Clinic of Dermatology

Nowadays the skin cancer is the most frequent kind of cancer. Different skin cancers from epidermal horn layer are usually well treatable: The Basal cell carcinoma and the Spinal cell carcinoma. The skin lymphomas are a special form of the lymph node cancer. The Melanom arises from the chromogen cells of the skin, the Melanocytes. It is the most dangerous form of all skin cancer diseases.

How does MM develop?

The MM develops from chromogen cells of the skin, the Melanocytes. Those cells form the skin pigmentation. Contrary to normal Melanocytes the malignant cells increase and can spread in different organs.

The MM can also arise at mucous membranes, lymph nodes or internal organs develop. It first spreads through lymphatic vessels into the lymph nodes and later over the blood vessels into other organs (metastases).

How frequently does a Melanom arise?

World-wide the tendency is rising.

Today in Bulgaria 2-3 of 100000 persons per year are diagnosed with Melanoma.

How frequently does a Melanom arise?

The Melanoma is the most dangerous form of skin cancer, because it metastases in about15-20% of cases in other organs.

It is therefore very important, that you visit a physician immediately, if you discover a suspicious skin change at your body.

The so-called ABCDE rule help the physician for the differential diagnose between melanoma and benign molls: (A) asymmetry, (B) Borders, (C) Color, (D) Diameter and (E) evolution or development of the lesion.

Who is at high risk to develop MM?

Some persons are with certain risk of more frequent melanoma development:

• with more than 50 molls (nevi);
• with bright skin (skin type III), red-blond hair, blue eyes;
• with history of melanoma in the family;
• with weakened immune defense (immunosupressed), for example due to another disease such as HIV infection or after a transplantation;
• already diagnosed with melanoma;
• with history of severe sunburns, particularly in childhood and youth.

How is melanoma recognized?

Regular self-check is very important. Persons with bright skin and many molls should examine their skin regularly for suspicious skin changes and contact a physician.

Most frequent form of symptoms

Usually symptoms appear relatively rapid (in few months) from an altered moll or a wart with increase in size and color changes. Occasionally MM can itch or bleed.

Diagnosis

Patients diagnosed on the basis the ABCDE rule as having a melanoma, must undergo surgical treatment and histological examination of skin changes. Only the microscopic investigation can prove the diagnosis and is helpful for the size of surgical intervention.

Diagnosis and treatment

Is the Melanoma treatable?

The early complete surgical removal of the melanoma is the most important therapeutical approach. Superficial melanomas with a penetration depth into the skin up to 1 mm are usually with good prognosis.

Older patients can undergo a Roentgen therapy. Investigation of the lymph nodes is also indicated. The further procedures are decided in individual cases, if melanoma is already spread in other organs.

Treatment

The standard treatment of MM is the surgical removal of the primary tumor within a safety margin, which size depends on the tumor thickness. A standardized treatment of the metastases is not yet established. An individual therapy concept is should be considered according to the kind, size, depth and localization of the tumor as well as the age and general health status of the patient.

Chemotherapy could be considered as another systemic approach. This is medication treatment - combination of cytostatic therapies, which destroy the tumor cells in different ways or restrain their growth.

Immune therapy

Today substances, form own body defense system (immune system) can be used against the tumor cells. Often effect is better after combination of an immune therapy with conventional chemotherapy.

Cooperation with the appropriate specialists is from great importance, for the specification of the treatment concept. We co-operate closely with the following specialized departments:

• oto-rhino-laringology;
• plastic syrgery;
• radio-oncology;
• nuclear medicine and radiology;
• re-establishment surgery;
• neurosurgery;
• oncology;
• pathology.

Follow-up

In order to recognize promptly the development of metastases or a second melanoma patients must be examined more frequently (the risk for a second melanoma is relatively small and is about five to eight per cent). Depending upon the clinical picture the dermatologist specifies the necessary clinical, ultrasound or laboratory investigations.