{"id":5214,"date":"2025-01-07T14:32:58","date_gmt":"2025-01-07T13:32:58","guid":{"rendered":"https:\/\/irccs.com\/patologie\/melanomas\/"},"modified":"2026-06-23T12:07:25","modified_gmt":"2026-06-23T10:07:25","slug":"melanomas","status":"publish","type":"pathology","link":"https:\/\/inoc.it\/en\/pathology\/melanomas\/","title":{"rendered":"Melanomas"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"><span  id=\"pathology\" class=\"h2_anchor\"><\/span>Pathology<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Melanoma is a skin cancer that originates from <strong>melanocytes<\/strong>, the cells responsible for producing <strong>melanin<\/strong>, the pigment that protects the skin from ultraviolet (UV) radiation and gives it its color. Under normal conditions, melanocytes form benign lesions known as <strong>moles (nevi)<\/strong>; however, in some cases they undergo malignant transformation, giving rise to melanoma.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Although less frequent than other skin cancers, melanoma is the <strong>most aggressive form<\/strong>, requiring prompt diagnosis and treatment. It can develop on <strong>clinically normal skin<\/strong> or from <strong>pre-existing congenital or acquired nevi<\/strong>. It is rare in childhood, but its incidence has shifted toward younger ages, making it increasingly common in adults under 30.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Types  <\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Four main clinical forms<\/strong> are recognized:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Superficial spreading melanoma<\/strong>: the most common form (\u224870%), initially growing horizontally across the skin<\/li>\n\n\n\n<li><strong>Lentigo maligna melanoma<\/strong>: typically occurs in older individuals in chronically sun-exposed areas<\/li>\n\n\n\n<li><strong>Acral lentiginous melanoma<\/strong>: rarer form affecting palms, soles, and nail regions<\/li>\n\n\n\n<li><strong>Nodular melanoma<\/strong>: the most aggressive form (10\u201315%), characterized by early vertical growth<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Rare variants include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Uveal melanoma<\/strong> (eye)<\/li>\n\n\n\n<li><strong>Mucosal melanoma<\/strong> (gastrointestinal and genital mucosa)<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">The Numbers in Italy<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">According to the <a href=\"https:\/\/www.registri-tumori.it\/cms\/pubblicazioni\/i-numeri-del-cancro-italia-2023\"><strong>AIRTUM<\/strong> (Italian Association of Cancer Registries)<\/a>, in 2024 melanoma was the <strong>third most frequent cancer before age 50<\/strong> in Italy for both sexes, with an estimated <strong>12,941 new cases<\/strong> (7,059 men and 5,872 women). The disease affects approximately <strong>1 in 55 men<\/strong> and <strong>1 in 73 women<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Symptoms<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">In early stages, melanoma is often <strong>asymptomatic<\/strong>. Occasionally, symptoms such as itching, bleeding, or fluid leakage may appear in more advanced disease.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The most important warning sign is a <strong>change in an existing mole<\/strong> or the appearance of a <strong>new pigmented lesion<\/strong>. The <strong>ABCDE rule<\/strong> is used for clinical assessment:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>A \u2013 Asymmetry:<\/strong> irregular, non-symmetrical shape<\/li>\n\n\n\n<li><strong>B \u2013 Borders:<\/strong> irregular or poorly defined edges<\/li>\n\n\n\n<li><strong>C \u2013 Color:<\/strong> multiple colors within the same lesion<\/li>\n\n\n\n<li><strong>D \u2013 Diameter:<\/strong> increasing size or thickness<\/li>\n\n\n\n<li><strong>E \u2013 Evolution:<\/strong> any rapid change in appearance<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"risk-factors\" class=\"h2_anchor\"><\/span>Risk Factors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Melanoma is a <strong>multifactorial disease<\/strong>, resulting from genetic predisposition and environmental exposure.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Key risk factors include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Family history and genetics:<\/strong> mutations in genes such as <strong>CDKN2A (p16\/p14)<\/strong> account for a small proportion of hereditary cases<\/li>\n\n\n\n<li><strong>UV exposure:<\/strong> particularly intermittent intense exposure and history of sunburns, especially in childhood<\/li>\n\n\n\n<li><strong>Tanning beds:<\/strong> associated with significantly increased risk, particularly with early or frequent use<\/li>\n\n\n\n<li><strong>Number and type of nevi:<\/strong> presence of numerous or atypical moles increases risk<\/li>\n\n\n\n<li><strong>Skin phototype:<\/strong> fair skin, light eyes, and red\/blond hair (phototypes I\u2013II) carry higher susceptibility<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Prevention<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Primary prevention aims to <strong>reduce UV-related risk:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Use protective measures such as <strong>sunscreen<\/strong>, <strong>clothing<\/strong>, and <strong>sunglasses<\/strong><\/li>\n\n\n\n<li><strong>Limit <\/strong>sun <strong>exposure <\/strong>during <strong>peak hours<\/strong><\/li>\n\n\n\n<li><strong>Avoid sunburn<\/strong>, especially in children and adolescents<\/li>\n\n\n\n<li><strong>Avoid tanning beds<\/strong> and UV lamps<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"diagnosis-and-examination\" class=\"h2_anchor\"><\/span><strong>Diagnosis and Examination<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Melanoma can arise anywhere on the body, most commonly on the <strong>trunk (men)<\/strong> and <strong>lower limbs (women)<\/strong>. Suspicious lesions are evaluated through <strong>clinical examination and dermoscopy<\/strong>, which allows detailed visualization of skin structures not visible to the naked eye and supports early diagnosis.<\/p>\n\n\n\t<div id=\"block_6a3a5adbbd9dc\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Early Identification<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"51\" data-end=\"214\">Early detection of cutaneous melanoma depends on careful observation of <strong data-start=\"123\" data-end=\"159\">moles and pigmented skin lesions<\/strong>. Clinical signs that should not be overlooked include:<\/p>\n<ul data-start=\"216\" data-end=\"384\">\n<li data-section-id=\"4y0cco\" data-start=\"216\" data-end=\"269\">Variations in pigmentation within the same lesion<\/li>\n<li data-section-id=\"m7nw0v\" data-start=\"270\" data-end=\"307\">Differences in shape and symmetry<\/li>\n<li data-section-id=\"5pfpx9\" data-start=\"308\" data-end=\"347\">Irregular or poorly defined borders<\/li>\n<li data-section-id=\"1iocpfb\" data-start=\"348\" data-end=\"384\">Any change in a lesion over time<\/li>\n<\/ul>\n<p><strong data-start=\"394\" data-end=\"408\">ABCDE Rule<\/strong><\/p>\n<p data-start=\"410\" data-end=\"473\">To facilitate recognition, the <strong data-start=\"441\" data-end=\"455\">ABCDE rule<\/strong> is commonly used:<\/p>\n<ul data-start=\"475\" data-end=\"811\">\n<li data-section-id=\"uel92\" data-start=\"475\" data-end=\"543\"><strong data-start=\"477\" data-end=\"495\">A \u2013 Asymmetry:<\/strong> one half of the lesion differs from the other<\/li>\n<li data-section-id=\"mrlap8\" data-start=\"544\" data-end=\"607\"><strong data-start=\"546\" data-end=\"562\">B \u2013 Borders:<\/strong> irregular, jagged, or poorly defined edges<\/li>\n<li data-section-id=\"49wtnn\" data-start=\"608\" data-end=\"677\"><strong data-start=\"610\" data-end=\"624\">C \u2013 Color:<\/strong> presence of multiple shades within the same lesion<\/li>\n<li data-section-id=\"qhj2t7\" data-start=\"678\" data-end=\"745\"><strong data-start=\"680\" data-end=\"697\">D \u2013 Diameter:<\/strong> greater than 6 mm or progressively increasing<\/li>\n<li data-section-id=\"8h96wu\" data-start=\"746\" data-end=\"811\"><strong data-start=\"748\" data-end=\"766\">E \u2013 Evolution:<\/strong> changes in size, shape, or color over time<\/li>\n<\/ul>\n<p><strong data-start=\"821\" data-end=\"845\">\u201cUgly Duckling\u201d Sign<\/strong><\/p>\n<p data-start=\"847\" data-end=\"1067\">An additional useful criterion is the <strong data-start=\"885\" data-end=\"909\">\u201cugly duckling\u201d rule<\/strong>: a mole that appears different from the others on the body\u2014darker, atypical, or morphologically unusual\u2014should always be considered suspicious and evaluated.