The skin is an organ that covers the whole body and whose mission is to protect it but also to regulate its temperature and to produce vitamins. It is made up of 3 different layers called the epidermis, dermis and hypodermis.
The epidermis is the outermost part of the skin. It acts as a barrier against external aggressions such as ultraviolet (UV) rays. It consists of 3 layers composed of 4 types of cells:keratinocytes, melanocites, Langerhans cells and Merkel cells.
The dermis is located below the epidermis and it contains hair follicles and sweat glands. It is made up of cells called fibroblasts that make collagen.
The hypodermis is made up of fat cells called {{adipocyte}}s and is found deep within the skin.
The skin can be affected by benign or malignant tumors:moles are benign tumors that can degenerate into cancer.
The main risk factors are:
We must think of melanoma when a mole (ABCDE rule):
Any pigmented spot that changes appearance quickly (shape, size, thickness, color) is a warning sign. To find out more, consult the file on the early detection of cutaneous melanoma from our partner the National Cancer Institute.
The lesion may itch, ulcerate, bleed.
Please note:the presence of these signs does not automatically mean that you have skin cancer. If one or more of these signs appear and persist, and in general if you are worried about a particular sign, it is important to talk about it with your doctor. He can examine the person, and refer him to a specialist if necessary to have the mole analyzed.
If a suspicious lesion is detected, the attending physician will refer the patient to a dermatologist who will make a diagnosis.
To do this, he will analyze the size, shape and color of the mole and then perform an excision of the lesion.
Then an anatomopathological examination of the lesion will be carried out to determine if it is cancerous.
During this diagnostic step, the dermatologist will perform an examination of the whole body to determine if there are other suspicious lesions of melanoma or other nevi likely to degenerate and therefore to be monitored.
In the event of a positive diagnosis, an extension assessment can be carried out to determine if the melanoma has spread to other parts of the body.
It is a multidisciplinary team of specialized professionals who will choose whether this assessment should be carried out. It may include various examinations such as an ultrasound, a scanner or an MRI.
The treatment of melanoma involves surgery and is very often carried out during the diagnostic phase. It may be necessary to complete the ablation if the lesion has not been removed extensively enough. This surgery may, depending on the case, be supplemented by other treatments such as radiotherapy or chemotherapy.
Surgery is the main treatment for melanoma, with a margin of safety depending on the thickness of the tumor. Histological analysis can determine whether the melanoma has been completely removed or not.
The treatment of metastatic melanoma is based on surgery, chemotherapy, immunotherapy, and much more rarely radiotherapy. It is a specialized multidisciplinary team that will decide on the treatment according to the stage of the cancer and its evolution. The choice of treatments will be explained to the patient during an announcement consultation as part of the announcement system.
Depending on the stage of the cancer, the treatments can have different objectives:to cure the cancer, to slow down its development, to prevent its recurrence, to treat the effects related to the treatment itself to bring a better quality of life to the patient.
The proposed treatment depends on the type of cancer, its characteristics, the stage of the disease and the medical history of the sick person.
To find out more, you can consult the document from our partner the National Cancer Institute on "treatments for melanoma of the skin"
People with melanoma may need care in addition to specific treatment for their cancer. This is called supportive care. Their objectives are to respond to the difficulties that the patient encounters both physically, such as pain or fatigue, and psychologically and socially. This care is provided by the patient's health care facility or "in town".
At the end of the treatments, a follow-up is set up in order to anticipate the risks of recurrence, to monitor moles at risk, to mitigate the undesirable effects of the treatments.
During the follow-up consultations, the doctor will carry out an examination of the entire skin and may prescribe medical imaging examinations such as scanner or MRI in case of doubt.
Throughout these stages, information must be provided on sun protection methods, specifying the importance of photoprotection in children and adolescents (family risk). The patient must also be trained in skin self-examination, which allows the detection of a new melanoma and the detection of a recurrence. Dermatological screening of first-degree relatives should be recommended because of the risk of familial melanoma (about 10% of cases).
Sources
National Cancer Institute, High Authority for Health. The management of your cutaneous melanoma. Patient guide – long-term condition. 2010.
National Cancer Institute, High Authority for Health Malignant tumour, malignant disease of lymphatic or hematopoietic tissue, Cutaneous melanoma, 2012
