Cancer cells, unlike normal ones, do not have tight connections with each other, which gives them the opportunity to separate from the primary focus during germination into the blood or lymphatic layer. With the flow of blood or lymph, melanoma cells spread throughout the body, settling in the lymph nodes and capillaries of internal organs and tissues.
Once a cancer cell starts to divide, a secondary focus of melanoma, metastasis, is formed. This focus may not differ at the cellular level from the primary one, and may acquire its own characteristics over time, mutate.
Types and localization of distribution
The spread of cancer cells begins only after melanoma germination in the tissues underlying the epidermis, in which there are blood and lymphatic vessels and capillaries. There are two ways to metastasize melanoma:
- Lymphogenous. Melanoma can penetrate into the lymphatic system by itself, and it can be done thanks to immunity cells. The immune system recognizes a malignant neoplasm as an enemy, trying to lyse or phagocytic cells. Due to the resistance of melanocytes to many influences, they do not die inside macrophages that transport them directly to the lymph nodes. Malignant cells can get into these nodes without the help of phagocytes, with a current of lymph.
- Hematogenous. Reaching a certain size of melanomas can either grow into the vessel wall, or acquire its own, supplying it with nutrients. Due to weak intercellular connections, melanomocytes under the action of blood flow are torn off and spread throughout the body, settling in organs and tissues.
In lymphogenous metastasis, melanoma initially affects the regional lymph nodes. (for example, axillary with primary tumor on the arm or neck, occipital, submandibular with primary localization in the head), and after - all the rest.
Hematogenous pathway of metastasis leads to the appearance of lesions in the internal organs.. Most commonly affected:
Less susceptible to metastasis:
- Adrenal glands
- Small intestine,
- Bones and spine.
As stated above, the cause of metastasis is a weak intercellular communication of tumor cells and their contact with lymphatic or blood vessels.
However, not all malignant neoplasms immediately metastasize. Regarding tumors that develop on the mucous membranes and skin, there is the concept of "cancer in place."
Due to the fact that these structures do not have their own vessels, in the early stages the tumor is not capable of producing metastases due to the fact that it does not grow into the underlying tissues.
Melanoma is considered the most malignant human tumor.. This is due to the fact that she in a very short time begins to germinate in the underlying tissues, in contact with the vessels, and its cells practically do not have intercellular bonds.
Signs of melanoma metastases
The defeat of the lymph nodes manifests itself equally in any localization of the primary focus and is accompanied by the following symptoms:
- Increase nodes
- Pain on palpation,
- Color change (redness or bluish tint is possible).
Lung metastases prognostic are considered more favorable than with other localization. Initially, they may manifest themselves as a dry, unproductive cough that lasts around the clock, after which the appearance of bloody contents in the outgoing sputum is possible. Infectious lung diseases may develop due to impaired lung cleansing function (bronchitis, focal pneumonia, etc.). At later stages, respiratory failure may be associated. Diagnosis is performed using bronchoscopy, CT, MRI, X-rays.
Liver damage manifests itself yellowness, intoxication, possible vomiting and indigestion, intolerance to fried, fatty foods and alcohol. Metastases with localization in the liver are considered an unfavorable variant of the disease. Diagnosis is made using biochemical studies of liver enzymes, CT, MRI.
The most difficult, for obvious reasons, flow metastases in the central nervous system. The defeat of melanoma of the brain manifests itself with psychosis, hallucinations, headaches, epilepsy, paresis and paralysis, loss of vision, smell, hearing, impairment of consciousness of varying severity (from stupor to coma), disorder of the activity of internal organs, fever. Diagnosis is performed using MRI.
If secondary foci of melanoma appear in the adrenal glands, then they may not manifest themselves at all for some time, or cause adrenal crises, lead to the development of Itsenko-Cushing syndrome (high content of corticosteroids in the body). Determined using ultrasound, x-rays, CT, MRI.
Metastases in the small intestine lead to diarrhea, constipation, blood in the feces, loss of appetite, pain in the abdomen. These metastases are detected by X-ray, CT, MRI.
Metastatic disease musculoskeletal system will lead to the occurrence of pathological fractures that may occur during the execution of daily activities or a slight load. Metastases in the vertebral bodies may initially manifest themselves as sciatica or osteochondrosis, which will serve as the beginning of the erroneous treatment. Diagnosis is carried out with the use of X-rays, CT, MRI.
In case of multiple metastatic lesions, radionuclide diagnostics with labeled compounds have proven themselves well. It allows you to detect metastases in sizes up to 1-2 mm.
Medical expert articles
The last (fourth) stage of one of the most aggressive forms of cancer, when the deeper layers of the skin and secondary tumors are already affected, spread not only to the nearest lymph nodes, but also to the distal ones, is diagnosed as metastatic melanoma. If vital organs are affected at the same time, only a miracle can save the patient.
