Metastatic melanoma

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.

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."

Epidemiology

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: the lungs (about 36%), the liver (about a third of cases, sometimes called the first target organ), the brain — one fifth of cases of secondary melanomas; bone tissue - up to 17%; digestive tract - no more than 9%.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Causes of the 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 disruption 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.

[10], [11], [12], [13], [14], [15]

At what stage does melanoma give metastases?

Clinicians identify five main stages of melanoma (0-IV), in addition, intermediate stages are identified, taking into account the thickness, the rate of cell division in the lesion, the presence of ulcerations and different 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 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.

[16], [17], [18]

Symptoms of the 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 marked increase in the size of the mole in the plane of the skin (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; over time, the surface darkens, becomes glossy, easily damaged, bleeds, ulcerates; the horizontal phase can last from several months to seven or eight years (it is more prognostically favorable); after the beginning of the vertical phase, the tumor begins to grow upwards and inwards, rapid metastasis occurs;
• nodular (nodular) melanoma immediately grows vertically (there is no phase of horizontal growth) - dome-shaped rises above the skin, has a different, often uneven, pigmentation (sometimes depigmented), clear boundaries and a circle or oval shape, smooth shiny easily injured surface; sometimes looks like a leg polyp; 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 the appearance of 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.

[19], [20], [21], [22], [23]

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 impaired. 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 scapular bones. 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, much more often there are secondary formations.

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, may 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.

Complications and consequences

Melanoma metastases are almost always multiple, which makes it very difficult to fight them. In addition, the metastasis stage comes at a time when the body no longer has the strength to resist. Secondary tumors disrupt the functioning of all vital organs and lead to the death of patients.

After removal of melanoma, even in a successful initial stage in the absence of detectable metastases, there is no guarantee that the tumor will not relapse. Up to 90% of such events occur in the first two years after treatment, but it is recommended to undergo periodic examinations by a dermato-oncologist, since there are cases when the disease manifests itself through a long-term relapse-free period.

Metastatic melanoma of the skin is in itself a complicated form. In addition, the usual postoperative complications are possible - suppuration, infection, not relieved pain, localized in the places of incisions.

Of great importance in the forecast is such an indicator as the mitotic index, which reflects the ability of cells to divide. A high mitotic index indicates intense cell division, and given that it is cancer, the lentigo-melanoma with a high metastatic index (apparently mitotic) has a greater likelihood of metastasis.

[24], [25], [26], [27], [28], [29], [30], [31]

Diagnostics of the metastatic melanoma

The earliest diagnostic event is an external examination of the patient, palpation of the lymph nodes and dermatoscopy, especially in a special immersion environment, which allows a good view of the horny layer of the epidermis and sufficiently accurate determination of whether a doubtful birthmark represents a danger. To do this, its parameters (shape, size, borders, uneven chromaticity, the presence of blue-white structures) are analyzed using the ABCDE rule. There is also a computer program that allows you to compare photos of a dubious mole with those available in the database, but such diagnostics have not yet received widespread use. In the presence of a suspicious nevus, in addition to a thorough examination of the skin and visible mucous membranes of the patient, a chest x-ray is done in two projections (front and side), as well as an ultrasound examination of the lymph nodes, organs of the peritoneum and the pelvis.

Invasive research methods (biopsy) directly primary education for melanoma are not allowed. A cytological analysis of the smear from the surface of the formation can be performed.

The final conclusion about the stage and morphology of the formation is made after a histological study of a remote mole, the exact depth of its germination and the mitotic index are determined.

But for the detection of micrometastases in sentinel lymph nodes that have not yet been enlarged, the method of ultrasound-guided aspiration fine-needle biopsy is being used more and more widely, making it possible to refuse traumatic prophylactic lymph node dissection.

Biopsy is used in some localizations of metastases, for example, in the lungs.

Before the operation, standard clinical tests are made to the patient, allowing him to assess his state of health.

