melanoma | MY SPECIAL DOCTOR

Melanoma: a serious danger to the health of our skin

26 February 20246 January 2024 by MinnieLuongo

Sea or mountains, who doesn’t like the sun in summer? Beware, however, of the negative effects it can have on our skin, especially if it is fair and full of freckles and moles. In fact, the most feared risk is melanoma, which is the third most frequent cancer in Italy under the age of 50.

Its onset is linked to genetic and environmental factors, starting with exposure to ultraviolet rays, of which burns are the effect. Burns are even more deleterious when they involve toddlers and, especially, children of parents with or survivors of melanoma. In fact, these children have a higher risk of developing cancer than the general population.

Prevention

The best prevention is early diagnosis. How? Every adult should observe their entire body surface every 2 to 3 months, and see a dermatologist when a mole changes color, shape, or size, or when a new mole appears. In addition, people with familiarity or many moles should have a checkup once a year. At that time, the dermatologist will evaluate the characteristics of all skin lesions, either with the naked eye or with the help of a noninvasive technique, dermoscopy. This is because melanoma is sometimes not recognizable to the naked eye and can be mistaken for a typical mole.

Everyone should know the “A-B-C-D-Erule,” which is useful for early diagnosis. A mole is suspected when:

A – It is asymmetrical

B – Presents irregular edges

C – Has a varied color: from light brown to dark brown to black

D – Has a diameter greater than 5 mm

E – It presents an evolution: changes in color, shape and/or size of the mole, elevation and the appearance of symptoms such as itching and/or bleeding are all suggestive of malignancy.

We always and frequently apply protective creams, do not stay too long in the sun, remembering that a parasol is not enough to protect us while a T-shirt and hat are useful. We can then enjoy the many benefits of the sun’s rays without risk. And when summer is over, let’s get checked by the dermatologist!

Melanoma: everything you need to know about this disease

25 February 20246 January 2024 by Dr. Nazzaro

melanoma is a malignant tumor that originates from melanocytes, cells that contain the pigment, called melanin, responsible for skin coloration. It can develop in the skin all over the body, but in rare cases it can arise in the mucous membranes, such as the mouth, genitals, and ocular conjunctiva. The incidence of this cancer continues to rise. It is one of the most frequent cancers, with an incidence ranging from 55 per 100,000 population in Australia to 0.4 per 100,000 in Japan. In Italy the incidence is about 6-13 cases per 100,000 subjects.

It is one of the major cancers that arises at a young age and currently in Italy constitutes the third most frequent cancer in both sexes under the age of 49 as more than 50% of melanoma cases are diagnosed by the age of 60, in contrast to other cancers that mainly affect the elderly population. The most affected site is the trunk in men and the lower limbs in women.

The risk factors

Risk factors for melanoma are divided into personal and environmental. As for the former, it plays a moto important role the family history in fact even though inheritance depends on multiple genes, patients with family members with melanoma have an increased risk of developing melanoma, just as it has been reported that individuals with melanoma have a ninefold increased risk of developing a second melanoma. An additional personal risk factor has been described in individuals with phototypes I and II (light eyes and hair, very fair skin), with numerous freckles and frequent sunburn.

As for environmental risks, on the other hand, the most important risk factor is certainly cumulative sun exposure, as well as exposure to artificial UV rays (tanning lamps). Other factors are:

Intense and intermittent sun exposure
Previous sunburns
Exposure to artificial UV radiation, especially if aged <35 years old

Therapeutic strategies

Early stage melanoma is treated surgically. The dermatologist or surgeon will excise the suspicious lesion and, after histologic confirmation of melanoma, margin enlargement surgery will follow. The aim is to ensure a margin of healthy skin around the malignant lesion so as to reduce the risk of local recurrence.

In more advanced stages, however, the oncologist will take charge of the patient and discuss with him or her the treatment strategy to be adopted, most often chemotherapy, explaining any side effects. Chemotherapy is a systemic treatment, that is, it acts on any cancer cells that may be present. Treatment involves the administration of one or more anticancer drugs. Intake is either oral or intravenous, which enters the bloodstream carrying it throughout the body. Chemotherapy can be given in an outpatient setting, at your primary care physician’s office, or at home. This of course depends on the patient’s health condition and prescribed therapy. Chemotherapy is usually chosen as therapy when the melanoma has metastasized.

Melanoma, doubts about generalized screening but all agree on the importance of prevention

16 February 20246 January 2024 by Renato Torlaschi

Because melanoma cases have been steadily increasing, U.S. citizens have been asked to undergo early screening for this most dangerous skin cancer for a few years now. But some dermatologists wonder whether widespread screening of people without symptoms has resulted in overdiagnosis, with loads of anxiety and unnecessary treatments. An account of the ongoing debate was reported on Medscape, the portal dedicated to medical and scientific popularization.

While the number of melanoma cases diagnosed in the United States doubled from 1982 to 2011 and continues to grow, mortality rates have decreased only slightly. From 2007 to 2016, deaths from melanoma fell by 4 percent in adults up to age 50 and 2 percent in those older.

“The large increase in diagnosed melanomas should be associated with a sharp decline in mortality,” argues Ade Adamson, dermatologist and professor at the University of Texas. But this is a very sensitive discussion because we are led to believe that screening healthy people and early detection will save lives, regardless of the type of cancer.”