<\/p>\n<p data-start=\"847\" data-end=\"1067\"><span role=\"text\"><strong data-start=\"1077\" data-end=\"1110\">Limitations of the ABCDE Rule<\/strong><\/span><\/p>\n<p data-start=\"1112\" data-end=\"1213\">It is important to note that the ABCDE rule may not identify all melanomas. It is less effective for:<\/p>\n<ul data-start=\"1215\" data-end=\"1346\">\n<li data-section-id=\"kisu6u\" data-start=\"1215\" data-end=\"1232\">Small lesions<\/li>\n<li data-section-id=\"1kat9nt\" data-start=\"1233\" data-end=\"1279\"><strong data-start=\"1235\" data-end=\"1259\">Amelanotic melanomas<\/strong> (without pigment)<\/li>\n<li data-section-id=\"olf4jz\" data-start=\"1280\" data-end=\"1346\">Certain aggressive variants, particularly <strong data-start=\"1324\" data-end=\"1344\">nodular melanoma<\/strong><\/li>\n<\/ul>\n<p data-start=\"1348\" data-end=\"1627\">Nodular melanoma accounts for approximately <strong data-start=\"1392\" data-end=\"1411\">10\u201330% of cases<\/strong> and is characterized by rapid vertical growth. It often appears as a <strong data-start=\"1481\" data-end=\"1559\">firm, dome-shaped nodule with relatively regular borders and uniform color<\/strong>, which may allow it to escape early detection using ABCDE criteria.<\/p>\n<p data-start=\"1348\" data-end=\"1627\"><span role=\"text\"><strong data-start=\"1637\" data-end=\"1682\">Alternative Criteria for Nodular Melanoma<\/strong><\/span><\/p>\n<p data-start=\"1684\" data-end=\"1747\">For nodular melanoma, alternative diagnostic criteria are used:<\/p>\n<ul data-start=\"1749\" data-end=\"1983\">\n<li data-section-id=\"ssb7l5\" data-start=\"1749\" data-end=\"1878\"><strong data-start=\"1751\" data-end=\"1764\">EFG rule:<\/strong>\n<ul data-start=\"1769\" data-end=\"1878\">\n<li data-section-id=\"1hezbnd\" data-start=\"1769\" data-end=\"1798\"><strong data-start=\"1771\" data-end=\"1787\">E \u2013 Elevated<\/strong> (raised)<\/li>\n<li data-section-id=\"t8262l\" data-start=\"1801\" data-end=\"1836\"><strong data-start=\"1803\" data-end=\"1815\">F \u2013 Firm<\/strong> (hard consistency)<\/li>\n<li data-section-id=\"15jjmt6\" data-start=\"1839\" data-end=\"1878\"><strong data-start=\"1841\" data-end=\"1856\">G \u2013 Growing<\/strong> (rapid enlargement)<\/li>\n<\/ul>\n<\/li>\n<li data-section-id=\"1fu33o5\" data-start=\"1880\" data-end=\"1983\"><strong data-start=\"1882\" data-end=\"1894\">3C rule:<\/strong>\n<ul data-start=\"1899\" data-end=\"1983\">\n<li data-section-id=\"1qv7hyo\" data-start=\"1899\" data-end=\"1925\"><strong data-start=\"1901\" data-end=\"1923\">Color irregularity<\/strong><\/li>\n<li data-section-id=\"lhjb4j\" data-start=\"1928\" data-end=\"1956\"><strong data-start=\"1930\" data-end=\"1954\">Contour irregularity<\/strong><\/li>\n<li data-section-id=\"bemz9x\" data-start=\"1959\" data-end=\"1983\"><strong data-start=\"1961\" data-end=\"1981\">Change over time<\/strong><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong data-start=\"1993\" data-end=\"2016\">Clinical Importance<\/strong><\/p>\n<p data-start=\"2018\" data-end=\"2306\" data-is-last-node=\"\" data-is-only-node=\"\">Early diagnosis is particularly critical, especially in older individuals, due to the aggressive behavior of some melanoma subtypes. Continuous self-monitoring of the skin and prompt dermatological evaluation of suspicious lesions remain the most effective strategies for early detection.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Self-examination<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"37\" data-end=\"302\"><strong>Self-Examination of the Skin<\/strong><\/p>\n<p data-start=\"37\" data-end=\"302\">Skin self-examination, performed by the patient independently or with the help of a family member (or using mirrors), is a highly useful tool for the <strong data-start=\"187\" data-end=\"228\">early detection of cutaneous melanoma<\/strong> and is considered an important element in prevention and early diagnosis.<\/p>\n<p data-start=\"37\" data-end=\"302\"><span role=\"text\"><strong data-start=\"312\" data-end=\"357\">How to Perform Self-Examination Correctly<\/strong><\/span><\/p>\n<ul data-start=\"359\" data-end=\"918\">\n<li data-section-id=\"p5bwaq\" data-start=\"359\" data-end=\"463\">Perform the examination <strong data-start=\"385\" data-end=\"398\">regularly<\/strong>, ideally after a bath or shower when the skin is clean and dry<\/li>\n<li data-section-id=\"d943ry\" data-start=\"464\" data-end=\"565\">Use a <strong data-start=\"472\" data-end=\"489\">well-lit room<\/strong> with a full-length mirror and a <strong data-start=\"522\" data-end=\"541\">handheld mirror<\/strong> for hard-to-see areas<\/li>\n<li data-section-id=\"1otvrq5\" data-start=\"566\" data-end=\"686\">Become familiar with the location, appearance, and characteristics of existing <strong data-start=\"647\" data-end=\"684\">moles, birthmarks, and skin spots<\/strong><\/li>\n<li data-section-id=\"jpfoeh\" data-start=\"687\" data-end=\"786\">Check for any <strong data-start=\"703\" data-end=\"748\">changes in size, shape, texture, or color<\/strong> compared with previous observations<\/li>\n<li data-section-id=\"1vrau3q\" data-start=\"787\" data-end=\"848\">Pay attention to any <strong data-start=\"810\" data-end=\"846\">non-healing lesion or ulceration<\/strong><\/li>\n<li data-section-id=\"q3mm2j\" data-start=\"849\" data-end=\"918\">Examine the entire body systematically, without omitting any area<\/li>\n<\/ul>\n<p><strong data-start=\"928\" data-end=\"961\">Step-by-Step Body Examination<\/strong><\/p>\n<ul data-start=\"963\" data-end=\"1587\">\n<li data-section-id=\"13cy6er\" data-start=\"963\" data-end=\"1052\">Inspect the <strong data-start=\"977\" data-end=\"1007\">front and back of the body<\/strong>, raising the arms to check the <strong data-start=\"1039\" data-end=\"1050\">armpits<\/strong><\/li>\n<li data-section-id=\"1ffwrsy\" data-start=\"1053\" data-end=\"1183\">Bend the elbows and carefully examine the <strong data-start=\"1097\" data-end=\"1156\">forearms, palms, fingernails, and the backs of the arms<\/strong>, repeating on both sides<\/li>\n<li data-section-id=\"15r7mdk\" data-start=\"1184\" data-end=\"1302\">Examine the <strong data-start=\"1198\" data-end=\"1229\">legs front, back, and sides<\/strong>, including the area between the buttocks and around the genital region<\/li>\n<li data-section-id=\"1koc864\" data-start=\"1303\" data-end=\"1398\">Sit down to carefully inspect the <strong data-start=\"1339\" data-end=\"1347\">feet<\/strong>, including soles, nails, and spaces between toes<\/li>\n<li data-section-id=\"m7olha\" data-start=\"1399\" data-end=\"1587\">Carefully examine the <strong data-start=\"1423\" data-end=\"1454\">face, neck, ears, and scalp<\/strong>\n<ul data-start=\"1459\" data-end=\"1587\">\n<li data-section-id=\"wz99p5\" data-start=\"1459\" data-end=\"1503\">Use a comb or hairdryer to part the hair<\/li>\n<li data-section-id=\"1635gbb\" data-start=\"1506\" data-end=\"1587\">When possible, ask for assistance, as the scalp is difficult to inspect alone<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p data-start=\"1594\" data-end=\"1777\" data-is-last-node=\"\" data-is-only-node=\"\">Regular self-examination helps identify suspicious lesions early and should always be complemented by periodic <strong data-start=\"1705\" data-end=\"1734\">dermatological evaluation<\/strong>, especially in individuals at higher risk.