Derleme
BibTex RIS Kaynak Göster

EPIDEMIOLOGY of COMMON SKIN CANCERS

Yıl 2019, Cilt: 4 - Dermatoloji ve Halk Sağlığı Özel Sayısı, 52 - 60, 11.03.2019
https://doi.org/10.35232/estudamhsd.499257

Öz













Non-melanoma skin cancers are the most common
cancers in people with fair skin and basal cell carcinoma (BCC) is the most
common among them. BCC progresses slowly, is locally aggressive and rarely
metastasizes. Although the mortality rate is low, morbidity and disease cost
burden is high. Cutaneous squamous cell carcinoma (SCC) is the second most
common skin cancer. Most of cutaneous SCCs are treated, but may cause
recurrence, metastasis and mortaliy. Melanoma is rare compared to BCC and SCC
but it is a very important public health problem due to its high mortality.
Melanoma is the most aggressive and has the highest mortality rate in all skin
cancers and early diagnosis is vital. Various environmental, phenotypic and
genotypic factors, particularly ultraviolet (UV) are involved in the etiology
of these three skin cancers. The incidence of these three skin cancer is increasing
rapidly worldwide. People should be educated about skin cancers and protection
from factors, particularly UV that are associated with etiology of skin
cancers. Thus, morbidity, mortality and cost burden associated with skin
cancers will decrease.





