Oncological educational program. The difference between skin cancer and melanoma: how to recognize them and what to do next?

Mucosal melanoma is a relatively rare disease and accounts for less than 1% of all melanomas.

These formations have a much more aggressive growth compared to cutaneous forms, are prone to active metastasis to regional and distant sites, and often recur, which causes high mortality rates. The prognosis for mucosal melanomas is poor, with a five-year survival rate of 10–15%.

Melanomas of the mucous membranes of the head and neck region account for half of all mucosal melanomas. They are mainly localized in the projection of the upper respiratory tract, oral cavity and pharynx. Other forms of mucous melanomas belong to the urogenital area. The distribution of tumors by location is presented in the table.

According to scientists, unlike other dermatological cancers, mucosal melanoma does not depend on exposure to ultraviolet radiation. In addition, there are no obvious risk factors for this type of tumor, including family history.

Melanoma of the mucous membranes affects the following organs:

• oral and nasal cavity;
• paranasal sinuses;
• trachea and bronchi;
• lips;
• pharynx;
• esophagus;
• stomach;
• intestines;
• gallbladder;
• anorectal area;
• vulva and vagina;
• urethra and bladder;
• conjunctiva of the eye.

For convenience, mucosal melanomas are sometimes divided into three subgroups:

• melanoma of the gastrointestinal mucosa;
• respiratory;
• genitourinary melanomas.

Given the tendency to early lymphogenous and hematogenous metastasis, it is sometimes difficult to determine whether a mucosal tumor is primary or metastatic. Depending on the location, the tumor will have certain characteristics. For example, primary melanomas of the oral cavity, nose, pharynx, as well as the anorectal and genital areas first develop in a radial direction, increase in area, taking the form of a spot; only then do they gain volume, rising above the surface of the mucosa, and begin to infiltrate the underlying base.

Some mucosal melanomas develop from melanocyte cells that are present in the tissue structure of the organ (lips, nose, oral cavity, anorectal area, etc.). The development of primary melanomas on the mucous membrane of organs where pigment cells are initially absent (trachea, bronchi) can be explained by disorders of tissue embryonic development.

What is oncology and how does it occur?

Oncology begins with the appearance in the body of just one mutated or altered cell. It is formed due to the influence of various diseases, exposure to sunlight, disruption of the immune system and hereditary characteristics; it grows, develops and gradually forms a tumor. Most of these cells are dealt with by the immune system - it identifies and destroys them, but some of them manage to escape the attention of our natural defenses or resist it. Unlike ordinary, healthy cells of the human body, which are born, work and die in a strictly designated place for them, cancer cells are able to move throughout the body. They enter the circulatory or lymphatic systems. The lymphatic system complements the cardiovascular system. The lymph circulating in it - the intercellular fluid - washes all the cells of the body and delivers the necessary substances to them, taking away waste. In the lymph nodes, which act as “filters,” dangerous substances are neutralized and removed from the body, transferred to other tissues, fixed in them and form metastases - new foci of the disease.

Most skin cancers begin in the top layer of the skin, the epidermis, which contains 3 main types of cells:

• flat, located in the upper area: form the main protective layer and are constantly renewed;
• basal, located in its lower part: constantly dividing and forming new cells, which move upward and turn into flat ones;
• melanocytes: produce a dark pigment - a substance that colors the skin yellowish or brownish, protecting its deeper layers from the harmful effects of the sun.

Most melanomas still produce melanin, which gives them a dark brown or black coloration. New growths in which this compound is not produced are pink, light brown or even white.

These tumors can develop anywhere, but most often occur on the neck and face, as well as the chest and back in men, and on the legs in women. The risk of developing them in these areas is lower in dark-skinned people - they usually suffer from this type of cancer on the palms, soles of the feet and tissues located under the nails.

Amelanotic melanoma - what is it?

