In a doctoral thesis conducted in our service in 1997, the frequency of melanoma in Catalonia was 5 per 100,000 inhabitants. Today these figures are not valid as the number of cases is multiplied by three every five years. In 2007, we detected 22 cases in our service and in 2012, and 66.
The risks of moles depend on several factors: if they are congenital or acquired, the size of the mole, the age of appearance and family or personal history, among others. In the case of children, the likelihood of malignancy is very rare, but it is not without risks. The congenital nevi that appear at birth and grow with the development of the child, can vary in size between 1.5 cm to 20 cm. The risk increases with size, so they must be checked periodically. Acquired nevi have a higher risk and will depend on the different clinical presentations.
The nevi, when they are giant, represent a congenital error in the ectodermal embryonic development that can affect the brain and the spinal cord. They are asymptomatic in the first years of life and may manifest late with symptoms of cranial hypertension , such as vomiting, headaches, etc.
The great problem that we detect in this type of nevus is the melanofobia that we used to transmit when we did not have the current methodology. Currently, we can avoid it thanks to new imaging techniques and greater clinical pathological knowledge. In a small percentage, the histopathological diagnosis is difficult, requiring a second opinion by an expert in dermatopathology.
There are many differential situations that are difficult to interpret as pigmented lesions in hormonal areas (vulva and mammary region), lesions in palms and soles , recurrent nevus to previous treatments, dysplastic nevi that simulate melanomas , non-pigmented melanomas that are confused with banal lesions, which always forces to make the histopathological examination.
The current lines
The objective now is to promote early diagnosis with what we will achieve its cure in most cases, the examination of the entire body surface without forgetting hidden areas such as the scalp, nails and mucous membranes. Prevention is important by eliminating the risk factors, such as aggressive and intermittent sun exposure (vacations) and the use of solar cabins. We want to give information of optimism both in the progress of the diagnosis , and in the treatments, since there is a percentage of melanomas with genetically determined metastases that are curable. A few years ago we could not give this good news.
Comprehensive control of nevi
Our residents face every day during their training situations of great responsibility. They recognize those risk nevus due to their clinical characteristics: size, asymmetric irregularities in the shape, change in color that visualize it with an epiluminescence magnifying glass that they always carry with them and perform the biopsy of the entire lesion in the suspicious ones. In our institute we use computerized digitalization that detects any change in the annual reviews.