Malignant melanoma - I-Melanoma Eyingozihttps://en.wikipedia.org/wiki/Melanoma
I I-Melanoma Eyingozi (Malignant melanoma) uhlobo lomdlavuza wesikhumba olusuka kumaseli akhiqiza umbala, ama-melanocyte. Kwabesifazane, ivame ukuvela emilenjeni, kanti kwabesilisa ivame ukuvela emhlane. Cishe i-25% ye-melanoma ivela ku-nevus. Izinguquko ku-nevi ezibonisa i-melanoma zihlanganisa ukwanda kosayizi, imiphetho engajwayelekile, ukushintsha kombala, noma isilonda.

Imbangela eyinhloko ye-melanoma ukuchayeka ekukhanyeni kwe-ultraviolet, ikakhulukazi kulabo abanamazinga aphansi e-pigment melanin (abantu abamhlophe). Ukukhanya kwe-UV kungavela elangeni noma kumishini yokushiswa kwesikhumba. Labo abane-nevus eziningi, umlando we-melanoma emndenini, kanye nokungasebenzi kahle kwamasosha omzimba basengozini enkulu ye-melanoma.

Ukusebenzisa i-sunscreen nokugwema ukukhanya kwe-UV kungavimbela i-melanoma. Ukwelashwa ngokuvamile kwenziwa ngokuhlinzwa. Kulabo abanomdlavuza omkhulu, ama-lymph nodes aseduze angahlolwa ukusabalala (i-metastasis). Abantu abaningi bayelapheka uma i-metastasis ingenzeki. Kulabo abanesabalalo le-melanoma, i-immunotherapy, i-biologic therapy, i-radiation therapy, noma i-chemotherapy ingathuthukisa ukusinda. Ngokwelashwa, amazinga okusinda kweminyaka emihlanu e-United States ayama-99% kulabo abanesifo sendawo, ama-65% lapho lesi sifo sesisakazekile kuma-lymph nodes, kanye nama-25% kulabo abanokusabalala okukude.

I-melanoma uhlobo oluyingozi kakhulu lomdlavuza wesikhumba. I-Australia ne-New Zealand banamazinga aphezulu kakhulu e-melanoma emhlabeni. Amazinga aphezulu e-melanoma ayenzeka naseNyakatho Yurophu naseNyakatho Melika. I-melanoma ivela kancane kakhulu e-Asia, e-Afrika nase-Latin America. E-United States, i-melanoma yenzeka cishe izikhathi ezingu-1.6 eziningi emadodeni kunabesifazane.

Izimpawu nezimpawu
Izimpawu zokuqala ze-melanoma yizinguquko ekubunjweni noma kumbala we-nevus ekhona. Endabeni ye-melanoma ye-nodular, kubonakala isigaxa esisha esikhumbeni. Ezingeni lokugcina le-melanoma, i-nevi ingase ilume, ibe nesilonda, noma yophe.

[A-Asymmetry] Ukungalingani komumo
[B-Borders] Imiphetho (engajwayelekile, enamakhona)
[C-Color] Umbala (ohlukile futhi ongajwayelekile)
[D-Diameter] Ububanzi (obukhulu kuno-6 mm = 0.24 amayintshi = obulingana nosayizi werabha lepensela)
[E-Evolving] Ukushintsha ngokuhamba kwesikhathi

cf) I-Seborrheic keratosis ingase ihlangabezane nenye noma yonke imibandela ye-ABCD, futhi ingaholela kuma-alamu angamanga.

I-metastasis yokuqala ye-melanoma ingenzeka, kodwa ayivamile; ngaphansi kwengxenye yesihlanu ye-melanoma etholwe ngaphambi kwesikhathi iba i-metastatic. Ama-metastases ebuchosheni avamile ezigulini ezine-melanoma metastatic. I-metastatic melanoma ingasakazekela esibindini, emathanjeni, esiswini, noma kuma-lymph node akude.