This is a malignant tumor whose cells contain an extremely small amount of the pigment melanin (this is what gives the brown color to “regular” melanoma). As a result, neoplasia is very similar to various other skin growths, both malignant and benign. Therefore, it is quite difficult to diagnose achromatic melanocytic tumor at an early stage.

Melanoma containing little melanin is characterized by fairly rapid growth into fatty tissue and early ulceration. This creates conditions for metastasis.

A peculiarity of non-pigmented melanoma is the cessation of its growth after the sending of the first metastases. Moreover, after this, the primary tumor can completely disappear.

Colorless melanoma cells contain small amounts of melanin due to:

• insufficient content of the amino acid tyrosine in the body;
• disruption of melanin formation during tumor cell division.

Why does melanoma occur?

Scientists and doctors do not know the exact reasons for the development of melanoma; modern medicine only understands the factors that increase the likelihood of its occurrence.

• The main one is considered to be exposure to ultraviolet radiation (UV), the main source of which is the sun and solariums, which are popular in large cities. UV rays affect DNA, the storehouse of genetic information contained in every cell of the body. If they manage to damage the DNA of genes that control the growth of skin cells, a person may begin to develop cancer.
• They also include moles

  , or so-called
  nevi
  - benign, containing the coloring pigment of the tumor.
  They do not damage others and do not spread to distant tissues, but they can degenerate into life-threatening neoplasms, and the more of them, the greater the chance of getting sick. The risks are also increased for owners of dysplastic nevi
  - unusual moles that can appear both on areas of the body exposed to radiation and on non-exposed ones - for example, the scalp or buttocks.

  Congenital melanocytic nevi

  , or birthmarks found in children from birth, also increase the likelihood of this type of cancer, which is why some of them are recommended to be removed surgically.

  Read also:  Gynecological examination - what types are there and how does each of them work?
• Family history

  : the risks of developing the disease are higher in people whose loved ones - parents, brothers, sisters or children - have already received a similar diagnosis. Such statistics may be associated with hereditary genetic changes, lifestyle - frequent exposure to the sun, and a combination of the above factors. In these cases, doctors recommend that all blood relatives regularly visit a dermatologist, carefully examine their own skin once a month, protect themselves from the sun and avoid exposure to artificial UV rays.

• Melanoma is more likely to develop in people with redheads

  or blond
  hair
  ,
  blue
  or
  green eyes
  , and skin that freckles or burns easily.

• Malfunctions of the immune system

  : Patients whose immune systems are weakened by diseases such as HIV or by various treatments such as those used in organ transplants are at particular risk. In such situations, the natural defense does not work correctly and does not destroy the altered cells, which leads to the development of dangerous tumors.

• Melanoma occurs more often in those who have previously been diagnosed with skin cancer.
• Age

  : This type of tumor is more common in older patients, but also occurs in younger patients, and in fact is one of the most common types of cancer in people under 30 years of age.

• Floor

  : Melanoma is more common in men than in women.

• Xeroderma pigmentosum

  is a rare hereditary disease that affects the ability of cells to repair damage to their DNA. It increases the risk of developing melanoma and other types of dangerous skin tumors at a young age, especially on exposed areas of the body.

What are the different forms of skin melanoma?

The main clinical forms of melanoma are:

1. superficial spreading (39-75%);
2. nodal;
3. malignant lentigo melanoma;
4. acral melanoma.

Superficial spreading melanoma (flat, radially growing melanoma)

The tumor develops equally often both on unchanged skin and from a pigmented nevus. It can be localized on open and closed areas of the skin, mainly on the lower extremities in women and the upper half of the back in men. It is a plaque of irregular configuration with a scalloped outline, areas of regression and discoloration, mosaic coloring, and keratosis on the surface. On average, after a few years, a node appears on the plaque, indicating the transition of horizontal growth to vertical.

