How can we define malignant melanoma?
It is defined as a skin cancer caused by an abnormal and uncontrolled growth of cells called melanocytes. It is the skin tumor that causes the most morbidity (complications such as hemorrhage, infection, pain) and mortality. Its incidence in our population is estimated at 10-11 cases per 100,000 inhabitants per year. This tumor has a very important socio-economic impact compared to other tumors due to its affectation in young patients (second cancer after leukemia in people under 65 years of age) and its aggressiveness (tumors less than 1 millimeter thick can produce distant metastasis and in tumors more than 4 millimeters thick).
How common is this tumor and why does it appear?
In recent decades it has multiplied alarmingly. The causes of why this disease develops are not known with certainty but there are a number of risk factors that are related to the appearance of this tumor, such as sun exposure, ultraviolet rays, patients with decreased immunity or those who have melanocytic nevi (freckles) in large numbers, for example having more than one hundred nevi, is an important risk factor for developing melanoma.
How do I know if a nevus (freckle) is a melanoma and what to do?
In the event that a nevus appears again, changes color, grows or hemorrhages, you should go to a specialist in melanoma surgery for evaluation and if necessary remove the lesion to be analyzed by the pathologist. The analysis of the nevus will tell us if it is a melanoma. If it is, it will tell us the thickness (Breslow index), the depth (Clark index) and other characteristics of the tumor. Based on all this information, the treatment of Melanoma will proceed.
What is the surgical treatment of malignant melanoma?
The initial treatment of malignant melanoma is always surgical, a wide excision must be performed (about 2 cm of margin around the tumor). In addition, an examination of possible metastasis in the lymph nodes close to the tumor must be performed, which is called sentinel lymph node biopsy. This technique consists of injecting a drug labeled with a radioactive isotope into the tumor area, this drug will migrate to the lymph node of the lymph node territory closest to the tumor (sentinel node) which must be removed and analyzed by the pathologist. The lymph node territories are located in the cervical, axillary and inguinal areas. In the case of metastases, a lymphadenectomy (removal of all the lymph nodes) of the affected territory will be performed.
Can malignant melanoma be cured?
Like any oncological disease, melanoma can be considered cured if 10 years after its removal it has not presented any metastasis or recurrence. Early diagnosis and surgery in its initial stages allows a longer survival and a better control of the disease. In more advanced stages (metastases in lymph nodes or in different viscera), surgery for metastases, radiotherapy, immunotherapy and the appearance of new drugs (Ipilimumab, Verumafenib) and others that are in the experimental phase allow the control and sometimes reduction of metastases and improve the survival of these patients.