Melanoma

Descripción General

Definición

El melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma es un tumor Tumor Inflammation maligno que surge de los LOS Neisseria melanocitos, las células productoras de melanina de la epidermis Epidermis The external, nonvascular layer of the skin. It is made up, from within outward, of five layers of epithelium: (1) basal layer (stratum basale epidermidis); (2) spinous layer (stratum spinosum epidermidis); (3) granular layer (stratum granulosum epidermidis); (4) clear layer (stratum lucidum epidermidis); and (5) horny layer (stratum corneum epidermidis). Skin: Structure and Functions.

Epidemiología

• 5ta malignidad más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum hombres y mujeres en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria Estados Unidos
• Edad promedio al AL Amyloidosis diagnóstico: 57 años
• Aumento de la incidencia a nivel mundial:
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Queensland, Australia (más alto): 72 por 100 000
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos: 27 por 100 000
• El cáncer de piel más mortal

Etiología

• Exposición excesiva a la radiación ultravioleta A (UVA) y B (UVB):
  • Exposición a la luz solar (UVB más estrechamente asociada con el melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma)
  • Más alto en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las áreas ecuatoriales (cuando se ajusta al AL Amyloidosis tipo de piel), donde los LOS Neisseria rayos UVB son más intensos
  • Uso de camas de bronceado (UVA)
  • ↑ número de quemaduras solares con ampollas = ↑ riesgo
  • Exposición a psoraleno y radiación UVA como tratamiento para la psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis u otras afecciones de la piel
• Papel del protector solar:
  • Es probable que los LOS Neisseria usuarios de protector solar se expongan más al AL Amyloidosis sol que el público en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum general
  • Protector solar que protege principalmente contra los LOS Neisseria rayos UVB (aumenta el riesgo de exposición a los LOS Neisseria rayos UVA)
• Predisposición genética y características personales:
  • Antecedentes familiares positivos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 5%–10% de los LOS Neisseria casos
  • Piel blanca, ojos azules, cabello rubio/pelirrojo, pecas
  • Presencia de > 40 nevos melanocíticos (un marcador de ↑ riesgo)
  • Síndromes genéticos:
    • Síndrome de melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma familiar con lunares atípicos múltiples: una condición genética autosómica dominante caracterizada por la presencia de múltiples lunares atípicos
    • Xeroderma pigmentoso: una afección autosómica recesiva causada por un defecto en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria mecanismos de reparación del ADN que provoca sensibilidad a la luz ultravioleta (i.e., quemaduras solares graves) y desarrollo de cáncer de piel
• Inmunosupresión:
  • Pacientes trasplantados
  • Neoplasias hematológicas

Anatomía

• Los LOS Neisseria melanomas surgen más comúnmente de la piel.
• Superficies mucosas: alrededor del 1% de los LOS Neisseria casos
  • Región de cabeza y cuello: cavidades oral, nasal y paranasal
  • Región anorrectal
  • Región vulvovaginal
• Ojos:
  • Uvea Uvea The pigmented vascular coat of the eyeball, consisting of the choroid; ciliary body; and iris, which are continuous with each other. Eye: Anatomy (95% de los LOS Neisseria melanomas oculares)
  • Conjuntiva

