CUTANEOUS MALIGNANT MELANOMAS: EPIDEMIOLOGICAL, CLINICAL AND THERAPEUTIC ASPECTS. EXPERIENCE OF THE PLASTIC SURGERY DEPARTMENT IN MOHAMMED VI HOSPITAL OF MARRAKECH- MOROCCO

Melanoma is a tumor proliferation developed at the expenseof melanocytes,the incidence of melanomais increasingworldwidemakesita realpublic health concern,the severity of thismalignancy tumor isassociated witha strong ability tometastasize,involvingthe prognosisof the patientif the lesionis notdetected early henceimproving earlydiagnosis remainsa major challenge. The objective of ourwork is to studythe epidemiological ,pathological,, therapeutic, prognostic and preventive aspects of melanomathrough aretrspective studyof 33patientscollectedfrom January 2010 to January 2017 inin plasticsurgery andburnsofthe CHUMohammed VIMarrakech. The average age of our patients was 61 years with a female predominance. Sun exposure was found in 91 % of our patients which supports the important role complained of sun exposure in the development of melanoma. The location the sole of the foot is by far the most frequent (73% of our patients). On histological level, Acrolentigineux (61%) and nodule (24%) types are the most common, with a Breslow thickness varies between 2 mm and 12 mm and Clark level varies between IV and V in 75% of our patients, reflecting the significant delay between the start of the lesion and the consultation which is estimated at 2 years and consequently the lack of effective means of screening for patients at risk in our population. On therapeutically level, at the initial stage, only surgical excision, constituting the gesture that allows both diagnosis and treatment of the lesion which must be done as soon as possible to ensure prolonged survival. At the loco-regional stage, surgical resection with regional lymph node dissection is the standard of care. The sentinel node biopsy provides very precise classification of cutaneous melanoma, but has not been reported to have a significant impact on survival. The dissection effect on survival is a subject of inquiry. Two distinct approaches have emerged to try to prolong the survival of patients with metastatic melanoma: Immunomodulation with anti- CTLA4 monoclonal antibodies and targeted therapy with inhibitors of BRAF or MEK for melanoma with BRAF mutated, recent studies have shown that the combination of inhibitors of BRAF and inhibitors of MEK may improve the progression-free survival and eventually increase overall survival, the choice of therapy should be individualized in each case depending on various factors such as BRAF mutation status, age, co-morbidities and topography of metastases ,while chemotherapy and radiation therapy can be used to relieve the symptoms without significant impact on patient survival. Preventing melanoma is a real public health problem requires education of the general population on the need for sunscreen and awareness of melanoma and encouraging early diagnosis with the training of health professionals.