{"id":580,"date":"2012-07-15T11:41:49","date_gmt":"2012-07-15T08:41:49","guid":{"rendered":"http:\/\/www.hvtd.org\/?p=580"},"modified":"2012-07-15T11:41:49","modified_gmt":"2012-07-15T08:41:49","slug":"pilotlarda-cilt-kanseri-malign-melanoma","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=580","title":{"rendered":"Pilotlarda Cilt Kanseri: Malign Melanoma"},"content":{"rendered":"
\n

\"\"<\/a>Malign Melanoma insidans\u0131 d\u00fcnya \u00e7ap\u0131nda b\u00fcy\u00fck de\u011fi\u015fiklik g\u00f6stermektedir. Ekvator civar\u0131nda ya\u015fayan \u00f6zellikle a\u00e7\u0131k tenli bireylerde insidans y\u00fcksektir. ABD\u2019de 2002 y\u0131l\u0131nda yap\u0131lan bir ara\u015ft\u0131rmada 53.000 yeti\u015fkin beyaz insanda melanoma varl\u0131\u011f\u0131 tahmin edilmi\u015f, bunlar\u0131n 7.400\u2019\u00fcn\u00fcn metastatik nedenlerden \u00f6lece\u011fi hesaplanm\u0131\u015ft\u0131r. Amerikal\u0131larda ya\u015fam boyu melanoma yakalanma riski 71\u2019de 1 olup, bu oran 2010 y\u0131l\u0131nda 50\u2019de 1\u2019e y\u00fckselecektir. Ancak \u00f6l\u00fcm oran\u0131nda bir yava\u015flama olaca\u011f\u0131 san\u0131lmaktad\u0131r.<\/p>\n

Etyoloji: <\/strong>Melanositlerde kansere d\u00f6n\u00fc\u015fme mekanizmas\u0131 tam olarak hala anla\u015f\u0131lamam\u0131\u015ft\u0131r. Risk fakt\u00f6rleri \u015funlard\u0131r:<\/p>\n

1. Nev\u00fcs de\u011fi\u015fikli\u011fi (%80)<\/p>\n

2. Xeroderma pigmantosum<\/p>\n

3. A\u00e7\u0131k ten fenotipi<\/p>\n

4. A\u015f\u0131r\u0131 g\u00fcne\u015f maruziyeti<\/p>\n

5. Ailesel atipik mole-melanom sendromu (FAMM)<\/p>\n

6. Atipik nev\u00fcs<\/p>\n

7. Eski melanom<\/p>\n

8. Birinci derece akrabalarda melanoma varl\u0131\u011f\u0131.
\n<\/strong><\/p>\n

Klinik: <\/strong>Melanoma \u00e7o\u011funlukla prek\u00fcrs\u00f6r melanotik nev\u00fcsten kaynaklan\u0131r. Klinik belirtilerin ABCD\u2019si: A<\/strong>symmetry, B<\/strong>order irregularity (d\u00fczensiz kenar), C<\/strong>olor veriegation (pigmantasyon \u00e7e\u015fitlili\u011fi), D<\/strong>iameter of lesion (lezyon \u00e7ap\u0131n\u0131n 6 mm\u2019den b\u00fcy\u00fck olmas\u0131).<\/p>\n

Primer cilt melonoma 4 klinik tipe ayr\u0131labilir:<\/p>\n

1.<\/strong> Y\u00fczeysel da\u011f\u0131l\u0131m g\u00f6steren tip: Melanomalar\u0131n %70\u2019i bu tiptedir. D\u00fczensiz, asimetrik kenarl\u0131, renk \u00e7e\u015fitlili\u011fi fazla, 6-8 mm boyutlu olup kad\u0131n ve erkeklerin v\u00fccutlar\u0131n\u0131n arka \u00fcst k\u0131s\u0131mlar\u0131nda, kad\u0131nlar\u0131n el ve ayaklar\u0131n\u0131n u\u00e7 k\u0131sm\u0131nda s\u0131kl\u0131kla g\u00f6r\u00fcl\u00fcr.<\/p>\n

2.<\/strong> Nod\u00fcler tip: %15-30\u2019unu olu\u015fturur. Deriden hafif y\u00fcksek koyu kahve renkli, siyah pap\u00fcler ya da nod\u00fcl \u00fclsere d\u00f6n\u00fc\u015febilirler, hatta kanayabilir. S\u0131kl\u0131kla ayak ve g\u00f6vdede g\u00f6r\u00fcl\u00fcr.<\/p>\n

3.<\/strong> Lentigo Maligna: %4-15 melanoma bu gruptad\u0131r. G\u00fcne\u015f yan\u0131\u011f\u0131 veya kahverengi mak\u00fcller yahut pigment de\u011fi\u015fikli\u011fi g\u00f6steren deri lezyonlar\u0131yla karakteristiktir. %5-8 oran\u0131nda invaziv melonama d\u00f6n\u00fc\u015febilir. Nod\u00fcler geli\u015fme g\u00f6stermeleri de karakteristik \u00f6zelliklerindendir.<\/p>\n

