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Symptoms

Melanoma can cause various symptoms, which can vary depending on the stage and extent of the tumor. The most common symptoms include:

  • A change in the shape, size, color or texture of an existing mole (birthmark).
  • The appearance of a new mole, especially in people who already have multiple moles.
  • An irregular border or uneven coloring of the mole.
  • A hardening or elevation of the mole.
  • Itching or pain in the area of the mole.

 

Location

Melanoma can occur in various parts of the body, but most commonly on the skin. It is especially common on areas of the body that are exposed to a lot of sunlight, such as the face, neck, arms, and legs. However, it can also occur in areas that are not normally exposed to the sun, such as the mouth, eyes, or genital area.

 

Diagnostics

Diagnosis of melanoma involves various tests to confirm the presence of a tumor, determine its size and extent, and detect any metastases. These include:

  • Medical history: the physician asks about the patient’s medical history and any risk factors.
  • Physical examination: the physician examines the affected skin area and assesses any changes.
  • Dermatoscopy: This is a special examination method in which the physician uses a dermatoscope (a type of magnifying glass) to view and evaluate the skin change.
  • Biopsy: If melanoma is suspected, a tissue sample is taken and examined under a microscope to make a definitive diagnosis.
  • Imaging: Imaging techniques such as X-ray, CT or MRI may be used to assess the extent of the tumor and any metastases.

 

Therapy

The therapy of melanoma depends on various factors, such as the stage and extent of the tumor, the age and health of the patient, and any concomitant diseases. Basically, there are three treatment options:

  • Surgical removal: if melanoma is detected early, it can usually be completely removed by surgery. Depending on the size and location of the tumor, this can be done on an outpatient or inpatient basis. In some cases, it is necessary to remove a larger area of skin to ensure that all cancer cells have been removed. In advanced melanoma, surgery may also be done in combination with other therapies such as chemotherapy, radiation therapy or immunotherapy.
  • Radiation therapy: radiation therapy may be used in some cases of melanoma, especially if the tumor is inoperable or to treat metastases. In these cases, the tumor is treated with targeted radiation to kill the cancer cells.
  • Systemic therapy: systemic therapy involves drugs that work throughout the body to fight cancer cells. These include chemotherapy, immunotherapy, and targeted therapies. The choice of therapy depends on the stage and extent of the tumor.

 

Course

The course of melanoma depends on several factors, including the stage and extent of the tumor, the patient’s age and health, and any concomitant diseases. Melanoma that is detected early and completely removed has a good prognosis and a high survival rate. However, in advanced stages, melanoma can metastasize and spread to other organs, significantly worsening the prognosis.

 

Prognosis

The prognosis of melanoma depends on several factors, such as the stage and extent of the tumor, the patient’s age and health, and any concomitant diseases. Melanoma that is detected early and completely removed has a good prognosis and a high survival rate. However, in advanced stages, melanoma can metastasize and spread to other organs, significantly worsening the prognosis. The 5-year survival rate is about 90% for stages I and II, 50-70% for stage III, and about 15-20% for stage IV.

 

Incidence

Melanoma is a comparatively rare tumor disease, but its incidence has increased worldwide in recent decades. In Germany, about 24,000 people are newly diagnosed with melanoma every year. Men are affected somewhat more frequently than women. The average age of onset is about 60 years.

 

Risk factors

There are various risk factors that can promote the development of melanoma. Among the most important are:

  • Skin type: people with fair skin and blond or red hair and blue or green eyes have a higher risk of developing melanoma than people with darker skin.
  • Sun exposure: Excessive sun exposure, especially during childhood and adolescence, increases the risk of melanoma. Artificial UV radiation from solarium visits can also increase the risk.
  • Number of moles: People with many moles have a higher risk for melanoma.
  • Family history: if there are previous cases of melanoma in the family, the risk for further cases is increased.
  • Immunodeficiency: People with weakened immune systems, e.g. due to medication or HIV infection, have a higher risk of melanoma.

 

Prevention

The most important measure to prevent melanoma is to protect the skin from UV radiation. This includes:

  • Avoiding overexposure to the sun, especially during midday.
  • Using sunscreens with a high sun protection factor
  • Wearing clothing that protects against UV radiation, such as long-sleeved shirts, pants and hats

In addition, people should regularly examine their skin for changes and seek medical attention if they notice any suspicious changes.

 

Pathogenesis

Melanoma arises from pigment-forming cells called melanocytes, which are found in the skin and mucous membranes. The exact causes for the development of melanoma are not yet fully understood, but there are several risk factors that may promote its development, such as:

  • Excessive sun exposure
  • Fair-skinned, blond or red hair
  • Presence of many moles
  • Familial predisposition

 

Classification

Melanomas are classified according to various criteria, such as the location, appearance, and depth of the tumor. The most important classification systems include:

  • Breslow thickness: Breslow thickness indicates the depth of penetration of the tumor into the skin and is an important prognostic criterion.
  • Clark level: The Clark level describes in which layer of the skin the tumor originated.
  • TNM classification: In addition to the size of the tumor, the TNM classification also takes into account the presence of lymph node metastases and distant metastases.

 

Staging

The stage of melanoma is determined using the TNM classification. The staging is important for the choice of therapy and prognosis.

  • Stage I: Melanoma has a thickness of less than 2 mm and is confined to the skin.
  • Stage II: The melanoma has a thickness of more than 2 mm and is confined to the skin.
  • Stage III: The melanoma has metastasized to lymph nodes.
  • Stage IV: The melanoma has spread to other organs, such as the lungs, liver or brain.

 

Similar diseases

There are several diseases that can cause similar symptoms to melanoma, such as:

  • Nevus cell nevi (moles): Nevus cell nevi are pigmented lesions that are usually harmless. However, in rare cases, they can progress to melanoma.
  • Lentigo maligna: Lentigo maligna is a precursor of melanoma that often occurs in older people. It manifests as a flat, brown or black discoloration of the skin.
  • Basal cell carcinoma: Basal cell carcinoma is the most common skin cancer and usually occurs in sun-exposed areas. It is manifested by a slow-growing, shiny or pearly lesion.
  • Squamous cell carcinoma: Squamous cell carcinoma is also a skin cancer that commonly occurs in sun-exposed areas. It is manifested by a crusted or bleeding lesion.

 

Literature

Hauschild A, Dummer R, Schadendorf D, et al (2013). “Guidelines for the management of cutaneous melanoma”. European Journal of Cancer. 49 (6): 1309-19. doi:10.1016/j.ejca.2012.11.005. PMID 23246215.

Oncology guideline program: S3 guideline Diagnosis, therapy, and follow-up of melanoma, long version 1.0, August 2020, AWMF registry number: 032-024OL.