Malignant melanoma - Melanoma Ganashttps://en.wikipedia.org/wiki/Melanoma
Melanoma Ganas (Malignant melanoma) minangka jinis kanker kulit sing berkembang saka sel sing ngasilake pigmen sing dikenal minangka melanosit. Ing wanita, sing paling umum ana ing sikil, nalika ing wong, sing paling umum ana ing punggung. Kira-kira 25% melanoma berkembang saka nevus. Owah-owahan ing nevi sing bisa nunjukake melanoma kalebu paningkatan ukuran, pinggiran sing ora teratur, owah-owahan warna, utawa ulkus.

Penyebab utama melanoma yaiku paparan sinar ultraviolet ing wong sing duwe pigmen kulit melanin sing sithik (populasi kulit putih). Sinar UV bisa uga saka srengenge utawa piranti penyamakan. Sing duwe akeh nevus, riwayat melanoma saka anggota kulawarga, lan fungsi kekebalan sing kurang luwih beresiko ngalami melanoma.

Nggunakake tabir surya lan nyegah sinar UV bisa nyegah melanoma. Perawatan biasane dibusak dening surgery. Ing kanker sing rada gedhe, kelenjar getah bening sing cedhak bisa dites kanggo nyebarake (metastasis). Umume wong bisa diobati yen metastasis durung kedadeyan. Kanggo wong sing wis nyebar melanoma, imunoterapi, terapi biologis, terapi radiasi, utawa kemoterapi bisa ningkatake kaslametan. Kanthi perawatan, tingkat kelangsungan urip limang taun ing Amerika Serikat yaiku 99% ing antarane sing nandhang penyakit lokal, 65% nalika penyakit kasebut nyebar menyang kelenjar getah bening, lan 25% ing antarane sing nyebar adoh.

Melanoma minangka jinis kanker kulit sing paling mbebayani. Australia lan Selandia Anyar nduweni tingkat melanoma paling dhuwur ing donya. Tingkat melanoma sing dhuwur uga dumadi ing Eropa Lor lan Amerika Utara. Melanoma dumadi luwih sithik ing Asia, Afrika, lan Amerika Latin. Ing Amerika Serikat, melanoma dumadi kira-kira 1,6 kaping luwih kerep ing wong lanang tinimbang wanita.

○ Tandha lan gejala
Tandha awal melanoma yaiku owah-owahan wujud utawa warna nevus sing ana. Ing kasus melanoma nodular, katon bongkahan anyar ing kulit. Ing tahap pungkasan melanoma, nevi bisa gatel, ulcerate, utawa getihen.

[A-Asymmetry] Asimetri saka wangun
[B-Borders] Border (ora teratur kanthi pinggir lan sudhut)
[C-Color] Werna (variegated lan ora teratur)
[D-Diameter] Diameter (luwih saka 6 mm = 0,24 inci = kira-kira ukurane penghapus potlot)
[E-Evolving] Evolve liwat wektu

cf) Keratosis seboroik bisa nyukupi sawetara utawa kabeh kriteria ABCD, lan bisa nyebabake weker palsu.

Metastasis melanoma awal bisa, nanging relatif langka; kurang saka seperlima melanoma sing didiagnosis awal dadi metastatik. Metastase otak umume ing pasien karo melanoma metastatik. Melanoma metastatik uga bisa nyebar menyang ati, balung, weteng, utawa kelenjar getah bening sing adoh.

○ Diagnosis
Nggoleki wilayah kasebut minangka cara sing paling umum kanggo curiga melanoma. Nevus sing ora duwe warna utawa wujud biasane dianggep minangka calon melanoma.
Dokter biasane mriksa kabeh mol, kalebu sing diametere kurang saka 6 mm. Nalika digunakake dening spesialis sing dilatih, dermoskopi luwih migunani kanggo ngenali lesi ganas tinimbang nggunakake mripat langsung. Diagnosis yaiku kanthi biopsi saka lesi kulit apa wae sing nduweni tanda-tanda potensial kanker.

