Melanoma - etiopathogenesis, diagnosis and treatment

Melanom je zloćudni tumor melanocita koji ima sklonost ranom limfogenom i hematogenom metastaziranju. Učestalost je u porastu u mnogim zemljama svijeta, a najčešće se pojavljuje u osoba svijetle puti koji su često izloženi suncu. Melanom nastaje na nepromijenjenoj koži ili iz prekursorskih lezija. Najveći maligni potencijal imaju divovski urođeni i displastični nevusi. Melanom je najčešće tamne boje, od smeđe do crne, no može biti i bez pigmenta. Melanom prolazi kroz tri faze rasta: melanoma in situ (označava fazu pojave malignih melanocita u bazalnom sloju epidermisa), radijalna faza (označava fazu lateralnog širenja) i vertikalna faza (faza invazije dermisa). Prema kliničkim značajkama i histološkoj slici razlikujemo lentigo melanoma (melanoma in situ), LLM (lentigo maligna melanoma),površinsko šireći melanom- SSM (superficial spreading melanoma), nodularni melanom (NM - nodular melanoma) i akrolentiginozni melanom (ALM - acral lentiginous melanoma). Najčešći je površinsko šireći melanom s najvećom pojavnošću na leđima u muškaraca i na donjim udovima u žena. Klinički znakovi koji upućuju na sumnju na melanom su asimetričan oblik, nepravilni, nazubljeni ili izbrazdani rubovi, boja koja može varirati od svijetlosmeđe do tamnosmeđe,veličina obično veća od 6 mm. Prognoza melanoma je primarno povezana sa debljinom tumora (Breslow), postojanjem ulceracija te povećanim brojem mitoza. Prvi stadij- primarni tumor bez metastaza ima 5-godišnje preživljenje 75%, drugi stadij- primarni tumor sa metastazama u regionalnim limfnim čvorovima 25%, a treći stadij- udaljene metastaze 0%. Ostali nepovoljni prognostički čimbenici su regresija dijela tumora, mikrosateliti, starija životna dob te muški spol. Terapija je uvijek radikalna kirurgija, 1-3 cm u zdravo. Ako se u regionalnim limfnim čvorovima dokažu metastaze, izvodi se i disekcija limfnih čvorova. Rana dijagnoza i edukacija ključ su uspješnog liječenja malignog melanoma.Melanoma is a malignant tumor of melanocytes that has tendencies to metastasize both lymphatic and hematogenous. The increasing numbers can be seen in all countries of the world. People with lighter skin that have been exposed to the sun are the ones who are affected by this kind of skin cancer. Melanoma occurs on the intact skin or from nevi. The biggest malignant potential have people with giant congenital and dysplastic nevi. Melanoma is dark colored that varies from brown to black but there are some that have no pigment. Melanoma has three stages of growth: melanoma in situ (it indicates the phase where the malignant melanocytes occur in basal layer of the epidermis), radial stage (indicates the phase of lateral expansion) and vertical stage (phase of dermis invasion). According to clinical characteristics and histological grade we can differentiate lentigo melanoma (melanoma in situ), LLM (lentigo maligna melanoma), SSM (superficial spreading melanoma), NM (nodular melanoma) and ALM (Acral Lentiginous Melanoma). Most frequent is the SSM which occurs on the backs of men and on lower extremities in women. Clinical signs that indicate melanoma are asymmetrically shaped, irregular, with jagged or ridged edges. Color can vary from darker shade of brown to lighter brown or yellow. They are usually bigger than 6 mm.Prognosis is connected with degrees of skin invasion (Clark), the thickness of tumor (Breslow) and its growth stage. First stage – primary tumor without metastasis life rate of 5 years is 75%, second stage – primary tumor with metastasis in regional lymph knots is 25%, and third stage – distant metastasis 0%. All rest unfavorable prognostic factors are ulcerated tumor, regression of part of tumor, enlarged number of mitosis, microsatellites, older age and male gender. Therapy is always radical surgery that cuts 1 to 3 cm in healthy tissue. It can also be treated by dissection of sentinel knot if metastasis are comformed. The most important is the prevention, protection from UV