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बुधवार, 16 मार्च 2016


Clinical Characteristics:
There are four types of cutaneous melanoma. In three of these—superficial spreading melanoma, lentigo maligna melanoma, and acral lentiginous melanoma—the lesion has a period of superficial (so called radial) growth during which it increases in size but does not penetrate deeply. It is during this period that the melanoma is most capable of being cured by surgical excision. The fourth type— nodular melanoma —does not have a recognizable radial growth phase and usually presents as a deeply invasive lesion, capable of early metastasis.
When tumors begin to penetrate deeply into the skin, they are in the so-called vertical growth phase. Melanomas with a radial growth phase are characterized by irregular and sometimes notched borders, variation in pigment pattern, and variation in color. An increase in size or change in color is noted by the patient in 70% of early lesions.
Bleeding, ulceration, and pain are late signs and are of little help in early recognition. Superficial spreading melanoma is the most frequent variant observed in the white population.
The back is the most common site for melanoma in men. In women, the back and the lower leg (from knee to ankle) are common sites.
Nodular melanomas are dark brown-black to blue-black nodules. Lentigo maligna melanoma is usually confined to chronically sun-damaged, sun-exposed sites (face, neck, back of hands) in older individuals. Acral lentiginous melanoma occurs on the palms, soles, nail beds, and mucous membranes.
While this type occurs in whites, it is most frequent (along with nodular melanoma) in blacks and East Asians.
A fifth type of melanoma, the desmoplastic melanoma, is recognized. This tumor type is associated with a fibrotic response to the tumor, neural invasion, and a higher tendency to local recurrence.
Occasionally, melanomas can be amelanotic, in which case the diagnosis is established histologically after biopsy of a new or changing skin nodule or because of a suspicion of a basal cell carcinoma. Sites appear to be the forearm and leg (excluding feet), while unfavorable sites include scalp, hands, feet, and mucous membranes.
In general, women with stage I or II disease have a better survival than men, perhaps in part because of earlier diagnosis; women frequently have melanomas on the lower leg, where self-recognition is more likely and prognosis is better.
Lymphadenectomy may control early regional disease. Liver, lung, bone, and brain are common sites of hematogenous spread, but unusual sites, such as the anterior chamber of the eye, may also be involved.
Biopsy: The recommended technique is an excisional biopsy, as that facilitates pathologic assessment of the lesion, permits accurate measurement of thickness if the lesion is melanoma, and constitutes treatment if the lesion is benign.
For large lesions or lesions on anatomic sites where excisional biopsy may not be feasible (such as the face, hands, or feet), an incisional biopsy through the most nodular or darkest area of the lesion is acceptable; this should include the vertical growth phase of the primary tumor, if present. Incisional biopsy does not appear to facilitate the spread of melanoma.
In ayurveda one can opt for Panchkarma: (Purificative Procedure) such as:
2. Associated therapy
Snehan especially various abhyanga
3. Internal Medicine
Manjistha, (Rubia cordifolia), Indian madder
Haridra, (Curcuma longa), Turmeric
Daruharidra, (Berberis species), Indian berberry
Bakuchi, (Psoralea corylifolia), Malaya tea
Chakramarda, (Cassia tora), Fetid cassia
Nimba, (Azadirachta indica), Neem tree..
Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur..
 drsnojha@rediffmail. com   - 

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