I-Seborrheic Keratosis: Ukukhula Okungathinti, Okubukeka Kanjalo Njengokhukhula Lwesikhumba

I-Seborrheic keratoses (SKs) yizikhumba ezithinta (ezingekho ne-cancer) ezivame kakhulu ezithinta abantu abadala, zithinta cishe wonke umuntu ophila isikhathi eside. Ngokuvamile zibizwa ngokuthi 'izikhukhula zokuguga' ngoba ziba ziningi ngokuhamba kwesikhathi, ziqala ngokuvamile eminyakeni engu-30 noma engu-40 futhi ziba ziningi kakhulu eminyakeni elandelayo. Ngemva kweminyaka engu-50, abantu abaningi abadala banezikhukhula ezingu-1 okungenani, futhi abaningi baneziningi noma ngisho nezikhulu.

I-SKs ivela kumakheratinocytes (amaseli esikhumba) akhula ukuze akhe ukukhula okucacile, okukhanyayo, okuphakanyisiwe okubonakala sengathi 'kuphakanyiswe' phezulu kwesikhumba — njengokuthi ungakhipha ngephuzu lesandla sakho (nakuba ungafuni ukuzama). Zihlukahluka ukusuka kumatshana alula ukuya kumabrown amnyama noma ngisho mnyama, ukusuka kumamitha ambalwa kuya kumasentimitha ambalwa ububanzi, futhi zisuka ezindaweni ezijulile zibe phezulu kakhulu. Uhlobo lwazo lwezinto luhlukile, lukhanyayo, noma luhlukile (njengemikhono), ngokuvamile zineziqhamo ezibonakalayo (amaseli amancane agcwele i-keratin) nezikhala ezibavumela ukuba zibe ne-cerebriform (njengobuchopho) noma ukubukeka okungajwayelekile ngaphansi kokwandiswa.

Isizathu se-seborrheic keratoses asiqondakali kahle, kodwa ukwakheka kwemvelo kukhulu — zivame ukuhamba emindenini. Ukukhanya kwelanga kudlala indima ethile, njengoba i-SKs ivame ukuvela ezindaweni ezithintwe ilanga, nakuba zikhula nasezindaweni ezivikelwe elangeni. Ukuguqulwa okukhuthazayo kumagene we-receptor ye-growth factor (ikakhulukazi i-FGFR3 ne-PIK3CA) sekukhona kwi-SKs, kodwa lezi yizinguquko zomzimba (ezenzeka kumaseli athile) hhayi izinguquko ezitholakala kumalungu. Naphezu kokuba nezinguquko ezikhuthazayo zokukhula, i-SKs iqinisekisiwe ukuthi ayinabungozi — azihambisani nesikhumba esithinta futhi azinayo imiphumela emibi.

Naphezu kokuthi zingathinti, i-seborrheic keratoses ibhekwa njengomthombo wezithunywa eziphuthumayo ze-dermatology kanye nokukhathazeka kwabantu. Isizathu silula: zingabukeka zishaqisayo. I-Seborrheic keratoses ezimnyama ivame ukudideka ne-melanoma — imibala yazo engajwayelekile, imibala ehlukahlukene (izithunzi eziningi zebrown ne-black), kanye nezikhala ezivame ukudala ukukhathazeka okufanele.

Ngisho nabachwepheshe abanolwazi bahluleka kwesinye isikhathi ukuhlukanisa i-SK emnyama, engajwayelekile ne-melanoma ngaphandle kokusebenzisa i-dermoscopy noma i-biopsy. I-SKs ezinzima, ezithambile zingadideka ne-squamous cell carcinoma noma i-actinic keratosis, ikakhulukazi esikhumbeni esithintekile ilanga lapho izimo eziphilayo ezithinta ne-cancer zingavela ne-SKs ezithinta. I-SKs ezivuthayo noma ezithukuthele — ezithinteka ngempahla, ezithinteka ngengozi, noma ezithinteka ngokucindezela — zingaba mnyama, zikhuluphale, zibe ne-crust, noma ngisho zibe ne-bleeding, zibonisa ukubukeka kwesikhumba esithintekayo.

Ukuphuma okusheshayo kwe-SKs eziningi bekukade kuhlotshaniswa ne-malignancy yangaphakathi (uphawu lwe-Leser-Trelat), nakuba ukubaluleka kwalesi sici kuhlolwa, futhi iningi le-SK eliphuthumayo alihlotshaniswa ne-cancer. Ukukhathazeka okukhona kwe-SKs kuqondakala futhi kuvame ukuba usizo — kukhuthaza ukuhlolwa kwesikhumba okuthola izinkinga zangempela. Ingozi ikwi-akhawunti ephambene: abantu abatshelwe ukuthi bane 'i-seborrheic keratoses kuphela' bangase babe nokungakhathali ngezikhumba ezintsha, becabanga ukuthi konke kuhle.