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Monitoring of Moles with Dermoscopy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"44\" data-end=\"293\">Today, melanoma diagnosis relies not only on clinical examination but also on <strong data-start=\"122\" data-end=\"151\">advanced diagnostic tools<\/strong> that have significantly improved the detection of subtle lesions, including those that do not clearly present the classic <strong data-start=\"274\" data-end=\"292\">ABCDE features<\/strong>.<\/p>\n<p data-start=\"295\" data-end=\"608\"><strong data-start=\"295\" data-end=\"309\">Dermoscopy<\/strong> (also called <strong data-start=\"323\" data-end=\"353\">epiluminescence microscopy<\/strong>) is a <strong data-start=\"360\" data-end=\"401\">non-invasive and painless examination<\/strong>. Using a specialized handheld device or digital imaging system, the clinician can examine structures beneath the skin surface that are not visible to the naked eye. This allows a more precise evaluation of:<\/p>\n<ul data-start=\"610\" data-end=\"736\">\n<li data-section-id=\"1namv4g\" data-start=\"610\" data-end=\"652\">Pigment distribution within the lesion<\/li>\n<li data-section-id=\"fvmn5h\" data-start=\"653\" data-end=\"688\">Structural patterns of the mole<\/li>\n<li data-section-id=\"15y3j6s\" data-start=\"689\" data-end=\"736\">Features suggestive of malignancy or atypia<\/li>\n<\/ul>\n<p data-start=\"738\" data-end=\"917\">Based on these observations, the specialist can determine whether the lesion is <strong data-start=\"818\" data-end=\"874\">benign, suspicious, or requires further intervention<\/strong>, such as follow-up monitoring or excision.<\/p>\n<p data-start=\"919\" data-end=\"1112\">Dermoscopy is particularly valuable for the <strong data-start=\"963\" data-end=\"1028\">early detection of pigmented lesions with malignant potential<\/strong>, especially in cases where clinical appearance alone is insufficient for diagnosis.<\/p>\n<p data-start=\"1119\" data-end=\"1380\" data-is-last-node=\"\" data-is-only-node=\"\">If any unusual change is observed during self-examination, it is essential to promptly consult a <strong data-start=\"1216\" data-end=\"1257\">general practitioner or dermatologist<\/strong>. Early evaluation remains the most important step for achieving <strong data-start=\"1322\" data-end=\"1379\">early diagnosis and more effective treatment outcomes<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Excisional Biopsy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"26\" data-end=\"345\">When a skin lesion is suspected of being a <strong data-start=\"69\" data-end=\"81\">melanoma<\/strong>, the first diagnostic step is an <strong data-start=\"115\" data-end=\"136\">excisional biopsy<\/strong>. This is a minor surgical procedure that involves the <strong data-start=\"191\" data-end=\"225\">complete removal of the lesion<\/strong>, together with a small margin of approximately <strong data-start=\"273\" data-end=\"309\">2 mm of surrounding healthy skin<\/strong> and underlying subcutaneous tissue.<\/p>\n<p data-start=\"347\" data-end=\"527\">This approach allows for an accurate <strong data-start=\"384\" data-end=\"417\">histopathological examination<\/strong>, which is essential to define key <strong data-start=\"452\" data-end=\"474\">prognostic factors<\/strong> and to plan the subsequent <strong data-start=\"502\" data-end=\"526\">therapeutic strategy<\/strong>.<\/p>\n<p data-start=\"529\" data-end=\"740\">After the biopsy, surgical treatment of the primary melanoma is completed through a <strong data-start=\"613\" data-end=\"631\">wider excision<\/strong>, with margins determined according to the <strong data-start=\"674\" data-end=\"709\">tumor thickness (Breslow depth)<\/strong> observed under the microscope.<\/p>\n<p data-start=\"529\" data-end=\"740\"><span role=\"text\"><strong data-start=\"750\" data-end=\"785\">Sentinel Lymph Node: A Key Step<\/strong><\/span><\/p>\n<p data-start=\"787\" data-end=\"960\">A fundamental aspect in melanoma management is the evaluation of the <strong data-start=\"856\" data-end=\"879\">sentinel lymph node<\/strong>, which is the first lymph node receiving lymphatic drainage from the tumor site.<\/p>\n<p data-start=\"962\" data-end=\"1221\">This minimally invasive procedure allows clinicians to determine whether <strong data-start=\"1035\" data-end=\"1071\">tumor cells have begun to spread<\/strong>, identifying patients with <strong data-start=\"1099\" data-end=\"1137\">non-palpable lymph node metastases<\/strong> who may require further surgical treatment, such as complete lymph node dissection.<\/p>\n<p data-start=\"1223\" data-end=\"1327\">The risk of lymph node involvement is strongly correlated with <strong data-start=\"1286\" data-end=\"1326\">tumor thickness and mitotic activity<\/strong>:<\/p>\n<ul data-start=\"1329\" data-end=\"1504\">\n<li data-section-id=\"19mc6jo\" data-start=\"1329\" data-end=\"1385\"><strong data-start=\"1331\" data-end=\"1352\">&lt; 1 mm thickness:<\/strong> lymph node involvement is rare<\/li>\n<li data-section-id=\"9ex9f0\" data-start=\"1386\" data-end=\"1453\"><strong data-start=\"1388\" data-end=\"1411\">1.5\u20134 mm thickness:<\/strong> risk of metastasis is approximately 25%<\/li>\n<li data-section-id=\"1rzm7tk\" data-start=\"1454\" data-end=\"1504\"><strong data-start=\"1456\" data-end=\"1477\">&gt; 4 mm thickness:<\/strong> risk may reach up to 60%<\/li>\n<\/ul>\n<p><strong data-start=\"1514\" data-end=\"1567\">Indications for Sentinel Lymph Node Biopsy (SLNB)<\/strong><\/p>\n<ul data-start=\"1569\" data-end=\"1896\">\n<li data-section-id=\"1d24jpr\" data-start=\"1569\" data-end=\"1678\"><strong data-start=\"1571\" data-end=\"1617\">Intermediate-thickness melanomas (1\u20134 mm):<\/strong> indicated due to a metastasis risk of approximately 10\u201320%<\/li>\n<li data-section-id=\"1cqre84\" data-start=\"1679\" data-end=\"1750\"><strong data-start=\"1681\" data-end=\"1710\">Thick melanomas (&gt; 4 mm):<\/strong> indicated, with risk exceeding 30\u201340%<\/li>\n<li data-section-id=\"1n2wfz5\" data-start=\"1751\" data-end=\"1896\"><strong data-start=\"1753\" data-end=\"1781\">Thin melanomas (&lt; 1 mm):<\/strong> not routinely indicated, but may be considered in the presence of specific clinical or histological risk factors<\/li>\n<\/ul>\n<p data-start=\"1903\" data-end=\"2016\" data-is-last-node=\"\" data-is-only-node=\"\">This step is essential for accurate staging and for guiding further therapeutic decisions in melanoma management.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Staging<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"25\" data-end=\"156\">To determine the stage of melanoma and select the most appropriate treatment, physicians integrate multiple sources of information:<\/p>\n<ul data-start=\"158\" data-end=\"398\">\n<li data-section-id=\"1e2g9e6\" data-start=\"158\" data-end=\"269\"><strong data-start=\"160\" data-end=\"178\">Clinical data:<\/strong> obtained from physical examination and imaging studies such as X-rays, CT scans, and MRI<\/li>\n<li data-section-id=\"k1zcal\" data-start=\"270\" data-end=\"398\"><strong data-start=\"272\" data-end=\"294\">Pathological data:<\/strong> derived from biopsy analysis, which provides detailed information on tumor characteristics and spread<\/li>\n<\/ul>\n<h3 data-section-id=\"1e5zz29\" data-start=\"449\" data-end=\"472\"><strong data-start=\"408\" data-end=\"447\">Key Pathological Factors in Staging<\/strong><\/h3>\n<ul>\n<li data-section-id=\"1e5zz29\" data-start=\"449\" data-end=\"472\"><span role=\"text\"><strong data-start=\"453\" data-end=\"472\">Tumor thickness: <\/strong><\/span>Tumor thickness measures the depth of melanoma invasion within the skin. The <strong data-start=\"550\" data-end=\"571\">Breslow thickness<\/strong>, currently the standard method, is more accurate than the older Clark level system and represents a major prognostic indicator. In general, greater thickness is associated with a higher risk of spread to lymph nodes or distant organs.