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Lunares vs Melanoma: pay attention to your skin

Lunares vs Melanoma: pay attention to your skin

Edited by: at 10/10/2023

Melanoma is a malignant tumor of the skin and mucous membranes that originates from pigmented cells of the body, which is curable if it is detected in early stages, but in late phases it can be very dangerous.

Dr. Fernando Cordera González De Cosío

What is melanoma?

Melanoma is a malignant skin and mucous tumor that originates from pigmented cells of the body. These tumors are curable if they are detected in early stages, but in later stages they can be very dangerous. It is essential to know that they appear as moles on the skin, so it is very important to recognize and treat them in time.

Melanoma can develop anywhere in the body, including in areas that are not exposed to the sun, which is one of the main risk factors for contracting this disease.

Melanoma may start with a mole

The diagnosis of melanoma is established by a biopsy, usually excisional, that is, by completely removing the mole with very small margins.. Also, it can be done by puncture, which consists of deep separation of the lesion, making a small hole in the central area of ​​this. The international guidelines do not recommend shaving biopsy (which consists of removing the superficial part of the mole), since with this type of biopsy the information of the depth of the condition is lost, and this is very valuable to decide how it is going to treat the condition.

How to know if a mole is likely to be malignant?

There is a rule that helps determine if a mole is more likely to be malignant and is known as the "ABCDE melanoma":

  • A Asymmetry: A lesion that is asymmetric is more likely to be malignant than a symmetric one.
  • B Irregular borders: A mole that has irregular edges is more likely to be malignant than one with well-defined borders.
  • C Colors: An injury that has two or more colors is more likely to be malignant than one that has only one color.
  • D Diameter: A lesion that measures more than 6 millimeters in diameter (like the gum of a pencil) is more likely to be malignant than one that measures less.
  • E Elevation or Evolution: A lesion that grows upward or sideways is more likely to be malignant than a lesion that does not grow.

Therefore, if someone has a mole with two or more of these characteristics it is generally recommended to remove it, that is, make a biopsy and send it to analysis in pathology. Also when removing it, the progression of a mole or nevus is slowed down, which, at first, may be benign and, with time, may turn into a melanoma.

Risk factors that favor the presence of melanoma

The main risk factor for developing this condition is sun exposure. In addition, people with white skin have a higher risk of melanoma than people with brown skin. Likewise, individuals who develop vesicles or "water bubbles" when exposed to the sun are also at an increased risk of acquiring this disease.

Speaking of the treatment

Once a biopsy is done, it is sent to analyze pathology and the pathologist, who must be an expert in the field, puts several surnames to the melanoma, which include: histological subtype, Clark level (degree of invasion), level Breslow (depth in millimeters), ulceration, mitosis (dividing cells), lymphatic and perivascular invasion, among others. All this information helps determine how the tumor is going to be treated.

After establishing the diagnosis of melanoma, the most important prognostic factor to define the treatment is the depth. There are studies in different parts of the world with thousands of patients, from which the margins that should be used to make melanoma resection have been studied, and the recommendations given are as follows:

  • In situ lesions (non-invasive) are treated with margins of 5 mm.
  • Lesions measuring less than 1 mm deep are treated with margins of 1 cm.
  • Lesions that measure more than 1 mm deep are treated with margins of 2 cm.

Sometimes that treatment is simple and can even be done under local anesthesia in the office. In others, the procedure is performed according to the anatomical site or the indicated margins, it is necessary to carry out the operation in the operating room and, sometimes, local skin flaps or skin grafts are placed to cover the defect.

And what happens with the ganglia

Melanoma is a tumor that tends to go to the lymph nodes, therefore, nowadays, it is recommended to perform a sentinel lymph node biopsy for any lesion that has a Breslow (depth) greater than 0.75 mm.

But, what is the sentinel lymph node biopsy for melanoma?

In the past, doctors surgically removed all the lymph nodes in the area that drained the skin in which the melanoma was (usually the groin or armpit). Now, for more than 10 years now, what the international guidelines recommend is to perform a sentinel lymph node biopsy in which only one or two lymph nodes are removed that provide the specialist with the same information, but the complications that occur are greatly reduced. by removing all the nodes.

The sentinel lymph node biopsy procedure involves injecting a radioactive material and a special blue dye around the skin where the melanoma is. These substances in a matter of minutes migrate to one or two lymph nodes in the lymphatic region, where the skin where the lesion is drained. Then, in the operating room, with a special device that detects the radioactive material, only one or two lymph nodes are identified and removed and sent to analyze pathology.. This procedure indicates if the melanoma has spread to the lymph nodes and this may change the management.

If in pathology it is determined that the ganglion is without tumor, the operation ends. On the other hand, if the ganglion turns out to have malignant cells, doctors infer that other nodes may be involved and, occasionally, it is indicated to remove all the nodes in the area.

The above is a specific technique for the treatment of melanoma that requires special technology and a surgeon oncologist with experience in the realization of it and can not be performed in any hospital. In expert hands, this sentinel node is a simple technique with low morbidity, which provides a lot of information about the stage of the tumor and helps determine if the patient requires additional treatment or not.

The treatment after surgery

Most patients who have melanoma in early stages are cured with surgery and do not require any additional treatment. People who have deeper tumors or nodes positive for melanoma metastases may benefit from receiving other additional treatments.

Previously several chemotherapy agents were tried and proved not to be very useful for the treatment of melanone. However, in recent years, biological treatments have been developed, known as immunotherapy, which have been shown to be more effective and less toxic than systemic chemotherapy.. Additionally, for patients whose lesion has a mutation in the BRAF gene, an agent called vemurafenib is used, which can also be highly effective in treating this disease.

Patient care after surgical treatment

Generally, all patients who have had melanoma require a complete dermatological examination at least once a year. For people who had deeper melanomas, a closer follow-up should be done, by examining the skin and the lymphatic regions every 3 to 6 months.

In addition, if a new suspicious pigmented lesion is detected for melanoma (either a new one or a recurrent one), it should be treated immediately; Since it can be an aggressive tumor.In some individuals it is indicated the performance of an image study called PET (positron emission tomography), in which the whole body is checked and a tumor can be detected in areas of the body that do not They are visible by physical examination.

The prevention first

To prevent the onset of melanoma, people should moderate their exposure to the sun. If one is going to be exposed to the sun, it is very interesting to use sunscreen of at least 15 SPF, also to wear long sleeves, sunglasses and avoid getting a tan. Tanning salons are especially dangerous and should be avoided. Many melanomas originate from moles or nevi that were initially benign and, over time, change, becoming malignant tumors. Therefore, it is very important to be aware of the ABCDE rule, described here.

Go to the specialist

The management of melanoma must be done by doctors specialists in the condition, which includes the review of a multidisciplinary team in which they are involved: a dermatologist, a pathologist, a surgeon oncologist and, on occasion, a medical oncologist and an oncologist radiologist. This with the aim of ensuring its cure, in addition to preventing the disease from passing into advanced stages that endanger life.

It is important to clarify that the treatment of this disease is constantly evolving, as evidenced by the rapid development of immunotherapy agents, which are becoming less toxic and more effective and, therefore, it is very important to treat with a specialist who is up to date with the most current procedures for this condition.

 

 

 

 

Surgical Oncology in Cuajimalpa de Morelos