Today, you will once again discuss the causes, risk factors and novelties in skin treatment, incl. and its most aggressive form – melanoma. Further discussion and subsequent explanation will have to be carried out. Especially since we are already in the summer season when many people choose the beach in order to get the desired sun tan.
Our associate is Dr. Daniel Yankov, a dermatovenereologist, one of the best dermatologists in Southeastern Bulgaria, helped many patients to detect skin carcinomas in a timely manner. She is involved in the diagnosis and treatment of bacterial, viral, allergic and other skin diseases as well as sexually transmitted diseases and skin diseases.
– Dr. Yankov, in May a national campaign for the prevention of skin cancer “Eurommelanoma 2018” was held. You are part of this useful initiative every year. What are your impressions this year?
– The “Eurommelanoma” campaign was held for the 13th consecutive year under the aegis of the Bulgarian Dermatological Society and the European Academy of Dermatology and Venereology. On the internet, there were coordinates of all specialists in all cities, dates were announced, hours in which patients they wanted could be reviewed for free. About a dozen patients passed through my office, and especially this day, fortunately, I did not find any malignant formations. But, of course, this is often the case in the rest of the year. Among my patients, there were different types of doubtful moles and the so-called keratoma-senile. These are benign neoplasms that occur in older people. Especially on the issues, the so-called exposed parts – the ears, the nose, the forehead or the crown, and especially the hairless men.
The “Eurommelanoma” campaign was held for the 13th consecutive year under the aegis of the Bulgarian Dermatological Society and the European Academy of Dermatology and Venereology. On the internet, there were coordinates of all the specialists in all cities, dates were announced, hours in which patients they could be reviewed for free. About a dozen patients passed through my office, and especially this day, fortunately, I did not find any malignant formations. But, of course, this is often the case in the rest of the year. Among my patients, there were different types of doubtful moles and the so-called keratoma-senile. These are benign neoplasms that occur in older people. Especially on the issues, the so-called exposed parts – the ears, the nose, the forehead or the crown, and especially the hairless men.
– Is sunburn just “guilty” about this alarming statistic or are there other risk factors?
– First of all, it is the ultraviolet radiation (sun) and the inappropriate use of photo-protective products.
The ozone hole is expanding
in the world over the last 10-20 years, melanoma incidence in Australia and New Zealand has increased several times, as ultraviolet rays there are most easily penetrated through the unprotected layer as well as aggressive exposure to the sun.
Of course, the reasons are many, but it is assumed that this is one of the leading ones. Another notable reason is the use of a solarium. It has long been established that the solarium increases with nearly 100% of the incidence of skin cancer. This has been proven at least 10 years ago and I personally warn all my patients about this danger. Young people come and ask if they can go to a solarium.
Dr. Daniel Yankov
We only recommend this when it comes to some skin diseases that have a repigmentation of the skin. For example, psoriasis is also a common illness. We recommend ultraviolet rays and sea treatment, which is beneficial. But I’m in a hurry to say that in this respect there are requirements for sun exposure – for a certain time, at certain times, and so on.
And another skin disease, but after treatment, you can affect the solarium in very small doses. It’s about the so-called. colorless lichen. Today, I had such a patient who, after treatment, complained that their stains were standing, did not pass. I assured him that after a few short sessions in the solarium the problem would be solved completely, the stains would be pigmented.
Speaking of provoking factors for skin cancer, besides the sun and the solarium, I can also point out the contact with carcinogenic substances. There are such areas, mainly industrial, where particulate matter can affect cell change. And last but not least are the genetic and predisposing factors. I have patients who are coming for examination worried by some little pigmentation only because their close relatives have died from melanoma.
– Dr. Yankov, although our subject is wider, recall the main melanoma – diagnosis, treatment, prognosis, prevention.
– Regarding diagnostics, we and another have discussed it, there is a rule in place in Europe – the ABCDE-the rule of thumb
the main features of the pigment entity
and assessing the likelihood of malignancy. But to a great extent it is also a question of the patient’s own commitment, of his observability. Detected on time, diagnosed and removed by relevant experienced oncologist or oncodermatologists, even malignant melanoma caught at an early stage can be cured at 100%.
