Acral Nevus: Ukuqonda iMole kwiIphakhe, iIphakhe, kunye neNail

I-acral nevus yi-melanocytic nevus (umqolo) etholakala kwiindawo ze-acral zomzimba — iithanga zeemvama, iindawo zeenyawo, kunye nezixhobo zeenwele (iindawo ze-subungual kunye ne-periungual). Le mikhwa ibizwa ngokubanzi ngokuba yi-acral kuba imele iindawo eziphezulu okanye iindawo zokugqibela zeemvama. I-acral nevi ifuna ingqalelo ekhethekileyo kwi-dermatology hayi kuba ib dangerous kakhulu kuneemqolo kwezinye iindawo, kodwa kuba iimqolo kwiindawo ezinjalo zibonakala zihluke ngokupheleleyo kuneemqolo kwezinye iindawo zomzimba ngenxa ye-anatomy eyahlukileyo yesikhumba se-acral — kwaye ngenxa yokuba i-acral melanoma, umhlaza obulalayo onokuphuma kwiindawo ezinjalo, ubulalayo kakhulu kwaye uvame ukufumaneka kwiimeko eziphakamileyo.

Isikhumba se-acral, esaziwa ngokuba yisikhumba esingenanwele (isikhumba esingenanwele), sinomgangatho ophawulekayo ohluke ngokupheleleyo kwisikhumba esinoboya esiqhuba umzimba. Siphawulwe ngaphezulu kwe-epidermis eyomeleleyo, ubukho beendawo ezahlukeneyo kunye neefurrows (i-dermatoglyphics — iimpawu zeemvama kunye neempawu zeenyawo), ukungabikho kweefollicles zeenwele kunye neengcambu ze-sabaceous, kunye ne-ecocrine sweat glands ezinamandla. Le mikhwa ye-anatomical ibalulekile kakhulu kumphumo wokuba i-melanocytic lesions ibonakale kwiindawo ezinjalo, idala iimpawu ezingenakuchazwa ngababoneleli bezempilo abangaziyo i-acral dermoscopy.

I-acral nevi iyavela, ngakumbi kwiindidi ezineemvama ezimnyama — uphando lufumene i-nevi ze-planta kwi-20 percent yeendawo ezithile. Uninzi lwazo luyabangelwa, kodwa ubalulekile kumphumo wazo klinikhi kukufuneka kuhlukaniswe ngokuthembekileyo kwi-acral melanoma, enobungozi obungcono kune-melanoma kwezinye iindawo ngenxa yokuphazamiseka kokufumaneka.

Ubungakanani obuhlukileyo be-acral nevi buvela kwi-architecture eyahlukileyo yesikhumba esingenanwele. Ngokungafaniyo nesikhumba esinoboya, apho ubuso besikhumba bujolise ngokufanelekileyo kwaye bungezelelwanga, isikhumba se-acral sihlelwe kwiindawo ezahlukeneyo (i-sulci) kunye neefurrows (i-sulci limitantes) ezidala iimpawu ze-dermatoglyphic esaziwa njengeempawu zeemvama kunye neempawu zeenyawo. I-ecocrine sweat ducts ivula kwiindawo eziphezulu zeemvama, ngelixa i-crista limitans (i-ridge ye-anatomy ye-dermis) ibekwe phantsi kwefurrow.

Le mikhwa ye-topographic ithetha ukuba i-melanocytes ngaphakathi kwe-acral nevi zihlala kwiindawo ezahlukeneyo kwiindawo ezithile ezingenakufaniswa nesikhumba esinoboya. Ku-dermoscopy — indlela yokuhlola efumaneka kakhulu yokuhlola i-lesions ezinemibala — i-acral nevi ibonisa iimpawu ezahlukeneyo ezingabonakali kwezinye iindawo zomzimba. I-pattern ye-furrow eparalel iyimodeli evamile yokubukeka, apho i-pigmentation ilandela i-furrows (i-sulci) ze-dermatoglyphics, ibonakala njengeemigca eparalel ye-pigment ehambelana nemigca yesikhumba.

