Vloga dermatologa pri zgodnjem odkrivanju in obravnavi bolnika z melanomom The role of a dermatologist in early detection and management of the patient with melanoma

Abstract

Kožna oblika melanoma sodi med rakava obolenja z največjim letnim prirastkom tako v svetu kot pri nas. Epidemiološki podatki ob hitro rastoči incidenci nakazujejo stabilno mortaliteto v zadnjih dveh desetletjih in konstantni delež debelih tumorjev za moške nad 60. letom starosti. Melanom je posledica kompleksne prepletenosti genotipa in dejavnikov iz okolja, ki določajo tudi fenotipske značilnosti, ki opozarjajo na povečano tveganje za pojav melanoma v življenju.
Vloga dermatologa je odkrivanje melanoma v zgodnjih stadijih bolezni, ko je klinično težje prepoznaven, zamenljiv z melanocitnimi nevusi ali drugimi lezijami na koži. Zgodnja diagnostika melanoma temelji na poznavanju novih diagnostičnih metod v dermatologiji, kot so dermoskopija, konfokalna mikroskopija in teledermatologija, kot tudi ustrezni organizaciji dela, ki omogoča prepoznavanje ter spremljanje posameznikov z večjim tveganjem za pojav melanoma. Pri tankih melanomih dermatolog opravi tudi terapevtski del, ekscizijo tumorja, medtem ko pri invazivnih in metastatskih oblikah bolezni predvidi interdisciplinarno zdravljenje pacienta.
Zaradi povečanega tveganja za razvoj novega primarnega melanoma je v obravnavi bolnikov po odkritem melanomu določena potreba po doživljenjskem spremljanju s strani dermatologa. Dermatološka zdrużenja oblikujejo in izvajajo programe primarne ter sekundarne preventive, katerih namen je zmanjševanje dejavnikov tveganja in zgodnje odkrivanje melanoma kot tudi drugih oblik kožnega raka.
Nova spoznanja potrjujejo patogenetsko raznolikost melanoma, kar kaže na potrebo po spremembah in individualizaciji ukrepov primarne ter sekundarne preventive kožnega melanoma.

Abstract (Eng)

Skin melanoma is one of cancers with the largest annual increase both in the world and Slovenia. Alongside the rapidly increasing incidence, the epidemiological data show stable mortality in the last two decades and a constant share of fatty tumours in male patients aged over 60 years.
Melanoma is a result of a complex interaction between the genotype and environmental factors that also determine the phenotypic characteristics signalling an increased risk of the occurrence of melanoma in one’s life.
The role of a dermatologist is to detect melanoma at early stages of the disease, when it is still difficult to recognise it clinically and melanoma can be mistaken for melanocytic nevi or other skin lesions. Early diagnosis of melanoma is based on new diagnostic methods in dermatology, such as dermoscopy, confocal microscopy and teledermatology, as well as on well-organised work which allows identification and monitoring of individuals with an increased risk for developing melanoma. In thin melanomas, the dermatologist also performs the therapeutic part, namely tumour excision, while in invasive and metastatic forms of the disease, he decides on the patient’s interdisciplinary treatment. Due to an increased risk for the development of a new primary melanoma, management of patients following detection of melanoma also requires lifelong monitoring by the dermatologist. The dermatological associations design and implement primary and secondary prevention programmes aimed at reducing the risk factors and early detection of melanoma, as well as other forms of skin cancer.
New findings confirm the pathogenic diversity of melanoma, which indicates the need to implement changes and individualise measures aimed at primary and secondary prevention of skin melanoma.