\nAd<\/em><\/p>\n<\/span>Skin cancer<\/span><\/h4>\nApplication to facilitate skin self-examination and early detection<\/strong>. read more<\/span>.<\/strong><\/p>\n<\/blockquote>\n<\/section>\n<\/div>\n<\/div>\n
Text: Miiskin.<\/div>\n<\/div>\n
<\/span>What is it acral<\/span> lentiginous melanoma<\/span>?<\/span><\/h2>\nAcral lentiginous melanoma is a type of melanoma that arises on the palms or soles. It is a form of melanoma that is characterized by its site of origin: palm, sole of the foot or under the nail (subungual<\/span> melanoma). It is more common in the feet than the hands. may arise de novo<\/span> in normal-appearing skin, or may develop within existing skin melanocytic<\/span> nevus<\/span> (Mole).<\/p>\nAcral lentiginous melanoma begins as a slow growing plane patch<\/span> of discolored skin. At first, the evil one<\/span> The cells remain within the tissue of origin, the epidermis<\/span> - the in the place<\/span> phase of melanoma, which can persist for months or years.<\/p>\nAcral lentiginous melanoma develops invader<\/span> when melanoma cells cross the basement membrane of the epidermis, and malignant cells enter the dermis<\/span>. Rapid growth nodular<\/span> Melanoma can also arise within acral lentiginous melanoma and proliferate deeper within the skin.<\/p>\n<\/span>Who gets acral lentiginous melanoma?<\/span><\/h2>\nAbout 1 to 3% melanomas<\/span> in Australia and New Zealand they are acral lentiginous melanoma. Melanoma is a potentially serious skin condition. Cancer<\/span> that arises from pigment<\/span> cells (melanocytes<\/span>) Although acral lentiginous melanoma is rare in Caucasians and people with darker skin types, it is the most common subtype in people with darker skin types.<\/p>\nAcral lentiginous melanoma is relatively rare compared to other types of melanoma. There is no connection to skin color (skin phototype), and it occurs at the same rate in white, brown or black skin. Acral lentiginous melanoma accounts for the 29-72% of melanoma in dark-skinned individuals, but less than the 1% of melanoma in light-skinned individuals, as they are prone to the more common types of sun-induced melanoma, such as spreading melanoma. superficial and lentigo<\/span> malignant melanoma<\/p>\nAcral lentiginous melanoma is equally common in men and women. The majority arises in people over 40 years of age.<\/p>\n
The cause or causes of acral lentiginous melanoma are unknown. It is not related to sun exposure.<\/p>\n
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<\/span>What is acral lentiginous melanoma like?<\/span><\/h2>\nAcral lentiginous melanoma on the palm of the hand, soles of the feet, or toes begins as an enlarged patch of discolored skin. It is often thought at first to be a stain. It can also be amelanotic<\/span> (no-pigmented<\/span>, usually red). Like other flat forms of melanoma, it can be recognized by the ABCDE rule: asymmetry, irregularity of the border, color variation, large diameter and evolution.<\/p>\nFeatures of acral lentiginous melanoma include:<\/p>\n
\n- Large size: >6 mm and often several centimeters or more in diameter at diagnosis<\/li>\n
- Variable pigmentation<\/span>: most often a mixture of brown, blue-gray, black and red colors<\/li>\n
- A smooth surface at first, then becomes thicker with an uneven surface that may be dry or warty<\/span>\n<\/li>\n
- \nUlceration<\/span> or bleeding<\/li>\n<\/ul>\n\n
<\/span>Acral lentiginous melanoma<\/span><\/h5>\n<\/section>\n\n\n
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Acral lentiginous melanoma <\/p>\n
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See more images of acral lentiginous melanoma.<\/p>\n
