Discover melanoma as soon as possible, thanks to increasingly precise, rapid and minimally invasive diagnostic techniques, capable of finding the disease when it is still in its infancy. And also to avoid unnecessary interventions for the patient. We are talking about one of the most aggressive skin cancers, the incidence of which has increased significantly in the last 30 years, more than any other neoplasm. Add to this the pandemic, which has had an impact on dermatological controls, reducing them. This is why disease and precision diagnostics are two of the themes at the center of the 96th SIDeMaST congress, the Italian Society of Dermatology, taking place in Milan from 22 to 25 June.
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“The early diagnosis of melanoma is the dermatologist’s main problem”, says Franco Rongioletti, president of the congress, director of the Clinical Dermatology Unit of the IRCCS San Raffaele Hospital and full professor of Dermatology at the Vita-Salute San Raffaele University in Milan: ” It must be clearly stated that many advances have been made in the treatment of advanced disease states, but our goal is to find out before it metastasizes ”. In fact, it is important to identify it when it is still in situ, that is, when the cells are confined to the epidermis, “at the top”, as the specialists say. When the thickness does not exceed 0.8 mm, the 5-year survival reaches 97%. “It is clear then – continues the expert – that providing images of fabrics quickly and with very high resolution is equivalent to saving many lives”.
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Non-invasive diagnosis
The non-invasive techniques that have revolutionized skin cancer diagnostics are dermatoscopy and confocal laser microscopy. “The first, in recent years, has proved very useful in the diagnosis of all skin cancers, for basal cell and squamous cell carcinoma, but above all for melanoma”, emphasizes the dermatologist. And for two reasons: because it allows to differentiate melanoma from benign in a very effective way, thus avoiding the removal, at times, of benign lesions. And then because, thanks to the widespread use of this technique, many studies have been carried out, especially in Italy, which have improved the knowledge of skin cancers.
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Dermatoscopy consists in the use of an instrument connected to a computerized videodermatoscope: in practice we are talking about a high definition microscope that allows you to see a lesion much better than through a visit with the naked eye, although very accurate. “With this technique we have had a 30-35% improvement in diagnostics compared to observation – the expert continues – which allowed us to discover details on melanoma that are now part of a dermoscopic alphabet”. For instance? “For example, it has a very variegated coloring: the colors of melanoma range from light brown to dark brown to blue to white. Still, we now know that the vascularization of melanomas is significantly irregular, really different from that typical of benign lesions “.
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A technique that has been combined with dermatoscopy to improve the diagnostics of skin tumors, and therefore more recent than the previous one, is confocal laser microscopy which consists of scanning the skin with a special microscope capable of seeing cells in detail: a technique non-invasive which allows to further limit unnecessary surgical interventions and biopsies. “Dermatoscopy – explains Rongioletti – gives us a deep and accurate but general image of the lesion. Instead, confocal microscopy allows us to evaluate the morphology of the cells: if it is regular it is a mole, if it is not we are in the presence of something else “.
But the histological examination remains fundamental
Confocal microscopy can be applied to the patient but also ex vivo, i.e. on skin tissue already removed, offering an image quite similar to that of the histological examination, with the advantage of speed. Having said that, however, it must be clear that the histological examination cannot be replaced, emphasizes the specialist: “The techniques we have spoken about must in any case be validated with the histological examination, which gives a precise diagnosis in 95% of cases”. In short, ex vivo confocal laser microscopy is a good technique to see if a tumor is easy to treat, and it is useful to the surgeon after an operation, to verify that the lesion has been completely removed: if not, it is possible to re-intervene. immediately, without waiting days. But the reference standard remains the dermo-pathology, that is the reading of the sample that the pathologist makes under an optical microscope.
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Protect yourself from the sun to protect yourself from melanoma
Every year in the world there are more than 100,000 new cases of melanoma and the causes, according to skin specialists, must be sought above all in exposure to the sun, intermittent or chronic in some countries, without adequate protection. So with these numbers and these trends it is always good to remember good practices, that is, good behaviors to avoid getting sick: “Use sunscreen, limit exposure from 11 to 16 and an annual dermatological visit for everyone”, concludes the doctor: “For people with particular risk factors – that is, with high numbers of moles (more than 50) and skin, light eyes and light hair or a family melanoma – a visit every six months is recommended.”