Melanoma is a malignant neoplasia that can arise on healthy skin or in the context of acquired, congenital or pre-existing melanocytic nevi. Melanoma symptoms are essentially absent or little manifest, and they appear in advanced stages.
The incidence of this pathology is continuously increasing all over the world, representing the third neoplasia in the age range 0-45 years. Contrary to other tumours, melanoma affects younger populations as well, and more than 50% of cases are diagnosed within 60 years old.
The risk to develop melanoma is strictly linked to the interaction of environmental factors (exogenous) and genetic-constitutional factors (endogenous). The most important exogenous factors are sun exposure and photoprotection. Endogenous factors are represented by phototype (colour of skin and eyes), sensitivity to the sun, number and type of nevi, familiarity for cutaneous tumours, or previous history of melanoma.
Patient self-check is extremely important to identify any changes of pre-existing moles and the appearance of new “spots” with rapid modification of their features (colour, shape, size).
In the last years, the field of prevention and early diagnosis of atypical pigmented lesions is dramatically improved, mainly thanks to the introduction of dermoscopy in the clinical practice.
Dermoscopy is a non-invasive diagnostic technique, actually considered the best instrument to detect atypical pigmented lesions and differentiate between benign and malignant melanocytic nevi.
This technique allows, in the hands of an experienced dermatologist, to improve the diagnostic sensibility of melanoma up to 40% beside the simple clinical examination. This reduces dramatically the number of unnecessary surgical excisions.
In the outpatient clinic, the medical examination is executed with a hand-held dermoscope and, together with an integral clinical evaluation, it represents the so-called “mole mapping”.
If necessary, a digital photographic monitoring of suspected pigmented lesions can be done, with re-evaluations within short periods.
In case of atypical lesions, surgical excision with histological examination represents the fundamental technique for both diagnostic and therapeutic purposes.
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