I-lesion ngayinye entsha ifanele ukuhlolwa okuhlukile. I-melanoma ekhula eduze kwe-seborrheic keratosis ib dangerous njengokukhula esikhumbeni esicacile — ukuqonda i-SKs zakho ezikhona akufanele kube nomthelela wokungabheki izindawo ezintsha noma ezishintshayo.

Izici eziningi ziyasiza ukuhlukanisa i-seborrheic keratoses ezimweni ezikhathazayo, nakuba ukuhlukaniswa okucacile kwesinye isikhathi kudinga ukuhlolwa kwezobuchwepheshe nge-dermoscopy noma i-biopsy. Ukubukeka 'okuphakanyisiwe' kuyisici esiyinhloko — i-SKs ibukeka sengathi zihlala phezulu kwesikhumba kunokukhula ngaphakathi kwayo, zinebhodi ecacile lapho ukukhula kuhambisana nesikhumba esijwayelekile. Uhlobo lwesikhumba olukhanyayo, oluncane luhlukile futhi luhlukile kumasiki, olukhanyayo lwe-actinic keratoses noma ubuhle obukhanyayo be-basal cell carcinoma.

I-horn cysts — ama-pores amancane, round, agcwele i-keratin abonakala njengezimpawu ezimhlophe phezulu kwe-SK — yisici esithile esivame kakhulu esingaveli ezimweni ezimbi. Izikhala ezinjengama-comedo (ama-pores amnyama afana ne-blackheads) phezulu zifana kakhulu. Umbala we-SKs uvame ukuba uniform ngaphakathi kwe-spectrum ye-brown-to-black, futhi nakuba zingaba mnyama kakhulu, ngokuvamile azinayo i-jet-black, blue-black, noma i-red-blue-white color variation ebukeka ku-melanoma.

I-SKs inezinhlangothi ezicacile, ezijwayelekile — ngisho nezinkulu zihlala zinezinhlangothi ezithambile, ezicacile kunokuthi zibe nezinhlangothi eziphukile, ezihlukile ze-melanoma. Usayizi uhlehla kakhulu (2mm kuya ku-3cm noma ngaphezulu) futhi akuyona into ethembekile yokuhlukanisa. I-SKs zingavela noma kuphi emzimbeni ngaphandle kwezandla nezinyawo, kanti umzimba, ubuso, nezitho zihlala zikhona.

Aziveli kumamemori amamukeli. Uma ungabaza, sebenzisa lo mthetho: uma ukukhula kwesikhumba kukukhathaza nganoma yisiphi isizathu — umbala, isimo, ushintsho, izimpawu — qiniseka ukuthi kuhlolwa ngok professional. Kuhle kakhulu ukuba ne-SK engathinti kunokuthi ungabheki i-melanoma ngoba ucabanga ukuthi bekungokunye kuphela i-keratosis. I-dermoscopy (ukuhlolwa ngensiza yokwandisa ethile) ezandleni zokuqeqeshwa ingahlukanisa i-SKs ne-melanoma ngokuqinisekile, ivame ukuvimbela isidingo se-biopsy.

Ngenkathi iningi le-seborrheic keratoses litholakala kalula klinikhi, i-biopsy (ukukhipha ngokuhlinzwa nokuhlolwa kwezokwelapha) ibalulekile ezimweni ezithile. Noma iyiphi i-lesion engakwazi ukuyichaza ngokuzethemba njengengathinti ngokusekelwe ekuhloleni klinikhi nase-dermoscopy kufanele ibhiyozwe — uma ungabazi, yikhiphe. Izizathu ezithile ze-biopsy zifaka i-lesion eshintshile ngokushesha ngosayizi, isimo, noma umbala (i-SKs ikhula kancane futhi iyazinzisa; ushintsho olusheshayo lukhombisa ukuxilongwa okuhlukile); i-lesion emnyama kakhulu noma emnyama lapho i-melanoma ingaqinisekiswa; i-lesion enezici ezingajwayelekile ze-SK (izikhala ezingajwayelekile, ukushintsha kombala okungajwayelekile kwe-SK, ukungabi nezici ezithile); i-lesion ebuhlungu, ethambile, noma ebleed njalo ngaphandle kokucacisa isizathu sokucindezela; i-lesion eyodwa ebonakala ihluke kwezinye i-SKs zomgibeli (i-'ugly duckling' phakathi kwe-keratoses); kanye noma iyiphi i-lesion kumuntu onomlando siqu we-melanoma, lapho umkhawulo we-biopsy kufanele ube phansi.