I have already mentioned the five factors: A is asymmetry, ie, if a moon is asymmetric, one must be overwhelmed. B is the edge – whether it is correct or incorrect. C is the third factor and denotes the color – if the moon is multicolored, it is an unfavorable scar. If the color is homogeneous and evenly distributed, it is a good scar and maybe it’s a simple nevus. Although there is a malignant melanoma that has no pigment but is just as dangerous. The fourth mark D indicates the diameter. And one more thing that can inform readers – they usually report that if the formations are less than 5 mm they are unlikely to be malignant. Although such a small entity with the years can evolve and progress in malignancy. But again, it’s all about surveillance and periodic reviews at least once or twice a year. The review takes no more than 10-15 minutes. The last sign is the E-Elevation, which means elevation. The other day I had a patient, a young girl who had a mole that had grown in recent years. It was in irregular shape, wrong color, there was one enlargement, ie. lifting into the motif itself. In such cases, I personally communicate with colleagues in Sofia where they can perform a puncture biopsy. We keep in touch and it will become clear within a few days whether it is a malignant entity. I want to point out that punctuation biopsy is a must. Something that is not done everywhere, unfortunately. A must. It follows, of course, the abolition of the entity.
– And is there something new in the treatment of melanoma?
– A few months ago we were at a conference on her dermatoscopy
novelties in the treatment of melanoma
There were guest speakers from abroad. There is a new modern treatment for melanoma, which is currently being applied in Bulgaria. I had a patient two weeks ago, who has been melanoma for 5 years, currently treating him with this latest therapy, making him infusions. When he came to see me, he did not have metastasis or tumor formations. Probably melted, after a few infusions have been affectedли много добре.
Now the man feels very good. So I have the opportunity to watch it from here on. Regarding this new therapy, I mean it is extremely expensive – 11 000 levs, but fortunately it is taken over by the state. And, in principle, timely review and removal of the entity may end with 100% success.
– Let’s talk about other types of skin cancer.
-Today I had a patient with the so-called. basal cell carcinoma or basilioma. For this type of skin cancer it is characteristic that it is the least aggressive, that is, it never leads to very severe consequences. It is usually more common in men, at least my observations are such. This type of formation appears on the protruding parts – the temple, the cheekbones, the nose, the head of the head. Accordingly, I directed my patient to a specialist. By burning this entity, things can end up there. Sometimes, however, several radiation therapy is required, but it ends with a good result.
There are other types, such as the squamous cell carcinoma we have been talking about. I want to pay some attention to the so-called spinalioma, indicating that he “prefers” the sites around the mucous membranes around the mouth of the mouth. Unfortunately, it also leads to a fatal outcome, as there are different types of forms that lead to deepening, to the breakdown of the tissue. I have seen such a case a decade ago with the half-face of this type of carcinoma. He also gives metastasis in the body by lymph and blood. And it leads to death if it is neglected for years. In any case, it is enough if one has neglected an entity for years. Because it does not happen for a day, it takes a long time to progress. While for melanoma, unfortunately, according to statistics, if it reaches a depth of more than 0.70 mm, it can now have access to lymph and blood vessels and to provoke metastases. That is why the consequences are severe. While other types of cancer require a significantly longer period of time to achieve adverse effects.
– What is the prevention of these skin diseases?Каква е превенцията на тези кожни заболявания?
– Overcoating is a major problem. People like to bake to get sunburned without realizing it, and maybe they do not know that this is extremely temporary. Normally, human skin falls unnoticed on the 28th day, ie, whatever you have to tan, it will disappear on the 28th day. Why is it then over-sunbathing when this darker color will last for no more than 28 days?
As for prophylaxis, it is the right photo-protection with a high sun protection factor. Now in America, they already have products with a factor of up to 100 SPFs. In Europe the requirements are up to 50 SPF. However, it is estimated that over 30 SPF in a small percentage gets higher protection, so we write between 30 and 50th factor. Some think that if they use a maximum defensive factor, say 50, they can sit in the sun all day without consequences. No, and they can burn if they bake between 12 and 16 o’clock in the afternoon. Particularly if they have made only one splatter in all cases they will get burns.
In this connection, I have to point out something very important. The skin has cell pumps that 10, 20, 30 years after such sunburn can develop abuse. Burning the face, especially on the shoulders. When the patient came and at his meeting saw a pigmentation of equality, it was certain that he had lost years ago. And that someday, as I said, may be in the form of abuse. Especially in childhood burns. I draw attention to the fact that I am confident that I have requested my child. In the end, you should not risk a later stage in the life of such a child to have an evil formation.
Yana BOYADJIEVA (Zdrave.to)