevus with the formation of dry crusts”

Yes, the surface of melanoma (or basal cell carcinoma) may be covered with crusts that form due to weeping or bleeding. And this is a truly alarming sign.

At the same time, there is another type of neoplasm - keratopapillomas (keratomas). Crusts regularly appear on the surface of such formations, which then fall off.

Diet for skin melanoma

The diet for melanoma should contain as little saturated fat as possible and contain the full range of vitamins and minerals. It is recommended to steam, bake or boil food. It is recommended to consume the following types of products:

Sea fish, squid, mussels, oysters, shrimp.
Olives, olive oil, peanuts, soybeans, sunflowers.
Green tea.
Boiled and baked vegetables.
Salads from raw vegetables.
Fruit juices and fresh fruits.
Dairy products with low fat content.
Various types of cereals, durum pasta, bran bread.
Various types of low-fat cheeses.
Turkey, chicken meat.
Sea kale salads.
Vegetables from the cruciferous family.

Sign 15 - “the appearance of a shiny glossy surface of the nevus”

Melanoma cells refract and reflect light rays in a special way. The consequence of this may be the appearance of a glossy surface on the mole.

At the same time, there is a separate type of skin tumors - blue nevi

. These moles very often have a glossy surface and are completely benign:

How does melanoma develop?

So far, the molecular genetic mechanism of tumor formation has been approved in dermatology. Against the background of gene mutations, damage to the DNA of healthy cells occurs. The number of genes changes, restructuring and disruption of the structure of enzymes and chromosomes is observed. Melanocytes begin to divide uncontrollably and spread to healthy tissue of the skin or mucous membranes.

How quickly melanoma develops depends on many factors, but the disease is considered to be rapidly progressive. Within a year from the moment of gene mutation and DNA damage, most of the tumors presented have already metastasized to the lymph nodes with further spread to the internal organs. A person does not immediately detect the first signs of melanoma, because at first it disguises itself as an ordinary mole. Diagnosis of cancer occurs mainly in late stages.

Sign 16 - “disappearance of the skin pattern on the surface of the nevus”

Most often, there is no skin pattern on the surface of melanoma. This is due to the fact that tumor cells lose their normal functions and engage in only one thing - constant division. As a result, after the mole degenerates, the skin pattern disappears.

At the same time, there are a huge number of benign moles on the surface of which there is no skin pattern:

I don’t see any point in further detailed analysis of all the signs. All of them can be interpreted in two ways - both in favor of melanoma and in favor of benign changes. Only the presence of two signs at once or the rapid onset of changes can indicate a malignant mole.

I think that I was able to clearly show you that each of these signs separately cannot clearly indicate melanoma.

Stages of melanoma

The stage of melanoma can be definitively established only after a histological examination has been performed. Staging is carried out in accordance with the generally accepted international TNM classification, where the letter T indicates the size and depth of germination of the primary tumor, N – involvement of regional lymph nodes, M – the presence of distant metastases.

Determination of the T stage is based on measuring the greatest thickness of the tumor, that is, the depth of its growth into the skin. This indicator is called Breslow thickness, after the name of the author who proposed the method in 1970:

Tis – cancer cells are located within the most superficial layer of the skin – the epidermis.
T1 – thickness less than 1 mm.
T2 – thickness 1–2 mm.
T3 – thickness 2–4 mm.
T4 – thickness more than 4 mm.

The letter N indicates the presence of metastases in regional lymph nodes. It can have values of 0, 1, 2 and 3. N0 - regional lymph nodes are not affected. N3 – the presence of metastases in more than three regional lymph nodes.

The letter M indicates the presence of distant metastases. It can take values 0 and 1. M0 – there are no distant metastases. M1 – distant metastases detected.

Briefly about the main thing:

Don’t panic if, after reading horror stories on the Internet, you find yourself with a sign of melanoma! Most likely everything is fine. The presence of only one of the 16 symptoms is very unlikely to indicate a malignant mole. Each of them individually can occur in benign neoplasms.

If a symptom develops over several months, you should definitely see an oncologist.

The likelihood of melanoma is very high if there is more than one sign - in this case, be sure to see an oncologist. You should also come to this doctor if you have even the slightest doubt that your mole is benign.