Treatment of melanoma with metastases
The appearance of metastasesespecially distant from the primary focus testifies to stage IV melanoma. This stage of the tumor considered inoperable due to the inability to remove all pathological formations.
For treatment applied radiation, chemo- andimmunotherapy. In some cases, it is possible to achieve a reduction or complete disappearance of metastases, after which it becomes possible to conduct surgery.
Note! Melanocytes are extremely resistant to any effects, which leads to low efficiency of the treatment.
What it is?
In the surface layer of the skin are cells containing melanin, a pigment substance, thanks to which we beautifully tan, we have a unique color of hair and eyes, unique moles and freckles on the skin.
Uncontrolled progressive proliferation of melanocytes, occurring in a specific place of the body, not only on the open skin, but also on the mucous membranes, under the mutagenic effect of ultraviolet rays (the dose for each individual) - this is melanoma. It looks at the beginning of the process, when it is best to treat it, often as a new, ordinary flat mole of irregular shape and does not show anything special. Therefore, they often reveal melanoma at later stages, which leads to disappointing results.
Does melanoma cause metastases? Yes, and fast enough. It is the ability to metastasize and is the defining characteristic of the aggressiveness of malignant tumors. Compared with other forms of skin cancer, which are cured and in relatively advanced stages, with melanoma, "delayed death is like."
Among all malignant tumors, one to four cases out of a hundred fall to melanoma. More often sick are people of the southern European race who are constantly exposed to increased natural insolation. Other types of skin cancer are found ten times more often, however, melanoma surpasses them in times of aggressiveness. About 50 thousand people die from melanoma every year in the world (according to the World Health Organization).
The highest incidence rates are recorded among white Australians and New Zealanders (23–29.8 cases per 100,000 inhabitants). Among Europeans, this figure is 2-3 times lower - every year about 10 primary applications per 100,000 inhabitants. Ethnic Africans and Asians, regardless of their place of residence, suffer from melanoma 8-10 times less often than the white race. Statistics show that the number of cases of malignant neoplasms of the skin is growing, including patients on the planet with a diagnosis of "melanoma" every decade becomes twice as large.
Very rarely, melanoma is diagnosed in children. Most sources call the most probable age of manifestation of melanoma 30-50 years old, the medical statistics of the Russian Federation notes that most of their patients first applied for a neoplasm already past half a century (in 2008, the average age of those who first applied was 58.7 years).
The risk of developing “black skin cancer,” as they also call melanoma, on a seemingly healthy and clean skin is approximately equal to the probability of malignancy of existing nevi.
Melanocyte degeneration can occur anywhere in the skin, however, most often the tumor is localized on the skin of the back in male patients, on the skin of the lower leg - female and on the face - in patients of advanced age. Female patients with skin melanoma are twice as likely as men.
Metastasis of melanoma, as statistics say, to the lymph nodes always, not counting the initial stages, when there is simply no metastasis. This is the main target organ. Then, in about 60% of cases, metastases are found in the skin.
The frequency of metastatic lesions of the internal organs is as follows: lungs (about 36%), liver (about a third of cases, sometimes called the first target organ), brain - one fifth of cases of secondary melanomas, bone tissue - up to 17%, digestive tract - no more than 9%.
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Causes of metastatic melanoma
Ultraviolet rays stimulate melatonin production. Excessive radiation exposure is blamed for the occurrence of mutations in melanocytes that trigger the process of their uncontrolled growth and reproduction.
The origin of the ultraviolet can also matter. The start to the development of melanoma is natural sunlight (usually burns). In this case, the danger is a quantitative factor. Artificial ultraviolet rays, and obtained in any, the most modern and positioned as safe tanning beds, regardless of the exposure time, increase the risk of developing melanoma by 74%. This conclusion was made by American oncologists from Minnesota on the results of a study conducted over a period of three years. They found that fans of tanning beds develop melanoma 2.5–3 times more often than people who have never visited it.
The risk group includes fair-skinned people - blondes, albinos, redheads. Take care of those who have a family history of cases of melanoma or multiple moles on the body. An increased risk of the development of this neoplasm is associated with a hereditary violation of the activity of a gene that suppresses tumor cell changes.
In the sense of malignant transformation, the pigment nevi already present on the skin are dangerous: giant, complex, borderline, blue. Also melanohazardous are nevus Ota, Dubreuil's melanosis, pigment xeroderma.
Risk factors for the development of malignant proliferation of melanocytes include living in areas of increased radioactive or insolation background, working in hazardous industries, periodical and even one-time burning in the sun before blisters, injury to birthmarks, and metabolic disturbances.
Any of the reasons mentioned above, often in combination, can trigger the pathogenesis of atypical melanocytes and their hyperproliferation. In the majority of patients with melanoma, especially in the metastasis stage, a violation of the normal sequence of the signal cascade of the BRAF gene is found, however, not in all. This is not the only molecular target in the pathogenesis of melanoma. Others have not yet been identified, however, significant efforts are being made.
