Sure you have a lot of moles on your body, but have you ever wondered if these moles are normal or not? Or why do some people have a higher number of moles that change in size and color? If so, you are in the right place! This article will help you understand the main cause of abnormal moles.
Melanoma is the type of cancer that develops in certain skin cells called “melanocytes”, which are responsible for producing melanin, the pigment that gives skin its color. Melanoma is the most common and serious type of skin cancer, which can be fatal if not diagnosed and treated early, and can develop anywhere on the body.
Melanoma and its severity
As we have already mentioned, melanoma occurs when the pigment-producing cells, the melanocytes, begin to divide repeatedly in an uncontrolled manner.
The development of melanoma has 5 stages.
The first is stage 0, melanoma in situ , in which the cancer affects only the outermost layer of the skin (the epidermis). At this stage, spread to other parts of the body is very unlikely.
In stage I melanoma continues to be found only on the surface of the skin, but a slight change in thickness of up to 2mm can be observed. This stage can be divided into two subgroups, IA or IB, depending on the thickness of the melanoma, and whether or not it has ulceration.
We speak of stage II when the cancer is comparatively thicker, extending up to 4mm. It affects both the dermis and the epidermis, but continues without affecting structures other than the skin. This stage is again divided according to thickness and whether or not it presents ulceration, but this time it is subdivided into three groups, IIA, IIB and IIC.
The real problem starts from stage III . In this stage, the melanoma has spread locally, to nearby lymph nodes, or to a site on the skin en route to a lymph node (this is called “in-transit metastasis,” “satellite metastasis,” or “metastasis”). microsatellite tumors). This stage has four subdivisions, which are differentiated based on size, the number of lymph nodes involved, whether there is ulceration, and whether the primary tumor has satellite lesions.
Stage IV is the most serious of all. At this point, the cancer has spread through the bloodstream to more distal sites, either to the skin or to other organs. This stage also has 4 subgroups, depending on how far the metastasis has reached: M1a alone and spread to the skin and soft tissues; M1b has spread to the lung; M1c has spread to any other organ that does not include the central nervous system; and M1d has spread to the central nervous system, including brain and spinal structures.
It may also be that after timely treatment we have recurrent melanoma . This means that an already removed melanoma has reappeared.
Which are the risk factors?
There are multiple factors that increase the risk of melanoma, but environmental factors and genetics play a very important role in its development.
Among the environmental risk factors we highlight exposure to the sun, especially if, as a consequence, repeated burns occur. The genotoxic effects of ultraviolet rays (UVA) are the main cause of melanoma. One thing you should know is that the harmful effects of UVA rays are not only “obtained” by sunbathing, but are also produced by repeated UVA tanning treatments.
Along with environmental factors, such as extensive exposure to sunlight, genetic factors play a key role in its appearance. If a person has a personal history of skin cancer, their ballots multiply. But this is not all, if any member of the direct family has a melanoma, the probability of developing skin cancer in the next generation increases.
It should be noted that people with a fair skin tone are 10 times more likely to develop skin cancer, due to the presence of less protective melanin pigment. People with a large number of freckles or pigmented moles are also more prone, especially when atypical moles are present.
How do the symptoms of melanoma appear in the body?
In the early stages, melanomas can be quite difficult to recognize, as when they first appear on the body they may look like a simple mole , with the difference that these “moles” gradually change in size and colour.
Sometimes, in the presence of a melanoma, there may be a sore on the skin that refuses to heal . This sore can be sensitive, painful or itchy, so it is important to note the change in the appearance, intensity and texture of the skin to facilitate diagnosis during the initial phase.
One thing to note is that melanomas can vary greatly in appearance . Most are flat spots, with irregular edges and brown with small black spots inside. Others are brown spots with red, white, black, or blue dots, and can sometimes appear as a small red, black, or gray hard lump.
Although rare, some melanomas (amelanotic melanomas) can be pink, red, or brown, so they may look like non-cancerous patches of skin.
Prevention and diagnosis
Prevention is always better than cure . Since one of the main causes of melanoma is the ultraviolet rays of the sun, it is advisable to protect yourself by using sunscreens, covering the whole body with protective clothing or avoiding the sun at peak hours where the rays are strongest (10am to 4pm).
It is worth mentioning that, when using sunscreens, it is not enough to apply them once and forget about them, but you have to reapply it every two hours. It is also important to remember that direct exposure to sunlight for a long time is harmful.
As we have already mentioned, the appearance of a new mole, or changes in an existing mole (growth, darkening, inflammation, pain,…), are warning signs of possible melanomas . Therefore, it is convenient to evaluate our moles from time to time to see if we find any warning signs.