<\/li>\n<li data-section-id=\"1e5zz29\" data-start=\"449\" data-end=\"472\"><strong data-start=\"817\" data-end=\"831\">Ulceration: <\/strong>Ulceration refers to the loss of the superficial epidermal layer covering the melanoma. Although not always visible clinically, it is identified microscopically. Its presence is associated with a <strong data-start=\"1028\" data-end=\"1047\">worse prognosis<\/strong> and a higher likelihood of disease dissemination.<\/li>\n<li><strong data-start=\"1108\" data-end=\"1133\">Lymph node metastasis: <\/strong>Lymph node involvement is classified as:\n<ul>\n<li data-section-id=\"5ca4nc\" data-start=\"1176\" data-end=\"1289\"><strong data-start=\"1178\" data-end=\"1198\">Micrometastases:<\/strong> not detectable on physical examination and identified through sentinel lymph node biopsy<\/li>\n<li data-section-id=\"l3e6vk\" data-start=\"1290\" data-end=\"1392\"><strong data-start=\"1292\" data-end=\"1312\">Macrometastases:<\/strong> clinically or visually detectable, confirmed through histological examination<\/li>\n<\/ul>\n<\/li>\n<li data-section-id=\"3dtr39\" data-start=\"1399\" data-end=\"1425\"><span role=\"text\"><strong data-start=\"1403\" data-end=\"1425\">Distant metastasis: <\/strong><\/span>Melanoma can spread to distant sites:\n<ul>\n<li data-section-id=\"3dtr39\" data-start=\"1399\" data-end=\"1425\">Metastases to <strong data-start=\"1481\" data-end=\"1534\">skin, subcutaneous tissue, or distant lymph nodes<\/strong> are generally associated with a relatively better prognosis<\/li>\n<li data-section-id=\"3dtr39\" data-start=\"1399\" data-end=\"1425\">Metastases to <strong data-start=\"1613\" data-end=\"1652\">internal organs or vital structures<\/strong> indicate more advanced disease and a poorer prognosis<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p data-start=\"1715\" data-end=\"1834\" data-is-last-node=\"\" data-is-only-node=\"\">These parameters together define the stage of melanoma and are essential for guiding prognosis and treatment decisions.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"therapies\" class=\"h2_anchor\"><\/span>Therapies<\/h2>\n\n\n\t<div id=\"block_6a3a5adbbdba3\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Surgery<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"16\" data-end=\"232\">Surgery is the primary treatment for most melanomas and, in many cases, the only treatment required. It also plays an important role in lymph node staging and in the management of selected cases of advanced melanoma.<\/p>\n<p data-start=\"16\" data-end=\"232\">\n<h3 data-section-id=\"18tr7kt\" data-start=\"897\" data-end=\"934\"><span role=\"text\"><strong data-start=\"238\" data-end=\"261\">Wide Local Excision<\/strong><\/span><\/h3>\n<p data-start=\"263\" data-end=\"510\">Wide local excision is performed to remove any residual cancer cells that may remain after the initial biopsy. It represents the standard treatment for <strong data-start=\"415\" data-end=\"435\">melanoma in situ<\/strong>, <strong data-start=\"437\" data-end=\"464\">stage I and II melanoma<\/strong>, and for many cases of <strong data-start=\"488\" data-end=\"509\">stage III disease<\/strong>.<\/p>\n<p data-start=\"512\" data-end=\"554\">During the procedure, the surgeon removes:<\/p>\n<ul data-start=\"556\" data-end=\"706\">\n<li data-section-id=\"wzzidy\" data-start=\"556\" data-end=\"617\">The area containing the melanoma, including the biopsy scar<\/li>\n<li data-section-id=\"1tla95v\" data-start=\"618\" data-end=\"706\">A surrounding margin of healthy skin and subcutaneous tissue (the <strong data-start=\"686\" data-end=\"705\">surgical margin<\/strong>)<\/li>\n<\/ul>\n<p data-start=\"708\" data-end=\"854\">The width of the surgical margin is determined by the <strong data-start=\"762\" data-end=\"783\">Breslow thickness<\/strong> of the melanoma, reflecting the depth of tumor invasion into the skin.<\/p>\n<p data-start=\"856\" data-end=\"953\">The objective is to achieve complete tumor removal while minimizing the risk of local recurrence.<\/p>\n<p data-start=\"856\" data-end=\"953\"><span role=\"text\"><strong data-start=\"959\" data-end=\"1019\">Sentinel Lymph Node Biopsy (SLNB) with Lymphatic Mapping<\/strong><\/span><\/p>\n<p data-start=\"1021\" data-end=\"1152\">Sentinel lymph node biopsy is an essential staging procedure used to determine whether melanoma has spread to the lymphatic system.<\/p>\n<p data-start=\"1154\" data-end=\"1341\">The <strong data-start=\"1158\" data-end=\"1181\">sentinel lymph node<\/strong> is the first lymph node that receives lymphatic drainage from the primary tumor site and is therefore the most likely location for early lymph node metastasis.<\/p>\n<p data-start=\"1343\" data-end=\"1691\">The procedure includes <strong data-start=\"1366\" data-end=\"1387\">lymphatic mapping<\/strong>, which helps identify the sentinel node accurately. To achieve this, a <strong data-start=\"1459\" data-end=\"1471\">blue dye<\/strong> and\/or a <strong data-start=\"1481\" data-end=\"1503\">radioactive tracer<\/strong> is injected near the tumor site. These substances travel through the lymphatic vessels, allowing the surgeon to locate and remove the sentinel lymph node with minimal surgical disruption.<\/p>\n<p data-start=\"1693\" data-end=\"1841\">Wide local excision and sentinel lymph node biopsy are complementary procedures that provide crucial information for staging and treatment planning.<\/p>\n<p data-start=\"1693\" data-end=\"1841\">\n<h3 data-section-id=\"18tr7kt\" data-start=\"897\" data-end=\"934\"><span role=\"text\"><strong data-start=\"1847\" data-end=\"1872\">Lymph Node Dissection<\/strong><\/span><\/h3>\n<p data-start=\"1874\" data-end=\"2042\">In selected patients with confirmed lymph node involvement, surgery may be performed to remove <strong data-start=\"1969\" data-end=\"2009\">all lymph nodes affected by melanoma<\/strong> within the involved nodal basin.<\/p>\n<p data-start=\"2044\" data-end=\"2206\" data-is-last-node=\"\" data-is-only-node=\"\">The indication for lymph node dissection is determined on an individual basis, taking into account the extent of nodal disease and the overall treatment strategy.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Molecularly Targeted Therapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"37\" data-end=\"331\">Molecularly targeted therapies act selectively against cancer cells by targeting specific genetic mutations that drive melanoma growth, while minimizing damage to healthy tissues. Identifying the mutation present in the tumor is essential because it determines eligibility for these treatments.<\/p>\n<p data-start=\"333\" data-end=\"367\">The most common mutations include:<\/p>\n<ul data-start=\"369\" data-end=\"930\">\n<li data-section-id=\"16x34su\" data-start=\"369\" data-end=\"701\"><strong data-start=\"371\" data-end=\"388\">BRAF mutation<\/strong>, found in approximately 50% of melanomas. Patients with this mutation may be treated with a combination of <strong data-start=\"496\" data-end=\"515\">BRAF inhibitors<\/strong> and <strong data-start=\"520\" data-end=\"538\">MEK inhibitors<\/strong>. Combining these agents has been shown to improve treatment effectiveness, reduce certain side effects, and delay the development of resistance by melanoma cells.