Igor Sinelnikov: “Melanoma is different from all other moles on the body, in its own way - it is the only one”

How is the stage of melanoma determined?

Based on the stage, one can judge the main characteristics of the disease in a particular patient. First of all, the stage indicates the extent of the spread of the pathology. For example, to detect stage I melanoma, a doctor only needs to perform a routine medical examination, but to determine the severity of the disease it is necessary to use special technologies. Most often, patients are prescribed a PET scan and sentinel lymph node biopsy.

There are 5 stages of melanocytic skin cancer. The first stage is usually called stage zero, or melanoma in situ. The last stage is the fourth. As the disease progresses, patient survival rates decrease.

It is important to understand that statistics provide only an approximate picture. Each melanoma patient is unique, and the individual prognosis always depends on many different factors:

• Stage 0

Stage zero melanoma is also called melanoma in situ. This means that your body contains several abnormal melanocytes. Melanocytes are cells that produce melanin, the substance that gives the skin its natural shade.

At this stage, melanocytes can become cancerous, but for now they are simply abnormal cells in the top layer of skin. Melanoma in situ looks like a small mole. Even if it seems to you that nothing bad is happening, any new or suspicious formations on the skin should be shown to a dermatologist.

• Stage 1

At stage 1A, the thickness of the tumor does not exceed 1 mm. There is no ulceration. This means that the tumor has not penetrated the skin. Stage 1B indicates one of 2 scenarios:

1. melanoma, not exceeding 1 mm in size, began to penetrate the skin;
2. melanoma has grown to a size of 1-2 mm, but has not penetrated into the lower layers of the skin.

The 5-year survival rate for stage 1A melanoma is 97%, and for stage 1B melanoma it is 92%. The 10-year survival rate is 95% for stage 1A melanoma and 86% for stage 1B melanoma.

• Stage 2

The second stage of melanoma means that the thickness of the tumor has exceeded 2 mm. At this stage, doctors examine the tumor to determine how deeply it has penetrated the layers of the skin. The usual treatment strategy is surgery to remove the malignant tumor. To assess how widespread the cancer is, doctors order a biopsy of the sentinel lymph node.

The 5-year survival rate for stage 2A melanoma is 81%, and for stage 2B melanoma it is 70%. The 10-year survival rate of patients with stage 2A melanoma reaches 67%, with stage 2B melanoma – 57%.

• Stage 3

This stage includes tumors of any size and shape. Stage 3 means that the skin cancer has spread to the lymphatic system. Doctors usually prescribe surgery to remove the cancerous tissue and lymph nodes. Standard treatments for stage 3 melanoma also include radiation therapy and the use of powerful chemotherapy drugs.

The 5-year survival rate of patients with stage 3 melanocytic skin cancer varies from 40 to 78%. The 10-year survival rate ranges from 24 to 68%.

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• Stage 4

Stage four melanoma means the cancer has spread to internal organs, such as the lungs, brain, and other structures. The disease also often affects lymph nodes located at a considerable distance from the primary tumor. Stage 4 melanoma is difficult to treat using conventional methods.

The 5-year survival rate reaches only 15-20%. The 10-year survival rate for stage IV melanoma is 10-15%.

Diagnostics

Among the main methods for studying skin melanoma are:

1. Collecting anamnesis of illness and life. The doctor finds out the time of appearance of the pathological formation and accompanying symptoms. Presumable causes and predisposing factors are determined. The presence or absence of a hereditary predisposition to tumor diseases is clarified.
2. Skin examination. The doctor conducts an objective examination of the tumor. Experts identify the so-called alphabet of melanoma. It is designed specifically to characterize pathological formations:
3. A (asymmetry) - asymmetry of the shape of the mole;
4. B (border irregularity) - uneven borders of the nevus;
5. C (color) - change in pigmentation of the mole;
6. D (diameter) — increase in nevus diameter;
7. E (evolving) - a combination of the above changes.

Dermatoscopy. It is carried out using a dermatoscope. Thanks to it, it is possible to increase the size of the pathological formation several times. This allows you to examine the structure of the tumor in detail.

Biopsy. The most reliable way to confirm skin cancer. The material selected during diagnosis is sent for histological examination. The danger of manipulation is that additional damage to melanoma can provoke an acceleration of the growth of the tumor process. Therefore, it is important to contact experienced doctors.

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:

1. new developments in cancer treatment;
2. the body's response to treatment;
3. age of the patient (regardless of the stage of the disease, older patients live shorter than others).

Frequency of occurrence

For any type and size of melanoma, the most common progression after surgery is metastases to other organs in almost 60% of patients.

The most dangerous period is the first three years after surgery, but in the first year, 60% are more likely to have metastases in regional lymph nodes. In stages 1 and 2, the incidence of lymph node involvement is low - every fifth person, and very rarely - less than 5% are affected by the postoperative scar.