The mechanism of malignancy of already existing nevi includes both hereditary and external factors - excessive insolation, injuries and others.
In the pathogenesis of melanoma, two main phases are distinguished - superficial or horizontal, when the spread occurs on the same plane with the skin surface, in the epithelium, and vertical, when the tumor begins to grow inside, into the deeper layers of the skin and subcutaneous fat layer. Metastases appear when the process moves to the vertical distribution phase and reaches the lymphatic and blood vessels. Cancer cells are carried by the lymph flow to the close, and later to the distant lymph nodes, and with the blood flow even distant vital organs reach. Melanoma with multiple metastases not only in the distal lymph nodes, but also in the internal organs has the most unfavorable prognosis. The main reason for the diagnosis of "metastatic melanoma" is late diagnosis. It reflects a deeply started process.
Metastases after removal of melanoma are most often found in the first year. However, it happens that metastases appear and much later. The process of metastasis has not yet been fully studied, but it is known that, even penetrating from the vascular bed into the target organ, the reborn cells and their conglomerates can be in a clinically undetectable state for a long time and manifest their presence unexpectedly, many years later.
The more time has passed since the moment of radical treatment, the lower the estimated risk of metastasis. After a period of seven years, it reaches a minimum. However, there are cases of late metastasis (after a ten-year recurrence-free interval). A unique case of the appearance of a secondary tumor in 24 years from the moment of removal of the primary one is known.
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At what stage does melanoma give metastases?
Clinicians identify five main stages of melanoma (0-IV), in addition, intermediate stages are identified that take into account the thickness, the rate of cell division in the lesion, the presence of ulcerations and various types of metastases.
At the third stage of melanoma, secondary formations are already found in the lymph nodes, vessels and / or skin areas closest to it (satellites). In stages IIIA and IIIB, the presence of altered cells can be determined only by microscopy of a smear-print and punctured lymph, in stages IIIC and IIID, an increase in regional lymph nodes is determined by palpation, and skin lesions by visual examination.
Stage IV corresponds to the appearance of palpable secondary tumors in at least the lymph nodes located at a distance from the primary focus. In this stage, any distant parts of the skin and muscle tissues can be affected, as well as internal organs. The most typical places are lungs, liver, brain, bones.Metastatic melanoma is diagnosed when metastases are detected.
In the initial (in situ), first and second stages of melanoma, its spread to the nearest skin and lymph nodes, even with microscopy, cannot be detected. However, the modern oncological concept suggests that with the appearance of a malignant tumor almost immediately there is a chance of metastasis. Modified cells are constantly detached from the primary formation and lymphogenous (hematogenous) are sent to new places, stop and grow, forming metastases. This process is quite complicated, the cells in the vascular bed interact with each other, other factors, and most of them die, without becoming metastasis. At the beginning, metastasis occurs slowly and imperceptibly, but with melanoma that has spread to a depth of more than 1 mm, and this corresponds to only the second stage, there is already a risk of detecting secondary tumors some time after its removal.
This neoplasm is most often classified using the TNM classification developed by the American Cancer Society, which reflects three categories:
- T (tumor translation: tumor) - reflects the depth of the spread of the process, the presence (absence) of surface damage, the rate of nuclear division of modified cells (metastatic melanoma is encoded by T3-T4 with letter additions),
- N (Node Lymph - lymph node) - reflects the presence of lesions in the lymph nodes, a digital index indicates their number, alphabetic, in particular b, indicates that lymphadenopathy is palpated or even visible visually,
- M (metastasis - metastases) - distant metastasis (M1 metastases are available, M0 - they were not found).
Melanoma primarily affects the lymph nodes located closely, the so-called sentinel. At the stage of early metastasis, they are removed, this stage of the disease is prognostically relatively favorable.
Metastasis to the skin, located at a distance not exceeding 2 cm from the maternal tumor is called a satellite. There are usually several of them; they are clusters of cancer cells (determined under a microscope) or appear as small or large nodules. Located outside the two-centimeter zone, secondary tumors on the skin are called transit metastases. Metastasis to the skin, especially transit, is considered an unfavorable sign, and to the internal organs.
Symptoms of metastatic melanoma
To avoid the diagnosis of “metastatic melanoma”, you should periodically examine the moles on your body and, if any of them raises doubts about its goodness, you should consult a dermato-oncologist.
The first signs that should alert you are a noticeable increase in the size of the mole in the skin plane (more than 5 mm) and / or vertically above it, asymmetric shape, uneven scalloped borders, noticeable changes in shape and color - asymmetric depigmented areas, points and areas of different colors. The alarming symptom is usually not one, rapid growth means that the mole adds about a millimeter per month in any direction.
Later symptoms include an itching sensation at a given location, inflammation of the skin around a dubious mole, depigmentation, loss of hair that has grown on it before, peeling of the surface of the mole, and the appearance of nodules on it.
