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U 1997 : 13,2 / 100.000 abitanti 1998 : 13,3 / 100.000 abitanti 1999 : 14,5 / 100.000 abitanti 2000 : 14,3 / 100.000 abitanti 2001 : 16,2 / 100.000 abitanti $!!0  S ~0xaxa? 1ԔԔ?"  t<TASSI DI INCIDENZA DEL MELANOMA nel quinquennio 1997 - 2001==i  S ~xaxa? 1ԔԔ?"` WEPIDEMIOLOGIA DEL MELANOMA NEI RESIDENTI IN EMILIA-ROMAGNA e RSM Quinquennio 1997-2001XX  ZTxaxa1 ?`pP A_Numero casi: 2861 Sesso: 1500 F (52,4%) e 1361 M (47,6%) Et media: 57,0 anni (55,2 F e 58,4 M)`       H  0f޽h ? ̙33y___PPT10Y+D=' = @B + !@`(  ` ` 6 `L0 LPrevenzione primaria ` 0`  0r$D  0>6___PPT9 *tende a ridurre l incidenza del tumore rimuovendo le cause che lo provocano ricaduta dopo 20-30 anni(e " 3e#4<DL ` < p@  RPrevenzione ustioni solari ` 6D @ P`r$D  0>6___PPT9 Gslip--------------hat slop-------------shirt slap-------------sunscreen(H " 3H#P  4<DLH ` 0f޽h ? ̙33y___PPT10Y+D=' = @B +T {sP (  hl  0  0 ,$D 0x  H? 0 l  HDf ? ` b messaggi per fasce di rischio /per determinate categorie professionali (medici, insegnanti): risultati dopo 3-5 anni diagnosi precoce8m nv hh  6"f p@ D&   <%f ?  p NPrevenzione secondaria%  <*f ? p bmira alla riduzione della mortalit e non alla riduzione dell incidenza ~[I }n#       ,<   H:f ?P{ 7MM e sopravvivenza a 10 anni: <0.76 mm: 92%; >4 mm: 42%>8"""H  0f޽h ? ̙33y___PPT10Y+D=' = @B +  ,V(  ,~ , s *;fp  f  , s *8Bf   f &x3_gH , 0f޽h ? ̙33y___PPT10Y+D=' = @B +  @8p0(  0~ 0 s *Xf0p  f l 0 0A M? ?0 Mr 0 B o?" $,$D 0H 0 0f޽h ? ̙33y___PPT10Y+D=' = @B +    4V (  4d 4 <?  `d 4 <?   4 Bdf ?0,$  0 s'Trasformazione MS di lesioni pigmentate0('&& 4 H8jf ?` : | Lesioni non melanocitarieFm }PP 4 BDhf ??,$D  0 KS, baso, cheratosi attiniche, ematomi, tumori vascolari, dermatofibromi possono simulare lesioni melanocitarie in trasformazione.J:, ': 4 Htf ?`  x Lesioni melanocitarieFm } 4 Bzf ?,$D  0 alterazioni  infiammatorie (irritazione, traumatismi, follicoliti) evoluzioni fisiologiche legate all et (cambiamento di pattern) gravidanza esposizione UV variazioni  fisiologiche non legate all et evoluzione verso la malignit n(o&ooeM  hhH 4 0f޽h ? ̙33y___PPT10Y+D=' = @B +  @88(  8~ 8 s *$f0p  f l 8 0A N? ?0 Nr 8 B o? d ,$D 0H 8 0f޽h ? ̙33y___PPT10Y+D=' = @B + DF(  D D Hf ? DIncidenza in relazione all et (%).#"(z L  D# t D 0A O??S O D Hf ?ka :0-20 D Hf ?|k ;20-30 D Hf ?k  ;30-40 D <8f ? kX  ;40-50  D Hf ? k W50-606  D H f ?+k_ ;60-70  D Hf ?dk ;70-80  D H|f ?l 9>80  D Hf ?   J19,8* D Hf ? J19,5* D Hf ? p  J16,9* D Hlf ? J16,2* D Hpf ?\0 P  ;8,7r D B ?~ 0@P D# @0P,$D  0t D 0A P??0@P P D Hxf ?  I0,7* D Hf ?