Centro Studi GISED

Melanoma

Melanoma is a malignant tumour of the skin that develop from cells called melanocytes. Melanoma can occur just in the skin or alternatively can metastasise through the blood or lymphatic system and reach other organs and bones.

Dear Doctor, I send you the following email because it has been recommended to me by a dermatologist to make a visit to the only specialist skin hospital, in..., for a suspect mole near the navel. The mole has grown over the years, it has an irregular border and it isn’t a uniform colour, it’s also greater than 6mm. In order to have an appointment and therefore the prescription to remove it, I have to wait 6 months. My doctor says to go and visit him in the meantime , he says that if there was danger he would see it. But I have read in numerous articles on the internet that the diagnosis isn’t done by sight, at least when the melanoma is in the advanced stages. I also have a small noticeable pinkish spot on my head, which I can’t see my self because its above the nape of my neck. Could this also be a risk? I really am quite worried. Do you know of a private specialist in..., who’s in possession of a microscope and the right equipment for all the examinations? I hope so. Thank you.

Dear Sir, I understand your anxieties. The diagnosis of melanoma is, in the first place, visible by an expert dermatologist. They consider a screening useful for a specialist evaluation of the lesions that respond to the so-called ABCD rule: Asymmetrical lesions, with irregular Borders, variegated Colourations, Dimension greater than 5mm, which is growing over time. A dermoscope can aid diagnosis in cases of doubt. As far as the lesion on your scalp is concerned, it’s difficult to give an opinion without further information. Nevertheless, I would say to you to not worry excessively. It’s in a place very rare for melanomas. Lastly, I’m sorry but it’s not within our knowledge or conduct to give indications on individual specialists. Best regards, Dr Luigi Naldi - Coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia - GISED

My name is (…) and I would like some information on melanomas in light of a situation that is very personal to me… In the summer of 2001 a friend of my mum’s went to have a growing melanoma removed from her right leg at the... Upon her return, they had analysed that it was at Clark’s level III of malignancy and that she should get it checkout out every 6 months for 5 years by which time she should be out of danger. 3 months later (December 2001) another 2 patches appeared on her back. In February 2002 she was admitted back into the ... where she wasn’t operated on, instead she was given a course of injections. In September 2002 she was re-admitted for another check-up and notwithstanding that she was losing hair she was told everything was proceeding for the better but now, in January 2003 another 2 patches have appeared (on her abdomen). She is 32 and her husband said that unfortunately the whole ordeal is very tedious (around 15/20 years) but isn’t fatal. The only thing that I could see was the size of the melanoma expanding over the mole and unfortunately it wasn’t 6mm, but much larger…..I read an article on the internet: “how previously, patients with subtle lesions (thickness <0.75mm) have a rate of survival over 5 years greater than 98%, while those with thicker lesions (>4mm) have a 50% chance of survival over 5 years. The presence of metastases in regional lymph nodes reduces the rate of survival to a 36% of surviving 5 years. This reduces again to 5% in cases where metastases have spread to remote locations over the body.” I would be grateful if you could let me know as much as possible, based on what I have told you… if in reality she is danger or if as she has been told, it’s just a long tedious process, but not fatal? Thank you and best regards.

Dear (…) thank you for the message. Melanoma is a malignant tumour that originates from melanocytes, cells present in the epidermis responsible for tanning. The same cells can group together to form melanocytic moles (or beauty spots). They are completely benign and very common. A melanoma can often arise on a mole that looks apparently healthy on the skin. The risk of melanoma is greater in individuals with pale skin, blue or green eyes and red or blond hair. The risk is greater when there is a history of excessive exposure to the sun, with sunburns, particularly as children. Moreover, there is a greater risk in those with lots of moles. A family history of melanomas is another factor to take into consideration and it’s good practice for the family of patients with melanomas to go for a check-up visit to a dermatologist. The prognosis (probability of survival) in the successive 5/10 years following diagnosis depends, above all, on the width of the initial lesion (expressed in mm) and the level of invasion according to Clark. The thickness is not the diameter of the lesion on the surface (as I think you supposed) but the vertical thickness of the lesion measured by microscope. III level of invasion according to Clark corresponds to about a 95% probability of surviving 5 years (therefore very high). I believe that the injections that your mother’s friend is undergoing are a drug, which helps the body’s defend itself against the tumours, defined as alpha interferon. I believe that the lesions you observe on her back are not related to the melanoma. She should be well protected against the sun and should follow her doctors’ instructions. It seems to me that she should be optimistic. Best wishes. Dr. Luigi Naldi - Coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia - GISED

Hi, I’m from... and I have a tremendous worry about melanomas, a worry that has emerged from the moment that I lost my father to a tumour a few years ago. I think that I’m a subject of risk in as much that since I was a baby I have always had lots of moles and it’s only now that I’m starting to worry. I’m worried about going to the doctor’s and in the summer I cover the moles with total sunblock. How can I overcome my worry about going to the doctor’s? Thank you.

Your principle problem, as you rightly say, is the worry of going to a doctor. You should know, even so, that to find a hidden melanoma behind a mole is rare and what is more important, if there is this risk the only way is surgical intervention on the suspected lesion. Therefore you should really be worrying about keeping yourself from going to see an expert. Dr Bruno Pansera – Dermatologist.