If you still have questions, the following will help you:

In-person appointment with an oncologist
(St. Petersburg)
Removal of
skin tumors (St. Petersburg)
My Online consultation (from anywhere in the world)

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Other articles:

Mole on the head. Is it possible to remove it?
Is it possible to remove a mole on the eyelid?
Is a puncture and scraping necessary before removing a mole?
Dysplastic nevi

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Prevention

People who are predisposed to developing melanoma need to follow some rules that will reduce the risk of the disease:

Reducing sun exposure is the main prevention against melanoma;
It is necessary to protect exposed skin from direct rays of the sun (wear sweaters with sleeves, hats or caps and pants);
The use of sunscreen is recommended;
Knowledge about the first signs and symptoms of melanoma is necessary so that if one of them is detected, immediately consult a doctor and begin treatment;
It is necessary to examine the skin for the presence of new formations or changes in old ones, so as not to miss the transformation of a mole into melanoma;

Diagnostics

Early diagnosis of melanoma is very important, since otherwise, due to the rapid metastasis of the tumor, it will not be possible to cure the person. To do this, you need to contact an experienced oncologist. The examination is initially carried out through examination and laboratory, instrumental studies.

If during the consultation the oncologist suspects melanoma of the skin, further examination is carried out through:

Surgical lymph node biopsy
Chest X-ray
ABCD rule (mnemonic rule for diagnosing melanoma)
Dermatoscopy
Histology

Diagnosis of melanoma by dermatoscopy makes it possible to examine the surface of a pigmented neoplasm at a 10-fold magnification. The results of dermatoscopy can be expressed in scores that reflect the degree of asymmetry, the number of shades, the structure of pigmentation and the clarity of boundaries and correlate with the risk of degeneration.

During a biopsy, the entire area of the tumor is removed, including approximately 5 mm of unaffected areas of the skin and subcutaneous tissue. For histology, the entire area taken is provided, since the pathologist must make sections from it to measure the maximum thickness of the neoplasm according to Breslow.

Expert opinion

Sakania Luiza Ruslanovna

Dermatovenerologist, cosmetologist, trichologist

Ask a Question

The wound that remains after cutting off a small lesion is sutured with a primary suture. If a large tumor is removed, the wound is covered with a bandage and not sutured until a diagnosis is made. Superficial and puncture biopsies are not recommended.

Sometimes an incisional biopsy is performed, for example, for the differential diagnosis of lentigo melanoma on the face or the acral form of the neoplasm. It is very important to detect the disease in time for further effective treatment.

Diagnostics and examinations at the Ukrainian Tomotherapy Center provide a real chance of recovery. In parallel with the research methods described above, X-rays, ultrasound, MRI, CT, and blood biochemistry are prescribed.

Treatment of melanoma: surgery, chemotherapy and immunotherapy

There are currently two types of treatment for melanoma :

Surgical treatment that involves removing the change, which is possible when the tumor has not invaded the surrounding tissue, lymph nodes and skin tissue. This ensures that the subject has a greater chance of long-term survival, with a risk of relapse of less than 5%. But this treatment can be used in limited cases, that is, when the tumor is less than 1 mm thick or an area in the range of 1 to 2 mm and has not yet invaded the lymph nodes.
Chemotherapy that should be used in cases of advanced or metastatic melanoma. It can be used in almost any case, but does not guarantee long-term survival, it only improves the quality of the patient's remaining life. This type of treatment uses drugs such as dacarbazine, lavinblastine or fotemustine, the latter drug is very effective in the case of brain metastases, as it can cross the blood-brain barrier.

Currently, the Veronesi Research Institute is testing a new method of treating skin melanoma based on immunotherapy and vaccination.

Immunotherapy strengthens the patient's immune system cells, in particular T-lymphocytes, and this stimulation can occur in two ways:

Drugs: A new drug called ipilimumab is currently being studied, which has shown good results in patients with metastatic melanoma who have not had positive results with traditional chemotherapy.
Modified dendritic cells that produce the substance interleukin 12p70, which is capable of transforming B-lymphocytes into cytotoxic cells that destroy cancer cells, can also be used as a vaccine.

The best therapy, however, is prevention, which consists of avoiding unprotected sun exposure for long periods of time and, if in the risk category, regular visits to a dermatologist.

Treatment is carried out in cooperation with foreign partners. This allows doctors at the European Oncology Clinic, if necessary, to prescribe treatment with drugs that are available for use only in a few countries around the world and offer patients participation in clinical trials of the latest drugs.

