Kućni lekar – Mladeži i melanomi: istine i zablude

Kućni lekar – Mladeži i melanomi: istine i zablude

Melanom je zloćudni tumor o kojem postoje brojne zablude i predrasude, ne samo medicinskih laika, nego i lekara. S obzirom da su i mladeži (nevusi) i melanomi uglavnom pigmentisane kožne promene, oni se često mešaju. Međutim, razlika je ogromna.

Mladeži su dobroćudne, a melanomi zloćudne kožne promene. Zablude su često rezultat usmenih predaja, a u poslednje vreme i sadržaja na nekredibilnim internetskim stranicama te “mišljenja“ i “činjenica” prikupljenih na forumima gde medicinski laici, često u dobroj nameri, ali ipak s velikom štetom, pogrešnim informacijama i neznanjem dovode druge u zabludu. U ovom članku predstavit ćemo dokazane činjenice prihvaćene u medicinskoj zajednici i objavljene u relevantnim naučnim časopisima.

Mladezi2Jedna od vrlo čestih zabluda je da su iritacija i trauma bitni u nastanku melanoma. Melanom je zloćudni tumor koji se razvija iz pigmentnih ćelija kože koje se zovu melanociti. Često se razvija iz postojećeg mladeža, ali se može razviti i iz melanocita koji se nalaze u drugim delovima kože. U vreme kad su spoznaje o melanomu bile puno skromnije, početni stadijumi nisu se prepoznavali pa je bolest u pravilu bila dijagnostikovana već u uznapredovaloj fazi.

U tom stadijumu bolesti, već nakon minimalne iritacije i traume dolazi do krvarenja što je bolesnicima bio povod za odlazak lekaru. To je razlog zbog kojeg se dijagnoza melanoma pogrešno dovodila u vezu s iritacijom ili traumom mladeža. U današnje vreme iritacija i trauma su odbačene kao uzročni faktori promene mladeža u melanom.

Sličnog porekla je i druga česta zabluda da se mladeži ne smeju dirati, tj. odstranjivati. Upravo suprotno, odstranjenje mladeža i patohistološka potvrda da se radi o dobroćudnoj promeni anulira strah od pretvorbe mladeža u melanom. Ako se melanom dijagnostifikuje u kasnijoj fazi, metastaze su možda prisutne već u trenutku operacije ili nastanu ubrzo nakon zahvata pa su ljudi skloni napredovanje bolesti pripisati hirurgu, a ne prirodnom toku i razvoju bolesti, što je pogrešno.

Zabluda koja je takođe starije ljude stajala života je mišljenje da ako promena nije bolna, nije ni opasna. Upravo suprotno, bol je najčešće simptom koji nema veze sa zloćudnim bolestima, već drugim stanjima poput upale. Međutim, zloćudne bolesti u ranoj fazi nastanka retko izazivaju bol. Ona se u pravilu javlja kao kasni znak zloćudnih bolesti koji signaliziraju uznapredovalost i zahvaćenost okolnih struktura i/ili udaljenih organa.

Strah od odstranjivanja mladeža i odlaganje operacije ima višestruki nepovoljni učinak. Ukoliko zbog straha i zablude osoba odbija odstranjenje (eksciziju) mladeža, potencijalna dijagnoza melanoma nepotrebno se odgađa i postavlja kasnije kad je bolest već klinički uznapredovala, što smanjuje mogućnosti izlečenja. Mladeži se najčešće odstranjuju u celosti (tada se govori o eksciziji ili ekscizijskoj biopsiji), a dovoljno je da se oko njih nalazi rub zdravog tkiva od jednog milimetra. U vrlo retkim slučajevima kod izrazito velikih tzv. gigantskih mladeža koji su najčešće prirođeni i zauzimaju veliku površinu kože ili kod većih mladeža smeštenih na delovima tela gde je operacija komplikovanija (npr. lice), moguće je izrezati samo deo promene kako bi se dobio uzorak tkiva za analizu (incizijska biopsija).

