Melanoma-What is melanoma?
Melanoma (melanoma), also known as malignant melanoma, a highly malignant tumor is a melanin. Mostly seen in adults over the age of 30, occurred in the skin, mucous membranes and internal organs. Eye view of the prominent tumor or slightly protruding from the skin surface, mostly black, and the surrounding tissue ill-defined. Most of the prognosis is poor for melanoma, the late lymphatic and blood transfer.
Melanoma - IntroductionMelanoma Melanoma (alias: melanoma, pigment diseases, from gangrene, Li gangrene), by abnormal melanocyte cell hyperplasia caused by common skin tumors, a high degree of malignancy, accounting for the vast majority of cases of skin cancer death . Occurred in the skin or mucous membrane close to the skin, also seen in the pia mater and choroid.Its incidence there are differences with different ethnic, geographic, racial Caucasians the incidence is much lower than that of black people, white people living in Queensland, Australia, the incidence rate of up to 17/100 000. Low-incidence areas of China, although melanoma, but the 21st century, the incidence rate actually was rising trend.Each year in the United States has a malignant melanoma of 25 000 new cases, about 6,000 people died. Incidence is rising rapidly. Sunlight is a risk factor for the same risk factors include family history, occurrence of malignant nevus, a large congenital melanocytic nevus and dysplastic nevus syndrome. Ethiopian rare.
Melanoma may be epidermal melanocytes, nevus cells or leather into melanoma cells. Tumors originate from ectodermal neural crest melanocytes located in the table is arranged between the cortex and the basal cell, cells to produce pigment, through the tree suddenly melanin particles transported to the basal cells and hair. The majority of malignant melanoma originated in normal skin melanocytes, about 40% to 50% occur in nevi.Varying the tendencies aspects of malignant melanoma in size, shape and color (usually pigmentation) and local invasion and distant metastasis. The rapid spread of the tumor, died in the diagnosis of a few months later. The early, very superficial lesions of the 5-year cure rate for 100%. Therefore, the cure rate depends on early diagnosis and treatment.
Melanoma - etiology1, frequent stimulate neviThe majority of malignant melanoma, black nevi subject to repeated friction, grabbed, and damage caused by malignant inappropriate excavation and drug corrosion, can Benign black nevus into malignant melanoma.2, melanoma - and the endocrineThe rapid development of malignant melanoma of pregnancy or child-bearing age women make, suggesting that the disease and endocrine-related.3, melanoma - occurs in benign neviIt is reported that: 84% of malignant melanoma from benign moles. According to the Wieeio report, due to too small moles reason, many patients, initial illness did not notice. Some people think that a benign mole is the greatest source of malignant melanoma.Melanoma - air pollutionA large number of emission of harmful substances such as Freon destroy the ozone layer, resulting in inadequate UV filtration of harmful UV and harmful substances in the air together in the human skin, resulting in abnormal expression of melanocytes, causing melanoma.5, the beauty of heart troubleMany people to the pursuit of the skin clean soft and heavy use of chemical cosmetics, resulting in chemical skin contamination, and even some chemical etchant to remove skin moles and counterproductive, to stimulate the proliferation of melanocytes.6, lack of health knowledgeNot pay sufficient attention to the length in feet, perineum, friction-prone parts of the mole, by virtue of their long-term by squeezing and friction, which ultimately caused their malignant transformation occurs.7, estrogen drugs abuseThe study found that malignant melanoma cells have estrogen receptors, so people suspected of excessive estrogen can stimulate the occurrence of melanoma.8, immunodeficiencyWith the improvement of living standards, the Chinese people life is significantly extended. Accompanied by the growth of the age, the body's immune functions gradually decline. The study found that immune function is one of the important cause of melanoma, clinically high incidence of melanoma in the elderly.9, benign melanin patchesThat is, mole, at the junction of the mole is most vulnerable to malignant mixed mole less endothelial moles are rarely malignant. Scalp melanoma majority is not mole change from, so it was that the disease is not completely related with the mole.10 melanoma - racialWhites than people of color with a high incidence of up to 42/100 000, such as the annual incidence rate of the U.S. white, while blacks only 0.8/10 million.
