Malignant melanoma: Detecting black skin cancer

Malignant melanoma (black skin cancer) is the most malignant form of skin cancer and is mainly caused by excessive sunlight. Skin changes are among the main symptoms, as black skin cancer is caused by degeneration of the pigment-forming cells (melanocytes) of the skin and mucous membranes. Signs and appearance of the malignant tumor are extremely diverse in terms of shape and color - there are even colorless forms. Bright malignant melanomas are no less dangerous than dark ones. The course of the disease is divided into four stages, according to which the therapy is directed. What symptoms you should look for to detect black skin cancer and how to prevent the tumor.

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Black skin cancer is a malignant tumor (tumor) of the outer skin or mucous membranes. The normal pigment-forming cells are called melanocytes.
The term black skin cancer or melanoma refers only to a specific type of malignant tumor of the skin cells. Every year, it is diagnosed in Germany at about 16,000 people - and rising.
However, skin cancer is understood by professionals as all malignant tumors of the skin cells. Every year, nearly 200,000 new people in Germany develop skin cancer, most of them with white basal cell or spiny cell cancer Popularly, however, the term skin cancer uses simplistic for the rarer, but much more dangerous black skin cancer, the malignant (malignant) melanoma.

What does black skin cancer look like? symptoms

Malignant melanomas occur most frequently in the area of ​​the back, chest or limbs. In men, the trunk is affected preferentially, in women, the lower legs.
Ninety-five percent of all malignant melanomas can be assigned to one of four types, which can be distinguished from one another during physical and histological examination (under the microscope). There are no differences in treatment between the four types.

General appearance of malignant melanoma

The external image of a melanoma can be very diverse, even colorless forms occur.
A malignant melanoma can manifest as a brown to blue-black, pigmented, flat or nodular raised tumor. Occasionally, central (central) parts of a malignant melanoma show regression tendencies; In these cases, pigment-free areas can occur. Even completely pigment-free melanomas can occur - albeit very rarely. One then speaks of amelanotic malignant melanoma. These are generally no less dangerous than dark pigmented melanomas; They are often recognized only in advanced disease stages.

Superficial spreading malignant melanoma (SSM)

The superficial spreading malignant melanoma got its name from the fact that the tumor cells spread out (superficial spreading) on ​​the skin surface for a relatively long time before the tumor grows deep.
The superficial spreading malignant melanoma is the most common type of malignant melanoma in Central Europe with about 60 percent of all cases. The mean age of onset is 50 years. Most commonly, superficial spreading malignant melanoma occurs on the back, chest or limbs. On the skin, one generally recognizes a flat, only slightly raised above the skin level tumor, which can also develop nodular parts in prolonged growth. Superficial spreading malignant melanomas generally show a sharp but irregular (mostly arched) borderline. The color of these tumors can vary between dark brown and blue-black.

Nodular malignant melanoma (nodular melanoma, NM)

A nodular or primarily nodular malignant melanoma is a melanoma that grows from the beginning in the form of a distinctly raised node. This is in contrast to the superficial spreading malignant melanoma, which initially spreads to the sides and eventually forms additional nodular structures at a later date.
About 20 percent of all malignant melanomas occurring in Central Europe belong to the type of nodular malignant melanoma. The tumor usually occurs on the back, chest or limbs. The average age of those affected is 55 years. The skin usually shows a dark brown to blue-black pigmented node. The surface of the knot may be smooth and covered with epidermis, but may also be wet or even break open and occasionally bleed. Following bleeding, the nodule is covered with red to blackish crusts. In comparison to superficial spreading malignant melanoma, nodular malignant melanoma generally grows rapidly into deeper layers of the skin.

Lentigo maligna melanoma (LMM)

Lentigo maligna melanoma develops from a specific precancerous lesion called lentigo maligna (lentigo = lentiform spot, maligna = malignant).
About 10 percent of all malignant melanomas occurring in Germany are lentigo maligna melanomas. Most patients with lentigo maligna melanoma are older than 60 years. Lentigo maligna melanoma or lentigo maligna as a melanoma precursor preferably occurs at skin sites that are particularly exposed to ultraviolet radiation from the sun. Lentigo maligna usually presents as a blurred and irregularly-defined, gray-brown to black, lying in the skin level spot.

