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Radiation Oncology, General Hospital
Cutaneous melanoma is a malign tumour located on the skin, usually black or coffee coloured. Some of the main risk factors include exposure to sunlight and freckles. They can develop on any part of the skin, but they are more frequent on men's chests and backs and women's legs. They are responsible for 65% of deaths due to skin cancer. Discovering and treating the illness in time is vital for stopping it spreading to other parts of the body.
Cutaneous melanoma is a cancer that originates in cells known as melanocytes. These cells produce melanin, which is why the tumours are usually coffee coloured or black, but they can also be pink, pale coloured or white. Overall, cutaneous melanomas represent approximately 1% of all tumours in both sexes, and every year 15 out of every 100,000 people are diagnosed, a figure that is increasing in nearly all European countries.
Cutaneous melanomas can develop on any part of the skin, but they are more frequent on the chest and back in men and the legs in women. The neck and face are other common sites. Having skin with a dark pigmentation reduces the risk of melanoma in these more common locations.
Melanomas are much less frequent than other types of skin cancer, but they are more dangerous, because they grow more quickly and they are very likely to spread to other parts of the body if they are not discovered and treated in time.
The first signs of a melanoma are as follows:
Melanomas do not always start with a freckle: they can also appear on normal-looking skin and can form on any part of the body. They very often appear on parts of the body that have been exposed to the sun, such as a person’s back, legs, arms or face. They can also occur on parts that have little exposure to sunlight, such as the soles of the feet, the palms of the hands and in the nail beds. These hidden melanomas are more frequent in people who have darker skin.
In Spain, the condition especially affects women, with an average initial-diagnosis age of 55, and men at an average age of 57. For white individuals, the incidence of cutaneous melanoma is increasing at an alarming rate, in all Cancer Registries. In Europe, it is the ninth most frequent cancer, with around 200,000 cases diagnosed every year. Although it only represents between 1.5 and 1.7% of skin cancers, it is responsible for 65% of deaths from skin cancer. This figure is stable in spite of the increased incidence, probably because of early diagnosis, which is the most important factor, and improvements in treatment.
The reason why melanoma occurs is unclear, although some risk factors have been identified, which should be taken into account:
It is usually diagnosed after observing a suspect freckle that presents alterations known as (1,2,3,4):
For this reason, if a new, unusual freckle is found, or a change is noted in an existing one, it should always be examined by a dermatologist, as early diagnosis is vital in this illness. The tests and procedures used to diagnose cutaneous melanoma include the following:
The recommendations for treatment depend on many factors, such as the thickness of the primary melanoma, the possibility that the cancer has spread or the presence of specific genetic changes in the melanoma cells, among others.
However, surgery is the main treatment against local and regional melanoma. It may also be an option for combating metastatic melanoma. If surgery is not an option, the melanoma can be called “unresectable”. In order to recommend a specific treatment plan, the doctors will take into account the state of the illness and the risk of relapse in each person. Subsequently, in accordance with the state, a systematic treatment can be indicated for a period of one year. In recent years, the treatment of melanomas that have spread extensively through the body has changed, as the newest forms of immunotherapy and targeted drugs have proven to be more effective than chemotherapy.
A complete physical examination must be conducted, including a general examination of the skin. The purpose of these tests is to identify risk factors and signs or symptoms that may indicate that the melanoma has spread beyond the original site. For most low-risk melanomas, less than 1 mm thick, it is generally unnecessary to carry out an additional search for metastasis or spreading.
In the case of people with high-risk melanoma, more exhaustive tests may be considered, including the following:
- Limiting exposure to ultraviolet rays.
- Avoid tanning booths.
- Protect children from the sun, to avoid sunburn.
- Pay attention to unusual freckles when examining your skin. If in doubt, it is always a good idea to make an appointment with a dermatologist, for a thorough check up.
Oral mucositis is the redness or a burning sensation produced by chemotherapy and radiotherapy. It consists of inflammation of the digestive mucous membrane, frequently in mucous membrane in the oral cavity, and may lead to an ulcer, causing pain and/or difficulty eating as well as affecting the quality of life and the patient’s ability to continue with treatment.
Good prevention and early detection are fundamental to avoid complications. To reduce the symptoms of mucositis it is important to follow the following advice:
If you notice ulcers in your mouth or any other change (redness, burning sensation, white spots, etc.) that cause pain or stop you from eating properly, consult your nurse and/or day hospital.
If you have a fever which develops call the immediate care line or go to A&E.
Sarcomas are an uncommon type of cancer that account for only 1-2% of all tumours in adults. They also represent a complex entity, given that there are more than 70 types, with differences in terms of their diagnosis, prognosis and treatment. Accordingly, sarcoma patients need to be assessed by multidisciplinary committees with vast experience in this disease.
Sarcomas are a set of rare tumours whose origin lies in the soft tissues of the body or the bones.
Soft tissues include muscles, nerves, vessels and fat. These tissues may also form part of organs.
The infrequency of sarcomas makes it necessary to handle clinical cases and their treatment on an individual basis, which generally involves a decision-making process that is shared by several professionals with expertise in this disease and the patients themselves.
The correct diagnosis of a sarcoma and its specific type is the first critical step to be taken, as it will form the basis of the clinical handling of the patient, as well as the precise information about the nature of their disease.
In contrast to many cancers, sarcomas do not usually generate symptoms in their early stages of growth. This is because they develop in areas of the body in which they can progressively grow by pushing against structures and organs.
The first symptom may be a painless lump. The majority of lumps are benign, but if it grows quickly, hurts, is deep and/or measures more than 5 centimetres, it is more likely to be a sarcoma. Sometimes the symptoms may appear as a result of excessive compression of the body’s various tissues and organs.
There is no clear factor that triggers a sarcoma. Certain inherited genetic syndromes may predispose a person to being more likely to develop a type of sarcoma, such as Li–Fraumeni syndrome, neurofibromatosis or familial adenomatous polyposis.
One of the most important steps is to confirm the clinical suspicion of sarcoma and identify its specific type. This requires a biopsy to obtain a fragment of the tumour so it can be studied by Pathological Anatomy.
It is sometimes diagnosed with molecular techniques in association with radiological tests like x-rays, computed tomography (CT), magnetic resonance imaging (MRI) or PET-CT.
The treatment of all sarcoma patients is always agreed by multidisciplinary committees composed of professionals with expertise in sarcomas from a variety of the services of our centre: Medical Oncology, Radiation Oncology, Traumatology, General Surgery, Radiology and Pathological Anatomy.
Given that sarcomas may arise in any part of the body, occasionally other specialists may also participate.
The treatment of sarcoma patients may include:
The most suitable procedure depends on a number of different factors in addition to the specific type of sarcoma. Targeted therapy and immunotherapy play a very important role in certain types of sarcoma. Finally, there are also clinical trials that experiment with new therapies.
The commonest are radiological tests like those described above (x-ray, CT, MRI and PET-CT).
As there is no specific cause of sarcomas, in the majority of cases there are no specific measures that can be taken beyond the usual healthy living habits recommended by the World Health Organization.
Patients with inherited genetic syndromes, however, are advised to undergo monitoring in specialist units.
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