Lentsch Eric J, McMasters Kelly M
Division of Otolaryngology, Head and Neck Surgery, University of Louisville, KY 40292, USA.
Expert Rev Anticancer Ther. 2003 Oct;3(5):673-83. doi: 10.1586/14737140.3.5.673.
Since its first description nearly two centuries ago, melanoma has been a difficult disease to diagnose and treat. With the incidence and mortality rates slowly increasing, understanding this disease is more important than ever. Herein, the current diagnostic and treatment recommendations for melanoma of the head and neck are reviewed, with special emphasis on the use of sentinel lymph node biopsy (SLNB). For the past decade, SLNB has been a well-accepted procedure in the treatment of truncal and extremity melanoma, providing useful information for both treatment and prognosis. Still, despite its clear role in the rest of the body, the role of SLNB has not yet been fully defined in the management of melanoma of the head and neck. The complexity of lymphatic drainage patterns and the frequent need to remove sentinel lymph nodes from the parotid gland, thus placing the facial nerve at risk, have made head and neck surgical oncologists slow to adopt this method. However, current data from several trials indicate that in the head and neck, sentinel lymph nodes can be identified reliably approximately 98% of the time using intraoperative lymphatic mapping. In addition, the false-negative and complication rates are appropriately low. SLNB allows for accurate staging of patients, informed discussions of prognosis and the use of adjuvant therapies, including radiation and interferon-alpha2b. For these reasons, the authors believe that SLNB will become the standard-of-care for head and neck melanoma as well as for other body sites.
自近两个世纪前首次被描述以来，黑色素瘤一直是一种难以诊断和治疗的疾病。随着发病率和死亡率的缓慢上升，了解这种疾病比以往任何时候都更加重要。在此，我们回顾了目前头颈部黑色素瘤的诊断和治疗建议，特别强调前哨淋巴结活检（SLNB）的应用。在过去十年中，SLNB在躯干和四肢黑色素瘤的治疗中已成为一种广泛接受的方法，为治疗和预后提供了有用信息。然而，尽管SLNB在身体其他部位的作用已明确，但在头颈部黑色素瘤的管理中其作用尚未完全明确。淋巴引流模式的复杂性以及经常需要从腮腺切除前哨淋巴结，从而使面神经面临风险，使得头颈外科肿瘤学家对采用这种方法持谨慎态度。然而，目前来自多项试验的数据表明，在头颈部，使用术中淋巴造影术大约98%的时间能够可靠地识别前哨淋巴结。此外，假阴性率和并发症发生率也较低。SLNB能够准确地对患者进行分期，有助于对预后进行明智的讨论，并使用包括放疗和干扰素-α2b在内的辅助治疗。基于这些原因，作者认为SLNB将成为头颈部黑色素瘤以及身体其他部位黑色素瘤的标准治疗方法。
