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???????? ???????????? ??????????? ??? 10 ??????????? ???? ?? ?????????? ??????? ????? ?????? ???????? ?? ? ??? ???? ???????? ???????? ??? ??? ?????? ??? ?????????? ??? ??????? ??? ???????? ???????????? (??). ????? ?? ?????????????? ???????????, ????? ? ??????? ??????, ??? ????, ??????? ? ?????? ?????, ????? ????? ?????????? ?? ?????????? ??? ? ???????????? ??? ????? ??? ?????? ????????????? ??????, ??? ???????? ???? ???? ???? ??? ?????? ??? ????? ??????. ?? ????? ???????? ?????? ????????? ????: ??? ??? ????? ??? ?????? ???? ?????????, ???? ??? ?????? ????? ? ?????????? ?? ????????? ??????? ???????? ???????????? (??). ? ???????? ????? ?????? ??? ????? ????? ??????, ????? ??????? ??????? ?? ??????? ??????????? ????? ???? ???? ??? ?? ????????????? ???????? ?????????? ????????? ??? ??? ????????. ?? ??????????????, ?? ???????, ?? ??????? ??? ????? ?? ?????????? ????? ??? ????? ???? ?????????? ??? ?? ?????????. ??????? ????? ????????? ? ? ???????? ???????????? ?????? ?? ????? ?? ????? ???? ??? ?????? ??? ??????????????? ????????? (SCC) ??? ??? ???? ????? ?????? ?? ???????????? ??????. ?????? ??? ? ??????????? ?????????? ??? ????????? ?????????????? ?????????? ?????????, ??????? ??????? ????????? ??? ????? ?? 10% ??????? ?? ?????????? ?? ??????????????? ?????????. ???? ?? ??????? ??? ????????? ?????, ???? ???? ?????? ????????. ???? ????????? ??? ??????????????? ???????????, ?? 40-60% ???????? ?? ?? ???????????? ????????? ?????????????? ??? ?????? ?? ??????????? ???? ??????? ????? ???? ??????. ??????? ?? 2-10% ??? ???? ?? ??????????????? ??????????? ???????????? ??? ????????? ?????? ??? ????????? ?????? ??? ?? ???. ??? ???? ????? ????????? ?????????????, ? ???????? ?????????, ??????????? ??? ????? ??? ?????? ?? ????????? ?? ??????????????? ?????????. ??? ???????????? ?????????????? ???? ??? ?????, ???? ?????????? ????? ? ?????????? ??? ??? ? ???????????? ?????????????? ??????? ?? ??????????? ?? ??????? ??? ????????. ???????, ??????? ??????????? ?????????? ??? ???????? ???????????? ?? ??? ??? ?????? ????? ???????????????? ????????????. ?? ????? ? ???????? ???????????? ? ? ???????? ????????????, ?????? ??? ?? ?????? ????????????, ????? ??? ????????? ? ??????????? ?? ???????? ?????. ??????????? ??????????? ??? ??????? ??? ???????, ???????, ?????, ?????, ???? ???????? ?????????? ??? ?????? ??? ??? ??????????, ?????, ????? ??? ?????? ????? ???????? ??? ??????? ??? ?????????? ????? ???? ????. ???? ????? ?????????? ? ??????????? ??????? ?????????????? ????? ?????? ??????? ???? ???. ???? ????, ?? ????????? ?????????????? ????? ????? ???? ?????? ??? ?????????????? ?? ??? ??? ??? ??? ?? ??? ?????. ????? ??? ?? ?????????? ?? ?? ??????? ??? ???? ?? ??? ????????? ??? ??????????. ?????? ????? ??????? ???? ??????? ??????? (???????????) ??????, ????? ??? ??? ??? ?????? ???? ???? ????????? ??? ????????. ??? ?????, ?? ????????? ?????????? ????????????? ???? ??? ??????? ?? ??? ??????? ??? ?? 