I-phenomenon ye-collision tumors — lapho i-melanoma noma enye i-malignancy ithuthukiswa ngaphakathi noma eduze kwe-seborrheic keratosis — iyinto engajwayelekile kodwa ibhalwe, iqinisa ukubaluleka kokuhlola izindawo ezibukeka ezingajwayelekile ngaphakathi kwe-SKs ezijwayelekile. Ukuhlolwa kwezokwelapha kwe-SK ebiopsywe kukhombisa izici ezithile: i-acanthosis (ukukhuluphala kwe-epidermis), i-papillomatosis (ukuphakama okunjengemikhono), i-hyperkeratosis (ukukhuluphala kwephezulu), kanye ne-horn cysts — umkhondo owaziwa ngama-pathologists ngokushesha. Ngesinye isikhathi, i-biopsy ye-lesion ethathwa njengokuthi i-SK ibonisa ukuxilongwa okungalindelekile — i-melanocytic nevus, i-melanoma in situ, noma i-squamous cell carcinoma — kugcizelela ukubaluleka kokugcina ukucabanga okufanele ngisho nase-SKs 'ezicacile'.

I-seborrheic keratoses ayidingi ukwelashwa kwezokwelapha, njengoba zingathinti futhi azinayo ingozi empilweni. Nokho, abanye abagulayo bafuna ukukhipha ngenxa yezizathu zokubukeka, ngenxa yokuphazamiseka okuvela empahleni noma emikhiqizweni, noma ukuze bathole ukuthula kwengqondo ngemuva kokukhathazeka ngokuqhamuka okukhathazayo. Indlela evame kakhulu yokukhipha i-cryotherapy — i-nitrogen liquid efakwe ukuze iqhume, ibangela i-SK ukuba ibhule futhi ihlale phansi phakathi kwezinsuku eziyi-1-2.

I-cryotherapy iyashesha, ayibizi, futhi iyasebenza kuma-SKs aphakanyisiwe noma aphakathi, kodwa ingadinga ukwelashwa okuningi kwezingxenye ezinzima futhi ingabangela ukungabi nombala okwesikhashana noma okungapheli (izindawo ezimhlophe), ikakhulukazi ezindaweni ezimnyama. Ukukhipha i-shave (ukukhipha okuphakanyisiwe) kusebenzisa umkhono ukuze ukhiphe i-SK phezulu noma kancane ngaphansi kwesikhumba ngemva kokufaka i-anesthesia yendawo. Lokhu kuhlinzeka ngempahla yokuhlolwa kwezokwelapha (okuqinisekisa ukuxilongwa) futhi kunikeza imiphumela emihle yokubukeka kwe-SKs eziphakanyisiwe.

Kubalulekile uma kukhona ukungaqiniseki kokuxilongwa, njengoba impahla ekhishwe ingahlolwa ngaphansi kwe-microscope. I-Curettage (ukuhlanza) nge-electrodesiccation iyasebenza kuma-SKs athambile, aphakanyisiwe. Ukukhula kuhlanjululwa nge-curette, futhi ibhasi ingacindezelwa kancane ukuze kuvinjwe ukuvuvukala nokuvimbela ukukhula kabusha.

I-Laser ablation usebenzisa ama-laser e-CO2 noma i-erbium ivaporizes impahla futhi ingaphatha i-SKs eziningi esikhathini esisodwa ngemiphumela emihle yokubukeka. I-Electrosurgery isebenzisa ugesi ukuze ibhujiswe impahla ye-SK. Kubantu abaningi be-SKs abafuna ukwelashwa, i-hydrogen peroxide 40% topical solution (i-Eskata) bekuyindlela yokwelashwa evunyelwe yi-FDA ehlinzeka ngokuqhamuka kwe-SKs ngokufaka ngqo, nakuba ukutholakala kungahluka.

Okubalulekile: ukuvikelwa kwe-inshurensi kokukhipha i-SK akuhambisani. Uma ukukhipha kwenziwa ngezizathu zokuxilongwa (i-biopsy ukuze kuhlolwe i-malignancy), ngokuvamile kuvinjelwe. Ukukhipha okungokubukeka kuphela kungase kungavikelwe, futhi abagulayo kufanele bacele ukuvikelwa ngaphambi kokuhamba phambili. Ngemuva kokukhipha, i-SKs ingaphinda ivela endaweni efanayo (ikakhulukazi uma ukukhipha kungaphelele) noma, ngokuvamile, i-SKs ezintsha zikhula kwezinye izindawo — ukukhipha akuvimbele i-SKs ezintsha ekwakheni.

