Melanoma is a skin condition which has steadily increased in the past 20 years.
- antecedents of melanoma
- presence of atypical naevi (beauty spots)
- number of naevi removed
- skin type
- family history of melanoma
- exposure to the sun
Melanomas occur in the younger section of the population and are mainly linked to antecedents and to exposure to the sun. This can be contributed to changes in life style (open-air sport activities, sun holidays,...)
This is a more aggressive form of the disease and if it is not detected and treated at an early stage it may lead to secondaries (bone, liver, brain,…) and can be lethal.
1. I am very fair-skinned, have freckles and very blond or red hair.
2. I am very sensitive to the sun, burn easily and do not tan or tan with great difficulty.
3. One of my family members has had melanoma or another form of skin cancer.
4. I have a lot of birth marks, large birth marks (>6mm), irregular shaped birth marks or birth marks of different colours.
5. I used to live or am living in a very sunny country.
6. I am often exposed to the sun: outdoor work or hobbies, sunbathing, regular use of sun beds
A melanoma usually presents itself as a brown or black mark, polychromatic corresponding to the A,B,C,D rule.
A: Asymmetry :
the mark does not have a symmetric shape.
B: Boundaries :
the mark has irregular boundaries.
C: Colour :
benign naevi have a homogenous brown colour, and malignant marks usually contain a mixture of brown and black pigments.
D: Diameter :
any rapid enlargement of the mark (+ 6mm) is suspect.
E: Rise :
thickening of the cutaneous spot in the shape of a nodule.
Other symptoms such as ulceration, bleeding, thickening or a small nodule in or under the brown or black mark require special attention.
Examination by means of a dermoscope allows the dermatologist to properly study the mark and to examine the melanin. On the basis of this examination, the suspect marks will be removed.
The biopsy and anatomo-pathological investigation will confirm the diagnosis.
Just as women under the age of thirty are advised to participate in an early breast cancer screening program and men from the age of fifty are advised to participate in prostate cancer screening, it is now advisable to undergo annual skin cancer screening, especially for patients who have lived in sunny countries and patients who partake in outdoor sports activities, patients who show a lot of naevi and for patients who have a family history of malignant melanoma.
In function of the diagnosis, stock is taken and additional treatment will be recommended (additional removal, safety margins,...)
On the basis of the results from the anatomo-pathological examinations treatment will first of all consist of surgical intervention.
The tumour is removed with a 1 to 3 cm margin.
In the case of larger tumours (indication according to Breslow) a biopsy of the sentinel node is required to check for any possible secondaries.
In a more advanced stage (recidives, metastases in the brain, bones, liver or longs) a general treatment is suggested: chemotherapy, immunotherapy, vaccination.
Some of these treatments are still at the experimental stage and must still be assessed.
The increases in new patients showing malignant skin melanoma is attributed to changes in life style and, to a lesser extent, to the ageing of the population.
The harmful effects of exposure to the sun have already been high-lighted for a very long time. Consequently, changes in life style such as sun holidays and outdoor sport activities (tennis, golf,...) increase the risks of skin cancer.
The UV-rays cause mutations in the genetic skin cell material and decrease the local reactions of the immune system. The mutant cells can no longer be restored or destroyed and consequently, they multiply of their own accord.
Preventions can be subdivided as follows:
1. Use of a high factor sun cream (at least factor 20) to be applied about 30 minutes before going into the sun and to be reapplied at two hourly intervals. 2. Avoid any exposure to the sun between 11 AM and 4 PM. 3. Wearing of clothing (T-shirt, cap hat and sunglasses).