<\/li>\n<li data-section-id=\"1izrkc\" data-start=\"703\" data-end=\"930\"><strong data-start=\"705\" data-end=\"723\">c-KIT mutation<\/strong>, found in approximately 1-3% of melanomas, particularly in mucosal melanomas and melanomas arising on the face, hands, and feet. These patients may benefit from targeted oral therapies such as <strong data-start=\"917\" data-end=\"929\">imatinib<\/strong>.<\/li>\n<\/ul>\n<p data-start=\"932\" data-end=\"1171\">Targeted therapies can be used both in patients with metastatic melanoma and in patients with high-risk melanoma following surgery to reduce the risk of recurrence. In the adjuvant setting, treatment is generally administered for one year.<\/p>\n<p data-start=\"1173\" data-end=\"1338\">Recent studies have also shown that, in selected situations, the use of immunotherapy before surgery (neoadjuvant therapy) may further reduce the risk of recurrence.<\/p>\n<p data-start=\"1173\" data-end=\"1338\">\n<h3 data-section-id=\"18tr7kt\" data-start=\"897\" data-end=\"934\"><span role=\"text\"><strong data-start=\"1344\" data-end=\"1360\">Side Effects<\/strong><\/span><\/h3>\n<p data-start=\"1362\" data-end=\"1480\">Side effects vary among individuals but are generally manageable with supportive care. Common adverse effects include:<\/p>\n<ul data-start=\"1482\" data-end=\"1935\">\n<li data-section-id=\"1v6dlhe\" data-start=\"1482\" data-end=\"1505\">Joint and muscle pain<\/li>\n<li data-section-id=\"19q95z9\" data-start=\"1506\" data-end=\"1515\">Fatigue<\/li>\n<li data-section-id=\"p0d0k2\" data-start=\"1516\" data-end=\"1542\">Skin redness and itching<\/li>\n<li data-section-id=\"8qdpa0\" data-start=\"1543\" data-end=\"1553\">Dry skin<\/li>\n<li data-section-id=\"1kqeqkz\" data-start=\"1554\" data-end=\"1657\">Photosensitivity, requiring careful sun protection through high-SPF sunscreen and protective clothing<\/li>\n<li data-section-id=\"s3tae7\" data-start=\"1658\" data-end=\"1821\">Development of skin lesions such as keratoses or keratoacanthomas and, less commonly, squamous cell carcinoma, which can usually be managed with surgical removal<\/li>\n<li data-section-id=\"7ldxd3\" data-start=\"1822\" data-end=\"1935\">Fever related to treatment, often controlled with temporary interruption of therapy and antipyretic medications<\/li>\n<\/ul>\n<p data-start=\"1937\" data-end=\"2105\" data-is-last-node=\"\" data-is-only-node=\"\">Careful monitoring and appropriate supportive measures help manage side effects effectively while allowing patients to obtain the maximum benefit from targeted therapy.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Immunotherapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"22\" data-end=\"290\">Immunotherapy, also known as biological therapy or biotherapy, uses the body&#8217;s natural immune defenses to recognize and destroy melanoma cells. This is achieved through drugs called <strong data-start=\"204\" data-end=\"229\">monoclonal antibodies<\/strong>, which enhance the immune system&#8217;s ability to target cancer.<\/p>\n<p data-start=\"22\" data-end=\"290\">\n<h3 data-section-id=\"18tr7kt\" data-start=\"897\" data-end=\"934\"><span role=\"text\"><strong data-start=\"296\" data-end=\"310\">Ipilimumab<\/strong><\/span><\/h3>\n<p data-start=\"312\" data-end=\"437\"><strong data-start=\"312\" data-end=\"326\">Ipilimumab<\/strong> is a monoclonal antibody that blocks <strong data-start=\"364\" data-end=\"374\">CTLA-4<\/strong>, a protein that normally acts as a brake on the immune system.<\/p>\n<p data-start=\"439\" data-end=\"498\">A useful analogy is to think of the immune system as a car:<\/p>\n<ul data-start=\"500\" data-end=\"720\">\n<li data-section-id=\"1ganp4s\" data-start=\"500\" data-end=\"553\">The <strong data-start=\"506\" data-end=\"521\">accelerator<\/strong> stimulates the immune response.<\/li>\n<li data-section-id=\"c4qdij\" data-start=\"554\" data-end=\"620\">The <strong data-start=\"560\" data-end=\"578\">steering wheel<\/strong> directs the response toward cancer cells.<\/li>\n<li data-section-id=\"t8c6t1\" data-start=\"621\" data-end=\"720\">The <strong data-start=\"627\" data-end=\"636\">brake<\/strong>, represented by CTLA-4, slows immune activity to prevent damage to healthy tissues.<\/li>\n<\/ul>\n<p data-start=\"722\" data-end=\"906\">Melanoma can exploit this brake to evade immune attack. By blocking CTLA-4, ipilimumab releases this inhibition and allows immune cells to respond more effectively against tumor cells.<\/p>\n<p data-start=\"908\" data-end=\"1032\">Ipilimumab is administered intravenously in the day-hospital setting, typically for <strong data-start=\"992\" data-end=\"1031\">four cycles at three-week intervals<\/strong>.<\/p>\n<p data-start=\"908\" data-end=\"1032\">\n<h3 data-section-id=\"18tr7kt\" data-start=\"897\" data-end=\"934\"><span role=\"text\"><strong data-start=\"1038\" data-end=\"1057\">PD-1 Inhibitors<\/strong><\/span><\/h3>\n<p data-start=\"1059\" data-end=\"1270\">Drugs that block the <strong data-start=\"1080\" data-end=\"1097\">PD-1 receptor<\/strong>, such as <strong data-start=\"1107\" data-end=\"1120\">nivolumab<\/strong> and <strong data-start=\"1125\" data-end=\"1142\">pembrolizumab<\/strong>, have demonstrated greater efficacy than ipilimumab in many patients, including some who do not respond to anti-CTLA-4 therapy.<\/p>\n<p data-start=\"1272\" data-end=\"1490\">PD-1 is another important immune checkpoint that melanoma cells can exploit to suppress immune activity. By inhibiting this pathway, these drugs restore the immune system&#8217;s ability to recognize and attack cancer cells.<\/p>\n<p data-start=\"1492\" data-end=\"1725\">More recently, additional immune checkpoint inhibitors have been developed. One example is <strong data-start=\"1583\" data-end=\"1597\">relatlimab<\/strong>, an anti-LAG-3 antibody that can be combined with nivolumab to further enhance antitumor immune responses in selected patients.<\/p>\n<p data-start=\"1492\" data-end=\"1725\">\n<h3 data-section-id=\"18tr7kt\" data-start=\"897\" data-end=\"934\"><span role=\"text\"><strong data-start=\"1731\" data-end=\"1760\">Combination Immunotherapy<\/strong><\/span><\/h3>\n<p data-start=\"1762\" data-end=\"1943\">Clinical studies have shown that combining anti-CTLA-4 and anti-PD-1 therapies can produce higher response rates and improved clinical outcomes compared with either treatment alone.<\/p>\n<p data-start=\"1945\" data-end=\"2090\">However, combination therapy is associated with a greater risk of adverse events and therefore requires careful patient selection and monitoring.<\/p>\n<p data-start=\"1945\" data-end=\"2090\">\n<h3 data-section-id=\"18tr7kt\" data-start=\"897\" data-end=\"934\"><span role=\"text\"><strong data-start=\"2096\" data-end=\"2125\">Use in Melanoma Treatment<\/strong><\/span><\/h3>\n<p data-start=\"2127\" data-end=\"2168\">Immunotherapy can be used effectively in:<\/p>\n<ul data-start=\"2170\" data-end=\"2286\">\n<li data-section-id=\"70s7d1\" data-start=\"2170\" data-end=\"2195\"><strong data-start=\"2172\" data-end=\"2195\">Metastatic melanoma<\/strong><\/li>\n<li data-section-id=\"1y6i6zs\" data-start=\"2196\" data-end=\"2286\"><strong data-start=\"2198\" data-end=\"2253\">High-risk melanoma after surgery (adjuvant therapy)<\/strong> to reduce the risk of recurrence<\/li>\n<\/ul>\n<p data-start=\"2288\" data-end=\"2366\">In the adjuvant setting, treatment is generally administered for <strong data-start=\"2353\" data-end=\"2365\">one year<\/strong>.<\/p>\n<p data-start=\"2368\" data-end=\"2557\">Recent evidence also suggests that, in selected patients, <strong data-start=\"2426\" data-end=\"2455\">neoadjuvant immunotherapy<\/strong> administered before surgery may further reduce the risk of recurrence and improve long-term outcomes.<\/p>\n<p data-start=\"2368\" data-end=\"2557\">\n<h3 data-section-id=\"18tr7kt\" data-start=\"897\" data-end=\"934\"><span role=\"text\"><strong data-start=\"2563\" data-end=\"2596\">Side Effects of Immunotherapy<\/strong><\/span><\/h3>\n<p data-start=\"2598\" data-end=\"2716\">Immunotherapy can trigger immune-related adverse events because it stimulates the immune system to become more active.