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Невус, меланоцитарный невус, родинки
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Невус, меланоцитарный невус, родинки

Warning: file_put_contents(): Only 0 of 1189 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 128 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 115 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 128 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 110 bytes written, possibly out of free disk 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by admin19.11.2015
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Невусы — это доброкачественные опухоли кожи, состоящие из производных от мела- ноцитов невусных клеток; невусы классифицируют в зависимости от времени их появления и расположения невусных клеток.

Анамнез

■ Невусы обычно бессимптомны, хотя иногда возможно раздражение одеждой или вследствие внешней травмы.

Эволюция очагов

■ Приобретенные невусы вначале появляются в виде плоских, круглых, равномерно окрашенных папул.

■ Во время фазы роста невусы распространяются латерально, оставаясь плоскими и симметричными.

■ Невусы могут быть лишь немного темнее кожи по цвету и слегка приподнятыми в центре, оставаясь стабильными по размеру и внешнему виду в течение нескольких лет.

■ С течением времени невусы продолжают оставаться слегка приподнятыми, сохраняя однородность окраски, оттенок которой становится более светлым.

■ Иногда выглядит как папула цвета кожи и в более позднем возрасте может полностью исчезнуть.

■ После 70 лет остаточные невусы наблюдаются редко.

■ Наиболее типичная локализация, Нетипичная локализация И Типичная локализация

Клиническая картина

Меланоцитарные невусы состоят их организованных групп невусных клеток, расположенных в коже на различных уровнях.

■ Невусы классифицируются по локализации и организации невусных клеток внутри кожи.

Невус, меланоцитарный невус, родинки

Пограничные невусы

■ Пограничные невусы представляют собой плоские или слегка приподнятые коричневые или цвета загара пятна.

На поверхности таких невусов присутствуют кожные линии.

■ Эти невусы чаще всего наблюдаются у детей.

■ Гнезда невусных клеток скапливаются на границе эпидермиса и дермы.

■ Невусы на ладонях, подошвах, гениталиях и слизистой оболочке обычно являются пограничными.

Сложные невусы

■ Сложные невусы представляют собой слегка или явно приподнятые пигментированные папулы.

■ Гнезда невусных клеток находятся как на границе эпидермиса и дермы, так и в пределах дермы.

■ Сложные невусы могут иметь границу неправильной формы, но они симметричны.

■ Поверхность может быть гладкой или слегка папилломатозной.

Центр пигментирован сильнее, чем периферия.

■ В позднем детском и подростковом возрасте толщина невусов возрастает, а их пигментация усиливается.

Внутриэпидермальные невусы

■ Внутриэпидермальные невусы чаще всего представляют собой приподнятые папулы фиброзного характера со слабой или умеренной пигментацией.

■ Цвет папул колеблется в пределах от темно-коричневого до цвета нормальной кожи.

■ Пигментация может быть пятнистой.

■ Из невуса могут расти жесткие темные терминальные волоски.

■ Внутриэпидермальные невусы чаще всего наблюдаются после подросткового возраста.

Невус, меланоцитарный невус, родинки

■ Гнезда и тяжи невусных клеток обнаруживаются в дерме; они могут простираться в подкожную жировую клетчатку.

■ Меланоцитарные клетки, светлые и довольно однородные по размерам, организованы в группы или тяжи и окружены пучками коллагена.

Пятнистый невус

■ Пятнистый невус представляет собой пятно бронзового или светло-коричневого цвета, напоминающее пятно типа «кофе с молоком», на фоне которого наблюдаются несколько небольших, мономорфных, слегка приподнятых темно-коричневых невусов.

■ У пятнистого невуса отсутствует увеличенный рост жестких волос.

■ В развитии пятнистого невуса воздействие солнечного света не играет роли.

■ Очаги обычно развиваются до начала зрелого возраста и персистируют как доброкачественные образования.

