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Melanoma: Sintomas, Diagnóstico, Tratamento e mais

Dra. Ana Maria Fagundes Sortino, Dermatologia
Publicado em 06/12/2017 - Atualizado em 10/12/2018



Dezembro é o mês de prevenção ao câncer da pele. Hoje falaremos do Melanoma um dos mais perigosos cânceres da pele e que apresenta um aumento mundial no número de casos.


O que é

O Melanoma é um tumor maligno com origem nas células produtoras de pigmento, chamadas melanócitos, que estão presentes na pele, mas também no epitélio de outros órgãos.

Sintomas

A grande maioria dos melanomas podem ser identificados através de uma regra muito difundida e de fácil memorização, chamada ABCDE:

Além desta regra, é fundamental conhecer a sua pele e ter uma ideia da localização e número de pintas que você tem. Para um maior sucesso na identificação de uma lesão suspeita, algumas crenças precisam ser modificadas, pois o melanoma pode ser tanto uma pinta plana, isto é, sem relevo, como uma pinta elevada. A cor é escura, marrom-enegrecida, na grande maioria dos casos, contudo existem melanomas de cor castanho-claro, róseos, azulados e até esbranquiçados com aspecto de cicatriz na pele (quando não lembramos de ter machucado). Outro ponto de atenção é que o melanoma pode surgir em qualquer local da pele, muitas vezes em áreas protegidas da exposição solar, como mamas, nádegas e genitais; assim como áreas de difícil visualização, como couro cabeludo, unhas, mucosa da boca e olhos. Ao notar alteração em uma pinta ou surgimento de nova lesão que evolui com crescimento ou sintomas, como coceira e/ou sangramento, procure o seu médico dermatologista.

Diagnóstico

O médico dermatologista e/ou oncologista fará o exame clínico completo da pele, identificando se a lesão é benigna ou suspeita clinicamente. Se forem necessários métodos de auxilio ao diagnóstico clínico, como a dermatoscopia e/ou mapeamento de corpo total com fotodermatoscopia (para pacientes com grande número de pintas, história pessoal ou familiar de melanoma ou de outra condição individual que justifique o mapeamento) o médico irá realizá-los ou solicitá-los. Em alguns casos específicos, como complemento na análise de lesões com características clínicas e dermatoscópicas duvidosas, pode ser indicada a Microscopia Confocal de reflectância à Laser para confirmar a necessidade de biópsia de uma lesão suspeita, em especial nas áreas cosmeticamente sensíveis.

A realização da biópsia excisional, isto é, retirada cirúrgica da pinta para análise através do exame anatomopatológico, confere o diagnóstico definitivo do melanoma. Para melhores chances de controle e até cura da doença é fundamental o diagnóstico do melanoma nas fases iniciais. Todavia, quando o melanoma é diagnosticado nas fases mais avançadas, ele pode se espalhar para outros órgãos como o cérebro, fígado e pulmões, e ser de difícil tratamento e até levar à morte.

Dicas:

- Siga a orientação médica de biópsia das lesões melanocíticas suspeitas, ou de novas lesões da pele, para não retardar um diagnóstico precoce de melanoma, evitando um futuro diagnóstico menos favorável.

- Lembre-se da importância de consultas anuais com o seu médico dermatologista (especialista pela Sociedade Brasileira de Dermatologia), médico oftalmologista e médico ginecologista/urologista para o diagnóstico precoce de melanomas oculares e de mucosas oral e genitais.

- Realize o autoexame periódico da sua pele.

Tratamento

O paciente com melanoma em geral é avaliado por uma equipe médica, composta pelo dermatologista, pelo cirurgião, pelo oncologista clínico.

Quando o tumor está restrito a camada mais superior da pele (epiderme), é chamado de melanoma in situ, sendo necessário nova cirurgia de ampliação de margens ao redor da lesão inicial e acompanhamento médico, em especial pelo dermatologista, ao longo de toda a vida, devido à possibilidade de ter um ou mais novos melanomas na pele.

Quando o tumor já acomete a derme (camada abaixo da epiderme), é chamado de melanoma invasivo, sendo também necessária a ampliação de margens e/ou à biópsia de linfonodo sentinela, de acordo com a espessura tumoral indicada no exame anatomopatológico. Estes casos devem ser acompanhados regularmente pelo médico oncologista, pois quando são identificadas metástases, isto é, melanoma acometendo outros órgãos além da pele, o tratamento com quimioterapia, terapia alvo ou imunoterapia será iniciado. O exame dermatológico periódico de toda a pele deve ser realizado ao longo do tratamento.

Prevenção

Reduzir e/ou limitar ao máximo a exposição às radiações Ultravioleta, tanto naturais, como artificiais.

Siga essas dicas:

- Use filtro solar de amplo espectro, com proteção UVB de no mínimo FPS 30 e 1/3 de proteção UVA. Isto significa que um filtro solar de FPS 30 precisa ter uma proteção UVA de 10; um filtro com FPS 50+ precisa ter uma proteção UVA de no mínimo 17. Leia os rótulos dos produtos.

- Aplique uma quantidade generosa de filtro solar na pele, antecedendo de 15 a 30 minutos a exposição solar, para que o produto tenha a eficácia descrita no rótulo.

- O uso do filtro solar não significa que você possa se expor ao sol por tempo indeterminado. O produto precisa ser reaplicado a cada 2 horas, como também após sudorese intensa (um exemplo são os exercícios ao ar livre) ou após mergulhos na água do mar e/ou piscina.

- Além do filtro solar, pratique fotoproteção através do uso de roupas, chapéu e óculos. Alguns tecidos, devido seu tipo de trama, podem receber um tratamento específico que garante o bloqueio de mais de 98% da radiação solar.

- Em atividades de trabalho, lazer e esportes ao ar livre, busque a sombra, sempre que possível.

- Evite queimaduras solares, principalmente nas crianças, pois apenas um episódio com eritema intenso e bolhas dobra a chance da pessoa desenvolver melanoma cutâneo quando adulto.

- Redobre seus cuidados de fotoproteção em ambientes altamente reflexivos, como a areia da praia, dentro d’água, na neve, etc. Nestas condições há um maior risco de queimaduras solares. 

- Tenha hábitos alimentares saudáveis e ingira alimentos ricos em Vitamina D. Quando indicado pelo seu médico, faça reposição com suplementos vitamínicos. Sempre evite a exposição solar intensa e/ou exposição sem filtros solares para produção de Vitamina D.

- Cuidado com os remédios alopáticos e também com os naturais, pois alguns componentes de medicações e/ou fórmulas podem levar a uma maior sensibilidade da pele à luz e facilitar queimaduras solares.

- Nos dias nublados, a exposição da pele por longos períodos, seja por trabalho ou lazer, assim como ficar em ambientes próximos a janelas e vidros, como no carro em viagens, também podem levar a queimaduras da pele. Nestes casos o uso de filtro solar de amplo espectro UVB e UVA está sempre indicado.

- Evite o bronzeamento intencional da pele, tanto com fontes de luz natural, como artificiais. Lembre-se que o bronzeamento artificial, baseado na emissão de radiação ultravioleta, é proibido no Brasil. (RDC No 56/2009)

Para saber mais acesse:

https://www.melanoma.org/understand-melanoma/preventing-melanoma?utm_content=buffer41cc8&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer

http://www.sbd.org.br/dermatologia/doencas-da-pele/sobre-o-cancer-da-pele/sinais-e-sintomas/

 https://www.aad.org/media/stats/conditions/skin-cancer

http://onlinelibrary.wiley.com/doi/10.3322/caac.21440/epdf

 

 

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