Nodular melanoma

Nodular melanoma, accounting for 10-30% of all skin melanomas, is the most aggressive type of tumor. The neoplasm usually appears on unchanged skin. Clinically it is a node, less often a polyp-like formation on the skin. Patients note a rapid, within several months, doubling of the node's volume, its early ulceration and bleeding. The most common localization is the skin of the back, neck, head, and limbs. Histologically, invasion of atypical melanocytes to different depths of the dermis and subcutaneous fat is revealed.

Malignant lentigo melanoma

Melanoma of the lentigo maligna type accounts for about 10-13% of all melanomas and is characterized by a long horizontal growth phase. In typical cases, it occurs in older people on open areas of the skin of the face and neck in the form of black-brown spots or plaques. This type of melanoma is less aggressive than other flat melanomas.

Acral melanoma

Acral melanoma occurs in the nail bed and accounts for about 8% of all skin melanomas. It usually appears as a dark spot under the nail, which makes its timely diagnosis extremely difficult.

Signs and symptoms of melanoma

Signs of melanoma or another type of cancer may include unusual lumps, sores, bumps, spots, or changes in the appearance of the skin.

Normal moles, or nevi, are usually uniformly colored brown or black formations. They can be either flat or protruding, round or oval, and their size usually does not exceed 6 millimeters. Some of them are present at birth, but most appear in childhood or adolescence. If they occur later in life, it is advisable to consult a doctor and check whether they pose a danger.

The most important symptom of the disease is the appearance of new spots on the skin, or a change in the size, shape or color of existing ones.

One of the methods for identifying suspicious formations is
ABCDE
system , which is used all over the world:
A
(Asymmetry) means
asymmetry
: both halves of a normal nevus are practically the same, but in melanomas they can be completely different from each other.
B
(Border) – border: the edges of dangerous moles are uneven, torn, jagged or blurred.
C
(Color) - color: a combination of different colors and shades of brown or black, as well as spots of pink, red, white or blue - a reason for an urgent visit to the doctor.
D
(Diameter) – diameter: formations larger than 6 millimeters are suspicious.
However, melanomas can also be smaller in size. E
(Evolving) – development: if there is any change in the size, shape or color of a mole, you should contact a dermatologist as soon as possible.

Another popular way to detect the disease is the so-called “ugly duckling” method.

, indicating that every spot on the skin that is different from the rest requires special attention from a specialist.

Most people have moles, and almost all of them are harmless. Harmless formations retain their color, shape and size for many years, do not itch, do not become crusty and do not secrete fluid.

In addition to the above, symptoms of melanoma include:

• non-healing sores;
• spread of pigment from the border of the spot to the skin located next to it;
• the appearance of unusual sensations, such as itching or soreness;
• redness or new swelling beyond the border of the nevus;
• change in the surface of the mole - peeling, bleeding, release of any fluid or crust formation.

It's also important to remember that a small percentage of melanomas start not only on the surface of the skin, but also in other places - under the nails of the fingers and toes, in the mouth, or even in the iris, the colored part of the eye. Any new or changing spots in these areas should also be addressed by a doctor.

How is skin melanoma diagnosed?

The most effective method for early detection of skin melanoma is periodic self-examination of the skin. There is a kind of “melanoma alphabet” that describes a number of signs of degeneration of a mole, indicated by the first four letters of the Latin alphabet:

1. A (asymmetry) - asymmetry: the shape of “good” moles is often symmetrical;
2. B (border irregularity) - the edges of the mole are usually smooth and clear. An uneven, scalloped outline is more characteristic of melanoma;
3. C (color) - benign nevi are colored more or less evenly. The unequal color of different parts of the neoplasm is more characteristic of a degenerated mole;
4. D (diameter) - the diameter of a mole is more than 6 mm: the larger the mole, the greater the likelihood of its degeneration. Malignant degeneration is indicated by various kinds of changes in a pre-existing mole. It was found that pigmented formations on the skin that regularly changed shape and color turned out to be melanoma 4 times more often than those whose appearance remained unchanged. Therefore, to the first four letters of the “alphabet of melanoma,” a fifth was added;
5. E (evolving) - the appearance of any external changes in the mole, which most often are: change in color (decrease or sharp increase in pigmentation); violation or complete absence of skin pattern in the area of ​​the nevus, “varnish” surface or peeling; the appearance of an inflammatory areola around the mole (redness in the form of a corolla); change in configuration along the periphery, blurring the contour of the nevus; an increase in the size of the nevus (especially over the age of 30) and its compaction; itching, burning, tingling in the mole area; the appearance of cracks, ulcerations in the mole area, bleeding; loss of existing hairs on the mole; sudden disappearance of a mole (especially after tanning in the sun or in a solarium).