Fisiopatología y Clasificación

Patogénesis

• La mayoría de los LOS Neisseria melanomas surgen en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la epidermis Epidermis The external, nonvascular layer of the skin. It is made up, from within outward, of five layers of epithelium: (1) basal layer (stratum basale epidermidis); (2) spinous layer (stratum spinosum epidermidis); (3) granular layer (stratum granulosum epidermidis); (4) clear layer (stratum lucidum epidermidis); and (5) horny layer (stratum corneum epidermidis). Skin: Structure and Functions como tumores indolentes de crecimiento lento.
• Puede surgir en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum lesiones precursoras preexistentes/nevos o de novo (a partir de piel sana).
• Tipos de nevos considerados precursores del melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma:
  • Nevo adquirido común
  • Nevo displásico
  • Nevo congénito
  • Nevo azul celular
• Mutaciones comúnmente encontradas:
  • CDKN2A (mutación específica más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma familiar)
  • BRAF (más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma de extensión superficial)
  • KIT (más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma lentigo maligno y melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma acral-lentiginoso)
  • RAS RAS Renal artery stenosis (RAS) is the narrowing of one or both renal arteries, usually caused by atherosclerotic disease or by fibromuscular dysplasia. If the stenosis is severe enough, the stenosis causes decreased renal blood flow, which activates the renin-angiotensin-aldosterone system (RAAS) and leads to renovascular hypertension (RVH). Renal Artery Stenosis
  • NF1 NF1 Neurofibromatosis type 1 (NF1), also known as phakomatosis, is a neurocutaneous disorder that is most commonly of autosomal dominant inheritance due to mutations in the NF1 gene. Neurofibromatosis type 1 presents a range of clinical manifestations with the most prominent features being various pigmented skin lesions called café au lait macules (CALMs), neurofibromas, freckling of the inguinal and axillary regions, and iris hamartomas. Neurofibromatosis Type 1
• Fases de crecimiento:
  • Crecimiento horizontal (crecimiento radial):
    • A lo largo de la unión dermoepidérmica
    • La mayoría de los LOS Neisseria melanomas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum esta etapa no hacen metástasis.
    • La microinvasión en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la dermis Dermis A layer of vascularized connective tissue underneath the epidermis. The surface of the dermis contains innervated papillae. Embedded in or beneath the dermis are sweat glands; hair follicles; and sebaceous glands. Skin: Structure and Functions puede estar presente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum esta etapa.
  • Crecimiento vertical:
    • Claramente invasivo profundamente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la dermis Dermis A layer of vascularized connective tissue underneath the epidermis. The surface of the dermis contains innervated papillae. Embedded in or beneath the dermis are sweat glands; hair follicles; and sebaceous glands. Skin: Structure and Functions
    • Asociado con potencial metastásico

Tipos morfológicos

Tipos principales:

Variantes poco comunes:

• Melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma amelanótico:
  • Consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum melanocitos pobremente diferenciados/desdiferenciados
  • Se presentan como lesiones planas o elevadas de color claro (rosado/rojo)
  • Confundido con lesiones benignas (e.g., nevo melanocítico), lo que lleva a un retraso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el diagnóstico (peor pronóstico)
• Melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma Spitzoide:
  • Se asemeja a los LOS Neisseria tumores de Spitz
  • Lesiones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum crecimiento: pápulas/nódulos que pueden presentarse con color rojo, marrón, negro o azul
• Melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma desmoplásico: placas o nódulos pálidos poco comunes, de crecimiento lento, que se asemejan a una cicatriz
• Melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma sintetizador de pigmentos (melanocitoma):
  • Tipo indolente de nódulos azul-negro
  • Bajo riesgo de metástasis

Clasificación

Profundidad de Breslow:

• Un método estandarizado de medición de la profundidad del melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma
• Uso de un micrómetro óptico instalado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el microscopio para medir desde la parte superior de la capa granular epidérmica hasta la invasión tumoral más profunda
• Utilizado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la 8va edición del sistema de estadificación de tumores del American Joint Committee on Cancer (pero el grosor del tumor Tumor Inflammation se registró con una precisión de 0,1 mm MM Multiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies. Multiple Myeloma en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum lugar de los LOS Neisseria 0,01 mm MM Multiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies. Multiple Myeloma originales)

Presentación Clínica

Melanomas cutáneos (más comunes)

• La mayoría presenta una nueva lesión en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la piel (de novo):
  • Lesión pigmentada sospechosa
  • Puede haber prurito o sangrado.
• Un nevo preexistente:
  • Cambio de forma, tamaño o color.
  • Signo del “patito feo”: 1 lunar de aspecto diferente entre otros lunares que son predominantemente de morfología similar

Otros melanomas

• Subungueal:
  • Banda marrón o negra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la uña
  • Con o sin distrofia ungueal
  • Extensión del pigmento sobre el pliegue ungueal
  • Afecta más comúnmente al AL Amyloidosis dedo gordo del pie y al AL Amyloidosis pulgar.
• Ocular:
  • Puede ser asintomático
  • Cambio en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la forma de la pupila
  • Mancha pigmentada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el iris
  • Cambios en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la visión
• Anal: signos y síntomas similares a otros cánceres anales

Diagnóstico

Antecedentes

• Exposición al AL Amyloidosis sol (ocupacional o recreativa)
• Antecedentes familiares
• Antecedentes de melanomas previos