1/8 ??? 1/4 ???? ??????. ?????? ?????, ??????? ?? ???????????? ??? ?? ??????????? ???? ????????. ?? ???????????? ???????? ????????, ???? ??????? ?? ????? ????? ???????? ? ??????? ???????????, ???, ???????, ? ??? ????????? ?????, ? ????? ???? ?? ?? ????? ??? ????????. ??????, ????????? ?????? ? ????? ??? ??????? ??????????? ? ???????????. ??????? ????? ?? ??????????? ??? ???? ?? ????????????? ??? ??????????. ?? ??????? ???????????, ?? ????????? ?????????????? ?????? ????? ??? ?? ?????????????. ??? ????? ????????? ??????????????, ????? ??????? ??? ????? ??????? ????? ??? ??? ???? ??? ????? ?????? ?? ?????????? ??????????? ????? ???????? ??? ????????-??? ???? ??????????????? ?????????. ???????? ???????????? ??? ??????? ????????? ??? ??????. ????? ?? ????????????? ?????? ????? ???????????? ??? ??????? ??? ???? ???????? ?????????? ??? ??????. ??? ??????? ?????? ??????? ??????, ????????? ??? ???????. ??????? ??????????????, ???? ? ????????????, ????? ???? ????????? ??? ??????? ?? ???????????? ??????? ??? ?? ??????????????? ?????????. ??? ?? ???????????? ??? ???????? ???????????? ???????????? ??????? ????????? ?????????????? ?????????? ???, ????? ?????? ?? ????????? ?? ????? ??? ????? ??? ?????? ??? ???? ????????. ???? ???? ??? ????? ????? ????: ?????? ????????? ?????????????? ????? ??? ?????? ??????????? ????????, ???? ?? ????? ???? ?????????? ? ??? ?????? ???? ????????, ???? ?? ????? ?????????? ??? ?? ???????????? ?????? ??? ?????? ???. ?????? ????????? ?????????????? ??? ??????? ??? ??????? ??????????? ?????? ????? ???? ??? ?????. ????? ????? ?????????, ??????? ???? ??? ??? ???????? ?? ????????. ??? ??????? ?????????????? ???? ???? ??? ??????. ? ??? ????? ???? ???????????? ???????, ??? ? ???? ????? ?????? ?? ????????. ??? ?? ??? ?????? ?????????????? ????? ??? ????????? ???? ?? ???? ??? ???????????, ?????, ???? ???? ? ?????, ????? ??? ???????, ???????? ? ??????????? ?? ???????? ?????????. ?? ???? ?????? ???? ?????? ?? ???????? ???? ??? ???? ???????? ??????? ??? ???????? ??? ?????? ????? ??? ?????????????.
???? ????? ? ????? ? ?????? ?????? ???? ???? ????? ? ????? ??? ???? ?????? ??? ????????? ??????????????. ? ????? ??? ?????? ???????????, ????? ???????????, ????, ????? ??? ??? ????? ??????? ???????? ??????? ???? ????, ??????????? ?? ???? ?????? ??? ???????? ??? ???? ??? ??????. ?? ????? ?? ???????? ??? ????? ???????? ??????, ????? ?? 70-80% ??? ??????? ????????? ??????? (UV) ??????? ?? ???????? ???? ??? ?? ???????. ????? ?? ???????? ??????? ??????? ????? ?? ????????????? ???? ????, ??? ????? ????? ??? ?? ????? ?????????????? ??????????, ??? ?? ?????? ???? ?????????? ?????? ???? ????. ? ????????? ??????????? ??? ????????? ??? ?????? ??? ??????? ??????????? ?????? ?? ????? ????? ??? ?????????? ??? ??? ????, ????? ?? ???????????? ????????????? ???? ??? ?????????? ???????????. ?????????? ?? ????????? ?????????????? ??????? ?? ?????????? ??? ?????? ?????? ?? ??????? ? ? ?? ???? ?????? ???????????? ???????.
