Melanoma
Melanoma . Arises from melanocytes. It is most often localized in the skin (90%), rarely in the conjunctiva, the choroidal membrane of the eye, the nasal mucosa, the oral cavity, the vagina, the rectum.
Melanoma of the skin appears more often at the age of 30-50 years. Among the risk factors - significant doses of ultraviolet radiation, nevi injury, family predisposition to melanoma, pigment xeroderma, melanosis of Dubreia. In 50-70% of cases, melanoma of the skin arises from pigmented nevusoa. The most dangerous is the borderline (zpidermalny) nevus. Most common on the skin of the scrotum, palms, soles, is a flat spot or pigmented nodule about 1 cm in size that does not rise above the skin. Less often melanoma develops from intradermal, blue nevuses. In large nevi are often included border nevus.
In 1/3 of the cases, the nevus that preceded melanoma developed already in adulthood; In 1/3 of the cases was congenital.
A prediction depends on a timely diagnosis of melanoma. Any changes in nevus-enlargement, discoloration, ulceration, bleeding - require immediate surgical intervention. A similar tactic is recommended in relation to the growing new pigmented formations on formerly normal skin. Melanoma of the skin more often occurs on the skin of the head, neck, limbs.
After removal of skin melanoma, the factors affecting the prognosis can be assessed. A special role is played by the degree of tumor invasion of various layers of the skin, which correlates with the development of metastases. Invasion levels I (in situ), II (involvement of the papillary layer) and partly III (penetration to the reticular layer) characterize the early diagnosis of the disease. The degree of IV (penetration into the reticular layer) and V (into the subcutaneous fatty tissue) indicate a late diagnosis. In the early stages of invasion, a 5-year survival rate is 60-80%. In addition to the degree of skin invasion, the tumor's prognosis is affected by tumor localization, the presence of metastases in the lymph nodes and other factors.
Metastasises melanoma in the skin, subcutaneous tissue, lungs, liver, brain and other organs and tissues.
The main method of treatment of localized melanoma is surgical. Regional lymph nodes are removed when they are enlarged. Adjuvant chemotherapy does not improve the results.
With disseminated melanoma, chemotherapy is shown, with regression of tumor formations observed in 20-40% of patients. The most effective treatment regimes are as follows: 1) imidazolecarboxamide 200-250 mg / m2 iv daily, 5 days; 2) lomustine 100 mg / m2 orally on the first day in combination with vincristine - 1.2 mg / m2 on days 1, 8 and 15 and dactinomycin 500 μg iv three times a week, 6 doses; 3) vinblastine 6 mg / m2 IV on the 1st day in combination with cisplatin - 120 mg / m2 on the first day, and bleomycetin-10 mg / m 1-5 days. Intervals between courses of chemotherapy - 4 weeks.
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