Every May 23 is commemorated throughout the planet. World Melanoma Day. The objective is to raise awareness about this oncological pathology and emphasize preventive care, since it is the least common variety of the disease. skin cancerbut at the same time it can be the most serious and has the greatest chance of spreading through the body.
The incidence of this type of tumors has been increasing in recent years throughout the world, and in Argentina the trend is reflected with a higher incidencein line with what happens in other countries.
“It is a neoplasm that arises from melanocytes, which are the cells that produce pigment in the skin,” the oncologist and head of the Melanoma and Sarcoma Service at the Alexander Fleming Institute (IAF) began to explain. Yanina Pflüger (MN 120531). And although it mainly affects the skin, the expert clarified that the disease “can originate in the mucous membranes and eyes.”
And after highlighting that “despite the fact that its incidence is increasing worldwide, in some countries like Australia, thanks to its prevention campaigns, they have shown a slight decrease,” the expert highlighted that “Argentina presents a sustained increase in incidence comparable to what happens in most of the rest of the world.”
According to Pflüger, “the people most at risk are those who have the phototype 1 (white skin and light eyes), while ultraviolet radiation also increases it, due to excessive solar exposition or the use of tanning beds.”
“Other predisposing factors are multiple molessunburns in past decades and immunosuppression,” he added.
Melanoma gives warning signs so it can be treated early to access treatment with better prospects for success. “It is important to be attentive when performing the self-examination to any lesion that changes shape, color, size or begins to generate any symptoms such as itching, burning or stinging,” said the head of the IAF Oncology Dermatology Service at this point. Marcela Moreno (MN 106,685).
There is a rule, which is A B C D E, to remember everything that should draw attention about a mole. In that sense, the specialist pointed out: “A: asymmetry, B: irregular edges, C: irregular color, D: diameter greater than 6 mm, but for me the main one must be E: Evolution.”
The skin self-exams by the patient they should be monthly. The dermatologist emphasized the concept that any lesion that evolves (that is, in which a change is noticed) should attract attention. “If in doubt, consult. And it is also important to keep in mind that not all lesions that present any of these characteristics mean that they are or will be malignant,” she contributed.
In this sense, his colleague Carolina Spinelli (MN 117.118), a dermatologist at the IAF Cutaneous Oncology Unit, added three other steps to the mnemonic rule. “In recent years, also we add the letters EFG to highlight that when faced with a lesion E (elevated), F (firm), and G that is growing (for Grow in English) in the last month, it should be present to rule out Nodular Melanoma, which is a type that grows rapidly in invasive,” he explained.
When talking about preventionexperts agree that the photoprotection It is the measure on which the most work should be done. “Mainly, at an early age, since care for people under 20 years of age is essential,” Moreno began in this regard. The first step is to avoid exposing yourself during midday hours, especially during the hottest times of the year, which is the time when we have the highest solar UVR index. If you do so, do not forget to use high sunscreen (factor 50 or more), renewing it every two hours. But it is very important to emphasize physical protection, through the use of appropriate clothing, hat and sunglasses.”
Another key indication is to avoid the use of tanning beds, whose exposure is directly related to melanoma due to the ultraviolet radiation they emit.
As a general guideline, it is recommended to do the clinical and dermoscopic dermatological control, but the person who determines the periodicity is the dermatologist. “This will depend on the type of skin of the patient, the number and type of moles they have, activities they carry out or carried out, history of sunburns at an early age, whether they have a personal or family history of skin cancer and what type. The control of a patient with light skin, with multiple moles and a history of significant photoexposure due to the activities she carries out, is not the same as a patient with a higher phototype with very few moles. In both cases they must have periodic control, but in the latter it can be more relaxed,” clarified the IAF expert.
In this regard, Spinelli stressed that “the control must be of the entire skin with a hand-held dermatoscope. If the patient has a history of melanoma or more than 100 nevus (as new lesions are known) or atypical nevus syndrome, total body digital dermoscopy, known among patients as mole mapping, will be indicated.”
“In the Cutaneous Oncology Unit of the Alexander Fleming Institute, we have the Fotofinder,” he said. In this study, clinical images of the entire body are taken in different positions and dermoscopic photos of the most important nevi are also recorded for better follow-up. It is carried out annually, the images are compared and thus we detect a new mole or changes in pre-existing ones early.”
According to Pflüger, “patients who have had cutaneous melanoma have increased risk of developing a new one”. And he added: “In addition, they have a higher risk of developing non-melanoma skin carcinomas, since their risk factor for skin phototype and solar photodamage is shared.”
“The treatment will depend on the instance in which the melanoma is diagnosed. Localized lesions must initially be operated on to resolve them. complete resection. And in many cases the regional lymph node area must be surgically studied. If the resection has been complete, the need to add systemic treatment later for one year,” explained Pflüger, who highlighted that “when detection occurs in advanced instances, systemic treatment with targeted therapy or immunotherapy”.
Within these new treatments, the expert maintained that in recent decades there has been an increase in approvals of new therapies in melanoma which are already widely disseminated and in use for patients. “There are new molecules in development that are generally being tested in clinical trials and many of them are used in combination. In this way, we try to have not only new options, but also to improve the effectiveness of current therapies,” he noted.
Finally, regarding the statistics, which report an increase in the number of cases of skin cancer, in Moreno’s view “this could correspond to patients over 40 years of age who were exposed to the sun inappropriately during their childhood, adolescence and early adulthood, which is the time of greatest sun exposure, and of greatest importance when talking about photoprotection.” “We must wait a while longer to know the real impact of the measures taken in recent years regarding the change of habits regarding sun exposure and photoprotection,” he concluded.