Some aspects of skin melanoma diagnostics and treatment in the Republic of Tajikistan

Abstract

Relevance: Melanoma is considered one of the most aggressive tumors. It is distinguished by early and multiple metastases, often unsatisfactory outcomes, and a variety of clinical and morphological forms. Its incidence is steadily growing in the
 world and the Republic of Tajikistan. The official statistics reported 222 newly diagnosed cases of skin melanoma in 2018 vs.
 159 in 2010. According to our figures, patients below 40 years are mostly women (56.2%), older patients are mostly men. The
 peak incidence is at the age of 40 and above, with the average patient age of 53. Other ages are also affected, including 1-2
 cases at the age of 0-4 years.
 The purpose of the study was to analyze the specifics of diagnostics, treatment, and survival rates of patients with skin
 melanoma in the Republic of Tajikistan and assess the errors in diagnostics and tactics at the primary healthcare level.
 Results: We studied the medical records of 26 patients treated in-patiently at the Republican Oncological Scientific Center
 of the Republic of Tajikistan in 2017-2019. The patient age varied from 20 to 89 years, men (73.1%) prevailed, the peak incidence
 was at the age of 45-66 years. More than half of the patients came to treatment within two years after the onset of the disease. The disease factors included: trauma incl. surgical intervention (38.4%), hereditary factor (7.7%), spontaneous occurrence
 (30.7%), and precancer diseases (nevi) (23.1%). The diagnosis was verified before surgery in 14 (53.8%) cases, intraoperatively
 in 2 (7.7%), and post-surgery in 10 (38.5%). The tumor was localized mainly on the body (38.5%) and the lower limb (23.1%). 21
 (80.8%) patients underwent various surgical interventions, 5 (19.2%) patients refused surgery. 8 (30.8%) patients had metastases at diagnosis; in 4 (15.4%), metastases appeared up to 3 years after surgery. The mortality before three years was 12 (46.2%).
 The 3-year observed survival was 52.1%.
 Conclusion: Timely diagnostics and optimal choice of treatment in skin melanoma are of importance. A high rate of diagnostic errors at the general practitioners’ level affects the overall survival of patients.