Very valuable additional clarifying information can be obtained by performing a dermoscopic examination of a pigmented skin tumor, which allows for a visual assessment of the tumor at 10-40x magnification.

Diagnosis of melanoma

In the oncology department, melanoma is diagnosed by world-class specialists using the most modern equipment.

A complete and high-quality examination is necessary not only to detect the disease. The data obtained during this process allows doctors to understand how far the altered cells have spread throughout the body and to select the most suitable treatment methods for the patient.

The procedure begins with asking about symptoms and examining questionable areas, as well as nearby lymph nodes. The next step is dermatoscopy

, or examining the skin using a special device - a dermatoscope, which is a magnifying lens and a light source.
If the doctor has reason to suspect the presence of melanoma, he performs a biopsy
- tissue sampling, and sends it to the laboratory for examination:

• tangential
  , or
  shave
  biopsy, involves taking samples using a surgical blade or scalpel;
• puncture
  - using a special tool, similar to a tiny round cookie cutter, to get deeper layers of skin;
• during excision
  , the entire tumor is removed along with a small area of ​​healthy tissue surrounding it - this is the preferred method of examination if melanoma is suspected;
• with incision
  , only part of the tumor is removed;
• aspiration
  , or biopsy using a syringe with a thin needle - is used to collect tissue from the lymph nodes, which makes it possible to detect altered cells in them.
• the disease spreads to internal organs, computer (MRI), magnetic resonance ()
  and
  positron emission tomography (PET)
  are . They create a clear image of tissue and allow detection of additional tumors in the lungs, liver or lymph nodes.

Blood tests

are not used to detect melanoma - they are prescribed before and during treatment to determine the quality of the bone marrow, liver, kidneys and other important organs. In addition, they are used to check the content of a special substance in the body - lactate dehydrogenase, a high level of which can be a sign of tissue damage and cell destruction.

Observation and examination after treatment

After radical surgery, local tumor recurrences are extremely rare. However, given that melanoma metastases can develop many years after removal of the primary tumor, lifelong monitoring by an oncologist is necessary.

Therefore, patients who have completed treatment must undergo an examination, which includes:

1. examination of all skin;
2. palpation of regional lymph nodes;
3. X-ray examination of the chest organs;
4. Ultrasound of the abdominal organs;
5. general and biochemical blood test;
6. determination of the level of lactate dehydrogenase (LDH) in blood serum (for melanoma with metastases).

In some cases, it is necessary to use other examination methods (MRI of the brain, CT of the abdominal and thoracic cavities, osteoscintigraphy, etc.).

During the first two years, control examinations are carried out every 3-6 months. During the third year every 4-12 months, then annually.

Stages of melanoma

After identifying a disease in a person, doctors determine its stage - determine which tissues it has damaged. This information is necessary for specialists not only to understand the patient’s prognosis, but also to select the most suitable treatment methods for him.

TNM system is used for staging melanoma.

