Câncer de pele melanoma

Descoberto em seus estágios iniciais, o câncer de pele melanoma é quase sempre curável. Porém, se diagnosticado tardiamente, tende a se espalhar para outras partes do corpo, no processo chamado metástase. O melanoma representa apenas 3% dos casos de câncer de pele no Brasil, mas é importante se proteger do sol e procurar o médico assim que perceber pintas diferentes, porque ele tem alto risco de metástase.

A pele é o maior órgão do corpo humano, responsável pela troca de calor e água com o ambiente, encarregado de proteger os órgãos internos contra bactérias e de captar e enviar para o cérebro informações sobre calor, frio, dor e tato. A pele tem três camadas: a epiderme, mais externa e mais fina, a derme e o tecido subcutâneo, mais profundo.  

A epiderme, por sua vez, tem três camadas: a superior, formada por células chamadas queratinócitos, a média e a mais interna, formada pelas chamadas células basais, que dão origem aos queratinócitos ou células escamosas, que impermeabilizam a pele, e aos melanócitos, que produzem melanina, o pigmento marrom que dá cor à pele e cuja função é proteger as camadas mais profundas da pele contra os efeitos nocivos da radiação solar. Negros e brancos possuem a mesma quantidade de melanócitos, mas as pessoas de pele escura produzem mais melanina, especialmente uma chamada eumelanina, mais eficiente na proteção contra os raios ultravioleta (UV) do sol. É por isso que negros e afrodescendentes têm menor risco de desenvolver câncer de pele. 

Alguns fatores aumentam o risco de desenvolver câncer, mas isso não quer dizer que você vai ter câncer de pele melanoma. Não se sabe ao certo o que causa o melanoma, mas há fatores de risco conhecidos associados à doença.

Há dois tipos básicos de câncer de pele, o não melanoma, que surge nas células basais ou nas escamosas, e o melanoma, que tem origem nos melanócitos, células que produzem a melanina, o pigmento que dá cor à pele. Na maioria das vezes, melanomas aparecem em pessoas de pele clara, no tronco dos homens e nas pernas das mulheres, embora possam surgir em outras partes do corpo também. Apesar de mais comum em pessoas de pele clara, negros e seus descendentes não estão livres da doença.

Sol: a exposição prolongada ao sol, sem protetor solar (é recomendado, no mínimo, fator 30), envelhece a pele e aumenta enormemente o risco de câncer no futuro.

Ter pele clara: o risco é bem maior entre pessoas brancas (loiras e ruivas) do que entre as negras ou afrodescendentes, o que não significa que negros não têm câncer de pele, porém é mais raro.

Grave queimadura de sol: na infância ou adolescência, aumentam o risco de aparecimento da doença mais tarde.

Já ter tido melanoma aumenta enormemente o risco de ter outro.

Pintas: uma pinta (nevus) é um tumor benigno, mas alguns tipos de pinta aumentam o risco de uma pessoa desenvolver melanoma. Pessoas com muitas pintas, especialmente as grandes, devem consultar um especialista regularmente e ter cuidado redobrado quando expostas ao sol.

Histórico familiar: cerca de 10% dos pacientes com melanoma têm um parente próximo (pai, mãe, irmãos, filhos) com a doença. Pode ser porque a família tem o hábito de passar muito tempo ao ar livre, porque são todos de pele muito clara ou ambos. Membros dessas famílias devem consultar o especialista pelo menos uma vez por ano, aprender a observar a própria pele e ter cuidado redobrado quando expostos ao sol. O melanoma familial, como é chamado, pode ocorrer também por um defeito hereditário, principalmente quando há mais de um melanoma em um indivíduo ou em parentes de primeiro grau. Nesses casos, é bom consultar um oncogeneticista.

Xeroderma pigmentosa: é uma doença genética rara. Os doentes, também conhecidos como “Filhos da Lua”, têm um dano no DNA que impede o reparo da pele atingida pelos raios do sol e de algumas fontes de iluminação artificial (emissões de radiação ultravioleta). Os portadores podem ter vários cânceres de pele, começando já na infância.

Imunossuprimidos: transplantados que tomam drogas para evitar a rejeição correm maior risco de ter câncer de pele, que, nesses casos, crescem mais depressa e podem até ser fatais

Idade: melanomas são mais comuns em adultos, mas também podem surgir em pessoas jovens.

Prevenção: filtro solar (no mínimo, fator 30), chapéu e óculos escuros, que protegem a área delicada em torno dos olhos, são as melhores armas para prevenir o câncer de pele. O cuidado deve ser redobrado com as crianças, porque a exposição exagerada ao sol nos primeiros 20 anos de vida é decisiva para o aparecimento de câncer de pele na meia-idade. Pessoas de alto risco (pele e olhos claros) precisam usar filtro solar no dia a dia também, principalmente no rosto e nos braços, em passeios, caminhadas, ao fazer exercícios ou compras ao ar livre. A recomendação vale também para aqueles dias de mormaço ou nublados.

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