I-Actinic Keratosis: Isixwayiso Se-Pre-Cancer Esithunyelwa Yisikhiye Sakho

I-actinic keratosis (AK), eyaziwa nangokuthi i-solar keratosis, iyindawo enzima, enezinhlamvu zesikhumba ethuthukiswa eminyakeni yokukhanya kwelanga. I-AKs ibhekwa njengezimo ze-pre-cancer — zimelela isigaba sokuqala esivela esikhumbeni esonakele ukukhanya kwelanga kuya kwi-squamous cell carcinoma (SCC). Abantu abangaphezu kwe-58 million baseMelika bane-AK eyodwa okungenani, okwenza kube yinye yezizathu ezivamile zokuvakashela udokotela wezikhumba.

025% kuya ku-16% ngonyaka ngonyaka, kodwa nansi into ebalulekile: ingozi iyakhula futhi iyanda. Umuntu onama-AKs amaningi (futhi abantu abaningi baneziningi) ubhekene nengcuphe enkulu yokuthuthukisa i-SCC kusuka kokuncane. Ucwaningo olwakha lwalulinganisa ukuthi abathintekayo abane-AKs eziyisixhenxe zine-10% yokuthi okungenani eyodwa ithuthuke ibe yi-SCC phakathi neminyaka eyi-10.

I-AKs ivame ukubonakala njengezindawo ezomile, ezinzima, ezinezindwangu ezinjengopende ezihamba ukusuka kumilimitha embalwa kuya kumacentimeter amaningi ububanzi. Zivame ukuba lula ukuzizwa kunokubona — ukuhamba nezandla zakho phezu kwesikhumba esithintekile ukukhanya kwelanga kungaveza izindawo ezinzima ngaphambi kokuba zibe sobala. Umbala uhamba ukusuka kwesikhumba ukuya kokupinki, okubomvu, noma okumbala okumnyama.

Zivame ukubonakala kakhulu ebusweni (ikakhulukazi emathafeni, emaphashini, emakhanda, nasezindebeni), ezindlebeni, emakhanda (ikakhulukazi kubantu abangenamakhanda noma abakhuluma), emithanjeni, ezandleni, nasezindaweni zezandla — izindawo ezithintekile kakhulu ukukhanya kwe-UV. I-AKs ingaba nobuhlungu, ibhande, noma ikhiqize umuzwa wokushisa noma wokushisa, ikakhulukazi uma ithintwa noma ibhujiswa. Zingashintsha ngendlela yokubukeka, zibonakala zithuthuka okwesikhashana ngaphambi kokuphinda, okwenza abantu abaningi bazitholele.

Omunye wemigomo ebalulekile ekuqondeni i-actinic keratosis ukuhlinzwa kwemikhakha — umqondo wokuthi ama-AKs abonakalayo angumkhono kuphela we-iceberg emkhakheni wokonakala kokukhanya kwelanga. Isikhumba esizungezile ama-AKs abonakalayo siqukethe ama-AKs amaningi angakabonakali (engakabonakali) — amaseli aqoqe umonakalo we-DNA ophumelelayo we-UV ukuze abe yi-pre-cancer kodwa engakathuthukiswa abe yizimo ezitholakalayo. Ucwaningo olusebenzisa i-microscopy yesikhumba kanye nokuhlaziywa kwemolekyuli lukhombisa ukuthi isikhumba esibonakala sisenhle phakathi kwama-AKs abonakalayo sinesimo esikhulu se-genetic damage, kuhlanganise ne-p53 mutations (izinguquko ze-gene ye-tumor suppressor ezitholakala kwi-SCC ethuthukile).

Lokhu kusho ukuthi ukwelapha ama-AKs abonakalayo ngenkathi ungawuhloniphi umkhakha ononakele kuyafana nokudlala umdlalo ongapheli we-whack-a-mole — izimo ezintsha zizoqhubeka zivele emkhakheni ononakele kuze kube phakade. Ukuhlola okukhomba umkhakha, okwelapha indawo yonke enonakele esikhundleni sokubhekana nezindawo ezithile, kubhekana nale nkinga eyisisekelo. Umqondo wokuhlola imikhakha uphinde uchaze ukuthi kungani abanye abathintekayo bezwa bephazamisekile ukubonakala okuqhubekayo kwe-AKs ezintsha — akukhona ukuthi ukwelashwa akusebenzi; kukhona ukuthi umkhakha ongaphansi kokonakala uqhubeka ukhiqiza izimo ezintsha.