, which is based on 3 key elements: The letter “
T
” describes the thickness of the tumor and its ulceration - the destruction of the skin in the affected area.
Using “ N
” they indicate the spread of changed cells to the lymph nodes - tiny “filters” of the lymphatic system. The lymphatic system complements the cardiovascular system.
The lymph circulating in it - the intercellular fluid - washes all the cells of the body and delivers the necessary substances to them, taking away waste. In the lymph nodes, which act as “filters,” hazardous substances are neutralized and removed from the body, retaining and neutralizing substances dangerous to humans. “ M
” is used to indicate the presence or absence of metastases—additional cancer sites located far from the main tumor. In the first three stages they are absent (“M0”), and only in the last, fourth, the diagnosis indicates “M1”.

Stage 0

, or melanoma
in situ
: reflected in medical documents as TisN0M0.
This means that only the epidermis, the outermost layer of the skin, is damaged by the disease. Nearby lymph nodes and distant parts of the body were not affected. Stage 1
: the tumor is no more than 2 millimeters thick, ulcerated or not, but other tissues are not affected.
Stage 2
: the thickness of the tumor may exceed 4 millimeters, but the rest of the organs are healthy.
Stage 3A
: melanoma is no thicker than 2mm, and has damaged 1-3 nearby lymph nodes, but the tumors in them are so small that they can only be detected under a microscope.
Stage 3B
: there are no signs of a primary lesion, but 1 lymph node has been damaged, or the disease has spread to small nearby areas of skin.
Either the neoplasm is no more than 4 mm thick, and altered cells are found in one to three lymph nodes, or on the skin surrounding the melanoma. Stage 3C
: involves several types of lesions:

• the primary tumor is not detected, but a small area of ​​adjacent skin or 2 or more lymph nodes are damaged;
• the lesion is less than 4 mm deep, the melanoma has spread to the skin or 4 or more nearby lymph nodes;
• the neoplasm is thicker than 4 mm, the changed cells are in the skin or 1-3 lymph nodes.

3D stage

: a tumor covered with an ulcer, thicker than 4 mm, damaged 4 or more lymph nodes, or the skin.
Stage 4
: melanoma of any size that has spread to distant tissues - lymph nodes, lungs, liver or brain.

Forecast

The survival rate of patients who received combination treatment is 4.5-49.2%.

Factors that significantly influence survival prognosis:

• are there regional metastases;
• are there distant metastases;
• what stage – IVa, IVb, IVc;
• invasion (germination) of the neoplasm into the underlying tissues;
• non-radical (incomplete) surgical removal of the primary focus of the disease;
• localization of the tumor (for example, in patients with MSO of the oral cavity, regional metastases appeared in 36.4% of cases, in patients with MSO of the nasal cavity and paranasal sinuses - in 7.8% of cases).

Treatment of melanoma

Oncology specialists carry out not only diagnostics, but also treatment of any stages of melanoma according to the most modern international protocols - efficiently, comfortably, without delays or queues.

To combat such tumors, doctors use several methods, the main of which is surgery

.

If a shallow lesion is detected during a biopsy, a biopsy is the removal of a tissue sample to be sent to a laboratory, where it is carefully examined under a microscope. the patient may require additional intervention to allow doctors to ensure that the damaged cells are completely removed. First, the area to be treated is numbed, then the doctor removes the tumor along with a small amount of normal tissue, and then sutures the wound.

In some situations, the so-called Mohs surgery

which is performed by an experienced dermatologist or surgeon. It involves removing very thin layers of skin and then examining them under a microscope. The procedure is repeated until there are no tumor cells left in the obtained samples. It takes a lot of time and requires great skill from a specialist, but it allows you to preserve the maximum amount of healthy tissue, which is especially important for patients with damage to the face or other exposed parts of the body.

In addition, the doctor may prescribe lymph node dissection

– removal of some, usually the lymph nodes closest to the melanoma. As a rule, this procedure is prescribed if they become enlarged or hardened, and during a biopsy, altered cells are found in them.

In the case of metastasis, or the appearance of additional tumors in distant organs, it is almost impossible to completely cure the disease with surgery alone. In such situations, surgery can relieve some symptoms, prolong life or improve its quality.

