Melanoma

Melanoma is a malignant tumor that arises from melanocytes, cells that synthesize the pigment melanin. This form of skin cancer is characterized by an aggressive course and a high ability to metastasize. Unlike other types of skin cancer, such as basal cell and squamous cell carcinoma, melanoma has a higher risk of progression and reduced patient survival. The disease can occur both against the background of previous nevi (moles) and as a neoplasm on an unfamiliar area of the skin. The main method of treating melanoma is surgical removal, but there are other approaches, including immunotherapy and targeted therapy, depending on the stage and characteristics of the tumor. Detecting melanoma in the early stages significantly increases the chances of successful treatment, so it is important to undergo regular dermatological examinations and monitor changes in the skin.

History of the disease and interesting historical facts

Melanoma has been known to mankind for many centuries, but its scientific understanding and diagnostics have changed significantly. The first mentions of the signs of pigmented tumors can be found in the works of ancient Greek doctors, such as Hippocrates. However, the conscious division of melanoma as a separate entity occurred only in the 19th century thanks to the work of dermatologists and oncologists. It is curious that the term "melanoma" was introduced into medical circulation in 1838 by the French doctor Alfred Leroy. It is noteworthy that at the beginning of the 20th century, melanoma was considered an inoperable disease, and only later, with the development of surgical methods and anatomy, did it become possible to successfully treat this disease. In the 70s of the 20th century, active typing of melanoma began, which led to improved diagnostics and the introduction of new therapeutic approaches.

Epidemiology

The epidemiology of melanoma shows an increasing trend towards an increase in incidence in most countries of the world. According to the World Health Organization, approximately 300,000 cases of melanoma are registered annually. The incidence varies by region, with the highest rates in countries with high solar radiation and white populations, such as Australia and New Zealand. According to statistics, the incidence worldwide has doubled over the past 30 years, and this trend is predicted to continue. It is important to note that melanoma ranks third among all types of skin cancer, and its share among malignant skin tumors is increasing. The survival rate at the first clinical manifestation of the disease is relatively high (85-90%), but in the presence of metastases, this figure decreases sharply.

Genetic predisposition to this disease

Studies show that genetic predisposition plays a significant role in the development of melanoma. The main genes associated with an increased risk of the disease are CDKN2A, CDK4 and BRAF. Mutations in the CDKN2A gene, which regulates the cell cycle, have been found in 20-40% families with a generalized form of melanoma. BRAF genes are key regulators of cell proliferation and survival, and mutations in this gene are found in 40-60% cases of sporadic melanoma. There are also other, less well-known genes, such as MC1R, which are associated with the formation of fair skin and a predisposition to melanoma. The use of genetic testing allows us to identify a risk group and perform earlier diagnosis in people with a genetic predisposition.

Risk factors for the development of this disease

There are several key risk factors that contribute to the development of melanoma, including:

• Intense solar radiation and ultraviolet radiation.
• History of sunburn, especially in childhood.
• The presence of a large number of moles (more than 50) on the skin.
• Family history of melanoma or other skin cancers.
• Diseases that suppress the immune response, such as HIV and some cancers.
• Age: The risk increases with age, especially after age 50.
• Skin type: People with fair skin, red or blond hair, and light-colored eyes are at higher risk.

Awareness of these risk factors is important for the prevention and early detection of melanoma.

Diagnosis of this disease

Diagnosis of melanoma involves a comprehensive approach with an emphasis on clinical, laboratory and radiological methods. The main symptoms of melanoma include:

• Change in the size, shape and color of a mole.
• The appearance of new nevi.
• Itching, bleeding or pain from the lesions.
• Dissimilation of pigment on the skin surface.

Laboratory tests may include general and specific tests, such as tumor biopsy. Radiological examinations (CT, MRI) are used to assess the extent of the process and metastasis. Other diagnostics include dermatoscopy, which allows visualization of changes in skin structures, and photographic monitoring, which helps track changes in moles. Differential diagnosis with other skin neoplasms, such as basalioma and pigmented keratomas, is also important, which requires the experienced opinion of a dermatologist.

Treatment

Treatment of melanoma depends on the stage of the disease and other associated factors. The main method is surgical removal of the tumor followed by histological examination. Pharmacological treatment includes the use of immunotherapy (for example, PD-1 and CTLA-4 checkpoint blockers) and targeted therapy aimed at specific mutations, such as BRAF and MEK. In some cases, especially with metastasis, chemotherapy courses are carried out. Radiation therapy is less effective in melanoma, but can be used for palliative treatment. It is worth noting that further research continues to identify new and more effective treatment methods, individualizing the approach to each patient.

List of medications used to treat this disease

The main drugs used in the treatment of melanoma are:

• Pembrolizumab (Keytruda).
• Nivolumab (Opdivo).
• Dabrafenib (Tafinlar).
• Trametinib (Mekinist).
• Ipilimumab (Yervoy).
• Vemurafenib (Zelboraf).
• Lapatinib (Tykerb), etc.

These drugs differ in their mechanism of action, which allows them to be combined to increase the effectiveness of treatment.

Disease monitoring

Monitoring of a patient with melanoma includes regular checks for recurrence and metastasis. Check-ups may be performed every 3-6 months for the first 2 years after treatment, with the intervals gradually increasing. The prognosis is highly dependent on the stage of the disease at diagnosis: early detection leads to a high survival rate (90% at 5 years), while metastatic melanoma has a significantly worse prognosis, with a 5-year survival rate of less than 30%. Complications may include recurrence of the disease, the occurrence of metastases in other organs, and side effects from the treatment.

Age-related features of the disease

The course of melanoma may vary in different age groups. In children and adolescents, this disease is less common, but can be more aggressive. In middle-aged and elderly people, the risk of developing melanoma increases significantly, which is why diagnosis and treatment become more relevant. Age-related changes in the skin, such as a decrease in the number of melanocytes, can also change the clinical picture of the disease. In addition, in old age, concomitant diseases are important, which can complicate both diagnosis and treatment.

Questions and Answers

• What is melanoma? Melanoma is a malignant tumor arising from melanocytes, with a high risk of metastasis and an aggressive course.
• What are the risk factors for developing melanoma? Risk factors include intense sun exposure, the presence of moles, family history and skin type.
• How is melanoma diagnosed? Diagnosis includes clinical examination, laboratory tests, radiological methods such as ultrasound and CT, and dermatoscopy.
• What are the treatments for melanoma? The main treatment methods are surgical removal, immunotherapy, targeted therapy and chemotherapy.
• What is the prognosis for melanoma? The prognosis depends on the stage of the disease: early detection gives a high probability of survival, while late diagnosis significantly worsens the prognosis.