Examen físico

• Examen regular Regular Insulin de la piel: debe ser minucioso y completo (todo el cuerpo) y realizarse con una iluminación óptima
• Técnicas complementarias:
  • Dermatoscopia
  • Microscopía confocal de reflectancia (permite la visualización de células de epidermis Epidermis The external, nonvascular layer of the skin. It is made up, from within outward, of five layers of epithelium: (1) basal layer (stratum basale epidermidis); (2) spinous layer (stratum spinosum epidermidis); (3) granular layer (stratum granulosum epidermidis); (4) clear layer (stratum lucidum epidermidis); and (5) horny layer (stratum corneum epidermidis). Skin: Structure and Functions y dermis Dermis A layer of vascularized connective tissue underneath the epidermis. The surface of the dermis contains innervated papillae. Embedded in or beneath the dermis are sweat glands; hair follicles; and sebaceous glands. Skin: Structure and Functions papilar)
  • Diagnóstico asistido por computadora
• Criterios ABCDE:
  • Desarrollado para diferenciar las lesiones melanocíticas benignas de los LOS Neisseria melanomas
  • Se justifica una evaluación adicional si la lesión cumple con ≥ 1 de los LOS Neisseria siguientes criterios:
    • A (asimetría): forma asimétrica
    • B (bordes): borde irregular/poco definido
    • C (color): pigmentación variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables o distribuida irregularmente
    • D (diámetro):> 6mm
    • E (evolución): cambio de tamaño, forma o color; nevo excepcional diferente de otros nevos

Biopsia

• Biopsia de espesor total por escisión (estándar de oro):
  • Escisión completa de la lesión con un margen de 1 a 3 mm MM Multiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies. Multiple Myeloma de piel normal
  • Diagnóstico histopatológico basado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum una combinación de características, que incluyen:
    • Melanocitos atípicos con núcleos grandes, nucléolos prominentes
    • Asimetría arquitectónica
    • Circunscripción deficiente (se observa que las células en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el borde son únicas, pequeñas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum lugar de anidadas)
    • Las células epidérmicas y dérmicas inferiores varían en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum tamaño y forma.
  • Inmunohistoquímica (e.g., S-100, Sox10 son proteínas expresadas por casi todos los LOS Neisseria melanomas)
  • Brinda información sobre la etapa de Breslow y el estado de la ulceración (ambos necesarios para la evaluación de la estadificación y el pronóstico)
• Biopsia incisional:
  • Para lesiones grandes
  • Si la lesión está en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un área difícil o cosméticamente sensible (e.g., facial, subungueal)

Estudios complementarios

Los LOS Neisseria estudios adjuntos se utilizan para la evaluación de la enfermedad metastásica.

• Estudios de laboratorio:
  • Hemograma
  • Pruebas de función hepática
  • LDH LDH Osteosarcoma
• Estudios de imagen:
  • Radiografía de tórax: para metástasis pulmonares
  • Ultrasonido: para linfadenopatía
  • TC o PET PET An imaging technique that combines a positron-emission tomography (PET) scanner and a ct X ray scanner. This establishes a precise anatomic localization in the same session. Nuclear Imaging: para metástasis a distancia

Estadificación

Tratamiento y Pronóstico

Cirugía

Escisión local amplia:

• Pilar del tratamiento
• Los LOS Neisseria márgenes recomendados dependen del grosor de la lesión.
• Es posible que se requiera un injerto de piel para el cierre según el tamaño y la ubicación.
• Para el melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma acral/subungueal, puede ser necesaria la amputación del dedo.

Cirugía micrográfica de Mohs:

• Técnica especializada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la extirpación de cánceres de piel localmente invasivos
• Controvertido en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma (ya que no hay ensayos clínicos que lo comparen con la escisión local amplia)
• Se utiliza para el melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma in situ y el lentigo maligno de cabeza y cuello
• No para melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma invasivo

Procedimientos adicionales

Biopsia de ganglio linfático centinela:

• Ganglio linfático centinela: primer ganglio linfático de drenaje en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el sistema linfático del tumor Tumor Inflammation
• Realizado para ganglios clínicamente negativos (para detectar metástasis ocultas) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Lesiones > 0,8 mm MM Multiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies. Multiple Myeloma de espesor
  • Lesiones de cualquier grosor con ulceración

Disección de ganglios linfáticos regionales:

• La disección completa de los LOS Neisseria ganglios linfáticos ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum aquellos con biopsia de ganglio centinela positiva), proporcionó una recurrencia reducida de los LOS Neisseria ganglios linfáticos regionales.
• Sin embargo, no hubo diferencia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la supervivencia entre la disección completa de los LOS Neisseria ganglios linfáticos versus observación.

