Generality
The malignant lesions are pigmented lesions that can degenerate and give rise to a skin tumor, such as melanoma .
These formations can arise on healthy skin, such as "ex novo" formations, or they originate from already existing or recently appeared lesions, which evolve in a neoplastic sense.
Compared to the benign ones, the malignant moles have some characteristics that make them " atypical " both to the naked eye and to the dermatoscopic examination.
To identify these lesions as soon as possible, it is necessary to pay attention to any changes in shape (the malignant moles are often asymmetric, with jagged margins and / or incisure) and appearance (bleed, itch or appear discontinuous over time). The color of the malignant moles is not, then, uniform, but turns towards a dark pigmentation (very intense black) or appears with shades of red-brown, white, black or blue. Also an increase in width and thickness can indicate an evolution of the lesion in a neoplastic sense, especially if this alteration occurs in a rather short time.
Unfortunately, it is not always easy to realize these changes, so the correct practice to follow is to undergo periodic dermatological checks, to assess the presence of possible malignant ones. Prevention and early diagnosis are the most effective strategies to manage melanoma and other skin cancers that can result from the transformation of these pigmented lesions. Furthermore, this approach can significantly improve the chances of treatment.
In the Malignant: What are they
Malignant moles (or moles) are lesions of the skin and mucous membranes, deriving from an abnormal development of melanocytes or snow cells, which can degenerate into tumors.
In benign and malignant
There are numerous types of moles, which are classified according to their clinical and dermoscopic characteristics. In most cases, the nature of these pigmented lesions is benign . These forms of moles are harmless and remain the same throughout the life of an individual, unless the conditions - to date, still unknown - are able to induce phenomena of carcinogenesis and favor the transformation from benign form into malignant.
The main clinical significance of malignant moles, on the other hand, consists in their potential ability to transform and behave like skin tumors, particularly serious for their aggressiveness.
Causes
The malignant cells are caused by an abnormal cellular proliferation, which determines the accumulation of melanocytes (cells responsible for the production of melanin, a pigment that gives color to our skin) or snow cells (elements deriving from melanocytes). In a number of cases, this process begins with the transformation in a neoplastic sense of a pre-existing lesion; in another percentage, on the other hand, the malignant neo can already develop as such on the intact skin.
The reason why this proliferative process occurs is not yet fully known, but the onset of these new forms seems to depend in part on:
- Genetic factors;
- Immune status;
- Exposure to ultraviolet radiation;
- Certain pharmacological treatments.
Furthermore, some moles may become more prominent during adolescence and pregnancy, demonstrating a certain degree of hormonal sensitivity.
Risk factors
The main risk factor for malignant organisms is excessive exposure to ultraviolet radiation, which reaches us in the form of UVA and UVB, whose source is mainly represented by the sun's rays.
Some people also have an average higher basic risk of developing these lesions if they have one of the following factors:
- Familiarity : presence of a first or second degree relative who developed melanoma;
- Phototype : individuals with fair skin and light eyes (light blue or green), tendency to form freckles and burn themselves in the sun;
- Number of moles : more than 50 moles on the skin;
- Previous personal history of melanoma : patients who have already developed this cancer in the past.
Symptoms and Complications
The malignant moles present themselves with different clinical characteristics: the degree of pigmentation can be varied, as well as the size and shape. In general, these lesions appear as macules, papules or localized, partially raised or flat nodules.
Where they develop
The malignant ones appear mainly in the skin, but can also appear on mucous membranes (lips and oral cavity, external genitalia and perianal region), conjunctiva and sclera.
How to recognize the dangerous moles
The moles considered "at risk" do not necessarily give rise to melanoma or other skin tumors, but must be kept under observation; in any specific case, the dermatologist will determine whether it is appropriate or not to perform a surgical removal with histological examination or to schedule a new check-up after a few months.
To recognize malignant moles as soon as possible, it is important to pay attention to any changes:
- Shape : the "at risk" moles have an irregular and not symmetrical shape, with jagged edges or incisure. Compared to the skin surface, these formations can be flat or raised. Also a growth of the malignant moles in width (above all if the dimensions are superior to the 6 mm of diameter) and in thickness (for example, if a flat lesion becomes raised on the cutaneous plan) can indicate an evolution in malign sense, especially if such change occurs in a rather short time.
- Color : inside the same malignant neo, the color is not uniform, but turns towards a dark color (very intense black) or presents shades of red-brown, white, black or blue.
- Aspect : the first signs that can indicate the presence of a malignant mole are the ex-novo appearance of a lesion or the progressive and rapid alterations (in the order of weeks or months). The benign do not change, however, the size, shape or color from year to year; in fact, any changes in the appearance of these formations take place very slowly. Even the formations that change their consistency are suspect (they soften or harden, become rough and irregular on the surface or tend to "crumble") and are surrounded by a nodule or a reddened area.
- Number : the malignant moles can occur both individually and in groups of several lesions; their number is determined by genetic makeup, but can be influenced by other factors, such as sun exposure.
- Other alarm signals : to identify malignant organisms, attention should also be paid to the appearance of signs of inflammation in the surrounding skin, such as itching, excessive sensitivity, pain, bleeding, serum loss, scaling and ulceration.
