Czy należy usuwać znamiona olbrzymie u dzieci?
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Czy należy usuwać znamiona olbrzymie u dzieci?

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Znamiona mogą występować u dzieci od urodzenia lub pojawiać się z czasem, ale każda zmiana na skórze powinna być uważnie obserwowana ze względu na ryzyko wystąpienia nowotworu. W przypadku znamion olbrzymich często zalecany jest zabieg usunięcia zmiany.

Znamiona olbrzymie należą do znamion melanocytowych. Są to wrodzone lub nabyte zmiany barwnikowe, a ich średnica wynosi powyżej 20 cm. Często znamiona nabyte pojawiają się we wczesnym dzieciństwie i znikają w procesie starzenia, zwykle po 60. roku życia. Niekiedy znamiona u niemowląt są niewyraźne i trudne do zauważenia, ponieważ jeszcze nie zawierają barwnika.

Znamiona olbrzymie dzieli się ze względu na ich wielkość na trzy grupy: G1 – między 20 a 30 cm, G2 – między 30 a 40 cm oraz G3 – powyżej 40 cm.

Jakie są wskazania do usunięcia znamion olbrzymich?

Zmiany barwnikowe u dzieci powinny być konsultowane z lekarzem, ponieważ ich występowanie zwiększa ryzyko powstania czerniaka, szczególnie w przypadku znamion olbrzymich. Badania potwierdziły, że w przypadku 1/3 dzieci powyżej 12. roku życia czerniak rozwinął się u pacjentów z wrodzonymi znamionami olbrzymimi.

Do usunięcia kwalifikują się te znamiona, w przypadku których zaobserwowano zmianę charakteru i wykazują cechy aktywności zgodnie z zasadą ABCDE, która określa elementy brane pod uwagę przy ocenie zagrożenia zmianą nowotworową. W badaniu uwzględnia się asymetrię rany, obecność nierównych, postrzępionych brzegów, nierówności w rozłożeniu barwnika, średnią wielkość zmiany oraz uwypuklenie powierzchni ponad poziom otaczającego zmianę naskórka. Do zabiegu chirurgicznego mogą również zostać zakwalifikowane znamiona, którym towarzyszą takie objawy jak stan zapalny, sączenie lub krwawienie ze zmiany, a także swędzenie, przeczulica czy ból w miejscu znamienia. Usuwane są też zmiany, które występują w miejscach łatwych do podrażnienia oraz trudnych do obserwacji, takich jak skóra głowy w części owłosionej, narządy płciowe oraz dłonie i stopy.

Zalecane jest usunięcie znamienia u dziecka przed okresem dojrzewania. Badania wykazują, że w tym czasie najczęściej występują transformacje znamienia w zmianę nowotworową.

Jakie są metody usunięcia znamienia olbrzymiego?

W zależności od wielkości znamienia olbrzymiego oraz jego charakteru możliwe jest usunięcie zmiany z wykorzystaniem laseroterapii lub zabiegu chirurgicznego.

Leczenie chirurgiczne polega na wycięciu zmiany wraz z marginesem zdrowej tkanki (1-2 mm). Przy zabiegu wykorzystuje się znieczulenie nasiękowe. W przypadku dużych zmian może być konieczne przeprowadzenie operacji w znieczuleniu ogólnym i wykonanie przeszczepu. Usuniętą tkankę poddaje się ocenie histopatologicznej.

W przypadku mniejszych zmian o łagodnym charakterze stosowana jest również laseroterapia przy użyciu lasera usuwającego barwnik lub lasera ablacyjnego. Zaletami laseroterapii w porównaniu z zabiegiem chirurgicznym są mniejsza inwazyjność i nieuszkadzanie zdrowej tkanki, a także szybszy proces gojenia.

Możliwe jest również skorzystanie z krioterapii. Jednak zarówno tej metody, jak i laseroterapii nie należy stosować, gdy istnieje podejrzenie nowotworowego charakteru zmiany.

Należy również pamiętać, że w przypadku zmian barwnikowych nie wolno wykonywać biopsji ani pobierać fragmentów do badania, ponieważ istnieje ryzyko rozsiewania komórek nowotworowych.

Źródła: podyplomie.pl, poradnikzdrowie.pl

Przeczytaj także: Blizna po usunięciu znamienia – jak ją pielęgnować?

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Chirurgia Plastyczna i Oparzenia”:

Zastosowanie opatrunków srebrowych w leczeniu oparzeń i odmrożeń, zespołu Lyella oraz ran przewlekłych

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