Melanoma of the skin: symptoms, therapy and prognosis

What does melanoma look like? The diagnosis

A birthmark that changes can be a problem, but not all changes are problematic.
A nevus can form, enlarge or thicken, but remain only a nevus.

The ABCDE rule summarizes suspicious changes in the nevi that may indicate melanoma:

• Asymmetry: one half of the nevus is different from the other.
• Limitation: the stain has irregular or jagged edges.
• Colorit: the birthmark has different and differently distributed colors or has a completely different color than the rest of the spot.
• Diameter: the mark is larger than 6 mm.
• Evolution: the birthmark changes shape, color and surface in a short time.

These changes must be kept under constant observation.

At first, melanoma appears like a flat or slightly raised outgrowth. It can have different colors, from:

• black
• brown
• grey
• pink
• white
• blue.

Often the melanoma edges are:

• blurred,
• asymmetric
• can bond with the skin in the healthy environment.

In some cases, melanoma may bleed.

Examination of the nevus
Anyone can examine a birthmark at home:

• with a large mirror (for example, for the armpits),
• with a little game (such as to examine the genitals),
• a second persona can photograph the back with a camera or mobile phone.

However, a visit to a dermatologist is essential because:

• one may have difficulty correctly judging a birthmark;
• the dermatologist checks the moles regularly in order to be able to determine a later evolution.

Symptoms of melanoma

Usually, melanoma originates in the uppermost layer of the skin, but it can quickly infiltrate into the depths of the skin layers.
Then it spreads over:

• Bloodstream
• Lymphatic system.

Most often, metastases are formed:

• on the skin,
• in the lungs,
• in the brain,
• in the liver,
• in the bones.

It can cause itching on the skin, ooze or bleed, but it can also be completely asymptomatic.

Treatment of melanoma and pharmaceuticals

The preferred treatment depends on:

• stage of the tumor,
• age of the patient,
• state of his general health,
• personal privileges.

Treatment of melanomas at an early stage
Usually, therapy in the early stages of melanoma is carried out by surgical removal. One can completely remove a very thin melanoma during the biopsy or surgical procedure (called excision).
In such a case, it does not require further therapy.
In the opposite case, the surgeon removes:
1. the tumor, 2. a small strip of skin at the edge of the melanoma,

3. a layer of tissue under the skin.

In patients with early-stage melanoma, a single operation may be sufficient.
After removal of the in situ melanoma, the patient must undergo at least one follow-up examination per year.

Treatment of metastatic melanoma

If the melanoma has spread beyond the skin area, the therapy may include:

Surgical intervention to remove the sentinel lymph nodes, if the melanoma has spread to the neighboring lymph nodes.
Further treatments before or after surgery may be advised.

Chemotherapy. Chemotherapy involves some drugs that destroy the tumor cells. You can:

• intravenous
• oral
• in combination in both forms.

Chemotherapy is a systemic treatment: it spreads throughout the body.
Chemotherapy can also be given in limited regions (locoregional chemotherapy).
The medicine is injected into a vein of the arm or leg with melanoma or metastasis, in a procedure called isolated limb perfusion.
This technique prevents blood circulation of the arm or leg to other areas of the body for a short time. In this way, the chemotherapeutic drugs go directly to the melanoma and not to other organs.

Radiotherapy. X-rays are used to kill tumor cells. Radiotherapy is only useful as an initial treatment of melanoma. Sometimes this can reduce the symptoms of melanoma that has spread to other organs.

Immunotherapy. Immunotherapy stimulates the immune system to help the organism eliminate tumor cells.
This therapy is based on substances produced by the body or those similar to them and produced in the laboratory. The biological therapy used to treat melanoma includes:

• Interferon
• Interleukin-2.

Targeted therapy. Targeted therapy is carried out with drugs that target specific signals in cancer cells.
In this way, the drugs limit the growth and spread of tumor cells.
Currently, the following drugs are used for this therapy:

• Ipilimumab (Yervoy)
• Vemurafenib (Zelboraf)

These medicines are part of the targeted therapy approved for the treatment of advanced inoperable or metastatic melanoma.
The targeted therapy is only effective in melanoma caused by a specific genetic mutation.

Experimental therapy for melanoma

Research into some treatment options for melanoma concerns:

• • New combination therapies. For example, combinations of:
    – chemotherapy, – immunotherapy, – targeted therapy,

    – radiotherapy.

    However, the combination of several treatments can cause serious side effects.

• New targeted therapies. For example, targeted drugs that block the growth of melanoma by destroying small blood vessels have been successful.
  These blood vessels bring nutrients to the melanoma and help the tumor cells spread throughout the body.
  A drug that can block this process helps keep melanoma small and localized.
• Vaccination. The therapy, which consists of a vaccination against melanoma, could bring altered tumor cells into the body to stimulate the activity of the immune system.

Life expectancy of a patient with melanoma

Melanoma is the rarest form of tumor in the skin.
It represents 75% of deaths from skin cancer. The survival rate is high if the diagnosis is made in the early stages of the tumor.
However, survival decreases in later stages of the disease, where treatment options are limited.
The prognosis for the final stage is the worst of all, with a 5-year survival rate less than 20%.
Stage IV in this tumor is characterized by the spread of cancer cells into:

• distant lymph nodes,
• other organs (lungs, brain).

Since this is the final stage for the cancer:

• therapy is limited,
• life expectancy is low.

Nevertheless, one must not give up hope.
Life expectancy improves if therapy helps to limit the spread of the disease and if the surgical procedure is successful.

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