Acrolentiginous malignant melanoma (ALM)

The acrolentiginous malignant melanoma is a special form of malignant melanoma that occurs on the hands, feet and mucous membranes.
Affected are especially fingers, toes (especially in the area of ​​the finger or toenail nail) as well as palms and soles, but also mucous membranes such as oral, genital, anal or intestinal mucosa. As a rule, one sees a stain which is at the level of the skin or the mucous membrane and occasionally out of focus, the color of which may vary from light brown to blue-black. In the course of further tumor growth nodular parts may be added, which may bleed under certain circumstances. An acrolentiginous malignant melanoma in the area of ​​the nail bed of a finger or toe nail may be manifest as a brown to black or bluish discoloration below the nail plate.
In Central Europeans, acrolentiginous malignant melanoma accounts for only about 5 percent of all malignant melanomas. The average age of onset is 65 years.

Sunbathing is the main cause of melanoma

The main cause of the increase in disease incidence in recent decades is the widespread sunbathing and the numerous holiday trips to southern countries. Other possible conditions for melanoma formation include conspicuous birthmarks, precancerous lesions such as the so-called lentigo maligna and an accumulation in certain families.
On the one hand, due to the thinning of the protective ozone layer, the intensity of UV radiation in the area of ​​the earth's surface has increased; On the other hand, people's leisure behavior has changed: Central Europeans spend more time in their free time and on holiday than they did 65 years ago. Particularly dangerous are sunburns in areas of the skin such as the back or calves, which are otherwise not exposed to UV radiation.
The skin of these parts is usually protected by clothing from UV radiation. It is therefore not used to exposure to UV light and, for example on holiday in southern countries, is exposed to unprepared radiation. In particular, fair-skinned people with light-sensitive, fair skin are at risk of developing a malignant melanoma years to decades after a severe sunburn . The skin of children is extremely sensitive to light. Although exposure to UVA radiation in the solarium does not cause sunburn, it may also increase the risk of malignant melanoma.

Nävuszellnävi (moles) and malignant melanomas

In about 60 percent of cases, melanoma develops in the region of a long-standing (years or decades) existing nevus cell nevus. Under a Nävuszellnävus one understands a pigment mark ( birthmark, liver spot ), which is composed of roundish pigment-forming cells (so-called nevus cells). Nevus cell naevi may look quite different when viewed with the naked eye. There are both blemishes on the skin level and raised nodules. The visible lesions may be punctate or large.
The color palette ranges from skin colors to reddish-light brown or medium brown to deep black-brown or black. Nävuszellnävi are usually harmless and not to be regarded as a precancer. However, they may be able to develop into so-called dysplastic nevus cell nevi. Dysplastic nevus cell naevi are pigmented lesions with conspicuous structure that can be recognized by the physician during physical or delicate examination and are at increased risk of malignant melanoma.

Family accumulation

About ten percent of all malignant melanomas occur frequently in families, that is, in close relatives of patients with malignant melanoma. This indicates that some people are at an increased risk of developing malignant melanoma due to hereditary predisposition. Frequently, the affected persons or their relatives have numerous pigmented lesions with increased risk of degeneration, the so-called dysplastic nevus cell nevi.
The number of dysplastic nevus cell nevi may range from 20 to over 50 skin lesions. This genetic disorder with the development of numerous dysplastic nevus cell nevi in ​​adulthood and with a significantly increased melanoma risk compared to the average population is also called dysplastic nevus cell nevi syndrome.

Emergence from a precancer

Another skin change that can develop into malignant melanoma over the course of years or decades is the so-called lentigo maligna (lentigo = lens or liver spot , malignant = malignant). This precancer can occur from around the age of 50 and usually manifests itself as a brownish spot in the area of ​​the face. About ten percent of all malignant melanomas arise from a lentigo maligna. About 20 percent of all malignant melanomas, on the other hand, appear on previously unaltered skin.

Diagnosis of black skin cancer

In the first place is in a suspected melanoma, the physical examination of the dermatologist. With the so-called incident light microscopy, the doctor can look at the abnormal findings with a magnifying glass.
In case of further suspicion, ultrasound examinations of the environment and the local lymph nodes are carried out. In addition to the exclusion of possible settlements, it is essential to remove the skin site and examine it histologically. Only then can a statement be made on the final finding.

Physical examination by the dermatologist

In the diagnosis of pigmented lesions the physical examination by the dermatologist comes first. In order to get an impression of the affected person's skin type and not to overlook any further skin lesions requiring treatment (especially malignant melanoma, dysplastic nevus cell nevus), the dermatologist usually asks his patient to undress completely.

Reflected light microscopy (dermatoscopy)

The reflected light microscope, a magnifying glass with a built-in lamp, which is held by the dermatologist to the surface of the skin, offers additional help in the evaluation of pigmentation.

