Jäckel A, Bock M, Deichmann M, Waldmann V, Näher H
Universitäts-Hautklinik, Ruprecht-Karls-Universität Heidelberg, Vossstrasse 2, 69115 Heideberg.
Hautarzt. 2001 Feb;52(2):98-103. doi: 10.1007/s001050051272.
The uvea is the most common site for extra-cutaneous melanoma and uveal melanoma is the most frequent primary intraocular tumour in adults. Because its different location, biology, histology, genetic features and prognosis in comparison to cutaneous melanoma, this tumour is considered as a distinct entity in the group of malignant melanoma. While primary uveal melanoma is usually treated by ophthalmologic oncologists, metastatic diseases is often managed by dermatologic oncologists. Hematogenous spread predominantly involves the liver and is often restricted to this organ for a long period. Metastatic uveal melanoma is usually resistant to chemotherapeutic regimens established for the therapy of cutaneous melanoma. Newer therapeutic modalities, such as local intra-arterial chemotherapy into the hepatic artery, perhaps combined with embolisation of feeder blood vessels of liver metastases, improves the prognosis of metastatic uveal melanoma. Currently the nitrosourea derivate fotemustine is the drug of choice in the local hepatic and systemic treatment and seems to be superior to other chemotherapeutic agents. Following the characterisation of primary uveal melanoma, we summarize the results of different treatment protocols for metastatic disease and give an overview of new strategies.
葡萄膜是皮肤外黑色素瘤最常见的发病部位，葡萄膜黑色素瘤是成人中最常见的原发性眼内肿瘤。由于其在位置、生物学特性、组织学、基因特征及预后等方面与皮肤黑色素瘤不同，该肿瘤在恶性黑色素瘤组中被视为一个独特的实体。原发性葡萄膜黑色素瘤通常由眼科肿瘤学家治疗，而转移性疾病则常由皮肤科肿瘤学家处理。血行转移主要累及肝脏，且通常在很长一段时间内局限于该器官。转移性葡萄膜黑色素瘤通常对为治疗皮肤黑色素瘤而制定的化疗方案耐药。较新的治疗方式，如经肝动脉局部动脉内化疗，可能联合肝转移瘤供血血管栓塞术，可改善转移性葡萄膜黑色素瘤的预后。目前，亚硝基脲衍生物福莫司汀是局部肝脏及全身治疗的首选药物，似乎优于其他化疗药物。在对原发性葡萄膜黑色素瘤进行特征描述之后，我们总结了转移性疾病不同治疗方案的结果，并概述了新的治疗策略。
