Skin melanoma: from almost invisible to visually indisputable. Some principles of guidance and clinical cases review
Summary. Melanoma is a malignant tumor that arises from melanocytes and most often affects the skin. This tumor can also occur on the cornea, conjunctiva, ciliary body, and any place where the mucous membrane is localized. Melanoma is one of the most dangerous tumors due to its ability to rapidly unpredictable metastasis. In Ukraine, according to the National Cancer Registry, the incidence as of 2018–2019 was 7.9 cases per 100,000 population. The most important phenotypic risk factor is the skin prone to sunburn. It has a genetic determinant in the form of a hereditary variant of the melanocortin-1 receptor, which is involved in the tumor process. Melanoma of the skin is divided into «in situ» and «invasive», which differ in the localization of atypical cells in the smears of the epidermis and in the underlying tissues, respectively. In turn, among the invasive forms there are four most common types: superficial, nodular, melanoma of malignant lentigo and acral. Diagnosis of melanoma is based primarily on the clinical examination of the patient. However, dermatoscopy may be used for early detection. Its application requires from the specialist a set of knowledge and skills that will gradually grow with the experience of practical work. Expected signs will be the next: atypical pigment network, chaotically located brown-black pigment globules or dots, asymmetrically placed areas of multicolored pigmentation, white-blue veil, polymorphic vascular pattern. If a suspicious formation is detected, it should be removed, followed by histological verification. In cases where the histological diagnosis is in doubt, additional information can be obtained from immunohistochemistry. The publication presents an overview of various forms of skin melanoma cases. Some of them are macroscopically obvious, others are confirmed dermatoscopically. The material is illustrated with micrographs, with a detailed description of the visualized structures. Recommendations for monitoring patients with this pathology are briefly summarized.
- Bauer J., Garbe C. (2003) Acquired Melanocytic Nevi as Risk Factor for Melanoma Development. A Comprehensive Review of Epidemiological Data. Pigment Cell Res., 16(3): 297–306. doi: 10.1034/j.1600-0749.2003.00047.x.
- Elder D.E., Massi D., Scolyer R.A., Willemze R. (2018) WHO Classification of Skin Tumours. Fourth Edition (https://apps.who.int/bookorders/anglais/detart1.jsp?codlan=1&codcol=70&codcch=4011).
- Garbe C., Amaral T., Peris K. et al. (2020a) European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics — Update 2019. Eur. J. Cancer, 126: 141–158. https://doi.org/10.1016/j.ejca.2019.11.014.
- Garbe C., Amaral T., Peris K. et al. (2020b) European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment — Update 2019. Eur. J. Cancer, 126: 159–177. https://doi.org/10.1016/j.ejca.2019.11.015.
- Gogas H., Eggermont A.M.M., Hauschild A. et al. (2009) Biomarkers in melanoma. Ann. Oncol., 20: 8–13. https://doi.org/10.1093/annonc/mdp251.
- Herraiz C., Garcia-Borron J.C., Jiménez-Cervantes C., Olivares C. (2017) MC1R signaling. Intracellular partners and pathophysiological implications. Biochim. Biophys. Acta Mol. Basis. Dis., 1863(10 Pt. A): 2448–2461. doi: 10.1016/j.bbadis.2017.02.027.
- Lee K.J., di Meo N., Yélamos O., Malvehy J. (2020) Dermoscopy/Confocal Microscopy for Melanoma Diagnosis. In: Cutaneous Melanoma, 145–194 p. https://doi.org/10.1007/978-3-030-05070-2_50.
- Mitra D., Luo X., Morgan A. et al. (2012) An ultraviolet-radiation-independent pathway to melanoma carcinogenesis in the red hair/fair skin background. Nature, 491(7424): 449–453. https://doi.org/10.1038/nature11624.
- Pizzichetta M.A., Talamini R., Stanganelli I. et al. (2004) Amelanotic/hypomelanotic melanoma: clinical and dermoscopic features. Br. J. Dermatol., 150(6): 1117–1124. https://doi.org/10.1111/j.1365-2133.2004.05928.x.
- Primiero C.A., McInerney-Leo A.M., Betz-Stablein B. et al. (2019) Evaluation of the efficacy of 3D total-body photography with sequential digital dermoscopy in a high-risk melanoma cohort: Protocol for a randomised controlled trial. BMJ Open, 9(11): e032969. https://doi.org/10.1136/bmjopen-2019-032969.
- Ruiter D.J., Spatz A., van den Oord J.J., Cook M.G. (2002) Pathologic staging of melanoma. Seminars in Oncology, 29(4): 370–381. https://doi.org/10.1053/sonc.2002.34116.
- Salerni G., Carrera C., Lovatto L. et al. (2012) Benefits of total body photography and digital dermatoscopy («two-step method of digital follow-up») in the early diagnosis of melanoma in patients at high risk for melanoma. J. Am.Acad. Dermatol., 67(1): e17–e27. https://doi.org/10.1016/j.jaad.2011.04.008.
- Soyer H.P., Argenziano G., Hofmann-Wellenhof R., Johr R.H. (2007) Color atlas of melanocytic lesions of the skin. In: Color Atlas of Melanocytic Lesions of the Skin. https://doi.org/10.1007/978-3-540-35106-1.
- Stolz W., Schiffner R., Burgdorf W.H.C. (2002) Dermatoscopy for facial pigmented skin lesions. Clinics in Dermatology, 20(3): 276–278. https://doi.org/10.1016/S0738-081X(02)00221-3.
- Valachis A., Ullenhag G.J. (2017) Discrepancy in BRAF status among patients with metastatic malignant melanoma: A meta-analysis. Eur. J. Cancer, 81: 106–115. https://doi.org/10.1016/j.ejca.2017.05.015.
- Vuong K., Armstrong B.K., Drummond M. et al. (2020) Development and external validation study of a melanoma risk prediction model incorporating clinically assessed naevi and solar lentigines. Br. J. Dermatol., 182(5): 1262–1268. https://doi.org/10.1111/bjd.18411.
- Whiteman D.C., Green A.C., Olsen C.M. (2016) The Growing Burden of Invasive Melanoma: Projections of Incidence Rates and Numbers of New Cases in Six Susceptible Populations through 2031. J. Invest. Dermatol., 136(6): 1161–1171. https://doi.org/10.1016/j.jid.2016.01.035.