Malignant Melanoma (MM) is a tumor that develops due to the abnormal growth of the skin cells called melanocytes. The exact cause of this cancer is unknown, but the onset of this tumor is attributed to sun exposure and the patients' genetic and immunological characteristics. This is supported by the fact that the country with the highest incidence of MM in the world is Australia. However, this is the case for the population immigrating from northern Europe (50 times more common than in their own countries) and not the native population.
At present, early diagnosis and surgery to remove the primary tumor with wide margins is the only way to improve survival rates in MM.
MM is classified according to different stages, from I (one) to IV (four). This is why any patient diagnosed with melanoma must be thoroughly examined to reach the correct diagnosis, determine staging and administer the most suitable treatment based on the severity of the disease.
Anyone with a mole should not automatically think they have a melanoma but if they apply the simple ABCDE rule every morning when taking a shower to their pigmented lesions (moles and freckles), they can notice any suspicious marks and see a physician as soon as possible.
- A: Asymmetry; the mole is not symmetrical
- B: Borders; the mole has ragged or notched edges instead of regular edges.
- C: Color; if the mole is light brown or tan, it is probably normal; if it is black or blue, or if patches of the mole have lost their color, suspect a melanoma.
- D: Diameter; if less than 6 mm, the mole is considered normal; if it is greater than 6 mm, it could be an MM.
- E: Evolution; if the mole changes shape or color or grows or bleeds over the course of time (a few months), suspect a MM.
If you suspect that a pigmented lesion is a MM, what should you do? A biopsy of the lesion should be done so that the pathologist can confirm the diagnosis and inform us that it is a melanoma.
Once the diagnosis is confirmed, all the relevant tests will be done to find out the stage of the disease and administer the most suitable surgical treatment.
1. Extension of margins and sentinel lymph node technique
This surgery involves two operations:
- Excision of the melanoma according to oncological guidelines (1-2 cm margin around the lesion according to stage), cosmetic reconstruction of the surgical area
- Location and biopsy of the sentinel lymph node (removal of the lymph node in the affected region).
2. Regional lymphadenectomy
This surgery involves removing all of the lymph nodes from the affected area (lymph node removal). Our group performs neck, axillary and groin lymphadenectomies (by laparoscopic surgery whenever possible).
3. Surgery of single abdominal visceral metastases
MM patients with visceral metastases have a poor prognosis. In our group, patients with single abdominal visceral metastases are treated surgically as complete removal of the tumor is achieved in most cases, attaining better survival rates and a better quality of life.
4. Isolated limb perfusion (ILP).
Patients with multiple melanoma skin metastases on their limbs can be offered a medical-surgical treatment by our group that can only be performed at accredited centers like our own. The treatment involves administering high doses of chemotherapy drugs (melphalan and TNF) (Beromun) under hyperthermic conditions (39-40ºC).
The limb should be isolated from the rest of the body using a tourniquet and cannulation of the main blood vessels (artery and vein) before being connected to an extracorporeal circulating pump (Performer). This procedure has two purposes:
- To increase limb temperature to 39-40ºC
- To prevent chemotherapy drugs, which must be perfused for 60-90 minutes according to the disease being treated, from entering the patient's general circulation during administration.
It should be pointed out that at present we are one of the most experienced centers at performing ILP with melphalan and Beromun in Spain with excellent results (disappearance of limb metastases in 84%, a complication rate of less than 2% and no pre-operative mortality).