Depending on the appearance and growth pattern, there are several types of skin melanoma:

Superficial spreading melanoma
occurs in approximately 60% of cases. Such tumors can remain in the radial growth phase for a long time, for several years, that is, grow in breadth without growing into the deeper layers of tissue. Metastasis occurs extremely rarely. But, sooner or later, the vertical growth phase will begin, and the tendency of melanoma to metastasize will increase sharply.
The nodular form
looks like a nodule that rises above the surface of the skin. Her growth is much more aggressive.
Lentigo maligna melanoma
appears as a spot on the skin with jagged, fuzzy edges. This is the most favorable type. Like superficial spreading melanoma, it can remain in the radial growth phase for a long time—up to 10–20 years—and only then begins to actively grow deeper and metastasize.
The acral-lentiginous form
most often appears as a spot on the palm or foot, in the area of the nail bed. It is similar to superficial spreading melanoma, but behaves more aggressively and metastasizes earlier. Due to the “inconvenient” location, a person may not notice this tumor for a long time and not see a doctor.

Types of melanosis

Doctors distinguish between several types of pathological pigmentation. The classification of the disease is based on provoking factors and symptoms. There are 5 types of melasma:

Uremic. Occurs against the background of renal failure.
Hepatic. Caused by liver disease (usually cirrhosis).
Kakhetic. Caused by severe forms of tuberculosis, impaired functioning of the adrenal glands.
Endocrine. Caused by diseases of the thyroid gland, a disorder of the pituitary gland.
Toxic (arsenic). Appears against the background of severe intoxication caused by arsenic and hydrocarbons. Gasoline, kerosene, motor oil and other petroleum products lead to poisoning.

In addition to the general large categories, specific types of melanosis are distinguished. These diseases are severe and threaten the health and life of patients. Such pathologies are eliminated mainly by surgical methods.

The following types of melasma are distinguished:

Chloasma. The development of pathology is provoked by hormonal imbalance. Occurs in women during pregnancy and menopause.
Becker's melanosis. Benign spots appear in young men.
Dubreuil's melanosis. The disease affects women over 50 years of age. The formations can degenerate into cancerous tumors.
Lentigo. Flat pigmented nevi appear on the epithelium.
Moynahan syndrome. A huge number of brown spots that are benign in nature form on the epidermis of patients.

Determining the stage of a skin tumor

There are several melanoma assessment parameters that can predict the development of melanoma. There are currently four types of melanoma staging classification .

First, there is Clark's classification, which is based on invasion into the deeper layers of the skin:

The first stage, in which the lesions are limited to the epidermis and located above the basement membrane.
The second and third stages, during which melanoma penetrates the papillary dermis (second stage) and the reticular dermis (third stage).
The fourth stage, in which the lesions extend into the reticular dermis and are thus very deep.
The fifth stage, the most serious, in which the damage is localized subcutaneously and invades the subcutaneous tissue and adipose tissue.

The second classification is based on tumor penetration into the skin, expressed in millimeters. Defined as Breslow classification:

Stage 1: the thickness of melanoma does not exceed 1 mm, the prognosis is good, survival rate is 95-100% within five years.
Stage 2: Melanoma has a thickness ranging from 1 to 1.69 mm and is low risk. Even so, the prognosis is good, and survival is 80-96% over five years.
Stage 3: The thickness of melanoma ranges from 1.70 to 3.99 mm, in this case, melanoma is defined as moderate risk. The prognosis is average, survival rate over five years is 60-75%.
Stage 4: The most dangerous stage of melanoma, survival over five years is very low - between 37% and 50%. The tumor is more than 4 mm thick.

The third classification is proposed by the American Joint Committee on Cancer (AJCC) and includes five stages - from 0 to 4:

Grade 0: The melanoma is in situ and does not invade adjacent structures.
Grade 1: Melanoma is less than or equal to 1 mm in thickness, with or without the presence of an ulcer, and 1 to 2 mm in diameter, without the presence of an ulceration.
Grade 2: In this case, the diameter of the melanoma may be between 1 and 2 mm and there are ulcers, or it may be more than 2 mm but without lymph node involvement.
Grade 3: metastatic type of melanoma, there are metastases and involvement of regional lymph nodes.
Grade 4: the last stage with the presence of distant metastases.

The latter classification is based on the TNM (Tumor-Node-Metastasis) system indicating the anatomy of the lesions:

T: determines the size of the tumor, its thickness and stage according to the Clark classification. Scores range from 0 (no primary tumor observed) to 4 (significant melanoma with a thickness of at least 4 mm and invasion of the subcutaneous layer is observed).
N: indicates lymph node involvement, the score in this case ranges from 0 when no lymph nodes are involved to 3 when more than 3 lymph nodes are involved.
M: indicates the presence or absence of metastases, scores ranging from 0 (no metastases) to 1 (presence of distant metastases).

Causes and risk factors for melanoma

Currently, the exact causes of melanoma are not known , although some changes at the genetic level have been identified that are associated with the occurrence of melanoma (for example, mutations in the p16 protein and adhesion molecules such as integrins).

