I-Actinic Keratosis: I-Sign ye-Pre-Cancer Ethumela Uhlanga Lwakho

I-actinic keratosis (AK), ebizwa ngokuba yi-solar keratosis, yindawo eqinile, enezinhlanga zesikhumba ezivela eminyakeni yokuchayeka elangeni. I-AKs ithathwa njengezindawo eziphambi kokuba zibe yizifo zomhlathi — zimele isikhumbuzo sokuqala esivela esikhumbeni esonakele elangeni ukuya kwi-squamous cell carcinoma (SCC). Ngaphezu kwezigidi eziyi-58 zamaMelika zine-AK eyodwa okungenani, okwenza kube yimbangela ejolise kakhulu yokuvakashela kwi-dermatology.

025% ukuya kwi-16% ngonyaka ngonyaka, kodwa nantsi into ebalulekileyo: umngcipheko uyakhula kwaye uhlanganisa. Umntu onama-AK amaninzi (futhi abantu abaningi banezininzi) ubhekene nomngcipheko ophezulu kakhulu wokuphuhlisa i-SCC kwi-AK eyodwa okungenani. 7 zihlala zine-10% yokuba okungenani enye ibuyele kwi-SCC phakathi kweminyaka eyi-10.

I-AKs ivame ukuvela njengezindawo ezomile, eziqinile, ezine-texture ye-sandpaper ezivela kumamilimitha ambalwa ukuya kwi-centimeters ezininzi ububanzi. Zivame ukuba lula ukuziva kunokubona — ukugijima iminwe yakho phezu kwesikhumba esichayekileyo elangeni kungavula izindawo eziqinile ngaphambi kokuba zibe sobala. Umbala uhleleka ukusuka kwisikhumba ukuya kwi-pink, ebomvu, okanye emnyama.

Zivela kakhulu ebusweni (ikakhulu emathangeni, emlonyeni, ezindlebeni, nasezindlebeni), emakhanda, emithanjeni, nasezandleni — iindawo ezine-UV exposure ephezulu kakhulu. I-AKs zingaba nobuhlungu, zibe ne-itchy, okanye zikhuphe umuzwa wokubamba okanye wokushisa, ikakhulu uma ziqhutywa noma zikhathazekile. Zingashintsha ngendlela ezibukeka ngayo, zibonakala zithuthuka okwesikhashana ngaphambi kokuphinda zibuye, okwenza abaningi baziqhele ukungazithathi nzima.

Omunye wemigomo ebaluleke kakhulu ekuqondeni i-actinic keratosis ukukhula kwe-cancer — umqondo wokuthi ama-AKs abonakalayo ayisikhumbuzo esincane se-iceberg emkhakheni wokonakala kwelanga. Isikhumba esijolise kuma-AKs abonakalayo sinezixhumi ezingenakubonwa (okungakabonakali) — amaseli ahlanganisile umonakalo we-DNA ophumelelayo we-UV ukuze abe yizifo eziphambi kokuba zibe yizindawo ezibonakalayo. Ucwaningo olusebenzisa i-microscopy yesikhumba kunye nokuhlola kwe-molecular luveza ukuba isikhumba esibonakala sisenziwe kahle phakathi kwama-AKs abonakalayo sinezinkinga ezinkulu zezakhi zofuzo, kuhlanganise ne-p53 mutations (izinguquko ezifanayo ze-gene ye-tumor suppressor ezitholakala kwi-SCC eyingozi).

Lokhu kusho ukuthi ukwelashwa kwe-AKs ezibonakalayo ngenkathi ungenakubona umkhakha ononakele kufana nokudlala umdlalo ongapheli wokushaya imikhono — izindawo ezintsha ziyaqhubeka nokuphuma emkhakheni ononakele kuze kube phakade.!! Ukwelashwa okujolise emkhakheni, okwelapha indawo yonke enonakele kunokwelapha izindawo ezithile, kubhekisisa le nkinga eyisisekelo. Umqondo wokukhula kwe-cancer uphinde uchaze ukuthi kungani abanye abaguli bezwa bephazamisekile ukubonakala kwe-AKs ezintsha ezingenakuphela — akukhona ukuthi ukwelashwa akusebenzi; kukhona umkhakha ononakele ohlala ukhiqiza izindawo ezintsha.

