A simple mole or a cancerous lesion? Melanoma diagnosis. Episode 50

Monika Rachtan
In Poland, 4 000 people are diagnosed with melanoma every year. Thanks to early reporting to the doctor, most of them manage to be completely cured. But are there ways to treat melanoma even more effectively in our country? This is what we will discuss today in the next episode of the programme "Patient First" with Professor Grażyna Kaminska-Winciorek. A warm welcome to you, Professor.

Grażyna Kamińska-Winciorek
Good morning, Madam Editor. Good morning, ladies and gentlemen.

Monika Rachtan
Before we get into the interview, let me introduce the professor. You are a dermatologist and head a large team at the National Institute of Oncology in Gliwice, specialising in melanoma and other cancers.

Grażyna Kamińska-Winciorek
Exactly, I mainly deal with melanoma and skin cancers, especially those that require systemic treatment.

Monika Rachtan
In a moment we will talk about what systemic treatment is, but first let me remind you that our programme is aimed at patients. So let's try to speak in simple language to explain all the difficulties and end our meeting with practical knowledge. The moment of diagnosis of melanoma, like any cancer, is difficult for many people. We usually know that melanoma is an aggressive cancer, but does its diagnosis mean a verdict?

Grażyna Kamińska-Winciorek
No, a diagnosis of melanoma is not a verdict. However, we must take into account at what stage the disease was detected. In Poland, 80% melanomas are diagnosed at an early stage, giving patients a 75-95% chance of survival. It is important to see your doctor quickly. If you notice a worrying lesion that is different from others, do not delay. Ideally, see your doctor within a month.

Monika Rachtan
Is it possible to get an appointment within a month in the Polish health system?

Grażyna Kamińska-Winciorek
It depends on the region. However, it is worth remembering that you can see your GP, who should refer you to a specialist as a matter of urgency. There is no point in putting off a visit until later.

Monika Rachtan
Many people wonder how a small lesion on the skin can make the whole body ill and lead to death.

Grażyna Kamińska-Winciorek
Melanoma at an early stage, when it has not crossed the basement membrane of the epidermis, is 100% curable. The problem arises when the cancer starts to become invasive and gives metastases. It then spreads to other organs, which can be fatal. It is important that patients do not delay seeing a specialist

Monika Rachtan
Are we in Poland aware of this danger of melanoma? Until a few years ago, when you walked down the main street in town. I happen to live in Wrocław. I remember streets like that, where there was a solarium, children were just allowed in there. Has that changed a bit?

Grażyna Kamińska-Winciorek
Fortunately, a great deal has changed in Poland. And here, too, my special thanks to all the people who are involved in projects such as the Melanoma Academy, Prof Rutkowski, where we fought for many years, among other things, to ban the use of tanning beds by people under 18. And this has been achieved in Poland since 2018. In addition to the warnings that are placed on tanning beds as a carcinogen, that is, this carcinogen. Also this ban applies to people who are under 18 years of age. Our awareness in Poland is also increasing. We are a people, a nation, who take care of ourselves, who follow the rules for staying safely in the sun. This is what I believe and this is also indicated by surveys, also conducted by the Melanoma Academy. Almost 90% know what the symptoms of melanoma are, i.e. we know exactly the ABCD criterion. Also more than 80%, however, report seeing these symptoms, so I think we are on a very good path. On the other hand, what still persists is, unfortunately, a bit like this. I always say that these are folk beliefs, that is, for example, cancer doesn't like the knife, melanoma spreads when you cut it out. Unfortunately, this is something that patients are very afraid of, especially if they are older people, because it is also taken from real-life examples, so, for example, the patient remembers when a neighbour, a neighbour's neighbour, someone in the family had an outbreak of melanoma cut out and unfortunately died soon afterwards. This is due to the fact that this person unfortunately already had advanced melanoma and death did not occur because we excised the focus but because unfortunately this cancer was already spreading generalisation. The patient did not react.