However, risk factors for melanoma are well documented. These include:

Sun: is a major risk factor for melanoma. UV rays can damage, sometimes irreversibly, DNA with subsequent changes in the mechanisms that control cell proliferation. Melanocytes, being the cells that produce melanin, are the most affected by the sun's rays, for this reason it is recommended to always use sunscreen with an SPF and avoid sunburn.
Heredity: If you have a family history of melanoma, you are more prone to developing this tumor. For this reason, it is necessary to keep your skin under control and avoid prolonged exposure to the sun.
Radiation: Other types of radiation, such as ionizing radiation (such as gamma rays or X-rays), can lead to the development of melanoma because they also cause DNA damage.
Skin type: Those who have fair skin dotted with moles and freckles, light eyes and light hair have a higher risk of developing melanoma, as fair skin has less melanin to protect against sun damage.
Immune problems: Individuals with weakened immune systems have an increased risk of developing melanoma due to the immune system's lack of control of cancer cells.

TNM classification of melanoma

The prevalence of cancer at the time of diagnosis largely determines the treatment option and prognosis.

One of the classifications that fully reflects the prevalence of the oncological process is the TNM system, which is widely used in the staging of melanoma. It was recommended by the American Joint Committee on Cancer (AJCC) in 2009. The letters T, N and M of the system mean the following:

T = tumor
: T is followed by a number indicating the depth of melanoma invasion.
N = node:
the number following N indicates the degree of involvement of regional lymph nodes in the oncological process.
M = metastasis
(formation of secondary tumor foci as a result of the spread of cells from the primary focus): M is followed by a number - 0 or 1, corresponding to no or distant metastasis.

The degree of germination (depth of invasion) of melanoma is determined using the Clark or Breslow scale. These are purely “technical” terms, the first scale shows in which layers of the skin malignant cells are found (for example, level 1: cells are detected only in the epidermis, up to the basement membrane), and the second scales the depth of their distribution in millimeters (small thickness: depth of invasion less than 0 .75 mm, intermediate: 0.76 - 3.99 mm, large: more than 4 mm).

In addition, the “T” may be followed by “a,” which means no ulceration, or “b,” which means there is ulceration. Ulceration indicates that the cells are spreading not only deep into the skin, but also wider, which means a worse prognosis.

The deeper and further the cancer cells spread (level of tumor invasion), the higher the stage. The higher the level of tumor invasion, the worse the prognosis.

Diagnostic methods

A malignant neoplasm develops independently, and is often hidden under the guise of birthmarks, thereby complicating early detection. If you suspect the formation of a cancerous tumor, you should consult a doctor. There is a high probability of an erroneous verdict.

At the first stage, the doctor conducts a general examination using a method called differential diagnosis, which diagnoses symptoms and signs of possible pathology. The affected areas are examined. The epidermis is examined using dermoscopy and magnifying glass. Magnification several times allows you to clearly see the characteristic features of the formation.

The disease development clinic requires, in addition to general tests, a blood test for melanoma for the s100 tumor marker.

A tumor marker for skin melanoma allows you to determine the presence of cancer in the cells of the skin and nervous tissue, as well as the stage of development of the disease. The excess of calcium-binding proteins depends on the stage of the disease; the more extensive the lesion, the more proteins. If melanoma is not confirmed, then this may indicate not the absence, but the early course of the pathology.

The initial diagnosis does not use a marker test. Previously, the course of the pathology is established by a general blood test. Indicators of increased erythrocyte sedimentation rate (ESR) indicate an oncological process in the body.

The depth of germination and spread of metastases is determined by:

Ultrasound examination;
Radiography;
Magnetic resonance and computed tomography.

If the growth of the tumor does not show primary symptoms, it can be detected by studying the structure of tissue cells obtained from the nodes of the lymphatic system.

When the studies carried out do not give an unambiguous result, the histology of the neoplasm is studied by cutting off part of the affected tissue.

Treatment is prescribed based on the results of general and special tests, MRI, ultrasound, CT, CT.

