Acral Nevus: Ukuqonda Izimpawu Ezisemathangeni, Ezinyaweni, Nasezithombeni

I-acral nevus iyinhlobo ye-melanocytic nevus (imole) etholakala ezindaweni ze-acral zomzimba — emathangeni ezandla, emasoleni ezinyawo, nasezindaweni zemanxiweni (izindawo ze-subungual ne-periungual). Lezi zindawo zibizwa ngokuhlanganyela ngokuthi i-acral ngoba zimelela iziphetho noma izingxenye zokugcina zezingalo. Ama-acral nevi afanele ukunakwa okukhethekile emithini yokwelapha hhayi ngoba ayingozi kakhulu kunezindawo eziningi, kodwa ngoba ama-mole kulezi zindawo abonakala ehlukile ngokuphelele kunezindawo zomzimba eziningi ngenxa yesakhiwo esiyingqayizivele sesikhumba se-acral — futhi ngoba i-acral melanoma, umdlavuza onobungozi ongavela kulezi zindawo, ubonakala unokuhlasela okukhulu futhi uvame ukuhlolwa ezingeni eliphakeme.

Isikhumba se-acral, esaziwa nangokuthi isikhumba esingenamathambo (isikhumba esingenamathambo), sinezakhiwo ezihlukile kakhulu kunesikhumba esinezinwele esigoqela ingxenye enkulu yomzimba. Siphawuleka ngokuba ne-epidermis eyindida kakhulu, ubukhona bezinhlangothi ezihlukile nezimbobo (dermatoglyphics — izithombe zeminwe nezinyawo), ukungabi khona kwezikhumba zezinwele nezinsiza ze-sebaceous, kanye nokuphakama kokuhlala kwe-eccrine sweat glands. Lezi zinguquko zesakhiwo zenza ukuthi izifo ze-melanocytic zibonakale ngendlela ehlukile kulezi zindawo, zakha imikhuba engahunyushwa kabi ngodokotela abangajwayele i-dermoscopy ye-acral.

Ama-acral nevi avamile, ikakhulukazi kubantu abanombala wesikhumba omnyama — ucwaningo luthole ama-nevi e-plantar kuze kube ngu-20 percent wama-populations athile. Iningi lawo liphila kahle, kodwa ukubaluleka kwawo kwezokwelapha kusemthethweni wokuwahlukanisa ngempumelelo ne-acral melanoma, enokubikezela okubi kune-melanoma kwezinye izindawo ngenxa yokuhlolwa okuphuthumayo.

Ukubukeka okuhlukile kwe-acral nevi kuvela esakhiweni esiyingqayizivele sesikhumba esingenamathambo. Ngokungafani nesikhumba esinezinwele, lapho ubuso besikhumba buphakathi nendawo futhi bungenamiphumela, isikhumba se-acral sihlelwe sibe nemigqa ehlukene (sulci) nezimbobo (sulci limitantes) ezakha imikhuba ye-dermatoglyphic esiyazi njengezithombe zeminwe nezinyawo. Iziteshi ze-eccrine sweat zivuleka phezulu kwemigqa, kanti i-crista limitans (umugqa wezitho zomzimba) iphansi komgqa wesurface.

Le nhlaka yokuhlela ibonisa ukuthi ama-melanocytes ngaphakathi kwe-acral nevi ahlukaniswe phakathi kwemigqa nezimbobo ngendlela ethile engafani nesikhumba esinezinwele. Ku-dermoscopy — indlela yokuhlola ethuthukisiwe ebalulekile yokuhlola izifo ezinemibala — ama-acral nevi akhombisa imikhuba ehlukile engabonwa kwezinye izindawo zomzimba. Imikhuba yokuhamba kwemigqa eyindida iyona evame kakhulu, lapho imibala ilandela izimbobo (sulci) ze-dermatoglyphics, ibonakala njengezintambo ezihambelana nemigqa yesikhumba.