Ukuphathwa okuphelele kudinga kokubili ukwelashwa okujolise ezindaweni ezibonakalayo ze-AKs kanye nokwelashwa okujolise emkhakheni wokonakala, kuhlanganiswe nokuvikelwa kwe-sun okuqinile ukuze kuvinjwe umonakalo we-UV kwi-skin esivele isonakele. Ukuqonda ukukhula kwe-cancer kushintsha indlela ocabanga ngayo ngama-AKs: azikho izenzakalo ezizimele kodwa zikhombisa inqubo ebanzi ethinta yonke indawo yesikhumba esichayeke elangeni. Lokhu kungokwakho abahlengikazi be-dermatology bavame ukweluleka ukwelapha izindawo ezinkulu kunokulandela izindawo ezithile.

Ukuphathwa kwe-AK kuhlukaniswa kube izigaba ezimbili ezibanzi: ukwelashwa okujolise ezindaweni ezibonakalayo ze-AKs, kanye nokuphathwa okujolise emkhakheni okwelapha zonke izindawo zokonakala kwelanga kuhlanganise nezifo ezingakabonakali. I-cryotherapy (i-nitrogen liquid) iyindlela evame kakhulu yokwelashwa okujolise ezindaweni — udokotela wezikhumba ufaka umjikelezo omfushane ku-AK ngayinye, okwenza ibhulethi eliqinile eliqinile futhi lishiyeke, lihlasele amaseli angajwayelekile. Kulula, akudingi imali eningi, futhi kuyasebenza kuma-AKs ahlukanisiwe, ngokuhamba kwezinga lokuhlanzeka elingu-75-99% ngendawo kuye ngokuqhuba.

Izinkinga zihlanganisa ubuhlungu, ukuvuvukala, umonakalo ophakeme (izikhumba ezimhlophe) ikakhulukazi esikhumbeni esimnyama, nokungabi khona kokwelashwa komkhakha ongakabonakali. I-Curettage (ukuhlanza) nge-electrodesiccation noma ngaphandle kwayo iyindlela yokwelashwa okujolise ezindaweni ezinzima ze-AKs. Ukuze ukwelashwa okujolise emkhakheni, i-topical 5-fluorouracil (5-FU, igama lomkhiqizo Efudex) iyikhemikhali yokwelapha efakwa endaweni ethintekile kanye noma kabili ngosuku izinsuku eziyi-2-4.

Ihlisa amaseli angajwayelekile, okwenza indawo ethintwayo ibe mnyama, ibhujiswe, ibhujiswe, futhi ibonakale ibuhlungu izinsuku eziningi — inqubo ethokozisa abaguli abaningi kodwa ibonisa ukuthi imishanguzo iyasebenza. Njengoba ubukeka kabi ngesikhathi sokwelashwa, umonakalo ongakabonakali uyasuswa. Ngemuva kokuphola, isikhumba esithintwayo sivame ukubukeka ngcono kakhulu kunakuqala, sinesikhumba esithambile nesithokozisayo.

I-Imiquimod (Aldara, Zyclara) iyisikhumbuzo sokuphendula komzimba esikhuthaza uhlelo lwezokwelapha lomzimba ukuba luhlasela amaseli angajwayelekile, efakwa izikhathi ezi-2-3 ngesonto ezinsukwini eziningi. Iphumela leyo ibangela ukuvuvukala okufanayo kodwa ngokuvamile kuncane kune-5-FU. I-Photodynamic therapy (PDT) ibandakanya ukufaka umkhiqizo ophendulayo (i-aminolevulinic acid noma i-methyl aminolevulinate) esikhumbeni, ilinde ama-AK cells ukuba awamukele (1-3 amahora), bese uyivula ngombala othile wokukhanya.

Umkhiqizo ophendulayo ugxila kakhulu kumaseli angajwayelekile, okwenza kube nokubhujiswa okukhethiweyo uma kuvulwa. I-PDT inemiphumela emihle yokubukeka kodwa ibangela ubuhlungu bokushisa ngesikhathi sokukhanya. I-Ingenol mebutate (Picato) bekuyindlela yokuphathwa emkhakheni edinga izinsuku ezi-2-3 zokufaka kodwa yakhishwa kwezinye izimakethe ngenxa yezinkinga zokuphepha.