Kaynakça

  • Perera E, Gnaneswaran N, Staines C, Win AK, Sinclair R. Incidence and prevelance of non-melanoma skin cancer in Australia: A systematic review. Australas J Dermatol. 2015;56(4):258-67.
  • Lai V, Cranwell W, Sinclair R. Epidemiology of skin cancer in the mature patient. Clin Dermatol.2018;36(2):167-76.
  • Verkouteren JAC, Ramdas KHR, Wakkee M, Nijsten T. Epidemiology of basal cell carcinoma: scholarly review. Br J Dermatol. 2017;177(2):359-72.
  • Savoye I, Olsen CM, Whiteman DC, Bijon A, Wald L, Dartois L et al. Patterns of ultraviolet radiation exposure and skin cancer risk: the E3N-sunexp study. J Epidemiol. 2018;28(1):27-33.
  • Dimitriou F, Krattinger R, Ramelyte E, Barysch MJ, Micaletto S, Dummer R, et al. The world of melanoma: epidemiologic, genetic, and anatomic differences of melanoma across the globe. Curr Oncol Rep. 2018;20(11):87.
  • Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012;166(5):1069-80.
  • Devine C, Srinivasan B, Sayan A, IIankovan V. Epidemiology of skin cancer in the mature patient. Br J O ral Maxillofac Surg. 2018;56(2):101-6.
  • Jurciukonyte R, Vincerzevskiene I, Krilaviciute A, Bylaite M, Smailyte G. Epidemiology of basal cell carcinoma in Lithuania, 1996-2010. Br J Dermatol. 2013;169(5):1100-5.
  • Prieto-Granada C, Rodriguez-Waitkus P. Basal cell carcinoma: epidemiology, clinical and histologic features, and basic dcience overview. Curr Probl Cancer. 2015;39(4):198-205.
  • Kauvar AN, Cronin T Jr, Roenigk R, Hruza G, Bennett R; American Society for Dermatologic Surgery. Consensus for nonmelanoma skin cancer treatment: basal cell carcinoma, including a cost analysis of treatment methods. Dermatol Surg. 2015;41(5):550-71.
  • Richmond-Sinclair NM, Pandeya N, Ware RS, Neale RE, Williams GM, van der Pols JC, et al. Incedence of basal cell carcinoma multiplicity and detailed anatomic distribution: longitudinal study of an Australian population. J Inwest Dermatol. 2009;129(2):323-8.
  • Norval M, Kellett P, Wright CY. The incidence and body site of skin cancers in the population groups of South Africa. Photodermatol Photoimmunol Photomed. 2014;30(5):262-5.
  • Reinau D, Surber C, Jick SS, Meier CR. Epidemiology of basal cell carcinoma in the United Kingdom: incidence, lifestyle factors, and comorbidities. Br J Cancer. 2014;111(1):203-6.
  • Christenson LJ, Borrowman TA, Vachon CM, Tollefson MM, Otley CC, Weaver AL, et al. Incedence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA. 2005;294:681-90.
  • Türkyılmaz M, Hacıkamiloğlu E, Baran Deniz E, Boztaş G, Dündar S, Kavak Ergün A, ve ark. Türkiye kanser istatistikleri 2015, Türkiye Cumhuriyeti Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü, Ankara, 2018.
  • Hakverdi S, Balci DD, Dogramaci CA, Toprak S, Yaldiz M. Retrospective analysis of basal cell carcinoma. Indian J Dermatol Venereol Leprol. 2011;77(2):251.
  • Ceylan C, Oztürk G, Alper S. Non-melanoma skin cancers between the years of 1990 and 1999 in Izmir, Turkey: demographic and clinicopathological characteristics. J Dermatol. 2003;30(2):123-31.
  • Tiftikcioğlu YO, Karaaslan O, Aksoy HM, Aksoy B, Koçer U. Basal cell carcinoma in Turkey. J Dermatol. 2006;33(2):91-5.
  • Savas S, Turgut Erdemir AV, Koku Aksu AE, Gurel MS, Ozkur E. Clinical and prognostic factors in the development of basal cell carcinoma. Clin Dermatol. 2017;35(6):616-23.
  • Pedersen SA, Gaist D, Schmidt SAJ, Hölmich LR, Friis S, Pottegard A. Hydrochlorothiazide use and risk of nonmelanoma skin cancer: a nationwide case-control study from Denmark. J Am Acad Dermatol. 2018;78(4):673-81.
  • Li C, Athar M. Ionizing radiation exposure and basal cell carcinoma pathogenesis. Radiat Res. 2016;185(3):217-28.
  • Mayer JE, Goldman RH. Arsenic and skin cancer in the USA: the current evidence regarding arsenic-contaminated drinking water. Int J Dermatol. 2016;55(11):585-91.
  • Lowenstein SE, Garret G, Toland AE, Jambusaria-Pahlajani A, Asgari MM, Green A, et al; National Cancer Institute Keratinocyte Carcinoma Consortium. Br J Dermatol. 2017;177(5):1202-7.