Izinhlobo zifaka phakathi imikhuba efana ne-lattice, lapho imigqa yemibala idlula emigqeni, kanye nemikhuba ye-fibrillar, lapho imigqa ezincane eziphakeme zenza ukubukeka okukhanyayo okubonwa kakhulu ezindaweni ezithwala isisindo se-sole. Imikhuba ye-crista dotted ibonisa amaphuzu emibala phakathi kwemigqa (cristae). Lezi zikhumba ezinhle ziveza ukusabalala okujwayelekile kwe-melanocytes ngaphakathi kwesakhiwo sesikhumba se-acral. Ukuqonda lezi zikhumba kubalulekile ngoba imikhuba emibi efanayo — imikhuba yokuhamba kwemigqa, lapho imibala ilandela imigqa kunokuba ilandele izimbobo — iyisikhumbuzo esiyinhloko se-dermoscopic ye-acral melanoma.

Ukuhlukanisa ama-acral nevi aphilile ne-acral melanoma kuyinto ebaluleke kakhulu — futhi eyinselele — emithini yokwelapha. I-acral melanoma (i-acral lentiginous melanoma, noma i-ALM) ibamba cishe amaphesenti amabili kuya kwamathathu wezo zonke i-melanomas emiphakathini ye-Caucasian kodwa ibonisa ingxenye enkulu kakhulu — kuze kube yizinkulungwane ezingama-60 kuya kwama-70 — ye-melanomas kubantu abavela e-Afrika, e-Asia, nase-Hispanic. Le mpikiswano yenza i-acral melanoma ibe yinkinga enkulu yokulingana kwezempilo.

I-acral melanoma inobungozi obubi kune-melanoma kwezinye izindawo, ikakhulu ngenxa yokuhlolwa okuphuthumayo — ubukhulu be-Breslow ngesikhathi sokuhlolwa bukhulu kakhulu kune-melanoma esikhumbeni esithola ilanga. Izici eziningi zifaka isandla kulokhu kuhlolwa: emathangeni nasezinyaweni akuvamile ukuhlolwa ngesikhathi sokuhlola isikhumba, i-melanoma ye-nail ivame ukudideka njengezifo ze-fungal noma ukulimala, abantu abanesikhumba esinsundu bangase bangaziboni njengabangozi ye-melanoma, futhi abahlinzeki bezempilo bangase bangajwayele i-melanoma kulezi zindawo. Ngokwezimfanelo, izici ezidinga ukukhathazeka nge-acral melanoma zifaka i-lesion enombala enkulu kunezikhawu eziyisixhenxe emathangeni noma ezinyaweni, ukwakheka okungalingani, imingcele engajwayelekile noma engacacile, ukwehluka kwemibala okuhlanganisa okunsundu, okumnyama, okwesibhakabhaka, noma okukhanyayo, kanye nezinguquko zakamuva noma ukuvela.

Ngokuqondile kwi-melanoma ye-nail, uphawu lukaHutchinson — imibala edlula esikhumbeni esizungezile (ukwandiswa kwe-periungual) — uphawu olubalulekile lokuxwayisa. Ku-dermoscopy, imikhuba yokuhamba kwemigqa — lapho imibala ilandela imigqa ye-dermatoglyphics kunokuba ilandele izimbobo — ibalulekile kakhulu ku-acral melanoma futhi iyisici esiyinhloko se-dermoscopic sokuhlola. Noma iyiphi i-lesion ye-acral enombala ebonisa imikhuba yokuhamba kwemigqa kufanele ibhiyozwe ngokushesha.!!