Melanoma - the pathogenesis ofMelanoma lesions occur in the dermis and epidermis at the junction of tumor cells similar to nevus cells, but significantly shaped stromal cells and cells filled with melanin vary according to cell morphology and melanin, can be divided into five types:A large epithelioid cellCommon, cells were polygonal.2, epithelial-like cellsLarge nuclei and typical.3, cellCytoplasm fibril-like, nuclear staining deep.4, the spindle cellsFor single-core or multicore.6 branches oligodentrocytesThan normal melanocytes nucleus profiled tumor cells casein enzyme showed a strong positive reaction with melanin is low and difficult to prove in the HE sections, so there is "no melanotic melanoma," said, but silver staining, a few cells may be detectable melanin.Melanoma - the pathological changesTypical pathological features of malignant melanomaIs not typical in the dermal-epidermal junction of melanocyte proliferation and tumor cells invaded the epidermis and dermis. Tumor cells showed a biphasic differentiation, epithelial cell and spindle cell type. Was significantly shaped nuclei, nuclear shape weird. Also seen single-core, dual-core or multi-core, common mitotic Evil black pathological form due to the different types is not the same.Malignant freckle-like moles melanoma skin atrophyBasal layer of the more atypical melanocytes, and invasion of the dermis, macrophages in the tumor cells or stromal cells, pigment cells contain a considerable number of melanocytes.
Dermal inflammatory cell infiltrationSuperficial spreading melanoma epidermal sudden downward irregular hyperplasia, seen in the dermal-epidermal junction and dermis atypical nevus cell nests, in addition to the epithelial and spindle cell type melanocytes, sometimes the epidermis the upper visible a small number of the paget kind melanocytes. Dermal inflammatory cell infiltration.FasciclesNodular melanoma is not typical vertical downward proliferation of the melanocytes invade the dermis, without violation of the epidermis. Epithelioid cell type melanoma cells often arranged in alveolar; spindle cell type, similar to fibroblasts, sometimes for fascicular arrangement.Dermal papilla visible bite pigment cellsExtremities freckle-like moles melanoma epidermal thickening, atypical nests of melanocytes containing large amounts of pigment at the lower part of the epidermis, melanocytes of common spindle. The upper epidermis also visible to paget kind of melanocytes, dermal papilla visible bite pigment cells.
Melanoma - clinical manifestationsFound that the proliferation of ocular melanoma associated genes symptomsMelanoma occurs in the elderly more men than women more than hair. Good lower extremity foot, followed by the torso, head and neck and upper limbs. The main symptoms of melanoma nodules grow rapidly. Early can occur in normal skin hyperpigmentation, nevus pigment increased, deepening black, followed by lesions of the damage continues to expand, increase hardness, accompanied by itching sensation. Melanoma lesions showed some uplift, plaques and nodules, and some were mushroom or cauliflower. To the subcutaneous tissue growth was subcutaneous nodule or mass type, to the edges of star spots or nodules. The common manifestations of melanoma regional lymph node metastasis, fraudulent claims to the regional lymph nodes and treatment. To the late transfer by the blood flow to the lungs, liver, bone, brain of various organs.Clinical classification(1) the superficial spread of the most common type, accounting for about 70%. Occurs in about 50 years old, women, mainly in the limbs, the male predilection in the trunk. Its degree of malignancy between the freckles and nodular type. An early manifestation of brown, brown, blue or black, most were red roses or pink, its jagged edges and texture of the skin disappear. Radiation growing season for 12 years, this period the incidence of lymph node metastasis less than 5%.(2) freckles type accounted for 10% to 15%, a minimum four types of the degree of malignancy. Occur in the head, neck, back of hands and other exposed parts, and more common in 60 to 70 years old, more common in women. Clinical manifestations of a larger, flat or slightly higher than the leather brown or brown lesions. When the radiation growth is accompanied by vertical growth, the local was the focal bulge, color is still brown, lymph node metastasis was 25%.(3) of the nodules of four types of malignant type, accounting for about 12 percent, occur in about 50 years old, to female ratio was 2:1, a good hair in the back. Clinical nodules of gray with a pink color, its color turns blue when the lesions continue to grow, was the dark purple jam-like dome-shaped or polypoid block of material, the vertical growth of its unique growth pattern, the rapid progression of usually lasts a few months to a year earlier ulcers and lymph node metastasis. This type of poor prognosis.(4) acral pigmentation melanoma occurs in the palms, soles of the feet, and A, the radiation growth phase lesions of brown, tan or black, not higher than the leather in A shows irregular brown yellow or brown stripes extended to the proximal nail bed, continuous radiation growing season in a year or so, not in time to enter the vertical growth phase, the lesion nodular uplift, lymph node metastasis rate also increases, prognosis is poor.Clinical stageAccording to the scope of the primary tumor, lymph node metastasis No distant metastasis, and the results to estimate the stage of disease and imaging.