Ultrasound examination of the skin tumor or the local lymph nodes

If the result of the light microscopic examination further confirms the suspicion of the presence of a malignant melanoma, an ultrasound examination of the skin change is carried out.

Investigations on the exclusion of metastases (removals)

In order to clarify whether at the time of diagnosis dislocations are already present in lymph nodes near the tumor or in distant body regions, depending on the estimated tumor thickness, some instrumental examinations are carried out before the operation.

Fine tissue examination

After surgical removal of the skin tumor, the excised tissue is always examined under the microscope by a physician (a pathologist or a specialized dermatologist).

Treatment of malignant melanoma

In malignant melanoma, surgery is the method of first choice. However, chemotherapy , immunotherapy and radiotherapy also play a role.
Regardless of the stage of spread, not only the entire externally visible skin change is cut out with the scalpel, but also usually a seam of externally healthy tissue mitentfernt.

chemotherapy

Chemotherapy in the form of medications (as a tablet or infusion) serves to kill tumor cells.
Chemotherapy can be used as a preventative treatment to kill any remaining cancer cells after surgery, increasing the chances of permanent healing. This procedure has proven to be advantageous, inter alia, for those patients in whom cases of lymph node involvement have already been detected. Chemotherapy in a patient who has no visible cancer cells after surgery (for example, removal of affected lymph nodes) is called adjuvant chemotherapy. Irrespective of this, chemotherapy may be used as a potentially life-prolonging measure in patients in whom melanoma removals can not be completely surgically removed.

immunotherapy

Immunotherapy tries to activate the body's immune system.
Immunotherapy is the attempt to stimulate the body's own defense system to combat the tumor by administering certain substances (interferon alpha, interleukins). In particular, interferon alpha is often used adjuvantly to increase the chances of permanent healing after complete surgical removal of affected lymph nodes.

radiotherapy

Radiation therapy is an adjunctive measure to reduce and eliminate cancer cells in metastases. Radiation therapy uses X-rays and other high-energy rays to kill cancer cells or reduce their size.

follow-up examinations

A patient who has had malignant melanoma removed is generally advised to seek follow-up visits to the dermatologist or a dermatological clinic for a period of ten years.

Black skin cancer can be prevented

The most important preventive measure for malignant melanoma is comprehensive protection against too much sunlight. Regular check-ups on suspicious pigmentation helps to reduce the risk of melanoma development.
In order to prevent the development of a malignant melanoma, consistent protection against UV radiation should be practiced at a young age. Parents have a great responsibility for their children, especially since the skin of children is particularly sensitive to UV radiation.
Childhood sunburns are considered to be a major risk factor for a possible subsequent malignant melanoma disease. In general, it is not recommended to sunbathe extensively. In general, it is recommended to wear bathing clothes and bikinis at home instead of swimming trunks or bikini light clothing that keeps the UV radiation from the skin with long sleeves and trouser legs or a long skirt.

The most important properties of ultraviolet (UV) radiation

There are three forms of UV light: UV-A, UV-B and UV-C. They occur in different proportions in sunlight and in solariums. Because of the potential danger to the skin, it makes sense to know its effects.
UV-A: lower energy (long-wave) than UV-B.
Occurrence: as part of the radiation of the sun as well as in the solarium;
effects:
  • fast tanning
  • premature aging of the skin (wrinkles, pigment shifts)
  • increases the risk of developing malignant melanoma decades later
UV-B: higher energy (short-wave) than UV-A.
Occurrence: as part of the sun's radiation
effects:
  • slow browning
  • sunburn
  • increases the risk of developing malignant melanoma decades later
UV-C: higher energy (short-wave) than UV-A and UV-B.
Occurrence: as part of the radiation of the sun; Due to the filtering effect of the earth's atmosphere, it practically does not reach the vicinity of the earth's surface

Regular check-ups by the dermatologist

In general, moles (including inconspicuous nevus cell nevi) should be checked by the dermatologist about every 12 months. Thus, a possible transformation into dysplastic nevi with the risk of later melanoma emergence can be detected relatively early.
If the healer determines that the development of dysplastic nevus cell nevus (pigmentation with a conspicuous structure) progresses in the case of individual pigment spots, the skin lesions concerned should be removed before the onset of a malignant melanoma.

Regular self-examination

A preventive measure that anyone can perform is regular self-examination. If necessary, the parents (in children) or the life partner can help. In case of increase in size and color change of a pre-existing Pigmentmals relationship in the appearance of signs of inflammation (redness, itching ) as a precaution, a dermatologist should be consulted. A special alarm is oozing and bleeding in the area of ​​the pigment.

 

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