{"id":3577,"date":"2008-08-01T16:16:51","date_gmt":"2008-08-01T20:16:51","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=3577"},"modified":"2008-08-01T16:16:51","modified_gmt":"2008-08-01T20:16:51","slug":"consulte-a-un-colega-n4-melanoma-maligno-grado-iv-como-manejarlo","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/3577","title":{"rendered":"Consulte a un colega N\u00b04: Melanoma Maligno Grado IV. \u00bfComo manejarlo?"},"content":{"rendered":"<p><strong> Dres Jaime Piquero Martin, Edgar La Rotta Higueras.<br \/>\nClinica de la Piel. Clinica Sanatrix Caracas Venezuela<\/strong><\/p>\n<p>Paciente femenina de 41 a\u00f1os amante del sol quien consulta por presentar onicomicosis por Fusarium\u00a0 en dedo anular de mano izquierda presentado en la edicion 204.\u00a0 Al examen f\u00edsico se aprecia placa pigmentada de 2 cm de di\u00e1metro de superficie micromamelonante en region temporal izquierda, retroauricular. Con el diagn\u00f3stico cl\u00ednico de Melanoma Maligno se toma biopsia en donde se aprecia neoplasia melanoc\u00edtica asimetrica exulcerada.<br \/>\n<!--more--><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/dsc02077.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3571\" title=\"dsc02077\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/dsc02077-300x199.jpg\" alt=\"\" width=\"300\" height=\"199\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/dsc02077-300x199.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/dsc02077.jpg 1024w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p>Presencia de melanocitos atipicos aislados y agrupados en nidos con tendencia a la confluencia. Estos melanocitos epiteliodes son grandes con nucleolo evidente, mitosis focales, estan distribuidos en bloques y aislados ocupando hasta la dermis reticular media. Se observa una zona de\u00a0 proliferaci\u00f3n vascular e infiltrado inflamatorio linfomononucler moderado, proliferaci\u00f3n de fibroblastos ( fibroplasia) y melanofagos. Diagnostico: Melanoma Maligno nodular ( Clark IV). Nota: el tumor ocupa hasta la dermis reticular y por ser una biopsia no es pertinente informar el nivel de Breslow .<\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3572\" title=\"mm1\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm1-300x225.jpg\" alt=\"\" width=\"300\" height=\"225\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm1-300x225.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm1.jpg 1024w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3573\" title=\"mm2\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm2-300x225.jpg\" alt=\"\" width=\"300\" height=\"225\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm2-300x225.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm2.jpg 1024w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm3.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3574\" title=\"mm3\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm3-300x225.jpg\" alt=\"\" width=\"300\" height=\"225\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm3-300x225.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm3.jpg 1024w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm4.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3575\" title=\"mm4\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm4-300x225.jpg\" alt=\"\" width=\"300\" height=\"225\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm4-300x225.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm4.jpg 1024w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm5.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3576\" title=\"mm5\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm5-300x225.jpg\" alt=\"\" width=\"300\" height=\"225\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm5-300x225.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/08\/mm5.jpg 1024w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p>No se palpan ganglios. Tomografia de cabeza y cuello sin alteraciones. Hematologia, y quimica sanguinea dentro de limites normales. Ex de orina con hematuria pero la paciente estaba premenstrual. En ECO transvaginal se aprecia LOE quistito simple a nivel de ovario derecho. Se plantea reseccion amplia del melanoma maligno con biopsia extemporanea, determinaci\u00f3n del ganglio centinela, reconstrucci\u00f3n de la herida, vaciamiento ganglionar cervical izquierdo mas paratidectomia superficial izquierda de acuerdo al resultado del ganglio centinela. En el mismo acto operatorio se practicara Ooforectom\u00eda derecha por video laparoscopia con biopsia extemporanea.<\/p>\n<p><strong>Luego de la intervenci\u00f3n \u00bf Que conducta debe seguirse?<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dres Jaime Piquero Martin, Edgar La Rotta Higueras. Clinica de la Piel. Clinica Sanatrix Caracas Venezuela Paciente femenina de 41 a\u00f1os amante del sol quien consulta por presentar onicomicosis por Fusarium\u00a0 en dedo anular de mano izquierda presentado en la edicion 204.\u00a0 Al examen f\u00edsico se aprecia placa pigmentada de 2 cm de di\u00e1metro de &hellip;<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[25],"tags":[184],"class_list":["post-3577","post","type-post","status-publish","format-standard","","category-consulte-a-un-colega","tag-melanoma"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/3577","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/users\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=3577"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/3577\/revisions"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=3577"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=3577"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=3577"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}