Non-pigment melanoma of the skin: symptoms that can be confused, prognosis

Melanoma or skin cancer is one of the most common and most dangerous types of cancer. This disease is prone to metastasis, with metastases appearing very quickly unlike other cancers that people live with for several years. And the death rate from him is just off scale. And the worst thing is that this disease affects first of all young people aged 25-45 years. The key to successful treatment in the case of melanoma is considered to be its early diagnosis. But how to grab the disease on the root, if we have a pigmentless melanoma that is not always noticeable even to the eye of the eye?

Epidemiology

Among all patients who have malignant neoplasms, patients with melanoma are considered the rarest category, because skin cancer occurs 10 times less often than other cancers.

Non-pigment melanoma is the rarest type of skin cancer. And it pleases, because this kind of oncology is considered the most dangerous because of the rapid spread of metastases throughout the body. By the way, according to statistics, in women achromatic melanoma develops more often than men or children.

This type of melanoma is also dangerous because in 20 percent of cases it is found in the late stages, when the process of metastasis acquires generalized forms. Survival of patients with non-pigment melanoma is slightly higher than 50 percent, while pigmentary melanoma can be cured in more than 70 percent.

[1], [2], [3], [4], [5], [6]

Causes of the non-pigmentary melanoma

As we already know, melanoma has the property of appearing on the site of moles or in their surroundings. This makes it possible to easily notice it by changing the appearance of the mole: its color, shape, and skin characteristics. It is not for nothing that dermatologists recommend to examine the marks given to us in the inheritance daily, noting any changes in them, and in the presence of a large number of birthmarks every year to undergo examination and dermatoscopy.

A little bit different is the situation with the pigmentless melanoma, which although is more rare, but still presents no less danger due to its unpleasant peculiarity to give metastases even at the initial stages of the disease. But if in the case of the usual pigment melanoma it is a matter of the degeneration of the cells of the mole, prone to such initially, then what causes the pathological changes in normal skin cells in the case of pigmentless melanoma?

[7], [8], [9], [10], [11]

Risk factors

The doctors can not answer this question right now, because "black holes" can be found even in studies on the pigmentary (achromatic) melanoma. To say specifically, what causes the degeneration of a more or less pigmented skin area is almost impossible. You can only talk about the risk factors for the development of this pathology.

To such factors, as well as in a case with usual melanoma, it is possible to carry:

• Type of skin. Melanoma is more often diagnosed in people with fair skin and blue eyes with blond hair, very often having freckles.
• UV irradiation. This is both an excessive stay in the open sun, and a regular visit to the solarium. It turns out that lovers of beautiful saturated sunburn are more prone to skin cancer than those who are satisfied with the natural shade of the skin.
• Increased solar activity. Staying at this time on the street and getting sunlight on the open areas of the body are a presumable cause of the development of pigment-free or pigmented melanoma.
• Sun burns. This is not about severe thermal burns with blisters filled with liquid, but about strong skin irritation, accompanied by reddening, itching, flaking, and in some cases, the appearance of bubbles, the convergence of the upper layers of the skin. This phenomenon is familiar to almost everyone, especially at the beginning of the beach season, when many, without calculating the intensity of sunlight, flee to the pharmacy for the "Panthenol" or to the store for sour cream. But melanoma can be a consequence not only of fresh burns, but even those that were received as early as childhood.
• Scars and trophic ulcers on the skin. Such formations are more susceptible to the appearance of malignant neoplasms than normal skin cells.
• Congenital sensitivity to ultraviolet rays. A rare hereditary pathology called "pigment xeroderma" is characterized by the appearance on the skin of large areas of intensely pigmented tissue of a rich brown color, which is considered more prone to degeneration than skin with a normal amount of pigment.
• Intraepidermal cancer or Bowen's disease.
• Paget's cancer that looks like an inflamed red spot.
• Border nevi (birthmarks with dark fringing, irregular shape, blurred edges, raised above the surface of the skin, etc.). Non-pigment melanoma can develop around such moles.
• Disorders of the endocrine system. A high level of sex hormones, in particular estrogen, can trigger pathological changes in the cells and their uncontrolled growth.
• Large complex. High fat people have a large area of skin, and the larger the skin area, the more likely that some part of it will undergo a rebirth. Not in vain because in children melanoma is diagnosed extremely rarely.
• Young and mature age.
• Weak immunity.
• Periods of pregnancy and lactation. At this time, the skin and the whole body become more sensitive to the effects of irritating factors, which include UV radiation.
• High radiation background. Radiation is known to be one of the main causes of various mutations, including intracellular mutations.
• Regular exposure of the skin to electromagnetic fields or chemicals. People who are stably aware of such negative effects, suffer from melanoma more often than others.
• Hereditary predisposition. The probability of malignancy (malignant degeneration) of cells is higher in those people who have cases of oncology (and not only skin cancer).

Usually several factors are involved in the appearance of achromatic melanoma. So a person with light skin and eyes, avoiding prolonged exposure to sunlight, may not know what melanoma is all his life, and his swarthy friend, who has a passion for a beautiful tan and a small scar on his skin, suddenly gets on the table with a surgeon about melanoma .

As for the causes of melanoma development, one can not help but dwell on such a point as preventive removal of moles, which have the risk of degeneration into melanoma. Many readers mistakenly think that after the above procedure, the risk of developing melanoma in the same place increases. In fact, this is not so. On the contrary, removing the risk factor only increases the chances of a healthy life.

Non-pigmentary melanoma after removal of the mole may appear near the site of surgery or away from it, or not appear at all. The development of skin cancer in this case will not be related to the operation to remove the nevus.

It is another matter if during the operation a small section of the border nevus was not removed. It is believed that the risk of cell degeneration at the site of removal is higher, but the cases of malignancy of the process in connection with the removal of moles were not recorded.

It is about the removal of moles with a clean histology, i.e. Not containing cancer cells. Otherwise, you can not give one hundred percent guarantees.

[12], [13]

Pathogenesis

As in the case of pigmentary melanoma, the pathogenesis of the achromatic form of skin cancer has not been sufficiently studied. In fact, the elevation on the skin is an accumulation of melanocytes that are not capable of producing enough melanin. It is believed that the fault of all cell mutations, occurring at the gene-molecular level. Under the influence of some factors listed above, the structure of DNA and its enzyme system changes, deviations from the norm in chromosomes are observed, the number of genes and their characteristics change.

By the way, scientists have long noticed that the malignancy of cells can also contribute to improper eating and taking certain medicines (hormonal drugs, oral contraceptives). As for food, the development of skin cancer is promoted by a diet with an abundance of animal fats and proteins (mainly meat food). An identical situation is also observed with a deficit in the diet of plant products that are sources of vitamin A and C.

[14], [15], [16],

Symptoms of the non-pigmentary melanoma

The first signs of achromatic melanoma are: appearance on the skin of a small elevation (tubercle) and its fairly rapid growth. Externally, the tubercle resembles a small wart, so it may not attract attention for a long time. Moreover, because of its color, it differs little from the color of the skin.

Achromatic melanomas can be flesh colored, have a slightly pinkish or whitish hue. When a new growth begins to grow, rough surfaces and exfoliated scales of the epithelial layer of the skin appear on its surface, the skin becomes more rough. In some cases, it looks like a scar, because it does not have even edges. When pressed, the seal does not cause discomfort and pain, so patients soon forget about an incomprehensible find on the body.

In appearance and form, pigment-free melanoma may resemble a small, almost flat elevation resembling a colorless birthmark, or it may have a domed structure (nodular or nodular non-pigment melanoma). In the second case, the growth of cells occurs vertically, i.e. Melanoma does not grow in breadth, but in height. Conventional flat melanomas are small in size, nodular melanoma can be more voluminous and large.

A distinctive feature of non-pigment melanoma is the uneven growth of its parts due to which from the side there is a noticeable asymmetry of compaction. The edges of the flat lesion are usually uneven, the pigmentation is uneven.

An exception is the nodular form of achromatic melanoma, which is a domed light slightly rough or warty growth that has a symmetrical shape and uniform color.

With growth, melanoma begins to bring discomfort. She can start to hurt, itch. On the site of the tubercle and around it there is reddening and puffiness of the tissues. The surface of melanoma often begins to crack and bleed, small sores form on it. This indicates the progression of the disease and its transition to later stages, which can be treated with great difficulty.

If the compaction initially had hairs, and then they began to fall out - this is also an alarming symptom, speaking in favor of maligning the process. Very often there is an increase in lymph nodes near the neoplasm.

Stages

The type of melanoma and the condition of the patient completely depend on the stage of development of the malignant process. It is accepted to distinguish 4 stages of skin cancer:

1. The first or the initial stage of melanoma is characterized by the appearance on the skin of a convex painless seal not more than 2 mm thick, located in the upper layers of the epidermis.
2. About the second stage, when the neoplasm thickens, penetrates deeper into the upper layers of the dermis, the metastases are not detected.
3. At the third stage, the skin on the surface of the tubercle begins to peel, crack and bleed, there is an increase in lymph nodes, which indicates the penetration of cancer cells into the lymph system.
4. The last fourth stage of melanoma is the spread of metastases to various organs and systems of the body. What does the pigment-free melanoma look like in the last stage? This seal with an uneven warty surface, sometimes reaching 3 or more centimeters, covered with a scaly crust with pinpoint hemorrhages and ulcers. Around him is a hyperemic area of healthy skin. Sealing causes constant discomfort: it hurts and itches. In color, it can remain pinkish, or in the case of a nodule form, it can acquire a nearly black shade.

Most melanoma-free melanoma is diagnosed for 3 or even 4 stages of the disease, because before that, it can practically not manifest itself, having a resemblance to an innocuous wart. Survival at stage 4 of the disease is almost zero. But even getting rid of melanoma at an earlier stage does not guarantee that the disease will not return in time, but in another place.

[17], [18], [19], [20]

Forms

As we have already understood, non-pigment melanoma can have different forms, and its symptoms depend on the stage of the disease development. Consider the 2 most common types of achromatic melanoma:

• Surface spreading view. The most popular form of melanoma, characteristic for both pigmented neoplasms, and those that arose on the skin without intense pigmentation. It is diagnosed in approximately 3 out of 4 cases of melanoma.

It looks like melanoma like a plaque with a heterogeneous color and structure, uneven edges and comparatively slow growth. It can be in the superficial layers of the skin for about 4-5 years, and then go deep into the body, letting metastases in various organs.

In men, such melanomas appear mainly on the hands, in women - on the legs.

• Nodal appearance. It occurs much less often, but is considered the most aggressive because of its propensity for rapid growth. Quite often appears on a place where there are no birthmarks. Papulovoy neoplasm as the disease progresses can remain light, but more often acquires a dark color. Rapidly increases in size (in a few months), begins to ulcerate and bleed.

The neural form of melanoma can also be located on the face, neck, back and other frequent bodies. By the way, in men this form of the disease is a little more likely than in the fair sex.

The subspecies of nodal melanoma is its desmoplastic variant, which looks like a hard node of irregular shape, strongly resembling a scar or scar. It is very difficult to diagnose this form of melanoma, because even a superficial biopsy can tip toward the keloid or dermatofibroma, which has nothing in common with oncology.

[21], [22]

Complications and consequences

Non-pigment melanoma is one of the most insidious oncological pathologies. Masking for other skin diseases, she parasitizes an unsuspecting person in the body until she takes the patient's body out completely, hitting various organs and systems, reducing immunity and leaving a person with a chance.

Absence in the early stages of obvious symptoms of the disease leads to melanoma progressing calmly, growing and spreading its pathologically changed cells throughout the body, where they again uncontrollably divide and disrupt the work of various organs. Metastases of non-pigmentary melanoma, depending on its location, can be found in the lymphatic system, brain, cervical region, lungs, bones and other organs and systems of man.

Cancer cells spread through the body through the lymphatic system. Enlargement of lymph nodes against the background of unusual compaction indicates the onset of metastasis. If a tumor without metastases can be removed permanently, the treatment of cancer with metastases is very difficult, because cancer cells at any time can appear in different organs.

Irradiation and chemotherapy in this case are not very effective. In most cases, they allow you to slow down the process a little, but it's not a complete cure. The patient dies sooner or later.

[23], [24], [25], [26], [27], [28], [29]

Diagnostics of the non-pigmentary melanoma

Diagnosing skin cancer is not so easy, and it does not matter whether melanoma develops against the background of pigment nevus or on the surface of unchanged tissues. In the first case, at the initial stage of the disease, it resembles a normal mole, in the second - with a wart or a grease. It is for this reason, when they discover areas of modified tissue in their bodies, people do not rush to run to the doctor and do not associate their appearance with cancer.

No matter how much they say on the Internet about the danger of melanoma, in life the disease is very rare. This further relaxes people who believe that if the likelihood of getting sick is not high, then their evil fate will surely sweep.

The chances of recognizing melanoma are very small. For example, the therapist, seeing on the skin of a patient a small bump of fleshy color, which does not bother anybody, is unlikely to attribute his appearance to the part of the beginning cancer. Even a dermatologist may well confuse a colorless seal with a wart if the patient does not emphasize that the tubercle has started to grow.

With suspicious seals on the skin, prone to increase, the logical thing to do immediately is to consult a dermatoonologist. The alarming symptoms (FIGARO rule) in this case are:

• The form. A flat new growth is lifted above the surface of the skin, i.e. Changes form.
• Change the size and other parameters. The tumor grows and changes appearance.
• Borders. If the seal initially had smooth outline, then with time the boundaries are blurred, the edges acquire an incorrect and indistinct shape.
• Asymmetry. If the convexity on the body is mentally divided in half, one half of it will be markedly different from the other in thickness and shape.
• The size. The tumor does not just grow, it gets quite large.
• Coloring. An alarming factor should be: uneven color of the growth, the appearance of inclusions of other colors, the formation of a red or dark rim.

Turning to a doctor with his problem should always tell when a strange bump appeared, how he behaved, when and how actively he began to grow, whether there were cases of cancer in the family, etc. Mandatory blood tests and urine tests will be performed by the doctor, which will provide information about the patient's condition and the presence of cancer markers in the blood (protein molecules, the products of the vital activity of cancer cells). If there are ulcers on the surface of the tumor, a smear from the damaged surface will be taken for the cytological analysis.

With non-pigmentary melanoma with the naked eye, it is very difficult to determine the nature of the neoplasm. Instrumental diagnosis of the disease begins with a study of compaction using a dermatoscope with the deduction of an enlarged image of the proposed melanoma on the computer screen. Sometimes an epiluminescent microscope is used for this purpose, which allows us to see the state of the growth under the epidermis.

If an increase in the lymph nodes is observed, its association with the penetration and division of cancer cells is helped by scintigraphy or a radioisotope study, and in some cases, a surgical lymph node biopsy.

More information could be given by a biopsy of the tissues of the neoplasm, but it is not always possible. For example, with an aggressive nodular form of skin cancer, a biopsy before surgery can not be performed, as it can cause rapid growth of an already rapidly growing tumor. Very often a biopsy and then a histological analysis of the tissues taken from the area of the lesion is performed after the operation to remove the neoplasm. The material for the study is taken immediately during the operation.

If the diagnosis confirms the presence of cancer cells in the tumor, it becomes necessary to check the various organs for the presence of metastases. For this purpose, the following can be appointed:

• ultrasound examination,
• review radiography,
• computer or magnetic resonance imaging of the brain, etc.

It is important to identify all the ways of spreading malignant cells and accurately determine the stage of the disease. This depends on the treatment scheme, which is selected based on these parameters.

Additional specific methods for diagnosing melanoma can be considered:

• lympho- and thermography (on the thermogram melanoma has the appearance of a bright spot due to the increased temperature inside the tissues caused by the increased metabolic processes in the focus of the disease),
• radioisotope diagnostics using radioactive phosphorus (in the region of active cell division, phosphorus accumulates more strongly),
• conducting a urine test on the Yaksha reaction (in cancer diseases, the addition of an oxidizer in the urine as a five percent solution of ferric chloride causes the appearance of a gray cloud that settles on the bottom of the tube).

[30], [31], [32], [33], [34], [35]

Differential diagnosis

Differential diagnosis for pigment-free melanoma is carried out with conventional warts and other benign neoplasms on the skin. But usually, all the points arrange the result of a histological examination performed before or after the surgical intervention.

Treatment of the non-pigmentary melanoma

Regardless of the type of melanoma, its treatment requires sufficient competence and care of doctors. Since melanoma-free melanoma, especially its nodal form, is prone to faster growth and spread of metastases, procrastination in this case is unacceptable. Carry out medical measures for skin cancer only in a specialized medical institution with the participation of medical specialists.

If diagnostic studies do not reveal in the compaction of malignant cells on the skin, and nevertheless the tumor will appear to the doctor as dangerous in terms of possible degeneration, removal of the failed melanoma by one of the following methods can be prescribed:

1. thermo- and electrocoagulation (moxibustion of a newly heated metal loop or electric current),
2. laser and chemical destruction (removal of skin defects with laser or aggressive chemicals)
3. cryodestruction (freezing of melanoma-like formations by liquid nitrogen)
4. radiosurgical method - non-invasive removal of tumors with the help of waves from 10 and above hertz.

These same methods can be used to control melanoma in the initial stage of the disease. Alas, pigment-free melanoma is rarely diagnosed at this stage, therefore the most popular method of melanoma removal is surgical treatment.

Removal of melanoma with a scalpel or an elektronozha can be carried out at the 1 and 2 stages of pathology. During the operation, the surgeon dissects the skin in the area of growth, capturing at least 5 cm of healthy tissue. If the lymphatic vessels pass through the melanoma, in the direction of the lymphatic drain, the indentation should be at least 7 cm. If melanoma is found on the face, the incision is not so large, taking only about 3 cm of unaffected skin.

Recent WHO studies have shown that the size of the indentation from the edge of the melanoma does not affect the survival rate after surgery, and therefore it can be reduced for cosmetic reasons. The recommended indentation depends on the thickness of the tumor:

• less than 1 mm - enough to retreat ½-1 cm,
• from 1 to 2 mm - retreat 2 cm,
• Melanoma of large size requires the capture of 2 or more centimes of healthy tissue.

Despite the fact that melanoma in the initial stages of the disease is located only in the upper layers of the skin, its excision is carried out to a great depth, up to the connective membrane (fascia) between the subcutaneous tissue and muscles. To remove the fascia itself is decided by the doctor individually.

As you can see, after removal of even a small melanoma, there remains a rather large deep wound, which can only be closed by skin plasty. The wound can be closed by moving local tissues or plastics with a free flap. When the tumor is located in the area of the fingers or toes, an amputation of the fingers is shown. Much less often, the method of exarticulation is used, in which the loss of blood is less.

Removal of the tumor should be done very carefully, trying not to damage it. This requirement is due to the fact that if the tumor is damaged, cancer cells can begin to spread rapidly through the body (such a self-preservation way). In order to avoid injury to the site of the accumulation of cancer cells, it is covered with a soaked iodine solution with a napkin that is attached to the skin with the help of threads.

The use of this method of treatment requires the introduction of anesthesia. Therefore, on the eve of the operation, an investigation is made for the tolerability of anesthetics.

In cases of non-pigmental melanoma of the 3rd stage, only by removing the tumor does the doctors manage. It's about regional lymph nodes, where cancer cells can enter and accumulate. Removal of lymph nodes is carried out if they are palpated on palpation (enlarged, but not painful).

Previously common practice was prophylactic removal of lymph nodes, even if they are not enlarged. The reason was that in a quarter of patients, cancer cells were detected even in nonpalpable lymphocytes. True, in this situation, the result of treatment was not much different from the result of treatment of those who had not cleared lymph nodes.

To date, the removal of lymph nodes (lymphadenectomy) is carried out only with their increase against the background of tumor growth, less often with the deep introduction of the tumor into the dermis.

The most difficult situation is with stage 4 melanoma. And yet, despite the fact that this stage of the disease is considered almost incurable, there is a certain chance to slightly increase the life expectancy of such patients and alleviate their suffering. This, of course, is an expensive treatment, because in addition to surgical removal of the melanoma itself and its metastases, chemotherapy and radiation therapy, as well as specialized cancer treatment with monoclonal antibodies, are conducted.

Surgical treatment in this case is performed to remove single metastases, to alleviate the symptoms of the disease and to reduce the number of cancer cells to optimize chemotherapy.

With a large amount of melanoma with sharply outlined edges, rapid growth of the tumor, appearance of ulcers and eruptions around the lesion on its surface, as well as when the tumor is located in places where excision is difficult to excise, combined therapy is carried out, which is a combination of radiotherapy and surgical treatment.

The initial dose of irradiation with close-focus X-ray therapy is 5 grams. The procedure is carried out daily for 5 days with repetition of the courses in 2 days. The minimum total dose of irradiation is 60 gray, the maximum - 120 gray. After the inflammation subsides, surgical treatment can be performed.

In its own form, radiotherapy with melanoma is not used because of its low effectiveness. In principle, melanoma is less sensitive to the effects of chemicals, however, when remote metastases are detected, it is used as an additional method of treating cancer. However, improvements from the application of this method can be expected only in 1 of 4-5 patients.

Chemotherapy is usually used in patients with localized forms of melanoma (for example, with non-pigment melanoma), with recurrent cancer in the limbs, with the spread of metastases to the brain and bones. In the same cases, there may be some improvement after radiotherapy.

Since any cancer disease is primarily a reduced immunity that does not allow the body to fight the disease, in addition to chemotherapy treatment (an additional blow to the immune system) actively use immunological therapy with the use of immunostimulants and monoclonal antibodies.

Vitamins in case of cancer can be prescribed as an addition to immunotherapy. In themselves, they do not play a special role in the treatment of the disease.

Medications for the treatment of melanoma

Drug therapy for pigment-free melanoma is considered an additional and not particularly effective method of treatment. Nevertheless, in combination with surgical treatment, chemo- and immunotherapy allows, if not to cure the disease, then at least to reduce the frequency of relapses and somehow prolong the patients life time.

Systemic drug chemotherapy is an intravenous injection of specific drugs as preparation for an operation to remove a tumor, which is performed either immediately after the administration of solutions for chemotherapy, or alternating several days.

It is widely enough in the treatment of melanoma chemotherapeutic method is used Imidazolecarboxamide. Dosage is calculated as 200-250 mg per 1 sq. M. Enter the drug intravenously for 5 days. Treatment with this drug helps to stabilize the condition in about 25% of patients with skin cancer.

Slightly less effective are antineoplastic drugs: "Arabinopyranosylmethyl nitrosourea", "Decarbazine", "Procarbazine", "Lomustin", "Temozolomide", "Vincristin", "Vinblastine", "Windesin", etc.

Consider the use of drugs for chemotherapy on the example of the drug "Decarbazine", which is one of the most effective drugs. The drug has antitumor, cytostatic, immunosuppressive and alkylating (violation of the DNA structure of the malignant cell, which does not allow it to divide) action. The drug is used for various types of cancer, including melanoma.

The drug is contraindicated for hypersensitivity to it, severe disturbance of bone marrow hematopoiesis, severe liver and kidney pathologies with a violation of their functionality. With caution, it is prescribed with a decrease in blood leukocytes and platelets (myelosuppression), with acute course of pathologies of viral, bacterial or fungal nature, in old age, for the treatment of children.

During pregnancy, the drug can harm the fetus, but at the insistence of the doctor, it can be used even in pregnant women due to the high risk for a woman's life. Breastfeeding for the duration of chemotherapy should be discontinued.

The drug is administered both intravenously and intraarterially.

The effective dosage is calculated as 150-250 mg per square meter. The course of treatment is 5 or 6 days. The interval between the courses is exactly 3 weeks.

If the drug is used as part of a combination therapy (the regimens include 3 or more drugs), the dosage is reduced to 100 mg per square meter, and the course of treatment varies from 4 to 5 days. The interval between courses remains unchanged.

Among the side effects of the drug I want to highlight: a deterioration in appetite, attacks of nausea and vomiting, stool disorders, soreness at the injection site, weakness, muscle pain, headaches, hyperthermia, menstrual irregularities (menstruation), azoospermia in men.

Monotherapy with separate drugs does not always allow to achieve such results, as when using therapeutic regimens of combined chemotherapy. Let us cite several single and multicomponent schemes used in the case of melanoma:

Imidazolecarboxamide is administered every day by a course of 5 days, the dose is 200-25 mg per square meter.

Lomustine for oral administration at a dosage of 100 mg per square meter.

On the 1st, 8th and 15th days of treatment, Vincristine is injected at a dosage of 1.2 mg per square meter.

Dactinomycin intravenously three times a week for 500 mcg (course 2 weeks), starting from the first day of treatment Lomustin.

Vinblastine in a dosage of 6 mg per sq.m.

On the 1st day of treatment, Cisplatin is injected at a dosage of 120 mg per square meter.

From 1 to 5 days Vinblastine is combined with Bleomycetin (a dosage of 10 mg, unlike others, is administered intramuscularly).

In some cases, inoperable melanoma or skin cancer with multiple metastases caused by BRAF V600 mutations (50% of melanoma cases) are resorted to using a new targeted drug called Zelboraf. Apply the drug as part of monotherapy.

The main active substance of the drug - vemurafenib - blocks the growth and spread of cells inside the body. The drug is not used for hypersensitivity to this and other components of the drug. In the period of bermennosti apply with caution, since the effect of the drug on the fetus is not fully understood.

"Zelboraf" is available in the form of tablets weighing 240 mg. A single dose of the drug for an adult is 4 tablets. Multiplicity of admission - 2 times a day with an interval of at least 4 hours.

The drug is taken regardless of the meal, it is not recommended to use tablets in the morning on an empty stomach.

During the medication, joint pain, weakness, skin reactions in the form of rashes and itching, increased photosensitivity of the skin, nausea, hair loss.

Now we will consider what preparations doctors recommend in the immunotherapy. According to the studies, interferon preparations (Interferon-alfa) and interleukins (Interleukin-2, Roncoleukin) proved to be well-established.

"Roncoleukin" is a drug from the group of immunostimulants that enhances the immune response to the negative effects of bacteria, viruses, fungi, and cancer cells. The active substance is a protein component of interleukin-2. Applied with various immunodeficiency states. In the treatment of cancer used before and after chemotherapy to reduce its negative consequences.

The drug may be administered either orally or injectively. In case of skin cancer, the drug should be administered under the skin as close to the area of the lesion. Injections are done 1 or 2 times a day. A single dose of 0.25-0.5 mg. It is desirable to chop melanoma from all sides.

The medicine is not prescribed with the system or untreated heart failure, severe disruption of the respiratory system and kidneys, thrombohemorrhagic syndrome, unsanitary purulent wound, in case of infectious-toxic shock, with metastases to the brain. Contraindications to the use of the drug are also allergy to yeast, pregnancy, hypersensitivity to the components of the drug.

Side effects during the application of the immunostimulant are very rare. They show symptoms resembling flu, sometimes with fever. This reaction indicates activation of the immune system and does not require treatment. If the temperature is greatly increased, you can take antipyretics.

An interesting point in immunotherapy is the use of monoclonal antibodies. Indicative in this regard is the use since 2011 of a drug based on ipilimumab, which is an antibody that produces the human body. The drug has the name "Ervoi", it was developed in the USA.

The drug is administered intravenously during 1.5 infusions. The dose for adults is determined from the ratio: 3 mg per kilogram of the patient's weight. Droppers are put 1 time in 3 weeks. Therapeutic course - 4 droppers.

During the treatment, the patient undergoes constant monitoring of the patient's condition and possible immuno-mediated reactions.

The drug is not prescribed for hypersensitivity to its components, during pregnancy and breastfeeding (due to lack of data on its safety for the fetus). In pediatrics is not used for the same reason.

Caution in prescribing the drug should be observed in patients with severe autoimmune pathologies in the acute stage and liver failure.

The most common side effects of the drug are: itching and rashes on the skin, diarrhea, increased fatigue, attacks of nausea and vomiting, abdominal pain and worsening of appetite.

Any drugs for the treatment of skin cancer are considered to be potent and can adversely affect the condition of patients, so they should be taken strictly under the supervision of the doctor, and in case of serious adverse reactions require withdrawal.

Alternative treatment

Despite the fact that at the disposal of traditional medicine to date there are many methods and tools for the treatment of skin cancer, pigment-free melanoma still takes the lives of many more young people. In this regard, it is clear the desire of sick people and their relatives to look for other methods of treating the disease, so to speak, on the side, with alternative healers and healers.

Let us not dwell now on the importance of the psychological attitude in the treatment of cancer pathologies and methods of acidification or alkalization of the body, which are supposedly effective for the treatment of many oncological pathologies. Let's talk about alternative treatment with the use of plants and herbs, which is used in addition to the basic methods of classical cancer treatment.

We will not go far, but just look under the feet. Known to many as an effective wound healing plantain will be useful for the treatment of melanoma. It is necessary to crush the fresh leaves of the plant before the appearance of juice and apply the gruel in the form of a compress to the area of melanoma.

By the way, a medicine with a similar effect can be found even without leaving home. Golden mustache - the native inhabitant of many apartments and offices - can also be applied in the form of applications on the affected area, pre-chopping the stems and leaves of the plant in a mortar.

Useful in the treatment of skin cancer is considered and birch bark, the birch bark of which contains a strong antitumor substance betulinol.

Grass hemlock is also known for its antitumor effect. Take tincture hemlock needs to inside and with great care (the plant is poisonous). Prepare the tincture, taking 1 part of the tops of the plant and 2 parts of alcohol. After 3 weeks, the medicine is ready.

Before taking the necessary dose of medicine mixed with water. Begin treatment with 1 drop and 40 days bring the dose to 40 drops. Then in the same way they take a tincture for another 40 days, but now the dose will decrease every day by 1 drop.

Another poisonous plant, loved by homeopaths and used in the treatment of cancer, is called a fighter (he is aconite or wolf root). When pigmented and pigmented melanoma is used as a tincture. For the medicine take 20 grams of plant roots and 0.5 liters of vodka. Take the tincture you need according to the scheme described above.

Notable bactericidal and antitumor effect is also possessed by celandine. For treatment, fresh plant juice is needed, in which 4 parts of petroleum jelly are added. This ointment needs to be lubricated daily with a tumor.

To noticeably increase the immunity in cancer and give the body the power to fight the disease on its own will help the known plant of ginseng, which is by no means accidentally called the root of life. Pharmaceutical tincture of ginseng root is taken 25 drops daily for 8 or more days.

And, of course, you can not underestimate the benefits of taking fresh beet juice. However, to achieve a pronounced antitumor effect, you need to drink 600 grams of juice a day, which must be defended for an hour.

As for the effectiveness of herbal and plant treatment, the following can be said here. Yes, cases of curing cancer patients are known with the help of only alternative recipes and a positive mood for recovery. However, scientists do not find a clear explanation for this phenomenon. Well, is it worth to hope for a miracle or to try to solve the problem in a complex way already by the patients themselves.

[36], [37], [38]

Homeopathy in the treatment of melanoma

When there is a question of life and death, any medicines are good, and even more so if they are natural. This is the opinion of homeopathic physicians who are also using affordable means to alleviate the plight of people with pigment-free or pigmented melanoma and other skin cancers.

Consider some of the drugs that are used in homeopathy in connection with the above diagnoses.

Touja tincture, which can be purchased in homeopathic pharmacies, is considered for cancer as a medicine for both external and internal reception. Twice a day, it is smeared with a tumor, and also 2 times a day for 20 minutes before a meal tincture is taken orally in the amount of 10 drops.

Alas, this medicine is not suitable for pregnant women and patients with epilepsy. It is not applicable to kidney disease.

Radium bromatum - a homeopathic preparation based on a trace element of radium is used in the treatment of skin cancer in 6 and 12 dilutions strictly according to the doctor's prescription and preferably before the appearance of ulceration on the tumor.

Arsenic potassium, which is available as homeopathic tablets, arsenic bromide (Arsenicum bromatum), silica (homeopathic preparation Silicea terra) can also be used to treat skin cancer.

When ulcers appear on the neoplasm, it is recommended to take a medicine based on the kondurango marsding plant.

With inoperable melanoma, homeopaths prescribe calendula preparations as an adjuvant.

As an anticarcinogenic treatment for melanoma, the following homeopathic remedies are used: Fluoricum acidum, Chromic acidum, Eosinum.

Prevention

Non-pigment melanoma is one of the most insidious varieties of skin cancer, it is much more difficult to diagnose and treat it than to prevent the disease. In principle, the measures for the prevention of achromatic melanoma are the same as in the case of a tumor that originated at the site of a mole.

The main preventive requirement, helping to avoid the development of skin cancer, is considered protection from the harmful effects of sunlight. And this protection should be complex.

On hot, sunny summer days it is recommended to use sunscreen (especially from 10 am to 4 pm), cover the open parts of the body with clothes, and face and eyes with special sunglasses and headdresses with wide margins.

In the daytime, in the absence of clouds, it is not recommended to be in the open sun. It is better to wait out a period of particularly high solar activity indoors or in the shade, preferably away from the water, which reflects the sun's rays well.

It should be remembered that sunburn in the shade is safer than in the sun or in the solarium. Irradiation with ultraviolet is a clear danger of developing skin cancer. It is necessary to avoid ultraviolet irradiation by any means, if necessary using protective screens.

It is known that vitamin D, so necessary for our body, can be obtained naturally by being exposed to sunlight. However, doctors consider this source of vitamin unsafe, giving preference to food products containing this vitamin, and multivitamin complexes.

It is necessary to regularly inspect your skin for the presence of tumors. If the skin has moles, they need to pay special attention, because they are more prone to pathological changes. It will also be useful to conduct annual dermatoscopy, especially for people with a large number of moles.

When there are incomprehensible tubercles or spots, it is recommended to consult a dermatologist for advice. The earlier melanoma is detected, the greater the chance of healing. The prognosis of this pathology entirely depends on which stage of melanoma was detected.

[39], [40], [41], [42], [43]

Forecast

The most favorable prognosis is observed at the initial stage of the disease. The greater the thickness of the neoplasm and its deepening into the dermis, the worse the prognosis. Neoplasm with a thickness of less than 0.75 mm in most cases is removed without consequences. The 5-year survival rate in this case is close to 100%. If the tumor is more than 0.75 mm, but less than 1.6 mm, survival rates are reduced to 85%. In larger melanomas, survival is below 50%.

Tumors on the limbs can be treated better than those that are localized on the body, especially in the neck and back of the neck, the upper back. It plays a greater predictive role and form of melanoma. Nodular pigmentless melanoma, characterized by rapid growth and active spread of metastases to the lymphatic system and various organs, has the worst prognosis. And if it is a question of multiple metastases, the prognosis is extremely unfavorable.

[44], [45]