<\/p>\n<p data-start=\"2718\" data-end=\"2755\">The most common side effects include:<\/p>\n<ul data-start=\"2757\" data-end=\"2942\">\n<li data-section-id=\"p0d0k2\" data-start=\"2757\" data-end=\"2783\">Skin redness and itching<\/li>\n<li data-section-id=\"5vzetr\" data-start=\"2784\" data-end=\"2793\">Colitis<\/li>\n<li data-section-id=\"qm6wg8\" data-start=\"2794\" data-end=\"2804\">Diarrhea<\/li>\n<li data-section-id=\"r8ex9h\" data-start=\"2805\" data-end=\"2845\">Elevated liver enzymes (transaminases)<\/li>\n<li data-section-id=\"1a06jwg\" data-start=\"2846\" data-end=\"2942\">Reduced or altered function of endocrine glands, particularly the thyroid and pituitary glands<\/li>\n<\/ul>\n<p data-start=\"2944\" data-end=\"3110\">Most immune-related adverse events can be effectively managed with <strong data-start=\"3011\" data-end=\"3030\">corticosteroids<\/strong> or other immunosuppressive medications that reduce excessive immune activation.<\/p>\n<p data-start=\"3112\" data-end=\"3316\" data-is-last-node=\"\" data-is-only-node=\"\">Patients experiencing symptoms suggestive of treatment-related toxicity should contact their oncology care team promptly so that appropriate evaluation and treatment can be initiated as early as possible.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Radiation Therapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"26\" data-end=\"358\">The treatment of melanoma, as with many other cancers, may involve a combination of therapeutic approaches, including surgery, radiation therapy, and systemic treatments. Treatment planning is carried out within a <strong data-start=\"240\" data-end=\"277\">Multidisciplinary Pathology Group<\/strong>, ensuring a personalized strategy tailored to each patient&#8217;s clinical situation.<\/p>\n<p data-start=\"360\" data-end=\"498\"><a href=\"https:\/\/inoc.it\/en\/medical-area\/radiotherapy\/\"><strong>Radiation therapy<\/strong><\/a> uses high-energy radiation (X-rays) to damage the DNA of cancer cells, preventing their growth and promoting cell death.<\/p>\n<p data-start=\"500\" data-end=\"589\">In melanoma, radiotherapy is used primarily in advanced stages of the disease, including:<\/p>\n<ul data-start=\"591\" data-end=\"895\">\n<li data-section-id=\"6e8c1h\" data-start=\"591\" data-end=\"708\">Controlling the growth of tumor lesions that are no longer responding to systemic treatments (<strong data-start=\"687\" data-end=\"707\">oligoprogression<\/strong>)<\/li>\n<li data-section-id=\"kyugsd\" data-start=\"709\" data-end=\"783\">Treating symptomatic metastatic lesions, particularly those causing pain<\/li>\n<li data-section-id=\"3lyi1b\" data-start=\"784\" data-end=\"895\">Reducing the risk of functional impairment when tumors involve critical structures such as the bones or brain<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3 data-section-id=\"18tr7kt\" data-start=\"897\" data-end=\"934\"><span role=\"text\"><strong data-start=\"901\" data-end=\"934\">The Radiation Therapy Pathway<\/strong><\/span><\/h3>\n<p data-start=\"936\" data-end=\"991\">The radiotherapy process consists of three main phases:<\/p>\n<p data-start=\"993\" data-end=\"1017\"><strong data-start=\"993\" data-end=\"1017\">Initial Consultation: <\/strong>The radiation oncologist evaluates the patient&#8217;s condition, determines whether radiotherapy is indicated, and identifies the most appropriate treatment approach.<\/p>\n<p data-start=\"1182\" data-end=\"1204\"><strong data-start=\"1182\" data-end=\"1204\">Treatment Planning:\u00a0<\/strong>The radiation oncologist and medical physicist work together to define the treatment area precisely and calculate the optimal radiation dose, maximizing effectiveness while minimizing exposure to surrounding healthy tissues.<\/p>\n<p data-start=\"1432\" data-end=\"1454\"><strong data-start=\"1432\" data-end=\"1454\">Treatment Delivery:\u00a0<\/strong>Radiotherapy sessions are administered by radiation therapists under the supervision of the radiation oncology team, according to the individualized treatment plan.<\/p>\n<p data-start=\"1622\" data-end=\"1830\" data-is-last-node=\"\" data-is-only-node=\"\">Throughout the entire treatment pathway, physicians, nurses, and allied healthcare professionals provide continuous information, support, and assistance to help patients manage therapy safely and effectively.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"ongoing-support\" class=\"h2_anchor\"><\/span>Ongoing Support<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At <strong>INOC \u2013 Istituto Nazionale Oncologico Candiolo<\/strong>, we provide continuous support before, during, and after treatment, accompanying each patient throughout the entire course of care and recovery.<\/p>\n\n\n\t<div id=\"block_6a3a5adbbe4f7\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Management of Side Effects<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><!-- wp:paragraph --><\/p>\n<p data-start=\"35\" data-end=\"319\">All cancer treatments are associated with\u00a0<strong data-start=\"77\" data-end=\"93\">side effects<\/strong>\u00a0that can affect the patient\u2019s\u00a0<strong data-start=\"124\" data-end=\"143\">quality of life<\/strong>\u00a0to varying degrees. Treatments for acute leukemia may also cause significant\u00a0<strong data-start=\"221\" data-end=\"259\">physical and psychological effects<\/strong>, which can impact daily functioning and overall well-being.<\/p>\n<p data-start=\"321\" data-end=\"676\" data-is-last-node=\"\" data-is-only-node=\"\">At <strong>INOC \u2013 Istituto Nazionale Oncologico Candiolo<\/strong>, attention to the patient\u2019s\u00a0<strong data-start=\"386\" data-end=\"405\">quality of life<\/strong>\u00a0remains a priority throughout the entire treatment pathway. The physicians and nurses of the\u00a0<strong data-start=\"499\" data-end=\"525\">Multidisciplinary Team<\/strong>\u00a0provide ongoing support to help manage side effects, including\u00a0<strong data-start=\"589\" data-end=\"615\">nutritional counseling<\/strong>,\u00a0<strong data-start=\"617\" data-end=\"642\">psychological support<\/strong>, and\u00a0<strong data-start=\"648\" data-end=\"675\">pain management therapy<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Psychological Support<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"30\" data-end=\"249\">The impact of cancer also extends to the\u00a0<strong data-start=\"71\" data-end=\"95\">psychological sphere<\/strong>. A cancer diagnosis is often a\u00a0<strong data-start=\"127\" data-end=\"146\">traumatic event<\/strong>\u00a0that affects all aspects of a person\u2019s life and may generate\u00a0<strong data-start=\"208\" data-end=\"248\">anxiety, fear, anger, and depression<\/strong>.<\/p>\n<p data-start=\"251\" data-end=\"527\">At <strong>INOC \u2013 Istituto Nazionale Oncologico Candiolo<\/strong>, alongside advanced medical therapies, the care pathway always includes\u00a0<strong data-start=\"360\" data-end=\"402\">specialized psycho-oncological support<\/strong>, helping patients cope not only with treatment but also with the delicate phases of\u00a0<strong data-start=\"487\" data-end=\"526\">physical and psychological recovery<\/strong>.<\/p>\n<p data-start=\"529\" data-end=\"690\" data-is-last-node=\"\" data-is-only-node=\"\">Patients may also participate in\u00a0<strong data-start=\"562\" data-end=\"594\">psychological support groups<\/strong>, where they can share experiences with others who are facing or have faced a similar condition.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Direct Access to Specialists<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">To ensure timely support and provide prompt answers to questions or concerns, <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>\u00a0offers a dedicated assistance service for all patients.