Czerniak umiejscowiony w obrębie kończyn (acrolentiginous melanoma, ALM) to jedna z rzadkich form tej choroby, cechująca się wysoką złośliwością oraz szybkim przebiegiem. W obrazie klinicznym może przypominać zmiany występujące w innych schorzeniach, takich jak cukrzyca, grzybica lub niewydolność żylna.
Owrzodzenie w przebiegu czerniaka
Na wystąpienie owrzodzeń w przebiegu czerniaka narażeni są przede wszystkim: mężczyźni, pacjenci cierpiący na cukrzycę, nadwagę lub otyłość, osoby pomiędzy 40. a 84. rokiem życia, a także osoby często zażywające kwas acetylosalicylowy oraz palące papierosy.
Badania naukowe dowodzą, że wystąpienie owrzodzeń w przebiegu czerniaka zwiększa ryzyko pojawienia się przerzutów oraz zajęcia wartowniczych węzłów chłonnych. Z tego powodu w grupie pacjentów z wrzodziejącą postacią czerniaka odnotowuje się zmniejszoną przeżywalność w porównaniu do pacjentów, u których owrzodzenia nie wystąpiły.
Czerniak dystalnych części kończyn
W przebiegu czerniaka dystalnych części kończyn zmiany chorobowe umiejscowione są w większości przypadków na podeszwie stopy i zwykle towarzyszy im owrzodzenie.
W przypadku pacjentów z cukrzycą owrzodzenia na podłożu czerniaka zlokalizowane w obrębie kończyn dolnych mogą stwarzać trudności diagnostyczne. Zmiany mogą zostać błędnie rozpoznane jako zespół stopy cukrzycowej lub inne jednostki chorobowe, np. ziarniniak ropny. Do weryfikacji diagnozy w wielu przypadkach prowadzi nieskuteczność standardowego leczenia zalecanego dla ran przewlekłych.
AML może również zostać błędnie rozpoznany jako krwiak podpaznokciowy lub grzybica. We wstępnej fazie rozwoju zmiana przybiera w takim przypadku postać ciemnej plamy pod paznokciem. Odnotowane są również przypadki swędzących, okresowo krwawiących zmian na stopach, które także mogą zostać błędnie rozpoznane jako zmiany grzybicze.
Leczenie ALM
Podstawą terapii jest leczenie chirurgiczne polegające na całkowitym wycięciu zmiany. Zabieg może zostać rozszerzony o limfadenektomię regionalnych węzłów chłonnych. Następnie usuwa się również bliznę pooperacyjną wraz z marginesem zdrowej tkanki.
U pacjentów ze stwierdzonymi przerzutami stosuje się ponadto leczenie uzupełniające w postaci radio– i chemioterapii (terapia dakarbazyną) oraz immunoterapii (terapia z wykorzystaniem ipilimumabu, pembrolizumabu oraz niwolumabu).
Źródło:
B. Imko-Walczuk, A. Cegielska i in., „Czerniak w populacji chorych po przeszczepieniu narządów, „NOWOTWORY Journal of Oncology” 2012, 62(2): 109-114.
Przeczytaj także: Zdalna diagnostyka owrzodzeń żylnych – jak ją przeprowadzić?
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