Melanoma
Early Diagnosis, Personalized Treatment, Better Life
Melanoma is the most dangerous form of skin cancer, developing from melanocytes—the cells that produce melanin. It can appear anywhere on the face or body, even in areas not exposed to sunlight, such as the palms, soles, and lower limbs.
- Early Diagnosis
• Personalized, Targeted & Advanced Treatments
• Improved Quality of Life
The incidence of melanoma is steadily increasing worldwide. In 2020, 324,000 cases were recorded, while in Greece, 1,313 cases were reported. This type of cancer affects men more frequently, but young women under the age of 30 are also at increased risk.
Melanoma can spread through the lymphatic system or bloodstream to vital organs such as the lungs, liver, brain, and bones. Early diagnosis is crucial to prevent metastasis.
Symptoms
Key signs that may indicate the transformation of a mole into melanoma include:
bleeding, itching, crust formation, inflammation, changes in color or size, asymmetry, multicolored appearance, redness, or increased sensitivity.
Types of Melanoma
Superficial Spreading Melanoma
Accounts for about 70% of melanoma cases and often appears on women’s legs and men’s backs. It is typically found in individuals aged 30–50 years. It is characterized by flat or slightly raised lesions that evolve gradually. If not treated, it may progress to a more aggressive form, such as nodular melanoma.
Nodular Melanoma
This type represents about 20% of cases. It appears as blue-black or purplish nodules that grow rapidly and may spread before diagnosis. It is more aggressive than other types, making early detection critical.
Lentigo Maligna Melanoma
This type mainly appears on areas with chronic sun exposure, such as the face. It progresses slowly and often resembles large freckles with irregular shape or color. It is more common in older adults.
Rare Forms of Melanoma
- Subungual Melanoma: Found under the nails, on palms, or soles.
- Ocular Melanoma: Develops in the choroid of the eye.
- Mucosal Melanoma: Located on mucous membranes such as the mouth or vulva.
- Internal Melanoma: Rarely occurs inside the body.
High-Risk Groups for Melanoma
- Fair-skinned people: Especially those with red or blonde hair, blue or green eyes, and skin that doesn’t tan (Fitzpatrick type I).
- Individuals with many or atypical moles: More than 50 moles with unusual features (dysplastic nevus syndrome).
- History of sunburns: Those who have had severe sunburns or prolonged sun or tanning bed exposure.
- Familial or personal history: People with a history of melanoma or skin cancer themselves or in their family.
- Weakened immune system: Individuals with AIDS, lymphoma, organ transplants, chemotherapy, or prolonged sun exposure.
Awareness of these factors is the first step toward early prevention and diagnosis.
Diagnosis
Diagnosis begins with a thorough medical history, focusing on any familial predisposition. Clinical examination and dermoscopy (simple or digital) are performed, along with mole mapping.
If a suspicious mole is found, it is removed and examined via biopsy, which confirms malignancy and determines the disease stage. The specialist physician then recommends the appropriate treatment, tailored to the patient’s needs.
The ABCDE Rule helps in assessing suspicious moles.
Key features to watch for:
- Asymmetry: Two sides of the mole are not symmetrical.
- Border: Irregular or blurry borders.
- Color: Variety of colors like brown, black, blue, or red.
- Diameter: Usually larger than 6 mm.
- Evolving: Changes in size, shape, color, or new symptoms like itching, bleeding, or pain.
Treatment Options
Surgery is the main treatment for most melanoma cases in stages 0, I, and II.
For Stage 0 melanoma, which is confined to the epidermis, treatment involves local excision under local anesthesia, often requiring no further intervention.
In Stages I and II, where the melanoma is deeper but hasn’t spread to lymph nodes or distant organs, treatment includes removal of the primary tumor and potentially nearby lymph nodes, depending on the results of the sentinel lymph node biopsy. If lymph node involvement is confirmed, lymph node dissection follows.
In Stage III, when melanoma has spread to lymph nodes or surrounding tissues, a combination of surgical removal and drug or radiation therapy is required.
In Stage IV, where melanoma has metastasized to distant organs, systemic treatment is recommended, such as immunotherapy and targeted therapy. Surgery and radiotherapy may be used to relieve symptoms.
Immunotherapy boosts the immune system to fight cancer cells, while targeted therapies focus on genetic mutations in melanoma.
Researchers are developing new treatments to improve prognosis and outcomes.
An innovative mRNA-based vaccine for melanoma is in clinical trials and may offer preventive or adjunctive treatment even in early stages of the disease.
If necessary, interferons or radiation may be administered to reduce the risk of recurrence. In more advanced stages, chemotherapy or immunotherapy may be required.
Melanoma follow-up should continue for at least 10 years with regular medical visits.
Prognosis depends on the stage and spread, with early diagnosis significantly improving life expectancy.