Malignant melanoma is a highly malignant tumor that quickly metastasizes to other organs. As the name suggests, it starts from the skin's melanocytes. Almost 50% of all melanomas develop from pigmented birthmarks. However, they can also arise "spontaneously" on completely inconspicuous skin.
Melanoma is the tumor with the highest rate of incidence in the world.
In Germany the so-called incidence increases by 8% every year. Incidence rates (melanoma / 100,000 population / year) are lowest in sub-Saharan Africa at 0.1. Australia has the highest incidence rate at 60.
In Germany the incidence is around 12 / 100,000 inhabitants / year.
Due to improved early detection, mortality could be reduced to 20% of all cases. Most melanomas are discovered between the ages of 30 and 70.
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There are different Risk factors the development of melanoma. A malignant (malicious) melanoma can result from one that has existed for years Mole / birthmark (Nevus cell nevus) develop.
It can also arise from completely inconspicuous skin. For example, play genetic factors a role.
There is an increased risk of melanoma development in FANN repair damage (see below), or familial accumulation of melanoma. Also acquired factors, such as severe sunburn, can promote the emergence.
It is estimated that the distribution of causes is as follows:
Malignant melanoma is divided into 5 stages according to the so-called TNM classification. This classification is based on the following three criteria:
$config[ads_text2] not foundIn addition to these three main criteria, there are two additional criteria that serve to subdivide the 5 stages:
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$config[ads_text3] not foundAccording to these criteria, stage 0 corresponds to a tumor that only grows locally and has a low mitotic rate without metastasizing. In stage I, the tumor thickness is <2mm and there are neither lymph nodes involved nor distant metastases. Stage II differs from the fact that the tumor is now> 2mm. From stage III, the lymph nodes are also involved, but there are no distant metastases. Distant metastases are only present from stage IV. The lower the stage, the better the prognosis.
The prognosis of the malignant melanoma depends on its stage, as well as the metastasis and numerous other factors.
These include:
In addition, the individual subtypes of melanoma have different chances of recovery, for example lentigo maligna melanoma (LMM) has a better prognosis than amelanotic melanoma (AMM). In addition, tumor location and gender are factors in the prognosis. Men generally have a worse prognosis than women. Overall, amelanotic melanoma has a very poor prognosis, regardless of gender and location. In contrast, the darkness of the melanoma usually has no influence on the prognosis.
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In general, with an early diagnosis, the chances of recovery are very good, especially if it is an "in-situ melanoma". This has not yet crossed the basement membrane (the boundary between the upper skin (epidermis) and the dermis), but it is already recognizable as potentially dangerous.
That is why it is important to have regular skin cancer checkups.
Read more on the subject at: How do you recognize skin cancer?
The reason for the good prognosis is that in this case still no metastasis has taken place. The division of the prognosis according to tumor stage is based on the 5-year survival rate. This indicates the proportion of patients who were still alive 5 years after the diagnosis.
Metastases in the liver or the brain in particular have a negative impact on the prognosis. In contrast, lung metastases often grow very slowly and are therefore easier to treat. The malignant tumors of the heart in particular are very rare and are found in 40-60% of cases as a metastasis of a malignant melanoma.
Basically, only the early, complete removal of the melanoma can lead to healing. Waiting, however, significantly worsens the forecast.
Note: For this reason, regular preventive examinations and early detection measures are very important.
There are four classic growth forms and special forms of melanoma. All melanomas follow the ABCD rule in terms of their irregularity. The contour (asymmetry), boundary, color (coloring) and size (diameter,> 5mm) are assessed according to this rule. Symptoms may include itching and spontaneous bleeding.
$config[ads_text1] not foundThe four classic growth forms are described below.
Superficial Spreading Malignant Melanoma (SSM)
Primary nodular malignant melanoma (NMM)
Lentigo Malignant Melanoma (LMM)
Acrolentiginous Malignant Melanoma (ALM)
(superficial = superficial, malignant = malignant)
As described above, the melanomas in their initial phase follow a horizontal growth (growth in width) within the epidermis (epidermis). This growth phase takes about 5 to 7 years, that is for a relatively long time, which is why the early detection rate is steadily increasing.
They're getting more and more Early forms, the so-called "Melanoma in situ“, Discovered with a relatively good prognosis. The "melanoma in situ" represents an increased growth of melanocytes within the epidermis.
This growth is accompanied by the development of atypical cells. The morph (the appearance) of the ssuperficial spreitendes malignant M.elanom (SSM) is very different. It ranges from light brown to brownish-black and is initially a flat focus, which later shows nodules or lumps.
