¿Es mi lunar peligroso? El ABCDE de los nevus

 

Cómo conocer tus lunares y detectar lesiones sospechosas

abcde-nevus

Los nevus melanocíticos, los lunares de toda la vida, son lesiones benignas de la piel producidas por el acúmulo de células productoras de melanina. Estas células son los melanocitos. En ocasiones muy infrecuentes los melanocitos pueden malignizar y producir lesiones cancerosas: los melanomas.

No es necesario tener un nevus para padecer un melanoma, sino que pueden aparecer a partir de piel previamente sana. Sin embargo, es común que durante la adolescencia y la edad adulta aparezcan lunares que previamente no se tenían, sin que esto signifique que son malos.

A continuación te explicamos qué tienes que tener en cuenta para diferenciar mejor entre lo benigno y lo que puede no serlo, cuándo tienes que consultar con tu médico y algunos consejos para que conozcas mejor tus lunares:

¿Cómo es un nevus normal?

Generalmente, los nevus son pequeños, simétricos y tienen bordes bien definidos. Su color se encuentra dentro de la gama de los marrones y es homogéneo en todo el nevus. En ocasiones pueden encontrarse pelos en ellos sin que esto sea un signo de malignidad.

¿Qué cambios en los lunares son importantes?

Se debe consultar cuando algún nevus presenta alguno de estos signos de alerta. Es sencillo: ABCDE. Cinco letras para que revises fácilmente tus nevus. Si te encuentras con alguno de estos signos, es recomendable consultar con un médico:

A: Asimetría. Cuando se divide un nevus en cuatro (mitad derecha e izquierda, mitad superior e inferior), sus partes suelen ser simétricas entre sí. Cuando existe una asimetría evidente entre las distintas partes del nevus, nos encontramos con un signo de alarma y debe ser revisado por un médico.

B: Bordes. También deben ser regulares, bien definidos, de manera que se diferencie perfectamente dónde acaba el nevus y donde empieza la piel normal. Si un lunar tiene bordes irregulares, mal definidos, debemos prestar atención.

C: Colores. La presencia de dos o más colores, o colores no homogéneos es un signo de alarma, así como cambios en la coloración habitual de los lunares ya conocidos.

D: Diámetro. Aquellos nevus mayores de 6 mm tienen más importancia. Deberían revisarse. Para que te sea más fácil: 6 mm es lo que mide la parte de atrás de un boli tipo BIC.

E: Evolución. Cambios bruscos o recientes en el aspecto o tamaño de las lesiones debe hacernos vigilar más de cerca los nevus.

Este es un nevus melanocítico normal. Observa que el ABCDE es normal:

nevus-melanocitico

Ahora mira estas lesiones. ¿A que te parecen sospechosas?

Todas presentan alguno de los signos de alerta: asimetría, bordes irregulares o múltiples colores

melanoma melanoma-asimetria melanoma-colores


 
El patito feo
Esto es muy importante. Las personas que tienen muchos nevus suelen conocerlos. Son similares unos a otros en aspecto, color y evolución. A veces un lunar tiene unas características diferentes a los otros y que no cuadran con el aspecto habitual del resto de los nevus. Es el signo del patito feo, el raro del grupo. Es recomendable consultar con el médico.
 
¿Qué otros cambios debo vigilar?

Todo cambio brusco en un lunar nos hará estar vigilantes. También la aparición de inflamación o ulceración alrededor de un nevus, el picor, el dolor o el sangrado. Hay que tener en cuenta que los nevus, como el resto de la piel, pueden irritarse o incluso podemos hacernos heridas sobre ellos. Esto sucede con frecuencia en zonas de roce y puede deberse a algo puntual. No obstante, ante la duda es mejor consultar.

Fotografiar los nevus
Es una buena idea, sobre todo si tienes muchos y para aquellos que no te ves habitualmente. Así podrás saber si han cambiado durante un periodo determinado de tiempo. Además, puedes llevar las imágenes contigo cuando vayas a revisarte los nevus que consideres sospechosos.
Localizaciones de difícil acceso
El cuero cabelludo, la planta de los pies, la espalda y la región interglútea, por ejemplo, son zonas que generalmente no nos vemos. Convendría revisarlas igualmente, pedir ayuda a otra persona o consultar con tu médico para que te ayude a realizar este examen de partes difíciles.
CONCLUSIÓN

El autoexamen de la piel y de los nevus habituales se ha demostrado útil para el diagnóstico precoz de lesiones malignas. Tan sólo has de fijarte en el ABCDE. La presencia de cualquiera de estos signos no te tienen que asustar. Sencillamente tendrás que revisarte los nevus con tu médico, porque es recomendable que alguien más habituado a este tipo de lesiones las eche un vistazo.

Por último, recuerda la importancia de prevenir quemaduras solares, que son un factor de riesgo para que se produzcan lesiones malignas de la piel. No te expongas innecesariamente al sol, usa fotoprotección y evita quemarte.


Eduardo González García
Médico residente, MFyC, Centro de Salud Arturo Eyries, Valladolid

REFERENCIAS:

  • Información adicional en la Campaña Euromelanoma de la European Association of Dermato Oncology
  • Lowell A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest, Amy S. Paller, David J. Leffell, Klaus Wolff Fitzpatrick. Dermatología en Medicina General. 8ª ed. Panamericana.

REVISIÓN: Junio 2019

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