Type of pathology

Oncology identifies a wide variety of melanomas:

Superficial tumor, or superficial, occurs in 70% of cases. The tumor develops slowly in the outer area of the skin. The appearance of an uneven spot is characteristic. Melanoma can be red, brown, or blue or white.
With nodular melanoma, neoplasms are diagnosed in elderly patients in 30% of cases. In women, the node grows on the surface of the thigh, and in men - in any area of the body. The tumor is found on the neck, back, abdomen and other areas of the body where the nevus is located. Myeloma is aggressive and grows vertically. The disease progresses over a year and a half, acquiring a plaque-like shape with clear boundaries and raised edges and a black or black-blue color. As the lesion enlarges, the surface of the node becomes ulcerated.
A lentiginous neoplasm, lentigo or Hutchinson's freckle, has a favorable course. The tumor arises from birthmarks and age spots, less often from moles. It is typically located on open areas of the body, in particular on the nose, lip, neck and hands. Characteristics of the disease include latent development over decades. The metastatic phase occurs extremely rarely. People live with pathology into old age.
The aggressive form of lentigo occurs in the upper layer of the dermis. Develops slowly. The affected area rises slightly above the surface of the skin and is unevenly colored. Melanoblastoma develops in old people who expose the body to uncontrolled sun exposure (especially during the gardening season).
A spindle cell tumor resembles a dome. Color – pink or brown. Smooth or warty to the touch. Affects limbs. Develops at a young age.
An acral neoplasm affects the nail area and occurs on the foot, in particular on the heel. Looks like a dark stripe or spot. It has a benign character.
Other types of melanomas occur on the tongue, on the mucous membrane of the mouth and nose, and on the scalp. New growths under the hair have a favorable prognosis.

Secondary lesions can occur in any internal organs. Typically, people die from melanoma with metastases and destruction of tissue in the brain, liver, lungs and bone marrow. Metastases can penetrate the bone of the hip, vertebra, pelvis and skull.

Cancer metastases on x-ray

Breslow classification

To estimate the chance of cure, it is important to consider the thickness of the tumor. The lower the level of invasion, the faster the recovery. A tumor that spreads into the deep layer of skin is dangerous by metastasis. To determine the progression of the disease, the thickness of the affected node is measured in depth.

Melanomas are classified in millimeters:

Up to 0.75;
From 0.75 to 1.5;
From 1.5 to 3;
From 3 to 4;
Over 4 mm.

A complication such as ulceration of melanoma indicates a later stage of the disease.

Clark classification

Malignant cells do not extend beyond the epidermis. The basement membrane is intact.
There is damage to the basement membrane, upper and papillary dermis.
Atypical cells completely fill the papillary layer.
The reticular dermal layer is affected.
Subcutaneous fat tissue is destroyed.

Forms of neoplasm

Pigmented - a brightly colored tumor. Available in red, black and brown.
Amelanotic melanoma is distinguished from healthy tissue by roughness, redness, itching and swelling of the affected area.

Stages

Like any oncological pathology, melanoma differs in stages:

In its initial form, the primary neoplasm resembles a birthmark. When a mole becomes malignant, the patient notes a change in its body and the area around it. Itching, swelling, and redness appear. The tumor may ulcerate and crust over. The disease does not affect the patient’s lifestyle and does not change the blood formula.
In the second stage, melanoma has a negative impact on a person’s overall health. The rate of disease development increases. The first symptoms of intoxication are noted. The node enlarges and causes discomfort to the wearer. The color, size and shape of melanoma changes. Already in the early stages, multiple satellites appear around the primary focus.
Regional lymph nodes are affected. The satellite form of melanoma covers a large surface of the skin. When pressure is applied to the nerve endings, tingling sensations are observed in the arms and legs.
The last stage of the tumor is incurable. Secondary lesions occur in vital organs, affecting the vascular and lymphatic systems. The primary node enlarges and grows into the deep layer of skin.

Amelanotic melanoma

Statistics show that only 95% of melanomas are pigmented to varying degrees. The remaining 5% are amelanotic melanomas.

Cancer cells contain a small amount of melanin pigment; the tumor has an uncharacteristic appearance, most often looking like a small lump under the skin. Because of this, non-pigmented melanoma is more insidious than pigmented melanoma. It is more difficult to identify; such patients later consult a doctor. The diagnosis is often made a year or later. This worsens treatment results and prognosis.

Amelanotic melanoma may be red, pink, purple, or appear like normal skin. Its shape is asymmetrical, the edges are unclear. Sometimes pain and itching, bleeding, and skin ulcers occur. Early diagnosis of non-pigmented melanoma is difficult due to the lack of coloration, but at the same time it is just as aggressive as pigmented melanoma and also metastasizes early.

What symptoms should you see a doctor for?

If they suspect melanoma, they go to a dermatologist, who will definitely refer the patient for a consultation with an oncologist. It should be remembered that only a highly qualified doctor in this field can distinguish the development of melanoma from an ordinary mole. However, great responsibility also falls on the patient, who, having discovered characteristic changes on the skin, must contact a medical institution, since this form of cancer tends to quickly progress and metastasize to the tissues and organs of the whole body. The symptoms that should alert anyone are the following:

the appearance of a dark spot on the skin with a tendency to increase;
a mole (nevus) has changed its appearance and color completely or partially;
uneven boundaries and irregular shape of the tumor are characteristic of cancerous degeneration;
the size exceeds 5-8 millimeters in diameter and continues to increase;
a pathological mole is usually itchy or some soreness is noted;
possible bleeding;
enlargement of regional lymph nodes.