According to Adamson, the technological advances contribute to the diagnosis excessive, and brings up the example of skin scanning instruments that detect small changes that the eye cannot see: but even for an expert it is difficult, sometimes impossible, to distinguish the malignant lesion of a melanoma from a benign one in its early stages. Damage such as misdiagnosis, overdiagnosis, cosmetic effects due to biopsies, and side effects associated with medications, as well as the inevitable psychological distress for patients, can result.

However, there are those who think differently. Joel Cohen, a spokesperson for the American Academy of Dermatology, believes that early diagnosis is absolutely essential: “intercepting a very small melanoma is something to celebrate.” After all, according to data provided by the American Society of Clinical Oncology, five-year survival rates for people whose melanoma is detected early are 92 percent; however, if the cancer has spread to other parts of the body, the rate drops to 23 percent.

However, experts all agree on one fact: prevention is the first important step in avoiding skin cancer. The American Academy of Dermatology urges everyone to follow a few behaviors: limit sun exposure, especially during the middle hours of the day; wear protective clothing such as wide-brimmed hats, sunglasses, long pants and long-sleeved shirts; generously apply a water-resistant, broad-spectrum sunscreen with SPF 30 or higher, even on cloudy days; reapply sunscreen every two hours; avoid tanning beds; and have your skin checked for new or suspicious spots.

https://www.medscape.com/viewarticle/912697

Melanoma, a new laser detects cancer cells in the blood and may help destroy them

15 February 20246 January 2024 by Renato Torlaschi

In the future, doctors may be able to detect and kill cancer cells with a noninvasive laser . This is promised in a paper published in Science Transitional Medicine, in which researchers at the University of Arkansas Medical Sciences showcased the performance of their innovative laser device, which boasts a 96 percent success rate and 1,000 times greater sensitivity than current technology.
As the authors point out, one of the most frightening aspects of the melanoma is its ability to metastasize early in the progression of the disease, and once metastases have involved distant organs, the average five-year survival rate plummets, from near 100 percent in cases of non-metastatic, early resected cancer, to just 10 to 15 percent.
Therefore, it is essential to eliminate the tumor before it has a chance to spread, and to do this, researchers aim to identify tumor cells released from the primary tumor and circulating in the bloodstream. This is precisely where the new device comes in, a short-pulsed laser that recognizes melanoma cells in the blood vessels near the surface of the body, which heat up slightly because of their darker coloration. The heating activates a small acoustic wave that is then intercepted by the laser’s ultrasound detector, effective enough to detect a single cell present in a liter of blood.
Tested on 28 melanoma patients and 19 healthy subjects used as controls, the laser detected circulating tumor cells in 27 of the melanoma patients and in none of the healthy people.
The device not only detects tumor cells but also appears to be able to destroy them, in a treatment that lasts less than an hour, the safety levels of which remain to be fine-tuned, however. According to the authors, the treatment will probably not be enough to completely eliminate the tumor, but it could be used in conjunction with other treatments to improve its performance. This laser could also be used to monitor the effectiveness of anti-cancer drugs, check for signs of melanoma post-treatment, or take on a preventive role similar to mammography.

Galanzha EI, Menyaev YA et al. In vivo liquid biopsy using Cytophone platform for photoacoustic detection of circulating tumor cells in patients with melanoma. Sci Transl Med. 2019 Jun 12;11(496).

Melanoma cases among young U.S. declined by nearly a quarter in 10 years: information campaigns work

11 February 20246 January 2024 by Renato Torlaschi

Public health campaigns encouraging people to protect themselves from the sun in the United States seem to be paying off, although for now they are only visible in the younger population. In fact, a new analysis found that the incidence of invasive melanoma in the United States has decreased in adolescents and young adults over the past decade, although it has increased in older age groups.

To be fair, the study’s senior author, dermatologist Jennifer Gardner of the University of Washington, Seattle, cautiously told Medscape Medical News that “we don’t know why this trend in melanoma reduction is occurring.”

However, it is a fact that in the U.S. there have been, over the years, campaigns and numerous expert messages relaunched by the media aimed at promoting sun protection starting in childhood and slowly there has been a widespread awareness of the dangers of excessive exposure to ultraviolet rays, which has certainly affected the habits of Americans.

The U.S. data are in line with what we have already seen in Australia, where a reduction in the incidence of melanoma cases has been documented since the 1980s, and again there have been numerous information campaigns.

Jennifer Gardner’s team analyzed data on 988,103 cases of invasive melanoma that had been recorded in two large databases, covering the first 15 years of this century. In particular, it was seen that between 2006 and 2015 the incidence of melanoma decreased significantly, by almost a quarter, among adolescents (aged 10 to 19 years) and young adults (aged 20 to 29 years). In contrast, skin cancers have increased significantly in adults aged 40 years and older: by an average of 1.8 percent per year in both men and women, with particularly pronounced increases in older age groups.

“We know that early childhood sunburn and excessive ultraviolet exposure early in life are a risk factor for the development of melanoma later in life. It is therefore possible,” Gardner explained, “that public health interventions may not have affected the incidence of melanoma in people over the age of 40 because they have been affected by prior exposure. It may be that older people have adopted UV protection behaviors later in life and we have not yet seen the impact of this change. However, to minimize the risk of developing skin cancers, we still strongly advocate that protection should be adopted throughout life.”

Source: Paulson KG, Gupta D et al. Age-Specific Incidence of Melanoma in the United States. JAMA Dermatol. 2019 Nov 13.