What is melanoma?

Melanoma is the most serious, malignant cancer of the skin and mucous membranes. It spreads very quickly by lymphatic and blood to other parts of the body and then his treatment is more difficult, a outcome can be fatal. Melanoma originates from melanocytes, cells that produce melanin, the pigment that gives color to skin, hair and eyes. In the skin, melanocytes are located between basal cells of the basal membrane, producing a protective melanin. Mostly, melanomas are brown or black, but may sometimes be of skin color, red, pink, blue or white.

melanom 1

 Melanomas often arise from existing moles directly from the skin. Risk for the occurrence of melanoma exists if is repeatedly traumatized or if the localization is constantly exposed to friction (by bra, button, belt, clothes edge during shaving, etc.). There are four subtypes of melanoma: Superficial spreading melanoma , nodular melanoma , lentigo maligna melanoma and Acral lentiginous melanoma .

 Melanoma can occur in all parts of the body, such as the parts that are constantly exposed to the sun, and the parts that are protected by clothing. In men melanoma occurs most commonly on the body, while in women, usually occurs on the back and legs. Subtype of malignancy can affect where the tumor will develop; lentigo melanoma is more common on the face, while the acral melanoma is more common on the hands, feet or nails.

melanom 2

 Representation of melanoma

The number of cases of melanoma has been increasing steadily and is one of the tumors with greatest expansion lately. The annual increase in the number of cases is about 4-5%, which means that the number of sufferers is double every 10-15 years.

In Europe annually it affects approximately 14 people per 100 000 population. Women in Europe are diagnosed with melanoma more frequently than men, while in the US it affects men and women equally. Numerous studies show that women with melanoma have a better survival rate than men. The reason for this is probably that women pay more attention to their appearance, earlier notice changes in skin before consult a doctor. From this it can be concluded that a key factor for a good prognosis is early detection of melanoma. Melanoma usually occurs in fifty years of life than lentigo maligna melanoma – a type of melanoma which primarily occurs in the seventh decade of life, most commonly the skin long exposed to the sun (face, hands).

 Melanoma occurs mainly in Caucasians, while the black and yellow race is quite rare. Most widespread is in Australia and countries with higher levels of solar radiation.

 People with melanoma have a higher risk of developing another primary melanoma compared to other people of the population. Also, people who previously had another malignant tumor of the skin have a greater chance of developing melanoma.

 In Macedonia in 2014 from melanoma 59 people died at a rate of 2,9 per 100 000 inhabitants, of which 32 are men and 27 are women. The rate of men was 3.1  deaths per 100 000 men and women rate of 2,6 deaths per 100 000 women.


Although there are numerous risk factors, skin cancer is usually caused by UV radiation from the sun. Excessive exposure to this radiation is the most common cause of all forms of skin cancer.

Two main types of UV radiation to which we are exposed penetrate the skin at different depths. Excessive exposure to the sun’s rays will start to damage DNA and tissue. At best, this causes premature aging and wrinkles. At worst, this leads to permanent skin damage and, ultimately, to skin cancer.

Limited exposure to sunlight is beneficial to all. UV-B rays stimulate the production of vitamin D3, which is important for good health, proper growth and strong bones. However, only a small dose of sun daily is all that is required.

While, on the one hand the sun makes us feel good (hence the popularity of tanning), on the other hand the damage that the sun makes to skin and body exceeds the short-term benefits such as good mood.

Skin damage from the sun is permanent. While burns may disappear, the major changes of the skin remain. Each subsequent period of prolonged exposure does more harm to already weakened local immune system and genetic material of the skin.

There are three main types of UV rays from the sun. The most dangerous UV-C rays are completely absorbed by the ozone layer. The remaining two types, UV-A and UV-B have different effects on the human body.


What is the UV Index (UVI)?

  • The UVI is a measure of the level of UV radiation.
  • The values of the index range from zero upward – the higher the UVI, the greater the potential for damage to the skin and eye, and the less time it takes for harm to occur.
  • The UVI is an important vehicle to alert people about the need to use sun protection.

 uvi_definitionWhat causes (risk factors) the occurrence of melanoma?

