We do not have the habit to check the condition of the skin from time to time, especially after holidays, during a visit to a dermatologist. And yet we are a nation with a fair complexion, that is, exposed to skin cancer, including melanomas. And when detected early, they are fully curable.
Fortunately, the fashion for a strong tan is over. But still many of us use the sun without moderation, risking skin burns and, consequently, the development of melanoma. We talk to prof. dr hab. n. med. Piotr Rutkowski, specialist in general and oncological surgery.
- What are the features of susceptible people?
Prof. dr hab. n. med. Piotr Rutkowski : These are people who tan frequently and for a long time, use sunbeds, with skin phototype 1 and 2 (to which approx. 70% of Poles belong), i.e. with fair skin and fair hair, freckles, with numerous pigmented nevi, as well as genetically burdened, i.e. those with a family history of melanoma. Most Poles have a skin phototype that burns easily and tans poorly. This promotes the formation of skin cancer. Poles are at high risk of developing melanoma.
- We often hear that melanoma is the rarest and most dangerous skin cancer. Why?
P.R. : It's not entirely true. Skin cancers are a group of several types of cancer. The two most common are skin cancers - basal cell and squamous cell.
The number of melanoma patients increases by 10% each year.
The first is responsible for 5 times more cases than the second. Tens of thousands of people are affected each year. Melanoma is a more aggressive cancer and is responsible for over 80% of deaths among all skin cancers. Basal cell carcinoma of the skin usually grows slowly, is extremely rarely metastatic, and is most common in areas where the skin is chronically exposed to ultraviolet radiation, such as the face. Squamous cell carcinoma also appears more often on the skin exposed to the sun, but it can also appear in places that are chronically irritated, in scars, and it can metastasize. The symptom is skin lumps,ulcers - bleeding, crusted, rough skin lesions. And melanoma, contrary to its name, doesn't have to be black.
- Does the location of the cancer affect the course of the disease and prognosis?
P.R. : The degree of advancement, that is the thickness of the lesions measured in millimeters and the presence of an ulcer, has the greatest influence on the prognosis. Early melanomas, up to 1 mm thick, which constitute approx. 30% of melanomas in Poland, can be effectively treated.
- Why is the timing of diagnosis so crucial in melanoma?
P.R. : The clinic I run treats about 400 melanomas a year. In the 1990s, the average thickness of the melanoma we encountered was about 4 mm, now it is below 1.8 mm. This is a very beneficial change because early melanoma can be cured in 98% of cases. It doesn't increase overnight, so it's time to see your doctor. Melanoma is an easily diagnosed cancer, but it is not easy to treat when it is advanced. Early, on the contrary, it is easy to treat. In Poland, early cancers are still not detected enough and hence the difference in the effectiveness of treatment. In Poland, 70% of patients survive melanoma, in the United States and Australia - over 90%. Where does the notoriety of melanomas come from? Hence, a tumor with a thickness greater than 4 mm gives only a 50% chance of survival. The main reason for this is lack of awareness. We are trying to change it. At the Czerniak Academy, we educate doctors and the society. It works! This year, for the first time, I saw as many early melanomas as never before. The skin examination does not hurt, it is short, takes about 10 minutes and is non-invasive.
- But there is still a myth that if you cut a skin lesion, you die.
P.R .: It is quite the opposite. It is rare in oncology that a cancer can be so easily diagnosed. Changes on the skin are difficult to overlook, and the excision of tissues with an appropriate margin of he althy skin and possibly the so-called the sentinel node heals the tumor. If we were to detect melanomas at an early stage, more than 95% of patients would be cured only by surgery. With the lesion thickness not exceeding 0.75 mm, the chances of survival are close to 100%. Unfortunately, in Poland 30% of patients start therapy in the advanced stage of the disease, which translates into lower chances. Until recently, patients with late diagnosis lived only 6 months. In Germany, the average thickness of treated melanoma is below 0.8 mm, in Poland it is below 2 mm, which is why the prognosis of Polish melanomas is much worse. Fortunately, in our case, the results of experiences are improving, which is mainly due to the fact that they are less frequentwe expose our skin to UV radiation and see a doctor more often.
- Only a few years ago, doctors could not offer patients too many effective therapies. The situation has improved now.