Grażyna Kamińska-Winciorek
The patient did not respond. Very often. Ladies and gentlemen, there is such a symptom of a denial reaction. And we also studied this psychologically, because we wondered why patients come to us with such advanced skin cancers, which are, after all, visible. I'm not just thinking about melanoma here, but I'm also thinking about skin cancers. These cancers are flat epithelial cell carcinomas, when they are huge tumours which, once they have disintegrated, are no longer able to be covered up, i.e. hidden from view by the patient. Then and only then do they provide a rationale for seeing a doctor. But unfortunately, this is very often due to this very fear of treatment, the fear of separation from family, of suffering, of pain, of what may be unknown. That is why this knowledge is so important, so that the patient knows what we can offer them, how the treatment process is going and what will happen in the next stages. It is very important that we make our society aware.

Monika Rachtan
When you said to the professor that you can just see this change, I was reminded of a story that one of the experts told me, that a woman came to her with an oozing breast lump and these breasts. This is the kind of female organ that we take special care of, that we pay special attention to. And I asked this doctor, how is that possible, what was this patient's response to why did you come in so late? And she replied because I am a security guard. And when I was standing at work, it was already like this lump had shifted my clothes and I couldn't work anymore because it was visible, so I decided that I would come and do something about it.

Grażyna Kamińska-Winciorek
So this example unfortunately confirms what I was saying earlier, but in a way we have to excuse these patients because they cannot cope with their anxiety and stress levels. Even though their families support them, they very often only end up there later. Just as it is prematurely, melanoma on the back in men are detected in 85% precisely by women. This is because women pay more attention precisely to the lesions, especially those that the man cannot see on the back. And let us remember that melanoma in men is located precisely on the back most often, because it is associated with these excessive sun positions, i.e. when the patient unfortunately pulls on his clothes, shirt and is in the sun, e.g. doing ordinary household chores, gardening and so on.

Monika Rachtan
Well, that is also what I remember about these garden jobs. I once had a conversation with a professor, and she told me that melanoma is a disease of beekeepers and gardeners, that there are occupational groups that are particularly at risk of contracting melanoma. I think to myself, if someone loves their garden, they are actually at risk, and we don't think about it that way. After all, I'm going out in the garden, why do I need this hat? I'm going out without a shirt because it's very hot.

Grażyna Kamińska-Winciorek
We think about it and this is also confirmed by the Melanoma Academy survey. Unfortunately, spending time on the balcony or in the allotment we do not consider this time as sun exposure. Only 20% people apply adequate sun protection, as they do on their way to work. We think that walking a short distance will not harm us in any way. Yet this is a repetitive activity. And let us remember what I always say, that melanoma is also related to UV exposure, which is constant throughout the year, passing through window glass, so it also penetrates through the window glass of cars when we drive to work.
Monika Rachtan
Sun protection is the kind of topic that we have already touched on very strongly in our programme with Professor Czarnecki, and I think this is a good time to correct some things, because there have been a lot of opinions in the comments. Our society. That sunscreens cause cancer and that when there were no sunscreens there was no melanoma. And that now we all use sunscreen and that's why we get melanoma? It's not about the sun at all. What would you say to these comments?

Grażyna Kamińska-Winciorek
I am already answering in three actually such summaries. Firstly, simply applying sun cream does not protect us against melanoma, for two reasons. Firstly, we have to follow the rules of safety in the sun, which means that we should not expose ourselves to the sun. Between 10 am and 3 pm, we should wear clothes. That is one thing. Secondly, what is also known as the surfer syndrome is very important, because it is based on the issue that, when we use sun protection products, that is, those typical filters, unfortunately, with the light prototypes, knowing that we are more exposed to the sun and to sunburn, we prolong this exposure. In the past, if we didn't use sunscreens, we would have an intense erythema after 45 or 60 minutes. Would this erythema occur a few hours after sun exposure? We would have been burned, we would have had skin peeling, blistering. And then that erythema, that burning sensation causes us to have the signal please get out of the sun, your skin is saying enough. In a way, if we use cosmetics with sun protection, we don't produce this erythema. We prevent the erythema reaction. And therefore we are extending exposure time.

