Melanoma – “serial” killer – MK

The first at risk are children

— Andrei Pavlovich, how common is melanoma in Russia today? And what are its reasons?

— Malignant tumors of the skin today are leading in the structure of oncological diseases in Russia. Approximately 600,000 are diagnosed annually, of which 90,000 are malignant tumors of the skin, melanoma – in 11,000. Over the past 10 years, the increase in the incidence of melanoma in our country amounted to 44%! Every year about 6% is added.

One of the reasons is the passion of our population, first with solariums, and now with the southern sun. Russians have begun to travel more actively around the world, and especially to the south, to the sea – for a chocolate tan, where they receive an increased ultraviolet load. But according to our skin phototype (light), this is contraindicated. Sunburn is not just one of the main risk factors for the formation of melanoma, but the main one!

And the first at risk are children under 3 years old. Sunburn on the body in children is one of the main reasons for the formation of melanoma on the skin in the future. But in Russia, especially those living in the north, they try to take their children to the south, to the sea. And the kids are there all day on the beach or on the street. Yes, for children under three years old all day in the sun is contraindicated even in our lane with my grandmother in the village. By the way, the back of the neck is especially vulnerable. Therefore, in the summer, kids must wear a panama hat that covers the back of the neck (today there are such special hats), and children should also wear cotton clothes with long sleeves and cover their legs. And on the body it is necessary to apply sun cream with a high degree of protection from its rays.

Why is a child’s neck so vulnerable in the sun? And is it true that if a baby is burned in the sun at least once in his life, then in the future he will definitely develop skin cancer?

– The back of the neck is more exposed to the sun than other parts of the body, as it is more often open. And if a child gets a serious sunburn of the skin even once, this is already a risk factor. For this reason, melanoma on his skin can occur in a few years and even decades. Therefore, white-faced Muscovites need to be especially careful near the sea: stay in the sun in the morning until 11 o’clock, and in the evening – from 4-5 o’clock. During these hours, the sun is less active and the child will receive a lower dose of radiation. This also applies to adults. These recommendations have long been known to everyone, but people are in no hurry to implement them.

– Explain to the most careless: why is solar radiation so dangerous during the daytime? What happens to the body of a person who wants to “snatch” as much sun as possible for a short vacation? And who else, besides children, should be afraid of its southern rays?

– In the daytime, the level of intensity of solar radiation is the highest, and UV rays become simply dangerous for human skin. Ultraviolet rays trigger photochemical and biological processes in the body of a tanner. And at the cellular level, they act on DNA, which violates their structures. Such mutations can cause dangerous cell degeneration.

The second risk group is white-skinned, fair-haired, blue-eyed and gray-eyed Russians (skin types 1 and 2), who burn easily in the sun. At risk are those who already had melanoma in their family. There is such a thing as FAMMM syndrome – a syndrome of familial atypical nevi (moles) and melanoma. This is a hereditary disease when a person has many atypical nevi on the skin. And this indicates an increased risk of developing melanoma of the skin. If, for example, a mother had a malignant tumor on the skin, her child is also at risk. When exposed to certain risk factors, such a mole can turn into a malignant tumor on the skin. The main one is ultraviolet radiation. There are also high risks associated with sunburn.

“Metastases are no longer a sentence”

– Andrei Pavlovich, what are the signs of this dangerous melanoma? Many confuse it with moles. How to distinguish melanoma from moles and warts? What should we pay attention to, since such an increase in diseases in our country?

– At a young age (up to 44 years), new moles often appear on the human body. This is fine. But if a mole or a pigmented formation suddenly appears on the body in an older group, this is a reason to contact a dermatologist or an oncologist. Or, let’s say, a long-standing mole begins to change: it becomes asymmetric. It was round with smooth edges, but then the edges became uneven. Or its color has changed: it has become darker. Or some darker inclusions appeared in it. She began to grow in size, to increase rapidly.