  • Caini S, Cattaruzza MS, Bendinelli B, Tosti G, Masala G, Gnagnarella P, et al. Cofee, tea and caffeine intake and the risk of non-melanoma skin cancer: a review of the literatüre and meta-analysis. Eur J Nutr. 2017;56(1):1-12.
  • Freedman DM, Sigurdson A, Doody MM, Mabuchi K, Linet MS. Risk of basal cell carcinoma in relation to alcohol intake and smoking. Cancer Epidemiol Biomarkers Prey. 2003;12(12):1540-3.
  • Zhang Y, Ferrucci LM, Cartmel B, Molinaro AM, Leffell DJ, Bale AE, et al. Alcohol intake and early-onset basal cell carcinoma in a case-control study. Br J Dermatol. 2014;171(6):1451-7.
  • Yen H, Dhana A, Okhovat JP, Qureshi A, Keum N, Cho E. Alcohol intake and risk of nonmelanoma skin cancer: a systemativ review and dose-response meta-analysis. Br J Dermatol. 2017;177(3):696-707.
  • Ramezani M, Sadeqhi M. Human papilloma virus infection in basal cell carcinoma of the skin: a systematic review and meta-analysis study. Pol J Pathol. 2017;68(4):330-42.
  • Karagas MR, Waterboer T, Li Z, Nelson HH, Michael KM, Blavinck JN, et al. ; New Hampshire Skin Cancer Study Group. Genus beta human papillomaviruses and incidence of basal cell and squamous cell carcinomas of skin: population based case-control study. BMJ. 2010;341:c2986.
  • Cameron MC, Lee E, Hibler B, Barker CA, Mori S, Cordova M, et al. Basal cell carcinoma: part 1. J Am Acad Dermatol. 2018; [Epub ahead of print]
  • Waldman A, Schmults C. Cutaneous squamous cell carcinoma. Hematol Oncol Clin North Am. 2019;33(1):1-12.
  • Schmults CD, Karia PS, Carter JB, Han J, Qureshi AA. Factors predictive of recurrence and death from cutaneous squamous cell carcinoma: a 10-year, single-institution cohort study. JAMA Dermatol. 2013;149(5):541-7.
  • Griffin LL, Ali FR, Lear JT. Non-melanoma skin cancer. Clin Med (Lond). 2016;16(1):62-5.
  • Muzic JG, Schmitt AR, Wright AC, Alniemi DT, Zubair AS, Olazagasti Lourido JM, et al. Incedence and trends of basal cell carcinoma and cutaneous squamous cell carcinoma: a population-based study in Olmsted County Minnesota, 2000 to 2010. Mayo Clin Proc. 2017;92(6):890-8.
  • Cocchetto V, Magrin P, de Paula RA, Aide M, Monte Razo L, Pantaleao L. Squamous cell carcinoma in chronic wound: marjolin ulcer. Dermatol Online J. 2013;19(2):7.
  • Work Group; Invited Reviewers, Kim JYS, Kozlow JH, Mittal B, Mover J, Olenecki T, Rodgers P. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2018;78(3):560-78.
  • Dusingize JC, Olsen CM, Pandeya NP, Subramaniam P, Thompson BS, Neale RE, et al. ; QSkin Study. Cigarette smoking and the risks of basal cell carcinoma and squamous cell carcinoma. J Invest Dermatol. 2017;137(8):1700-8.
  • Rastrelli M, Tropea S, Rossi CR, Alaibac M. Melanoma: epidemiology, risk factors, pathogenesis, diagnosis and classification. In Vivo. 2014;28(6):1005-11.
  • Cadby G, Ward SV, Cole JM, Moses EK, Millward M, Palmer LJ. The association of host and genetic melanoma risk factors with Breslow thickness in the Western Australian melanoma health study. Br J Dermatol. 2014;170(4):851-7.
  • Whiteman DC, Green AC, Olsen CM. The growing burden of invasive melanoma: projections of incidence rates and numbers of new cases in six susceptible populations through 2031. J Invest Dermatol. 2016;136(6):1161-71.
  • Schadendorf D, van Akkooi ACJ, Berking C, Griewank KG, Gutzmer R, Hauschild A, et al. Melanoma. Lancet. 2018;392(10151):971-84.
  • Li WQ, Cho E, Wu S, Li S, Matthews NH, Qureshi AA. Host characteristics and risk of incident melanoma by Breslow thickness. Cancer Epidemiol Biomarkers Prev. 2018 [Epub ahead of print]
  • Baykal C, Atci T, Polat Ekinci A, Buyukbabani N. An update on cutaneous melanoma in Turkey: evaluation of 19-year data in a single tertiary centre and review of the literatüre. J Eur Acad Dermatol Venereol. 2017;31(2):236-40.
  • Abali H, Celik I, Karaca B, Turna H, Kaytan Saglam E, Akman T, et al. Cutaneous melanoma in Turkey: analysis of 1157 patients in the Melanoma Turkish Study. J BUON. 2015;20(4):1137-41.
  • Gamsizkan M, Yilmaz I, Buyukbabani N, Demirkesen C, Demiriz M, Cetin ED, et al. A retrospective multicenter evaluation of cutaneous melanomas in Turkey. Asian Pac J Cancer Prev. 2014,15(23):10451-6.