Grażyna Kamińska-Winciorek
And indeed such work has highlighted the fact that this surfer's syndrome is related not to the fact that filters have a potential cancerogenic effect, but to the fact that we somehow inadequately extend our sun exposure time. Having light photo skin types, low photo types, that is, we unfortunately easily succumb to sun stress. And we should avoid the sun in general. And this is something to bear in mind. And the third thing that should be mentioned here is that several papers have emphasised, for example, the possibility of the chemical components in chemical filters passing into the bloodstream, for example. They were also e.g. found in excreted urine. This is why some filters are already constructed in such a way that we do not rely solely on chemical filters, but on mixed filters, i.e. chemical and physical filters. Physical filters, for example, are recommended mainly for children, but here I can also say that this is clothing. No, no, no. Filters Of course, we are talking about filters that can be in cosmetics, that is, in all kinds of gels, lotions, creams and so on. But also, of course, filters can be in clothes, which are themselves as such chemical filters that, for example, wash out when washed. But let's remember that there is something else. Analogous to SPF, which is the Protection factor itself, which we find on cosmetics, we have UPS, which is the Ultraviolet Protection factor, which is the corresponding factor that indicates the sun protection factor in clothing, but this is, for example, determined by the right amount of weave and so on. So that's something to bear in mind. Well that is very interesting. On the other hand, I think that this is only said by opponents who perhaps think that nothing should be done, no filters should be applied, that sunbathing is healthy. Of course, we could also say that there is such a paradoxical reaction, because we know that prolonging time in the sun obviously promotes the production of vitamin D3. And we also know that this vitamin D3 can protect patients from developing melanoma, but this does not mean that we should tan to get that melanoma.

Monika Rachtan
Healthy moderation in all things I think it is.

Grażyna Kamińska-Winciorek
Absolutely moderation and prudence and, above all, knowledge. On the other hand, what is important. Let's remember that 90% melanomas develop within sun-damaged skin and are related to either chronic sun exposure or these short, intense sun exposures. Only a small percentage of these melanomas show the absence of this association. And indeed, someone may say never tan. Why did I contract melanoma? Because it has just this rare form of melanoma, independent of the sun. There is an exception in every disease, whereas this cannot be generalised. The sun in the sense of the sun is not harmful, but overexposure to the sun, ultraviolet radiation both natural, artificial. This increases the risk of exposure. Why? Because sunburn occurs, but also because, for example, the so-called 'im pressure level' caused by a particular type of radiation increases.

Monika Rachtan
When we talk about this prevention, because it's avoiding the sun, it's prevention, I also wonder if patients come to the dermatologist's office with nothing wrong. Everything is fine, but I come in for a check-up to be sure. Do you observe such patients?

Grażyna Kamińska-Winciorek
There is a great trend and for that I thank all my patients. Maybe not future patients, but it is this secondary prevention, which is the very examination of performing the assessment according to the ABCD criteria. The complete skin examination by the doctor, as well as the free skin examination, are all part of secondary prevention. But for whom this secondary prevention is primarily aimed at people who are at risk, which I will discuss in a moment. On the other hand, there are actually several trends, or groups of patients who present to surgeries, and I think it will be a slightly different group. Both in surgeons, in oncologists, in oncologists themselves, and also in dermatologists. I think in dermatology we will be detecting more melanomas just at these early stages, because that is mostly prevention. Patients want to get tested. There are usually two groups of people. People of mature age, i.e. between 30 and 40, who tend to have young children, who take care of themselves and do everything to minimise the risk of getting the disease. The second group is just mothers-fathers who come with their children because they are worried about the children.

Grażyna Kamińska-Winciorek
Here, it should certainly be emphasised, and I always say this with great pleasure, that the 75% of absorbed ultraviolet radiation over a lifetime is up to the age of 17. They are therefore responsible for introducing precisely these patterns, patterns of appropriate behaviour in the sun, of staying in, of avoiding these excessive exposures, of using protective clothing, hats, goggles and filters. This is one issue. And a third group, when it is these mature people who often bring their parents. Because let us remember that melanoma is mainly a disease of seniors in Poland too, that is, people who are over 75. Let us remember that these are usually melanomas and which are highly locally advanced. These are usually coarse melanomas and large tumours, because people over 75 often have other co-morbidities as well, and often either they no longer have time to look after their skin, or they underestimate it, because, for example, the lesions occur in other places which they are not able to check. Therefore, attention to children, but also attention to our parents, grandparents. This is extremely important. We know that these.