Immunotherapy for melanoma

Immunotherapy is a medicine that stimulates your own immune system and helps it more effectively recognize and destroy cancer cells. In the case of melanoma, several types are used:

• Immune checkpoint inhibitors are drugs that prevent altered cells from “masquerading” as healthy ones, allowing our natural defenses to distinguish normal tissue from tumor tissue. These include pembrolizumab (Keytruda), nivolumab (Opdivo), atezolizumab (Tecentriq), and ipilimumab (Yervoy).
• Interleukin-2 is a protein that strengthens the immune system.
• Oncolytic viral therapy
  - the administration of vaccines such as BCG BCG, or Bacillus Calmette-Guerin, is a microbe that activates the human immune system without causing serious illness in people, activating the work of a person's natural defenses.
• Imiquimod is a cream applied to the skin that stimulates the immune response to altered cells.

Melanoma on the hand. Photo.

1. Mole removed without histology
2. After two months, a black spot appears at the removal site
3. Removal and histology - melanoma Breslow 1.1, Clark IV, 1 mitosis sq/mm
4. Wide excision in Israel and sentinel lymph node biopsy

History: Why do we need histology of a benign mole?

Targeted therapy for melanoma

Targeted therapy is drugs that work only against certain components of tumor cells, and practically do not damage healthy tissue.

Drugs such as Vemurafenib (Zelboraf), Dabrafenib (Tafinlar), Encorafenib (Braftovi), Trametinib (Mekinist), Cobimetinib (Cotellic), Binimetinib (Mectovi), Imatinib (Gleevec) and Nilotinib (Tasigna) attack specific proteins found in tumors. . Thanks to their action, melanoma decreases in size or stops growing.

Chemotherapy for melanoma

Chemotherapy is a special medicine that kills the changed cells. They are usually injected into a vein or taken orally as tablets. They move with the bloodstream and act in all areas of the body. This type of treatment can be used in the last stages of the disease after trying other methods that have not shown good results. It is not often used as a first-line treatment because newer forms of immunotherapy and targeted therapy are usually more effective.

Radiation therapy for melanoma

Dangerous cells can be destroyed, including using radiation therapy - radioactive radiation or particles. This method is not suitable for all patients - it is used, for example, to treat unusual types of melanomas, as well as tumors in very early stages when surgery is not possible. In addition, it may be prescribed to reduce the risk of relapse - the tumor growing again, or as palliative therapy - to relieve symptoms caused by the disease spreading to the brain or bones.

Types and classification

In accordance with the international classification of cancer stages (TNM) from 2022, several types of mucosal melanoma are distinguished.

By tumor prevalence:

Based on the presence of regional metastases, tumors are divided into three types:

Based on the presence of distant metastases, melanoma of the mucous membranes can be of three types:

Prognosis and survival for melanoma

The prospects for each person are individual - they depend not only on the advanced stage of the disease, its stage and response to treatment, but also on age and general health.

To make approximate patient prognoses, doctors use a special term - “five-year survival rate”. It represents statistical data and does not say anything about the chances of each individual patient - this figure shows the percentage of people alive for 5 or more years from the moment melanoma was discovered.

At the so-called localized stages, until the tumor has time to spread beyond the skin at the site of origin, it is about 99%. At regional level, when the tissues and lymph nodes closest to the tumor are damaged, it is approximately 66%. Once melanoma has spread to distant areas such as the lungs, liver or skin of other parts of the body, the five-year survival rate rarely exceeds 27%.

Some epidemiological aspects (statistics) of skin melanoma

Melanoma occurs approximately 10 times less frequently than skin cancer and accounts for 1–4% of the total structure of human malignant neoplasms. This tumor is one of the most malignant and is characterized by rapid growth and early rapid lymphogenous and hematogenous metastasis.

About half of melanoma cases occur in people aged 30–50 years. It is extremely rare that a tumor can develop in children. Melanoma can develop on the skin of any area of ​​the body, but its favorite localization in women is the lower extremities (lower leg), and in men - the torso (back). In older people, the tumor is somewhat more often localized on the skin of the face.

