What is Melanoma?
Melanoma is the most serious type of skin cancer that develops from cells called melanocytes, which give skin its color. While it can be completely cured if recognized at an early stage, it can carry the risk of spreading (metastasis) to nearby tissues or other organs in late stages.
Melanoma can develop from an existing mole on the skin or appear as a new spot or mole.
Risk Factors
- Sun exposure: Intense and recurrent sun exposure, especially severe sunburns in childhood
- Fair skin: Fair skin, light colored eyes and hair
- Many moles: Presence of more than 50 moles increases the risk
- Atypical moles: Moles with irregular edges and multiple colors
- Family history of melanoma: Melanoma in first-degree relatives
- Genetic factors: CDKN2A, CDK4 gene mutations
- Weak immune system: Those receiving immunosuppressive treatment
- Solarium use: Exposure to artificial UV rays
Symptoms of Melanoma and ABCDE Rule
Monitoring changes in moles is very important for early detection of melanoma. The ABCDE rule can be guiding to recognize suspicious lesions:
- A – Asymmetry: Two halves of the mole do not match. When you draw a line, the two halves look different.
- B – Border: Edges are irregular, indented, indistinct or jagged. Normal moles have smooth edges.
- C – Color: Contains different shades of color. Brown, black, gray, red, white or blue tones can be seen together.
- D – Diameter: Moles larger than 6 mm are risky (pencil eraser size). However, smaller melanomas can also occur.
- E – Evolving: Change in size, color or shape of the mole, itching, bleeding or crusting is warning.
Melanoma Locations
Melanoma can occur anywhere on the body. Most common locations:
- In men: Back area is most common
- In women: Legs are most common
- General: Arms, face, neck
- Rare locations: Under the nail, soles of feet, palms, mucosal areas (mouth, genital area), inside the eye
Melanoma Stages
Stage 0 (in situ)
Melanoma is only in the epidermis (upper skin layer).
Stage I-II
Melanoma has spread to the dermis (lower skin layer) but has not reached lymph nodes.
Stage III
Spread to regional lymph nodes.
Stage IV
Metastasis to distant organs (lung, liver, brain, bone).
Diagnosis
- Dermatological examination: Full body mole screening
- Dermoscopic examination: Detailed evaluation with a special device with magnifier
- Biopsy: Taking tissue sample from suspicious lesions
- Histopathological examination: Definitive diagnosis under microscope
- Imaging: PET-CT, MRI, CT in advanced stages
Treatment
Treatment is planned according to the stage and spread of the disease.
Early Stage Melanomas
- Surgical excision: Complete removal of melanoma with a safety margin is usually sufficient.
- Sentinel lymph node biopsy: Risk of spread is evaluated.
Advanced Stage Treatments
- Immunotherapy: PD-1 inhibitors (pembrolizumab, nivolumab), CTLA-4 inhibitors (ipilimumab). Activates the immune system against melanoma.
- Targeted therapies: BRAF and MEK inhibitors. Used in patients carrying BRAF mutation.
- Chemotherapy: Considered when no response is obtained to other treatments.
- Radiotherapy: Can be used in control of metastases.
Regular Follow-up
Regular dermatological follow-up is of great importance for both early diagnosis of new lesions and control after treatment. Follow-up program after treatment:
- First 2 years: Check-up every 3 months
- 3-5 years: Check-up every 6 months
- After 5 years: Check-up once a year
Prevention Recommendations
- Protect from sun: Avoid direct sunlight especially between 10:00-16:00.
- Use sunscreen: Use broad-spectrum, SPF 30 or higher sunscreens. Reapply every 2 hours.
- Protective clothing: Use hat, long-sleeved clothes and sunglasses.
- Avoid solarium: Artificial UV rays increase the risk of melanoma.
- Mole check: Check moles on the skin at regular intervals.
- Early application: Consult a dermatologist without delay in suspicious color or shape changes.
Important Warning
Early diagnosis is life-saving in melanoma treatment. Any new mole noticed on the skin or change in existing moles must be evaluated by a dermatologist. Perform monthly self-mole examination and report suspicious situations immediately.
