Malignant melanoma - Melanoma Malignant
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Melanoma timcheall air 2.5cm (1 òirleach) le 1.5cm (0.6 òirleach)
Ged a chaidh a’ chùis seo a dhearbhadh mar melanoma, tha an lorg lèirsinneach nas coltaiche ri hematoma ìnean. Mar as trice bidh hematomas ìnean (mì-chinnteach) a 'dol à sealladh taobh a-staigh aon no dà mhìos fhad' sa tha iad air am putadh a-mach. Mar sin, ma mhaireas an dochann airson ùine mhòr, dh’ fhaodadh gum bi amharas ann gu bheil melanoma ann agus bu chòir biopsy a dhèanamh.
References
Is e seòrsa de tumhair a th’ ann am melanoma a bhios a’ cruthachadh nuair a dh’fhàsas melanocytes malignant. Tha melanocytes a 'tighinn bhon suaicheantas neural. Tha seo a’ ciallachadh gum faod melanomas leasachadh chan ann a-mhàin air a’ chraiceann ach cuideachd ann an àiteachan eile far am bi ceallan suaicheantas neural a’ siubhal, leithid an t-slighe gastrointestinal agus an eanchainn. Tha ìre mairsinn còig bliadhna de 97% aig euslaintich le melanoma ìre 0, ach chan eil ach ìre de mu 10% aig an fheadhainn le galar ìre IV.
A melanoma is a tumor produced by the malignant transformation of melanocytes. Melanocytes are derived from the neural crest; consequently, melanomas, although they usually occur on the skin, can arise in other locations where neural crest cells migrate, such as the gastrointestinal tract and brain. The five-year relative survival rate for patients with stage 0 melanoma is 97%, compared with about 10% for those with stage IV disease.
A melanoma is a tumor produced by the malignant transformation of melanocytes. Melanocytes are derived from the neural crest; consequently, melanomas, although they usually occur on the skin, can arise in other locations where neural crest cells migrate, such as the gastrointestinal tract and brain. The five-year relative survival rate for patients with stage 0 melanoma is 97%, compared with about 10% for those with stage IV disease.
Tha Cutaneous melanoma (CM) na sheòrsa de tumhair craiceann a tha gu math cunnartach, le uallach airson 90% de bhàsan aillse craiceann. Gus dèiligeadh ri seo, bha eòlaichean bho the European Dermatology Forum (EDF) , the European Association of Dermato-Oncology (EADO) , and the European Organization for Research and Treatment of Cancer (EORTC) air co-obrachadh.
Cutaneous melanoma (CM) is a highly dangerous type of skin tumor, responsible for 90% of skin cancer deaths. To address this, experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization for Research and Treatment of Cancer (EORTC) had collaborated.
Cutaneous melanoma (CM) is a highly dangerous type of skin tumor, responsible for 90% of skin cancer deaths. To address this, experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization for Research and Treatment of Cancer (EORTC) had collaborated.
Tha melanoma, seòrsa de aillse craiceann, a’ seasamh a-mach airson a dhàimh dlùth ris an t-siostam dìon. Tha seo follaiseach bhon àrdachadh ann an daoine le siostaman dìon lag, làthaireachd cheallan dìon an dà chuid anns na tumors tùsail agus an sgaoileadh gu pàirtean eile den bhodhaig, agus leis gu bheil an siostam dìon ag aithneachadh cuid de phròtainean a lorgar ann an ceallan melanoma. Gu cudromach, tha leigheasan a bhrosnaicheas an siostam dìon air gealladh a nochdadh ann a bhith a’ sabaid melanoma. Ged a tha cleachdadh leigheasan àrdachadh dìonachd ann a bhith a’ làimhseachadh melanoma adhartach na leasachadh an ìre mhath o chionn ghoirid, tha rannsachadh o chionn ghoirid a’ nochdadh gum faod a bhith a’ cothlamadh nan leigheasan sin le chemotherapy, radiotherapy, no leigheasan moileciuil cuimsichte leasachadh mòr air builean. Ach, faodaidh an leithid de immunotherapy raon de bhuaidhean co-cheangailte ri dìon a bhrosnachadh a bheir buaidh air diofar bhuill-bodhaig, a dh’ fhaodadh a bhith ga chleachdadh a chuingealachadh. A’ coimhead air adhart, dh’ fhaodadh dòighean-obrach san àm ri teachd airson làimhseachadh melanoma adhartach a bhith a’ toirt a-steach leigheasan a tha ag amas air puingean-sgrùdaidh dìon sònraichte leithid PD1, no drogaichean a chuireas bacadh air slighean moileciuil sònraichte leithid BRAF agus MEK.
Melanoma is one of the most immunologic malignancies based on its higher prevalence in immune-compromised patients, the evidence of brisk lymphocytic infiltrates in both primary tumors and metastases, the documented recognition of melanoma antigens by tumor-infiltrating T lymphocytes and, most important, evidence that melanoma responds to immunotherapy. The use of immunotherapy in the treatment of metastatic melanoma is a relatively late discovery for this malignancy. Recent studies have shown a significantly higher success rate with combination of immunotherapy and chemotherapy, radiotherapy, or targeted molecular therapy. Immunotherapy is associated to a panel of dysimmune toxicities called immune-related adverse events that can affect one or more organs and may limit its use. Future directions in the treatment of metastatic melanoma include immunotherapy with anti-PD1 antibodies or targeted therapy with BRAF and MEK inhibitors.