|`   I7,8* D H`f ?y   P10,40H D 0f޽h ? ̙33y___PPT10Y+D=' = @B +  @8H(  H~ H s *f0p  f l H 0A Q? ?0 Qr H B o?2T,$D 0H H 0f޽h ? ̙33y___PPT10Y+D=' = @B +j  `L!(  L~ L s *f]  f ~ L s *Xf f d L H|f ?  ,$D  0 dcompaiono generalmente fra 6 e 12 mesi aumentano durante l infanzia e l adolescenza si scuriscono in gravidanza generalmente < 5 mm l esposizione al sole ne favorisce la comparsa&m Z XXq L Bf ?  ,$D  0 i> 5 mm, scuri o irregolarmente pigmentati, rosa, bruno chiaro e scuro, bordi irregolari o indistinti2jm i 0hH L 0f޽h ? ̙33y___PPT10Y+D=' = @B +  @8`(  `~ ` s * k0p  k l ` 0A R? ?0 Rr ` B o?@ T ,$D 0H ` 0f޽h ? ̙33y___PPT10Y+D=' = @B +E ldd(  d d 0kk0  ULa maggior parte dei MM in et adolescenziale e infantile insorge su nevo congenitoVV, d 0f W  oZhu et al., Scalzo et al 1997&H d 0f޽h ? ̙33y___PPT10Y+D=' = @B +  @8t(  t~ t s *6k0p  k l t 0A S? ?0 Sr t B o?r  ,$D 0H t 0f޽h ? ̙33y___PPT10Y+D=' = @B + xj(  x x Hk ?]< J QRazza0H<p x HXk ?  qCaucasici Asiatici Neri2 p P    x# P  ,$D  0 x Hԏk ?P   ,$D 0 ;>2 x BPk ?  ,$D 0 ;>2H x 0f޽h ? ̙33y___PPT10Y+D=' = @B +  |(  |~ | s *k0p  k l | 0A T? ?0 T| 0 P @  |# P 0 @ ,$D 0rr | B o?0 P rr | B o?p @ H | 0f޽h ? ̙33y___PPT10Y+D=' = @B +  1) (    HDk ?`@ KMelanomi multipli,  Bk ?  ,$D 0 *B riscontro sincrono in @ 40% dei pazienti, negli altri entro 1 anno dal 1 il 2 melanoma pi sottile tendenza a svilupparsi nella stessa sede del 1 melanomam n"("1""9" ,8  NkD o?@ nIl rischio particolarmente elevato per quei soggetti che hanno sviluppato il primo melanoma in et < 40 anni0oxn  TkD o? `g,$D  0 Psopravvivenza uguale ai pazienti con 1 MM non fattore prognostico sfavorevole lPm m x*"$"83XXH  0f޽h ? ̙33y___PPT10Y+D=' = @B +  0(  ~  s *k0p  k l  0A U? ?0 U|  @P #  @P,$D 0rr  B o? $`rr  B o?@PH  0f޽h ? ̙33y___PPT10Y+D=' = @B +     @  (  ~  s *\kj  k   s *k0  k * (0   `4kDy ?9: eFitzpatrick, 1994    `kDy ?  a Marreth, 1992  Bk ?c ,$D  0 0(esp. costante a lungo termine - azione protettiva) a. cumulativa (per lentigo maligna MM) b. intensa intermittente c. ustioni solari nell infanzia|]l n<< l n<5̙(̙̙ ̙,CJ 0xx  Z kDy ?@Hn,$D  0 eelevato numero di nevi, capelli rossi, fototipo I o II, efelidi, storia familiare di MM, nevi atipici.fe& 7 0  # 0 ,$D  0xr   Ho?p0     0WGnRd1[ ?Tipo di fotoesposizioneArial Black0    T(kD o?M < ] &m H  0f޽h ? ̙33y___PPT10Y+D=' = @B +D kcP (     `vDy ?`h c)Gestione delle singole lesioni pigmentate**'   ``vDy ?7 fdeterminare il rischio ELM0" I  Z$ vDy ?O0,$D 0 lesione con atipie morfologiche.    *  ZvDy ?  ,$D 0 l4lesione con i caratteri del MM o altamente sospetta55 B  ZDPS?   p  # p  ,$D  0  ZDy?  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