Melanoma - Black Skin Cancer | Diseases and diagnoses 2023

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Skin cancer: melanoma

Malignant melanoma, also known as "black skin cancer", is the most malignant form of skin cancer and is responsible for more than 90 percent of all deaths from skin tumors. According to Statistics Austria, around 1,500 people develop malignant melanoma every year in Austria. Its danger lies in the high tendency to form metastases in the early stages. Therefore, the earliest possible diagnosis and surgical removal are important. In addition to sensible use of the sun, regular skin self-examinations (at least twice a year) are the best protection against skin cancer. In addition, new therapeutic approaches in recent years have led to a significant improvement in treatment results, even in advanced stages of the disease.

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What are the causes of melanoma?
How can you prevent melanoma?
What are the symptoms?
How is the diagnosis made?
How is melanoma treated?
Whom can I ask?
How are the costs going to be covered?

What are the causes of melanoma?

Melanoma is caused by severe damage to pigment-forming cells in the skin (melanocytes). These cells normally serve to produce the brown melanin pigment after exposure to the sun. It is responsible for getting tanned and is supposed to protect us from damage caused by sunlight.

Sun exposure is the main trigger, but not the sole cause. Melanomas also develop on skin that is not exposed to the sun and on mucous membranes and from certain moles. Tumor formation can also be promoted by toxins, hormones, drugs, etc. Furthermore, immunodeficient people such as AIDS patients and transplant patients are more likely to develop melanomas.

Note Frequent visits to the solarium increase the risk of melanoma. The younger the “consumer”, the greater the potential damage. Therefore, since September 1, 2010, there has been a ban on solariums for young people under the age of 18.

How can you prevent melanoma?

In addition to sensible use of the sun, regular skin self-examinations (at least twice a year) are the best protection against skin cancer. In addition, an annual examination should be carried out by the dermatologist. People with an increased risk of skin cancer should have a dermatologist twice a year. Digital reflected light microscopy can be used to determine whether suspicious skin changes are benign or malignant. With this painless, harmless enlargement process, changes in the skin can also be precisely observed in the further course under standardized conditions.

What are the symptoms?

Melanomas usually develop from a pigment spot over a long period of time. They are brown to deep black tumors of various sizes and shapes. Typical is an irregular appearance with an irregular edge and several colors. Itching, bleeding and inflammation can occur in the area of the skin changes.

How is the diagnosis made?

Melanomas have typical features that make them easy to recognize. The distinction between melanoma and birthmark is particularly relevant. The so-called ABCDE rule can serve as an aid:

A = asymmetry: the birthmarks are round and symmetrical. Melanomas grow more in one direction and are therefore asymmetrical.
B = limitation: the moles are sharply delimited to normal skin in the edge zone. Melanomas show a jagged and irregular boundary to normal skin. Dark colored areas and light skin seem to merge seamlessly.
C = Colorit (color): Birthmarks have a uniform (homogeneous) light brown to dark brown color. Melanomas are characterized by various brown and black or reddish and gray shades.
D = diameter: birthmarks remain the same size for many years after their initial growth phase. Melanomas always increase in size.
E = Enlargement: Melanomas grow rapidly, birthmarks slowly.

The dermatologist can often identify melanoma based on the changes in the skin. A confirmation of the diagnosis is possible by means of digital reflected light microscopy. Sequential digital dermatoscopy and whole-body photography are also used for early detection and follow-up. In addition, there is a range of other imaging methods to choose from, which have shown a high level of informative value in clinical studies (e.g. confocal laser scanning microscopy, electrical impedance spectroscopy, multiphoton laser tomography, multispectral analysis, optical coherence tomography, Raman spectroscopy). If metastases are suspected, computed tomography, magnetic resonance tomography, ultrasound and x-rays are used.

How is melanoma treated?

The treatment of choice is surgical removal of the melanoma with a safety margin. Often a biopsy of the sentinel or sentinel lymph nodes is also performed. If these lymph nodes are healthy, there is a high degree of certainty that no other downstream lymph nodes have a tumor.

With some melanomas, surgery on the tumor alone is not enough. If the melanoma penetrates more than 1.5 millimeters, there is a risk that metastases will occur at a later point in time. Depending on the stage of the disease, there are several ways to improve the results of the operation to improve the chances of recovery or at least to extend the tumor-free interval or survival time.

Immunotherapy: It tries to activate the body's own defenses and thus stop tumor growth or even completely eliminate the tumor. So-called checkpoint PD-1 blockers (e.g. ipililumab, pembrolizumab, nivolumab) are used. Immunotherapy has become more and more important in recent years, as it sometimes leads to significantly better treatment results than conventional approaches.
Chemotherapy: The aim is to reduce the size or regression of cancerous tumors. Medicines (cytostatics) are used, which are supposed to kill tumor cells - with the greatest possible protection of healthy body cells.
New targeted therapies such as BRAF inhibitors dabrafenib and vemurafenib, MEK inhibitors trametinib and cobimetinib) can extend the life of those affected in metastatic melanoma.

An adjuvant therapy is used if no tumor can be detected, but the risk of metastasis is high due to the size of the primary tumor. In the past, radiotherapy and interferons were primarily used; today, immunotherapy is increasingly used.

In the so-called neoadjuvant therapy, systemic therapy is administered before the surgical repair of metastases. Various immune and targeted therapies are possible.

Various combinations of active ingredients are being evaluated for the treatment of inoperable metastatic melanoma.

Numerous studies on new treatment approaches are currently underway. In particular, great hopes rest in the development of tumor vaccines.

Aftercare

Depending on the individual risk, regular check-ups should be carried out over a period of up to ten years in order to detect recurrences and second melanomas at an early stage. After this period, the measures should be limited to a regular self-examination and the annual full-body examination for second melanomas.

Whom can I ask?

If your skin changes appear suspicious, you should contact a dermatologist immediately. Early diagnosis and therapy are important because melanomas detected in good time can be cured well surgically and thus the development of potentially life-threatening metastases can be prevented.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at: