Every 3 months, examine the skin of your whole body, have it examined every year by a specialist – more frequently if you belong to a category at risk.
Pay special attention to any change in pre-existing moles; use the ABCDE rule, EGF and Ugly Duckling Sign.
2. WHAT DOES HAVING A BIOPSY OF A MOLE AT RISK REALLY MEAN?
A so-called excisional biopsy is the first diagnostic examination in the case of a suspicious lesion: it consists of removing the pigmented lesion with a 2 mm margin of apparently intact skin, which is then sent to the laboratory for histological examination.
This examination will show whether the lesion is benign and malignant.
3. WHAT CAUSES MELANOMA?
Hereditary factors and sun exposure are the major causes. Close relatives of people with melanoma are at greater risk of developing melanoma, especially if any moles have an atypical appearance. People with light-colored skin, eyes and hair are also at greater risk.
4. DOES BEING IN THE SUN INCREASE THE LIKELIHOOD OF GETTING MELANOMA?
Since ultraviolet radiation increases the risk of developing melanoma or non-melanocytic skin cancer, limit your exposure to the sun during the hours from 10 a.m. to 4 p.m., protect oneself with appropriate clothing and dark glasses, and use sun creams with a high protection factor. In any event, still limit the time you stay in the sun to a minimum.
5. WHAT ARE THE BEST TREATMENTS AVAILABLE TODAY?
In early-stage disease, ample margin surgical removal of melanoma is the treatment indicated. Since the diagnosis of melanoma is almost always known only after surgical removal of the suspicious lesion, a second radical operation is almost always necessary. At the same time, with the exception of a few cases – usually if the melanoma is classed as a Stage pT1a – what is known as the sentinel lymph node will also be biopsied. If your sentinel node shows the presence of metastases, a 12-month adjuvant therapy with anti PD-1 antibodies will be considered, depending on the risk of recurrence and your characteristics. If you have the BRAF V600 mutation, an alternative option is the combination of dabrafenib and trametinib.
If there is metastasis, treatment will be mainly immunotherapy based on anti PD-1 antibodies, possibly in combination with anti CTLA-4 antibodies, along with so-called BRAF and MEK inhibitor therapy for people whose melanoma has the V600 mutation of the BRAF gene.
Treatment choices are made on the basis of the particular characteristics of the patient and the disease. The multidisciplinary treatment team of professionals will design a personal treatment program appropriate for each patient.
6. ARE THERE VACCINES AGAINST MELANOMA?
Most cancer vaccines are therapeutic vaccines. This is also the case for melanoma. There are two major groups of vaccine types: molecular and cellular. Molecular vaccines are protein, peptide or DNA or mRNA-based, while cellular vaccines are irradiated tumor cell-based or dendritic cell-based vaccines. However, these procedures are still in the study phase and not available to clinical practice. Many studies are in progress with both molecular vaccines (e.g., mRNA vaccines) and cell-based vaccines, especially the dendritic cell-based versions.
7. WHAT IS CELLULAR TREATMENT OF MELANOMA?
Cell therapies can either use ‘natural’ cells, in particular tumor-infiltrating lymphocytes (TILs) or specific lymphocytes taken from the peripheral blood, expanded in vitro and then reinfused back into the patient. This type of treatment is known as autologous therapy. The other possible cell therapy is with genetically modified (‘engineered’) lymphocytes. These are also expanded in vitro and reinfused into the patient (Car-T ‘Chimeric Antigen Receptor T-cell therapies’).
TIL-based therapies to treat melanoma go back a long way. They have recently come back into the limelight on account of the latest very promising data from some European and US studies. Indeed, the procedure to obtain FDA approval has been started for Lifileucel, a TIL-based therapy. The situation is different for Car-Ts (Chimeric Antigen Receptor T-cell therapies). Although the use of Car-Ts in clinical practice has changed in some cases of cancer of the blood, when it comes to solid tumors, like melanoma, research is still at the early trial level.
8. DO HORMONES AFFECT WHETHER YOU GET MELANOMA?
The importance of female hormones in melanoma is controversial. In fact, there does not appear to be an increased incidence of melanoma with the use of oral contraceptives, while studies on infertility therapies haven’t produced clear-cut results. The role of hormone replacement therapy after surgery or menopause is also debated. However, the majority of studies suggest that there is no increased risk of melanoma, especially with estrogen and progestogen combinations.
In conclusion, it is generally not considered necessary to modify or discontinue hormone therapies if a person is diagnosed with melanoma. However, a gynecologist should be consulted to assess the individual risk-benefit of hormone treatment.
9. IS PREGNANCY A PROBLEM?
Hormones released during pregnancy stimulate the growth of melanocytes and moles. In fact, pregnant women often notice color changes to moles and skin. However, most studies have shown that pregnancy does not affect the onset of melanoma. However, if you have had a melanoma, it is advisable to avoid pregnancy for the following two to five years. This precaution is due to the controversy that still exists over the effect pregnancy has on the natural course of melanoma.
10. IS THERE A SPECIAL DIET FOR MELANOMA?
Diet can affect the prevention, development and treatment of several cancers, including melanoma. Studies have shown that just changing your diet – adding more fruit and vegetables – may prevent cancer, improve the therapeutic efficacy of drugs, and reduce chemotherapy-induced side effects. Coffee and green tea are also being actively researched in relation to melanoma on the basis that they are natural antioxidants, which are at the core of skin protection. Research is investigating the role of various dietary supplements but it will take time to see if they have an impact in the clinical management of melanoma patients.
11. WHY SHOULD PEOPLE GO TO THEIR GP OR FAMILY PAEDIATRICIAN FOR A CHECK-UP?
The role of the general practitioner (GP) and pediatrician is of the utmost importance. They are the people who are most likely to examine their patients’ skin for other reasons, and so spot an early suspicious lesion, referring him/her to a dermatologist. The GP and pediatrician can urge patients to pay attention to any changes they see in a mole, using the ABCDE rule and the “ugly duckling” sign, i.e., a mole that “stands out” and looks different from other skin spots. They are also the ones who can suggest appropriate sun protection to match individual risk factors, like a person’s phototype, number of moles, and family history of melanoma.
12. WHY IS MULTIMEDIA TRAINING OF DOCTORS IMPORTANT?
The multimedia distance-learning platforms are important tools to keep on hand as a dynamic e-learning tool, whose large virtual library provides in-depth information on how to diagnose early onset melanoma and the diagnostic methods available. It also an invaluable way of linking in to expert input and advice, and become part of specialist multidisciplinary teams. In USA, Australia and Europe there are several multimedia e learning programmes. Melanoma Multimedia Education, developed by Italian Melanoma Intergroup (IMI), aims to provide practitioners with a comprehensive understanding of the primary and secondary prevention of cutaneous melanoma and a broad overview of updated diagnostic and therapeutic procedures.
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