The ability to metastasize is one of the key properties of malignant tumors, distinguishing them from benign neoplasms. Cancer cells are able to break away from the primary tumor, spread throughout the body and form secondary foci - metastases. When this happens, the cancer is usually diagnosed as stage four, and the patient's prognosis is greatly worsened. As a rule, it is impossible to achieve remission with metastatic cancer. The goal of treatment is to prolong the patient's life and relieve him of painful symptoms.
Each type of cancer tends to metastasize to certain organs. Most often, secondary lesions are found in the lungs, liver, brain, and bones. Subcutaneous metastases and secondary skin lesions are rare.
Melanoma, what is it?
Melanocytes synthesize pigments responsible for coloring the skin, eye color, and hair. Pigmented formations filled with melanin are called moles and can appear throughout life. Certain causative factors of an exogenous (from the Greek “exo” - external) and endogenous (“endo” - internal) nature can cause malignancy of nevi. As a result, areas of the body where there are congenital or acquired nevi are at risk of developing melanoma: the skin, less often the mucous membranes and the retina. The altered cells are able to multiply and grow uncontrollably, forming a tumor and metastasizing. Most often, among benign “brothers”, a single malignant neoplasm is discovered.
The clinical picture is varied. The size, outline, surface, pigmentation, and density of the tumor vary widely. Any changes that occur with a mole should alert you.
How are cutaneous and subcutaneous metastases diagnosed?
Sometimes skin metastases can be the first manifestation of cancer, while the primary malignant tumor does not cause symptoms. In other cases, they appear after the patient is diagnosed with cancer with metastases in other organs. Also, metastatic skin lesions can be the first sign of relapse, and this often occurs a long time after surgery. The average time interval from diagnosis of the primary tumor to the appearance of skin metastases is 2–3 years, but longer intervals of up to 22 years have been described.
Skin metastases are often difficult to diagnose and can be easily confused with primary benign and malignant skin tumors, infections, eczema, and vasculitis. Dermatologists play an important role, since it is usually to them that such patients turn first.
If metastatic skin lesions are suspected, an excisional biopsy is performed. The pathological focus is completely removed and histological examination is carried out. To determine which malignant tumor the metastasis originated from, immunohistochemical analysis is performed. Certain marker proteins help identify the primary neoplasm.
Character traits
A melanoma tumor developing from a nevus is characterized by a prolonged increase in changes (up to several years) and subsequent aggressive transformation (1-2 months). Early self-diagnosis and timely examination by a specialist will help identify the symptoms of melanoma:
- Smooth mirror surface, with disappearance of skin grooves.
- Increase in size, growth over the surface.
- Unpleasant sensations in the area of the mole: itching, tingling, burning.
- Dryness, peeling.
- Ulceration, bleeding.
- Signs of an inflammatory process in the area of the mole and surrounding tissues.
- The emergence of subsidiaries.
The sudden appearance of subcutaneous lumps and nodules may also indicate a developing disease.
How dangerous is metastasis to the skin?
Skin metastases in cancer are rare, and their appearance always indicates an aggressive malignant tumor, advanced disease and worsening prognosis. Thus, in one study involving 4020 cancer patients, it was found that from the moment of detection of skin metastases, the average life expectancy of patients ranged from 1 to 34 months, depending on the type and characteristics of the primary tumor.
In another study of 228 patients, the median survival for cutaneous metastases was 6.5 months. The indicators for individual types of cancer were:
- squamous cell carcinoma of the head and neck (except skin) - 8.8 months;
- squamous cell skin cancer - 6.5 months;
- esophageal cancer - 4.7 months;
- colon and rectal cancer - 4.4 months;
- pancreatic cancer - 3.3 months;
- stomach cancer - 1.2 months;
- liver and gall bladder cancer - less than 1 month.
Survival rates for breast cancer turned out to be the highest - 13.8 months after the start of observation, 50% of patients were alive. For melanoma, this figure was 13.5 months, and for lung cancer - 2.9 months. Some patients with breast, simplex, larynx, squamous cell skin cancer and melanoma were able to live more than 10 years. The worst survival rates were observed for lung cancer.
