Garbe Claus, Hauschild Axel, Volkenandt Matthias, Schadendorf Dirk, Stolz Wilhelm, Reinhold Uwe, Kortmann Rolf-Dieter, Kettelhack Christoph, Frerich Bernhard, Keilholz Ulrich, Dummer Reinhard, Sebastian Günther, Tilgen Wolfgang, Schuler Gerold, Mackensen Andreas, Kaufmann Roland
University Department of Dermatology, Tübingen, Germany.
Melanoma Res. 2007 Dec;17(6):393-9. doi: 10.1097/CMR.0b013e3282f05039.
Melanoma is a malignant tumor that arises from melanocytic cells and primarily involves the skin. The most important exogenous etiological factor is exposure to ultraviolet irradiation. Diagnosis of melanoma is based primarily on its clinical features, and the A-B-C-D rule is useful in identifying pigmented lesions, which are suspicious for melanoma (Asymmetry, Border irregular, Color inhomogeneous and Diameter more than 5 mm). Dermoscopy is very helpful in clarifying the differential diagnosis of pigmented lesions. About 90% of melanomas are diagnosed as primary tumors without any evidence for metastasis. The tumor-specific 10-year survival for all such tumors is about 75-85%. The most important prognostic factors for primary melanoma without metastases are vertical tumor thickness (Breslow depth) as measured on the histological specimen, presence of histopathologically recognized ulceration, invasion level (Clark level) and identification of micrometastases in the regional lymph nodes via sentinel lymph node biopsy. The current tumor node metastasis classification for the staging of primary melanoma is based on these factors. Melanomas can metastasize either by the lymphatic or by the hematogenous route. About two-thirds of metastases are originally confined to the drainage area of regional lymph nodes. A regional metastasis can appear as satellite metastases up to 2 cm from the primary tumor, as intransit metastases in the skin between the site of the primary tumor and the first lymph node and as regional lymph node metastases. In the stage of regional metastasis, the differentiation between micrometastasis and macrometastasis and the number of lymph nodes involved are crucial. As soon as distant metastasis develops, prognosis depends on the site of the metastasis and on the lactate dehydrogenase levels in the blood. The frequency and extent of follow-up examinations is based on the initial tumor parameters. In thin primary melanomas up to 1-mm tumor thickness, clinical examinations at 6-month intervals are sufficient and in thicker primary melanomas, at 3-month intervals. Lymph node sonography as well as determination of the tumor marker protein S100beta are recommended. Additionally, in the stage of regional metastasis, whole body imaging should be performed every 6 months; in the stage of distant metastasis, surveillance has to be scheduled individually.
黑色素瘤是一种起源于黑素细胞且主要累及皮肤的恶性肿瘤。最重要的外源性病因是暴露于紫外线辐射。黑色素瘤的诊断主要基于其临床特征，A-B-C-D法则有助于识别可疑为黑色素瘤的色素沉着病变（不对称、边界不规则、颜色不均匀和直径大于5毫米）。皮肤镜检查对明确色素沉着病变的鉴别诊断非常有帮助。约90%的黑色素瘤被诊断为原发性肿瘤，无任何转移证据。所有此类肿瘤的10年肿瘤特异性生存率约为75-85%。无转移的原发性黑色素瘤最重要的预后因素是组织学标本上测量的肿瘤垂直厚度（ Breslow深度）、组织病理学认可的溃疡的存在、浸润水平（Clark水平）以及通过前哨淋巴结活检确定区域淋巴结中的微转移。目前用于原发性黑色素瘤分期的肿瘤淋巴结转移分类基于这些因素。黑色素瘤可通过淋巴或血行途径转移。约三分之二的转移最初局限于区域淋巴结的引流区域。区域转移可表现为距原发性肿瘤2厘米以内的卫星转移、原发性肿瘤部位与第一淋巴结之间皮肤中的移行转移以及区域淋巴结转移。在区域转移阶段，微转移和大转移的区分以及受累淋巴结的数量至关重要。一旦发生远处转移，预后取决于转移部位和血液中的乳酸脱氢酶水平。随访检查的频率和范围基于初始肿瘤参数。对于肿瘤厚度达1毫米的薄原发性黑色素瘤，每6个月进行一次临床检查就足够了，对于较厚的原发性黑色素瘤，则每3个月进行一次。建议进行淋巴结超声检查以及肿瘤标志物蛋白S100β的测定。此外，在区域转移阶段，应每6个月进行一次全身成像；在远处转移阶段，监测必须单独安排。