P.R .: What frustrated doctors were the results of treating patients with metastatic melanomas without surgical treatment. Half of these patients died within 6 months. The last 5 years have been a breakthrough in the treatment of metastatic melanomas. This is due to the development of a molecularly targeted therapy that acts on the protein associated with the defective BRAF gene, as well as the development of immunotherapy that affects the immune system. In recent years, 8 new drugs have been registered in Europe, 7 of which are available in Poland under the reimbursement system in 20 multi-specialist cancer centers. For patients with metastatic inoperable melanoma and a mutation of the BRAF gene, we can offer targeted treatment available in Poland as part of the drug program. As many as 90% of patients respond well to such treatment. The median survival is currently 2 years. This is a great progress because 4 years ago this time was four times shorter. Currently, the 3-year survival rate is 45%.
- What exactly is immunotherapy?
P.R. : Immunotherapy is a treatment aimed at strengthening the body's immune response against melanoma cells. Administration of drugs strengthens lymphocytes, which causes regression of advanced metastatic changes. The results that have already been collected show an annual survival of 60-70% among patients with metastatic disseminated melanoma, a 3-year survival of even 45%, and a 5-year survival of approx. 35%. However, this is a treatment that has its limitations (e.g. it does not work in patients with active brain metastases), it cannot be used in all patients, e.g. with autoimmune diseases, and must also be carried out in multidisciplinary oncology centers experienced in immunotherapy with due to side effects. Nevertheless, access to new therapies and organization of treatment in Poland is currently the best among all Central and Eastern European countries!
Skin cancer - how to recognize it?
- What should I say to those who say they are sunbathing to get enough vitamin D levels?
P.R. : The increase in the incidence of melanoma is directly related to the increased exposure to ultraviolet radiation, i.e. skin damage caused by the sun and sunbeds. Melanoma used to be elderly, but now we have patients of all age groups. If the young are ill, it means that they have worked hard for it. FROMfrom a medical point of view, we should not sunbathe. Exposure to the sun should not exceed 10 minutes in the afternoon. There is also no safe "dose" of the solarium. The synthesis of vitamin D, which is the greatest positive that the sun gives, takes 10-12 minutes when the skin is exposed. Vitamin D cannot be produced overnight, so we recommend oral supplementation more and more often.
- So when should we not be in the sun?
P.R. : Avoid overexposure to the sun's rays, especially between 11am and 3pm when the sun is most intense. And this does not only apply to the summer months, as melanoma is diagnosed throughout the year. When leaving the house, you should take appropriate clothes to limit your body's exposure to the sun, and use sunscreen and sunscreen.
- Do you do that?
P.R. : Of course, and I come back from vacation with my skin intact! Sunbathing is like an invitation to skin cancer. Excess sun also causes the skin to age faster, and the greater the total dose of UV radiation absorbed by the skin, the more visible the effects of its damage.
- How do you assess the knowledge of Poles on the prevention of skin cancers and melanomas?
P.R. : In Poland, there is a large discrepancy between the knowledge about the dangers of tanning and their practical application. "We know, but we do not research - what do Poles know about melanoma?" this is the slogan of the last Melanoma Awareness Week. A survey conducted by TNS commissioned by the Melanoma Academy shows that most of us (90%) know what melanoma is. Unfortunately, only 15% of respondents went to the doctor at least once to check moles. In Scandinavian countries and the United States, there has been no increase in new cases of skin cancer after public sunbathing campaigns. It seems that Poles simply need more time to understand the dangers of excessive sunbathing and going to tanning beds.
- Melanoma: causes, symptoms, treatment
- Hereditary malignant melanoma: indications for genetic testing
- SKIN CANCER - symptoms and types [PHOTOS]
Czerniak is a cancer with the highest dynamics of incidence in Poland, which is why it is such an important problem. Every year in our country more than 3,500 cases are recorded, of which about 30 percent are fatal. The incidence of this cancer in Poland doubles every 10 years, and in the last 20 years it has increased by over 300percent!
On the other hand, healing results are improving. The specialists of the Cancer Center-Institute are able to cure about 80 percent of patients, but unfortunately, these are more advanced melanomas than in our western neighbors. In Germany and the USA, more than 90 percent of patients are cured. This is only due to the earlier visit of the patients to the doctor, which means faster cancer detection.
According to an expertprof. Piotr Rutkowski, surgeon, oncologist, head of the Department of Soft Tissue, Bone and Melanoma, COI WarsawProf. dr hab. med. Piotr Rutkowski, Oncology Center-Institute Maria Skłodowskiej-Curie, head of the Department of Tumors of Soft Tissues, Bones and Melanomas, deputy chairman of the Scientific Council of the Melanoma Academy - the scientific section of the Polish Society of Oncological Surgery, past-president of the Polish Society of Oncological Surgery