In some cases, even in the presence of some similar signs, oncology is not confirmed, but only a melanoma doctor, that is, a dermatologist or dermato-oncologist, can accurately determine the nature of the neoplasm.

Symptoms

Pigmentation on the epithelial tissues of the face is the main symptom of melanosis. Brown-brown defects cause incredible psychological and physical anxiety. Unnatural coloring affects the skin of the forehead, cheeks, nose, and upper lip. The spots are located symmetrically, appearing simultaneously on both sides of the face, armpits, genitals and other places on the body .

Common symptoms of the disease include:

diffuse pigmentation of epithelial tissues (found in newborns);
hypersensitivity of the skin to ultraviolet radiation;
merging of affected areas into large foci;
swelling;
compaction and coarsening of the stratum corneum;
atrophy of epithelial tissues;
impaired functioning of the nervous and endocrine systems.

The affected skin is constantly irritated. Patients feel itching and burning in the area of age spots.

Causes of development and risk factors

Melanoma is one of the types of skin malignant neoplasms that develops from pigment cells - melanocytes that produce melanins, and is characterized by an aggressive, often unpredictable and variable clinical course.

Its most common localization is the skin, much less often - the mucous membrane of the eyes, nasal cavity, mouth, larynx, skin of the external auditory canal, anus, and female external genitalia. This tumor is one of the most severe forms of cancer, disproportionately affecting young people (15-40 years of age), and ranking 6th among all malignant tumors in men and 2nd in women (after cervical cancer) .

It can develop independently, but more often it is “masked” against the background of birthmarks, which does not cause concern for people and creates significant difficulties for doctors in terms of its earliest possible diagnosis. The way this neoplasm develops quickly and is difficult to detect in the initial stages is another danger that often interferes with timely diagnosis. Within 1 year it spreads (metastasizes) to the lymph nodes, and soon through the lymphatic and blood vessels, to almost all organs - bones, brain, liver, lungs.

Video: The simplest test for skin cancer

Causes

The main modern theory of the occurrence and mechanism of development of melanoma is molecular genetic. In accordance with it, in normal cells DNA damage occurs in the form of gene mutations, changes in the number of genes, chromosomal rearrangements (aberrations), violations of chromosomal integrity, and the DNA enzyme system. Such cells become capable of tumor growth, unlimited reproduction and rapid metastasis.

Such disorders are caused or provoked by damaging risk factors of an exogenous or endogenous nature, as well as their combined effects.

Exogenous risk factors

These include chemical, physical or biological environmental agents that have a direct effect on the skin.

Physical risk factors:

Ultraviolet spectrum of solar radiation. Its connection with the occurrence of melanoma is paradoxical: the latter occurs mainly in areas of the body covered by clothing. This indicates the development of the neoplasm not so much as a result of the direct, but rather the indirect effect of ultraviolet radiation on the body as a whole. In addition, it is not so much the duration that matters, but the intensity of irradiation. In recent years, the scientific literature has drawn attention to the particularly high danger of sunburn - even those received in childhood and adolescence, in older age they can play a significant role in the development of the disease.
Increased background of ionizing radiation.
Electromagnetic radiation - tumor is more common among people professionally associated with telecommunications equipment and the electronics industry.
Mechanical trauma to birthmarks, regardless of its frequency, is a high risk. It is not entirely clear whether it is the cause or the trigger, but this factor accompanies 30-85% of melanoma cases.

Chemical factors

They are important mainly among those working in the petrochemical, coal or pharmaceutical industries, as well as in the production of rubber, plastics, vinyl and polyvinyl chloride, and aromatic dyes.

Of the biological factors, the most important are:

Nutritional features. A high level of daily consumption of proteins and fats of animal origin, low consumption of fresh fruits and vegetables with a high content of vitamins “A” and “C” and some other bioactive substances are a risk in terms of the development of superficial spreading and nodular (nodular) forms of melanoma, and also tumors of unclassified growth type. With regard to the systematic consumption of alcoholic beverages, it is theoretically assumed that they can provoke the growth of melanomas, but there is no practical evidence of this. It has been precisely proven that there is no connection between the consumption of drinks containing caffeine (strong tea, coffee) and malignant neoplasms. Therefore, nutrition for skin melanoma should be balanced mainly with products of plant origin, especially fruits and vegetables, and contain a rich amount of vitamins and antioxidants (blueberries, green tea, apricots, etc.).
Taking oral contraceptives, as well as estrogen drugs prescribed for the treatment of menstrual irregularities and autonomic disorders accompanying menopause. Their influence on the development of melanoma remains only a guess, since no clear relationship can be traced.

