– Nie każde rozdrapanie pieprzyka może wiązać się z nowotworem skóry. To mit, że podrażniony pieprzyk może zmienić się w czerniaka – podkreśliła w rozmowie z Forum Leczenia Ran specjalista dermatologii i wenerologii, lekarz medycyny estetycznej Anna Grodecka.
Jak zaznaczyła dermatolog, czerniaki czy inne raki skóry mogą mieć postać wrzodziejącą, czyli niegojącego się owrzodzenia. Tego typu rak skóry nie jest jednak związany z podrażnieniem pieprzyka. Nie ma żadnych dowodów, które mówiłyby o tym, że pieprzyki, które są często podrażniane, częściej zamieniają się w czerniaki.
Jak postępować przy rozdrapaniu pieprzyka?
Ekspertka uspokoiła, że znakomita większość czerniaków powstaje de novo, czyli na skórze niezmienionej. Jeżeli natomiast doszło do rozdrapania pieprzyka i jesteśmy świadomi, kiedy to nastąpiło pielęgnacja wówczas powinna wyglądać tak samo, jak każdej innej małej ranki.
– Powinniśmy wówczas zdezynfekować zranione miejsce i zachować prawidłową higienę. Jeżeli natomiast wytworzy się w tym miejscu stan zapalny, miejsce wokół będzie zaczerwienione, a pacjent odczuwa w tym miejscu ból, powinien on wówczas zgłosić się do lekarza.
Specjalistka zwróciła również uwagę na fakt, że jeżeli pacjent nie był świadomy urazu, a dostrzegł na swoim ciele mały brązowy guzek wtedy powinien zgłosić się do dermatologa, w celu wykonania dermatoskopii. Niepokojącym objawem może być również ranka na ciele, która podkrwawia i nie goi się. Wtedy również należy niezwłocznie zgłosić się do specjalisty.
Dlaczego? Co może ona oznaczać?
– Jeżeli zmiana pojawiła się kilka tygodni czy kilka miesięcy temu zazwyczaj mówimy o raku podstawnokomórkowym skóry, który ma właśnie postać wrzodziejącą, czyli zazwyczaj małego, niegojącego się guzka. Natomiast jeżeli zmiana pojawiła się bardzo szybko, w ciągu kilku dni/ kilku tygodni wtedy mówimy o czerniaku guzkowym-wrzodziejącym.
Po jakim czasie możemy mówić, że rozdrapany pieprzyk się nie goi?
– Prawidłowy czas gojenia rozdrapanego pieprzyka wynosi tyle samo co każdej innej rany, czyli 7-14 dni. W tym czasie tak mała rana powinna się wygoić. Jeżeli pomimo odkażania i zachowania prawidłowej higieny, rana nie goi się, zdecydowanie należy wówczas zgłosić się do lekarza.
Czy w takim razie, wystające pieprzyki powinniśmy profilaktycznie usuwać?
– Przed rozwojem dermatoskopii, kiedy dermatolog nie miał jeszcze narzędzi do tak dokładnej analizy zmiany na ciele, faktycznie pieprzyki narażone na ciągłe podrażnianie były wskazaniem do usunięcia. Natomiast aktualnie, wskazaniem do usunięcia pieprzyka są jedynie kwestie dermatoskopowe, tzn. jeżeli w dermatoskopii zmiana ma cechy niepokojące. Wówczas taką zmianę usuwamy.
Niekiedy owszem usuwamy również zmiany, które z uwagi na umiejscowienie są nieustannie podrażniane, a co za tym idzie prowadzą do powstania stanu zapalnego, podkrwawiają. Wtedy owszem usuwamy, ale nie dlatego, że boimy się, że przekształcą się one w zmianę czerniakowatą, a jedynie aby uniknąć miejscowego stanu zapalnego.
Do jakich powikłań może dojść w miejscu rozdrapania pieprzyka?
– Czasami zdarza się tak, że rozdrapany pieprzyk powoduje w konsekwencji powstanie blizny koloidowej. Wtedy taka zmiana zaczyna twardnieć. To też jest dobry moment na to, by zgłosić się do lekarza i ocenić, czy rosnący w środku guzek jest zmianą niepokojącą, która może być rodzajem nowotworu skóry lub czerniaka, czy raczej jest to guzek związany z procesem bliznowacenia.
Zatem podkreślmy to, profilaktyka czerniaka to nie usuwanie wszystkich wystających znamion w niewygodnych miejscach, a badanie dermatoskopowe raz na dwa lata u dermatologa.
– Tak jest, badanie dermatoskopowe jest badaniem refundowanym przez Narodowy Fundusz Zdrowia w formie profilaktyki. U osób zdrowych zaleca się to badanie raz na 2 lata. Natomiast u osób z grupy ryzyka, jakimi są chorzy leczeni immunosupresyjnie, czyli wszyscy pacjenci onkologiczni, reumatologiczni, przyjmujący leki obniżające odporność oraz osoby znajdujące się w pierwszej linii z czerniakiem, u których jest istotnie wyższe ryzyko wystąpienia czerniaka (czyli rodzeństwo, dzieci, rodzice) badanie to powinno być wykonywane raz w roku.
Na czym polega to badanie?
– Dermatoskopia ma duża czułość, dużą swoistość dlatego jesteśmy w stanie wychwycić czerniaka w pierwszym stadium, kiedy jego wyleczalność wynosi 98%. Podczas badania specjalista skupia się na wszelkich pieprzykach i zmianach na ciele, poczynając od najmniejszego palca u stopy po czubek głowy. Bardzo często zdarzają się pacjenci, którzy podczas wizyty odpinają 2 guziki w koszuli i przez taką dziurkę od klucza chcą mi pokazać jeden pieprzyk.
Dlaczego w Polsce badanie dermatoskopowe nie jest jeszcze tak powszechne?
– Nie umiem odpowiedzieć na to pytanie, ale mam nadzieję, że z roku na rok ta świadomość będzie rosła. Co ważne, z zakresu dermatoskopii została przeszkolona już część lekarzy rodzinnych, którzy tego rodzaju badania przesiewowo wykonują. Jeżeli zauważą coś niepokojącego, wtedy kierują pacjenta do dermatologa.
W niektórych krajach, gdzie wykrywa się dużo przypadków czerniaka, np. w Australii to jest zupełnie naturalne, że takie badania robią lekarze rodzinni. Są również takie projekty, w których do pierwszej dermatoskopii przesiewowej szkolone są pielęgniarki.
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