Голубой невус

■ Голубые невусы представляют собой единичные голубоватые пятна или папулы, которые чаще всего локализуются на голове, шее и ягодицах.

■ Голубоватый оттенок цвета невусу придают сильно пигментированные меланопиты в глубоких слоях дермы.

■ Голубые невусы типично возникают в раннем детстве или имеются при рождении.

■ Они имеют тенденцию к медленному увеличению и персистируют 10—15 лет. Веретенообразные, сильно пигментированные невусные клетки расположены в средних или нижних слоях дермы.

Невус Шпитца

■ Невус Шпитца, или невус из веретенообразных клеток, обычно представляет собой красновато-розовую куполообразную гладкую папулу

■ Чаще всего он встречается , волосистой части головы или ногах у детей предподросткового возраста.

■ Биопсия кожи показывает чередование веретенообразных невусных клеток и участков крупных плеоморфных невусных клеток.

Такие изменения у взрослых вызывают обеспокоенность по поводу меланомы.

■ Сами очаги и их биологическое развитие являются доброкачественными.

■ Большинство дерматологов предпочитают полную эксцизию невусов Шпитца, чтобы свести к минимуму риск рецидивов и ассоциированного плеоморфизма.

Невус, меланоцитарный невус, родинки

Галоневус

Галоневус возникает первично в подростковом возрасте.

На месте ранее существовавшего невуса развивается окружающий ободок гипопигментации, который предвещает постепенное исчезновение невуса в течение нескольких месяцев.

Биопсия кожи показывает пограничный или сложный невус, окруженный плотным инфильтратом лимфоцитов.

Галоневус, вероятно, является ответом организма-хозяина, направленным против не- вусных клеток.

Очаговые атитпичные невусные клетки, которые наблюдаются в большинстве предшествовавших невусов, являются доброкачественными.

Галоневус обычно репигментируется в течение нескольких лет.

Под лампой Вуда ободок гипопигментации акцентируется.

Галоневусы также встречаются на фоне и могут развиваться у пациентов с меланомой.

Лица с галоневусами должны проити полный осмотр кожи на наличие витилиго, а также скрининг меланомы.

Рецидивирующий невус

Феномен рецидивирующего невуса может наблюдаться на месте предшествовавшего, частично удаленного невуса.

Произвольное расположение пигментации вдоль рубца может вызвать подозрение на меланому.

При гистологическом исследовании также может быть неотличим от меланомы. Предыдущая биопсия в анамнезе и ревизия оригинального образца являются критическими моментами при постановке диагноза.

Невус, меланоцитарный невус, родинки

Лабораторная диагностика

Невусные клетки собираются в группы или гнезда в отдельных участках кожи.

■ Пограничные невусы формируют гнезда невусных клеток на границе эпидермиса и дермы.

■ Внутридермальные невусы формируют гнезда и тяжи невусных клеток в пределах дермы, которые иногда распространяются в подкожный жировой слои.

Сложные невусы создают гнезда невусных клеток на границе эпидермиса и дермы, а также в дерме.

Термин «комбинированный невус» используется для обозначения доброкачественного невуса с признаками типичного пограничного или сложного невуса и более глубоким компонентом голубого невуса.

Течение и прогноз

■ Большинство меланоцитарных невусов являются доброкачественными и созревают в течение лет, как описано выше.

Невусы, которые отклоняются от этой картины, вызывают подозрения и требуют биопсии.

■ Пограничные невусы редко встречаются у взрослых.

■ При биопсии любой пограничный меланоцитарный очаг у взрослого, если не известно, что он существовал с детства, считается атипичным, если не меланомой in situ.

Дифференциальный диагноз

■ Меланоцитарные невусы:

  • диспластический невус;
  • меланома (необходим тщательный гистологический анализ квалифицированного дерматопатолога).

■ Невусы Шпитца:

  • гемангиома;
  • пиогенная гранулема;
  • ювенильная ксантогранулема.

Обсуждение

■ Необходима большая тщательность, чтобы свести к минимуму риск неверного диагноза при меланоцитарном очаге.