Monika Rachtan
Older people too, if they have multimorbidity, are overwhelmed by the disease, by all these health problems that arise.

Grażyna Kamińska-Winciorek
Often they are not able to travel to the doctor, they are not able to find an extra day to make that doctor's appointment, so we should definitely take care of that.

Monika Rachtan
You said earlier, Professor, about the fact that when a worrying lesion appears, it's a good idea to go to a doctor and that in the first instance it could be a primary care doctor, it could be a dermatologist, it could be a surgical oncologist. So these specialists are, it turns out a lot, a lot of possibilities. Now the question is, are patients also very afraid of the cost of treatment? Can all these procedures that are involved in treating melanoma be done quickly and safely on the National Health Service?

Grażyna Kamińska-Winciorek
Yes, i.e. we should be able to carry out a comprehensive skin assessment with dermatoscopic examination at every dermatologist. The principle of the dermatologist's practice is precisely based on equipment. Surgical excision alone, because let us remember that this is still the main method of treating melanoma. If it is locally advanced melanoma. This is also a very simple procedure. It just needs to be performed either in an outpatient setting or as part of one-day surgery. The procedure usually takes 15, 20 minutes tops. To the surgeon, it consists of a simple excision of the lesion, suturing of this wound, of course supplying, the defect through sutures and then removing the sutures. Usually depending on the location of the patient.

Monika Rachtan
He is not lying in hospital.

Grażyna Kamińska-Winciorek
She does not have to lie down. It is a 15, 20 minute procedure under local anaesthetic. It really is simple to perform. On the other hand, it is important to avoid any complicated techniques, such as plasters, which are unnecessary and not recommended at all. Of course, I am not talking about advanced cases, so if someone really sees or suspects advanced melanoma, which is, for example, an extensive lesion requiring a different procedure, then such a patient should certainly visit a specialist centre with extensive experience in precisely such procedures. Because the worst thing is to correct later this first unsuccessful operation, and what I always emphasise is that the surgical excision of the lesion is actually the most important element and in the diagnosis of both melanoma, because micro-grading, that is, the histopathological grade is given, but later on in this further procedure, because let us remember that every melanoma must later still undergo radicalisation. Here, depending on the indication, we will either follow it up with a salvage node biopsy or not. So it is important to just go back to this list of centres in Poland that deal with melanoma treatment. And to answer the last question, systemic treatment is an expensive treatment, but in Poland, fortunately, we have had really well-functioning drug programmes for at least two years.

Grażyna Kamińska-Winciorek
Patients very often ask and don't I get better treatment abroad for example, do I have to go abroad? And then we can really proudly say no. There may be others, but the ones that are most important at the moment, which are the Gold Standard therapeutic standard are available to our patients under the drug programme, so as much as possible we can offer that to the patient.

Monika Rachtan
I would like to go into a little more detail about this patient diagnostic pathway in particular. Earlier, you spoke about patient groups, groups of people who are not yet patients, who are at particular risk of developing melanoma because of their skin type. And can you tell us about these groups?

Grażyna Kamińska-Winciorek
Such a long sentence built up that he did not develop the thought. Thank you. Thank you for your vigilance. Yes, because this is the next group of patients who come to me. These are the patients in the so-called risk group. Who is that? First of all, people with a light skin prototype, or to say a low skin prototype. That is, they are photo type 1, 2, which means they always get a sunburn or they usually get a sunburn and never produce a tan, or they produce this tan a little bit these pale people. It could also be someone like that with a complexion of, say, more olive.