At the clinic, indicating the presence of metastases in the liver, make liver function tests, assess the level of lactic dehydrogenase (LDH).

Melanoma metastases are usually multiple. For their search, modern instrumental diagnostics is used - radiation (radiography, computed tomography), mangitoresonance tomography, ultrasound, fibrogastroscopy, scintigraphy.

[32], [33], [34], [35], [36]

Differential diagnosis

Differential diagnostics is carried out with melano-dangerous and benign nevi, according to the stages of the disease, the presence of single or multiple metastases. This is of great importance for choosing the tactics of providing the most effective assistance.

In the initial stages, as well as in case of solitary and single metastatic tumors, surgical treatment is fundamental, even in the presence of micrometastases, in combination with drug therapy.

Disseminated melanoma of the skin is highlighted, for which surgical treatment is no longer relevant, but palliative drug therapy is carried out.

Secondary tumors differentiate from other neoplasms, often benign, for example, lipoma or metastasis of melanoma to the subcutaneous fatty tissue, melanotic schwannoma gasserova of the brain node or metastatic melanoma of the base of the middle cranial fossa. Heart metastases are distinguished from the clinical consequences of chemotherapy and radiation exposure.

[37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48]

Prevention

Any disease is easier to prevent than to cure. Melanoma in general is still incurable at late stages, so early and correct diagnosis is the main prevention of disease progress and the appearance of metastases, when the prognosis for survival is already less optimistic.

Experts recommend removing any mole that bothers you, even the most innocuous, not in beauty salons, but in specialized medical institutions, while using removal methods that make it possible to conduct a subsequent histological examination of the removed tissues.

Preventing the formation of melanoma is the correct behavior in the sun - preventing sunburn, burning red. Sunbathing should be early in the morning or after 4 pm, when the sun's rays are not so aggressive. The time spent in the sun is also worth limiting.

In the presence of moles on the body, you should try to protect them from the sun's rays, wear wide-brimmed hats, light, light, natural, but closed, clothes on sunny days, use quality sunglasses and light-cream creams with a minimum SPF15.

In the light of new research, it is better to refuse to visit tanning beds altogether, since artificial ultraviolet, even obtained from the most modern and safe sources and observing the recommended time intervals, is not completely harmless to the skin.

People at risk should be doubly careful.

Food should be full, antitumor properties have many products - fresh carrots, parsley, tomatoes, pumpkin. Coffee lovers are less likely to get skin cancer, the Boston researchers concluded. It is useful to eat foods containing selenium (meat and offal, mushrooms, onions, garlic, black bread, Brazil nuts) and vitamin E (vegetable oils, sunflower seeds and most nuts, peas, beans, cabbage, eggs).

After removal of melanoma in the early stages, people are recommended to undergo a course of treatment with herbal remedies that have cytostatic activity and prevent the spread of metastatic lesions. This is the chaga birch mushroom, gay, herbs - golden root, celandine, common thistle, mistletoe, Siberian liana (prince) and others. Homeopathic treatment after surgery can also bring tangible benefits and prevent relapses.

[49], [50], [51], [52], [53], [54], [55], [56], [57], [58]

Forecast

If we talk about metastatic melanoma with distant metastases, then patients with such a diagnosis have a high risk of death in the first five years after diagnosis. It is estimated at more than 80%. However, still not 100%!

How long do people live with stage IV melanoma? The data is disappointing: with all the efforts of physicians, even patients from research groups, on average, do not live a year. Although there are various cases, perhaps even a complete cure, so you should not give up.

Slightly higher is the five-year survival rate in the group of patients with an easier stage of melanoma. In stage III of the disease with metastatic tumors in regional lymph nodes, as well as in patients with vertical spread of melanoma to a depth of more than 4 mm (II stage b and c) after radical treatment, the likelihood of relapse is estimated at 50-80%.

[59], [60], [61], [62], [63]