4.<\/strong> Acral lentiginous: Beyaz tenlilerdeki melonomlar\u0131n %2-8\u2019ini olu\u015fturur. Esmer ve kara tenlilerde ise bu oran %29-72 aras\u0131ndad\u0131r. Tipik olarak avu\u00e7 i\u00e7inde, ayak taban\u0131nda ya da t\u0131rnak u\u00e7lar\u0131nda d\u00fczensiz pigmente lezyonlar halinde g\u00f6r\u00fcl\u00fcr.<\/p>\n

Malign Melanomal\u0131 (MM) u\u00e7ucuculara u\u00e7u\u015f m\u00fcsaadesi i\u00e7in nas\u0131l bir politika izlenece\u011fi konusunda FAA\u2019in Havac\u0131l\u0131k T\u0131bb\u0131 Yetkilendirme B\u00f6l\u00fcm\u00fc (AMCD), y\u0131lda 8 binden fazla yay\u0131nlanm\u0131\u015f melonoma vakalar\u0131n\u0131 incelemekte ve bu hastal\u0131\u011f\u0131n \u00f6nemli art\u0131\u015f g\u00f6sterdi\u011fini saptam\u0131\u015f bulunmaktad\u0131r.<\/p>\n

Olgu:<\/strong> 5 bin saatten fazla u\u00e7u\u015fu olan 60 ya\u015f\u0131nda erkek pilot. 1. S\u0131n\u0131f t\u0131bbi sertifikas\u0131n\u0131 2003 y\u0131l\u0131 May\u0131s ay\u0131nda yenilemek \u00fczere ba\u015fvurdu\u011funda melanoma \u00f6yk\u00fcs\u00fc nedeniyle AMCD\u2019ye havale edilmi\u015f. \u0130lk kez \u015eubat l999\u2019da bir muayenede sa\u011f bald\u0131r\u0131nda b\u00fcy\u00fcmekte olan bir leke fark edilerek biyopsi yap\u0131lm\u0131\u015f ve bu lekenin melanoma oldu\u011fu, Breslow kal\u0131nl\u0131\u011f\u0131n\u0131n 0.92 mm, Clark\u2019s d\u00fczeyinin 3 oldu\u011fu tespit edilmi\u015f. Metastaz saptanmam\u0131\u015f. CAT Scan\u2019ler beyin, g\u00f6\u011f\u00fcs, kar\u0131n ve pelvis\u2019te negatif bulunmu\u015f. 2003\u2019de \u00e7ekilen beyin MR\u2019da da patoloji bulunmam\u0131\u015f. Pilot kendisini u\u00e7u\u015f i\u00e7in \u00e7ok iyi ve aktif hissetti\u011fini; herhangi bir a\u011fr\u0131s\u0131, \u00f6zellikle ba\u015f a\u011fr\u0131s\u0131 olmad\u0131\u011f\u0131n\u0131, G\u00dc ve G\u0130 \u015fik\u00e2yetlerinin bulunmad\u0131\u011f\u0131n\u0131, v\u00fccudunda bir cilt rengi de\u011fi\u015fikli\u011fi olmad\u0131\u011f\u0131n\u0131 s\u00f6yl\u00fcyor. G\u0130 refl\u00fc i\u00e7in Famotidine, mevsimsel alerjik rinit i\u00e7in Loratidine\u2019den ba\u015fka ila\u00e7 alm\u0131yor; Penicilin alerjisi var. Tonsillektomi d\u0131\u015f\u0131nda cerrahi m\u00fcdahale g\u00f6rmemi\u015f. Alkol, sigara ve uyu\u015fturucu kullanm\u0131yor. Ailesinde MM \u00f6yk\u00fcs\u00fc yok.<\/p>\n

Tan\u0131 ve gidi\u015f:<\/strong> \u015e\u00fcpheli b\u00f6lge ve lekelerden biyopsi yap\u0131lmas\u0131 \u015fartt\u0131r. \u0130\u011fne biyopsisi lezyonun g\u00f6r\u00fcnen k\u0131sm\u0131n\u0131n 2-3 mm kenar\u0131ndan yap\u0131lmal\u0131d\u0131r. Eksizyonel biyopsinin lenfatik drenaja paralel olmas\u0131 gereklidir. AJCC (American Joint Committee on Cancer) 2001 y\u0131l\u0131nda MM i\u00e7in ana de\u011fi\u015fiklikleri 4 maddede toplam\u0131\u015ft\u0131r:<\/p>\n

1. Melanoma i\u00e7in tan\u0131da en \u00f6nemli fakt\u00f6r Breslow derinli\u011fidir.<\/p>\n

2. Mikroskobik \u00fclserasyonun, kal\u0131nl\u0131\u011f\u0131n d\u0131\u015f\u0131nda ikinci \u00f6nemli fakt\u00f6r oldu\u011fu saptanm\u0131\u015ft\u0131r. S\u0131n\u0131fland\u0131rmada \u00fclserasyonun olmay\u0131\u015f\u0131 a; varl\u0131\u011f\u0131 b olarak g\u00f6sterilmi\u015ftir.<\/p>\n

