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.