<\/p>\n<p class=\"isSelectedEnd\">From\u00a0<strong>Monday through Friday<\/strong>, between\u00a0<strong>8:00 a.m. and 5:00 p.m.<\/strong>, patients can contact the\u00a0<a href=\"https:\/\/inoc.it\/en\/medical-area\/oncology-day-hospital\/\">Oncology Day Hospital<\/a>\u00a0Secretariat at\u00a0<strong>+39 011 993 3775<\/strong>\u00a0to request an urgent consultation.<\/p>\n<p>Patients are promptly connected with their specialist physician, ensuring rapid access to expert advice, clear information, and immediate support when needed.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Supportive and Palliative Care<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Cancer patients often have\u00a0<strong>complex needs<\/strong>\u00a0that extend beyond the treatment of the disease itself and require comprehensive,<strong>\u00a0multidisciplinary care.<\/strong><\/p>\n<p class=\"isSelectedEnd\">At <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>, patients who need additional support have access to specialists from a range of disciplines, ensuring personalized management of cancer-related symptoms and associated conditions. Services may include nutritional counseling, physical rehabilitation, pain management, and support for other medical needs that may arise during the course of treatment and recovery.<\/p>\n<p>The goal is to\u00a0<strong>improve quality of life, promote overall well-being, and provide comprehensive care<\/strong>\u00a0tailored to each patient\u2019s individual needs.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Social Work Services<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"26\" data-end=\"278\">The Social Work Service at INOC &#8211; Istituto Nazionale Oncologico Candiolo provides\u00a0<strong>information, guidance, and support to patients and their families<\/strong>\u00a0regarding access to community services and the welfare and social security benefits available under current legislation.<\/p>\n<p data-start=\"280\" data-end=\"491\">During dedicated consultations, social workers assist with matters such as disability recognition, access to aids and prosthetic devices, employment-related benefits and leave, and other social support services.<\/p>\n<p data-start=\"493\" data-end=\"621\" data-is-last-node=\"\" data-is-only-node=\"\">The service is available on\u00a0<strong data-start=\"521\" data-end=\"575\">Wednesdays and Fridays from 9:00 a.m. to 1:00 p.m.<\/strong>\u00a0and can be contacted at\u00a0<strong data-start=\"600\" data-end=\"620\">+39 011 993 3059<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Follow-up<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><!-- wp:heading --><\/p>\n<div class=\"qMYqUG_convSearchResultHighlightRoot\">\n<div class=\"\" data-turn-id-container=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-101\" data-is-intersecting=\"true\">\n<section class=\"text-token-text-primary w-full focus:outline-none has-data-writing-block:pointer-events-none [&amp;:has([data-writing-block])&gt;*]:pointer-events-auto R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]\" dir=\"auto\" data-turn-id=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-101\" data-turn-id-container=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-101\" data-testid=\"conversation-turn-204\" data-scroll-anchor=\"false\" data-turn=\"assistant\">\n<div class=\"text-base my-auto mx-auto pb-10 [--thread-content-margin:var(--thread-content-margin-xs,calc(var(--spacing)*4))] @w-sm\/main:[--thread-content-margin:var(--thread-content-margin-sm,calc(var(--spacing)*6))] @w-lg\/main:[--thread-content-margin:var(--thread-content-margin-lg,calc(var(--spacing)*16))] px-(--thread-content-margin)\">\n<div class=\"[--thread-content-max-width:40rem] @w-lg\/main:[--thread-content-max-width:48rem] mx-auto max-w-(--thread-content-max-width) flex-1 group\/turn-messages focus-visible:outline-hidden relative flex w-full min-w-0 flex-col agent-turn\" data-conversation-screenshot-content=\"\">\n<div class=\"flex max-w-full flex-col gap-4 grow\">\n<div class=\"min-h-8 text-message relative flex w-full flex-col items-end gap-2 text-start break-words whitespace-normal outline-none keyboard-focused:focus-ring [.text-message+&amp;]:mt-1\" dir=\"auto\" tabindex=\"0\" data-message-author-role=\"assistant\" data-message-id=\"d27ac05a-ed3c-46a0-8691-7e5329ed3565\" data-message-model-slug=\"gpt-5-5\" data-turn-start-message=\"true\">\n<div class=\"flex w-full flex-col gap-1 empty:hidden\">\n<div class=\"markdown prose dark:prose-invert wrap-break-word w-full light markdown-new-styling\">\n<p data-start=\"18\" data-end=\"257\">Once treatment has been completed, patients enter the <strong data-start=\"72\" data-end=\"91\">follow-up phase<\/strong>, during which regular visits and examinations are performed to <strong data-start=\"155\" data-end=\"190\">monitor treatment effectiveness<\/strong>, <strong data-start=\"192\" data-end=\"211\">assess recovery<\/strong>, and identify any <strong data-start=\"230\" data-end=\"256\">long-term side effects<\/strong>.<\/p>\n<p data-start=\"259\" data-end=\"519\">Follow-up is particularly important for the <strong data-start=\"303\" data-end=\"344\">early detection of disease recurrence<\/strong>, allowing timely intervention if necessary. It also provides patients with an ongoing opportunity to discuss any concerns and receive guidance from their <strong data-start=\"499\" data-end=\"518\">specialist team<\/strong>.<\/p>\n<p data-start=\"521\" data-end=\"713\">The follow-up schedule is planned by the <strong data-start=\"562\" data-end=\"585\">treating specialist<\/strong>, who evaluates the patient&#8217;s clinical condition at each visit and reviews the results of any required tests and investigations.<\/p>\n<p data-start=\"715\" data-end=\"843\">Follow-up generally continues for <strong data-start=\"749\" data-end=\"766\">5 to 10 years<\/strong>, depending on the characteristics of the disease and the treatment received.<\/p>\n<p data-start=\"845\" data-end=\"1058\" data-is-last-node=\"\" data-is-only-node=\"\">Visits are scheduled more frequently during the <strong data-start=\"893\" data-end=\"926\">initial years after treatment<\/strong>, typically every <strong data-start=\"944\" data-end=\"967\">three to six months<\/strong>, and become progressively less frequent over time as the <strong data-start=\"1025\" data-end=\"1057\">risk of recurrence decreases<\/strong>.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"z-0 flex min-h-[46px] justify-start\"><\/div>\n<div class=\"mt-3 w-full empty:hidden\">\n<div class=\"text-center\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/div>\n<div class=\"pointer-events-none -mt-px h-px translate-y-[calc(var(--scroll-root-safe-area-inset-bottom)-14*var(--spacing))]\" aria-hidden=\"true\"><\/div>\n<p><!-- \/wp:paragraph --><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"multi-disciplinary-team\" class=\"h2_anchor\"><\/span>Multi Disciplinary Team<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every cancer requires a&nbsp;<strong>multidisciplinary approach<\/strong>&nbsp;at all stages of disease management. At INOC &#8211; Istituto Nazionale Oncologico Candiolo, this is provided by a team of specialists from various clinical and surgical departments, known as the&nbsp;<strong>GIC<\/strong>, Interdisciplinary Care Group (or MDT). The GIC ensures that each patient is supported throughout the diagnostic and therapeutic process, including arranging and coordinating examinations and maintaining communication with the patient and their family.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For each patient, the GIC (MDT) defines and shares a personalized care pathway based not only on the type and stage of the tumor but also on the patient\u2019s individual characteristics. The goal is to achieve the best possible outcomes both oncologically and functionally, while maintaining a high quality of life.