As you can see from these data, everything is individual. In general, the best prognosis for skin metastases is observed in patients with malignant breast tumors. In recent decades, survival rates have been improved with the use of more modern chemotherapy drugs. The clinics of the federal network "Evroonko" use the most modern treatment methods, original antitumor drugs of the latest generations. This allows for the best survival rates among patients with metastatic cancer.
Clinical classification. Types of melanoma
Melanoma manifests itself in various forms, there are 3 main types:
- Superficially widespread.
Tumor of melanocytic origin. The most common disease (70 to 75% of cases) among middle-aged Caucasians. Relatively small, complex in shape with uneven edges. The color is uneven, reddish-brown or brown, with small patches of bluish tint. The neoplasm tends to become a tissue defect, accompanied by discharge (usually bloody). Growth is possible both on the surface and in depth. The transition to the vertical growth phase can take months or even years.
What malignant tumors most often metastasize to the skin?
Theoretically, any type of cancer can metastasize to the skin. A relationship was found between the incidence of skin metastases and the prevalence of the malignant tumor itself. In other words, the more common a particular cancer disease is, the more often it causes secondary lesions to form in the skin. The top three cancer pathologies in which skin metastases are most often found include breast cancer in women, lung cancer in men, and adenocarcinomas of the digestive tract in both sexes.
The likelihood of skin lesions is highest with the following malignant tumors:
- Melanoma - about 7–20%. These tumors account for up to 13% of skin metastases in men.
- Breast cancer - 30%. Responsible for 70% of skin metastases in women.
- Cancer of the paranasal sinuses - 12%.
- Laryngeal cancer - 16%.
- Oral cancer - 12%.
- Lung cancer accounts for 24% of all cases of skin metastases in men.
- Colon cancer accounts for 19% of all skin metastases in men.
Patterns of metastasis of malignant tumors to the skin depend not only on gender, but also on age. For example, in men under 40 years of age, skin metastases most often occur with melanoma, colon cancer, and lung cancer. In older age groups, squamous cell carcinoma of the oral cavity is added to this list. In women of any age, the most common cause of skin metastases is breast cancer. Until the age of 40, malignant tumors of the ovaries and colon predominate. After 40 years, melanoma and lung cancer are added to these cancers.
What does melanoma look like in a photo?
- Nodal.
Nodular (diminutive from the Latin “nodus” - node) formation is less common (14-30%). The most aggressive form. Melanoma cancer is characterized by rapid growth (from 4 months to 2 years). Develops on objectively unchanged skin without visible damage or from a pigmented nevus. Growth is vertical. The color is uniform, dark blue or black. In rare cases, such a tumor, which resembles a nodule or papule, may not be pigmented.
- Malignant lentigo.
The disease affects older people (after 60 years) and is detected in 5-10% of cases. Open areas of the skin (face, neck, hands) are covered by dark blue, dark or light brown nodules with a diameter of up to 3 mm. Slow radial growth of the tumor in the upper parts of the skin (20 years or longer before vertical invasion into the deep layers of the dermis) can involve the hair follicles.
How common are cutaneous and subcutaneous cancer metastases?
In visceral (located in internal organs) malignant tumors, subcutaneous metastases are found in 5.3% of all cases of metastatic lesions of various locations. Secondary skin lesions account for even less - about 0.7–0.8%. Although, in some scientific studies, the authors indicate figures of up to 9%. In 2003, a meta-analysis looked at 1,080 cases of cutaneous cancer metastases in 20,380 patients. The authors suggested an incidence of 5.3%.
In general, at the moment there is no exact unambiguous data on how common skin metastases of cancer are. More recent scientific papers provide higher figures. But scientists do not believe that skin metastases have begun to occur more often in cancer patients - they are simply being diagnosed better now.
Among all malignant skin tumors, 98% are primary tumors and only 2% are metastatic lesions.
The first signs of melanoma
Melanoma is the acquisition by cells of unfavorable signs of malignancy (malignancy properties), expressed by various symptoms.
