Kütanoz Lezyonların Tanısı ve Tedavisi
Özet
Baş ve boyun bölgesinde sıkça görülen kutanöz lezyonlar, iyi ve kötü huylu (malign) olmak üzere iki ana gruba ayrılmaktadır. İyi huylu lezyonlar arasında saçsız ve pembe-sarı renkli sebase nevüs ile koyu renkli konjenital melanositik nevüs öne çıkarken; sebase nevüs zemininde malign dönüşüm riski bulunmakta ve büyük konjenital nevüslerde yaşamın ilk on yılında melanom gelişme riski artmaktadır. Malign lezyonlar arasında en sık izlenen bazal hücreli karsinom (BHK) olup, genellikle güneşe maruz kalan bölgelerde ortaya çıkar, lokal invaziv seyredebilir ancak metastaz riski düşüktür. Skuamöz hücreli karsinom (SHK) ise ikinci sıklıkta görülen cilt kanseridir; aktinik keratoz öncü lezyonudur ve özellikle kulak ile dudak yerleşimlerinde yüksek metastaz oranına sahiptir. Agresif bir neoplazm olan lentigo maligna melanom tüm tümör kalınlığına bağlı olarak prognoz gösterirken; nadir görülen dermatofibrosarkom protuberans lokal olarak agresif seyreder. Nöroendokrin kaynaklı Merkel hücreli karsinom ise hızlı büyüyen ve yüksek nüks oranı ile karakterize son derece agresif bir tümördür. Bunların yanı sıra, çocukluk çağında en sık parotis ve yanakta izlenen infantil hemanjiom gibi vasküler lezyonlar da bölgede sıkça karşımıza çıkmaktadır. Bu lezyonların tedavisinde cerrahi eksizyon birincil seçenek olmakla birlikte, sınırları net olmayan tümörlerde Mohs mikrografik cerrahisi ve hemanjiomlarda propranolol gibi medikal ajanlar tercih edilmektedir.
Cutaneous lesions observed in the head and neck region are classified into benign and malignant categories, with benign conditions including sebaceous nevus, which carries a risk of malignant transformation, and congenital melanocytic nevus, where larger lesions increase the risk of melanoma during the first decade of life. Basal cell carcinoma (BCC) is the most common skin cancer, primarily linked to ultraviolet exposure, exhibiting local invasiveness but low metastatic potential, while squamous cell carcinoma (SCC), the second most frequent skin cancer originating from actinic keratosis, shows high metastatic rates particularly when located on the ears and lips. Highly aggressive melanoma, such as lentigo maligna melanoma, depends on tumor thickness for its prognosis, whereas dermatofibrosarcoma protuberans acts as a rare, locally aggressive sarcoma, and Merkel cell carcinoma represents a rapidly growing neuroendocrine malignancy with high recurrence rates. Additionally, vascular lesions like infantile hemangiomas commonly present in childhood, frequently expanding in the parotid and cheek areas. While surgical excision remains the primary therapeutic approach for these cutaneous lesions, Mohs micrographic surgery is preferred for ill-defined tumors, and medical options like propranolol are utilized for managing hemangiomas.
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