Due to the development of relapses of the disease, only 60% of patients live longer than five years, but the disease can return after 15 years - in 7%, and after 25 years - in 10%. Every fifth person with an unimportant individual prognosis, however, does not experience a relapse in the next 5 years.

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.

How does the quality of drugs affect the cure for melanoma?

Current treatment for advanced melanoma often includes targeted and immune-based drugs. Their cost is usually quite high, so it is important that the authenticity and high quality of these medicines are guaranteed. This is why they are worth purchasing in Israel:

1. Israeli drugs are reliably protected from counterfeiting. The guarantor of the authenticity and high quality of medicines in Israel is the Ministry of Health, which exercises strict control over the production and sale of medicines.
2. New medicines are being rapidly introduced in Israel. In this country, approval of a drug does not require a lengthy bureaucratic procedure.
3. The Israeli pharmaceutical company TEVA is one of the most advanced in the world. Medicines from this company are prescribed in 60 countries.

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.

Relapse groups

In 1985, the domestic oncologist Anisimov proposed, for the convenience of describing the clinical picture, to divide recurrent tumors into six groups:

• The first - round and few formations, often outside the scar and mainly subcutaneously - in the fatty tissue, often fall under the criteria of “transit” metastasis according to Wagner.
• The second is multiple irregular cutaneous and subcutaneous infiltration accompanying vessels and nerves; it is assumed that the external picture of relapse is formed by tumor cells that have taken root in small vessels.
• The third is nodules directly associated with the operation area that have grown from malignant cells remaining in the skin.
• The fourth is polycyclic multiple formations.
• The fifth is a lot of bulging nodules, often on a stalk, like morel mushrooms.
• The sixth is a combination of all five options.

Classification is rarely used in clinical practice, because the assessment of treatment results is based solely on the size of the nodes, and not on their appearance.

Comment from a doctor at the oncology center:

– Melanoma affects even young people. The lighter your eyes and skin, the more easily you burn in the sun, the more difficult it is for you to tan, the higher your risk of developing melanocytic skin cancer. Yet melanomas occur even in people with dark skin color.

On average, 1 in 5 people will be diagnosed with melanoma during their lifetime. Skin cancer cannot be guaranteed to be avoided, but the likelihood of developing a tumor can be reduced. Wear thick clothes with sleeves. Try not to walk outside in the middle of the day, during peak solar activity. Use sunscreen regularly. All of this will help you reduce your risk of skin cancer.

Women between the ages of 20 and 30 often come to us, so Christina’s case is not an exception to the rule. I told this girl the following: if you have already had melanoma, then your risk of developing a second such tumor throughout your life is 10-20%. For this reason, every 4-6 months you need to undergo a preventive examination by a dermatologist. If a second melanoma does appear, it must be detected as early as possible.

Find out if the treatment is prescribed correctly

Early detection of melanoma is the key to reducing mortality rates. Melanomas are perhaps the most obvious cancers. If detected early and treated immediately, they pose no real threat. But once melanoma metastasizes, no therapy is effective.

If melanoma is detected early, it can be cured with 100% probability. That's why you need to go to a dermatologist as soon as you notice a suspicious growth on the skin.

Forecast

Every year, melanoma is diagnosed in an average of 15 people out of every hundred thousand adults, approximately 3 patients die, and with a fairly stable mortality rate in the last quarter century, men began to die more often. Gender determines a lot in the prognosis of the disease, other things being equal, but young people experience the disease with less difficulty.

The probability of death with a late relapse is many times lower than with an early relapse. Early detection of progression promises better treatment results.

It is extremely difficult to predict the course of melanoma, because even a common process is not considered absolutely fatal; this malignant disease does not often live up to expectations. Don’t guess “to be or not to be”, contact specialists if you have problems, or better yet, before they appear - we will always help.

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Bibliography

1. Semiletova Yu.V., Anisimov V.V., Vagner R.I. /Treatment of patients with primary skin melanoma. Current state of the problem // Siberian Journal of Oncology. 2010. No. 4. 2. Semiletova Yu.V., Anisimov V.V., Lemekhov V.G. et al./Risk factors for relapse after radical treatment of skin melanoma//Sibir.onko.zhur.; 2012. No. 2 (50) 3. Stroyakovsky D. L., Abramov M. E., Demidov L. V. et al. /Practical recommendations for drug treatment of skin melanoma // Malignant tumors: Practical recommendations RUSSCO #3s2, 2018 (volume 4. de Vries E., Bray FI, Coebergh JW, Parkin DM /Changing epidemiology of malignant cutaneous melanoma in Europe 1953–1997: rising trends in incidence and mortality but recent stabilizations in western Europe and decreases in Scandinavia// Int J Cancer 2003; 107. 5. MacKie RM, Bray C., Vestey J., et al./Melanoma incidence and mortality in Scotland 1979– 2003 // Br J Cancer 2007;96.

Cost of melanoma treatment in Israel

Below is a table in which you will find prices for some types of diagnosis and treatment of melanoma at the Ikhilov Cancer Center.