Weeping, ulcerated surface or bleeding, just like that, without injury - adverse symptoms. A lacquered surface without a skin pattern is the same as a palpatory sensation of a change in the density of formation.
The appearance on the surface of the skin surrounding the dubious moles of satellites - pigmented (flesh-pink) nodules or spots, that is, metastases to the nearby skin indicates that the stage of melanoma is at least IIIC.
Melanoma can develop in several forms. There are the following:
- the most common (more than 2/3 of cases) is superficially spreading, looking like a brown almost flat spot of irregular shape and uneven color (darker, bodily pinkish-gray areas), localized more often on the trunk and extremities, with time the surface darkens and becomes glossy , easily damaged, bleeds, ulcerated, the horizontal phase can last from several months to seven to eight years (it is more prognostically favorable), after the beginning of the vertical phase, the tumor begins to grow in p, and inside, there is a rapid metastasis,
- nodular (nodular) melanoma immediately grows vertically (there is no horizontal growth phase) - dome-shaped rises above the skin, has a different, often uneven, pigmentation (sometimes depigmented), clear boundaries and a circle or oval shape, a smooth shiny easily injured surface, sometimes looks like polyp on the leg, has a rapid development - from six months to one and a half years,
- lentigo-melanoma (malignant melanosis) - spots without a certain form and clear boundaries, resembling large freckles, horizontal growth is very slow from ten to twenty years, more common in older people on exposed parts of the body and face, the vertical phase is manifested by the fact that the boundaries become zigzag or wavy, the stain begins to rise above the skin, nodules, ulcerations, scabs, cracks appear on its surface - this phase is fraught with metastases,
- spotted (acral-lentiginous) melanoma is a rare type, mainly affects dark skin, develops on the fingers, palms, feet, under the nail (a dark band is formed).
High probability of metastasis in melanomas, developing on mucous membranes. They are usually detected by chance at examinations at the dentist, otolaryngologist, proctologist and gynecologist. The pigmentation of such formations is usually noticeable and uneven.
Pigmentless melanoma is extremely rare. It is often diagnosed in the late stages. It can belong to any kind - superficial, nodal, lentiginous.
General signs of metastatic melanoma, as well as all cancers in the late stages, are manifested by constant malaise, anemia, thinness, pallor, decreased immunity and, as a result, endless slow-downs of acute respiratory viral infections and exacerbations of existing chronic pathologies.
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What do melanoma metastases look like?
Visually visible secondary tumors on the skin. Satellites look like small multiple dark spots or nodules located near the mother tumor or the place of its removal. This form is typical for the localization of primary education on the skin of the trunk or limbs. Satellite metastases in melanoma spread through the lymphatic vessels, appear in about 36% of cases. Can be combined with nodal metastases, which occur in more than half of patients with metastatic melanoma.
Nodal (subcutaneous metastases of melanoma) that have spread to the lymph flow usually look like subcutaneous or intracutaneous tumors, often with an ulcerated, bleeding surface. Usually regional. Secondary nodal foci, appearing as a result of hematogenous spread, look like multiple round or oval nodes scattered in any parts of the body, but their favorite places are the chest, back and abdomen. The skin above them is intact, flesh-colored or bluish, when accumulated melanin shines through under its thin layer. The size most often ranges from 50mm to 4 cm, with larger sizes, the tumors can coalesce, the skin becomes thinner, becomes glossy, the integrity of the cover is broken (cracks, sores). At first glance, secondary skin tumors may resemble lipomas, epidermoid cysts, scars, dermatosis. Melanoma metastases in subcutaneous fatty tissue may not be noticeable on external examination, however, they are determined by palpation.
Respiratory skin metastases are rare in melanoma, in less than 1.5% of cases. At the same time, dissemination of the skin surface with defective melanocytes occurs via the lymphogenous way. Characterized by the location of the maternal tumor on the temporal areas of the scalp, wrists, legs and chest. They resemble externally erysipelas - the skin around the primary focus aches, has a bluish tinge and swelling. Can be combined with satellites.
Rarely, but somewhat more often than a rodent-like (up to 4% of cases, mostly with melanoma localized in the lower legs), there are thrombophlebic skin metastases. Painful seals hyperemic, with dilated superficial veins. The location is regional, the spread of cancer cells is lymphogenous.
The detached melanoma cells, entering the lymphatic flow, first of all, attack the sentinel lymph nodes. They are the first barrier to the spread of cancer cells and are the first to suffer. At the beginning, melanoma metastases to the lymph nodes are detected by microscopy of their contents obtained by puncturing. At later stages, the nodes closest to the maternal tumor are already enlarged and well felt, and later visible. However, as long as 2-3 sentinel lymph nodes are affected and there is no further spread, they can still be removed. If metastases are found in the distant nodes of the lymphatic system, the patient’s position is treated as much worse, although much depends on their number and location.
