Malignant melanoma - Malign Melanoma
☆ Germaniyaning 2022 yilgi Stiftung Warentest natijalariga ko'ra, iste'molchilarning ModelDermdan qoniqish darajasi pullik teletibbiyot maslahatlariga qaraganda bir oz pastroq bo'lgan.
Taxminan 2,5 sm (1 dyuym) x 1,5 sm (0,6 dyuym) o'lchamdagi melanoma
Ushbu holat melanoma tashxisi qo'yilgan bo'lsa-da, vizual topilma tirnoq gematomasiga ko'proq o'xshaydi. Tirnoq gematomalari (yaxshi) odatda bir-ikki oy ichida yo'qoladi, chunki ular tashqariga chiqariladi. Shuning uchun, agar lezyon uzoq vaqt davom etsa, melanomadan shubhalanish mumkin va biopsiya o'tkazilishi kerak.
References
Melanoma - bu melanotsitlar malign bo'lganida paydo bo'ladigan o'sma turi. Melanotsitlar nerv tepasidan kelib chiqadi. Bu shuni anglatadiki, melanomalar nafaqat terida, balki oshqozon-ichak trakti va miya kabi asabiy hujayralar harakatlanadigan boshqa joylarda ham rivojlanishi mumkin. 0-bosqich melanomasi bo'lgan bemorlarning besh yillik omon qolish darajasi 97% ni tashkil qiladi, IV bosqichli bemorlar esa atigi 10% ni tashkil qiladi.
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.
Cutaneous melanoma (CM) teri o'smalarining o'ta xavfli turi bo'lib, teri saratonidan o'lim holatlarining 90% ga sabab bo'ladi. Buni hal qilish uchun the European Dermatology Forum (EDF) , the European Association of Dermato-Oncology (EADO) , and the European Organization for Research and Treatment of Cancer (EORTC) mutaxassislari hamkorlik qilishdi.
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.
Teri saratonining bir turi bo'lgan melanoma immunitet tizimi bilan yaqin aloqasi bilan ajralib turadi. Bu immuniteti zaif odamlarda ko'payishi, asl o'smalarda ham immunitet hujayralari mavjudligi va ularning tananing boshqa qismlariga tarqalishi va immunitet tizimi melanoma hujayralarida mavjud bo'lgan ba'zi oqsillarni taniy olishidan dalolat beradi. Muhimi, immunitet tizimini mustahkamlovchi muolajalar melanomaga qarshi kurashda va'da berdi. Ilg'or melanomani davolashda immunitetni kuchaytiruvchi terapiyadan foydalanish nisbatan yaqinda bo'lgan ish bo'lsa-da, so'nggi tadqiqotlar shuni ko'rsatadiki, bu terapiyani kimyoterapiya, radioterapiya yoki maqsadli molekulyar davolanish bilan birlashtirish natijalarni sezilarli darajada yaxshilashi mumkin. Biroq, bunday immunoterapiya turli organlarga ta'sir qiluvchi immunitet bilan bog'liq bir qator yon ta'sirlarni keltirib chiqarishi mumkin, bu esa uni qo'llashni cheklashi mumkin. Oldinga qarab, rivojlangan melanomani davolashning kelajakdagi yondashuvlari PD1 kabi ma'lum immun nazorat nuqtalarini yoki BRAF va MEK kabi o'ziga xos molekulyar yo'llarga xalaqit beradigan dorilarni o'z ichiga olishi mumkin.
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.
Melanomaning asosiy sababi teri pigmenti melanin (oq populyatsiya) darajasi past bo'lgan odamlarda ultrabinafsha nurlanishdir. UV nurlari quyosh yoki bronzlash moslamalaridan bo'lishi mumkin. Ko'p nevuslari, oila a'zolarining melanoma tarixi va immuniteti zaif bo'lganlar melanoma xavfi yuqori.