Melanoma is one of the most immunologic malignancies based on its higher prevalence in immune-compromised patients, the evidence of brisk lymphocytic infiltrates in both primary tumors and metastases, the documented recognition of melanoma antigens by tumor-infiltrating T lymphocytes and, most important, evidence that melanoma responds to immunotherapy. The use of immunotherapy in the treatment of metastatic melanoma is a relatively late discovery for this malignancy. Recent studies have shown a significantly higher success rate with combination of immunotherapy and chemotherapy, radiotherapy, or targeted molecular therapy. Immunotherapy is associated to a panel of dysimmune toxicities called immune-related adverse events that can affect one or more organs and may limit its use. Future directions in the treatment of metastatic melanoma include immunotherapy with anti-PD1 antibodies or targeted therapy with BRAF and MEK inhibitors.
Is e prìomh adhbhar melanoma nochdadh solas ultraviolet anns an fheadhainn le ìrean ìosal de melanin pigment craiceann (sluagh geal). Faodaidh an solas UV a bhith bhon ghrèin no innealan tanaidh. Tha an fheadhainn le mòran nevus, eachdraidh melanoma de bhuill teaghlaich, agus droch ghnìomhachd dìon ann an cunnart nas motha aig melanoma.
Le bhith a’ cleachdadh sunscreen agus a’ seachnadh solas UV dh’ fhaodadh sin casg a chuir air melanoma. Mar as trice tha làimhseachadh air a thoirt air falbh le lannsaireachd. Anns an fheadhainn le cansearan beagan nas motha, faodar nòsan lùbach faisg air làimh a dhearbhadh airson sgaoileadh (metastasis). Bidh a ‘mhòr-chuid de dhaoine air an leigheas mura h-eil metastasis air tachairt. Dhaibhsan anns a bheil melanoma air sgaoileadh, faodaidh immunotherapy, leigheas bith-eòlais, leigheas rèididheachd, no chemotherapy leasachadh a thoirt air mairsinn. Le làimhseachadh, tha na h-ìrean mairsinn còig bliadhna anns na Stàitean Aonaichte aig 99% am measg an fheadhainn le galair ionadail, 65% nuair a tha an galar air sgaoileadh gu nodan lymph, agus 25% am measg an fheadhainn le sgaoileadh fad às.
Is e melanoma an seòrsa aillse craiceann as cunnartaiche. Tha na h-ìrean melanoma as àirde san t-saoghal ann an Astràilia agus Sealan Nuadh. Tha ìrean àrda de melanoma cuideachd a’ nochdadh ann an ceann a tuath na Roinn Eòrpa agus Ameireagadh a Tuath. Tha melanoma a’ nochdadh mòran nas lugha ann an Àisia, Afraga, agus Ameireagaidh Laidinn. Anns na Stàitean Aonaichte, bidh melanoma a ‘tachairt timcheall air 1.6 tursan nas trice ann am fir na boireannaich.
○ Soidhnichean agus comharraidhean
Is e comharran tràth melanoma atharrachaidhean ann an cumadh no dath nevus a tha ann mar-thà. Ann an cùis melanoma nodular, is e coltas cnap ùr air a ‘chraiceann a th’ ann. Aig ìrean melanoma nas fhaide air adhart, faodaidh an nevi itch, ulcerate, no bleed.
[A-Asymmetry] Neo-chunbhalachd cruth
[B-Borders] Crìochan (neo-riaghailteach le oirean agus oiseanan)
[C-Color] Dath (eadar-dhealaichte agus neo-riaghailteach)
[D-Diameter] Trast-thomhas (nas motha na 6 mm = 0.24 òirleach = mu mheud inneal-brisidh peansail)
[E-Evolving] Leasaich thar ùine
cf) Faodaidh keratosis seborrheic coinneachadh ri cuid de shlatan-tomhais ABCD, no a h-uile gin dhiubh, agus faodaidh seo leantainn gu rabhaidhean meallta.
Tha meatastasis de melanoma tràth comasach, ach gu math tearc; bidh nas lugha na còigeamh cuid de melanomas a chaidh a dhearbhadh tràth a’ fàs meatastatach. Tha meatastases eanchainn cumanta ann an euslaintich le melanoma meatastatach. Faodaidh melanoma meatastatach cuideachd sgaoileadh chun adha, cnàmhan, abdomen, no neadan lùbach fad às.
○ Diagnosis
Is e a bhith a ‘coimhead air an raon sin an dòigh as cumanta air amharas a thoirt air melanoma. Mar as trice thathar a’ làimhseachadh nevus a tha neo-riaghailteach ann an dath no cumadh mar thagraichean airson melanoma.
Mar as trice bidh lighichean a’ sgrùdadh a h-uile ball-dòrain, a’ toirt a-steach an fheadhainn nas lugha na 6 mm ann an trast-thomhas. Nuair a thèid a chleachdadh le eòlaichean ionnsaichte, tha dermoscopy nas cuideachail airson leòntan malignant a chomharrachadh na bhith a’ cleachdadh an t-sùil rùisgte a-mhàin. Tha breithneachadh air a dhèanamh le biopsy de leòn craiceann sam bith aig a bheil comharran a dh’ fhaodadh a bhith aillse.
○ làimhseachadh
#Mohs surgery
Faodaidh do dhotair immunotherapy a mholadh gu sònraichte ma tha melanoma ìre 3 no ìre 4 agad nach gabh a thoirt air falbh le obair-lannsa.
#Ipilimumab [Yervoy]
#Pembrolizumab [Keytruda]
#Nivolumab [Opdivo]