The most severe degree of damage corresponds to the situation when wandering cancer cells have settled in the internal organs. In a hematogenous manner, they are spread throughout the body and infect vital organs, which, or even part of, cannot be removed. With respect to metastasis to the internal organs, the expression "look" is not correct. They manifest themselves symptomatically and are visualized using various instrumental methods - ultrasound, MRI, X-ray, and are also detected through laboratory studies.
Metastases of melanoma to the brain are clusters of continuously dividing melanocytes in different parts of it, so various symptoms will manifest themselves. Metastatic brain tumors are characterized by general malaise, decreased appetite and body weight, and febrile conditions. Cerebral manifestations can be expressed by headaches, nausea, vomiting, sleep disorders, gait, coordination of movements, memory, speech, and personality changes. Metastasis of melanoma to the brain can cause intracranial hemorrhage, convulsions, paresis and paralysis, other neurological disorders, depending on the lesion. For example, metastases of melanoma in the pituitary gland are manifested by headache, ophthalmoplegia (paralysis of the oculomotor nerve), and other visual impairments, expressed thirst and polyuria (neurogenic diabetes insipidus). Magnetic resonance scans of the brain are assigned for diagnosis, but it is far from always able to give an exact answer about the origin and quality of the neoplasm.
Metastatic melanomas to the liver, besides the general symptoms of malaise, are manifested by constant nausea and vomiting, especially after eating non-dietary products, discomfort in the liver, jaundice. Palpation is also determined by the increase and compaction of the body, in addition, there is splengomegaly. An ultrasound study shows that the surface of the liver is covered with dense tubercles.
The biochemical composition of the blood is violated. Indomitable vomiting lasting more than a day, especially with blood, black stools, and visually enlarging the abdomen are symptoms that require urgent attention.
Melanoma often metastasizes to the lungs, in some sources this organ is called the primary target, in others the liver or the brain. This localization of the secondary tumor manifests itself, in addition to the general symptoms, shortness of breath, wheezing, uneven breathing, constant dry cough with poor sputum, sometimes with blood, chest pain, there may be high fever.
The neoplasm is usually visualized by ray methods. Metastases can be focal, round shape. With a small spread, they are most favorable. Have hematogenous origin. More often, melanoma is accompanied by infiltrative metastases of lymphogenous origin, which appear in the image as local dimming or a net that encircles the lungs. In practice, there are mostly mixed forms.
Metastasis of melanoma in the bone is manifested by local, non-quarable pain and frequent fractures. The appearance of malignant cells in the bones and tumor growth disrupts the equilibrium state of metabolic processes between osteoblasts that synthesize young cells of the bone matrix, and osteoclasts that destroy bone tissue. In most cases, osteoclasts and bone resorption are activated under the influence of cancer cells, however, osteoblastic activity sometimes prevails, which contributes to abnormal bone compaction, although mixed forms are most common.
Melanoma metastasizes to the bone less frequently than to the liver, lungs and brain. First of all, there are metastases of melanoma in the spine, then in the ribs, skull, bones of the thighs and sternum. After this, the cancer cells disseminate the bones of the pelvis (typical of the localization of the maternal tumor in the groin) and, last of all, the scapula. Secondary tumors are localized in the medullary parts, which are used for the accumulation of calcium, are spongy bones, well supplied with blood. The tubular bones are involved in the pathological process extremely rarely, when all the "favorite" places are already taken.
Osteolytic processes lead to hypercalcemia, which negatively affects the course of various processes in the body - the kidneys, the central nervous and cardiovascular systems, and the gastrointestinal tract are affected.
Metastasis of melanoma in the heart appears in the advanced stage of the disease. With melanoma, this localization is more common than with other primary foci. Cancer cells often migrate to the heart from the lung, getting there both through the lymphatic pathway and through the bloodstream. Most often, metastases are found in the pericardium, then in any cardiac chamber. Valves and endocardium rarely suffer. Metastatic tumors in the heart manifest a violation of cardiac activity, they are detected late, they have no effect on the mechanism of death and survival.
If metastasis extends to the organs of the gastrointestinal tract, dyspeptic symptoms appear. Against the background of common manifestations of cancer intoxication - exhaustion, weakness, there is pain in the abdomen, flatulence, nausea, vomiting. When localized in the esophagus, there is primarily a violation of the ability to swallow. The pains are localized behind the sternum and in the upper abdomen, there may be perforation of the walls and bleeding. The tumors in the stomach are characterized by epigastric pain, nausea, vomiting, black tar-like fecal masses. A secondary tumor of the pancreas is manifested by symptoms of chronic pancreatitis. Melanoma metastases in the intestine are extremely rare, however, they are the most malignant. Manifesting symptoms of intestinal dysfunction, can lead to perforations through its walls or intestinal obstruction.
Very rarely, melanoma as a primary neoplasm can develop on the mucous membrane of the alimentary canal; secondary formations occur more often there.