Quyosh kremidan foydalanish va ultrabinafsha nurlardan qochish melanomani oldini oladi. Davolash odatda jarrohlik yo'li bilan olib tashlanadi. Bir oz kattaroq saratoni bo'lganlarda, yaqin atrofdagi limfa tugunlari tarqalishi (metastaz) uchun tekshirilishi mumkin. Ko'pchilik metastaz bo'lmasa, davolanadi. Melanoma tarqalganlar uchun immunoterapiya, biologik terapiya, radiatsiya terapiyasi yoki kimyoterapiya omon qolishni yaxshilashi mumkin. Davolash bilan, Qo'shma Shtatlarda besh yillik omon qolish darajasi mahalliy kasalliklarga chalinganlar orasida 99% ni, kasallik limfa tugunlariga tarqalganda 65% va uzoqdan tarqaladiganlar orasida 25% ni tashkil qiladi.
Melanoma teri saratonining eng xavfli turi hisoblanadi. Avstraliya va Yangi Zelandiya dunyodagi eng yuqori melanoma darajasiga ega. Melanomaning yuqori darajasi Shimoliy Evropa va Shimoliy Amerikada ham uchraydi. Melanoma Osiyo, Afrika va Lotin Amerikasida kamroq uchraydi. Qo'shma Shtatlarda melanoma erkaklarda ayollarga qaraganda taxminan 1,6 marta tez-tez uchraydi.
○ Belgilar va alomatlar
Melanomaning dastlabki belgilari mavjud nevusning shakli yoki rangidagi o'zgarishlardir. Nodulyar melanoma bo'lsa, bu terida yangi bo'lak paydo bo'lishi. Melanomaning keyingi bosqichlarida nevus qichishi, yarasi yoki qon ketishi mumkin.
[A-Asymmetry] Shaklning assimetriyasi
[B-Borders] Chegarasi (qirralari va burchaklari bilan tartibsiz)
[C-Color] Rang (rang-barang va tartibsiz)
[D-Diameter] Diametri (6 mm dan katta = 0,24 dyuym = qalam o'chirgichining o'lchamiga teng)
[E-Evolving] Vaqt o'tishi bilan rivojlaning
cf) Seboreik keratoz ABCD mezonlarining bir qismi yoki barchasiga javob berishi va noto'g'ri signallarga olib kelishi mumkin.
Erta melanomaning metastazi mumkin, ammo nisbatan kam; erta tashxis qo'yilgan melanomalarning beshdan biridan kamrog'i metastatik bo'ladi. Metastatik melanoma bilan og'rigan bemorlarda miya metastazlari tez-tez uchraydi. Metastatik melanoma jigar, suyaklar, qorin bo'shlig'i yoki uzoq limfa tugunlariga ham tarqalishi mumkin.
○ Diagnoz
Ko'rib chiqilayotgan hududga qarash melanomadan shubhalanishning eng keng tarqalgan usuli hisoblanadi. Rangi yoki shakli tartibsiz bo'lgan nevuslar odatda melanoma nomzodi sifatida qabul qilinadi.
Shifokorlar odatda barcha mollarni, shu jumladan diametri 6 mm dan kam bo'lgan mollarni tekshiradilar. O'qitilgan mutaxassislar tomonidan qo'llanilganda, dermoskopiya faqat yalang'och ko'zni ishlatishdan ko'ra malign lezyonlarni aniqlash uchun foydalidir. Tashxis potentsial saraton belgilariga ega bo'lgan har qanday teri lezyonining biopsiyasidir.
○ Davolash
#Mohs surgery
Shifokoringiz immunoterapiyani tavsiya qilishi mumkin, ayniqsa sizda jarrohlik yo'li bilan olib tashlanishi mumkin bo'lmagan 3 yoki 4 bosqichli melanoma bo'lsa.
#Ipilimumab [Yervoy]
#Pembrolizumab [Keytruda]
#Nivolumab [Opdivo]