The basic test performed on moles to check if they are potentially cancerous lesions is the ABCDE test for melanoma , where asymmetry, borders, color, diameter and evolution are evaluated.
- Asymmetry (A): The symmetry of the mole is important in recognizing whether or not the mole is cancerous, as the non-cancerous mole tends to be symmetrical (both sides of the mole the same). Instead, the cancerous mole has one half of the “mole” different from the other.
- Borders (B): Irregular borders, that is, those that appear fuzzy, notched, rough, or jagged, are characteristic of cancerous moles.
- Color (C): Changes in the color of an existing mole have to give us clues that something may not be going very well. Depending on the color, melanomas can be detected because an existing mole changes color, or because new moles appear with peculiar colors (a darker color than the rest of the moles, brown, black, white, red or blue pigmentation, …).
- Diameter (D): The size of the cancerous mole also changes over time, along with its color and shape. Moles larger than 6mm wide (the size of a pencil eraser) should draw our attention.
- Evolution (E): It is important to notice the appearance of new moles, but especially if the appearance of an existing mole changes its appearance over time, because if it does, you have many ballots that it is a melanoma .
In the event that abnormalities are detected in a mole and melanoma is suspected, your doctor may recommend a biopsy of the mole, and if it is a melanoma, the complete removal of the spot is carried out. It should be noted that most of the moles biopsied for suspected melanoma are ultimately simple moles.
Melanoma Treatment
Melanoma can spread very quickly through the body, and cause death within a few months. That is why it is so important to detect and treat it early, since the smaller the depth and extension of the melanoma (early stages), the greater the chances of survival and success in treatment.
Like other types of cancer, melanoma is also treated with radiation, chemotherapy, or surgery. Depending on the stage of the melanoma, the oncologist will decide on one treatment or another.
For people with superficial melanomas (stages I and II), surgery is the best option. It consists of removing the cancerous lesion, which is later analyzed in a pathological laboratory to determine its extension and diversity. It is very important that no cancer cells remain after surgery, so doctors tend to remove about 1 cm of healthy skin around the tumor. If not, the cancer can spread again.
In some very specific occasions, in which the person cannot undergo surgery, either due to their health condition or because the melanoma is in delicate areas, doctors may resort to pharmacological treatment with a chemotherapy cream, or to the destruction of melanoma with cryosurgery (extreme cold).
In the event that the melanoma has metastasized (spread to distal areas), surgery is no longer a viable option (except to remove lymph nodes), and pharmacological treatments become more important. These include immunotherapeutic drugs , which block the protective action of cancer cells so that our immune system can attack them, and targeted therapy , which uses drugs that attack the biological mechanisms of cancer cells so that they stop replicating, and eliminate them. .
Also of note is the use of radiotherapy , which is used to kill cancer cells with radiation when the cancer has spread to the brain, and chemotherapy , which is given intravenously to treat melanomas that have spread, but is usually given only when no other options are available.
In summary , the treatment of a melanoma has better results the sooner it is diagnosed, therefore, it is important not to ignore the change in appearance, texture or color of the skin. Self-examination can lead to an early diagnosis, favoring a better prognosis.
References:
Caini, S., Gandini, S., Sera, F., Raimondi, S., Fargnoli, M. C., Boniol, M., & Armstrong, B. K. (2009). Meta-analysis of risk factors for cutaneous melanoma according to anatomical site and clinico-pathological variant. European journal of cancer (Oxford, England : 1990), 45(17), 3054–3063. https://doi.org/10.1016/j.ejca.2009.05.009
Lasithiotakis, K., Leiter, U., Krüger-Krasagakis, S., Tosca, A., & Garbe, C. (2006). Comparative analysis of incidence and clinical features of cutaneous malignant melanoma in Crete (Greece) and southern Germany (central Baden-Württemberg). The British journal of dermatology, 154(6), 1123–1127. https://doi.org/10.1111/j.1365-2133.2006.07163.x
Markovic, S. N., Erickson, L. A., Rao, R. D., Weenig, R. H., Pockaj, B. A., Bardia, A., et. al. (2007). Malignant melanoma in the 21st century, part 1: epidemiology, risk factors, screening, prevention, and diagnosis. Mayo Clinic proceedings, 82(3), 364–380. https://doi.org/10.4065/82.3.364
Melanoma Research Foundation (s.f.). https://melanoma.org/
Wells, G.L. (2021). Melanoma. MSD Manuals. https://www.msdmanuals.com/en/home/skin-disorders/c%C3%A1nceres-de-piel/melanoma?query=melanoma
