Bösch U, Banic A
Abteilung für Plastische und Wiederherstellungschirurgie, Inselspital Bern.
Ther Umsch. 1999 Jun;56(6):318-23. doi: 10.1024/0040-5930.56.6.318.
Early diagnosis and total tumor excision are fundamental to assure a favorable outcome in the treatment of the malignant melanoma. Previously a large local excision up to 5 cm was recommended. In the past two decades some prospective studies showed the same survival rate when using narrower margins of excision (1-3 cm). The elective lymphadenectomy increases the survival rate only in a small group of patients and has a high rate of complications. The concept of lymphatic mapping can greatly help in finding the lymph node ("sentinel lymph node") which is the first one to receive lymphatic drainage from the affected area. This node has the highest probability of containing a metastasis and is excised. With this procedure the number of patients requiring lymphadenectomy can be limited to those who have documented lymph node metastases. The sentinel biopsy technique can provide new insight into the tumor biology of melanoma and helps in determining adjuvant therapy. In order to evaluate the influence of sentinel node biopsy on survival rate of melanoma patients clinical trials have been designed. Systemic melanoma metastases carry a poor prognosis. Surgical resection of isolated metastases may provide good palliation, in combination with other therapies.
早期诊断和肿瘤全切对于确保恶性黑色素瘤治疗取得良好预后至关重要。此前推荐进行高达5厘米的大范围局部切除。在过去二十年中，一些前瞻性研究表明，采用更窄的切除边缘（1 - 3厘米）时生存率相同。选择性淋巴结清扫仅在一小部分患者中提高了生存率，且并发症发生率很高。淋巴绘图的概念可以极大地帮助找到淋巴结（“前哨淋巴结”），它是第一个接收来自受影响区域淋巴引流的淋巴结。该淋巴结含有转移灶的可能性最高，会被切除。通过这种方法，需要进行淋巴结清扫的患者数量可以限制在那些有记录的淋巴结转移患者中。前哨活检技术可以为黑色素瘤的肿瘤生物学提供新的见解，并有助于确定辅助治疗。为了评估前哨淋巴结活检对黑色素瘤患者生存率的影响，已经设计了临床试验。系统性黑色素瘤转移预后较差。孤立转移灶的手术切除与其他疗法联合使用可能会提供良好的姑息治疗效果。
