Lucija Kračun, MD
Specialist of family practise
AAAMED diploma for aesthetic medicine
A lot is written and talked about skin cancer every year because skin cancer is the most common type of cancer in humans. The skin is our largest organ, and some parts of the skin are exposed every day to UV rays and other risk factors involved in the development of skin cancer.
In 2018, 3.604 people were diagnosed with non-melanoma skin cancer in Slovenia. Malignant melanoma accounts for 15% of all skin cancers and accounts for 90% of all skin cancer deaths. About 600 people in Slovenia get malignant melanoma every year. In this article, we will focus on the most dangerous skin cancer – melanoma.
HOW DOES MELANOMA OCCUR?
Melanoma develops in melanocytes – cells that produce melanin. Melanin gives the skin its color. Normally, skin cells develop in a controlled and orderly way – healthy new cells push older cells towards the surface of the skin, where they die and eventually fall off. But when DNA damage occurs in some cells, new cells can begin to grow uncontrollably, and eventually a mass of cancer cells can form. What damages the DNA in skin cells and how this leads to melanoma is not clear. It is likely that a combination of factors, including environmental and genetic factors, causes melanoma. Nevertheless, doctors believe that exposure to ultraviolet (UV) radiation from the sun and tanning beds is the main cause of melanoma.
• Fair skin; light skin means less protection against UV radiation due to a lower content of melanin pigment. People with fair skin, blondes and redheads with light eyes and freckles are significantly more exposed than black people, which does not mean that black people cannot get melanoma.
• A large number of skin moles (more than 50) and atypical moles (dysplastic nevi)
• Sunburn of the skin with blisters (especially in childhood)
• Excessive exposure to UV rays (both in the sun and in solariums)
• People who live near the equator and high in the mountains
• Gender – it is more common in men
• Occurrence of malignant melanoma in the family. If a close relative (brother, sister, parents…) had melanoma, it is more likely that you will get the disease yourself.
• Weakened immune system. People with weakened immune systems have an increased risk of developing melanoma and other skin cancers. Your immune system may be weakened if you take medicines to suppress the immune system, for example after an organ transplant, or if you have a disease that weakens the immune system.
• Xeroderma pigmentosa
WHERE DOES MALIGNANT MELANOMA APPEAR?
Most often, melanoma develops on exposed parts of the skin – hands, face, ears, shins, back…
However, it rarely appears on parts of the body that are not exposed to the sun. The risk of developing melanoma can be limited by reducing sun exposure.
- Melanoma in the eye. Ocular melanoma most often occurs in the uvea and can cause vision changes.
- Melanoma under a nail. Acral-lentiginous melanoma is a rare form of melanoma that occurs under the fingernails or toenails. Also, on the palms and soles. It is more common in black people and Asians.
- Melanoma in the gastrointestinal tract, urinary tract, and vagina, it is very difficult to detect them
UV light, therefore, does not cause all melanomas, especially those that appear on hidden parts of the body that have not been exposed to sunlight. This means that other factors can also contribute to the development of melanoma.
SIGNS AND SYMPTOMS
• A change in an existing mole
• The appearance of a new mole or atypical growing change on your skin
Melanoma does not always arise from a mole, but also as a newly formed change on healthy skin.
Normal moles are round or oval, with clear edges, less than 6 mm in diameter and evenly colored. Most moles begin appearing in childhood.
Most people have between 10 and 40 moles.
The appearance of only these can change over time, and some may even disappear with age.
DIAGNOSIS AND STAGE OF THE DISEASE
The diagnosis is based on the history of changing pigment marks, newly formed marks, exposure to the sun and burns, and dermatoscopic examination of the skin. We establish a definitive diagnosis with a biopsy and histopathological examination of the tissue.
The stage of the disease is determined using the TNM system. In the case of a primary tumor, we determine the depth of invasion according to Breslow and Clark. With further investigations, we determine the presence of macro- or micrometastases in regional lymph nodes and the presence of metastases in distant organs. Based on the tests performed, we determine the stage of the disease and further treatment.
BASICS OF TREATMENT
Treatment of primary melanoma is always surgical – excision of the entire lesion with a sufficiently large safety margin of healthy skin, which depends on the thickness of the primary melanoma. We also treat metastatic lymph nodes surgically. If necessary, the surgical procedure can be supplemented with local irradiation of the tumor site or lymph nodes. There is no standard complementary treatment, but treatment with high-dose interferon is recommended. In recent years, we have available targeted drugs that significantly prolong survival and the quality of survival.
• Avoid the sun between 10:00 and 16:00
Adjust daily activities and sports activities outside this area, even in winter.
• Use sunscreen year-round regularly
Use at least SPF 30 and be sure to apply and reapply
• Wear protective clothing
Use a hat with wide lapels, light dark clothes with long sleeves and sunglasses. Clothing with UV protection, which must be of good quality, is extremely important for children and people who are active outdoors.
• Avoid tanning beds!
• Get to know your skin
Monitor your skin regularly and see your doctor if you notice any changes. A phone on your back can help you take pictures of your skin.
• Oncology Institute, Ljubljana
• Mayo Clinic
• Aleksej Kansky and colleagues: Skin and venereal diseases
• Atlas of Dermatology, Taylor and Francis Group