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"In 90% of cases of early melanoma, the patients are cured completely", professor Konstantin Titov of RUDN says
"In 90% of cases of early melanoma, the patients are cured completely", professor Konstantin Titov of RUDN says
May 20 is the world day of melanoma diagnostics. Until a few years ago, this shocking diagnosis meant, in most cases, that the patient was doomed. Melanoma is very aggressive: it progresses quickly and actively metastasizes. Professor Konstantin Titov, the head of the Department of Surgery and Oncology of the Department of the Continuous Medical Education of the Medical Institute of RUDN, the head of the Department of Cutaneous and Soft Tissue Tumors of A. S. Loginov Moscow Clinical Research Center, spoke about the methods of self-examination, the time to consult a doctor, and the novel methods in the treatment of melanoma.

It is not only about moles

Melanoma is a malignant tumor that develops from melanocytes, which are cells responsible for the production of dark pigment in the skin. People believe that melanoma always develops from a nevus (mole). However, only one in five melanomas is formed in the area of a mole. In 80% of cases, the tumor occurs spontaneously on the unchanged skin of the body and face, as well as on the palms, feet, and even under the nails. People often say that a new “mole” appeared, referring to a neoplasm.

However, not every growing mole or another skin defect turns out to be a melanoma. There are many benign neoplasms that do not require radical intervention, for example, papillomas or warts.

A dermatologist will examine moles and other suspicious skin areas under multiple magnification with a simple and informative method of skin examination called dermatoscopy. If the doctor performing dermatoscopy notices signs of growth and inflammation, he will refer the patient to an oncologist. who will then take further decisions.

The early stage

The good news is that early forms of the disease are completely curable in 90% of cases; the treatment includes a local surgical excision of the tumor under local anesthesia. The surgery must be performed by an oncologist. This is an extremely gentle minor-scale intervention. The surgeon removes the nevus itself and an area of 5-10 mm around it with the skin and the subcutaneous tissue. If the results of the tests confirm melanoma, the scar is also removed. Never try to remove the neoplasm on your skin without consulting a doctor. In this case, the destruction of the mole with a laser or pharmacy products, or freezing it with liquid nitrogen is unacceptable. First, the removed tissue must be sent for histological examination, which will show whether the process is benign or malignant. Second, laser rays or liquid nitrogen cannot penetrate the skin to the required depth to remove the affected tissue completely.

Novel methods of treatment

In Russia, patients often visit a doctor later than they should. Approximately 20% of patients with melanoma are diagnosed with stage III–IV of the tumor process at the initial examination. In this case, the surgery is more extensive and involves the tumor itself and the lymph nodes of the affected area. And then, until 2012, the patient had to undergo chemotherapy, a method which is not effective enough against melanoma, and many patients died within the first year of treatment.

In 2019, targeted and immune therapy medications were added to the official recommendations for the treatment of melanoma. These methods mean that today melanoma patients who would have been doomed even 7 years ago, survive and have every chance of a long life.

How do they work? First of all, the molecular/genetic type of the tumor is determined. In half of cases, a mutation in the BRAF gene is detected in the removed melanoma. The mutation triggers the process of uncontrolled cell division in the tissue, resulting in melanoma.

Targeted therapy influences the genetic component of melanoma, so it is effective only if a mutation in the gene is present. In Russia, two monoclonal antibodies medications have been registered that interrupt the pathological signal for cell division.

The second strategy is immunotherapy. Medications from this group help the immune system better recognize tumor cells. They are called immune checkpoint inhibitors. The destruction of sick cells is achieved not directly, as in the case of chemotherapy, but through the activation of the immune system cells. It is activated under the influence of the new medications and attacks the tumor.

The trigger mechanism

The condition is hereditary only in 10% of melanoma patients. If a member of your family had melanoma, you can visit a geneticist and have a blood test for genes predisposing to melanoma. This test is now offered in major dermatological and cancer clinics.

9 out of 10 melanomas are the result of excessive sunbathing on the beach or in tanning beds.

Even a single severe sunburn followed with redness, blisters and temperature doubles the risk of melanoma. For the person who got sunburnt twice, the risk is tripled. Do you get sunburnt every summer? Be especially attentive to your body.

Melanoma often develops 20 to 30 years after active tanning. It doesn’t matter whether the person got tanned on the beach or at a bronzing salon. It is not a coincidence that the onset of the disease most often occurs at the age of 50 to 55.

Sunscreens may be harmful

According to statistics, a global increase in new cases of melanoma is registered every year. What is the reason? Experts have several versions. One of them is that the ozone layer continues to deteriorate and it protects us against UV radiation worse and worse. The sun is really becoming more agressive.

Another hypothesis is that sunscreens may trigger cancer.

The physical UV absorbers that reflect and disperse solar radiation, which are zinc oxide and titanium dioxide, and the chemical UV filters may be dangerous for the skin.

In addition, people who believe in the reliable protection of the sunscreen tend to spend more time in the sun and receive increased doses of dangerous radiation.

The best way to protect yourself against melanoma is to give up tanning at all. This is especially true for people who have fair skin, freckles and moles.

Everyone, regardless of the color of their skin and hair, must follow the rules for limiting exposure to sunlight. It is relatively safe to sunbathe in the morning before 10:00, and later during the day, after 16:00.

Do not forget about regular self-examination based on the ABCDE principle, which refers to evaluating such parameters of the nevus as: A (asymmetry), B (border), C (color), D (diameter), and E (evolution).

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