Melanoma in general
Malignant melanoma is a type of skin cancer that develops from pigment-producing cells called melanocytes. Melanomas typically occur in the skin but may occasionally develop in other tissues such as the mucosa of the gastrointestinal tract and the anogenital area, in the eye, and on the meninges.
Melanomas tend to spread early to local lymph nodes and later to more distant organs such as the liver, the lungs, and the brain. While people with disseminated melanoma have a poor prognosis, localized melanoma (that is diagnosed early) has a 5-year survival rate of about 99 %. It is therefore important that melanomas be diagnosed and treated in their early stage.
How common is melanoma in Slovenia and abroad?
Each year, 31.5 per 100,000 people in Slovenia are diagnosed with malignant melanoma. This means that about 600 Slovenians are confronted with this diagnosis each year. Compared to the European average, which is 23.0 cases per 100,000, the disease burden is therefore high in Slovenia. In terms of mortality (6.1 per 100,000), Slovenia is in second place in Europe, closely behind Norway. In recent years, rates of diagnosis have been increasing dramatically, making melanoma the 6th most common form of newly discovered cancer.
Course of the disease
Melanomas can develop anywhere on the skin, not only on parts that are exposed to ultraviolet (UV) radiation. In women, they typically develop on the legs while in men a common site is the back. The first sign of a new melanoma is generally the appearance of a new mole or freckle on the skin. About 70 % of melanomas appear “de novo”, meaning they arise on previously healthy skin. Only a small proportion of melanomas develops from pre-existing moles.
Typically, melanomas initially grow radially after which they progress into a vertical growth phase. The depth of the melanoma at the time fo diagnosis is an important predictor of the disease’s outcome. When diagnosed, melanomas can still be small in size or they can be up to a few centimeters in diameter. Late in the diseases’ course, the mole may start to ulcerate, bleed, and itch.
Who is most affected?
Melanomas most frequently occur in middle age, but can affect younger people too. Globally, men are about 1.5 times more likely to be diagnosed with a melanoma, but in Slovenia, they occur more frequently in women. Most affected are people with a lighter complexion, who have been exposed to ultraviolet radiation, especially during childhood and early adulthood.
People who have been previously diagnosed with melanoma, as well as people with a greater number of atypical skin lesions, people who receive immunosuppressive medications, and people with a positive family history, are also more susceptible to developing melanoma.
Prevention and diagnosis. What do I need to look out for?
While there is no certain way of preventing melanoma, you can take measures to lower your risk of developing melanoma and other skin cancers. Avoiding direct exposure to sunlight between 10 am and 4 pm is most effective. When exposure cannot be avoided, it is recommended that you wear light, long-sleeved clothing and use a hat. Sunscreen with a sufficient SPF (sun protection factor) should also be regularly applied to any bare skin.
One of the most important elements in melanoma prevention and detection are monthly skin exams to check for new or changing skin spots or moles. You can perform the exam alone or with the help of someone else. It is important to also check less easily visible areas such as your scalp and your back. When examining your skin at home, look out for A-B-C-D-E sings.
If you notice any new spots or freckles on your skin or notice that existing moles have begun to change in size and appearance, consult with a medical professional.
Dermoscopy and its role in medical practice
Whole-body dermoscopy is the process of capturing images of a patient from multiple angles in order to obtain a full scan of the patient’s skin. These images can then be stored in a database so they can be compared between visits. The goal is to determine which moles and other skin lesions changed and evolved in the intervening period. The procedure is therefore most useful in tracking and monitoring a patient’s skin and not directly in diagnosing melanoma. Rather, whole-body dermoscopy presents a useful tool for dermatologists to focus their attention on specific lesions.
When marked evolution between doctor’s visits is observed, further examinations may be necessary. Your dermatologist may decide to further inspect the mole with a handheld dermatoscope so as to see the mole’s microstructure and decide if excision or biopsy is necessary.