Over the past ten years, the annual number of cases of skin melanoma in Belarus has increased 1.5 times: from 461 cases in 2001 to 676 in 2010. In general, every 6-8 years the number of patients with melanoma doubles in the world.

In approximately half of the cases, melanoma develops on apparently healthy skin, in other cases - on the site of congenital or acquired pigmented nevi and Dubreuil's melanosis.

Symptoms

In most cases, melanoma develops from a mole (nevus). Early signs of a tumor include:

• horizontal increase in size of moles - growth in width over the surface of the skin;
• changes in the boundaries of the nevus - they become uneven, blurred, asymmetrical;
• change in the color of the mole, the appearance of heterogeneity (black, brown and other areas on one nevus), light spots in and around it.

These signs do not always indicate the development of skin melanoma. On the other hand, at a very early stage, the symptoms of the disease are easy to miss with the naked eye. Therefore, it is important to consult a doctor when the first signs or even suspicions appear. Timely treatment can save the patient's life.

Late symptoms:

• vertical growth - the formation rises above the surface of the skin;
• peeling, itching, pain, bleeding of the surface of the nevus;
• enlargement of regional and distant lymph nodes.

Sometimes people, especially those who are characterized by increased anxiety, begin to suspect melanoma, mistaking it for ordinary moles. There is another extreme - patients ignore the initial signs of melanoma, considering them a newly appeared or injured nevus, age-related pigmentation. It is important to distinguish a mole from a malignant formation.

Moles usually have a smooth surface and even, symmetrical edges. Their color varies from light brown to dark brown, it is uniform, without light or dark inclusions. The normal size of a mole is considered to be up to 6 mm in diameter (you can use a pencil eraser as a guide). Moles extremely rarely change their size, and they are not characterized by unpleasant or painful sensations.

Causes and risk factors

Melanoma develops due to malignancy (malignant degeneration) of melanocytes. No reliable causes of cell degeneration have been identified; every person is at risk of the disease. Factors that increase the risk of tumor development:

• hereditary predisposition;
• Phototypes I and II – fair skin, hair and eyes, pink freckles;
• multiple moles, age spots;
• excessive ultraviolet radiation - both natural and in a solarium;
• age over 50 years;
• endocrine diseases;
• previous melanoma.

The combination of any three of these factors is a reason for regular preventive visits to a dermatologist.

Symptoms of the disease

Amelanotic melanoma is a nodule on the skin:

• round or oval;
• densely elastic to the touch;
• "fleshy";
• flesh-colored, pinkish, brownish or bluish-reddish in color;
• with a surface on which there is no usual skin pattern;
• may have a leg;
• It doesn't hurt, but it may itch.

Unlike pigmented melanoma, a tumor of melanocytes without pigment is often more symmetrical, it is less prone to swelling and the formation of small satellite papillae around it.

“Colorless” melanomas grow quickly - growing from 2-3 mm to 2-3 cm in just 2-4 months. Such a “nodule” may be lumpy, and ulcers or formations similar to small papillomas can be found on it.

The most dangerous thing is that the growth of achromatic melanoma is observed not only upward, but also deep into the skin. It is prone to decay. Therefore, in the later stages, the tumor looks like an ulcer, the edges of which are dense and raised, and small papillae are visible at the bottom.

How to recognize amelanotic melanoma in the early stages?

The first symptoms of non-pigmented melanoma are the appearance of a pink spot on the skin (clean or in the area of ​​pigment formations). Such a spot grows over several weeks/months and is characterized by increased friability and bleeding.

Some types of melanoma without pigment look like a gradually enlarging wart or papilloma. Other non-pigmented melanomas appear as a brown streak on the nail that extends to the tip of the finger.

In the initial stages, non-pigmented tumors do not hurt or itch, so they are rarely paid attention to.