Iimpawu ezahlukeneyo ziquka i-pattern ye-lattice-like, apho imigca ye-pigment idlula kwiindawo, kunye ne-pattern ye-fibrillar, apho imigca emincinci ye-oblique ibonisa ukubukeka kwe-striated okubonwa kakhulu kwiindawo ezibambekayo ze-soles. I-pattern ye-crista dotted ibonisa i-pigment dots kwiindawo (i-cristae). Le mikhwa yokubukeka ibonisa ukusabalala okujolise kwi-melanocytes ngaphakathi kwe-architecture yesikhumba se-acral. Ukuqonda le mikhwa kubalulekile kuba i-pattern ye-malignant efanayo — i-pattern ye-parallel ridge, apho i-pigment ilandela i-ridges kungekhona i-furrows — iyinkcukacha ye-dermoscopic eyona ibaluleke kakhulu yokuhlola i-acral melanoma.

Ukwahlula i-acral nevi engabangelwa kwi-acral melanoma yenye yeemisebenzi ezibaluleke kakhulu — kunye nezingxaki — kwi-dermatology ye-clinical. I-acral melanoma (i-acral lentiginous melanoma, okanye i-ALM) ibalelwa kwi-2 ukuya kwi-3 percent yezo zonke i-melanomas kwiindawo ze-Caucasian kodwa ibonisa umphumo ophakamileyo — ukuya kwi-60 ukuya kwi-70 percent — ye-melanomas kwiindidi ze-Afrika, i-Asia, kunye ne-Hispanic. Le ngxaki yenza i-acral melanoma ibe yinkxalabo enkulu yezeMpilo.

I-acral melanoma ibonisa umphumo ombi kunemelanoma kwezinye iindawo, ikakhulu ngenxa yokuphazamiseka kokufumaneka — ubungakanani be-Breslow bokufumaneka bujolise kakhulu kwi-acral melanoma kunemelanoma kwi-skin ebonelelwe ilanga. Iimeko ezininzi zenza ukuba kube nokuphazamiseka: iithanga kunye neendawo azihlolwanga rhoqo ngexesha lokuhlola isikhumba, i-nail melanoma ivame ukungaqondwa njengezifo ze-fungal okanye umonakalo, abantu abaninzi abaninzi abaninzi bangaziboni njengabahlaselwa kwi-melanoma, kwaye abaphathiswa bezempilo bangasebenzi kakuhle kwi-melanoma kwiindawo ezinjalo. Ngokubhekiselele, iimpawu ezithile ezimele zikhathazeke kwi-acral melanoma ziquka i-lesion enombala ophakamileyo ngaphezu kwee-milimitha ezi-7 kwi-thanga okanye kwi-sole, umfanekiso ongalinganiyo, imiphetho engalunganga okanye engacacanga, ukwahluka kwemibala okubandakanya i-brown, i-black, i-blue, okanye i-red, kunye notshintsho olutsha okanye ukutshintsha.

Ngokuqhelekileyo, i-Hutchinson's sign — i-pigment ehlala ivela kwi-nail ukuya kwisikhumba esijolise kuyo (i-periungual extension) — iyisixwayiso esibalulekileyo. Ku-dermoscopy, i-pattern ye-parallel ridge — apho i-pigment ilandela i-ridges ze-dermatoglyphics kungekhona i-furrows — ibaluleke kakhulu kwi-acral melanoma kwaye iyona mveliso ye-dermoscopic ebaluleke kakhulu yokuhlola. Nayiphi na i-lesion ye-acral enombala ophakamileyo ibonisa i-pattern ye-parallel ridge kufuneka ibhiyozwe ngokukhawuleza.!!

