Skin cancer - Melanoma

GENERAL INFORMATION ON MELANOMA

Melanoma is a malignancy, whose most common site of localization is the skin. The incidence and mortality of this cancer are increasing worldwide.

The diagnosis of melanoma is essentially clinical use of an appliance, the dermatoscope, allows for a screening of pigmented lesions of skin and thus preventing the development of melanoma.

Melanoma is a cancer which if not diagnosed and treated early can be very dangerous and difficult to cure.

Every year in Italy about 35,000 people develop melanoma and about 7,300 die from it.

If detected early, melanoma can be treatable, and 'a cancer that originates in melanocytes (skin cells that contain pigment called melanin); Melanoma is formed by melanocytes transformed into cancer cells, melanoma has a high ability to metastasize.

The lesion can appear suddenly on healthy skin or may arise from a preexisting nevus; locations most at risk are those generally more sun-exposed (the trunk for men and legs for women), the strongest risk factor known is the fact 'sun exposure, especially for those of fair skin or red hair (cd phototypes at risk), some large congenital nevi may lead to an increased risk of developing melanoma, other risk factors are:

• have more than 50 in
• having had sunburn in childhood
• have a family history of melanoma

Some rules can help to recognize a melanoma from a nevus quiet:

• A progressive change the appearance and the size of a mole
• The asymmetry and irregularity of the margins of the lesion
• The color is not uniform (this is varied)
• Any spontaneous bleeding (not due to trauma) of a pigmented lesion of the skin

The examination dermatoscope:

The skin is observed with an instrument called dermatoscope (or microscope epiluminescence). The latest equipment generation (Videodermoscopy polarized light) allow the examination of pigmented lesions with high resolution, enabling the recording of images acquired by using the so-called follow-up (controls and minitoraggio over time), the device allows you to highlight any aspects of the nevus, not visible to the naked eye, which may allow the diagnosis of melanoma.

All nevi may safely be removed surgically, in addition, the removal of a suspicious lesion is the only way to find out early if it is a melanoma and then save the life of the patient.

In the early stage melanoma is curable with adequate surgical excision of the lesion, in some cases may also be necessary to remove one or more regional lymph nodes after being located with an appropriate exam (SLN).

The final diagnosis is made with histological examination by pathological anatomy, histology Based on the result, the oncologist will then decide on the necessity of having to also perform adjuvant therapy with interferon, which may vary depending on dose or duration of If, after surgery, the patient should be included in a program of clinical and instrumental (different from case to case) for at least 10 years.

Time recovery and prognosis

In case of removal of melanoma in its early stages (stage 0 and 1) the healing is quick and without sequelae, with a 5-year survival rate of 100% ° for upper stages, the prognosis is in the thickness of the lesion histologically. I

melanoma patients undergoing surgery should also be followed up with outpatient established timetable, depending on the thickness and histologic staging Home, for at least 10 years after diagnosis, and periodically subjected to radiographic examination and pulmonary lymph nodes and liver ultrasound, in selected cases it will require a total body CT scan or a CT-PET (Positron Emission Tomography), as required by Italian guidelines and international melanoma.

After a few years after the pat. function of melanoma, if free from disease, may eventually be subject to correction scarring of the residue, especially in delicate areas such as the face.

Removing skin cancers and congenital giant nevi

Malignant tumors of the skin (basal or squamous cell epitheliomas, sarcomas, etc.) require different surgical procedures depending on the type, place of occurrence and their extent, ranging from simple removal and direct suture, skin flaps in proximity, skin grafts or plastic real reconstructions in the case of melanoma, as well as a removal with safety margins, in some cases (thicker than an inch or more of the third level) is required the search for the so-called sentinel lymph node to see if the melanoma has already reached the lymph system, this procedure requires a hospital as an outpatient preceded by an examination called lymphoscintigraphy, nuclear medicine examination carried out in the same day or the day before, with very high precision that allows to identify the lymph node that receives lymph from the region of melanoma to be able to remove and then analyze it.

Giant congenital nevi should come to the attention of the plastic surgeon as soon as possible, in some cases it may be already in fact indicated a removal first days of life when the nevus is still localized in the surface layers of the skin. the possibility of removal of these large pigmented lesions are different: it goes by excision and grafts taken from healthy areas thin, and excision repair with skin grafts, previously healthy expanded (dilated gradually) with skin expanders. The complete removal, sometimes it can take many actions and many years of treatment, the minimum residual pigmentation may remain after the above procedures, can be removed with a laser treatment, which will also permanently remove any loose hairs, often present in these lesions.