Sebastian G
Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden.
Hautarzt. 2006 Sep;57(9):756-63. doi: 10.1007/s00105-006-1187-7.
Excision is the treatment of choice in stage I malignant melanoma. As supported by several controlled clinical studies, reduced safety surgical margins from 0.5 to 2 cm are sufficient. Most surgical defects can be closed by simple skin flap techniques. In critical anatomic sites (e. g. face, hand, foot) micrographic surgery is the therapy of choice. Sentinel lymph node biopsy (SLNB) was proposed as a minimally-invasive procedure for the histopathologic staging of the regional lymph nodes. Today SLNB is standard in the diagnostic approach to melanomas thicker than 1 mm. The therapeutic relevance of SLNB is unclear. The most common sign of tumor progression is involvement of regional lymph nodes. The treatment of choice in patients with neck metastases is the radical, modified or selective neck dissection. In the case of axillary metastases, levels I-III of the axillary lymph nodes are excised. With groin metastases, superficial inguinal dissection is usually preferred. There are no randomized controlled trials comparing the outcome of combined inguinal and pelvic lymph node dissection and superficial inguinal lymph node dissection.
切除是I期恶性黑色素瘤的首选治疗方法。多项对照临床研究表明，手术切缘从0.5厘米减至2厘米是安全的。大多数手术缺损可通过简单的皮瓣技术闭合。在关键解剖部位（如面部、手部、足部），显微外科手术是首选治疗方法。前哨淋巴结活检（SLNB）被提议作为区域淋巴结组织病理学分期的微创方法。如今，SLNB是厚度超过1毫米黑色素瘤诊断方法的标准。SLNB的治疗相关性尚不清楚。肿瘤进展最常见的迹象是区域淋巴结受累。颈部转移患者的首选治疗方法是根治性、改良或选择性颈部清扫术。对于腋窝转移，切除腋窝淋巴结I-III级。对于腹股沟转移，通常首选浅表腹股沟清扫术。尚无随机对照试验比较腹股沟和盆腔淋巴结联合清扫术与浅表腹股沟淋巴结清扫术的结果。