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"clinical-divisions\" class=\"h2_anchor\"><\/span>Clinical Divisions<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>melanoma diagnostic and therapeutic pathway at INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong> involves a multidisciplinary team of specialists who work closely together to ensure accurate diagnosis, personalized treatment planning, and comprehensive patient care.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/skin-tumor-surgery\/\" type=\"medical-area\" id=\"5126\">Skin Tumor Surgery<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/reconstructive-plastic-surgery\/\" type=\"medical-area\" id=\"5159\">Reconstructive Plastic Surgery<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/medical-oncology\/\" type=\"medical-area\" id=\"5169\">Medical Oncology<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/anesthesia-and-resuscitation\/\" type=\"medical-area\" id=\"5185\">Anesthesia and Resuscitation<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/nuclear-medicine\/\" type=\"medical-area\" id=\"5106\">Nuclear Medicine<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/radiotherapy\/\" type=\"medical-area\" id=\"5104\">Radiotherapy<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/radiodiagnostics\/\" type=\"medical-area\" id=\"5101\">Radiodiagnostics<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/pathologic-anatomy\/\" type=\"medical-area\" id=\"5118\">Anatomical Pathology<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"clinical-studies\" class=\"h2_anchor\"><\/span>Clinical Studies<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Researchers at <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong> are actively engaged in numerous <strong>national and international melanoma research projects<\/strong>, with the aim of developing more effective and personalized treatment strategies.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">One of the Institute\u2019s main areas of investigation focuses on the <strong>molecular structure of melanoma<\/strong>. Through advanced experimental models, researchers seek to identify the biological mechanisms that drive tumor growth, develop <strong>new molecularly targeted therapies<\/strong>, and better understand the causes of <strong>resistance to targeted treatments<\/strong>, which remains a major challenge in melanoma care.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In addition, <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong> is conducting a clinical study on <strong>liquid biopsy<\/strong>, an innovative technique that enables the genetic and molecular characteristics of a tumor to be analyzed through a simple blood sample. This approach allows clinicians to <strong>monitor metastatic melanoma in real time<\/strong>, detect emerging molecular changes, and adapt biological treatments when resistance develops, helping to improve the effectiveness of <strong>personalized therapy<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Research is also underway to identify <strong>new therapeutic strategies<\/strong> based on innovative approaches such as <strong>cell therapy<\/strong>. Among these, studies are exploring the use of <strong>CAR-engineered immune cells<\/strong>, which are designed to recognize and selectively attack melanoma cells, offering promising new possibilities for patients with advanced disease.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Through these research programs, <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong> continues to contribute to the advancement of melanoma diagnosis, monitoring, and treatment, helping to bring innovative therapies from the laboratory to clinical practice.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"why-choose-us\" class=\"h2_anchor\"><\/span>Why Choose Us<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At INOC &#8211; Istituto Nazionale Oncologico Candiolo, acute leukemia patients are treated in a&nbsp;<strong>highly specialized<\/strong>&nbsp;manner, thanks to the synergistic work of the dedicated<a href=\"https:\/\/inoc.it\/en\/pathology\/melanomas\/#multi-disciplinary-team\">&nbsp;Interdisciplinary Care Group (GIC)&nbsp;.<\/a><\/p>\n\n\n\t<div id=\"block_6a3a5adbbe58f\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Clinical Experience and Tailored Approach<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Thanks to the large number of cases treated each year, INOC &#8211; Istituto Nazionale Oncologico Candiolo is a\u00a0<strong>national reference<\/strong>\u00a0center for the care of this disease. This extensive experience allows us to manage even the most complex cases, always using a\u00a0<strong>personalized approach<\/strong>, tailored to the clinical and individual profile of each patient.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Imaging Technologies and Advanced Diagnostics<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Establishing a treatment plan always begins with an accurate and timely diagnosis. Patients have access to\u00a0<strong>state-of-the-art imaging technologies<\/strong>, such as ultrasound, contrast-enhanced CT, MRI, and cholangio-RM, which are critical for accurately assessing the extent of the tumor.<\/p>\n<p><strong>Advanced laboratory tests<\/strong>, including molecular analyses, are also available to help define biological features of the disease and guide treatment choices.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Minimally Invasive Surgical Techniques and Multidisciplinarity<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>When appropriate, surgeries are performed using\u00a0<strong data-start=\"244\" data-end=\"268\">minimally invasive<\/strong>, laparoscopic or robotic\u00a0<strong data-start=\"244\" data-end=\"268\">techniques<\/strong>. These approaches involve the use of camera-equipped instruments introduced into the abdomen through small incisions, thus reducing surgical trauma.\u00a0<strong>Benefits<\/strong>\u00a0to the patient include\u00a0<strong>shorter hospital stay times, faster recovery, and lower risk of complications compared with traditional open surgery.<\/strong><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Clinical Research and Access to Trials<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><!-- \/wp:heading --><\/p>\n<p>As an IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare), INOC &#8211; Istituto Nazionale Oncologico Candiolo combines clinical care with a strong focus on scientific research. Patients can be considered for\u00a0<a href=\"https:\/\/inoc.it\/en\/pathology\/melanomas\/#clinical-studies\"><strong>participation in active clinical trials<\/strong><\/a>, offering access to innovative therapies not yet available in standard practice. This integration of care and research is a distinctive strength that translates into tangible benefits for patients.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Care and Support Every Step of the Way<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><a href=\"https:\/\/inoc.it\/en\/pathology\/melanomas\/#multi-disciplinary-team\">The Interdisciplinary Care Group\u00a0<\/a>(GIC or MDT)\u00a0<strong>supports th<\/strong><strong>e patient at every stage<\/strong>: from diagnosis, through treatment, to follow-up. Special attention is paid to<strong>\u00a0nutritional support, psychological health and reintegration into daily life.<\/strong>\u00a0The organization of checkups, examinations, and treatment is designed to ensure\u00a0<strong>continuity, serenity, and a humane, caring<\/strong>\u00a0approach to each patient\u2019s needs.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"class_list":["post-5214","pathology","type-pathology","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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