Video: How melanoma develops

Endogenous risk factors

They are divided into two groups, one of which consists of factors that are a biological feature of the organism:

low degree of pigmentation - white skin, blue and light eyes, red or blond hair, a large number of freckles, especially pink ones, or a tendency to have them;
hereditary (family) predisposition - what matters is mainly the disease of melanoma in the parents; the risk increases if the mother was ill or there were more than two people with melanoma in the family;
anthropometric data - a higher risk of its development in people with a skin area of more than 1.86 m2;
endocrine disorders - high levels of sex hormones, especially estrogens, and melanostimulating hormone (melatonin), produced in the middle and intermediate lobes of the pituitary gland; the decrease in their production after the age of 50 coincides with a decrease in the incidence of melanoma, although some authors, on the contrary, indicate an increase in its frequency in older age;
immunodeficiency states;
pregnancy and lactation, which stimulate the transformation of pigmented nevi into melanoma; this is typical mainly for women with a late first pregnancy (after the age of 31), and pregnancy with a large fetus.

The second group is nevi, which are skin changes of a pathological nature and are characterized by the highest degree of probability of degeneration into melanoma, and are also its predecessors. These are benign formations consisting of pigment cells (melanocytes) of varying degrees of maturity (differentiation), located in varying numbers in different layers of the skin. A congenital nevus is called a birthmark, but in everyday life all formations of this type (congenital and acquired) are called birthmarks. The greatest risks are:

black or dark brown pigmented nevi measuring 15 mm or more;
the presence of 50 or more of these formations of any size;
Dubreuil's melanosis is a small brown spot with irregular contours that slowly increases over the years, which is usually localized on the face, hands, on the skin of the chest, and less often on the mucous membrane of the oral cavity;
cutaneous xeroderma pigmentosa, characterized by high sensitivity to sunlight; this is a hereditary disease that is passed on to children only if there are specific DNA changes in both parents; These changes result in cells being unable to recover from damage from ultraviolet radiation.

How to distinguish a mole from melanoma?

The actual incidence of the latter from nevus has not been clarified. The types of nevus with the highest risk have been established: complex type - 45%, borderline - 34%, intradermal - 16%, blue nevus - 3.2%; giant pigmented - 2-13%. In this case, congenital formations account for 70%, acquired - 30%.

Melanoma symptoms

At the initial stages of the development of a malignant tumor on healthy skin, and even more so against the background of a nevus, there are few obvious visual differences between them. Benign birthmarks are characterized by:

Symmetrical shape.
Smooth, even outlines.
Uniform pigmentation, giving the formation a color ranging from yellow to brown and even sometimes black.
A flat surface that is flush with the surface of the surrounding skin or slightly evenly raised above it.
No increase in size or slight growth over a long period of time.

Each “birthmark” goes through the following stages of development:

Borderline nevus, which is a spotty formation, the nests of cells of which are located in the epidermal layer.
Mixed nevus - cell nests migrate into the dermis over the entire area of the spot; clinically, such an element is a papular formation.
Intradermal nevus - the formation cells completely disappear from the epidermal layer and remain only in the dermis; gradually the formation loses pigmentation and undergoes reverse development (involution).

What does melanoma look like?

It may take the form of a flat pigmented or non-pigmented spot with a slight elevation, round, polygonal, oval or irregular in shape with a diameter of more than 6 mm. It can maintain a smooth shiny surface for a long time, on which small ulcerations, unevenness, and bleeding subsequently occur with minor trauma.

Pigmentation is often uneven, but more intense in the central part, sometimes with a characteristic rim of black color around the base. The color of the entire neoplasm can be brown, black with a bluish tint, purple, variegated in the form of individual unevenly distributed spots.

In some cases, it takes on the appearance of overgrown papillomas, resembling a “cauliflower”, or the shape of a mushroom on a wide base or on a stalk. Near the melanoma, additional separate lesions (“satellites”) sometimes appear or merge with the main tumor. Occasionally, the tumor manifests itself as limited redness, which turns into a permanent ulcer, the bottom of which is filled with growths. When developing against the background of a birthmark, a malignant tumor can develop on its periphery, forming an asymmetric formation.

A sufficient understanding of the population about the initial signs of melanoma greatly contributes to its timely (in the initial stages) and effective treatment.

