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皮肤黑色素瘤:早期检测的公共卫生方法。

Cutaneous melanoma: public health approach to early detection.

作者信息

Weinstock Martin A

机构信息

Dermatoepidemiology Unit, V A Medical Center-111D, 830 Chalkstone Avenue, Providence, RI 02908, USA.

出版信息

Dermatol Ther. 2006 Jan-Feb;19(1):26-31. doi: 10.1111/j.1529-8019.2005.00053.x.

Abstract

Melanoma is a major public health problem. There will be a projected 60,000 cases of invasive melanoma diagnosed in 2005, and that number is increasing each year. Fortunately, the prognosis is improving as well, but we still have approximately 8000 deaths per year related to this tumor. To reduce this number of deaths, we need to look at the skin--inspect--and see--recognize potential early melanomas when we look at them. Most of the population does not see a dermatologist regularly, and there are many barriers to general clinicians inspecting the skin, including inadequacy of dermatologic skills. Patients are ultimately responsible for their own skin, but only a small proportion of people actually perform thorough skin self-examination on a recommended monthly basis. There are various tools used by some dermatologists to facilitate early detection, including total body and lesional photography and epiluminescence microscopy (dermoscopy) of lesions. A basic skin cancer triage algorithm has been developed and tested in primary care, with promising results for improving practice. The general population also needs better guidance on early melanoma detection. Hence, instead of relying on the "ABCDs" for a morphologic diagnosis, the message of "a new or changing skin lesion" is being promoted to facilitate early diagnosis of thin, curable tumors. Together, patients and clinicians can improve early detection to reduce melanoma-related mortality.

摘要

黑色素瘤是一个重大的公共卫生问题。预计2005年将有60000例侵袭性黑色素瘤被诊断出来,而且这一数字每年都在增加。幸运的是,预后也在改善,但我们每年仍有大约8000人死于这种肿瘤。为了减少死亡人数,我们需要观察皮肤——检查——并在观察时识别潜在的早期黑色素瘤。大多数人不经常看皮肤科医生,普通临床医生检查皮肤存在许多障碍,包括皮肤科技能不足。患者最终要对自己的皮肤负责,但实际上只有一小部分人按照建议每月进行全面的皮肤自我检查。一些皮肤科医生使用各种工具来促进早期发现,包括全身和病变部位摄影以及病变的表皮透光显微镜检查(皮肤镜检查)。一种基本的皮肤癌分诊算法已在初级保健中开发并进行了测试,在改善实践方面取得了有希望的结果。普通人群在早期黑色素瘤检测方面也需要更好的指导。因此,为了便于早期诊断薄的、可治愈的肿瘤,正在推广“新的或变化的皮肤病变”这一信息,而不是依靠“ABCD”进行形态学诊断。患者和临床医生共同努力,可以提高早期发现率,以降低黑色素瘤相关的死亡率。

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