I-Chemical peels (i-trichloroacetic acid) kanye ne-laser resurfacing (i-ablative fractional laser) nazo zinikeza ukwelashwa komkhakha. Kubantu abaningi abane-AKs ezinkulu, indlela yokuhlanganisa isebenza kahle kakhulu: ukwelashwa okujolise emkhakheni ukuze kuhlanzeke umonakalo ongakabonakali, kulandelwe ukwelashwa okujolise ezindaweni ze-AKs ezisele.

Ukuphathwa kwe-AK okujolise emkhakheni — ikakhulukazi i-5-FU ne-PDT — kubandakanya izindleko zokuqonda ezinzima kodwa ezibalulekile ezibamba abaningi abaguli bephazamisekile. Ukuqonda isikhathi sokwelashwa kusiza ukuhlela nokuhlala uqhubeka ngezikhathi ezinzima. Nge-5-FU (Efudex), umjikelezo ojwayelekile uthatha izinsuku ezi-2-4 zokwelashwa kobuso (kude kakhulu ezandleni nasezandleni).

Phakathi kwesonto lokuqala, izindawo ezithintwayo ziba pinki futhi zibe nethonya elincane — ama-AKs angakabonakali owawungekho ubonakala njengoba imishanguzo ibhekisela kumaseli angajwayelekile. Ngempela, isikhumba esithintwayo siba mnyama, sikhuphuka, sibhujiswe, futhi sibe nembobo. Ubuso bungavuvukala, bube nembobo enkulu, futhi bubukeke buphazamisekile.

Abaningi abaguli bachaza le nqubo njengokubukeka njengokuthi bahluphekiwe kakhulu. Ukungakhululeki kufaka phakathi ukushisa, ukuvuvukala, ubuhlungu, nokukhathazeka. Izinsuku ezintathu nezine ziletha ukuvuvukala okuphezulu kulandele ukuqala kokuphola njengoba amaseli anonakele ehamba phambili futhi isikhumba esinempilo sibuya phezulu.

Ukuphola okuphelele kuthatha izinsuku ezi-2-4 ezengeziwe ngemuva kokumisa ukwelashwa. Umphumela wokugcina ungukubukeka okusha, okuthambile, okukhanya — abaningi abaguli babika ukuthi babukeka bencane ngeminyaka uma sebepholile. Nge-PDT, isigaba esiphuthumayo sisheshisa kodwa siba namandla: iseshini yokuvula ukukhanya ibangela ubuhlungu obukhulu bokushisa obuhlala amahora ambalwa, kulandelwa izinsuku ezi-3-7 zokubomvu, ukuvuvukala, nokuhlanza.

Isikhathi sokuphumula somphakathi sivame ukuba izinsuku ezi-5-10. Ukuhlela okusebenzayo kubalulekile: hlela ukuphathwa komkhakha ngesikhathi lapho unganciphisa khona izibopho zomphakathi nezokusebenza. Ukugwema ilanga ngesikhathi nangemva kokwelashwa kubalulekile, njengoba isikhumba esithintwayo sithinteka kakhulu.

Ukuba nesistimu yokuxhasa eyazi ukuthi uzobukeka kanjani ivimbela izimpendulo eziphazamisekile emndenini nasemsebenzini. Ukuphathwa kobuhlungu ngama-compresses abandayo, ama-moisturizers athambile (i-petroleum jelly iphephile), kanye ne-analgesics (i-acetaminophen, i-ibuprofen) kusiza ukuphatha ukungakhululeki. Abanye abaguli babhalisela uhambo lwabo lokwelashwa ngezithombe zansuku zonke — le miphumela isebenza njengokukhuthaza komuntu (ukubona ukuthuthuka okuqhubekayo ngesikhathi sokuphola) kanye nolwazi oluwusizo lokuhlela ukwelashwa kwesikhathi esizayo.

Ngenkathi ama-actinic keratoses amaningi ehlala ezinzile noma athuthuka okwesikhashana, ezinye izinguquko zikhombisa ukwanda okungenzeka kwe-squamous cell carcinoma okudingayo ukuhlolwa ngokushesha. I-AK eqinile ethuthuka, eqinile (ebhujiswe), noma ethuthukisa isisekelo esitholakalayo singase sibe sithuthuka ukusuka ezimweni ezithile ukuya kwi-cancer eyingozi.!! Ukukhula okwandayo noma ubuhlungu ku-AK eyayingenakubona ngaphambili kukhombisa ukungenelela kwezicubu ezijulile.