■ Клиницист должен сообщить дерматопатологу возраст пациента, локализацию и клиническую историю очага, результаты всех предыдущих биопсий и клиническии дифференциальный диагноз.

■ Следует предоставить адекватный биопсийный материал.

■ Обязанностью врача также является соотнесение результатов исследования патолога с клиническим диагнозом.

Невус, меланоцитарный невус, родинки

Лечение

■ Все невусы должны быть оценены врачом.

■ За исключением синдрома диспластического невуса, у большинства людей невусы имеют довольно однородную клиническую картину и сходный внешний вид.

У конкретного человека один невус практически не отличается от другого.

Дермальный невус с зернышками ороговения на поверхности. Он кажется налепленным на поверхность и имеет консистенцию себорейного кератоза. Очаг легко удаляется кюреткой.

■ Полезным ориентиром служат четыре базовых ABCD-правила определения меланомы.

■ Большинство доброкачественных невусов симметричные, с четкими правильными границами, однородного цвета (возможны небольшие вариации в оттенках доминирующего цвета), с максимальным диаметром менее 6 мм.

Невусы у одного и того же пациента, которые внешне отличаются от остальных, должны вызывать подозрение.

■ Подозрительные невусы должны быть подвергнуты биопсии.

■ Рекомендуется консультация опытного дерматолога.

Наблюдающаяся в настоящее время эпидемия рака кожи заставляет многих пациентов пройти скрининговый тест.

■ Не следует упускать такую возможность для раннего обнаружения и лечения, а также для информирования пациента.

■ Следует поощрять исследование всей поверхности кожи.

■ Пациентов следует обучить тому, как самим проводить осмотр кожи. Следует поощрять их делать это регулярно.

Следует сочетать обучение методике самостоятельного осмотра с прохождением скрининговых тестов.

■ Учтите все изменения, на которые нужно обращать внимание, включая такие симптомы, как зуд и болезненность.

■ Пациент должен без малейшего сомнения обращаться по поводу любых дальнейших изменении и беспокоящих его симптомов.

■ Следует поощрять осторожное поведение на солнце, регулярное применение солнцезащитных средств и ношение защитной одежды.

Куполообразная папула с гладкой поверхностью. Это типичное проявление дермального невуса на лице и туловище. Пациентов часто больше беспокоят возвышающиеся над поверхностью очаги, чем плоские и темные.

На заметку практикующему врачу

Доброкачественные невусы имеют однородный внешним вид и предсказуемый жизненный цикл.

■ Невусы, которые отклоняются от этой картины, должны вызывать подозрение и подвергаться биопсии.

■ При оценке пациентов с невусами помогает дерматоскопия. Требуется знание этой методики и опыт оценки ее результатов.

Пятнистые лентигинозные невусы представляют собой распространенные безволосые коричневые очаги, покрытые темно-коричневыми или черными пятнышками Эта особая форма невуса является доброкачественной.

Типичное проявление дермального невуса на лице. Куполообразная папула имеет телеангиэктазии на поверхности и напоминает базальноклеточную карциному. Очаг оставался стабильным в течение лет.

Дермальный невус без пигмента. Пациенты часто полагают, что родинки должны быть пигментированные. Эта гладкая белая папула оставалась неизменной в течение многих лет.

Этот дермальный невус имеет консистенцию мятого мешочка. Биопсия показывает избыток соединительной ткани и очень немного невусных клеток.

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/var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 128 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 120 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 128 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 115 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 128 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 116 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 157 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 113 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_CacheSimpleFile.php on line 200 Warning: file_put_contents(): Only 0 of 20312 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/libs/WpPepVN/Cache/Backend/File.php on line 182 Fatal error: Uncaught exception 'WpPepVN\Cache\Exception' with message 'Cache file /var/www/filosof/data/www/medser in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/libs/WpPepVN/Cache/Backend/File.php on line 188