Achromatic, that is, unpainted melanoma is often found in the later stages, when metastasis has already appeared. It is characterized by the same clinical symptoms, only there is no specific dark color, which, above all, pay attention. Achromatic (pigmentless) melanoma appears on a clean area of the skin, its shape corresponds to the usual, the skin color with a reddish, pinkish, grayish tinge. It also, like pigmented, grows quickly and changes shape, asymmetrical, with uneven edges, or nodular, can bleed, itch, become covered with scabs and sores.
Metastasis of non-pigmented melanoma spreads in the same ways and to the same organs. Many people consider this form of melanoma to be more malignant, it is believed that metastases appear and spread throughout the body much earlier than with the usual “black” cancer. Perhaps this opinion is created because often patients with an achromatic tumor come to the attention of doctors already with pronounced metastases, not having a clue that they have melanoma.
Often there are pains with melanoma with metastases, sometimes they require constant anesthesia. The most painful are metastases to the brain and bone tissue.
Causes and risk factors for metastasis
This complication of skin cancer occurs under the influence of natural environmental factors, among which the dominant place belongs to intense ultraviolet radiation.
Metastatic melanoma occurs due to such reasons:
- Female. In women, the incidence is 0.5 times higher. This is due to chromosomal and genetic features.
- Age over 70 years. Elderly people accumulate a large number of gene breakdowns.
- Hair color. Blondes and red-haired people are more often subject to similar complications. They do not have a protective pigment.
- Eye color. The risk group includes those with blue, green or gray iris. In such people, protective pigments are in low concentrations.
- The presence of freckles on the face.
- A large number of moles. They are reborn and metastasize.
- Congenital pigment spots. They are called nevi. These specks often give rise to metastasis.
- Injury of all kinds of skin formations. This particularly applies to those structures that rise above the skin. Patients touch them when walking in the shower or dressing.
- Senile stains. These rashes can also be reborn and metastasize.
- Pigment xeroderma. It is a genetically determined systemic disease.
- Solar or thermal burns. With a similar trauma to the skin, irreversible changes in the structure of the dermis occur.
- The spread of melanoma is deeper than the basal layer. When a tumor penetrates deep tissues, it is a guarantee that metastases will spread through the body in a hematogenous and lymphogenous manner.
Signs of new foci
Melanoma metastases do not have specific clinical manifestations. But that skin cancer metastasizes is evidenced by non-specific symptoms. New foci are manifested by such symptoms:
- Weakness and fatigue. Asthenization of the body occurs due to energy deficiency.
- The appearance of pain in any part of the musculoskeletal system. This symptom appears immediately after the onset of bone metastasis.
- Headaches when metastasis enters the brain and its membranes. They do not have a clear localization and are aching in nature.
- Progressive weight loss. The spread of cancer cells in the body contributes to the absorption of nutrients, which previously went to the restoration of tissues.
- The frequent incidence of viral and bacterial infections. It appears after a decrease in immune status.
- Dyspnea. This symptom occurs when metastases penetrate the lung tissue.
- Cough and hemoptysis. Such clinical symptoms also appear when a skin tumor penetrates the lungs.
- Tachycardia and arrhythmia. Heartbeat quickens and loses rhythm when metastasis reaches the myocardium.
Diagnosis of metastases
Diagnostic measures differ little from those in primary skin cancer. Melanoma with metastases is determined using the following methods:
- Physical examination of the patient. The doctor is trying to assess visually the increase in the number of birthmarks and other formations on the skin. The dermatologist determines the contours of their edges, the elevation above the skin and the coloration.
- Dermatoscopy. This instrumental method consists in the study of the detailed structure of skin lesions using a special apparatus.
- Scintigraphy The technique is based on the accumulation of special fluorescent pigment by the bone structures. The latter is concentrated in places where metastasis has occurred.
- Laboratory diagnosis of blood and urine. With the help of general tests, it is possible to establish an increased concentration of white blood cells and an accelerated ESR. Biochemistry shows an increase in liver enzymes in the presence of metastases in this organ of digestion.
- Intake of material for microscopy. It is performed using a biopsy. Cells are examined for malignancy.
- Radiography of the chest. It helps to identify new lesions in the lungs.
- Computed and magnetic resonance imaging. These instrumental techniques are highly accurate. They are considered the “gold standard” for the diagnosis of cancers of various localization.
How is this complication treated?
Melanoma metastases are treated comprehensively. The combination of techniques includes chemotherapy, radiation and surgical removal. Such tactics help the metastases to operate with the regional method - without the risk of their further spread.
Treatment is divided into several stages:
- Close-focus radiological effect. It is performed until the onset of radiation reaction on the skin.
- Expectant tactic. At this stage, ancillary chemotherapy is performed. Doctors are waiting for the primary radiation reaction to disappear.
- Broadband excision of the site of metastasis. This method is used in order to avoid further germination of the tumor.
