原发性皮肤黑色素瘤的外科治疗：切除边缘与前哨淋巴结检查的作用

Surgical management of primary cutaneous melanoma: excision margins and the role of sentinel lymph node examination.

作者信息

Thompson John F, Scolyer Richard A, Uren Roger F

机构信息

Sydney Melanoma Unit, Level 3, Gloucester House, Sydney Cancer Centre, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2006, Australia.

出版信息

Surg Oncol Clin N Am. 2006 Apr;15(2):301-18. doi: 10.1016/j.soc.2005.12.007.

DOI:10.1016/j.soc.2005.12.007

PMID:16632216

Abstract

Surgical strategies for managing patients who have primary cutaneous melanoma have changed dramatically over the past 30 years. More conservative excision margins have been shown to be adequate, and routine complete lymph node dissection (CLND)has been abandoned since the sentinel node (SN) biopsy technique was introduced. Knowledge of a patient's SN status not only provides a reliable guide to prognosis, but also allows CLND to be avoided in 80% to 85% of patients. Recent clinical trial results suggest that SN biopsy, with immediate CLND if an SN is positive,confers a survival advantage in those who have metastatic disease in regional nodes. Minimally invasive and noninvasive methods of SN assessment, such as magnetic resonance spectroscopy, are being evaluated.

摘要

在过去30年里，针对原发性皮肤黑色素瘤患者的手术治疗策略发生了巨大变化。研究表明，更保守的切除边缘已足够，自前哨淋巴结（SN）活检技术引入后，常规的根治性淋巴结清扫术（CLND）已被摒弃。了解患者的SN状态不仅能为预后提供可靠指导，还能使80%至85%的患者避免进行CLND。最近的临床试验结果表明，SN活检，若SN为阳性则立即进行CLND，对于区域淋巴结有转移性疾病的患者具有生存优势。目前正在评估SN评估的微创和非侵入性方法，如磁共振波谱分析。