I-melanocytic nevi ingavela ngaphakathi kwe-nail matrix — ith tissue elinokwakheka kwe-crescent elisekhaya le-nail lapho i-nail plate ikhula khona — ikhiqiza ibhendi ye-pigmentation ye-nail ebizwa nge-melanonychia striata (i-longitudinal melanonychia). Lokhu kubonakala njenge-stripe emnyama noma emnyama-brown eqhubeka ubude be-nail ukusuka esisekelweni kuya emaphethelweni akhululekile. I-longitudinal melanonychia iyisithombe se-clinical esikhiqiza ukukhathazeka okukhulu kokuxilongwa ngoba ingaba uphawu lwe-benign nail nevus, i-nail melanoma, noma ezinye izimo eziningi ezihlanganisa i-ethnic melanonychia (i-pigmentation ejwayelekile kubantu abanesikhumba esinsundu), i-pigmentation eyenziwe yimithi, ukutheleleka kwe-fungal, noma i-subungual hematoma.

Kubantu abadala abavela e-Afrika, i-longitudinal melanonychia ivamile kakhulu futhi ivamise ukuveza ukuvuselelwa okujwayelekile kwe-melanocytic — ithinta cishe bonke abantu abadala base-Afrika ngonyaka we-50 futhi ama-nail amaningi ajwayelekile. Kubantu abamhlophe, i-longitudinal melanonychia ivamile kancane futhi ivame ukuveza ukukhathazeka nge-melanoma. Izici eziphakamisa ukukhathazeka kwe-benign nail nevus zifaka ibhendi elincane (ngaphansi kwemithathu millimeters), elihambisanayo, elinezingqimba ezivamile ezinemibala emnyama, ethola kumntwana noma kumuntu omncane, ezinzile ngokuhamba kwesikhathi.

Izici eziphakamisa ukukhathazeka nge-nail melanoma zifaka ibhendi enkulu (ngaphezu kwemithathu millimeters) noma ibhendi evulekile, imikhawulo engajwayelekile noma engacacile, ukungafani kwemibala ngaphakathi kwebhendi (emnyama, emnyama, izindawo ezimnyama), uphawu lukaHutchinson (ukwandiswa kwe-pigment periungual), i-nail plate dystrophy (ukuphuka, ukuhamba, ukuncipha), nokwenzeka emgqeni owodwa womuntu omdala. I-thumbs, i-index finger, ne-great toe yizigaba ezivame kakhulu ukuthinteka nge-nail melanoma. Noma yiziphi i-longitudinal melanonychia ezintsha noma ezishintshayo kumuntu omdala kufanele ihlolwe udokotela wezokwelapha onolwazi nge-nail dermoscopy.!! I-biopsy ye-nail matrix kwesinye isikhathi iyadingeka ukuze kutholakale ukuxilongwa okuqondile.

Ngokubheka izinselelo zokuhlola ama-lesions apigmented esikhumbeni se-acral, indlela ehlelekile ibalulekile. Ukuhlola kwe-clinical kuqala ngokubona indawo, usayizi, ifomu, umbala, izici zomkhawulo, kanye nomlando we-lesion. Izimiso ze-ABCDE ezisetshenziselwa ukuhlola ama-moles kwezinye izindawo zisebenza kuma-lesions e-acral kodwa ngokwenza izinguquko — umkhawulo wokukhathazeka kufanele ube phansi ngenxa yokuthi ukuxilongwa okuphuthumayo kudinga ukuhamba phambili.

I-dermoscopy ibalulekile ekuhloleni ama-lesions e-acral futhi idinga ukuqeqeshwa okukhethekile ezithombeni ze-acral dermoscopic. I-algorithm yeziqondiso ezintathu ye-dermoscopy ye-acral inikeza indlela ehlelekile: kuqala, thola ukuthi i-lesion ibonisa iphethini eyaziwayo ye-benign (i-parallel furrow, i-lattice-like, i-fibrillar, noma i-crista dotted); kwesibili, uma kungatholakali iphethini ye-benign, hlola iphethini ye-parallel ridge (ebonisa i-melanoma); kwesithathu, uma iphethini ingacacile, cabanga nge-biopsy noma ukulandela eduze nge-serial dermoscopy. I-biopsy iyas recommended nganoma iyiphi i-lesion ye-acral enephethini ye-parallel ridge, noma iyiphi i-lesion enezici ezingajwayelekile ezingahambisani nephathini eyaziwayo ye-benign, noma iyiphi i-lesion eshintsha usayizi, ifomu, noma umbala, noma iyiphi i-lesion epigmented enkulu kunezithupha eziyisixhenxe, kanye noma iyiphi i-lesion ekhuthaza ukukhathazeka kwe-clinical kungakhathaliseki ukuthi imiphumela ye-dermoscopic.