- Skin plastics. With its help, eliminate the wound defect.
Metastases for melanoma are evidence of its progression. Accordingly, they are considered a poor prognostic sign. But if metastasis is detected in a timely manner and drug measures are initiated without delay, the prognosis for life and recovery improves. The survival rate of qualitatively treated patients with such a diagnosis is 85–90%.
If only present lesion of regional lymph nodesthen the five-year survival rate for this tumor is 20-45%.
In case of metastases in internal organs, distant lymph nodes, bones survival rate is 8-10%.
Brain damage almost always fatal.
What is metastasis?
In the course of self-development, a malignant neoplasm can go beyond the original location and spread throughout the body. If such a cancer cell survives in any part of the body, then such a formation is called metastasis.
Melanoma with metastases has an increased risk, since this tumor is characterized by accelerated growth and rapid disruption of the organs. To date, there are several factors that increase the risk of developing melanoma:
- Regular skin contact with direct sunlight,
- Propensity to form nevi
- Burdened family history,
- Racial predisposition During the statistical analysis, it was noted that people with white skin, blond hair and blue eyes suffer from melanoma more often,
- A history of severe burns of the skin,
- Old age.
A number of histological studies have shown that melanoma may be the result of another malignant neoplasm. Metastatic melanoma is a secondary tumor of another oncogenesis with a more favorable prognosis.
For all metastatic tumors, stage IV of the cancer process was developed. At this stage, surgical treatment will be ineffective due to the massive spread of malignant cells throughout the body.
Ways to spread
With the development of melanoma, there are several ways in which metastases can penetrate into other organs:
The lymphogenous transmission pathway is characterized by metastasis by spreading atypical melanoma cells through the lymphatic ducts. Due to the current of lymph metastases first penetrate the nearest lymph nodes, and then to other organs.
The hematogenous pathway is the transmission of malignant cells through blood vessels. Due to this mechanism of distribution, melanoma can affect organs located relatively far from its initial localization.
Organs with increased susceptibility to metastasis in hematogenous route of transmission:
Types of skin metastases:
- Nodular shape. This species is characterized by the formation of metastases, representing a particular series of subcutaneous nodules of unequal size. Their location does not depend on the location of the original tumor.
- Sperm shape. Presented in the form of a limited edematous area of skin that has a purple hue.
- Satellites. When this form appears multiple rashes. Elements of the rash are presented in the form of spots that have a similar shade to the tumor. Satellites are characterized by a close proximity to the original tumor.
- Tromflebit-like form. It tends to radially spread in the form of painful and dense formations. At the same time, the surface veins begin to expand, and the skin around the melanoma becomes swollen.
Factors contributing to metastasis:
- Melanoma of the fourth stage. At this stage of the development of a malignant neoplasm, tumor germination occurs in adjacent organ structures. The similar factor extremely adversely influences the further forecast for the patient.
- The presence of a patient with severe comorbidity. Chronic diseases in advanced cases can lead to decompensation of organ function. In this case, there is a decrease in the overall resistance of the organism and the suppression of protective mechanisms.
- Localization and size of the initial oncogenesis. Unfavorable is the location in the face and neck. If the melanoma is large, this indicates a high probability of metastasis.
- Elderly patient age. In the course of statistical analysis, it was noted that patients over 60 years of age have lower survival compared with younger patients.
If the influence of these factors on the patient’s body is not excluded, the tumor will grow rapidly and metastasize.
The first thing that catches the eye when visually examining a patient is an increase in the size of the regional lymph nodes. An experienced doctor is able to assess the characteristics of the lymph node only through a palpation method of research. The affected node becomes immobile, soldered to the surrounding tissues and painless. In melanoma, in most cases, the cervical, occipital, submandibular, supraclavicular, axillary, and inguinal lymph nodes are affected. The density of knots can be described as tightly elastic.
With the progression of the disease, additional symptoms appear that are a consequence of the intoxication process. Such patients begin to lose weight quickly, and they experience constant weakness. In addition, a very unfavorable sign is the constant increase in temperature. If melanoma gives metastases to the brain, then focal symptoms will prevail in such patients.
All patients suffering from malignant neoplasms may develop paraneoplastic syndrome. This is a condition caused by the negative influence of the tumor on the organs, accompanied by changes in the endocrine and immune systems. It is not uncommon that systemic connective tissue diseases develop in such a cohort of patients against oncogenesis.
When melanoma metastasizes to the kidneys, the glomerular filtration rate begins to decrease. In such patients, the level of filtration of urine drops sharply. If chemotherapy with a kidney transplant is not performed on time, then such a patient may die.
If a patient often suffers from acute respiratory viral infections and has a constantly elevated temperature, this is considered to be an unfavorable factor that can significantly worsen the prognosis of survival for the patient. Not uncommon, when an enlarged lymph nodes even precedes the appearance of a tumor. Many patients seek advice on lymphadenopathy, however, a more detailed examination reveals the melanoma itself, which became the "culprit" of this condition.