Grażyna Kamińska-Winciorek
Olive skin is already classed as photo type three, so they tend not to succumb to sun stress. These are the people who have dark eyes, dark hair and can usually spend longer in the sun. What's next? First of all, a sunburn incident. In the interview, it turns out that according to the literature, for example, in the US population of people just with photo low type, these burns accounted for 70%. And now it turns out that even one incident of sunburn, i.e. if in our case the so-called proverbial epidermis came off, there was a peeling of blisters after sunbathing, then unfortunately we are almost all in this risk group. Almost all of us unfortunately, because unfortunately 90% of Poles have had at least one incident of sunburn in their history, and at least three sunburns unfortunately increase the risk of melanoma by five times. So that's what we keep talking about this sun protection. Then people with very numerous pigment nevi are not necessarily just d.s. plastic nevus syndrome, or atypical nevi, but also normal pigment nevi, and it is thought that there should be more than 50 of these nevi.

Monika Rachtan
They would look like that to a person who has completely never seen them.

Grażyna Kamińska-Winciorek
Pigmented nevi, or what our patients popularly call 'rhymes'. These are lesions in the nature of either spots, i.e. indistinct lesions, or papules, or small protuberant nodules, i.e. raised above the skin. They can be in a selected pattern. The cutaneous ones just look like this, as I have described, but the acquired ones, for example, have the character of dots of numerous dots, such with a reticular pattern. So what we see in dermatoscopy, but what needs to be distinguished here, is primarily a syndrome of plastic nevi. How is it defined? It is primarily a person who has more than a hundred nevi, or a hundred moles. They vary in size. They can be roughly from 3 to 8 mm in diameter. They vary in appearance, i.e. they can be macules, papules, they can have cuticles, and they also occur most frequently in places not only on the neck and décolleté, but also on the limbs. And this is the syndrome of typical nevi. And these patients are at risk. But now, again perversely, what has happened is that by creating this awareness in these patients, these patients now have a lower incidence of melanoma, because these are the people who know that if they see an ABCD criterion met, or they know that if the lesion changes, it is newly formed different from the others.

Grażyna Kamińska-Winciorek
They go to the doctor as soon as possible. The lesion is excised and, in a sense, we also cut out this precursor to melanoma. So this is very important and I think our patients should learn from this that it is important to take care of their skin and to be aware of what is on their skin. And that comes from the fact that we pay attention to it. The American societies emphasise that, in fact, a skin examination should take place at least once a month, so it should be such a good habit, just like paying the bills.

Monika Rachtan
If we can't do it ourselves, then. ask our loved ones. You said that it is useful to be aware of what we have on our skin. And if we have scars from burns, if we have undergone a skin transplant, for example, what is that risk of getting melanoma?

Grażyna Kamińska-Winciorek
Yes, the risk of melanoma is indeed perhaps not that high, but we certainly know that these skins are more likely to react less well to the sun, so they burn more often. Therefore, such scars certainly need to be particularly protected from excessive sunlight. Cancer flat on the bank is more likely to appear in these scars and this should also be borne in mind. On the other hand, a completely different group are patients, e.g. through national vaccination or bone marrow transplantation, whose risk of developing melanoma is 5 to 10 times higher, because this is due, among other things, to the radiation therapy they have undergone, as well as the pressure they are under.

Monika Rachtan
Let's go back to the diagnostic process, because we have this first operation, which is actually called biopsies. Cutting out the biopsies.

Grażyna Kamińska-Winciorek
By cutting it out, i.e. we cut out the lesion in its entirety this has nothing to do with taking an excision and it should also be said that we do not cut it out partially. Only the lesion should be cut out in its entirety with an adequate margin, which is usually estimated at 1/2 millimetre. And this is also a common Question and can't it be more? And why not more right away if there is suspicion? These are the recommendations, because if we excise the lesion with a wider margin, then we could potentially disturb, for example, the meadow drainage, which could affect the abnormal outcome of the sentinel node biopsy itself. Something that is not exactly curative, but is diagnostic in nature.