Ukuxilongwa
Ukubheka indawo okukhulunywa ngayo kuyindlela evame kakhulu yokusola i-melanoma. Ama-nevus anombala ongajwayelekile noma umumo ngokuvamile aphathwa njengamakhandidethi e-melanoma.
Odokotela ngokuvamile bahlola wonke ama-moles, kuhlanganise nalawo anobubanzi obungaphansi kuka-6 mm. Uma kusetshenziswa ochwepheshe abaqeqeshiwe, i-dermoscopy iyasiza kakhulu ekuboneni izilonda eziyingozi kunokusebenzisa iso lenyama lodwa. Ukuxilongwa kwenziwa nge-biopsy yanoma yisiphi isilonda sesikhumba esinezimpawu zokuthi singaba nomdlavuza.

Ukwelashwa
#Mohs surgery

Udokotela wakho angase ancome i-immunotherapy, ikakhulukazi uma une-melanoma yesigaba sesi-3 noma sesi-4 engakwazi ukususwa ngokuhlinzwa.
#Ipilimumab [Yervoy]
#Pembrolizumab [Keytruda]
#Nivolumab [Opdivo]
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Emiphumeleni ka-2022 ye-Stiftung Warentest evela eJalimane, ukwaneliseka kwabathengi nge-ModelDerm bekungaphansi kancane kunokuxhumana okukhokhelwayo kwe-telemedicine.
  • I-melanoma cishe ubude bayo u-2.5 cm (1 intshi) no-1.5 cm (0.6 intshi).
  • Malignant Melanoma — ithanga eliphakathi kwesokudla. i‑Seborrheic keratosis ingabhekwa njengokuxilongwa okuhlukile.
  • Malignant Melanoma in situ – Ihlombe elingaphambili. Nakuba ukwakheka kwesilonda kungasymmetrical, kuchazwa kahle ngombala ofanayo. Kwabase‑Asia, lesi silonda sibonakala njenge‑benign lentigo, kodwa i‑biopsy idingeka kubantu baseNtshonalanga.
  • Malignant Melanoma – Isilonda sangemuva. Kwabase-Asia, itholakala kakhulu njenge-lentigo, kodwa i-biopsy kufanele yenziwe kubantu baseNtshonalanga.
  • I‑acral lentiginous melanoma enkulu — Kwabase‑Asia, i‑acral melanoma enthandwa nasemadwaleni ivamile, kanti emazweni aseNtshonalanga i‑melanoma ezindaweni ezichayeke elangeni ivame kakhulu.
  • I-black plaque ethambile ezungeze isilonda iyinto evamile ku-acral melanoma.
  • Indawo emnyama ehlasele i-nail matrix ngaphandle kwezipho ibeka ubungozi.
  • Amelanotic melanoma ngaphansi kwesipikili kuyinto eyivelakancane. Kubantu asebekhulile abanokukhubazeka okungajwayelekile kwezinzipho, i-biopsy ingase ibhekwe ukuze ihlole kokubili i-melanoma ne-squamous cell carcinoma.
  • Nodular melanoma (i-melanoma enodular)
  • Amelanotic Melanoma ― Ithanga langemuva. Abantu abanombala omhlophe bavame ukuba nesilonda esingu-lightly pigmented noma amelanotic melanoma. Leli cala alibonisi izinguquko zemibala ezibonakala kalula noma ukuhlukahluka.
  • Scalp ― Kubantu base-Asia, izimo ezinjalo zivame ukutholakala njenge‑benign lentigo (hhayi i‑melanoma). Kodwa‑ke, amabalazwe amakhulu anombala ezindaweni ezichayeke elangeni adinga i‑biopsy kubantu baseNtshonalanga.
  • Malignant Melanoma — ingalo. Isilonda sibonisa umumo ongalingani kanye nomngcele ongajwayelekile.
  • Malignant Melanoma in situ – Ingalo.
  • I‑Malignant melanoma esiphakathi nasemuva. Ukuba khona kwe‑ulcerated patch kubonisa i‑melanoma noma i‑basal cell carcinoma.
