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Melanocytes are cells found in the lowermost part of the epidermis. They produce melanin, which is the pigment that gives the skin its colour. When melanocytes become altered, dividing uncontrollably, invading other tissues and installing themselves in other organs, a cancer known as melanoma develops.
Melanoma usually develops in the skin, although it can also appear in the mucosa of the mouth, rectum, vagina or the choroid layer of the eyes.
In recent decades, its incidence has increased sharply, and it now accounts for about 1.5% of all tumours in both sexes.
The main risk factor is exposure to ultraviolet radiation, both natural (sun) and artificial (tanning booths).
One of the most common symptoms is the appearance of a new mole or changes in an existing one. It is very important to find changes that look different from the rest of the body such as asymmetries, irregular edges, unusual colours (reddish, whitish or bluish), and those that increase in size or lesions with diameters greater than 6 mm.
Any suspicions should be reported to a dermatologist who, after examining the skin, will proceed, if necessary, to perform a biopsy. Other diagnostic tests may be carried out later.
12 new cases per 100,000 inhabitants/year
Due to improper exposure to ultraviolet radiation
It is estimated that 7,500 new cases will appear in 2022
Checking the skin at least once a month is important for the earliest possible diagnosis. The recommendation is to do it once a month because there is a group of melanomas that grows rapidly, and we can only recognise them at this frequency. The method should be systematic, so that you cover the entire surface of the skin.
Since there is a part of our skin that we see during everyday life, emphasis should be placed on areas that are not accessible to our sight under normal conditions, such as the soles of the feet, the buttocks, the back of the thighs, the back or the scalp. It is useful to use mirrors (one large and one hand-held) to access all areas, as well as photographs, especially if you have several moles.
There are different types of melanoma. Its prognosis will depend on each individual case and the stage it is in, i.e. its thickness and whether or not there are affected lymph nodes.
Throughout its history, the IVO has acquired great experience in treating this type of cancer, being one of the first centres in Spain to install the sentinel lymph node biopsy technique for melanoma.
Surgery is the main treatment. After diagnosis, which is obtained by completely removing the tumour or, in large tumours, by biopsy of part of the tumour, the margins are cleaned by removing 0.5 to 2 cm of apparently healthy skin around the primary tumour. These safe surgical margins are employed to reduce the possibility of melanoma remnants that may have been missed in the analysis of the sample used for diagnosis.
Surgery is also used to check for metastases in regional nodes (for example, those in the armpit when the melanoma is in the arm), known as a sentinel node biopsy, and, in some circumstances, to remove metastases from both nodes and other organs.
In addition, there are occasions when radiotherapy or other local treatments may be used. However, undoubtedly the most important treatments that have undergone the greatest change in recent years are those that are administered either to reduce the likelihood of a removed melanoma developing metastases over time (adjuvant treatment) or to treat metastatic disease. For these circumstances, there are drugs that have been developed to curb the tumour’s molecular characteristics, both gene mutations that lead to the uncontrolled reproduction of the cancer cell and molecules that inhibit immune system cells and prevent them from attacking the cancer cell.
Mohs surgery, along with its variants, aims to analyse 100% of the surgical margins. In addition, if there are any margins where traces of a tumour have been identified, this allows the exact location of the tumour to be determined. In this way, the need for a new surgery is restricted to removing just a little more skin in the affected area. This surgery, commonly used for other skin cancers, is reserved for certain types of melanoma, mainly lentigo maligna and acral lentiginous melanoma. These two types of melanoma appear mainly on the face (lentigo maligna), on the palms of the hands, soles of the feet, and on the nail units (acral lentiginous).
These types of melanoma have the distinctive trait that they can extend beyond what the eye can see and, therefore, pose a greater risk of affecting the margins in a conventional excision and making this involvement not detected in routine histological studies. The main advantage we achieve is to ensure complete removal and save healthy tissue in the event of needing to perform more than one surgical intervention by focusing only on the affected area. This is especially relevant in facial lesions, where as much healthy tissue as possible must be preserved.
The Melanoma Tumour Committee is made up of a multidisciplinary team of expert professionals.
The IVO dermatology service is an expert in performing Mohs surgery and its variants.
The Service's team of professionals accompanies cancer patients throughout the whole disease process.
A clinical trial is a research study carried out on people with the aim of learning more about how the body reacts to certain treatments. These trials generally seek to find drugs that are more effective than the current best therapeutic option for patients, or that have similar efficacy but a better toxicity profile.
Bearing in mind that almost all currently available treatments are the result of clinical research, the importance of clinical trials is obvious.
The IVO has a clinical trials unit for all types of tumours and participates in phase 1-3 studies as well as other types of studies.
Whether you receive the news of an initial diagnosis of cancer or a relapse, coping with cancer can be emotionally overwhelming. Each person has their own way of coping with a non-melanoma skin cancer diagnosis, but there are some recommendations that can help you through this process:
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