Melanoma

UV light is thought of to be the main trigger for melanoma. The majority of patients have been exposed to either natural or artificial UV light over many years or suffered repeatedly from sunburn, particularly in childhood. The probability of contracting this form of cancer is higher for those with pale skin or a genetic disposition making them more susceptible to skin cancer.

Other factors which may contribute towards malignant melanoma are:
- acquired or congenital pigmented lesions such as liver spots or moles
- genetic mutations
- previous occurrence of melanoma


 

Melanoma is not painful at first. However, some symptoms may become apparent if metastasis has already occurred. These vary greatly, depending on where the metastases are located. Warning signs for melanoma include the following:
- Appearance of a new mole (or liver spot).
- Changes in size or colour of an existing mole
- The mole has an irregular shape or ragged, uneven edges.
- The mole itches or bleeds.
- The skin surrounding the mole is red or swollen.
- A mole which looks different to all others on the body could also be melanoma.

There are several different varieties of melanoma:

Nodular melanoma
This is the most aggressive type of melanoma. It often occurs on the chest, back or extremities. It develops within a matter of months into a knotty, raised tumour which often bleeds, varies in colour from blue to dark brown and grows rapidly down into the deeper layers of the skin.

Superficial spreading melanoma
This is the most widespread type of melanoma, and tends to develop on the chest, back or extremities over a period of one to four years. It causes flat, sometimes knotty, pink, brown, grey or bluish-black growths on the skin, which often stand out clearly from surrounding healthy skin. Rarely, they may be white.

Lentigo maligna melanoma
These melanomas develop slowly over several years or even decades from an early stage of skin cancer known as lentigo maligna. The cancer appears predominantly on areas of the skin exposed to sunlight such as the neck, face, hands and arms. The melanomas are white, pale grey or pale brown in colour and most commonly affect older people.

Acral lentiginous melanoma
This is the least common type of melanoma. The symptoms are typically irregular patches of skin of different colours appearing on the palms of the hand, the soles of the feet, or around the fingertips or the tips of the toes. However, it can also occur under nails and be mistaken for a wart, nail fungus or nail injury.

Mucosal melanoma
This type of melanoma is very rare and is located on the mucous membranes in the genital region, mouth nose or nasal sinuses. Usually, no symptoms appear before a diagnosis is made. Some people, however, may experience itching and bleeding (for example nose bleeds).

Amelanotic melanoma
In this instance, the skin stops producing pigment. As a result, the melanoma are often only discovered once they have reached an advanced stage. They also vary greatly in appearance, making them even more difficult to diagnose.

The Skin Cancer Centre at Universitätsklinikum Erlangen collaborates with the interdisciplinary German Centre for Immunotherapy to treat patients with malignant growths on their skin. We collaborate with our regional and national cooperation partners to provide a central point of contact and to ensure that you get the best and most comprehensive diagnosis and therapy possible. You can rest assured that you will be well taken care of, from your initial examination and diagnosis, through treatment and on to after care.

The first step with melanoma usually involves surgically removing the tumour. If the operation is not successful or the disease has already progressed to a more advanced stage, it might be necessary to turn to radiation therapy or use medication. In interdisciplinary collaboration with specialists from the Department of Dermatology, the Department of Oncology and other departments associated with the DZI, we can offer many different options for treatment.

If surgery alone is not enough or not possible, or if the melanoma has already metastasised, we have various types of medication at our disposal. These include targeted treatments, immunotherapy and chemotherapy.

Targeted treatment
Targeted treatment for melanoma focuses on the specific properties of cancer cells that allow uncontrolled cell division. A gene mutation which permanently activates the signal chain involved in the survival and normal growth of cells within the body causes cell division to career out of control. This specific mutation can be found in approximately 50% of melanoma. Inhibitors can be used to hinder the mutated protein in the signal chain, thereby causing tumour cells to die.
 

Immunotherapy
Immunotherapy has significantly improved the prognosis for melanoma in recent years and is effective irrespective of whether or not the tumours have certain gene mutations. Immunotherapy uses various substances that activate the body’s own immune cells to destroy mutated cells.

One possible course of immunotherapy treatment involves activating the body’s own immune cells to block what is known as a checkpoint for receptor molecules on immune cells. This reactivates the immune system, allowing it to recognise and eliminate cancer cells.  In addition, patients may also be able to participate in clinical studies investigating other potential treatment methods focusing on, for example, dendritic cells and T-cells specific to melanoma, and suitable for patients with particular types of melanoma.

Chemotherapy
During chemotherapy, patients are treated using cytostatic drugs. These are aimed at damaging tumour cells. However, they are only usually used when other options of treating the cancer using drugs have been unsuccessful.

Do you have any questions on the treatment of melanoma? Please feel free to get in touch with us by phone, e-mail or via our contact form.