  • Melanoma e-onyaweni. Ukuma nombala ongalingani, kanye nokuvuvukala okuhambisana nakho, kuphakamisa i-melanoma.
  • Acral melanoma – i-melanoma ye-acral (i-melanoma ye-nail) kubantu base-Asia. Isiqeshana esimnyama esingajwayelekile esidlulela ngaphandle kwesikhumba esijwayelekile esizungeze inzipho, kuyisibonakaliso esibalulekile esikhombisa ukonakala okukhulu.
  • Nakuba lesi sigameko sitholwe njenge-melanoma, okutholakele kufana kakhulu ne-hematoma yezinzipho. I-hematoma yezinzipho (benign) ivamise ukunyamalala phakathi nenyanga eyodwa kuya kwezimbili njengoba iphushwa ngaphandle. Ngakho-ke, uma isilonda siqhubeka isikhathi eside, kungase kusolwe i-melanoma futhi kwenziwe i-biopsy.
  • Amelanotic nodular melanoma – ukuvela okungajwayelekile kwemelanoma.
References Malignant Melanoma 29262210 
NIH
I-melanoma wuhlobo lwesimila olwakha lapho ama-melanocyte abe yingozi. Ama-melanocyte avela ku-neural crest. Lokhu kusho ukuthi i-melanoma ingakhula hhayi esikhumbeni kuphela, kodwa nakwezinye izindawo lapho amangqamuzana e-neural crest ehamba khona, njengepheshana lamathumbu nobuchopho. Iziguli ezine‑stage 0 melanoma zinezinga lokusinda leminyaka emihlanu elingu‑97 %, kanti lezo ezisesigabeni IV zinezinga elilinganiselwa ku‑10 % kuphela.
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) uhlobo oluyingozi kakhulu lwesimila sesikhumba, olubangela u‑90 % wokufa komdlavuza wesikhumba. Ukuze kubhekwe le nkinga, ochwepheshe abavela ku-European Dermatology Forum (EDF), European Association of Dermato‑Oncology (EADO) kanye ne-European Organization for Research and Treatment of Cancer (EORTC) babambisene.
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
i-Melanoma, uhlobo lomdlavuza wesikhumba, igqama ngobuhlobo bayo obuseduze nesimiso somzimba sokuzivikela ezifweni. Lokhu kubonakala ngokwanda kwayo kubantu abanamasosha omzimba abuthakathaka, ukuvela kwamangqamuzana omzimba kuwo womabili amathumba okuqala nokusabalala kwawo kwezinye izingxenye zomzimba, kanye neqiniso lokuthi amasosha omzimba angakwazi ukubona amaprotheni athile atholakala kumangqamuzana e-melanoma. Okubalulekile, ukwelashwa okuqinisa isimiso somzimba sokuzivikela ezifweni kubonise isithembiso ekulweni ne-melanoma. Nakuba ukusetshenziswa kwemithi yokuqinisa amasosha omzimba ekwelapheni i-melanoma ethuthukisiwe kuyintuthuko yamuva nje, ucwaningo lwakamuva lubonisa ukuthi ukuhlanganisa lezi zindlela zokwelapha ngamakhemikhali, i-radiotherapy, noma ukwelashwa kwamangqamuzana okuhlosiwe kungathuthukisa kakhulu imiphumela. Kodwa-ke, i-immunotherapy enjalo ingabangela uhla lwemiphumela emibi ehlobene nokuzivikela komzimba ethinta izitho ezihlukahlukene, okungase kunciphise ukusetshenziswa kwayo. Uma ubheka phambili, izindlela zesikhathi esizayo zokwelapha i-melanoma ethuthukisiwe zingase zibandakanye izindlela zokwelapha eziqondiswe ezindaweni ezithile zokuhlola amasosha omzimba njenge-PD1, noma izidakamizwa eziphazamisa izindlela ezithile zamangqamuzana njenge-BRAF ne-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.