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Cutaneous Metastatic Melanoma

Cutaneous Metastatic Melanoma

Introduction

Definition and characteristics

Cutaneous metastatic melanoma is a type of melanoma distinguished by the migration of melanoma cancer cells from their point of origin to the skin. Infamous for its belligerent attributes and its tendency to metastasize, it prominently features melanoma cells in the skin, often appearing as nodules or growths. The transmission of these malignant cells to the skin often occurs via the lymphatic system or the bloodstream. The emergence of cutaneous metastatic melanoma usually signals poor prognosis and frequently represents a sign of advanced disease progression.

Prevalence and risk factors

A severe skin cancer type known as cutaneous metastatic melanoma shows a high global incidence. Multiple risk factors predispose to this aggressive cancer, including frequent sun exposure, lighter skin types, familial melanoma history, and specific genetic alterations. Its incidence has displayed a consistent rise over time, marking it as an emerging public health issue. Hence, comprehension of the risk factors prevalent in this disease is pivotal for its early diagnosis and mitigation efforts.

Stages and progression

As a form of skin cancer, cutaneous metastatic melanoma possesses the potential to metastasize to distant body areas. The stage of the disease and its rate of progression have significant implications on the treatment plan and the overall prognosis. The disease stages span from stage 0 (in situ) to stage IV (metastatic), and as the disease advances, it may invade lymph nodes, other organs, or even other skin areas. Variables such as tumour thickness, ulceration and the presence of cancer cells in the lymph nodes can influence the disease's stage and prognosis. Thus, grasping the progression stages of cutaneous metastatic melanoma is crucial for precise diagnosis, treatment strategizing, and the long-term disease management.

Diagnosis and Detection

Clinical presentation and symptoms

Patients afflicted with cutaneous metastatic melanoma usually exhibit identifiable symptoms which often start with the emergence of new skin lesions or changes to pre-existing moles. The lesions may not always conform to a regular shape, and uneven borders are common characteristics. Their color could range widely and might usually be larger than their nearby moles. Sometimes, these may secrete blood or cause itchiness. In addition to this, the patient can also detect enlargement of nearby lymph nodes and develop systemic symptoms, like weight loss or fatigue. Understanding these clinical warnings plays a pivotal role in the early detection and diagnosis of cutaneous metastatic melanoma, facilitating timely treatment.

Dermoscopy and imaging techniques

The role of dermoscopy and other imaging techniques cannot be overstated in diagnosing cutaneous metastatic melanoma. Dermoscopy, alternatively called dermatoscopy or incident light microscopy, is a non-invasive strategy for studying skin lesions under magnification, aiding the identification of specific features of melanoma like irregular, asymmetrical borders and diverse pigment patterns. Moreover, the use of imaging techniques such as ultrasound, CT, and MRI supplements the diagnosis by detecting deeper and larger tumors, and assessing lymph node involvement. All these provide essential data for clinicians at the juncture of decision-making regarding future management, significantly enhancing the prognosis by facilitating early detection.

cutaneous metastatic melanoma

Biopsy and histopathological examination

Biopsy and histopathological examination remain critical practices in detecting and tracking the progress of cutaneous metastatic melanoma. Biopsy mainly involves extraction of a tissue sample for microscopic scrutiny, which facilitates a thorough assessment of malignant cells. During a histopathological examination, this tissue sample is analyzed to identify essential aspects like the tumor's thickness, presence of ulceration, and the extent of cancer invasion. This critical data provides valuable insights into the diagnosis, staging, and treatment planning and enhances the capacity of healthcare experts to make pertinent decisions regarding appropriate treatments, such as surgical interventions or systemic therapies. Such processes also assist in prognostic predictions and help decide the requirement for further surveillance and follow-up.

Treatment Options

Surgical interventions

In the surgical treatment of cutaneous metastatic melanoma, a range of approaches exist. The most frequently adopted is wide local excision, a process that entails removal of the primary tumor and a surrounding area of healthy tissue. It might become necessary to perform a sentinel lymph node biopsy to establish whether the cancer has infiltrated neighboring lymph nodes. If these lymph nodes are compromised, a thorough lymph node dissection could be required. Moreover, strategies such as isolated limb perfusion or isolated limb infusion may be utilized for melanomas that have metastasized to a limb, given that these treatments allow the delivery of high-dosed chemotherapy straight to the infected limb with aim of neutralizing the cancer cells. The decision of the surgical procedure leans on the melanoma's extent and location.