?? ???? ?? ????? ? ?????? ?? ????? ? ?????? ?? ???????? ???? ??? ?????? ??? ??????? ???? ???? ??????????? ????? ?? ?? ?????, ?? ??? ??????????? ???????? ????? ??? ?????? ?? ?????????? ????????? ??????????????. ?????? ????, ???? ????? ???, ?????? ????? ???? ?????? ??? ?????? ????? ??????????. ?????, ?? ????????? ?????????????? ????? ??? ?????? ?? ????? ???? ??? ??? ?????? ??? 50 ????. ??????? ??????? ????????? ??? ?????? ???? ???? ????? ???? ??? 80 ????, ????? ????????? ??????????????. ??????, ????? ??? ?????? ? ????? ??? ?????????????? ?????????? ???? ??????????? ??? ??????????????, AIDS, ???????????? ??????? ? ?????????? ?????? ?? ??????????? UV, ????? ???????? ????? ?? ?????????????? ?? ???????????? ??? ???????????? ??? ????, ??? ?????? ????? ?? ?????????? ????????? ??????????????. ????? ???????????????? ??? ? ???????? ???????????? ???????? ??? ??? ????? ???????????? ?????, ??? ?????????? ???? ?? ?????????????? ?? ???????. ????????, ??? ??????? ?????? ?? ??????? ??? ???? ???? ???? ?????????????? ????? ????????? ??? ???????????????? ????????????. ??? ???? ????? ???????? ??? ???????? ????? ?????? ??????????????? ????????? ??? ?????????? ??? ????????? ??????????????. ???? ?? ?????????? ??? ????????, ? ??????? ?? ?????? ?? ????? ?????? ??? ?? ?????????? ?? ? ???????? ???????????? ????? ????????. ???? ??????? ?? ?? ??????? ???? ?????? ??? ?????? ?? ??? ??????????? ??????? ? ?????? ?? ??? ??????. ?????? ?????????? ??????????. ? ?????????? ??????? ??????? ?? ??? ???????? ????.
???????????? ???????? ???????? ??????? ????????????? ?????? ??? ????????? ????? ???? ?????????????? ??? ???? ???? ? ?? ????????? ?? ????? ?????? ?????????, ???? ?? ????? ????????? ?????? ????????? ??????????????. 5-?????????????? (5-FU) ?????? ? ???? ?? ????????????? ??? 0,5-5% ???? ??????? ??? ?? FDA (?????????? ???????? ??? ?.?.?) ??? ????? ? ??? ??????????? ?????? ???????? ??? ??? ????????? ??????????????. ????? ??????????????, ??? ???? ???? ??? ???????????? ??????, ???? ??? ??? ??????????? ??????. ???????? ????? ???? ???? ?????? ??? ? ??? ????? ??? ????? ??? ??? ?? ????????? ?????????, ????????? ??????? ????????? ????? ??? 93%. ??????????, ?????? ??? ?????????? ???????? ?????? ?? ???????????, ???? ????? ?????????. ?? ?????? ??????? ???????????? ?????? ??? ????????? ??? ?? ???? ??? ?????????. ?????? ?????? ???? ??? ?? ????????? ?????????? ????? ????. ????????? (Imiquimod) 5% ?????, ??? ???? ??????????? ??? ??? ???, ??? ?? ??????????? ?????: ????????? ?? ????????????? ??????? ??? ?? ??????? ???????????, ??? ?????? ????? ??? ??????????? ?? ????????? ??? ?? ???????????? ???????. ????????? ????? ???? ??? ????? ??? ????? ??? ???????? ??? 4-6 ?????????. ? ????? ????? ???? ??????, ???? ?????? ????? ??????????? ?????????, ?????????? ??? ????. ??????????? (Diclofenac) ????? ??? ?? ?????????? ??????????????? ??????? ?? ????? ??????????????? ?? ????????? ?? ?? ??????????? ???, ??? ?????? ????? ??? ????????? ??????????? ??? ????. ?? ????????? gel ??????????? ??? ????? ??? ????? ??? ??? ?? ????? ?????. ? ??????????? ????????? ??? ?????????? ?????????, ????? ?????? ????? ???? ??????, ??? ?? ??????????? ??? ?????????? ??? ???????? ??? ????????????, ????????? ???? ?? ????????? ??????????? ??? ??? ?????. ??????????????? ?? ????? ??? ???????????? ?????????????? ?? ????? ??????? ?????????.