Video: How to recognize melanoma?

Stages of development of a malignant tumor:

Initial, or local (in situ), limited;
I - melanoma 1 mm thick with a damaged surface (ulceration) or 2 mm - with an intact surface;
II - thickness up to 2 mm with a damaged surface or more than 2 mm (up to 4 mm) with a smooth surface;
III - a tumor with any surface and thickness, but with nearby foci or metastases to at least one “duty” (closely located) lymph node;
IV - tumor growth into underlying tissues, distant skin areas, metastases to distant lymph nodes, lungs or other organs - brain, bones, liver, etc.

Knowledge of reliable and significant symptoms of the transition of benign formations to an active state is of great importance. How to recognize a malignant formation and the moment of transformation of a birthmark into it? Early signs are as follows:

An increase in the planar dimensions of a previously unchanged or very slowly enlarging mole, or the rapid growth of a newly emerging nevus.
Changing the shape or outline of a pre-existing formation. The appearance of compactions or asymmetry of contours in any part of it.
Change in color or disappearance of uniform coloring of an existing or acquired birthmark.
Change in intensity (increase or decrease) of pigmentation.
The appearance of unusual sensations - itching, tingling, burning, “bloating.”
The appearance of redness around the birthmark in the form of a corolla.
Disappearance of hair from the surface of the formation, if any, disappearance of the skin pattern.
The appearance of cracks, peeling and bleeding with minor injuries (light friction with clothing) or even without them, as well as growths like papilloma.

The presence of one of these symptoms, and even more so their combination, is a reason for the patient to contact a specialized oncology treatment and prevention facility to carry out differential diagnosis and decide how to treat melanoma, which depends on its type and stage of development.

What it is

Melanosis, or melasma, is the formation of coffee-colored pigment spots on the skin.

Pathology most often occurs in women against the background of hormonal imbalance, when the concentration of progesterone and estrogen in the body does not correspond to the norm.

Pigment spots form in women:

carrying a child;
using oral contraceptives;
resorting to hormone therapy during menopause.

Pigment spots are formed under the influence of sunlight. They occur in women living in southern countries. Summer is a period of risk. Increased solar activity provokes the development of pigmentation on epithelial tissues.

Therapy methods

A doctor of appropriate qualifications can determine the type of melasma and draw up a treatment regimen. Having identified the provocateurs of the disease, the doctor selects medications to eliminate the root cause of the pathology and age spots from epithelial tissues.

Drug therapy

To treat melanosis use:

vitamins C, A, E and PP;
enterosorbents - Polysorb;
hepatoprotectors with antioxidant properties - Hepatosan, Sirepar, Heptral, Gepabene, Karsil.

With the development of erythema (excessive redness of the skin resulting from dilation of blood capillaries), antihistamines are used:

Suprastin;
Tavegil;
Zyrtec.

To treat melasma that has progressed to severe forms, corticosteroids are used:

Hydrocortisone;
Prednisolone;
Prednisone.

In case of toxic melasma, the patient is isolated from the source of poisoning. Medicines are prescribed that can restore the functioning of internal organs affected by the effects of poisons. First of all, endocrine organs, kidneys and liver begin to be treated.

Reticular pigmentation is eliminated with local drugs. Coffee stains disappear under the influence of:

hydrogen peroxide - a liquid with bleaching properties;
ointments and creams with retinol - preparations containing vitamin A that can moisturize the skin and restore epithelial cells (Retinoic ointment);
Salicylic ointment - a product that has an exfoliating and brightening effect;
cosmetic creams with photoprotection that prevent the occurrence and progression of pigmentation (Shiseido Urban, Bioderma Photoderm, anti-sun cream from Biocon);
3% citric acid solution, which has a whitening effect.

Cosmetological methods

Skin defects are removed in beauty salons.

Hardware treatment methods are used if the patient has no contraindications and the pigment spots are benign.

Cosmetologists remove darkened areas of skin using the following procedures:

Laser resurfacing. The specialist carefully treats damaged epithelial tissue without affecting healthy areas. The skin in problem areas is smoothed and brightened.
Chemical peeling. During the procedure, damaged, keratinized skin is exfoliated.
Photorejuvenation. The method allows you to cleanse the skin of the dead layer and improve the condition of the epithelium.
Ultrasonic peeling. Pigment spots are cleaned with an ultrasonic scrubber.
Enzyme peeling. Special enzymes are used to remove pigment. The procedure brightens and rejuvenates the skin.
Biorevitalization or mesotherapy. Injection solutions that can whiten the skin are injected into the lesions.