Metastasis of melanoma in the liver leads to rapid decompensation of the patient. The liver is a very important component of the digestive system, performing a number of additional functions. Hepatic parenchyma filters blood from foreign toxins, which provides protection to other organs and systems.
It is common for cancer cells to have cyclicity in metastasis and growth progressiveness. This means that the first case of the spread of metastases can gradually regress and be invisible upon re-examination. During clinical observations, it was noted that if the size of the metastasis does not exceed 0.7 mm in diameter, then it will not progress further in growth. If the size of the secondary focus is more than 1.5 mm, the patient should be included in the high-risk group.
Relapse of the disease in such patients is observed in the first 3 years. Based on the foregoing, it can be concluded that all patients with identified melanoma metastases should undergo regular examinations by an oncologist.
Treatment of metastasis is a very time-consuming process with low efficiency. If melanoma begins to spread beyond its initial localization, then the prognosis for survival in these patients is less than 10%. To treat a malignant neoplasm at this stage is possible only with the help of radiation and chemotherapy. Surgical intervention in this case is strictly contraindicated. It was not uncommon when the removal of metastatic melanoma was performed, but this only led to a deterioration of the patient’s condition.
Types of melanoma metastases
Melanoma gives metastases in several ways:
Lymphogenous metastasis of melanoma manifests itself by an increase in the size of regional (located near melanoma) lymph nodes, and then as the process progresses, distant lymph nodes also increase.
In addition, patients begin to complain of weakness, weight loss, frequent colds, anemia, fever, night sweats.
Hematogenous metastasis of melanoma (through blood vessels) most often affects the liver, lungs, brain and bones.
Melanoma metastases to the liver - an increase in the size of the liver, jaundice, heaviness in the right hypochondrium, bitter taste in the mouth, anorexia.
In the presence of lung metastases there are complaints of persistent cough with mucous or mucopurulent sputum, shortness of breath, frequent pneumonia (patients who re-tolerate pneumonia within a year must be examined for primary lung cancer), hemoptysis.
Metastasis of melanoma to the brain manifested by headaches, visual impairment, nausea and other neurological symptoms, the manifestations of which depend on the location and number of secondary tumors.
Bone melanoma metastases lead to local pain, destruction of bone tissue, fractures.
Clinical forms of melanoma:
- nodular melanoma.
Makes 10-30% of all melanomas, the most aggressive. Externally similar to a knot or polyp, it appears almost always on previously unchanged skin. It grows fast enough, ulcerates and bleeds.
- flat or radially growing melanoma.
It is located more often in women on the lower extremities, in men it is more often found on the skin of the body. Looks like a flat plaque, sometimes with a different color.
It occurs, as a rule, in older people. Most often located on the face, neck and a spot.
- acral form of melanoma.
Appears in the bed of the nail plate and looks like a normal dark speck.
In order to be able to understand whether there is a danger of malignancy, the scientists developed the Glazg 7-point system of signs of malignancy of skin lesions:
- change in size, volume,
- shape change, outlines,
- color change,
- bleeding, ulceration,
- change in sensation, sensitivity,
- diameter over 7 mm.
But even with the large amount of information and its availability regarding the disease, people only come to the doctor for examination in 50% of cases with metastasis of melanoma to the lymph nodes.
Necessary diagnostic measures for the detection of melanoma metastases:
- examination of the skin, and not just the area with the alleged melanoma.
- palpation of all lymph nodes, in case of suspicion of a neoplasm - to make a puncture biopsy.
- chest X-ray.
- Ultrasound of the abdominal organs.
- cytological examination of smear prints in ulcerated tumors.
- excisional biopsy with urgent intraoperative histological examination. With an excisional biopsy, a complete excision of oncogenesis is performed, while 2-10 mm recede from its edges and sent for histology.
- CT scan of the brain.
In the presence of melanoma metastases, treatment will be complex or combined. With metastases in regional lymph nodes The treatment consists of the complete removal of the primary tumor site with regional lymph nodes.
For over 30 years in the Russian Federation, in addition to surgical treatment, they treat melanoma with Dacarbazine and Interferon-Alpha. What has changed over the years? What drugs in the treatment of melanoma appeared? The answer is no. How did the treatment Dacarbazine and Interferon, and remains. Recall that in the treatment of Dacarbazine, life expectancy can be increased by 6-7 months, while it will help only 11% of patients. Well, let's turn to foreign drugs Zelboraf, Keitrud, Optive, etc. This is somewhat better. Life expectancy increases to 11-18 months.
For the selection of an effective method of treatment, you can ask for
- methods of innovative therapy,
- the possibility of participation in experimental therapy,
- how to get a quota for free treatment in the cancer center,
- organizational matters.
After consultation, the patient is scheduled for the day and time of arrival for treatment, the department of therapy, and if possible, the attending doctor is appointed.