Ukuphathwa okuphelele kudinga kokubili ukwelashwa okuqondiswe ezimweni ezibonakalayo ze-AKs kanye nokwelashwa okukhomba umkhakha wokonakala, kuhlanganiswe nokuvikela okuqinile kokukhanya kwelanga ukuvimbela umonakalo we-UV okwengeziwe esikhumbeni esivele sithintekile. Ukuqonda ukuhlinzwa kwemikhakha kushintsha indlela ocabanga ngayo ngama-AKs: akuwona umcimbi ohlukanisiwe kodwa izibonakaliso zenqubo ebanzi ethinta yonke indawo yesikhumba sakho esithintekile ukukhanya kwelanga. Lokhu kungokwakho ukuthi odokotela bezikhumba bavame ukuhlinzeka ngokuqhuba izindawo ezinkulu esikhundleni sokulandela izindawo ezithile.

Ukwelashwa kwe-AK kuhlukaniswa ngezigaba ezimbili ezibanzi: ukuhlinzwa okubhekiswe ezimweni ezibonakalayo ze-AKs, kanye nokuhlinzwa okubhekiswe emkhakheni okwelapha izindawo eziphelele zokonakala kokukhanya kwelanga kuhlanganisa nezifo ezingakabonakali. I-cryotherapy (uketshezi lwe-nitrogen) iyindlela evamile yokwelapha okubhekiswe ezimweni — udokotela wezikhumba ufaka umjikelezo omfushane ku-AK ngayinye, okwenza umphumela ophuma phansi ophuma phezulu, uphule izicubu ezingajwayelekile. Iphumelela, ayibizi, futhi iyasebenza kuma-AKs ahlukanisiwe, ngokuphuma okungama-75-99% ngonyaka kuye ngenkambiso.

Izinkinga zihlanganisa ubuhlungu, ukuvuvukala, ukungasebenzi kahle (izindawo ezimhlophe) ikakhulukazi esikhumbeni esinsundu, futhi akukho ukwelashwa komkhakha ongakabonakali. I-Curettage (ukuhlanza) ngenkathi noma ngaphandle kokuhlanza izindawo ezinzima kuyinketho ethile yokwelapha ezimweni ezinzima. Ukuze uhlinze emkhakheni, i-topical 5-fluorouracil (5-FU, igama lomkhiqizo Efudex) iyikremu ye-chemotherapy efakwa endaweni ethintwe yisikhumba kanye noma kabili ngosuku phakathi nezinsuku ezi-2-4.

Iphula izicubu ezingajwayelekile, ibangela indawo ethintwe ukuba ibe mnyama, ibhujiswe, ibhujiswe, futhi ibonakale ibuhlungu isikhathi eside — inqubo ethokozisa abathintekayo kodwa ibonisa ukuthi imithi iyasebenza. Lokhu kubukeka kubi kakhulu ngesikhathi sokwelashwa, kubonisa ukuthi umonakalo ongakabonakali uyabhekwa. Ngemuva kokuphola, isikhumba esithintwe sivame ukubukeka kahle kakhulu kunakuqala, sinesikhumba esithambile nesithokozisayo.

I-Imiquimod (Aldara, Zyclara) iyashintsha umphumela wokuphendula komzimba ukuze ibhujise izicubu ezingajwayelekile, ifakwa izikhathi ezi-2-3 ngesonto phakathi nezinsuku eziningi. Iphula ukungasebenzi kahle kodwa ngokuvamile ibuhlungu kakhulu kuno-5-FU. I-Photodynamic therapy (PDT) ihlanganisa ukufaka umphumela wokukhanyisa (i-aminolevulinic acid noma i-methyl aminolevulinate) esikhumbeni, ilinde ama-AK cells ukuthi awamukele (1-3 amahora), bese uwavula ngombala othile wokukhanya.