Melanoma - DiagnosticMelanoma diagnosis is generally difficult, a few atypical cases, to rely on pathological examination confirmed. Indirect immunofluorescence labeling of melanin organization, PAP immunoenzyme notation mark determination and pigment of the original check is helpful in the diagnosis, "pigment" or less pigmented melanoma diagnosis and identification of benign nevus cell tumor and whether malignancy was helpful.There are two classification systems can be used for the assessment of stage Ⅰ melanoma: (1) according to Breslow's description, the deepest violation of the granular layer to the tumor as a measurement of the depth of the melanoma. (2) the depth of tumor invasion according to Clark's classification, anatomy. Clark's classification, grade Ⅰ melanoma confined to the epidermis; level II melanoma has violated the papillary layer of dermis; level III melanoma has been widely involving the papillary layer; grade Ⅳ melanoma violation of the reticular dermis ; Ⅴ grade the melanoma violation of the subcutaneous fat. Breslow thickness and depth of melanoma involving the (Clark level) increase with a poor prognosis.Melanoma - the differential diagnosisMelanoma to check the disease should be noted that benign borderline tumors, identification of juvenile melanoma and cellular blue nevus, also should be noted that the phase identification with basal cell carcinoma. Should also be noted that the obsolete hematoma differentiated sclerosing hemangioma, senile moles, seborrheic keratosis, a bed.A benign at the junction of the mole endoscopic findings were benign nevus cells, no heterosexual cell, only to grow in the dermis, the inflammatory response is not obvious.Juvenile melanoma (2) slow-growing children face was round nodules. Microscopically, cells were pleomorphic, and mitotic figures. The tumor cells infiltrating the epidermis and the tumor surface nor the formation of ulcers.Cellular blue nevus occurs in the buttocks, sacral tail, waist, pale blue nodules, smooth surface and irregular. The microscope dendritic protrusion dark cells, large prismatic cells, and assembled cell Island. Mitotic activity or necrosis, should take into account the possibility of malignancy.(4) basal cell carcinoma is a malignant tumor of epithelial cells. The basal layer of epidermis to the deep infiltration of the cancer nests surrounded by a layer of columnar or cuboidal cells. Cancer cells staining deep, no definite arrangement. Cancer cells may contain melanin.Sclerosing hemangioma of epidermal hyperkeratosis, leather emulsion proliferation and expansion of the capillaries, often extending down the epidermis protrusion around, seemingly within the epidermis hematoma.Elderly mole found in the elderly surface verrucous nevus, hyperkeratotic, the granulosa some thickening or atrophy, acanthosis, complete the grassroots level may also have hyperpigmentation. Proliferation of dermal papilla, the appearance of papillomatosis.7 seborrheic keratoses lesions was also found papillomatosis, subepidermal clear boundaries, incomplete keratosis the granulosa starts thickening, thinning or even disappearance, the proliferation of epidermal cells may have a small amount or more melanin.8 A bed hematomaMore history of trauma. Microscope, dried blood cells, epithelial fibroblasts.Melanoma - CheckAnti-melanoma serum do indirect immunofluorescence labeling of melanin organization, when the antiserum was diluted 1:2, the highest positive rate of up to 89%.2 Vacca PAP immunoenzyme notation, marked the determination of when the antiserum dilution of 1:400, 82.14% were positive.3 of the original check melanin pigment of the original oxidation by renal excretion, the urine was dark brown, said the black urine. In the urine of the ferric chloride, potassium dichromate, sulfuric acid, can promote its oxidation, coupled with sodium nitrate, urine was purple; before adding acetic acid, plus sodium hydroxide, the urine blue.
(1) I period: No regional lymph node metastasis.(2) Phase II: associated with regional lymph node metastasis.(3) III period: with distant metastasis.Overall, pigmented skin lesions following changes are often suggestive of the possibility of early melanoma:(1) The color of variegated signal of the malignant lesions. Freckles type and superficial spreading type doping often brown or black, red, white or blue, especially in the blue is more bad.(2) edge is often uneven jagged change, extend or their own nature due to the degeneration of tumor spread to the surrounding.(3) surface is not smooth, often rough with scales shaped flaky desquamation, when there is bleeding, exudate, can be higher than the leather.(4) The skin around the lesion may be edema or loss of the original radiance of your skin or into a white, gray.(5) feeling of abnormal local itching, burning, or tenderness.