Vrlo česta zabluda, koja je već odavno opovrgnuta brojnim naučnim radovima, jeste da je incizijska biopsija izrazito opasna za bolesnika zbog mogućeg širenja (diseminacije) zloćudnih ćelija te da se stoga ne sme sprovoditi. Početna biopsija se u pravilu provodi u lokalnoj anesteziji, u ambulantnim uvetima. Zahvat je brz, jednostavan, odličnog kozmetičkog učinka uz minimalni stres za bolesnika, bez opasnosti od širenja bolesti ukoliko se zaista dijagnostifikuje melanom.

Mladezi1Moguće je istovremeno odstraniti više promena ako su sumnjive. Tek kad se patohistološkom analizom dokaže da je reč o melanomu, pristupa se  operaciji koja podrazumeva odstranjivanje celog mladeža s dovoljno širokim rubom zdrave kože kako bi bili sigurni da je bolesno tkivo u potpunosti odstranjeno.

U praksi se sumnjivi mladež najčešće odstrani (ekscidira) u celosti, ali s uskim zdravih rubom. Ukoliko se postavi dijagnoza melanoma, pristupa se širem odstranjivanju zdravog tkiva (reekscizija ožiljka), a potreban rub zdravog tkiva koji se mora odstraniti zavisi od najveće debljine melanoma. Nije tačno da se uvek mora odstranjivati  veliki deo zdravog tkiva oko melanoma. No isto tako, zdravi rubovi nakon operacije melanoma nisu automatski i znak adekvatne operacije jer se nakon početne operacije u pravilu mora pristupiti široj eksciziji kako bi se odstranio dovoljan rub zdravog tkiva zbog sklonosti melanoma širenju u okolne limfatične prostore.

Redovni pregledi mladeža i odstranjivanje onih koji su sumnjivi na zloćudnu promenu ili se kliničkim pregledom proglase displastičnim ili atipičnim, dovest će do višestrukih povoljnih učinaka. Nestat će strah jer se patohistološkom dijagnozom nakon operacije uglavnom utvrdi da je reč o “običnom” mladežu koji ne predstavlja opasnost za zdravlje. Ukoliko se ipak utvrdi da je reč o melanomu, rano otkrivanje omogućuje potpuno izlečenje. Čak i kad je bolest otkrivena u nešto uznapredovanijoj fazi, detaljna patohistološka analiza omogućit će precizno utvrđivanje stepena uznapredovalosti bolesti i određivanje vrste i opsežnosti drugih dijagnostičkih i terapijskih postupaka.

S jedne strane, mladeži su zaštitni znak nekih pojedinaca poput glumice Marylin Monroe ili bivše manekenke Cindy Crawford te su u prošlosti smatrani znacima lepote zbog čega su ih dvorske dame iscrtavale na svojim licima. S druge strane, oni se mogu pretvoriti u zloćudni tumor koji je u ranoj fazi nastanka u potpunosti izlečiv, no ako se na vreme ne otkrije, u stadijumu postojanja udaljenih metastaza, više nema mogućnosti potpunog izlečenja.

Između ovih krajnosti nalazi se spektar stadijuma bolesti u kojima je izlečenje moguće, ali mnogo neizvesnije.

Kod odlaska lekaru imajte na umu da dijagnoza melanoma nije smrtna presuda za bolesnika niti da većina ljudi kod postavljanja dijagnoze ima prisutne udaljene presadnice (metastaze). Kao i kod drugih zloćudnih bolesti, otkrivanje bolesti u najranijem stadijumu bolesti (melanoma in situ) omogućuje 100-postotno izlečenje. U SAD-u samo četiri posto bolesnika kod dijagnoze melanoma ima udaljene presadnice (dok je npr. kod raka jajnika taj postotak preko 50 posto). Zbog javnozdravstvenih akcija i kampanja te kontinuirane edukacije stanovništva u nekim zemljama, posebno u Australiji, značajno se povećao broj melanoma otkrivenih u ranoj fazi kada su prognoze odlične. Stopa otkrivanja “tankih” melanoma znak je zdravstvene prosvećenosti populacije.

Izvor: http://kucnilekar.com/mladezi-melanomi-istine-zablude

Priredila: Vladana Lilić

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