I-melanocytic nevi ingavela ngaphakathi kwe-nail matrix — isikhumba esine-crescent-shaped esisekelwe kwi-nail apho i-nail plate ikhula khona — ibangela ibhendi ye-pigmentation kwi-nail ebizwa ngokuba yi-melanonychia striata (i-melanonychia ye-longitudinal). Oku kubonakala njenge-stripe emdaka okanye emnyama emdaka ibaleka ubude be-nail ukusuka kwi-bhasi ukuya kumda ophumayo. I-melanonychia ye-longitudinal yindlela ye-clinical ekhupha umphumo omkhulu wokuxhalaba kokufumaneka kuba ingabandakanya i-nail nevus engabangelwa, i-nail melanoma, okanye ezinye iimeko ezininzi ezibandakanya i-melanonychia ye-ethnic (i-pigmentation eqhelekileyo kwiindidi ezimnyama), i-pigmentation ebangelwa yimithi, i-fungal infection, okanye i-subungual hematoma.

Kubantu abadala abavela kwi-Afrika, i-melanonychia ye-longitudinal iyavela kakhulu kwaye ngokubanzi ibonisa ukwakhiwa okujolise kwi-melanocytic — ibandakanya abantu abaninzi be-African American ngonyaka we-50 kwaye iinail ezininzi zihlala zixhaphakile. Kubantu abadala be-Caucasian, i-melanonychia ye-longitudinal ayivamile kwaye ivame ukuvusa ukukhathazeka kwi-melanoma. Iimpawu ezikhuthazayo ezibonisa i-nail nevus engabangelwa ziquka ibhendi encinci (phantsi kwee-milimitha ezi-3), efanayo, ibhendi enemiphetho eparalel, ibonakaliswa ngombala omdaka omncinci, ibonwa kumntwana okanye kumntu osemntwini, uzinze ngexesha.

Iimpawu ezikhuthazayo ezikhuthazayo kwi-nail melanoma ziquka ibhendi ebanzi (ngaphezu kwee-milimitha ezi-3) okanye ibhendi ebanzi, imiphetho engalunganga okanye engacacanga, ukwahluka kwemibala ngaphakathi kwebhendi (i-brown, i-black, i-gray), i-Hutchinson's sign (ukwandiswa kwe-pigment ye-periungual), i-nail plate dystrophy (ukuphuka, ukwahluka, ukuncipha), kunye nokwenzeka kwi-digit enye yomntu omdala. I-thumb, i-index finger, kunye ne-great toe ziindawo ezivame kakhulu ukuba zihlaseleke kwi-nail melanoma. Nayiphi na i-melanonychia ye-longitudinal entsha okanye etshintshayo kumntu omdala kufuneka ihlolwe ngumdla we-dermatologist onolwazi kwi-nail dermoscopy.!! I-biopsy ye-nail matrix ngamanye amaxesha ibalulekile ukuze kufumaneke ngokuqinisekileyo.

Ngenxa yeengxaki zokuvavanya iimpawu ezinemibala kwi-skin ye-acral, indlela ehleliweyo ibalulekile. Ukuvavanywa kwekliniki kuqala ngokubona indawo, ubungakanani, umfanekiso, umbala, iimpawu zomda, kunye nomlando we-lesion. I-ABCDE criteria esetyenziselwa ukuvavanya i-moles kwezinye iindawo ifanelekile kwi-lesions ze-acral kodwa ngonyango oluthile — umda wokukhathazeka kufuneka ube phantsi ngenxa yokuphakama kwezingozi zokungavavanywa kwangexesha.