Umphumela wokukhanyisa ugxile kakhulu ezicubwini ezingajwayelekile, ubangela ukunciphisa okukhululekile uma uvulwa. I-Ingenol mebutate (Picato) bekuyindlela yokuhlinzwa emkhakheni eyayingadingi izinsuku ezi-2-3 zokufaka kodwa yakhishwa ezimakethe ezithile ngenxa yokukhathazeka ngokuphepha. I-Chemical peels (i-trichloroacetic acid) kanye ne-laser resurfacing (i-ablative fractional laser) nazo zinikeza ukwelashwa emkhakheni. Kubantu abaningi abane-AKs ezinzima, indlela yokuhlanganisa iyasebenza kahle kakhulu: ukuhlinzwa okubhekiswe emkhakheni ukuze kuhlanzeke umonakalo ongakabonakali, kulandelwa ukwelashwa okubhekiswe ezimweni ezithile ze-AKs ezisele.

Ukwelashwa kwe-AK okubhekiswe emkhakheni — ikakhulukazi i-5-FU ne-PDT — kuhilela izindleko ezithile zokubukeka kanye nokunethezeka ezibamba abathintekayo abaningi bephazamisekile. Ukuqonda isikhathi sokwelashwa kusiza ukuhlela nokuhlala uqhubeka ezikhathini ezinzima. Nge-5-FU (Efudex), umjikelezo ojwayelekile uthatha izinsuku ezi-2-4 zokwelapha ubuso (kude kakhulu ezandleni nasezandleni).

Ngesonto lokuqala, izindawo ezithintwe ziba pinki futhi zibe nethonya elincane — ama-AKs angakubonakali owazi ukuthi akhona aveza ngokuthi imithi ibhekana nezicubu ezingajwayelekile. Ngempela, isikhumba esithintwe siba mnyama, sikhukhuleka, sibhujiswe, futhi sibe nempilo yokubukeka. Ubuso bungavuvukala, bube mnyama kakhulu, futhi bubukeke bukhathazekile.

Abantu abaningi bachaza lesi sikhathi njengokubukeka njengokuthi bahlaselwe kakhulu. Ukungakhululeki kuhlanganisa ukushisa, ukuvuvukala, ubuhlungu, kanye nobunzima bokulala. Izinsuku ezintathu nezine ziletha ukuvuvukala okuphezulu kulandela ukuqala kokuphola njengoba izicubu ezonakele zikhukhuleka futhi isikhumba esinempilo sikhula ngaphansi.

Ukuphola okuphelele kuthatha izinsuku ezi-2-4 ezengeziwe ngemuva kokumisa ukwelashwa. Umphumela wokugcina ungumkhono omusha, ongenamaphutha, ophilayo — abantu abaningi babika ukuthi babukeka bephila iminyaka eminingi uma sepholile. Nge-PDT, isigaba esiphuthumayo sisheshisa kodwa siba namandla: iseshini yokuvula ukukhanya ibangela ubuhlungu obukhulu obuhlala amahora ambalwa, kulandela izinsuku ezi-3-7 zokubomvu, ukuvuvukala, nokukhukhuleka.

Isikhathi sokuphumula somphakathi sivame ukuba izinsuku ezi-5-10. Ukuhlela okusebenzayo kubalulekile: hlela ukwelashwa emkhakheni ngesikhathi lapho unganciphisa khona izibopho zomphakathi nezomsebenzi. Ukugwema ukukhanya kwelanga ngesikhathi nangemva kokwelashwa kubalulekile, njengoba isikhumba esithintwe sithinteka kakhulu.

Ukuba nesistimu yokwesekwa eyazi ukuthi uzobukeka kanjani kuvikela izimpendulo eziphazamisayo emndenini nakubangani. Ukuphathwa kobuhlungu ngama-compresses abandayo, ama-moisturizers anobungane (i-petroleum jelly iphephile), kanye nezidakamizwa zokuphatha (i-acetaminophen, i-ibuprofen) kusiza ukuphatha ukungakhululeki. Abanye abathintekayo babhalela uhambo lwabo lokwelashwa ngezithombe zansuku zonke — le miphumela isebenza njengokukhuthazwa komuntu (ukubona ukuthuthuka okuqhubekayo ngesikhathi sokuphola) kanye nolwazi oluwusizo lokuhlela ukwelashwa okuzayo.