<\/span>Subungual melanoma<\/span><\/h3>\nWhen acral lentiginous melanoma arises in the nail region, it is known as nail unit melanoma. If it starts in the womb (nail growth area), it is called subungual melanoma. It can be presented as diffuse<\/span> discoloration or irregular pigmented longitudinal bands on the nail plate. Advanced melanoma destroys the nail plate completely. It may be amelanotic.<\/p>\n\n<\/span>Melanoma of the nail unit<\/span><\/h5>\n<\/section>\n\n\n
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Subungual melanoma <\/p>\n
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See more images of melanoma of the nail unit.<\/p>\n
<\/span>What is the cause of acral lentiginous melanoma?<\/span><\/h2>\nAcral lentiginous melanoma is due to the development of malignant pigment cells (melanocytes) along the basal<\/span> cap<\/span> of the epidermis. These cells may arise from an existing melanocytic nevus or, more often, from normal-appearing skin. It is unknown what causes melanocytes to become malignant, but it involves genetic<\/span> mutations<\/span>.<\/p>\n<\/span>What tests should be done?<\/span><\/h2>\n<\/span>Dermoscopy<\/span><\/h3>\nDermatoscopy, or the use of a dermatoscope, by a dermatologist<\/span> or another doctor trained in its use, can be very useful in distinguishing acral lentiginous melanoma from other skin lesions, in particular:<\/p>\n\n- Melanocytic naevi<\/span> (moles)<\/li>\n
- Viral warts<\/li>\n
- Bleeding \u2013 subcorneal<\/span> hemorrhage<\/span> or subungual hematoma<\/span>\n<\/li>\n<\/ul>\n
The most frequently observed dermoscopic features of acral lentiginous melanoma are:<\/p>\n
\n- \nAsymmetric<\/span> structure and colors<\/li>\n
- Pigment Parallel Ridge Pattern distribution<\/span>\n<\/li>\n
- Blue-gray structures.<\/li>\n<\/ul>\n
See dermoscopy of acral lentiginous melanoma.<\/p>\n
<\/span>Biopsy<\/span><\/span><\/h3>\nIf the skin injury<\/span> suspected acral lentiginous melanoma, it is better to cut it (excision<\/span> biopsy). It is best to avoid a partial biopsy, except in unusually large lesions. An incisional or puncture biopsy could miss a focus of melanoma arising in a preexisting nevus. However, sometimes the lesion is very large and before significant surgery is performed, a biopsy is arranged to confirm the diagnosis. Biopsy of a lesion suspicious for acral lentiginous melanoma should remove a long ellipse of skin, or there should be several biopsies<\/span> taken from multiple sites, as a single site could miss a malignant focus.<\/p>\nThe pathological diagnosis of melanoma can be challenging. Histological<\/span> Features of acral lentiginous melanoma include an asymmetric proliferation<\/span> of melanocytes at the dermoepidermal junction.<\/p>\n<\/span>\nPathology<\/span> report<\/span><\/h3>\nthe pathologist<\/span>The report should include a macroscopic<\/span> description of the specimen and melanoma (naked eye view) and microscopic<\/span> description.<\/p>\n\n- Diagnosis of primary<\/span> melanoma<\/li>\n
- \nBreslow thickness<\/span> to the nearest 0.1 mm<\/li>\n
- Clark's invasion level<\/li>\n
- Excision margins: the normal tissue around the tumor<\/span>\n<\/li>\n
- \nMitotic<\/span> rate - a measure of how fast cells are proliferating<\/span>\n<\/li>\n
- Whether or not there is ulceration<\/li>\n<\/ul>\n
The report may also include comments on the cell type and its growth pattern, invasion of blood vessels<\/span> or nerves<\/span>, inflammatory<\/span> reply, regression<\/span>, and if there is an associated nevus (original mole).<\/p>\n<\/span>What is the thickness of Breslow?<\/span><\/h3>\nBreslow thickness is reported for invasive melanomas. It is measured vertically in millimeters from the top of the granular layer<\/span> (or base of superficial ulceration) to the deepest point of tumor involvement. It is a strong predictor of results; the thicker the melanoma, the more likely it is that metastasis<\/span> (spread).<\/p>\n<\/span>What is Clark's level of invasion?<\/span><\/h3>\nClark's level indicates the anatomical plane of the invasion.<\/p>\n