Systemic therapy

Systemic therapeutics for cutaneous metastatic melanoma employs drugs spread throughout the body to target cancer cells. These drugs, taken orally or intravenously, are purpose-built to inhibit the propagation of cancer cells. Existing systemic therapy options encompass chemotherapy, targeted treatment, and immunotherapy. Chemotherapy drugs function by eradicating rapidly multiplying cells, inclusive of cancer cells. Alternately, targeted therapy drugs center upon the genetic anomalies and proteins propelling the melanoma cells' growth. Immunotherapy drugs empower the body's natural immune system to detect and eradicate cancer cells. The potential benefits of these treatments have been encouraging, raising survival rates and quality of life for individuals confronted with advanced melanoma. Albeit, systemic therapy requires a consideration of various factors including the patient's health, the tumor's characteristics, and specific genetic mutations. A team approach is usually adopted to select the appropriate systemic treatment for each patient.

Immunotherapy and targeted therapy

Immunotherapy and targeted therapy stand out as appealing options in the fight against cutaneous metastatic melanoma. Immunotherapy marshals the immune system to battle the cancer cells, whereas targeted therapy applies drugs that pinpoint the abnormalities in the cells. The developed therapies have demonstrated significant clinical utility, enhancing response rates and overall survival of metastatic melanoma patients. Immunotherapy, by using immune checkpoint inhibitors such as anti-PD-1 antibodies, has shown significant effectiveness; it enables the immune system to identify and eliminate cancer cells. Targeted therapy aims to inhibit unique molecular targets in cancer cells, such as BRAF mutations. These therapies have reshaped the treatment landscape for cutaneous metastatic melanoma, providing renewed hope for patients who previously had limited options. There is ongoing research to develop new combination treatments and beat resistance mechanisms, aimed at further benefiting patients with this severe disease.

Bibliography

  1. Arnold, M., Singh, D., Laversanne, M., & Vignat..., J. (2022). Global burden of cutaneous melanoma in 2020 and projections to 2040. JAMA (https://jamanetwork.com/journals/jamadermatology/fullarticle/2790344)

  2. Saginala, K., Barsouk, A., Aluru, J. S., Rawla, P., & Barsouk, A. (2021). Epidemiology of melanoma. Medical sciences. (https://www.mdpi.com/2076-3271/9/4/63/pdf)

  3. Long, G. V., Swetter, S. M., Menzies, A. M., & Gershenwald..., J. E. (2023). Cutaneous melanoma. The Lancet. (https://melanoma.org.au/wp-content/uploads/2023/07/Long-GV-et-al.-Lancet_July-2023.pdf)

  4. Burns, D., George, J., Aucoin, D., Bower, J., & Burrell..., S. (2019). The pathogenesis and clinical management of cutaneous melanoma: an evidence-based review. ... of Medical Imaging and ...(https://www.sciencedirect.com/science/article/pii/S1939865418302261)

  5. Long, G. V., Swetter, S. M., Menzies, A. M., & Gershenwald..., J. E. (2023). Cutaneous melanoma. The Lancet. (https://melanoma.org.au/wp-content/uploads/2023/07/Long-GV-et-al.-Lancet_July-2023.pdf)

  6. Lam, G. T., Prabhakaran, S., Sorvina, A., & Martini..., C. (2023). Pitfalls in Cutaneous Melanoma Diagnosis and the Need for New Reliable Markers. Molecular Diagnosis & ...(https://www.newswise.com/pdf_docs/167531304537497_Pitfalls%20in%20melanoma%20diagnosis.pdf)

  7. Joyce, D. & Skitzki, J. J. (2020). Surgical management of primary cutaneous melanoma. Surgical Clinics. (https://www.surgical.theclinics.com/article/S0039-6109(19)30119-7/abstract)

  8. Mason, R., Au, L., & Ingles Garces..., A. (2019). Current and emerging systemic therapies for cutaneous metastatic melanoma. Expert Opinion on ...(https://www.researchgate.net/profile/Lewis-Au/publication/332685757_Current_and_emerging_systemic_therapies_for_cutaneous_metastatic_melanoma/links/5cd2d615299bf14d957f170a/Current-and-emerging-systemic-therapies-for-cutaneous-metastatic-melanoma.pdf)

  9. NATHAN, P. (2020). Cutaneous melanoma--a review of systemic therapies. Acta dermato-venereologica. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9189748/)

  10. Ralli, M., Botticelli, A., Visconti, I. C., & Angeletti..., D. (2020). Immunotherapy in the treatment of metastatic melanoma: current knowledge and future directions. Journal of immunology ...(https://www.hindawi.com/journals/jir/2020/9235638/)