Diagnosis, therapy and prognosis of melanoma
Synonyms in a broader sense
Malignant melanoma, skin cancer, dermatology, tumor
English: melanoma
definition
Malignant melanoma is a highly malignant tumor that quickly metastasizes to other organs. As the name suggests, it starts from the skin's melanocytes. Almost 50% of all melanomas develop from pigmented birthmarks. However, it can also arise "spontaneously" on completely inconspicuous skin.
Diagnosis of melanoma
The earlier that Melanoma is recognized, the better the prognosis. Therefore should be a regular Skin cancer screening be performed. Melanomas that are discovered before they can metastasize to other organs and that can be completely surgically removed are considered cured.
Hence, from time to time you should focus on changing yourself Moles or Birthmarks investigate.
When making a diagnosis, the ABCD rule proceeded. You can find out more about this in the section "Types and symptoms of melanoma“Read.
Noticeable are spots that are not evenly round or oval in shape. The boundary of a time should be sharp and regular. Paintings that look washed out or have frayed edges should grab your attention.
If a birthmark has several shades, it should be watched closely. Particularly dark spots also require observation. If the size is more than 5mm, should Birthmarks in the eye be kept.
If a melanoma is suspected, usually no biopsy (Tissue sample) taken. This should be avoided because of the premature metastasis it causes, so they are completely removed if suspected.
Read more about the topic here biopsy
Staging / staging
Staging is the division of the tumor into stages. There are various criteria for this:
- Penetration depth, tumor thickness
- For primary melanomas> 1mm: lymph node biopsy
- To detect distant metastases: physical examination, imaging tests (ultrasound, MRI, X-ray, etc.)
- Possibly. Determine tumor markers in the blood
The depth of tumor penetration is determined depending on the affected skin layers. They are divided into Level I to Level V.
The absolute maximum tumor thickness is determined with a magnifying glass and is of great importance in the surgical removal of the tumor. A certain (depending on the tumor thickness) safety margin must always be maintained. For example, if the tumor is between 1 and 4 mm thick, healthy tissue is removed within a safety distance of 2 cm from the tumor. This prevents the development of new tumors in the same place.
In half of the cases there are metastases in the surrounding lymph nodes. In 25% of cases, distant metastases in other organs occur first. In principle, any organ can be affected. Mainly, however, are affected:
- Lymph nodes (60%)
- Lungs (36%)
- Liver (20%)
- Brain (20%)
- Bone (17%)
Therapy melanoma
The first measure the primary tumor should be removed completely and with an appropriate safety margin. The treatment of malignant melanoma depends on the stage in which the tumor is.
- Stage 1:
- Removal of the primary tumor
- Checks for 10 years (incl. Ultrasonic the lymph nodes)
- Stage 2:
- like stage 1
- PLUS Lymph node biopsy
- Stage 3:
- like stage 2
- PLUS Removal of the lymph nodes and metastases
- PLUS chemotherapy (Dacarbazine) and immunotherapy (interferon?)
- Stage 4:
- like stage 3
- PLUS Palliative therapy (relieve pain, etc.)
In stage 3, for example, with ?-Interferon treated. Interferons are the body's own antibodies. The best known effect of interferons is the defense against viruses. They also influence the growth, i.e. the division and multiplication of cancer cells.
Chemotherapy drugs are used when the tumor has already spread, i.e. metastases are present. These drugs work specifically on cells that are dividing rapidly. It is precisely this rapid growth that characterizes everyone Tumor cells out.
Prophylaxis melanoma
To prevent the Skin cancer is the right one for people with fair skin Sun protection very important. See: sunburn
Even if you have many Birthmarks you should avoid too much sun. Using the right sunscreens with sufficient high sun protection factor can you help prevent it. By covering your skin with sufficient clothing, you also protect your skin from the sun's rays, because at some point even the sun cream will no longer be effective.
Caution is required, especially with small children.
If you have a large number of birthmarks, you should regularly see a dermatologist (Dematologist) must be visited for control.
forecast
For the Prognosis of melanoma several factors play an important role.
The Tumor thickness, the metastasis and the localization (Place of occurrence) of the primary tumor are important.
Melanomas on the arms and legs have a better prognosis than melanomas on the trunk. This is due to the fact that metastasis of melanoma of the extremities can only occur in one side.
Melanomas are with the help of the TNM classification assigned.
The T in this case stands for the Penetration depth of the tumor that N denotes the Lymph node involvement (N0 = no lymph node involvement, N1 = at least one lymph node involved) and M. stands for the presence of Distant metastases (M0 = no distant metastases, M1 = distant metastases present).
Melanoma survival rate
There is also the American classification AJCC which should be illustrated in the table below with the respective 10-year survival rate. This value indicates how many patients are alive after 10 years of the disease.
| stage | How is the tumor characterized? | 10 year survival rate |
|---|---|---|
| I. |
Tumor thickness <1.5 mm Ø lymph node involvement (N0) Ø distant metastases (M0) |
> 90% |
| II |
Tumor of any thickness M0 Ø lymph node involvement |
> 43% |
| III | Tumor any thick lymph node involvement M0 | > 19% |
| IV | Distant metastases (M1) | 3% |
