Skin tumors: mapping and monitoring of moles

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We all have at least one on the body, they are of various sizes, usually dark in color: they are the moles, also called nevi, those ugly spots on the skin that need a periodic check because there is the risk that they may become particularly aggressive skin tumors, such as melanoma.

Cutaneous melanoma is a tumor that derives from the tumor transformation of melanocytes, some of the cells that form the skin, and it affects above all around 45-50 years, even if the average age at diagnosis has been lowered in the last decades.

In Italy the data AIRTUM (Italian Association of Cancer Registries) speak of about 13 cases per 100,000 people, with an estimate that is around 3,150 new cases every year among men and 2,850 among women. Furthermore, the incidence is constantly growing and has even doubled in the last 10 years. It should be remembered that cutaneous melanoma represents only a small percentage (about 5%) of all the tumors affecting the skin.

From the clinical point of view, 4 types of cutaneous melanoma are distinguished: superficial spreading melanoma (the most common, represents about 70% of all cutaneous melanomas), malignant lentigo melanoma, acral lentiginous melanoma and nodular melanoma (the most aggressive, it represents about 10-15% of cutaneous melanomas).

Unlike the first three types, which initially have a superficial growth, nodular melanoma is more aggressive and invades the tissue in depth since its early stages.

The cutaneous melanomas originate on an intact skin or from pre-existing nevi, which are present from birth or early infancy (congenital) or appear during the course of life (acquired). (Source AIRC)

It is therefore very important, during the course of life, to undergo periodic controls of the moles to reduce the risk of developing skin cancers.

Why can the mole be transformed into melanoma? What should be paid attention to? What are the screening exams and how often should they be performed? Who are the most at risk subjects?

We asked it to Dr. Stefano Veglio Specialist in Dermatology at Aosta and Dubai.

Dr. Stefano Veglio

Dr. Veglio, what are the nei? Can you explain what the skin is made of and what is the role of melanocytes?

"Moles are made up of an aggregation of particular melanocytes, cells that produce melanin. They are positioned between the two most superficial layers of the skin, epidermis and dermis, which are fundamental for protecting and structuring our precious coating, respectively. These cells are used to produce the pigment that protects us from the harmful effects of ultraviolet rays. The reason why they aggregate to form that spots is completely unknown ".

There are various kind of moles and over time the medicine has typified and classified them because a form of aggressive tumor can emerge from them: cutaneous melanoma. What are the causes?

"As with most tumors, the causes remain unknown, but genetic predisposition still play an important role and we must take into account the number of burns suffered at an early age". What are the characteristics of the mole not to be overlooked? Is there a type of mole that is more likely to become a tumor?

What are the characteristics of the mole not to be overlooked? Is there a type of mole that is more likely to become a tumor?

"It’s very important to see a change in a mole or the appearance of a new mole after the age of 25. It is not easy to define exactly what kind of feature a malignant mole could have, but surely a modification of a pre-existing lesion or a newly created mole must raise a suspicion. Certainly flat nevi and those already present at birth are more at risk ". The images represent melanomas, can you explain them?"

The images represent melanomas, can you explain them?

"The images are actually classical examples of melanoma: flat moles, slightly irregular in the edges and with a non-homogeneous color. I chose these photos because sometimes this types are actually underestimated by patients, more attracted instead by protruding lesions palpable to the touch. Being able to diagnose a melanoma in this phase allows in many cases to save the patient's life: the flat melanoma is generally thinner, while when this tumor begins to thicken, very often it expands even deep, with very high risk of metastasis to the interior organs".

It is not the site, but the kind of mole that makes the difference. Is that so?

"It is correct, but we must not forget that those the on hands and feet are more at risk of developing more aggressive tumors. Many times patients are worried about nevi in the folds or in areas of rubbing, but these aspects are generally not very important. It is not in fact the traumatism that transforms a mole from benign into malignant: it is necessary to observe the modifications of a mole in color, shape and size ".

Can the aesthetic ugliness of a mole be an alarm factor?

"Absolutely not. Most people worry about what it’s ugly but those lesions are in fact usually less dangerous. Obviously an ignored and neglected melanoma gives rise to a lesion that is certainly ugly to see ".

Let's talk about prevention. The mole itself is harmless, but it can become a tumor. The presence of naevi is not an alarm, but you must still pay attention. How is prevention possible?

"It is advisable to undergo a dermatological examination once a year, with more frequent checks in case of new or growing moles. For people with many nevi it can be indicated the so-called "mapping", a photograph of all areas of the body useful to understand if any mole changes or appears "ex-novo". It is a completely painless procedure, very useful in selected cases. It could also be easy to take pictures with the help of a family member or a friend: to print and archive it can be used for simple self-managed checks that are useful to understand if something had changed compared to the past ".

It is important to always contact the dermatologist, but self-control is equally important. There is the acronym ABCDE, what does it consist of?

It refers to the characteristics of a new suspect:

A: Asymmetry of the lesion

B: often jagged or irregular edges

C: Irregular color or black color

D: great Dimension of the mole

E: Evolution, or changes in the time of the lesion.

It must be remembered that all these characteristics are hardly present in melanoma at the same time: if you just notice one, it is necessary to perform a dermatological check. The conclusive opinion on the benignity of the mole obviously belongs to the specialist, also using a fundamental system of investigation, dermatoscopy, a lens that allows to see the mole in its deepest aspects and which provides diagnostic tools now considered indispensable for the diagnosis of melanoma ".

We all have to regularly undergo the supervision of the moles, at what age is the first consultation recommended? And who are the most at risk? Is there a genetic predisposition?

We all have to regularly undergo the supervision of the moles, at what age is the first consultation recommended? And who are the most at risk? Is there a genetic predisposition? "We generally recommend first checks after adolescence. People with light skin are certainly more at risk, especially if they have suffered burns at an early age, and those with relatives affected by melanoma. Genetics is an aspect not to be underestimated: with new systems it’s now possible to investigate the personal genetic predisposition to many types of cancer, including melanoma: it will probably become a fundamental instrument of prevention in the coming years ".

Another important preventive factor is moderate sun exposure ...

"Sunlight, as we know, increase our wellbeing and helps to calcify the bones: it is anyway necessary to avoid burns and inconsiderate exposures, especially in the first 20 years of life. The nation that has the highest incidence of melanoma in the world is Australia, populated by people with fair skin who have been exposed to heavy solar radiation in a tropical climate certainly unsuitable for their complexion. For the rest we must remember that the sun is responsible more heavily for the development of other kind of skin tumors, such as cutaneous carcinomas ".

According to an old cliché "Don’t touch a mole", instead today it is often recommended to remove a mole considered at risk. Is the surgical technique the most suitable?

"Sure. Surgically removing a mole with scalpels and sutures does not expose you to any risk of tumor proliferation. Lasers, although now highly evoluted, do not absolutely guarantee complete removal of the mole and expose the patient to recurrence of the lesion. That can be a great problem, not only for aesthetics but also because it’s a source of concern about the nature of the growing back".

Prevention and monitoring, these are the main actions to avoid risks to our health. Each of us has at least one mole on our body and those visible on the face could be a discomfort for someone of us. This is not true for the famous presenter of Rai Uno Bruno Vespa who seems to have a total of 25, as jokingly stated in an interview, adding that every year he undergoes the mapping of his face to photograph those speckles, ugly for many of us but not for everyone!

Article by Nicoletta Mele published on Health online. 

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