Monika Rachtan
Okay, and is there a possibility that the melanoma excised during this biopsy is going to the lab? It turns out to be melanoma. And the professor comes to the patient and says Dear patient, for it to be melanoma, But everything has been excised. We don't have to do anything anymore. But is it always melanoma under this diagnosis? When we get the result of the examination from the pathomorphology department, do we always still have to do some further procedures?

Grażyna Kamińska-Winciorek
Thank you very much for this question, because patients often do not believe that this is how it all really is. Patients often don't fully understand that I say with a smile on my lips Please sir, you had melanoma. They don't understand how you can be happy to say there is melanoma. Well, precisely because this melanoma in situ is 100 per cent cured. And that is the good news. So are the patients. I actually love talking about melanoma, because this is actually my daily life with my patients. Secondly, the patients' surprise is also when I say, you have a lesion that may be suspicious for melanoma, it should be excised. And then the patient really gets into a lot of stress and says But what do you mean, what can happen then? What I always say is that we are on a very good path, because the very basis of victory is that you are already here in this office today and that you will have this lesion or lady cut out. So it is worse if the patient just hides the lesion and does not come, because this delays the diagnostic and therapeutic process and unfortunately reduces the risk, reduces the possibility of a full cure, that is, increases the risk of these advanced melanomas later.

Grażyna Kamińska-Winciorek
And now back to the good news of course. The diagnosis is always based on the stage of the melanoma. We will approach a patient who has what is called thin melanoma differently. Differently if it is a thick melanoma, or colloquially speaking, a person with what is called thin melanoma, i.e. less than 0.8 millimetres thick. In fact, if there was no lesion, of course, they do not require any procedure other than widening the margins, that is, they will have logical results after the collection, after excision of the entire lesion. We check if there are indications to biopsy the contents of anything. If there are none, then we have to widen the lesion in the context of the margins for excision of the melanoma. This is simply to trim it. That is to say, it has to be excised a second time and then the patient asks why should I trim? After all, everything was excised. Yes, but the rule is that in melanoma just e.g. in situ we trim by half a centimetre of melanoma from thin to a centimetre of melanoma, then thicker unfortunately to two centimetres. But someone once researched and verified that this must be the case. Yes, yes, he researched, because we say this is how we operate based on consensus, this is how certain trends change to wider excisions, smaller excisions. Let us remember that often this margin is not achievable for lesions located in the so-called facial aesthetic units. This is when, for example, we would have to perform some complex plastic surgery or transplantation. We just minimise these surgeries, because this later disrupts the slightly regional run-off. And now what should these patients with this thin melanoma do? First of all, they should watch their skin. They should see a dermatologist every six months to have a derma scan and a holistic assessment of their skin. This is extremely important and it is crucial for these patients. Why do patients often ask Well. So we're examining this skin because we're afraid that it might be metastasised. Among other things, yes. But the most important aspect is that this patient has a seven per cent risk of developing a second, completely different melanoma. He is at risk having melanoma and I haven't told him about that yet either. So having a history of melanoma, either our own or family history, we are also in this risk group, So we should come for assessment between 6 and 10 months.

Grażyna Kamińska-Winciorek
If we have melanoma, it is as the consensus says, i.e. approximately every 6 months for 5 years and then at least once a year for subsequent appointments.

Monika Rachtan
With Mrs Professor.

Grażyna Kamińska-Winciorek
I think it is. I think it's a good habit for our patients. But coming back to the imaging studies, if they are already melanoma, which include melanoma, where there is an indication for a sentinel node biopsy, go, we do that biopsy. Then, of course, we recommend complementary treatment if there are indications for it, that is, in stage three melanoma, and we also perform imaging examinations and this frequency of imaging examinations, that is, among others, a total tomography, or additionally, instead of a tomography of the central nervous system, a magnetic resonance imaging or PET. But this is like another examination, not a first-line examination. Let us remember this. We perform such examinations in these patients at stage three, between three and six months. What are we looking for? We need to detect potential metastases early. Let us remember that if a patient is in a slightly regional stage with melanoma, that is stage three, they unfortunately have a five-year survival rate of up to 50%, that is 30 50% patients survive five years and we need to minimise detection of the disease at a late stage. That's why these examinations are so frequent and the patient also needs to be aware, needs to be aware of the examination of their skin, because very often, for example, the patient has to be aware of their skin.