Ngenkathi iningi le-actinic keratoses lihlala lizinzile noma linciphisa okwesikhashana, ezinye izinguquko zikhombisa ukuhamba okungenzeka kwe-squamous cell carcinoma okudingekayo ukuhlola ngokuphuthumayo. I-AK eyandayo ethinta, ethambile (ebhardwe), noma ethuthukisa isisekelo esibonakalayo esingatholakala ingase ihambe ukusuka esikhathini esithile iye kwi-cancer ethuthukile. Ukwanda kokuthinta noma ubuhlungu kwi-AK eyayingenazo izimpawu ngaphambili kukhombisa ukuhlanganiswa kwezicubu ezijulile.

I-AK eqala ukuhamba ngokwakho (hhayi ngenxa yokuhlanza noma ukucindezela) ifuna i-biopsy. Ukukhula okusheshayo noma ukwandisa okukhulu phakathi kwezinsuku kuya ezinyangeni kuyakhathaza. Ukuthuthukiswa kwe-horn ye-cutaneous — ukwakheka okuqinile, okukhanyayo kwe-keratin — endaweni ye-AK kukhombisa ukungahambi kahle kwe-keratinocyte okudingekayo ukuhlolwa kwe-histologic, njengoba kuze kube ngu-20% ye-horns ye-cutaneous ibamba i-SCC esisekelweni sawo.

Uma i-AK iqhubeka noma ibuyela ngokushesha ngemuva kokwelashwa okufanele (ikakhulukazi ngemuva kwe-cryotherapy), i-biopsy iyadingeka ukuze kuqinisekiswe i-SCC ethuthukile engaphenduli ezindleleni zokwelapha eziphezulu. Noma iyiphi i-AK emlonyeni (i-actinic cheilitis) idinga ukwelashwa okuphuthumayo nokubhekwa eduze, njengoba i-lip SCC inezinga eliphezulu lokuhamba. Kubantu abanama-AKs amaningi, ukusungula ukuhlola okujwayelekile kwezikhumba (njalo ezinyangeni eziyi-6-12) kudala uhlaka oluhlelelekile lokubheka umkhakha jikelele nokubamba ukuhamba kusenesikhathi. Phakathi nezivakashi zobuchwepheshe, ukuhlola okwenziwa njalo ngokuhlanganisa isikhumba sakho nezithombe ezedlule kukusiza ukuthi uqaphele izinguquko ezithuthukayo.

Ama-actinic keratoses adinga ukuqapha okuqhubekayo ngoba umonakalo ongaphansi kokukhanya kwelanga okwakha wona awupheli ngemuva kokwelashwa — ama-AKs amasha azokuqhubeka avela emkhakheni ononakele, futhi ama-AKs akhona adinga ukuqapha ukuhamba. I-Skinscanner inikeza indlela elula yokubhalisela futhi ulandele ama-AKs akho phakathi nezikhathi zokuvakashela udokotela wezikhumba. Ngokuthwebula izithombe zesikhumba sakho esithintekile ukukhanya kwelanga njalo, udala irekhodi elibonakalayo elichaza izinguquko ezincane kakhulu noma ezithuthukayo ukuze ungaziboni ezinsukwini zokuhlola.

I-AI yethu ingasiza ukuthola izindawo ezinzima, ezinezinhlamvu ezihambisana nama-AKs futhi ibonise izinguquko ezingase zikhombise ukuhamba — ukujula, ukuphakama, noma ukukhula okusheshayo okudingekayo ukuhlolwa kochwepheshe. Kulabo abahlinzekwa emkhakheni njengama-5-FU noma i-PDT, ukubhalisela isikhumba sakho ngaphambi, phakathi, nangemva kokwelashwa kudala irekhodi eliyigugu lokuphendula kokwelashwa kanye ne-benchmark yokuthola ukuphindaphinda okuzayo. Ikhono lokuqhathanisa elibheke kokubili lihlala lusebenza kahle kakhulu ekubhekeni ama-AKs amaningi abantu abaningi abathintekayo — ukulandela izindawo eziyishumi noma eziyishumi nambili ezihamba ebusweni bakho, emakhanda, nasezandleni phakathi nezinyanga kuya eminyakeni kudlula amandla okukhumbula komuntu kodwa kulula nge-rekhodi yezithombe. I-Skinscanner ikwenza uqhubeke ngokwakho ekubhekeni, ukwengeza (hhayi ukushintsha) izivakashi zakho zobuchwepheshe bezikhumba ngerekhodi elibonakalayo elenza zonke izivakashi zibe nemiphumela engcono.