Risk factors for the occurrence of melanoma:

  •  – Excessive (uncontrolled) exposure to the sun or ultraviolet radiation (professionals or amateurs)
  • - Pigmented skin or people with light skin
  • - Adults over 50 years
  • - Persons with over 50 moles
  • - Melanoma in the family
  • - Personal data on melanoma
  • - Sunburns
  • - Intensive sunbathing in a short period of time (holiday), or “weekend” sunscreen
  • - Use of Solarium
  • - Radiotherapy
  • - Weakened immunity of chemotherapy after organ transplantation, in HIV / AIDS patients.

How to recognize danger signs?

 The risk of developing skin cancer is often associated with our genes. All individuals should take precautions and once a year to go to a dermatologist. Melanoma often is not recognized at first glance because it is difficult to distinguish from ordinary moles and other benign tumors.

 To set the early diagnosis of melanoma using a rule-ABCDE. Changing is doubtful if is asymmetrical (A), no clear boundaries (B), if the color is changing (C), if the diameter is greater than 6 mm (D). Evolution (E) (also – elevation) as a change of color, size, shape, surface elevation and symptoms such as itching or bleeding major signs of malignancy. Also, the emergence of new changes in the skin of healthy individuals older than 40 years are considered suspicious in which case you should consult a dermatologist.

melanom 3

Self-examination of moles

 Make quick Self-examination using a mirror:

mladezi 1 Check face and ears with a mirror. Use a hair dryer to check the scalp.
mladezi 2Check palms, hands and nails. Using a mirror check the elbows, armpits and upper arm.
mladezi 3 Check neck, abdomen and chest (women need good examination of under breast).
mladezi 4 Using a small mirror in the large mirror check nape, shoulders, back, buttocks, back of thighs, arms and ears.
mladezi 5 In the next position using a mirror inside of the thighs, legs, soles, upper feet, nails and the area around the genitals.

* The method is recommended by the Foundation for the fight against skin cancer (The Skin Cancer Foundation).

Useful tips to help prevent the harmful effects of sun rays

The use of safety means does not include the basic precautions that should be taken during sun exposure:

sonce 1Excessive sun exposure is dangerous. Take ground cover under shade. Avoid sun exposure at a time when the sun (UV) is strongest.
sonce 2Do not expose Babies and young children directly to the sun.
sonce 3Protect yourself, babies and young children with a hat, sunglasses and a shirt.
sonce 4Select SPF appropriate for your skin phenotype, and according to your skin type select the best base (cream, fluid, gel, spray). Apply it rich at least half an hour before sun exposure and repeat the application especially after swimming, sweating and wiping with a cloth.


  1. Sun exposure is not advised in order to skin tanning or sunbathing. However, if you choose to expose to the sun,you  should do it gradually (first day only one hour, the second day two hours, etc.).
  2.  Do not plan activities in nature and the outdoors when the sun is strongest.
  3.  Avoid the sun from 10-17 am. At that time of the day shelter is obligatory (parasol, tree, tent, house).
  4.  Clothes are the best protection from sun and they should be made of lightweight, tightly woven with a bright color, and sleeves and trouser legs have to be long.
  5.  A hat with a wide brim for good sun protection for eyes, ears, face, back or neck.
  6. Sunglasses that provide 99-100 percent UV – A and UV – B protection will greatly reduce eye damage from sun exposure.
  7. To use high-quality sunscreen with a protection factor (SPF) at least 30, with a waterproof formula. The protective means are necessary to use even when going outdoors for only a short time.
  8. To avoid tanning salons.
  9. The protective means should be applied for at least 30 minutes before sun exposure and added frequently (every two hours), especially after bathing, sweating and wiping with a cloth.
  10. To Be rubbed on the skin evenly and in a thick layer.
  11. Special attention should be given to the lips, eyebrows and ears.
  12. Do not forget the reflection of sunlight from various surfaces like, snow, water, sand, concrete, grass and the penetration of sunlight through the clouds. Safety equipment should be used when the weather is cloudy.
  13.  Persons who are in the risk group for developing skin cancer (eg. People with red or blond hair and fair skin, people with many moles, people who are already healed skin cancer etc.) would have protect the exposed skin throughout the year.
  14.  Parents especially need to pay attention to proper care of their children
  15.  WARNING: protective assets are not intended to compensate for natural protection and extending the time of exposure to the sun!



Sector for promotion, analysis and monitoring of non-communicable diseases