Znamienka

Návštevníci kožných ambulancií chcú vedieť, kedy hrozí "zvrhnutie", t.j. malígna premena pôvodne nevinného pigmentového fliačika na zhubný nádor...

freepik_dermatologist_dermatoscope

"Medzi mojimi pacientmi sa často stretávam až s neprimeranou obavou, či to-ktoré znamienko nie je nebezpečné, či ho netreba preventívne vybrať, aby sa z neho nevyvinula kožná rakovina či melanóm. Naopak, mnohí sa domnievajú, že odstránenie znamienka, aj keď to odporučí odborný kožný lekár, má za následok jeho zvrhnutie a vznik rakoviny. Ako to teda s našimi znamienkami naozaj je? Veriť rôznym poverám typu „aj moja babka mala také znamienko a len čo jej ho vyoperovali, dostala z toho rakovinu a potom zomrela? Pokúsim sa trochu objasniť problematiku znamienok a hlavne vyvrátiť takéto neopodstatnené mýty." hovorí dermatologička MUDr. Katarína Poláková, PhD. z Preventívnehoi centra OÚSA v Bratislave.

Mnohí návštevníci kožných ambulancií sa pýtajú, kedy vlastne hrozí „zvrhnutie“, alebo malígna premena pôvodne nevinného pigmentového fliačika na zhubný nádor. V posledných rokoch celosvetovo i u nás narastá výskyt novozistených prípadov malígneho melanómu. I keď vzťah tohto nádoru k ultrafialovému žiareniu nie je celkom jednoznačný, pokles ozónu v stratosfére za posledných 30 rokov mal za následok zvýšenie počtu melanómov.

Melanóm sa častejšie vyskytuje u ľudí s bledou pokožkou, s tendenciou k spáleniu sa na slnku, u jedincov so svetlými vlasmi a očami. Riziko získať toto ochorenie je vyššie v rodinách, kde sa už melanóm vyskytol, alebo v rodinách s tzv. dedičnými syndrómami dysplastických névov. Za jeho výskyt je okrem rodinnej predispozície zodpovedné aj excesívne opaľovanie, imunitné defekty a v určitom percente i veľké, vrodené pigmentové névy. Časť takýchto tumorov vzniká z pôvodných pigmentových znamienok, časť melanómov sa však vyvinie aj bez nich.

Aké sú neželané zmeny na znamienku, ktoré by nás mali nabádať k tomu, aby sme vyhľadali odborného kožného lekára?

Ako pomôcka sa používa americký tzv. ABCDE systém. Treba vedieť, že ak sa znamienko, ktoré má pôvodne pravidelné oválne či okrúhle okraje mení, a tieto sa stanú nepravidelné - A (assymetry), jeho ohraničenie - B (border) sa stáva neostrým, farba - C (colour) sa tiež mení, znamienko buď tmavne, alebo sa z neho v niektorých častiach stráca pigment, priemer znamienka - D (diameter) sa zväčší a pôvodne ploché znamienko sa vyvyšuje - E (elevation), je potrebné tento problém konzultovať s dermatológom. Avšak samotné tieto znaky sú len vytrhnuté z kontextu, a bez iných doplňujúcich kritérií, ktorými sú napríklad svrbenie, zápal, mokvanie či krvácanie povrchu, ale hlavne vyšetrenie znamienka špeciálnym kožným mikroskopom tzv. dermatoskopom, nemožno stanoviť správnu diagnózu. Pomocou dermatoskopu sa s vysokou spoľahlivosťou určí nevhodný vývoj, alebo nepriaznivé zmeny na znamienku.

Ak sa vytvárajú pigmentové névy aj po puberte - v dospelosti, hovoríme im dysplastické. Tieto sú vzhľadovo odlišné od predchádzajúcich benígnych a je u nich väčšie riziko malígnej transformácie. Takéto névy sú zvyčajne väčšie ako 5mm, asymetrického tvaru, pigmentácia je nepravidelná, okraj neostrý, často s červenkastým nádychom. Vyskytujú sa niekedy sporadicky, ale neraz je ich vysoký počet častý u viacerých členov jednej rodiny. To sa považuje za tzv. syndróm dysplastických névov. Väčšinou len u týchto névov je riziko ich neskoršej premeny na malígny melanóm. Preto musia byť ľudia z týchto rodín pravidelne kontrolovaní dermatológom.

Väčšina našich znamienok nie je nebezpečná, žijeme s nimi celý život, ak nám však esteticky prekážajú, môžeme si ich dať chirurgicky odstrániť. Ak sa jedná o dysplastické névy, ak sa znamienka vyskytnú v miestach chronického dráždenia či nastane ich opakované zranenie, odporúčame ich preventívne chirurgicky odstrániť s následným histopatologickým vyšetrením. Histologický rozbor totiž definitívne určí povahu znamienka a v prípade nutnosti pomôže i ďalšiemu optimálnemu a promptnému terapeutickému riešeniu.

Tip: Preventívne vyšetrenie celého kožného povrchu a slizníc kvalifikovaným odborníkom-dermatológom pomáha vytypovať rizikové znamienka. Poučenie o vhodnom správaní sa na slnku podľa typu pokožky i o vhodnej ochrane pred agresívnym ultrafialovým žiarením je podľa nás prínosom nielen v primárnej prevencii malígneho melanómu, ale i dobrou radou pred letnou sezónou.

 Zdroj foto: Freepik

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