Melanoma

What is it?

The Melanoma and Skin Tumors Program is based on a multidisciplinary approach focusing on diagnosis and treatment with the participation of specialized specialists: medical oncologists, surgeons, dermatologists, radiotherapists, ophthalmologists and neurosurgeons.

All clinical aspects are covered, from diagnosis to surgery to drug therapy at all stages of the disease.

HOW CAN IT BE PREVENTED?

The first and simplest way to prevent skin cancer, including melanoma, is to protect the skin from the sun. In particular, light-skinned people should lead a lifestyle that minimizes overall sun exposure, especially during childhood and/or adolescence.

It is important to remember that the use of sunscreen should be combined with other basic measures, which include:

  • avoiding mid-day sun exposure (11 a.m. to 3 p.m.);
  • adequate protection (especially for light-skinned people);
  • using protective means that cover well the head, neck and back (hats and T-shirts) and/or looking for shade (umbrellas, trees or buildings);
  • wearing sunglasses.

Causes and risk factors

  • light skin color and light/red hair color;
  • family history of first-degree relatives with melanoma (they account for less than 5% of all melanomas);
  • sunburns and erythema at any age, especially in childhood;
  • age: melanoma is rare during adolescence;
  • previous melanoma: a person who has had melanoma has an increased risk of a second melanoma and should continue to be examined by a specialist;
  • presence of large congenital nevi on the skin;
  • rare predisposing genetic diseases (xeroderma pigmentosum).

Which are the symptoms?

Melanoma is the result of a complex series of genetic and molecular events, the nature of which is only partially known. Exposure to ultraviolet radiation, especially UVB rays, correlates with an increased incidence of melanoma.

The initial stage of transformation of a nevus into melanoma often occurs through an atypical or dysplastic nevus. In these cases, the nevus remains benign, but has a higher risk of degeneration into melanoma.

The next stage is the so-called radial or horizontal growth melanoma, in which cells spread only in the epidermis.

In the next step, the tumor cells invade the dermis.

In the vertical growth phase, the tumor proliferates in the dermis and is at risk of metastatic spread.

In the metastatic phase, melanoma can spread to the lymph nodes and/or visceral organs such as the lungs, liver and brain.

Self-examination of the skin reveals changes in existing benign nevi or the appearance of new lesions. Suspicion should be raised in the case of lesions larger than 6 mm, with irregular margins, discoloration within the lesion, asymmetric shape and a tendency to develop (change in one or more signs of ABCD). The abbreviation ABCDE summarizes the main diagnostic features:

  • A: asimmetria (asymmetry)
  • B: bordi (edges)
  • C: color (colore)
  • D: size (dimensioni)
  • E: development (evolutività)

In the case of suspicious moles, a specialized dermatological examination should be carried out. A specialist can examine the lesion with instruments (such as a dermatoscope) to make a clinical diagnosis. If clinically indicated, a biopsy of a suspicious lesion may or may not confirm a clinical diagnosis. A pathologist will examine the lesion under a microscope and, possibly using specific staining (immunohistochemistry), make a correct diagnosis and provide important information for therapy and prognosis.

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How is it diagnosed?

Melanoma and neurosurgery: in addition to the surgical treatment of central nervous system lesions, the neurosurgical service provides complex microsurgery and stereotaxic radiosurgery on the Gamma Knife.

Melanoma and radiotherapy: the radiotherapy service can offer the most advanced treatments such as three-dimensional conformal radiotherapy, tomotherapy and intensity modulated radiotherapy.

Melanomas and surgery: there is a dedicated surgeon who, in addition to surgical removal, performs, in collaboration with the nuclear medicine service, the examination and removal of the sentinel lymph node and, ultimately, the excision of lymph nodes at all levels.

Melanomas and ophthalmology: the ophthalmological service has an ophthalmic oncology department that can monitor ocular melanomas from diagnosis to treatment. In particular, for uveal melanomas, Gamma Knife radiotherapy or transpupillary laser thermotherapy (TLT) is used as an alternative to enucleation.

The dermatology service, which also has innovative equipment for epiluminescence microscopy, in close collaboration with the oncology service, is an important reference point for the prevention and early diagnosis of melanoma.

In cancer therapy, standard and experimental methods of treatment are used:

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How is it treated?

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