Skin melanoma: from almost invisible to visually indisputable. Some principles of guidance and clinical cases review

May 28, 2020
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Melanoma is a malignant tumor that arises from melanocytes and most often affects the skin. This tumor can also occur on the cornea, conjunctiva, ciliary body, and any place where the mucous membrane is localized. Melanoma is one of the most dangerous tumors due to its ability to rapidly unpredictable metastasis. In Ukraine, according to the National Cancer Registry, the incidence as of 2018–2019 was 7.9 cases per 100,000 population. The most important phenotypic risk factor is the skin prone to sunburn. It has a genetic determinant in the form of a hereditary variant of the melanocortin-1 receptor, which is involved in the tumor process. Melanoma of the skin is divided into «in situ» and «invasive», which differ in the localization of atypical cells in the smears of the epidermis and in the underlying tissues, respectively. In turn, among the invasive forms there are four most common types: superficial, nodular, melanoma of malignant lentigo and acral. Diagnosis of melanoma is based primarily on the clinical examination of the patient. However, dermatoscopy may be used for early detection. Its application requires from the specialist a set of knowledge and skills that will gradually grow with the experience of practical work. Expected signs will be the next: atypical pigment network, chaotically located brown-black pigment globules or dots, asymmetrically placed areas of multicolored pigmentation, white-blue veil, polymorphic vascular pattern. If a suspicious formation is detected, it should be removed, followed by histological verification. In cases where the histological diagnosis is in doubt, additional information can be obtained from immunohistochemistry. The publication presents an overview of various forms of skin melanoma cases. Some of them are macroscopically obvious, others are confirmed dermatoscopically. The material is illustrated with micrographs, with a detailed description of the visualized structures. Recommendations for monitoring patients with this pathology are briefly summarized.

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