○ Pengobatan
#Mohs surgery

Dokter sampeyan bisa menehi rekomendasi imunoterapi utamane yen sampeyan duwe melanoma tahap 3 utawa tahap 4 sing ora bisa diilangi kanthi operasi.
#Ipilimumab [Yervoy]
#Pembrolizumab [Keytruda]
#Nivolumab [Opdivo]
☆ Ing asil Stiftung Warentest 2022 saka Jerman, kepuasan konsumen karo ModelDerm mung luwih murah tinimbang konsultasi telemedicine sing dibayar.
  • Melanoma kira-kira 2,5cm (1 inci) kanthi 1,5cm (0,6 inci)
  • Malignant Melanoma ― paha medial tengen. Keratosis seborrheic bisa dianggep minangka diagnosis diferensial.
  • Malignant Melanoma in situ ― Pundhak anterior. Sanajan bentuk lesi kasebut asimetris, uga ditetepake kanthi warna sing rata. Ing Asia, lesi iki biasane ana minangka lentigo jinak, nanging biopsi kudu dibutuhake ing populasi Kulon.
  • Malignant Melanoma ― Lesi punggung. Ing wong Asia, biasane didiagnosis minangka lentigo, nanging biopsi kudu ditindakake ing wong Kulon.
  • Gedhe acral lentiginous melanoma ― Ing wong Asia, acral melanoma ing telapak tangan lan tlapak sikil umume, dene ing wong Kulon, melanoma ing wilayah sing kena sinar srengenge luwih umum.
  • black plaque sing alus ing saubengé lesi minangka temuan umum ing acral melanoma.
  • Titik ireng sing wis nyerbu area matriks kuku ing njaba kuku nuduhake malignancy.
  • Amelanotic melanoma ing ngisor kuku iku kedadeyan langka. Kanggo wong tuwa kanthi cacat kuku sing ora teratur, biopsi bisa uga dianggep kanggo mriksa melanoma lan karsinoma sel skuamosa.
  • Nodular melanoma
  • Amelanotic Melanoma ― Punggung mburi. Wong sing duwe kulit putih asring ngalami lesi lightly pigmented or amelanotic melanomas. Kasus iki ora nuduhake owah-owahan utawa variasi warna sing gampang diamati.
  • Kulit Kepala ― Ing wong Asia, kasus kaya ngono biasane didiagnosis minangka lentigo jinak (dudu melanoma). Nanging, patch pigmen gedhe ing wilayah sing kena sinar srengenge mbutuhake biopsi ing populasi Kulon.
  • Malignant Melanoma ― lengen. Lesi kasebut nuduhake wangun asimetris lan wates sing ora teratur.
  • Malignant Melanoma in situ ― Lengen.
  • Malignant melanoma ing tengah mburi. Anane patch ulcerated nuduhake melanoma utawa karsinoma sel basal.
  • Melanoma ing sikil. Wangun lan warna asimetris, lan inflamasi sing diiringi melanoma.
  • Acral melanoma ― Nail ing wong Asia. Tembelan ireng sing ora teratur sing ngluwihi kulit normal ing sakubenge kuku minangka temuan penting sing banget nyaranake malignancy.
  • Sanajan kasus iki didiagnosis minangka melanoma, temuan visual luwih mirip karo hematoma kuku. Hematoma kuku (jinak) biasane ilang sajrone siji nganti rong sasi nalika diusir. Mulane, yen lesi tetep suwe, melanoma bisa dicurigai lan biopsi kudu ditindakake.
  • Amelanotic nodular melanoma ― Manifestasi melanoma sing ora biasa.
References Malignant Melanoma 29262210 
NIH
Melanoma minangka jinis tumor sing dibentuk nalika melanosit dadi ganas. Melanosit asalé saka puncak saraf. Iki tegese melanoma bisa berkembang ora mung ing kulit nanging uga ing papan liya ing ngendi sel-sel puncak saraf lelungan, kayata saluran pencernaan lan otak. Pasien karo melanoma tahap 0 duwe tingkat kelangsungan urip limang taun 97%, dene sing duwe penyakit tahap IV mung udakara 10%.
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.
 European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics: Update 2022 35570085
Cutaneous melanoma (CM) minangka jinis tumor kulit sing mbebayani banget, tanggung jawab kanggo 90% kematian kanker kulit. Kanggo ngatasi masalah iki, ahli saka the European Dermatology Forum (EDF) , the European Association of Dermato-Oncology (EADO) , and the European Organization for Research and Treatment of Cancer (EORTC) wis kerja sama.
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.
 Immunotherapy in the Treatment of Metastatic Melanoma: Current Knowledge and Future Directions 32671117 
NIH
Melanoma, jinis kanker kulit, stands metu kanggo hubungan cedhak karo sistem imun. Iki dibuktekake saka kedadeyan sing tambah akeh ing wong sing duwe sistem kekebalan sing kurang, anané sel kekebalan ing tumor asli lan panyebaran menyang bagian awak liyane, lan kasunyatan manawa sistem kekebalan bisa ngenali protein tartamtu sing ditemokake ing sel melanoma. Sing penting, perawatan sing ningkatake sistem kekebalan wis janji kanggo nglawan melanoma. Nalika nggunakake terapi nguatake kekebalan kanggo ngobati melanoma maju minangka perkembangan sing relatif anyar, riset anyar nuduhake yen nggabungake terapi kasebut karo kemoterapi, radioterapi, utawa perawatan molekuler sing ditargetake bisa ningkatake asil. Nanging, imunoterapi kasebut bisa nyebabake macem-macem efek samping sing ana gandhengane karo kekebalan sing mengaruhi macem-macem organ, sing bisa mbatesi panggunaane. Ing ngarep, pendekatan ing mangsa ngarep kanggo ngobati melanoma lanjut bisa uga kalebu terapi sing nargetake pos pemeriksaan kekebalan khusus kaya PD1, utawa obat-obatan sing ngganggu jalur molekuler tartamtu kaya BRAF lan 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.