SIK GÖRÜLEN DERİ KANSERLERİNİN EPİDEMİYOLOJİSİ

Yıl 2019, Cilt: 4 - Dermatoloji ve Halk Sağlığı Özel Sayısı, 52 - 60, 11.03.2019
https://doi.org/10.35232/estudamhsd.499257

Öz













Melanom
dışı deri kanserleri beyaz ırkta en sık görülen kanserlerdir ve bunlar arasında
en sık bazal hücreli karsinom (BHK) görülür. BHK yavaş ilerleyen, lokal agresif
ve nadiren metastaz yapan bir deri kanseridir. Mortalitesi düşük olmasına
rağmen morbiditesi ve hastalık maliyet yükü yüksektir. Kutanöz skuamöz hücreli
karsinom (SHK) ise ikinci en sık görülen deri kanseridir. Bu hastaların büyük
bir kısmı tedavi edilir; ancak rekürrens, metastaz ve mortaliteye neden
olabilir. Melanom, BHK ve SHK’ya göre nadirdir ancak yüksek mortalitesi
nedeniyle çok önemli bir halk sağlığı problemidir. Tüm deri kanserleri içinde
melanom en agresif ve mortalitesi en yüksek olanıdır ve erken tanı hayati öneme
sahiptir. Üç deri kanserinin etiyolojisinde de başta ultraviyole (UV) olmak
üzere çeşitli çevresel, fenotipik ve genotipik faktörler rol oynamaktadır. Bu
üç deri kanserinin insidansı dünya çapında hızla artmaktadır. İnsanlar deri
kanserleri ve deri kanserleri ile ilişkili başta UV olmak üzere etiyolojide
rolü olan faktörlerden korunma konusunda eğitilmelidir. Böylece deri kanserleri
ile ilişkili morbidite, mortalite ve maliyet yükü azalacaktır





