Melanoma is a malignant tumor that arises from the cells that give the skin its color: melanocytes. Cancer is a potentially serious if not diagnosed and treated in early stages, so early diagnosis is important. The incidence of melanoma has increased dramatically in the past 50 years, in parallel with recreational exposure to the sun and tanning habit, particularly in countries with high solar radiation and people with fair skin.
The production mechanisms of cancer are complex and include many factors, both genetic and environmental. In the case of melanoma, sunlight is the main factor responsible, especially in people with fair skin and blue eyes, with numerous freckles or nevi, and family history of melanoma. It has been shown that sun exposure increased risk involving burns constitute or intense sun exposure and timely during the first years of life, ie recreational sun exposure or holiday. Indiscriminate exposure to UV tanning booths also be considered a risk factor.
In most cases, melanoma starts as a mole or nevus, but usually show different characteristics have freckles all. It’s a sin in a rather symmetric, non-round, with irregular or poorly defined, with various colors inside (especially if one of them is black), and generally tends to quickly reach a larger size than the other freckles ( more than 6 mm. – the size of the eraser of a pencil).
Melanoma may appear on normal skin, or arise from an existing freckle or nevus. Therefore, risk in people is as important as controlling regularly scan suspicious freckles all skin.
It is very important that suspicious freckle evaluated by a dermatologist. Overall the diagnosis of melanoma is made on clinical suspicion after direct vision and confirmed by a biopsy. A biopsy is the excision of the lesion and microscopic examination. Studies show that the dermatologist has a capacity significantly higher than the general practitioner and other specialists to recognize melanoma. It is important to see a dermatologist or a referral for suspected melanoma.
Skin biopsy confirmed the clinical impression of melanoma and also evaluates various parameters important for prognosis and evolution. The most important is the melanoma, ie the depth at which malignant melanocytes reach the dermis. If this thickness or depth (known as Breslow level) exceeds 1 mm, melanoma has a higher risk of spread to distant sites (metastasis).
If melanoma meets certain criteria and is considered a risk of metastasis, staging should be performed by sentinel node technique. In this procedure, which usually does not require hospitalization, injecting a tracer that identifies the first lymph node that drains the area where is located the melanoma. Is removed and analyzed this node, and metastasis looking if it is, whether melanoma cells have invaded. The result of this test indicates directs and subsequent treatment.
Initial treatment is always melanoma surgery, removal. This procedure can be performed under local anesthesia almost always. The margins of melanoma removal, ie the area of healthy skin around it is removed, should be adequate to Breslow thickness or level with the objective that the biopsy analysis. This means that in many cases, to know by the first biopsy Breslow level requires a second surgery to enlarge the margins (in many cases, this can be done in reampliación same surgery that sentinel node biopsy).
As further processing, in many melanomas low thickness (Breslow less than 1 mm) should not be chemotherapy or radiation therapy. In high-risk melanoma metastasis (thick melanomas and sentinel node biopsy positive) behavior varies according to each patient according to the centers. The efficacy of chemotherapy treatments and immunomodulators (vaccines) used to date has been limited. The only drug approved for the treatment of high-risk melanoma is interferon. If there are metastases, life expectancy is greatly reduced, and treatment can be surgical pose (removal of metastases) according to each patient and the location thereof.
Early diagnosis is very important in cancer, in which the effectiveness of treatments is very limited when there invasion and spread of the disease. The campaigns to warn the general population indiscriminate exposure to the sun, especially in fair-skinned people with many freckles, or a family history of melanoma.Avoid sunbathing in the middle of the day, and should be used properly photoprotective creams or lotions.The photoresist is especially important in childhood. The effectiveness of sunscreens, even those of high protection factor, is limited, so also should employ physical protection with wide-brimmed hats, caps and shirts suitable tissue not to miss the light. This is especially important in the summer, in the most sunshine hours in places like the beach where the reflection of light in the sea and sand irradiation increases, and high altitude (mountain) where light filtering the atmosphere is lower.
Also, everyone should learn to self-explored freckles skin for new, different from the other, and meet the ABCD rule of asymmetry, irregular borders, different colors and diameter greater than 6 mm. Under suspicion of melanoma, the patient should be seen by a dermatologist.
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