There is one in the lighter areas of the tumor Immune reaction in front.
The relative frequency of this clinical picture is 65%, whereby Areas of the skin that are often exposed to the sun (e.g. face), are particularly affected.
The mean age of onset is around 50 years.
(nodular = nodular, malignant = malignant)
This type of melanoma appears more aggressive to be, because this is where the vertical growth phase into the deep. That primarily nodular malignes M.elanom (NMM) consists of a fast - within months - growing node, which is usually dark brown - black, often with a piebald pattern.
The melanoma cells form this node in the dermis (sclera). Hardly any tumor parts can be found in the epidermis.
The relative frequency this clinical picture is 15%. Here too, as in superficial spreading malignant melanoma (SSM), areas of the skin exposed to the sun are particularly affected. The mean age of onset of 55 years is also close to that of superficial spreading malignant melanoma (SSM).
Under one Lentigo maligna one understands one Increase in atypical melanocytes within the epidermis (upper skin). These cells have a tendency to develop into a lentigo malignant melanoma (LMM).
Lentigo maligna can grow horizontally as a precancerous condition for years - even decades.
The transition to the vertical growth phase (deep growth) and thus to lentigo maligna melanoma is characterized by the formation of small nodules. In this area, the tumor cells expand vertically in both directions.
The forecast is because of the long horizontal growth quite good.
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The relative frequency this clinical picture is 10%, especially that face and the back of Hand are affected.
The mean age of onset is 68 years, significantly higher than for Superficial spreading malignant melanoma (SSM) and Primary nodular malignant melanoma (NMM).
(Akren = hands, feet, nose ears; malignant = malignant; lentigines = spots, similar to freckles, but larger and darker)
With this one rather rare melanoma First horizontal growth comes to the fore, later described vertical growth with Formation of blackish knots. This disease is similar in appearance and growth Lentigo Malignant Melanoma (LMM).
With dark-skinned peoples that is Acrolentiginous Malignant Melanoma (ALM) the most common type of melanoma. Because their localization is not always easily accessible, ALM is often diagnosed late and therefore has one accordingly unfavorable prognosis.
The relative frequency this clinical picture is 5%. The acra = body ends are particularly affected (Hand, foot, nose, ear...) and the nail beds.
The mean age of onset is 63 years.
The first and most important measure in the case of a malignant melanoma is its complete removal, whereby a sufficient safety distance must be observed so that no residual tissue, which is not visible at first glance, remains and leads to further growth of the melanoma. Surgical removal is only avoided in elderly people in a far advanced stage of malignant melanoma with no chance of recovery. In the case of particularly large melanomas, a skin transplant may be necessary, which is possible either as a personal donation or an external donation. In addition, the so-called sentinel lymph node, i.e. the lymph node that is first in the lymphatic drainage area of the melanoma, is removed. To do this, it is marked with the radioactive substance technetium 99 and removed through a small skin incision. This is then also examined to rule out metastasis. If metastasis is found in this sentinel lymph node, the other lymph node stations are also removed and examined. If a lymph node is already enlarged, the entire lymph node region is removed without first examining the sentinel lymph node.
Further therapy depends on the stage of the disease and is determined both by the tissue examination of the surgically removed melanoma and by the examination for distant metastases.
There are several attempts to treat malignant melanoma in addition to surgical removal:
Surgical removal of the melanoma and / or therapy with interferons remain the means of choice.
Read more on the topic: Melanoma therapy
Malignant melanoma is one of the most dangerous cancers.
Melanomas are therefore malignant, rapidly metastasizing Tumorsthat of Melanocytes go out. Melanocytes are cells in the skin that make the pigment Melanin have saved. Melanin causes, among other things, the tanning of the skin.
This tumor spreads very quickly and early on via the lymphatic system (lymph) and the blood. That fact makes it so dangerous. Other skin tumors, such as this Basalioma scatter very rarely, which makes them relatively harmless in comparison.
Depending on the type of melanoma, the biological behavior of the tumors also differs. Some metastasize more often than others.
The course, however, is the same for all melanomas. They develop from a single cell clone, which is predisposed to degenerate, from which the primary tumor develops.
This first grows within the epidermis (epidermis), the so-called melanoma in situ, and later when it reaches the basement membrane skin broke through as an invasive melanoma. This growth is called vertical growth. The more superficial the melanoma in the skin is ingrown, the greater the chance of recovery.
People with sun sensitive skin are more at risk than others. Red-blonde hair and one accordingly light skin tone bring one almost five times higher Risiko with black hair with darker skin tone.