All changes in moles, warts should be paid very serious attention and at the slightest change go to specialists. There is another formidable sign: this is when a mole begins to bleed. Here you can’t hesitate: you must not just go to the oncologist – run!

Why is melanoma so dangerous? In general, it is possible to recover from it today?

Melanoma itself is not dangerous if it is detected at an early stage. It is easy to cure it at the initial stage – a small operation and that’s it. But you need to know that it quickly metastasizes to almost all organs and tissues: to the lungs, liver, bones, to the brain … In this sense, melanoma is a real insidious killer.

And it is very important to “catch” melanoma at an early stage. The main sign that speaks about the forecast is its thickness. There are thin ones (up to 1.5 mm), when the prognosis is good: the cure is almost 100%. And there are thick ones, then the prognosis is much worse. But in Russia, melanoma is detected at stage 3 in 10% of patients, and with stage 4 in 9% of cases. This suggests that in our country almost 20% of melanoma patients are neglected cases.

That is why timely diagnosis is so important: if doctors manage to find melanoma at the initial (thin) stage, the cure will be almost one hundred percent. But when the tumor already becomes thicker and grows into the lymphatic blood vessels, gives metastases, it becomes extremely dangerous.

— Does Russia have new, more effective methods for diagnosing melanoma today, in addition to the well-known ultrasound, X-ray, CT?

“Today, the most effective method for detecting these malignant tumors is digital dermatoscopy. This is an examination of moles with a high magnification, which allows you to enlarge their image up to 140 times! And this method is applied using artificial intelligence and a neural network. In principle, to understand that this is melanoma, doctors can also visually, knowing its external signs. But… In addition to the well-known signs, hundreds of others are automatically detected, which the clinician will not see visually with all his desire. And the neural network will see (the system is trained for 130,000 studies). And together with artificial intelligence, the program sums up all the factors and gives an accurate hint to doctors: does the patient have melanoma. And this method of diagnosing a tumor is now available to all Russians.

This method of research is good because all the information remains in memory – in a kind of electronic passport of the skin of a particular patient. And if this person goes to the doctors again, the doctors will have the opportunity to compare what happened to his skin, say, 2-3-5 years ago, and what has changed since then.

– That is, now doctors with the help of artificial intelligence and neural networks can not analyze anything themselves?

– It needs to be analysed. The program, the technique is only a tool, a hint. And doctors will have to decide: what to do with the patient: whether to treat him with drugs, whether to perform an operation. If, for example, the neoplasm is threatened, then it is necessary to take a biopsy, to conduct a histological examination, perhaps. we will have to connect our old methods – ultrasound, CT, X-ray …

– Andrey Pavlovich, the word metastases is still associated in the minds of people with the concept of a sentence. This is true?

— No, it’s not. Although 10 years ago, metastases were practically a death sentence. Radiation therapy, and chemotherapy for metastases were not effective. But in 2018, a revolution took place: scientists in the United States and Japan received the Nobel Prize for discovering a “brake” protein in the human immune system, the release of which helps direct the patient’s own immune cells to fight cancer. This helped to find new approaches to the treatment of melanoma. Now it is possible to practically translate the metastatic course of melanoma into a chronic state. Before that, melanoma managed to “hide” from the immune system.

More modern domestic drugs have also appeared, which, in a number of parameters, are even more effective than imported analogues. We also use the so-called targeted therapy for the treatment of melanoma – therapy of “molecular-targeted” action.

By the way, May 23rd will be World Melanoma Day. And in many countries throughout May, the month of the fight against this deadly disease is held. In Russia, on the eve of this Day, open days were held in many oncological institutions. … Moles, age spots, nevi, small formations on the skin … Well, who, tell me, takes them seriously and pays attention to them? However, it is a mole, especially if it is “warmed up” in the sun or injured, that over time can become a threat to life. Summer is coming and the sun’s UV rays can not only make your skin chocolate, but also “give” … a cancerous tumor. It is a strong episodic, as experts say, exposure to the sun on the skin that leads to sunburn, and in the future to the occurrence of malignant melanoma on the skin.