3. Etkilenmi\u015f b\u00f6lgesel lenf nod\u00fcllerinin say\u0131s\u0131, yerel etkilenen lenf nod\u00fcl\u00fc say\u0131s\u0131ndan daha \u00f6nemlidir.<\/p>\n

4. Bariyer g\u00f6revindeki lenf nod\u00fcllerinin durumu, tan\u0131 ve gelecek ya\u015fam s\u00fcresi i\u00e7in \u00e7ok \u00f6nemlidir.<\/p>\n

Tedavi:<\/strong> Melanomun temiz dokuya kadar \u00e7\u0131kart\u0131lmas\u0131 esast\u0131r. WHO, 2 mm derinli\u011fi olan lezyonu 1 cm kenarl\u0131 vaziyette \u00e7\u0131kartmay\u0131 yeterli bulmaktad\u0131r. B\u00fcy\u00fck lenf nod\u00fcl\u00fc bulunan hastalarda lenf nod\u00fcl diseksiyonu yap\u0131lmal\u0131d\u0131r. Elektif lenf nod\u00fcl diseksiyonu hala tart\u0131\u015fmal\u0131d\u0131r. \u00d6zellikle 60 ya\u015f alt\u0131 hastalarda primer melanom\u2019un 1-4 mm kal\u0131nl\u0131\u011f\u0131nda olanlarda belki d\u00fc\u015f\u00fcn\u00fclebilir. \u0130nterferon-2b (\u0130NTRONA) ile adjuvan tedavi, metastatik melanomal\u0131 hastalarda iyice d\u00fc\u015f\u00fcn\u00fcl\u00fcp karar verilerek yap\u0131lmal\u0131d\u0131r. FDA bu tedaviyi AJCC\u2019nin Stage II ve Stage III melanomada \u00f6nermektedir.<\/p>\n

Havac\u0131l\u0131k T\u0131bb\u0131 Yorumu: <\/strong>FAA t\u0131bbi y\u00f6nergesinde MM varl\u0131\u011f\u0131 veya yoklu\u011fu konusundaki karar i\u00e7in AMCD yetkili k\u0131l\u0131nm\u0131\u015ft\u0131r. Melanomal\u0131 u\u00e7ucularda MR kontrol\u00fcyle sertifikasyon politikas\u0131 Tablo 1\u2019de \u00f6zetlenmi\u015ftir.<\/p>\n

Sonu\u00e7:<\/strong> Bu pilota 1 y\u0131l i\u00e7in \u00f6zel stat\u00fcde u\u00e7u\u015f izni verilmi\u015ftir. 1 y\u0131l sonra beyin MR sonu\u00e7lar\u0131na bakarak ikinci de\u011ferlendirme yap\u0131lacak ve 1-5 y\u0131ll\u0131k s\u00fcre i\u00e7inde hastal\u0131\u011f\u0131n takibine ba\u011fl\u0131 olarak tekrar karar verilecektir.
\n<\/strong><\/p>\n

Kaynak : <\/strong>Doan PS. Primary cutaneous malignant melanoma. The Federal Air Surgeon\u2019s Medical Bulletin. 2007; 45-4: 7-9<\/p>\n

\u00c7eviri :<\/strong> Dr. Abdullah \u00d6ks\u00fcz<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Malign Melanoma insidans\u0131 d\u00fcnya \u00e7ap\u0131nda b\u00fcy\u00fck de\u011fi\u015fiklik g\u00f6stermektedir. Ekvator civar\u0131nda ya\u015fayan \u00f6zellikle a\u00e7\u0131k tenli bireylerde insidans y\u00fcksektir. ABD\u2019de 2002 y\u0131l\u0131nda yap\u0131lan bir ara\u015ft\u0131rmada 53.000 yeti\u015fkin beyaz insanda melanoma varl\u0131\u011f\u0131 tahmin edilmi\u015f, bunlar\u0131n 7.400\u2019\u00fcn\u00fcn metastatik nedenlerden \u00f6lece\u011fi hesaplanm\u0131\u015ft\u0131r. Amerikal\u0131larda ya\u015fam boyu melanoma yakalanma riski 71\u2019de 1 olup, bu oran 2010 y\u0131l\u0131nda 50\u2019de 1\u2019e y\u00fckselecektir. Ancak \u00f6l\u00fcm oran\u0131nda bir yava\u015flama olaca\u011f\u0131 san\u0131lmaktad\u0131r. […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[6],"tags":[],"class_list":["post-580","post","type-post","status-publish","format-standard","hentry","category-bulten"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/580","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=580"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/580\/revisions"}],"predecessor-version":[{"id":582,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/580\/revisions\/582"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=580"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=580"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=580"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}