In malignant melanoma (MM) (synonyms: Achromatic melanoma; amelanotic melanoma; balloon cell melanoma; malignant acrolentiginous melanoma; desmoplastic malignant melanoma; epithelioid cell melanoma; epithelioid cell melanosarcoma; skin melanocarcinoma; malignant melanoma; malignant melanoma on a nail; malignant melanoma of the skin; malignant melanoma in freckles; malignant acrolentiginous melanoma; malignant amelanotic melanoma; malignant nodular melanoma; malignant superficial spreading melanoma; melanoma; Melanotic sarcoma; Nevus malignus; Neurotrophic malignant melanoma; Nodular melanoma; Regressive malignant melanoma; Mucinous melanoma; Superficial spreading melanoma; ICD-10-GM C43. -: Malignant melanoma of the skin) it is a highly malignant (malignant) neoplasm of the pigment cells (melanocytes), the so-called black skin cancer. It accounts for about two to three percent of all adult cancers. A distinction is made between cutaneous melanomas (skin melanomas) and occlusal melanomas (mucosal melanomas). More than 60% of melanomas develop on unchanged skin (de novo). These are associated with shorter survival than forms arising from melanocytic nevi. Approximately 95% of melanoma arises on the skin and there in light-exposed areas. In rare cases it originates from the uvea (middle eye skin, which consists of the choroid, the ray body (corpus ciliare) and the iris) and the mucous membranes (= mucosal melanomas).Melanomas in the area of the oral mucosa represent approx. 0.2-0.8 % of all melanomas occurring on the entire body.Mucosal melanomas (mucosal melanomas) account for approx. 2 % of all skin cancer types. Sex ratio: Women are more commonly affected than men. Frequency peak: The maximum incidence of malignant melanoma is between the ages of 20 and 70. The median age of onset in women is 58 years and in men 64 years.In subungual (“below a nail”) melanoma, the time from first symptom to correct diagnosis is about 2 years! The incidence (frequency of new cases) in fair-skinned people is about 13-15 cases per 100,000 inhabitants per year (in Europe and North America). From 1970-2008, an increase in age-standardized incidence rates from 3 cases to 21 cases per 100,000 inhabitants per year can be seen in Germany! The highest incidence rates are in Australia and New Zealand.In children and adolescents, melanoma is rare: 0-19 year olds show an age-standardized incidence rate of 4.9/1,000,000/year; 0-4 years: 0.7; 5-9 years: 1.0; 10-14 years: 3.0; 15-19 years: 14.7 (US-America).
The number of melanoma diagnoses documented annually increased by 53.2% in Germany from 2001 to 2011. Progression and prognosis: In Germany, approximately 60-70% of all melanomas are diagnosed at stage IA, i.e., with tumor thickness up to 1 mm. These patients have a low risk of recurrence (recurrence of the disease).In the case of subungual melanoma, the time from the first symptom to the correct diagnosis is about 2 years!Malignant melanoma can recur. Recurrences usually develop within the first three years after primary diagnosis.Patients who had primary high-risk melanomas, i.e., histologically tumors in the T1b to T4b category, had recurrence in 13, 4 % of cases within 2 years in a study of 700 patients evaluated. Approximately 70% of cases are locoregional lesions (change confined to a narrowly defined area of the body) and approximately 30% are more distant metastases (daughter tumors located in a more distant tissue).Within the first five years after the end of therapy, the risk of metastases (daughter tumors) is highest. It has a tendency to metastasize (form daughter tumors) very early lymphogenically (“by the lymphatic route”), and less frequently hematogenically (“by the blood route”), resulting in an overall unfavorable prognosis. Death is ultimately caused by metastases, which can occur in almost any organ (brain, liver, lungs, lymph nodes, bones, etc.). This is why early detection of malignant melanoma is so important.A smaller proportion of patients with distant metastases of melanoma who can be operated tumor-free survive long-term (> 5 years). The percentage of long-term survivors is currently 5-10%. Notice:
- According to a report from the American Cancer Society, men and women with malignant melanoma have about 13 and 16 times the risk, respectively, of developing additional melanomas than the general population.
- A high number of nevi and UV damage on the back are associated with an increased rate of new melanomas.
- The recurrence (relapse) rate of pregnancy-associated malignant melanoma (SAMM) was significantly increased at 12.5% compared with 1.4% (non-SAMM), according to one study. Metastases also occurred more frequently (25.0% vs. 12.7%).
- Invasive skin melanomas in the head and neck region are considered particularly aggressive.
- For prognosis from recurrence, it does not matter whether late (> 10 years) recurrent melanomas or early (≤ 10 years) recurrent melanomas are involved (melanoma-specific survival mean 31 months from recurrence versus mean 32 months from recurrence).
The 5-year survival rate is 85% in men and 91% in women. In stage IA, the 5-year survival rate is 95%. In advanced stage (distant metastases in other organs), the 3-year survival rate is 50-52% with PD-1 inhibitor therapy and 58% so far with immune combination. The 5-year survival rates In Germany from 2001 to 2011 for each stage were 96.8% (stage I), 74.2% (stage II), 56.7% (stage III), and 18.4% (stage IV).For subungual melanoma, the 10-year survival rate is approximately 43%.
