Abstract
The authors summarize the view on the epidemiology, prevention and diagnosis of melanoma. The thesis presents data related to the USA, so let me compare the published data with the situation in the Czech Republic.
The authors speak very aptly of two "clinical extremes", ie primary thin melanoma, whose prognosis is very good, and on the other hand, metastatic melanoma with a very poor prognosis. Not only the lay but also the professional public is still little aware of this fact - the diagnosis of melanoma is considered fatal.
The authors rightly point out the fact that not only the skin, but also other organs derived from the neural crest may be the seat of melanoma. Not only for this fact, but also for the necessity of cooperation of dermatologists, pathologists, surgeons, oncologists, etc. in the diagnosis and treatment of patients with melanoma, this tumor is an example of the necessity of interdisciplinary cooperation.
In the United States, melanoma is reported to be the fifth most common tumor in men and the sixth most common tumor in women with an incidence of 18.3 per 100,000 and a mortality of 2.7 per 100,000. At the same time, in 2002 the USA was in the fourth place in the incidence of melanoma in men, the Czech Republic in the ninth place.
In women, the incidence of melanoma in the USA was in 11th place and in the Czech Republic in 15th place in the world. This ranking has long been led by Australia and New Zealand, followed by the Nordic countries (Sweden, Norway, etc.).
The incidence in the Czech Republic in 2003 already reached 16.9 per 100,000 inhabitants and the mortality rate 2.9 per 100,000 for women and 4.0 per 100,000 for men. Similarly, the increase in incidence in the last 30 years (1970 vs. 2000) is 447%, which even exceeds the increase in the percentage of melanomas registered in the USA.
The effect of exposure to ultraviolet radiation has been increasingly discussed in the etiopathogenesis of melanoma in recent years. Particular emphasis is placed on repeated sunburns, burns in childhood, skin burns in people with a low phototype.
Similarly, long-term photochemotherapy (PUVA) - for example, used in the treatment of psoriasis, is associated with a higher risk of melanoma. The role of other sources of UV radiation (solariums) is similar to exposure to the sun, although this has not been clearly demonstrated in clinical studies.
It is this fact that needs to be communicated to our patients. Even more important is to constantly explain that the use of sunscreen is not enough, but that the main principles of photoprotection are not to expose yourself unnecessarily to the sun.
Other factors influencing the development of melanoma include the occurrence of melanoma in the family, immunosuppression and the presence of a large number of melanocytic acquired pigment nevi, dysplastic acquired nevi and congenital large pigment nevi. According to some dermatologists, even the first two types seem to be the "benign counterpart of melanoma", they are benign pigmented tumors of melanocytes.
Prevention of melanoma is part of the routine examination of patients as part of cancer prevention, which is performed by every doctor. According to foreign experience, primary prevention, including the reduction of risk factors, is the most effective.
Awareness-raising for our fellow citizens should be targeted so that they learn to behave in the sun, are able to use protective equipment and protect children in particular from the sun. Secondary prevention, which is already in the hands of dermatovenerologists and means early detection and treatment of melanoma, has slowly begun to establish itself in our republic.
Since 2000, Czech dermatovenerologists have joined the European Melanoma Day, organized by the European Academy of Dermatovenerology. Thanks to this event, in recent years, 20-30 melanomas have been detected in one day a year.