Markovic Svetomir N, Erickson Lori A, Rao Ravi D, Weenig Roger H, Pockaj Barbara A, Bardia Aditya, Vachon Celine M, Schild Steven E, McWilliams Robert R, Hand Jennifer L, Laman Susan D, Kottschade Lisa A, Maples William J, Pittelkow Mark R, Pulido Jose S, Cameron J Douglas, Creagan Edward T
Division of Hematology, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Mayo Clin Proc. 2007 Apr;82(4):490-513. doi: 10.4065/82.4.490.
Critical to the clinical management of a patient with malignant melanoma is an understanding of its natural history. As with most malignant disorders, prognosis is highly dependent on the clinical stage (extent of tumor burden) at the time of diagnosis. The patient's clinical stage at diagnosis dictates selection of therapy. We review the state of the art in melanoma staging, prognosis, and therapy. Substantial progress has been made in this regard during the past 2 decades. This progress is primarily reflected in the development of sentinel lymph node biopsies as a means of reducing the morbidity associated with regional lymph node dissection, increased understanding of the role of neoangiogenesis in the natural history of melanoma and its potential as a treatment target, and emergence of innovative multimodal therapeutic strategies, resulting in significant objective response rates in a disease commonly believed to be drug resistant. Although much work remains to be done to improve the survival of patients with melanoma, clinically meaningful results seem within reach.
了解恶性黑色素瘤患者的自然病史对于其临床管理至关重要。与大多数恶性疾病一样，预后高度依赖于诊断时的临床分期（肿瘤负荷程度）。患者诊断时的临床分期决定了治疗方法的选择。我们回顾了黑色素瘤分期、预后和治疗方面的最新进展。在过去20年里，这方面取得了重大进展。这一进展主要体现在前哨淋巴结活检的发展，作为一种降低与区域淋巴结清扫相关发病率的手段；对新生血管生成在黑色素瘤自然病史中的作用及其作为治疗靶点的潜力有了更多了解；以及创新的多模式治疗策略的出现，在一种通常被认为对药物耐药的疾病中产生了显著的客观缓解率。尽管要提高黑色素瘤患者的生存率仍有许多工作要做，但临床上有意义的结果似乎指日可待。
