No more than 30 days should elapse between the suspicion of melanoma and the first dermatological specialist visit. To check moles, every part of the body must be examined, always using the dermatoscope, an optical instrument that allows you to identify lesions not visible to the naked eye. It is important that the time between the first dermatological visit and surgery to remove the suspected lesion is no more than one month. After removal, histological reporting must take place within 2 weeks of specimen acceptance. And it is necessary for the doctor to personally communicate the diagnosis to the patient. They are some of the 10 recommendations accompanied by ten concrete actions to shorten the time for melanoma diagnosis and save more lives, presented today in a virtual press conference. The decalogue was drawn up by the patient associations and scientific societies involved in the project “Target Melanoma”, promoted by AIMAME (Italian Association of Melanoma and Skin Cancer Patients), APaIM (Italian Melanoma Patients Association), Emme Rouge and Melanoma Italia Onlus (MIO), with the patronage of ADOI (Italian Hospital Dermatologists-Venereologists Association), AIOM (Italian Association of Oncology Medica), IMI (Italian Melanoma Intergroup) and SIDeMaST (Italian Society of Medical, Surgical, Aesthetic Dermatology and Sexually Transmitted Diseases). The 10 recommendations were sent to the Minister of Health, Roberto Speranza, and to the Undersecretary of Health, Pierpaolo Sileri.
“Target Melanoma”, created thanks to the unconditional contribution of Pierre Fabre and Eau Thermale Avène, aims to understand the reasons that can cause late diagnosis and thus highlight the strengths and weaknesses of the Italian diagnostic path, to reduce cases of melanoma identified at an advanced stage.
“In one year the new diagnoses of melanoma, in Italy, increased by 20%, from 12,300 in 2019 to almost 14,900 in 2020. No other neoplasm has seen such a high increase – he says Giovanni Pellacani, Director of the Dermatology Complex Operative Unit Umberto I Polyclinic, La Sapienza University of Rome -. Prevention and early diagnosis are the most important weapons to defeat this skin cancer. If discovered early on and eliminated with proper surgical excision, melanoma is completely curable. The arrival of summer is an opportunity to spend more time outdoors. Just follow some simple rules of prevention, in particular avoid exposure to sunlight between 12 and 16, in any case always protect yourself with appropriate sunscreen, hat and sunglasses. It is important to check your skin regularly and, if you notice the appearance of a suspicious lesion, a dermatological visit should be booked immediately. The ABCDE rule is the first step towards prevention, because it helps to distinguish a mole from a melanoma: Asymmetry, Irregular edges, Inhomogeneous color, Diameter greater than 6 mm and Evolution. About 70% of cases are detected early on. With the implementation of the 10 recommendations we want to increase this percentage ”. “We also propose concrete actions to put each recommendation into practice – he explains Ketty Peris, President of SIDeMaST -. To comply with the 30-day deadline between the suspected melanoma and the first dermatological specialist visit, an institutional booking process is required dedicated to suspected tumor lesions, with the identification of the priority classes (U: urgent, service to be performed within 72 hours ; B: short, to be performed within 10 days). Dermatologists involved in the ‘melanoma’ path must have a dermatoscope and instrumentation to document the lesion sent for removal. Provincial reference centers must be identified and equipped with digital dermatoscopy and confocal microscopy. Furthermore, in dermato-oncological clinics the time of the visit must not be less than 20 minutes per patient. To comply with the recommended timing for the removal of the mole, i.e. no more than one month after the first dermatological visit, we ask for an adequate availability of surgical outpatient clinics. And in order for the histological report to be communicated within 2 weeks of acceptance of the sample, the laboratories must be equipped with instruments and resources, also favoring the recognition of reference centers for any ‘second opinions’ “.
“Surgery is the treatment of choice for early stage melanoma,” he points out Paola Queirolo, Director of the Melanoma, Sarcoma and Rare Tumors Division at the European Institute of Oncology in Milan -. With the arrival of immuno-oncology and molecularly targeted therapies, the approach to advanced disease has changed radically. These weapons have opened up a new ‘world’. The first step in the treatment of the patient with advanced melanoma is the evaluation of the mutational status. In fact, in 40-50% of cases there is an alteration of the gene BRAF, which identifies patients who can benefit from the combination of targeted therapies, with a significant improvement in survival. As indicated in the decalogue, the molecular test for BRAF it is recommended in the case of radically operated advanced stage or stage III melanoma, on the last metastatic lesion if available, otherwise it can be performed on the primary lesion. In the mutational report of BRAF the method used must also be indicated. In this sense it is important to intensify and make constant and continuous the quality controls of the laboratories that carry out the molecular tests and to favor the implementation of laboratory networks for the ‘Next Generation Sequencing’., next generation gene sequencing technique “.
“In Italy, melanoma is the second most frequent cancer in men under 50 and the third in women in this age group – he says Ignazio Stanganelli, President of IMI, Associate Professor of Dermatology Clinic of the University of Parma and Director of the Oncological Dermatology Center – Skin Cancer Unit of the Tumor Institute of Romagna IRST IRCCS -. The risk of onset is linked to genetic, phenotypic and environmental factors. The most important is identified in the exposure to UV rays, in relation to the absorbed doses, the type of exposure (intermittent rather than chronic) and age (sunburn in children and adolescents at greater risk). The dermatologist deals with all aspects of the diagnostic-therapeutic process. Given the complexity of therapeutic choices and the availability of new treatments, a multidisciplinary approach is recommended. Cases should be discussed in disease groups. The close collaboration between the various professional figures involved (dermatologists, pathologists, oncologists, plastic surgeons, radiotherapists and geneticists, molecular biologists) is essential to guarantee the best treatment path “.
At the 17th Congress of the European Association of Oncological Dermatology (EADO), which took place last April, two surveys were presented, part of the “Target Melanoma” project, aimed at patients and dermatologists. The results show, in our country, a good organization of the treatment process once it has started, but 47% of patients say that they personally collect the results of the histological examination at the report desk. “One of the critical points concerns the doctor-patient communication – he explains Chiara Puri Purini, on behalf of the four patient associations that promoted the project -. The recommendations provide that the diagnosis of melanoma is communicated personally to the patient by the dermatologist or by the doctor who is in charge of its management, who must have the time necessary for the explanation of the histological report and the subsequent phases of the treatment and follow-up path , leaving room for all the questions and doubts of the person who, at that moment, discovers that he is suffering from melanoma. And, after the tenth year from diagnosis, at least one annual skin specialist visit is indicated for the rest of life, involving the family doctor, who will be able to follow the patient together with the reference specialist. This is why it is important to facilitate, through digital sharing systems, communication between the general practitioner and the hospital “.
Almost 170,000 people live in Italy after the discovery of the disease. “To reduce new diagnoses – concludes Prof. Pellacani -, more primary and secondary prevention campaigns are needed to inform citizens about the rules of correct exposure to the sun, the risks associated with the use of sun lamps and the importance of regular monitoring. of moles by the dermatologist. And it is necessary to include melanoma in tumors on which to invest in prevention, following the example of breast, colorectal and cervical cancer ”.