I-AK eqala ukuhamba ngokwakho (hhayi ngokushefa noma ukuhlinzwa) ifuna i-biopsy. Ukukhula okusheshayo noma ukwandisa okukhulu ezinsukwini kuya ezinyangeni kuyakhathaza. Ukuthuthukiswa kwe-horn ye-cutaneous — ukwakheka okuqinile, okunjengomkhono we-keratin — endaweni ye-AK kukhombisa ukungahambi kahle kwe-keratinocyte okudingayo ukuhlolwa kwe-histologic, njengoba kuze kube ngu-20% we-horns ye-cutaneous inama-SCC ezisekelweni zayo.

Uma i-AK iqhubeka noma ibuyela ngokushesha ngemuva kokwelashwa okufanele (ikakhulukazi ngemuva kwe-cryotherapy), i-biopsy iyadingeka ukuze kuqinisekiswe ukuthi ayikho i-SCC eyingozi engathinteki ezindaweni eziphezulu. Noma iyiphi i-AK emlonyeni (i-actinic cheilitis) ifanele ukwelashwa okuphuthumayo nokubhekwa ngokucophelela, njengoba i-lip SCC inezinga eliphezulu lokuhamba. Kubantu abanama-AKs amaningi, ukusungula ukuhlola okujwayelekile kwe-dermatologic (ngonyaka eziyi-6-12) kudala isikhala esihlelwe sokubheka umkhakha wonke nokubamba ukwanda kusenesikhathi. Phakathi nezivakashi ezisebenzayo, ukuhlola ngokwakho okwenziwa njalo kuqhathaniswa nezithombe zakho zangaphambilini kukusiza ukuthi uqaphele izinguquko ezithuthukayo.

I-actinic keratoses ifuna ukuqapha okuqhubekayo ngoba umonakalo ophakathi kokukhanya kwelanga owenza lezi zimo awupheli ngemuva kokwelashwa — ama-AK amasha azaqhubeka nokuphuma endaweni elimele, futhi ama-AK akhona adinga ukuqapha ukuze kubonakale intuthuko. I-Skinscanner inikeza indlela elula yokubhalisela nokulandela ama-AK akho phakathi kwezikhathi zokuvakasha kudermatology. Ngokuthwebula izithombe zesikhumba sakho esibhekene nelanga njalo, udala irekhodi elibonakalayo elikhombisa izinguquko ezincane kakhulu noma ezithambile ezingabonakali ezibukweni zansuku zonke.

I-AI yethu ingasiza ekutholeni izindawo ezinzima, ezineziqu ezijwayelekile zama-AK futhi ibonise izinguquko ezingase zibonise intuthuko — ukujula, ukuphakama, noma ukukhula okusheshayo okudinga ukuhlolwa ngochwepheshe. Kulabo abahamba phambili ekwelashweni kwendawo efana ne-5-FU noma i-PDT, ukubhalisela isikhumba sakho ngaphambi, phakathi, nangemva kokwelashwa kudala irekhodi elibalulekile lokuphendula kokwelashwa kanye ne-benchmark yokuthola ukuphindaphinda okuzayo. Ikhono lokuqhathanisa elihambisana nezithombe liyasiza kakhulu ekuqapheni ama-AK amaningi abaninzi abathola umonakalo ophakathi kokukhanya kwelanga — ukulandela izindawo eziyishumi noma ezingamashumi amabili ebusweni bakho, emakhanda, nasemakhanda ezandleni ezinyangeni kuya eminyakeni kudlula ikhono lokukhumbula lomuntu kodwa kulula nge-dokumenteshini yezithombe. I-Skinscanner ikunika amandla ukuba ube nengxenye ekuqapheni kwakho, uthuthukisa (hhayi ukufaka esikhundleni) ukuvakashelwa kwakho kochwepheshe kudermatology ngedokumenteshini ebonakalayo eyenza isikhumbuzo ngasinye sibe nemiphumela engcono.