I-dermoscopy ibalulekile ekuvavanyeni i-lesion ye-acral kwaye ifuna uqeqesho oluthile kwiipatheni ze-dermoscopic ze-acral. I-algorithm yezigaba ezintathu ye-dermoscopy ye-acral inika indlela ehleliweyo: kuqala, qinisekisa ukuba i-lesion ibonisa umfanekiso ophilayo ofanelekileyo (umgca ophakathi, umgca ofana ne-lattice, i-fibrillar, okanye i-crista enezikhumbuzo); yesibini, ukuba akukho mfanekiso ophilayo ufumanekayo, jonga umgca ophakathi (okhumbuza i-melanoma); yesithathu, ukuba umfanekiso awucacanga, cinga i-biopsy okanye ukulandela ngokusondeleyo nge-dermoscopy yeziqhamo. I-biopsy iyacetyiswa kwi-lesion ye-acral enomgca ophakathi, nayiphi na i-lesion enezimpawu ezingaqhelekanga ezingahambelani nomfanekiso ophilayo, nayiphi na i-lesion etshintsha ubungakanani, umfanekiso, okanye umbala, nayiphi na i-lesion enomngcipheko wekliniki ngaphandle kokubona i-dermoscopic.

I-biopsy yokususa ikhethwa kune-biopsy engaphelelanga ukuze kuqinisekiswe uvavanyo lwe-histopathologic olunembile. Kwi-nevi ze-acral ezivumelekileyo, ukulandelela okujolise kumgangatho ofanelekileyo kukhuthazwa ngokuvavanywa kwekliniki kunye ne-dermoscopic ngexesha elichongiweyo ngumgangatho wobungozi bomntu. Abaguli kufuneka bafundiswe malunga nokufaneleka kokujolisa — utshintsho kubungakanani, umfanekiso, umbala, okanye iimpawu ezintsha — kunye nokubaluleka kokufaka iipalms, iisole, phakathi kweenxalenye, kunye neenail kwiingxelo zokuzihlola.

I-moles kwiipalms, iisole, kunye neenail zikwindawo eziphakamisa ukukhathazeka kakhulu ngenxa yokudibanisa kwazo ne-acral melanoma kunye nolwazi olujolise kumphakathi lokuba i-melanoma kwiindawo ezinjalo ihlala ivavanywa kamva. I-Skinscanner ibonelela ngovavanyo oluphendulwayo lwe-AI xa uthatha umfanekiso we-lesion enombala kwi-skin ye-acral, ivavanya iimpawu zayo zokubona kubandakanya ubungakanani, umfanekiso, umda, umbala, kunye nesimetriki. I-AI iqeqeshwe ukuba ibone iipatheni ezidibanisa ne-nevi ze-acral ezivumelekileyo kwaye ibonise iimpawu ezikhathazayo ze-acral melanoma, isiza ukuhlanganisa umgca phakathi kokubona indawo kunye nokufumana uvavanyo lweprofesional.

Oku kubaluleke kakhulu kuba abantu abaninzi abawufaki iipalms, iisole, kunye neenail kwiingxelo zabo zokuzihlola, kwaye xa befumana i-lesion enombala kwiindawo ezinjalo, umfanekiso ongajolisi (uqhathaniswa ne-moles kwezinye iindawo) unokubangela ukukhathazeka okungafanelekanga. I-Skinscanner inceda ukuhlinzeka ngolwazi oluchanekileyo malunga ne-lesions ezinemibala ye-acral, ichaza ukuba kutheni i-moles kwiindawo ezinjalo zibonakala zihluke kwaye yiziphi iimpawu ezifanele ukukhathazeka okanye ukunceda. Kubantu abajolise kwi-nevi ze-acral ezikhoyo, ukuthathwa kwemifanekiso ngokuqhubekayo nge-app kuvumela ukulandela naluphi na utshintsho ngexesha — le yinto ebaluleke kakhulu ekuqinisekiseni i-lesion enokuthi iguquke ukusuka kwi-benign iye kwi-malignant.

I-Skinscanner ayithathi indawo yokuvavanywa kwe-dermoscopic ngumgqatswa oqeqeshiwe kwi-dermoscopy ye-acral — umahluko phakathi komgca ophakathi nomgca ophakathi udinga uvavanyo oluphucukileyo ngaphezu kokuthathwa kwemifanekiso okujolise. Kodwa ekuvavanyweni kokuqala nasekugcineni, i-Skinscanner ibonelela ngenyathelo lokuqala elilula, eliphendulayo lokujolisa kwi-skin ye-acral.