Ngenkathi i-seborrheic keratoses uqobo zingathinti, zisebenza njengokukhumbuza okusebenzayo ukuze uqaphele isikhumba sakho. Bheka udokotela uma uthola ukukhula kwesikhumba okusha okumnyama kakhulu (okumnyama) noma okunezimbala eziningi ngaphakathi, njengoba i-melanoma kufanele ikhishwe. Noma yisiphi ukukhula okushintsha ngokushesha ezinsukwini kuya ezinyangeni kudinga ukuhlolwa — i-SKs ikhula kancane eminyakeni eminingi; ushintsho olusheshayo lukhombisa okuthile okuhlukile.

Funa ukuhlolwa nganoma yisiphi ukukhula kwesikhumba okuvuvukalayo noma okuvuvukalayo ngaphandle kokucacisa ukulimala. Uma ukukhula kuba buhlungu noma kuthambile ngaphandle kokucacisa isizathu sokucindezela, ukuhlolwa kwezobuchwepheshe kuyadingeka. Ukuphuma okusheshayo kwe-SKs eziningi (uphawu lwe-Leser-Trelat) kufanele kukhuthaze ukuhlolwa kwezokwelapha, njengoba kungase kuhlotshaniswe ne-malignancy yangaphakathi.

Uma unenkinga yokuhlukanisa i-SKs zakho kwezinye izimo esikhumbeni sakho — ikakhulukazi uma unokulimala kwelanga, i-actinic keratoses, noma umlando we-cancer yesikhumba — ukuhlolwa kwesikhumba okuvamile kwezobuchwepheshe kusiza ukuqinisekisa ukuthi i-SKs ezithintekayo azifihli ukuvuma kwezimfanelo ezithinta. Ngemibuzo yokubukeka, xhumana nodokotela we-dermatologist mayelana nezinketho zokukhipha ezifanele izimo zakho ezithile, uhlobo lwesikhumba, nezilindelo. Ungazami ukukhipha i-SKs ekhaya usebenzisa ukusika, ukushisa, noma izinsiza ezinamandla — lokhu kubeka engcupheni yokubola, ukutheleleka, ukukhipha okungaphelele, nokuphuthelwa i-malignancy eyahluleka.

Enye yezizathu ezivame kakhulu zokuthi abantu basebenzise amathuluzi okuhlola isikhumba ukuhlole ukukhula abakubona futhi banqume ukuthi kungaba yinto okufanele bakhathazeke ngayo. I-Skinscanner ibaluleke kakhulu kulokhu ngoba i-seborrheic keratoses ivame ukudideka nezinye izimo ezinzima. Ngokuthwebula isithombe sokukhula okukhathazayo, uthola ukuhlaziywa kwe-AI okusheshayo kwezici zayo — kuhlanganisa nezici ezikhombisa i-SK (ukubukeka okuphakanyisiwe, uhlobo lwe-waxy, i-horn cysts) uma kuqhathaniswa nezici ezikhombisa ukukhathazeka nge-melanoma noma ezinye izifo (izikhala ezingajwayelekile, ukushintsha kombala, ukungahambisani).

Lokhu kuhlolwa kokuqala kusiza ukwenza isinqumo esiqondile sokuthi kufanele ube ne-evaluation ye-professional ngokuphuthumayo, ngesikhathi sokuhlangana kwakho okulandelayo, noma ungakwenzi nhlobo. Kubantu abaningi be-SKs, i-Skinscanner inikeza indlela esebenzayo yokubheka ukukhula kwakho okukhona nokuhlonza okusha okubonakala kuhlukile kumphumela wakho ojwayelekile. Umqondo we-'ugly duckling' — i-lesion ebonakala ihluke kakhulu kwezinye — awuhambisani kuphela nezikhukhula kodwa nase-SKs.

Ukukhula okungahambisani nokubukeka okujwayelekile kwezinye i-keratoses kudinga ukunakwa okukhulu. Ukuhlola okuvamile kudala uhlu lwezithombe lwezikhumba zakho, kwenza kube lula ukuthola izimo ezintsha ezithinta izikhumba ezikhona. I-Skinscanner ayifaki ukuhlolwa kwe-dermatologic — noma yisiphi ukukhula okunezici ezikhathazayo ze-malignancy kudinga ukuhlolwa kwezobuchwepheshe futhi kungenzeka kube ne-biopsy. Kodwa inikeza ukuhlaziywa okutholakalayo, okusheshayo okukhuthaza ukuthi uhambise izinkinga ezijwayelekile zokuhlukanisa i-seborrheic keratoses ezingathinti ezivela ezimweni ezidinga ukunakwa kwezokwelapha.