Melanoma - TreatmentSurgeryTreatment of melanoma is surgical excision. Although the tumor resection margin of the range there are still controversial, but most experts believe that when the tumor thickness <1mm, should be removed from the tumor margin, about 1 0cm normal skin. Deeper lesions require radical sexual surgery and sentinel lymph node biopsy.Malignant freckle mole melanoma and malignant freckles and moles are usually treated by wide excision, if necessary can be carried out skin grafts.Chemotherapy(1) single drug(1) nitrosourea drugs: have a certain effect on melanoma. Comprehensive literature, of BCNU treatment of 122 cases of melanoma, the effective rate of 18%, MeCCNU treatment of 108 cases, 17%, CCNU treatment of 133 cases, 13% efficiency.(2) triazene microphone amine (DTIC): DTIC emergence of melanoma a step forward to become the most widely used drugs. GaiIanl reported DTIC's the best efficacy, treatment of 28 cases of melanoma, each dose of 350mg/m2 once every 6 days, 28 days for a course, the effective rate of 35%.The combination therapy: malignant melanoma is less sensitive to chemotherapy, but the combination therapy can improve efficiency and reduce toxicity.ImmunotherapySpontaneous regression of malignant melanoma, indicating that the immune function. Bacillus Calmette-Guerin (BCG) can make melanoma patients in vivo lymphocyte tumor nodules, and to stimulate the patient to produce a strong immune response to achieve the role of treatment of cancer. BCG available skin punctures, intratumoral injection and oral. With BCG intratumoral injection of local small lesions, up to 75% ~ 90% efficiency. In recent years, trial of interferon, interleukin - 2 (ILA-2) and lymphokine activated killer cells (LAK cells) and other biological response modifier, certain positive results.Melanoma - prognosisMelanoma recurrence and metastasis were high and poor prognosis. Prognostic factors, including:(1) depth of tumor invasionAccording to the World Health Organization follow-up results of a malignant melanoma, the prognosis and tumor thickness are closely related. Tumor ≤ 0.75mm, 5-year survival was 89%, ≥ 4mm who is only 25%.(2) lymph node metastasisWithout lymph node metastasis, 5 year survival rate was 77%, while only 31% of lymph node metastasis. The survival rate was also about the number of lymph node metastasis.(3) the lesion siteLocation and prognosis of malignant melanoma. Occur in the trunk prognosis of the worst 5-year survival was 41%; in the head of those who followed the 5-year survival rate was 53%; limbs is better, lower limb 5-year survival was 57%, upper extremity 60 %; mucosa melanoma prognosis is even worse.(4) age and genderIs generally believed that the female patients was significantly better in men, younger age, year over year old man.(5) the surgical approachTumor thickness and resection thickness ≤ 0.75mm, resection from the tumor margin of 2 ~ 3cm;> the 4mm those from the tumor edge 5cm range is wide excision. Non-compliance with regional lymph node dissection, often promote tumor spread to the body, affecting prognosis.Melanoma - NursingPost-operative carePatients should be minimal exposure to sunlight.In the observation of tumor recurrence, the recurrence of the same place more common than distant metastasis or regional lymph node metastasis.Issued a number of skin cancer tendency, in the care, the entire skin area should often be closely observed, with particular attention to the more hidden parts in the ear, etc..Diet careMelanoma patients treated at the same time, the auxiliary scientific and rational diet care help to help the rehabilitation of patients with melanoma.
1 Eat less fatThe long-term high-fat diets lead to melanoma, colorectal cancer, breast cancer. In addition, cancer patients in the course of treatment or disease progression, often nausea, vomiting, tired of greasy, poor digestive function, performance, low-fat diet should be used.2, protein intake should not be excessive and should be a varied dietLead to digestive function, or the tumor increases the body consumption caused by malnutrition, or cachexia due to cancer patients in the radiotherapy and chemotherapy often cause gastrointestinal reactions, many people blindly using high-protein diet. The high-protein diet will increase the burden on the gastrointestinal tract, gastrointestinal digestion and absorption of weaker and unfavorable treatment of tumors. Many experiments show that high-protein diet and sub-camp cancer, prostate cancer incidence was positively correlated.
Melanoma - PreventionA normal life, to try to avoid the sun, use sun screen shade is important, the most effective primary prevention measures, especially for those at high risk of protective measures.2, focusing on the education of the general public and professionals to improve the three early implementation of the immediate early discovery, early diagnosis, early treatment.