Metastasectomía quirúrgica:

• Se puede hacer para metástasis distantes aisladas
• A veces se realiza después de una buena respuesta inicial a la terapia adyuvante

Terapias adyuvantes para el melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma avanzado

• Por lo general, no se recomienda para etapas IIC e inferiores
• Para la enfermedad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum etapa III (afectación de los LOS Neisseria ganglios linfáticos) y etapa IV (enfermedad metastásica)
• Opciones:
  • Inmunoterapia (combinación de):
    • Nivolumab Nivolumab A genetically engineered, fully humanized immunoglobulin g4 monoclonal antibody that binds to the pd-1 receptor, activating an immune response to tumor cells. It is used as monotherapy or in combination with ipilimumab for the treatment of advanced malignant melanoma. It is also used in the treatment of advanced or recurring non-small cell lung cancer; renal cell carcinoma; and Hodgkin’s lymphoma. Melanoma o pembrolizumab Pembrolizumab Squamous Cell Carcinoma (SCC) (anticuerpo contra la muerte celular programada)
    • Ipilimumab (anticuerpo monoclonal contra el antígeno 4 del linfocito T citotóxico)
  • Terapia dirigida:
    • Para la mutación BRAF V600E/K: combinación de vemurafenib Vemurafenib An indole sulfonamide compound and inhibitor of BRAF kinases that is used for the treatment of unresectable or metastatic melanoma. Targeted and Other Nontraditional Antineoplastic Therapy (inhibidores de la quinasa BRAF) con cobimetinib Cobimetinib Targeted and Other Nontraditional Antineoplastic Therapy (inhibidor de MEK)
    • Otra opción para mutación BRAF V600E/K: dabrafenib DaBRAFenib Targeted and Other Nontraditional Antineoplastic Therapy + trametinib Trametinib Targeted and Other Nontraditional Antineoplastic Therapy, encorafenib + binimetinib
    • Para mutación KIT: imatinib Imatinib A tyrosine kinase inhibitor and antineoplastic agent that inhibits the bcr-abl kinase created by chromosome rearrangements in chronic myeloid leukemia and acute lymphoblastic leukemia, as well as pdg-derived tyrosine kinases that are overexpressed in gastrointestinal stromal tumors. Targeted and Other Nontraditional Antineoplastic Therapy (inhibidor de la tirosina quinasa)
  • Terapia citotóxica:
    • No es muy eficaz y no mejora la supervivencia a nivel general
    • Limitado a pacientes para quienes se han agotado otras opciones
  • Radioterapia:
    • Principalmente, para la paliación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la enfermedad localmente avanzada
    • La radiocirugía estereotáctica tiene un papel en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la metástasis cerebral.

Pronóstico

Factores pronósticos negativos:

• Factores relacionados con el paciente:
  • Edad avanzada
  • Hombres
• Factores relacionados con la lesión:
  • Estadio tumoral avanzado: grosor del tumor Tumor Inflammation, ulceración, afectación de los LOS Neisseria ganglios linfáticos y presencia de metástasis a distancia
  • ↑ Tasa mitótica
  • Melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma nodular

Tasa de supervivencia a 5 años:

• Etapa I: > 90%
• Etapa II: 45 %–77%
• Etapa III: 27 %–70%
• Etapa IV: < 20%

Diagnóstico Diferencial

• Nevus Nevus Nevi (singular nevus), also known as “moles,” are benign neoplasms of the skin. Nevus is a non-specific medical term because it encompasses both congenital and acquired lesions, hyper- and hypopigmented lesions, and raised or flat lesions. Nevus/Nevi atípico: una neoplasia melanocítica benigna que imita el aspecto del melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma, ya que puede ser asimétrico y > 6 mm MM Multiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies. Multiple Myeloma con variedad de colores. Por lo tanto, se necesita una biopsia para excluir el melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma.
• Queratosis seborreica: una neoplasia benigna que consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum queratinocitos inmaduros que ocurre comúnmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria ancianos. Una queratosis seborreica por lo general se presenta como una lesión cutánea bien delimitada, redonda, exofítica y oscura.
• Dermatofibroma: una proliferación benigna de fibroblastos dérmicos que se presenta como un nódulo móvil, firme e indurado que mide alrededor de 0,5 – 1 cm de tamaño. Además, una depresión en la piel suprayacente aparece como un signo del “hoyuelo” tras la compresión lateral.
• Otras neoplasias malignas de la piel: los LOS Neisseria carcinomas de células escamosas o basocelulares suelen presentarse como lesiones eritematosas, escamosas o ulceradas elevadas. Los LOS Neisseria tumores malignos pueden parecerse a los LOS Neisseria melanomas amelanóticos. El diagnóstico se establece mediante biopsia.