DEFINITION OF MELANOMA
Melanoma maligna is a type of neoplasia which malignant stems from cells that may form melanin everywhere part of the skin or eyes. Also derived from mucus membranes in the pubic area; oral cavity. This disease usually occurs on the adults in de novo or pigmented lentigo maligna nevus. Other definitions of maligna melanoma IE skin malignant tumor originating from the system melanocytic of the skin (melanocytes) to the image be blackish lesions on the skin. Usually causes extensive metastasis in a short time, not only through the flow of lymph to the regional, but also spread through the bloodstream to the tools in, and can cause death. This is a type of cancer of the skin is the most violent and potentially deadly. In America, obtained data on six of the seven died of this cancer sufferer. And the number of people has stricken with increased from year to year. Melanoma Maligna can develop from moles arising out of existing or emerging.
The cause is not known for sure. Can arise from normal skin (de novo) nevus pigmentosus or derived from (junction nevus), melatonin Hutchinson's freckles are pigmented, giant nevus, blue nevus. The cause of the occurrence of skin cancer there are two, namely the cause from within the body as well as from outside the body. Many factors are thought to play a role in the onset of maligna melanoma including genetic factors (existing at birth), Sunshine (maligna melanoma often is associated with the cause of the skin against the Sun's light. For example, the melanoma tumor usually grown men on the back as well as with women, tumors grow on the back of the leg), and also the cause of carcinogens, factor phenotypes (blond hair, blue eyes, light skin like the kneeing on the person bright skinned at the same time, someone who is bright skinned and less pigmented has a high risk of melanoma tumor gets maligna. Generally, melanoma effect on parents, but on any teenager presents to be found), and the presence of potential precursor against melanoma. Other risk factors include namely the Atypical Mole Syndrome, Large Nevi Congenital Melanocytes. Lentigo maligna melanoma family history and the history of positive malignant
The disease is spread all over the world. Correlation of the incidence of melanoma is usually the opposite of the latitude, i.e. insidennya higher on the area near the Equator and is lower progressively on a region nearer the poles. The disease is rare before puberty, but can be of all ages. The highest incidence in the age of 35-55 years. It can be about the men and women with equal frequency, but morbiditasnya is higher in men.
Early forms of very difficult to distinguish with the other tumors. Because melanoma is a fatal disease malignant when distant metastasis, then the ability to recognize early violence needs to be deepened. Localization in the lower extremities was reported, and then in the head/neck, body, extremities top, nails. The key invention malignant melanoma cure is early, so that a diagnosis of melanoma should be increased when the sufferers reported new pigmented lesions or moles that change, such as:
- Change in color
- Changes in size (especially rapid growth)
- The onset of the symptoms (itching, burning, or pain)
- Elevation occurred on previously flat lesions
- Changes on the surface of or changes in pigmented lesions consistency
- The development of satellite lesions
The American Academy of Dermatology stressed the importance of ABCD when evaluating any pigmented lesion, namely:
A = Asymmetry
B = Border irregularity
C = Color variegation
D = Diameter of more than 6 mm
The primary measure of melanoma malignant can be classified in four major types, namely:
1. Lentigo Melanoma Malign
LMM melanotic Hutchinson's also called precancerous freckles are or Dubreilh. Lentigo maligna lesions arise from who has been there before. LMM occupy approximately 5% of primary skin melanoma, primarily occurs in the elderly. Contrary to other melanoma, LMM substype on areas of the body that are exposed to sunlight, especially the face. Lentigo maligna lesions on the usually small colored patches of degeneration; dark brown; Brown or black. On the surface can be found the presence of pigmentation; spots scattered irregularly. The lesion extends vertically and along. Can develop into an invasive nodule blackish blue and somewhat hyperkeratosis
2. The Spreading Melanoma Malignant Surface
Generally arise from normal skin or nevus (de novo). It is the kind that is often encountered, which is about 70% of the entire melanoma malignant. More often found at a younger age compared to LMM, i.e. in the range 40-50 years. Lesions in the form of archiformis plaque measuring 0.5-3 cm long with its edges and along. On the surface there is a mixture of various colors like Brown, grey, blue, black, and often reddish, extends radials. In General after the lesion reaches the size of 1-2.5 cm, occur vertically growth phase and develop into nodules blackish blue. Predictions on the woman found in the lower limbs and backs, while in men the body and neck.