I-biopsy ye-excisional ikhethwa kune-biopsy engaphelele ukuze kutholakale ukuhlolwa kwe-histopathologic okunembile. Kubantu abaqinisekisiwe abane-benign acral nevi, ukuhlolela okujwayelekile kuyafaneleka ngokuhlola kwe-clinical kanye ne-dermoscopic ngezikhathi ezinqunywe ngempilo yomuntu. Abaguli kufanele bafundiswe ukuthi baphendule kanjani — izinguquko osayizi, ifomu, umbala, noma izimpawu ezintsha — kanye nokubaluleka kokufaka izandla, izinyawo, phakathi kwezinyawo, kanye nama-nail ezihlolweni zabo zokuzihlola.

Ama-mole ezandleni, ezinyaweni, kanye nama-nail aphakathi kwezinto ezikhathazayo kakhulu ezitholakala esikhumbeni ngenxa yokuxhumana kwawo ne-acral melanoma kanye nokuqaphela okujwayelekile ukuthi i-melanoma kulezi zindawo ivame ukuxilongwa sekwedlule. I-Skinscanner ihlinzeka ngokuqinisekiswa kwe-AI okwenziwa ngokushesha uma uthatha isithombe se-lesion epigmented esikhumbeni se-acral, ihlola izici zayo ezibonakalayo ezihlanganisa usayizi, ifomu, ukujwayeleka komkhawulo, ukujwayeleka kombala, kanye nokuhambisana. I-AI ifundiswe ukuqaphela ama-pateni ahlobene ne-benign acral nevi nokukhomba izici eziphakamisa ukukhathazeka nge-acral melanoma, ukusiza ukuhlanganisa isikhala phakathi kokubona indawo nokuthola ukuhlolwa kwe-professional.

Lokhu kubaluleke kakhulu ngoba abaningi abantu abahlanganisi izandla zabo, izinyawo, kanye nama-nail ezihlolweni zabo zokuzihlola, futhi lapho bethola i-lesion epigmented kulezi zindawo, ukubonakala okungajwayelekile (kuqhathaniswa nama-moles kwezinye izindawo) kungadala ukukhathazeka okungafanele. I-Skinscanner isiza ukuhlinzeka ngokuqonda okucacile mayelana nama-lesions e-acral apigmented, ichaza ukuthi kungani ama-mole kulezi zindawo kubonakala kuhluke nokuthi yiziphi izici ezidinga ukukhathazeka uma kuqhathaniswa nokuthula. Kubantu abalandelayo ama-acral nevi akhona, ukuthwebula izithombe ngokulandelana nge-app kuvumela ukulandela noma yiziphi izinguquko ngokuhamba kwesikhathi — into ebaluleke kakhulu ekutholeni i-lesion engase iguquke isuka ku-benign iye ku-malignant.

I-Skinscanner ayithathi indawo yokuhlola ye-dermoscopic ngudokotela oqeqeshiwe ku-dermoscopy ye-acral — ukuhlukaniswa phakathi kwe-parallel furrow kanye ne-parallel ridge patterns kudinga ukuhlolwa okukhanyayo okudlula izithombe ezijwayelekile. Kodwa ekuhloleni kokuqala nasekuqhubekeni kokuhlola, i-Skinscanner inikeza isinyathelo sokuqala esitholakalayo, esisheshayo sokuphila kahle kwesikhumba se-acral.