??????????????? ???? ????? ? ??? ????? ???????????????? ???????? ???? ??????? ???? ????????? ??????? ??????. ????? ???? ? ?????????? ??? ??????????. ???? ?????, ??????????? ?? ??? ??????? ????? ? ??? ??????????? ??????, ??? ????? ??? ??????. ?? ?????? ???????? ?????????????? ? ?????????? ??????? ??? ???????. ???????? ?????????? ??? ?????? ?????? ?? ??????????? ???? ?? ????????, ??? ?? ???????? ????????, ????????? ??????? ?????? ?? ??????? ??? ?????. ???????????? ????????? ??? ??? ????? ????????? ????? ????, ??? ?????? ?? ????? ?????????. ??????? ??? ??? ???????????? ???????? ??? ??????????? ??? ????? ????????? ??????????????? ???? ??????????????? ???? ? ?? ?????????. ???? ? ?????????? ?????? ?? ????????? ?? ??????? ????? ??? ?? ??????? ??? ????????????. ??? ?? ??? ????????? 5-????????????? (5-FU) ????????????? ??? ??????????????? ?????? ?? ??????? ??? ????? ????????? ??? ??? 5-????????????? (5-FU) ??? ?? ??????? ??? ?????????? ????????? ????????? ??????? ???? ??? ???????????????. ?????? ????????? ???? ? ???????, ??? ?????? ??? ??? ????????? ??? ???????? ??? ????????????, ??????????????? ??? ??? ??? ???????? ??????? ????????? ?????????????? ??? ????????. ???????????? ??? (TCA) ???/? ???????? ?????? ???????????????? ?????????? ???? ??? ?????. ?? ??? ????????? ??? ???????? ????????????? ??? ??????? ??????????????? ???? ???? ???????? ???? ??????. ???? ? ??????? ??????? ?????? ?????????? ??? ?????? ?? ?????????? ????????? ????????????? ??? ????????. ??????????? ???????? ?? LASER ??? laser ?????????? ??? ??????? (carbon dioxide) ? erbium Y.A.G ???????? ???? ?????, ??? ? ?????? ????? ??? ???? ????? ?? ???????? ??????????. ???? ????? ??? ???? ??????? ??? ?????? ?? ?????? ? ?????? ????????, ??? ??? ?????? ?? ????? ????????? ?????????????? ??? ?????????????? ??? ???????? ??? ??? ???????, ????? ??? ??? ????????? ?????????? ??? ?????. ?????? ????, ?????? ?????????? ?????? ?? ????? ???????? ??? ?????? ??????? ????????? ?????? ?????? ?? ???????. ?? laser ????? ??????? ?? ????? ??? ????????? ??????? ? ??? ??? ???????????? ????????, ???? ?? ????? ????????? ????? ????????. ???????????? ???????? (PDT) ? ???????????? ???????? PDT ?????? ?? ????? ??????? ??? ?????? ??? ??????? ??? ??? ??????. ?????? 5-???????????????? ??? (5-ALA), ???? ?????????? ???????????????, ??????????? ???? ??????. ?????????????, ? ??????? ?? ?? ??????? ????????? ?? ?????? ??? ?? ????? ??????????? ?? 5-ALA. ? ???????? ?????????? ??????????? ??? ????????? ??????????????, ??? ???????? ????? ????? ??? ???? ????? ?????, ?????? ??? ?????? ?????? ??? ?????????? ????????????.
??? ?? ????????? ??? ???????? ???????????? ? ????????? ?????? ??? ?? ?????????? ??? ???????? ???????????? ????? ?? ?????????????? ??? ????? ??? ??? ??? ????. ???????? ??????????? ??????? ????????? ??? ??? ???????? ??? ??? ??? ????, ??? ?????????? ????? ??????????.
?? ??????????? ????? ???????? ???????? ???: Pearon G. Lang, Jr., MD, and MSKCC Dept. of Dermatology ???????????? ?????????: Rex A. Amonette, MD David J. Leffell, MD Perry Robins, MD ???????????? ????????? ??? ????????: Penny Emmanouil, MD A Publication of the Skin Cancer Foundation ??? ???????????? ??????????? ??? ????????, ?????????????: ?? ?????? ???????? ??? ???????? 149 Madison Ave., Suite 901, New York, NY 10016 www.skincancer.org 1993. Revised 2002, 2004, 2007, 2010. Printed in USA |
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