Sentinel lenf nodu tutulumu olmayan, erken evre, malign melanom hastalarında sağkalımının araştırılması ve prognostik belirteçlerin sağkalıma etkisi
Research of survival in patients with early malignant melanoma without sentinel lymph node involvement and the effect of prognostic markers on survival
- Tez No: 538916
- Danışmanlar: DR. ÖĞR. ÜYESİ EMRAH KAĞAN YAŞAR
- Tez Türü: Tıpta Uzmanlık
- Konular: Plastik ve Rekonstrüktif Cerrahi, Plastic and Reconstructive Surgery
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2019
- Dil: Türkçe
- Üniversite: Kocaeli Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Plastik Cerrahi Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 61
Özet
ÖZET Kutanöz malign melanomların büyük çoğunluğu, radyal ve vertikal büyüme fazları boyunca ilerleyebilen intraepidermal melanositlerin çoğalmasından gelişir.131 Histolojik incelemede en erken lezyon dermis epidermis bileşkesinin üzerindeki kıl folikülleri ve ekrin kanalların üzerinde atipik melanositlerin görülmesidir.132 Malign Melanom(MM) cilt kanserlerinin küçük bir yüzdesini (%3) teşkil etmesine rağmen ezici bir çoğunlukla, mortalite oranları en yüksek deri kanseridir.(%65)132 Tümörün vertikal olarak büyümesini temsil eden Breslow en önemli lokal prognostik faktördür. 5 Sağ kalımı etkileyen en önemli parametre ise lokal lenf nodu tutulumudur.6 Agresif seyirli bu deri tümörünün erken tespiti çok önemlidir. Sentinel lenf nodu tutulumu bozulmuş prognoz ile ilişkilidir.Yapılan son AJCC (8.) klavuzuna göre evreleme sistemi değişmiş ve Breslow
Özet (Çeviri)
The majority of cutaneous malignant melanomas develop from the proliferation of intraepidermal melanocytes, which can progress through the radial (including in situ and micro-invasive stages) and vertical growth phases.131 The earliest lesion on histological examination is the presence of atypical melanocytes on the hair follicles and ecrine channels on the epidermis junction of the dermis.132 Although malignant melanoma is a small percentage of skin cancers (approximately 3%), it is seen in majority of patients and has the highest mortality rate (approximately 65%).132 Breslow, which representsthe vertical growth of the tumour, is the most important local prognostic factor. 5 Local lymph node involvement is the most important parameter affecting survival.6 Early detection of this aggressive skin tumour is highly important. Sentinal lymph node involvement is often associated with impaired prognosis. According to the latest AJCC (8) manual, the staging system has changed and Breslow value of lessthan 0.8 mm ulceration or between 0.8 mm and 1.0 mm is accepted as a criterion for sentinel lymph node examination regardless of the ulceration. Furthermore, with a heterogeneous survival time in the advanced stage, the prognosis of MM in early stages can be more predictable. It was necessary to conduct this study in our country, due to the fact that there is not enough studies conducted on prognostic variables and prognostic factors in early stage MM patients. The approval of the Kocaeli University Ethics Committee was obtained for this thesis study. 101 patients were histopathologically diagnosed with malignant melanoma, which were not clinically advanced and sentinel lymph node biopsies were evaluated retrospectively. Among the malignant melanoma subtypes, superficial malignant melanoma was observed to be the most common subtype in both sexes, alining with the current literature. The average number of mitosis that had been expected to increase along with the increasing Breslow thickness was evaluated and a positive relationship was revealed. With the increase of the most important prognostic factor Breslow, a shorter life span was determined in accordance with the literature. Lymphocytic response as a good prognostic marker was used in the survey analysis of patients evaluated in the conducted study, and patients with lymphocyte response was found to be better than those patients without lymphocyte response. In the conducted study, the prognosis of the acral lentigenous type was found to be better in comparison to the survival time of subtypes and was statistically significant(p
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