Kaynakça

  • Perera E, Gnaneswaran N, Staines C, Win AK, Sinclair R. Incidence and prevelance of non-melanoma skin cancer in Australia: A systematic review. Australas J Dermatol. 2015;56(4):258-67.
  • Lai V, Cranwell W, Sinclair R. Epidemiology of skin cancer in the mature patient. Clin Dermatol.2018;36(2):167-76.
  • Verkouteren JAC, Ramdas KHR, Wakkee M, Nijsten T. Epidemiology of basal cell carcinoma: scholarly review. Br J Dermatol. 2017;177(2):359-72.
  • Savoye I, Olsen CM, Whiteman DC, Bijon A, Wald L, Dartois L et al. Patterns of ultraviolet radiation exposure and skin cancer risk: the E3N-sunexp study. J Epidemiol. 2018;28(1):27-33.
  • Dimitriou F, Krattinger R, Ramelyte E, Barysch MJ, Micaletto S, Dummer R, et al. The world of melanoma: epidemiologic, genetic, and anatomic differences of melanoma across the globe. Curr Oncol Rep. 2018;20(11):87.
  • Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012;166(5):1069-80.
  • Devine C, Srinivasan B, Sayan A, IIankovan V. Epidemiology of skin cancer in the mature patient. Br J O ral Maxillofac Surg. 2018;56(2):101-6.
  • Jurciukonyte R, Vincerzevskiene I, Krilaviciute A, Bylaite M, Smailyte G. Epidemiology of basal cell carcinoma in Lithuania, 1996-2010. Br J Dermatol. 2013;169(5):1100-5.
  • Prieto-Granada C, Rodriguez-Waitkus P. Basal cell carcinoma: epidemiology, clinical and histologic features, and basic dcience overview. Curr Probl Cancer. 2015;39(4):198-205.
  • Kauvar AN, Cronin T Jr, Roenigk R, Hruza G, Bennett R; American Society for Dermatologic Surgery. Consensus for nonmelanoma skin cancer treatment: basal cell carcinoma, including a cost analysis of treatment methods. Dermatol Surg. 2015;41(5):550-71.
  • Richmond-Sinclair NM, Pandeya N, Ware RS, Neale RE, Williams GM, van der Pols JC, et al. Incedence of basal cell carcinoma multiplicity and detailed anatomic distribution: longitudinal study of an Australian population. J Inwest Dermatol. 2009;129(2):323-8.
  • Norval M, Kellett P, Wright CY. The incidence and body site of skin cancers in the population groups of South Africa. Photodermatol Photoimmunol Photomed. 2014;30(5):262-5.
  • Reinau D, Surber C, Jick SS, Meier CR. Epidemiology of basal cell carcinoma in the United Kingdom: incidence, lifestyle factors, and comorbidities. Br J Cancer. 2014;111(1):203-6.
  • Christenson LJ, Borrowman TA, Vachon CM, Tollefson MM, Otley CC, Weaver AL, et al. Incedence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA. 2005;294:681-90.
  • Türkyılmaz M, Hacıkamiloğlu E, Baran Deniz E, Boztaş G, Dündar S, Kavak Ergün A, ve ark. Türkiye kanser istatistikleri 2015, Türkiye Cumhuriyeti Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü, Ankara, 2018.
  • Hakverdi S, Balci DD, Dogramaci CA, Toprak S, Yaldiz M. Retrospective analysis of basal cell carcinoma. Indian J Dermatol Venereol Leprol. 2011;77(2):251.
  • Ceylan C, Oztürk G, Alper S. Non-melanoma skin cancers between the years of 1990 and 1999 in Izmir, Turkey: demographic and clinicopathological characteristics. J Dermatol. 2003;30(2):123-31.
  • Tiftikcioğlu YO, Karaaslan O, Aksoy HM, Aksoy B, Koçer U. Basal cell carcinoma in Turkey. J Dermatol. 2006;33(2):91-5.
  • Savas S, Turgut Erdemir AV, Koku Aksu AE, Gurel MS, Ozkur E. Clinical and prognostic factors in the development of basal cell carcinoma. Clin Dermatol. 2017;35(6):616-23.
  • Pedersen SA, Gaist D, Schmidt SAJ, Hölmich LR, Friis S, Pottegard A. Hydrochlorothiazide use and risk of nonmelanoma skin cancer: a nationwide case-control study from Denmark. J Am Acad Dermatol. 2018;78(4):673-81.
  • Li C, Athar M. Ionizing radiation exposure and basal cell carcinoma pathogenesis. Radiat Res. 2016;185(3):217-28.
  • Mayer JE, Goldman RH. Arsenic and skin cancer in the USA: the current evidence regarding arsenic-contaminated drinking water. Int J Dermatol. 2016;55(11):585-91.
  • Lowenstein SE, Garret G, Toland AE, Jambusaria-Pahlajani A, Asgari MM, Green A, et al; National Cancer Institute Keratinocyte Carcinoma Consortium. Br J Dermatol. 2017;177(5):1202-7.
  • Caini S, Cattaruzza MS, Bendinelli B, Tosti G, Masala G, Gnagnarella P, et al. Cofee, tea and caffeine intake and the risk of non-melanoma skin cancer: a review of the literatüre and meta-analysis. Eur J Nutr. 2017;56(1):1-12.
  • Freedman DM, Sigurdson A, Doody MM, Mabuchi K, Linet MS. Risk of basal cell carcinoma in relation to alcohol intake and smoking. Cancer Epidemiol Biomarkers Prey. 2003;12(12):1540-3.
