{"id":7620,"date":"2009-04-24T23:50:21","date_gmt":"2009-04-25T03:50:21","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=7620"},"modified":"2009-04-25T09:28:45","modified_gmt":"2009-04-25T13:28:45","slug":"consulta-a-un-colega-n6-melanoma-maligno-nodular-clinicamente-tipico-debe-hacersele-biopsia-incisional-o-excisional-o-dejar-que-el-cirujano-oncologo-lo-maneje-desde-el-principio","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/7620","title":{"rendered":"232 &#8211; Consulta a un Colega N\u00ba6: Melanoma Maligno nodular cl\u00ednicamente t\u00edpico \u00bfDebe hacersele biopsia incisional o excisional o dejar que el cirujano onc\u00f3logo lo maneje desde el principio?"},"content":{"rendered":"<p><strong><em>Dres Jaime Piquero Martin, Edgar La Rotta Clinica de la Piel Caracas Venezuela<\/em><\/strong><\/p>\n<p>Paciente femenina de 49 a\u00f1os con tumoraci\u00f3n de unos dos cm de di\u00e1metro con \u00e1reas de superficie pigmentadas y otras exulceradas sangrante, pediculada localizada en flanco izquierdo.<\/p>\n<p><!--more--><\/p>\n<div id='gallery-1' class='gallery galleryid-7620 gallery-columns-2 gallery-size-thumbnail'><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/04\/melanom-abril-2009a1.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/04\/melanom-abril-2009a1-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/04\/melanoma-14-4-2009-0741.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/04\/melanoma-14-4-2009-0741-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/04\/mm-1.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/04\/mm-1-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/04\/mm-2.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/04\/mm-2-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/04\/mm-3.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/04\/mm-3-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/04\/mm-4.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/04\/mm-4-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/04\/mm-5.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/04\/mm-5-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure>\n\t\t<\/div>\n\n<p>Se toma biopsia incisional, apreci\u00e1ndose bloques celulares redondeados de melanocitos pagetoides y epitelioides atipicos que no maduran adecuadamente, ocupando toda la dermis representada. Presencia de 2 mitosis en 10 campos de 40X. Proliferaci\u00f3n vascular e infiltrado inflamatorio linfomononuclear discreto a moderado de fibroblastos y melanofagos. Breslow de 2 \u2013 3 mm Clark IV.<\/p>\n<p>Se refiere a cirujano onc\u00f3logo a fin que haga la extirpaci\u00f3n completa y el resto del manejo<\/p>\n<p>Pregunta: Un tumor como este que es cl\u00ednicamente un Melanoma<\/p>\n<p>\u00bfDebe hacersele extirpaci\u00f3n con amplio margen desde el inicio, o solo biopsia incisional a fin de corroborar para luego enviarlo a cirujano onc\u00f3logo para que proceda a la extirpaci\u00f3n amplia, mapeo etc. ?, ello con la finalidad de no modificar el drenaje linf\u00e1tico local<\/p>\n<p>\u00bfHistol\u00f3gicamente podria ser un Melanoma metast\u00e1tico?<\/p>\n<p><br class=\"spacer_\" \/><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dres Jaime Piquero Martin, Edgar La Rotta Clinica de la Piel Caracas Venezuela Paciente femenina de 49 a\u00f1os con tumoraci\u00f3n de unos dos cm de di\u00e1metro con \u00e1reas de superficie pigmentadas y otras exulceradas sangrante, pediculada localizada en flanco izquierdo.<\/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":[],"class_list":["post-7620","post","type-post","status-publish","format-standard","","category-consulte-a-un-colega"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/7620","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=7620"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/7620\/revisions"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=7620"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=7620"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=7620"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}