Level 1 \u2013 melanoma in situ
Level 2 \u2013 Melanoma has invaded the papillary dermis<\/span>
Level 3: melanoma has filled the papillary dermis
Level 4 \u2013 Melanoma has invaded the lattice<\/span> dermis<\/span>
Level 5: Melanoma has invaded subcutaneous<\/span> tissue<\/p>\nThe deeper the Clark level, the greater the risk of metastasis<\/span> (secondary propagation). It is useful in predicting outcome in thin tumors and less useful for thicker ones compared to the Breslow thickness value.<\/p>\n<\/div>\n
<\/span>What is the treatment for acral lentiginous melanoma?<\/span><\/h2>\nThe initial treatment of primary melanoma is to remove it; The lesion must be completely removed with a margin of 2-3 mm of healthy tissue. Further treatment depends primarily on the Breslow thickness of the lesion.<\/p>\n
After the initial excisional biopsy; The radial excision margins, measured clinically from the edge of the melanoma, recommended in the Australian and New Zealand Guidelines for the Management of Melanoma (2008) are shown in the table below. A flap or graft may be needed to close the wound. In the case of acral lentiginous and subungual melanoma, this may include partial amputation of a digit<\/span>. Occasionally, the pathologist will report an incomplete excision of the melanoma, despite wide margins requiring additional surgery or radiotherapy<\/span> to ensure that the tumor has been completely removed.<\/p>\nMelanoma in situ \u2013 excision margin 5 mm
Melanoma <1.0 mm - margen de escisi\u00f3n 1 cm
Melanoma 1.0\u20132.0 mm \u2013 excision margin 1\u20132 cm
Melanoma 2.0\u20134.0 mm \u2013 excision margin 1\u20132 cm
Melanoma > 4.0 mm \u2013 excision margin 2 cm<\/p>\n
<\/span>Staging<\/span><\/h2>\nStaging melanoma means finding out if melanoma has spread from its original place on the skin. Most melanoma specialists refer to the American Joint Committee on Cancer (AJCC) cutaneous<\/span> melanoma staging guidelines (2009). In essence, the stages are:<\/p>\nStage 0 \u2013 melanoma in situ
Stage 1 \u2013 thin melanoma <2 mm de espesor
Stage 2: thick melanoma > 2 mm thick
Stage 3: Spread of melanoma to involve locals lymph nodes<\/span>
Stage 4 \u2013 Distant metastasis<\/span> have been detected<\/p>\n<\/span>Should the lymph nodes be removed?<\/span><\/h2>\nIf local lymph nodes become enlarged due to metastatic<\/span> melanoma, must be completely removed. This requires a surgical procedure, usually in general. anesthetic<\/span>. If they are not enlarged, they can be analyzed to see if there is microscopic spread of the melanoma. The test is known as a sentinel node biopsy.<\/p>\nIn New Zealand, many surgeons recommend sentinel lymph node biopsy for melanomas thicker than 1 mm, especially in younger people. However, although biopsy can help stage cancer, it does not offer any survival advantage. The need for a sentinel lymph node biopsy is currently controversial.<\/p>\n
Lymph nodes containing metastatic melanoma often enlarge rapidly. An involved node is usually not tender and has a firm to hard consistency. If this occurs between planned follow-up visits, tell your doctor right away.<\/p>\n
If melanoma is extended<\/span>, other forms of treatment may be necessary but are not always successful in eradicating the cancer. Immunotherapy, biologics such as ipilimumab and BRAF<\/span> inhibitors such as vemurafenib and dabrafenib are promising.<\/p>\n<\/span>What happens at the follow-up?