  • Zhang Y, Ferrucci LM, Cartmel B, Molinaro AM, Leffell DJ, Bale AE, et al. Alcohol intake and early-onset basal cell carcinoma in a case-control study. Br J Dermatol. 2014;171(6):1451-7.
  • Yen H, Dhana A, Okhovat JP, Qureshi A, Keum N, Cho E. Alcohol intake and risk of nonmelanoma skin cancer: a systemativ review and dose-response meta-analysis. Br J Dermatol. 2017;177(3):696-707.
  • Ramezani M, Sadeqhi M. Human papilloma virus infection in basal cell carcinoma of the skin: a systematic review and meta-analysis study. Pol J Pathol. 2017;68(4):330-42.
  • Karagas MR, Waterboer T, Li Z, Nelson HH, Michael KM, Blavinck JN, et al. ; New Hampshire Skin Cancer Study Group. Genus beta human papillomaviruses and incidence of basal cell and squamous cell carcinomas of skin: population based case-control study. BMJ. 2010;341:c2986.
  • Cameron MC, Lee E, Hibler B, Barker CA, Mori S, Cordova M, et al. Basal cell carcinoma: part 1. J Am Acad Dermatol. 2018; [Epub ahead of print]
  • Waldman A, Schmults C. Cutaneous squamous cell carcinoma. Hematol Oncol Clin North Am. 2019;33(1):1-12.
  • Schmults CD, Karia PS, Carter JB, Han J, Qureshi AA. Factors predictive of recurrence and death from cutaneous squamous cell carcinoma: a 10-year, single-institution cohort study. JAMA Dermatol. 2013;149(5):541-7.
  • Griffin LL, Ali FR, Lear JT. Non-melanoma skin cancer. Clin Med (Lond). 2016;16(1):62-5.
  • Muzic JG, Schmitt AR, Wright AC, Alniemi DT, Zubair AS, Olazagasti Lourido JM, et al. Incedence and trends of basal cell carcinoma and cutaneous squamous cell carcinoma: a population-based study in Olmsted County Minnesota, 2000 to 2010. Mayo Clin Proc. 2017;92(6):890-8.
  • Cocchetto V, Magrin P, de Paula RA, Aide M, Monte Razo L, Pantaleao L. Squamous cell carcinoma in chronic wound: marjolin ulcer. Dermatol Online J. 2013;19(2):7.
  • Work Group; Invited Reviewers, Kim JYS, Kozlow JH, Mittal B, Mover J, Olenecki T, Rodgers P. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2018;78(3):560-78.
  • Dusingize JC, Olsen CM, Pandeya NP, Subramaniam P, Thompson BS, Neale RE, et al. ; QSkin Study. Cigarette smoking and the risks of basal cell carcinoma and squamous cell carcinoma. J Invest Dermatol. 2017;137(8):1700-8.
  • Rastrelli M, Tropea S, Rossi CR, Alaibac M. Melanoma: epidemiology, risk factors, pathogenesis, diagnosis and classification. In Vivo. 2014;28(6):1005-11.
  • Cadby G, Ward SV, Cole JM, Moses EK, Millward M, Palmer LJ. The association of host and genetic melanoma risk factors with Breslow thickness in the Western Australian melanoma health study. Br J Dermatol. 2014;170(4):851-7.
  • Whiteman DC, Green AC, Olsen CM. The growing burden of invasive melanoma: projections of incidence rates and numbers of new cases in six susceptible populations through 2031. J Invest Dermatol. 2016;136(6):1161-71.
  • Schadendorf D, van Akkooi ACJ, Berking C, Griewank KG, Gutzmer R, Hauschild A, et al. Melanoma. Lancet. 2018;392(10151):971-84.
  • Li WQ, Cho E, Wu S, Li S, Matthews NH, Qureshi AA. Host characteristics and risk of incident melanoma by Breslow thickness. Cancer Epidemiol Biomarkers Prev. 2018 [Epub ahead of print]
  • Baykal C, Atci T, Polat Ekinci A, Buyukbabani N. An update on cutaneous melanoma in Turkey: evaluation of 19-year data in a single tertiary centre and review of the literatüre. J Eur Acad Dermatol Venereol. 2017;31(2):236-40.
  • Abali H, Celik I, Karaca B, Turna H, Kaytan Saglam E, Akman T, et al. Cutaneous melanoma in Turkey: analysis of 1157 patients in the Melanoma Turkish Study. J BUON. 2015;20(4):1137-41.
  • Gamsizkan M, Yilmaz I, Buyukbabani N, Demirkesen C, Demiriz M, Cetin ED, et al. A retrospective multicenter evaluation of cutaneous melanomas in Turkey. Asian Pac J Cancer Prev. 2014,15(23):10451-6.
Toplam 45 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Derlemeler
Yazarlar

Ersoy Acer 0000-0002-6072-6466

Hilal Kaya Erdoğan 0000-0002-8172-1920

Yayımlanma Tarihi 11 Mart 2019
Gönderilme Tarihi 19 Aralık 2018
Yayımlandığı Sayı Yıl 2019 Cilt: 4 - Dermatoloji ve Halk Sağlığı Özel Sayısı

Kaynak Göster

Vancouver Acer E, Kaya Erdoğan H. SIK GÖRÜLEN DERİ KANSERLERİNİN EPİDEMİYOLOJİSİ. ESTÜDAM Halk Sağlığı Dergisi. 2019;4:52-60.

Uluslararası Hakemli Dergi

Crossref Content Registration logo

Dergimiz Açık Erişim Politikasını benimsemiş olup dergimize gönderilen yayınlar için gerek değerlendirme gerekse yayınlama dahil yazarlardan hiçbir ücret talep edilmemektedir. 

by-nc.eu.png

Bu eser Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı ile lisanslanmıştır.