In the malignant: which are the most at risk?
Males can be present from birth or early childhood (congenital) or appear during the course of life (acquired).
In pediatric age, the most endangered lesions are above all the very rare in congenital giants, which have a diameter greater than 20 cm. Among the lesions acquired during growth, on the other hand, the neoformations are more dangerous, which show alterations in appearance in a short time and present irregular characteristics as regards shape and color ( in the atypical ).
Other injuries at risk are those located in areas of the body subject to friction, rubbing or repeated trauma (eg razor and comb, shoes during walking, trousers etc.).
Possible consequences
The most serious evolution of malignant moles is skin cancer, including melanoma, caused by an uncontrolled proliferation of melanocytes.
This neoplastic disease is very aggressive, as it is able to spread both in depth and in extension, reaching lymph nodes and organs even very far from the point of origin, giving rise to metastases relatively quickly. If this tumor is identified and treated in the early stages of development, healing is possible.
Diagnosis
To assess the morphological characteristics and recognize any suspicious changes affecting pigmented skin lesions, it is advisable to periodically undergo a dermatological examination .
The dermatoscopic examination allows the monitoring of neoformations considered "anomalous", thanks to an adequate and differential photographic documentation, and allows to intervene in the event that a modification has occurred.
A lesion can be biopsied and histologically examined if it has the following suspicious features:
- Margins that change over time or very irregular;
- Color changes;
- Ache;
- Bleeding;
- Ulceration;
- Itch.
The biopsy sample must be deep enough for accurate microscopic diagnosis and, if possible, must include the entire lesion, especially in cases of high suspicion of malignancy. Imaging tests for images such as chest x-rays, computed tomography and magnetic resonance imaging are useful for defining whether and where the disease has spread.
In the malignant: rule of the ABCDE
In the interval between a dermatological check and the other, it is important to perform periodic self-examination of moles and other lesions present on the skin, considering above all the growth or changes in appearance and color, since they could indicate an evolution towards a malignant form.
During this self-assessment it is sufficient to remember the so-called ABCDE rule, which takes into account the major criteria that a lesion on the skin should have to make the patient suspect the presence of a melanoma and, consequently, induce him to consult a doctor:
- A as Asymmetry : if an imaginary line is drawn that passes through the center of a malignant neo, it is possible to notice a strong discrepancy between the dimensions of the two portions, therefore the lesion is formed by two different halves. In a benign neo, we note, instead, a uniform and symmetrical (or almost) growth.
- B as Borders : the irregular and jagged margins are an alarm bell. A benign lesion has definite and very regular edges; on the contrary, a malign neo has discontinuous and totally irregular margins.
- C as Color : the malignant moles are very dark or not homogeneous; furthermore, pigmentation variations may be present (shades of brown or black, red, white and blue); a benign neo has a uniform color, usually coffee, also very intense.
- D as Size : a malignant neo tends to increase in width and / or thickness and is suspect especially if the dimensions are greater than 6 mm in diameter.
- And as Evolution : in malignant forms, progressive modifications occur in the initial appearance of the neo (shape, size and color) in a short period of time (6-8 months).
Treatment
In malignant patients with atypical morphological characteristics in terms of color, shape and size can be monitored with periodic dermatological checks or removed with surgery under local anesthesia. If action is taken in time, the chances of recovery are excellent. In the opposite sense, that is if the malignant moles were to be recognized late, the possibilities diminished.
How can malignant organisms be treated?
Currently, several viable strategies are available for treating malignant moles. The main option is surgery, which often manages to free the pathology permanently, provided that action is taken promptly. Generally, we proceed by eliminating the malignant moles and the areas of dermis surrounding the lesion.
Radiotherapy is limited to those cases in which the tumor tissue has not been completely removed by surgery, therefore it has a mainly residual value. To treat the malignant, there are also different types of drugs for topical use, which stimulate a reaction of our body to expel and kill cancer cells.
Prevention
The prevention of malignant diseases is carried out by controlling the risk factors, undergoing periodic dermatological examinations to identify the tumor at an extremely early stage and surgically removing suspicious lesions.
The presence of the moles must not be alarming, but it must be borne in mind that they can become dangerous when modifications occur which require a timely evaluation by a specialist doctor.
The self-examination of the skin surface by the patient himself, performed with method and regularity between a dermatological control and the other, allows to monitor any changes in the appearance of the malignant.
To remember
- Never expose yourself to the sun without adequate protection on the skin: use sunscreens with a protection factor appropriate to your skin type (between 20 and 50+), effective against UVB and UVA rays and without sensitizing ingredients.
- Avoid exposure to the sun in the central hours of the day.
- Avoid or minimize the use of tanning lamps and tanning beds.
- Keep skin stains and moles under control, according to the ABCDE rule: Asymmetry, Irregular Edges, Variable Color, Size and Rapid Evolution.
- Carry out a dermatological examination on a regular basis: the clinical examination of the skin and the mapping allow the diagnosis of melanoma as early as possible, identifying the appearance of new ones in the malignant ones or the change of those already existing.
