Controversial issues on melanoma

Molecular Profile of Skin Cancer

Neoplasia occurs as a result of genetic mutations. Research evaluating the association between gene mutations and skin cancer is limited and has produced inconsistent results. There are no established guidelines for screening skin cancer at molecular level. It should also be noted that the combinations of some mutations may play a role in skin tumors’ biology and immune response. There are three major types of skin cancer, and the originality of this study comes from its approach of each of them.

Psychological Impact of Melanoma, How to Detect, Support and Help

Incidence of melanoma is increasing every year. A few years ago, we could not speak about long term survivors with melanoma. Chemotherapy did not give a good effect in the past. Metastasis occurred very rapidly, and the progression of melanoma was very fast. But now, with new forms of therapy, especially immunotherapy and target therapy, for the first time, we have long-time survivors. For the prognosis of melanoma, the most important is the stage in which melanoma is detected. For all dermatologists, it is very important to be aware of the psychological impact of melanoma on patients. Dermatologists should recognise psychological disorders. Several different scales can be used for the detection of depression and anxiety – some of them are completed by researchers, some of them are completed by patients, and also, we have combined scales. The need for adequate social and family support as well as psychological help to achieve better coping with illness is necessary. Learning techniques to overcome fear and stress would help in better functioning of all affected, regardless of the stage of the disease. The most severe cases of anxiety and depression, in addition to psychotherapeutic interventions, should also be considered medication therapy.

Malignant melanoma in organ transplant recipients: incidence, outcomes, and management strategies: a review of literature

Malignant melanoma is considered to be an immunogenic tumor, which is expected to change its behaviour in the field of immunosuppression. Although the incidence of melanoma in organ transplant recipients is increased to a smaller degree than in non-melanoma skin cancer, its potential morbidity and mortality has to be considered in the posttransplant care. The aim of this review is to investigate the relationship between melanoma and immunosuppression and to discuss management strategies for different melanoma scenarios in pre-transplant as well as posttransplant period.

Brazilian consensus on photoprotection

Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of non-melanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection.

Wrong melanoma thickness measurement: check it or leave it?

Cutaneous malignant melanoma (CMM) is one of the most aggressive forms of skin cancer, accounting for about 90% of deaths from cutaneous neoplasms, and its incidence has increased significantly in recent years. According to the 2012 European criteria for diagnosis and treatment of malignant melanoma, diagnosis should be based on the combination of clinical features, dermoscopic data and histological examination, preferably after excisional biopsy. Tumour thickness and other parameters for local staging according to the AJCC classification should be included in the pathology report. Although many factors influence the prognosis and course of the disease, it has been established in a number of studies that tumour thickness is the most important parameter. Therapy of malignant melanoma in its initial stages mostly consists of wide local excision with 1 to 2 cm margins, and sentinel lymph node biopsy that is usually performed in cases of tumours with a thickness greater than 1 mm. We present the case of a 58-year-old Bulgarian male with cutaneous superficial spreading malignant melanoma, in which, after complete excision, histological examination established an inaccurate tumour thickness (0.7 mm), with consequent inadequate staging and further management. After reassessment of the results in another institution (as well as their confirmation by two additional independent histopathology laboratories in our country – 1.92 mm), in the National Oncological Hospital where the patient was initially evaluated, sentinel lymph node biopsy was not performed, contrary to the generally accepted European and World standards. With the present case we raise some current issues regarding diagnosis and therapy of Bulgarian patients (not only in the case presented) with malignant melanoma in the 21st century, and discuss the urgent need for external quality control procedures and standardization of the histopathologic reporting, which is of paramount importance in the staging and subsequent management of these patients.