To make it easier to remember the signs of melanoma, use the “FIGARO” rule:
Shape – swollen above the surface;
And changes - accelerated growth;
Borders are openwork, irregular, indented;
And symmetry is the absence of mirror similarity between the two halves of the formation;
P size – a formation with a diameter of more than 6 mm is considered a critical value;
About paint - uneven color, inclusion of random spots of black, blue, pink, red.
In widespread practice, the English version is also popular, summarizing the main, most typical features - the “ABCDE rule”:
A symmetry is an asymmetry in which, if you draw an imaginary line dividing the formation in half, one half will not be similar to the other.
B order irregularity – the edge is uneven, scalloped.
Color is a color that is different from other pigment formations. Interspersed areas of blue, white, and red colors are possible.
D iameter – diameter. Any lesion larger than 6 mm requires additional observation.
E volution – variability, development: density, structure, size.
Without special studies, it is difficult to determine the type of nevus, but timely changes in the nature of the spot will help detect malignancy.
The story of Christina from St. Petersburg, a patient at the Ichilov Cancer Center:
– While vacationing in Israel, I discovered a lump on the top of my foot. Then I didn’t even think that it could turn out to be cancerous. I decided that the bump looked unsightly and went to a dermatologist to have it removed. The doctor removed the lump and sent it for examination. It turned out that I had melanoma. I decided to play it safe and here, in Israel, I turned for advice to the Ichilov Oncology Center.
Before the diagnosis, of course, I knew that anyone can get cancer, but I didn’t worry about it. I went to the beach with my friends. I often neglected sunscreen because I wanted to have a beautiful tan. I like it when my skin feels like it's been kissed by the sun. I visited solariums and didn’t even think about the danger.
When I found out that I had melanoma, I decided: okay, it’s just a spot on the skin. It will be removed and everything will be fine. As it turns out, I am now in a high-risk group. Since I already had melanoma, the tumor may appear again.
I didn’t understand how serious it was until I talked to an oncodermatologist. Only then did I realize that this disease greatly affects the patient’s life. And I’m glad that I contacted the cancer center on time.
Diagnostics
- Visual method. Examination of the skin using the “rule of malignancy.”
- Physical method. Palpation of accessible groups of lymph nodes.
- Dermatoscopy. Optical non-invasive surface examination of the epidermis using special devices providing 10-40x magnification.
- Siascopy. Hardware spectrophotometric analysis, which consists of intracutaneous (depth) scanning of the formation.
- X-ray.
- Ultrasound of internal organs and regional lymph nodes.
- Cytological examination
- Biopsy. It is possible to collect both the entire formation and its parts (excisional or incisional).
Factors influencing survival
The 5-year and 10-year survival rates for different stages of melanoma are based on data obtained from patients who survived at least 5 or 10 years from the date of diagnosis.
The following factors influence survival:
- new developments in cancer treatment;
- the body's response to treatment;
- age of the patient (regardless of the stage of the disease, older patients live shorter than others).
Treatment
- Treatment of local local injuries consists of timely detection and surgical intervention. Removal is most often performed under infiltration anesthesia. For excision of large formations, general anesthesia may be used. In addition to malignant tumors, there are a number of pre-melanoma diseases in which the surgical method is indicated.
- Local-regional damage. Treatment includes wide-area excision and lymph node dissection of the affected lymph nodes. Types of unresectable, transiently metastatic tumors are subjected to isolated regional chemoperfusion. In certain cases, a combined approach has proven itself to be effective, with additional therapy that stimulates the immune system.
- Treatment of distant metastases is performed with monomodal chemotherapy. Certain types of mutations are targeted by targeted drugs.
Preventive measures
In its early stages, melanoma is highly treatable. However, the success of therapy primarily depends on the timely detection and treatment of cancer.
If you notice a new mole or suspicious spot on your skin, you need to go to a dermatologist for examination as soon as possible. Timely diagnosis is especially important if your immune system is weakened by HIV or another infectious disease.
Consistent use of sunscreen is one of the best ways to prevent skin cancer. It is also advisable to wear clothing that protects from solar radiation, for example, T-shirts made of special material that does not transmit ultraviolet rays.
You should definitely familiarize yourself with the classic method for diagnosing melanomas called “ABCDE”. It will help you determine how dangerous a particular mole may be.
