For over 25 years the diagnostic strategies for melanoma, cancer of the skin that is becoming increasingly common in the population, are constantly evolving in order to optimize the results. Early medical diagnosis based on experience, coupled with innovative approaches to digital, they represent the best strategy to reduce mortality due to melanoma.
Melanoma is the most aggressive skin cancer , held until a few years ago, a rare cancer but now is showing a steady increase in cases identified each year. In fact, the United States melanoma has a growth rate higher than any other cancer.
Melanoma predominantly affects subjects aged between 30 and 60 years , is much more common in people of European origin, with lighter skin.
Melanoma is a malignant tumor that originates from melanocytes , specific cells of the skin deputies to the synthesis of melanin, a substance that exerts a protective function against the sun. RECENT DISCOVERIES
recently presented the results of a study demonstrating the effectiveness of a monoclonal antibody (ipilimumab) in activating the immune system against melanoma. This can lead to a significant improvement in survival of patients in advanced stage of disease.
addition, a group of California researchers has been able to identify for the first time a small but highly specific population of undifferentiated cells, stem type, responsible for the development of melanoma.
STRATEGIES FOR EARLY DIAGNOSIS
The prognosis of cutaneous melanoma, the rate of growth of the tumor is closely tied to the thickness it has reached the skin at the time of diagnosis and subsequent removal. In the USA the stage invasive melanoma is the fifth and sixth types of cancer most frequently diagnosed in men and women respectively.
Make early diagnosis for this tumor means being able to detect tumor growth, in the skin, with a thickness of less than one millimeter. The 5-year survival after diagnosis of invasive melanoma has increased 83% of cases diagnosed in the seventies up to 93% of cases identified in early 2000.
Since the primary therapeutic approach for the treatment of melanoma, that is its surgical removal, has not changed substantially from the technical point of view, it is considered that the increase in survival at 5 years is mostly due to earlier diagnosis of the disease.
Early diagnosis and precise, with a quick surgical treatment are considered the cornerstones for success in the treatment of melanoma, as is clear from the review of diagnostic approaches for this tumor to be published in the journal CA: A Cancer Journal for Clinicians .
Although histological examination, following a skin biopsy represents the most reliable diagnostic technique, from the beginning has tried to develop non-invasive, which is one of the few cancers that spread outside of 'body.
Before the eighties, the diagnosis of melanoma was based on the macroscopic response, and usually quite ominous in terms of prognosis, a bleeding skin lesion.
In 1985, with the intent to make earlier diagnosis, were detailed the precise morphological criteria, known by the acronym ABCD: Asymmetry, irregular Borders, Color variable diameter> 6 mm.
The validity of the ABCD criteria was tested successfully in screening programs in the general population.
In the nineties, the dermoscopy was applied in the common diagnostic practice. This technique, through the use of a set of lenses that are closer to the skin, allows up to 10 times magnification, coming on to analyze anatomical structures below the epidermis to the dermis of the papillae.
last decade, the digital approach has implemented the dermoscopic diagnosis in clinical practice. Through the use of specific software for image analysis, dermoscopy has been computerized, allowing also the comparison between different images of skin lesions, previously stored on databases.
There are also some studies on specific molecular markers (expression of messenger RNA) whose presence or absence to discriminate between melanomas and benign skin lesions.
Overall, developments in scientific and technical last 25 years has led to an increase in sensitivity and specificity of diagnosis of melanoma . However, it is essential that any diagnostic tool is supported by technical knowledge and clinical experience, characteristic of the dermatologist, in order to optimize the early diagnosis of melanoma.
(by Roberto Insolia - Press-Stampa.net)
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