Grażyna Kamińska-Winciorek
in the case of a locally ended new lesion. The first metastases will often be noticeable to the naked eye when the patient, for example, sees red nodules or black spots, or palpable changes that, for example, resemble fat. This is important.

Monika Rachtan
I wonder if it is sometimes the case that a patient has a resected melanoma and it turns out that a node biopsy is just needed. It's useful to know what and that this patient gets lost in that queue, that he's scared and doesn't come in. And now if I have melanoma here, where is this biopsy going to be?

Grażyna Kamińska-Winciorek
This is also a common question, because we usually associate biopsy with some kind of removal of a piece of tissue or just a fragment of a node. Patients often think that this is just a biopsy, aspiration, and a sentinel node biopsy is based on the fact that the appropriate isotope dye is applied under the lesion after excision, and we check the first lymphatic drainage, which is the sentinel node, i.e. it guards further groups of nodes and later the whole organism against the spread of melanoma. That is, it is the first meadow of these potential cancer cells. And if we cut this node and examine it, we also know at what stage the patient is, i.e. whether it was one node or two or three nodes. Of course, we won't talk here about further indications, e.g. for lymphatic defects, i.e. extending the scope of this operation. Currently, we usually end up with follow-up treatment, which reduces the risk of regional block recurrence in these patients and is also already the standard of care in our country. Very good treatment, including targeted, molecular as well as mono therapy.

Monika Rachtan
What exactly does this treatment consist of? Because complementary surgery and molecular treatment therapy. Again, this doesn't say much to patients, and it's very good, so those who have indications would probably like to receive this treatment. Yes, it is very good.

Grażyna Kamińska-Winciorek
And here, too, the question often arises: why should I do this if I am already cured? This is because, unfortunately, being in stage three, I have a higher risk of either local or distant metastases and giving this treatment reduces this risk. Unfortunately, it does not eliminate this risk, nor does the administration of systemic therapy in stage four patients.

Monika Rachtan
And what does this systemic therapy consist of?

Grażyna Kamińska-Winciorek
Systemic therapy is based on molecularly targeted drugs, delivered as tablets or infusions. This treatment targets melanoma cells with a specific mutation, not necessarily related to mutations in the patient's DNA. Infusions are applied every 2-4 weeks or every 3-6 weeks, making the therapy convenient for patients.

Monika Rachtan
So the complications that occur are not directly life-threatening for the patient? And even if there is such a risk, the specialist teams are able to deal with it?

Grażyna Kamińska-Winciorek
Complications depend on the degree of toxicity of the drug. We inform patients about possible side effects, but it is important that they report to their doctor if they occur so that we can initiate appropriate treatment.

Monika Rachtan
Let's change the subject from the negative aspects.

Grażyna Kamińska-Winciorek
Although I started by scaring people, it is important to understand that the therapies we have allow us to prolong a patient's life by turning a terminal disease into a chronic one. Patients can thus experience important life moments.

Monika Rachtan
Is the empathy that you and the team display common in the Polish health system?

Grażyna Kamińska-Winciorek
I hope so. In oncology, we are very empathetic because we understand what patients are going through. It is important that all doctors have this empathy, regardless of specialty.

Monika Rachtan
Observing the doctors and listening to the patients, it is clear that once you get to the right centre, the care is of a high standard. Unfortunately, problems often arise earlier, usually for organisational reasons.

Grażyna Kamińska-Winciorek
The problem may stem from a lack of information. It is important that patients know where they can get help and get to a specialist centre as soon as possible.

Monika Rachtan
Our programme partner is the Institute for Patients' Rights and Health Education, which promotes the humanisation of medicine. What does this mean for you?

Grażyna Kamińska-Winciorek
Humanising medicine is all about seeing and meeting the needs of the patient, whether through empathy, support or education. It is important to take the time to talk to and to approach each patient individually.