3. Nodular Melanoma Malignant
It can occur without radial growth phase preceded. So ABCD rule could not be applied to this subtype. Approximately 10-30% of cases of melanoma is a type of nodular. A place that often affected are the head, neck and body. The lesions are usually in the form of nodules that raises, Pigmented uniform. Its color ranges from dark brown to blackish-blue, or sometimes amelanotic.
4. Lentigo Maligna Melanoma Akral
Generally arising in normal skin (de novo). Is the type of the rarest (1%), but can be very violent due to the delay in diagnosis. Predictions on the soles of the feet and the hands, fingers and feet, the base of the nails, and mucous membrane. Lesions in the form of spots with pigment scattered with varying intensity. On the surface can arise papule, nodule, and can undergo ulceration.
Cancer of the skin is different from other diseases, cancer of the skin or a skin disease can be seen directly with the eyes of the examiner. The methods of the examination can be done by anamnesis history of disease. And by the way did the mole surgically removed then observed under the microscope. From the mole surgically removed can be known of her type of cancer and stage of the cancer.
And can also be done with a laser diagnosis. Can capture three-dimensional images of the chemical changes and the structure that has been going on under the surface of human skin. See skin disorders are prominent on the size greater than 2.5 cm.
Normally, skin cells in the epidermis splits with regular and legs. New cells often reject the old cells to the outer surface of the skin where the old cells will die. This process is controlled by DNA. Skin cancer is valid because there is a disruption in this process in which the cell divides and forms a big growth.
Melanoma Malignant is a type of skin cancer which is the most malignant; it can spread to other bodies such as go to the lymphatic glands, causing hypertension, hypercholesterolemia.
THERAPY OR TREATMENT
The actions that are performed on patients with cancer melanoma maligna complete appointment this is the cancerous tissue with the surgery, has been known to occur when the spread of advanced operations needed to lift network the surroundings. For medicaments treatment with chemotherapy (anti-cancer drugs) that are grouped into several categories: alkylating agents, plant alkaloids, anti metabolite, antitumor antibiotics, enzymes, hormones and biological response modifiers. And treatment in nonmedikomentosa includes radiotherapy, surgery and physical therapy.
Division of therapy based on the stage of melanoma:
Stadium Clinic I Melanoma Maligna
To date method of surgery with wide excision is still a way of melanoma treatment. Handling on the lesion type ALM requires special measures more than other types, namely:
- For the lesion located at the base of the nail (subungual melanoma) and finger the distal part of the hands or feet, do disarticulation metakarpal or metatarsal.
- For lesions located in the fingers or toe proximal part, performed an amputation karpometakarpal or tarsometatarsal
- For lesions on the palms of the hands or feet (palmar or plantar melanoma), extensive excision is done with the boundary edges of the excision are tailored to the anatomy and functions
Determination of optimal excision border and consideration of adoption of regional lymph glands as a prophylactic actions, especially depending on the type and location of melanoma malignant, the degree of invasion of Clark and depth (thickness) Breslow.
Stadium Clinic II Melanoma Maligna
Wide excision accompanied the adoption of regional lymph glands.
Stadium Clinic III Melanoma Maligna
Chemotherapy the best traditional agents namely Dacarbazine Triazeno Imidazole Carboxamide Dimethyl/(DTIC). Can be given individually or combined with other systemic medications Chemotherapy. Response to treatment with DTIC occurs in 20-25% of sufferers. Systemic Chemotherapy recommended is:
DTIC: 200-300 mg/m2 (intravenous) for 5 days, repeated every 3-4 week.
Nitrosourea: 200 mg/m2 single dose (oral), repeated every 6 weeks.
Or a combination of DTIC and nitrosourea.
BCG is a non-specific active immunotherapy, primarily used for the melanoma treatment metastasis to hold a malignant skin. Given intraregional and provide sufficient influence is beneficial. The results are uncertain, depending on the immune system.
Lately done immunotherapy adoptive, using leukaferesis to get the lymphocytes of cancer patients, then the cells were incubated with interleukin-2, to form the killer cells that enable limfokin (LAK), and then the cells LAK is infused back with the granting of interleukin-2.