Center for Dermatooncology, Department of Dermatology, 72076 Tübingen, Germany.
Eur J Cancer. 2010 Jan;46(2):270-83. doi: 10.1016/j.ejca.2009.10.032. Epub 2009 Dec 1.
Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumour and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. Diagnosis is made clinically and staging is based upon the AJCC system. CMs are excised with one to two centimetre safety margins. Sentinel lymph node dissection is routinely offered as a staging procedure in patients with tumours more than 1mm in thickness, although there is as yet no resultant survival benefit. Interferon-alpha treatment can be offered to patients with more than 1.5mm in thickness and stage II to III melanoma as an adjuvant therapy, as this treatment increases the relapse-free survival. The lack of a clear survival benefit and the presence of toxicity however limit its use in practice. In distant metastasis, all options of surgical therapy have to be considered thoroughly. In the absence of surgical options, systemic medical treatment is indicated, but with, to date, low response rates. Therapeutic decisions should be made by the melanoma team and the informed patient after full discussion of the options.
皮肤黑色素瘤（CM）是最危险的皮肤肿瘤形式，导致 90%的皮肤癌死亡。一个由欧洲皮肤病学会、欧洲皮肤病肿瘤学会和欧洲癌症研究与治疗组织的多学科专家组成的独特协作组织成立，根据系统文献回顾和专家经验，就 CM 的诊断和治疗提出建议。诊断是临床做出的，分期是基于 AJCC 系统。CM 用 1 到 2 厘米的安全边界切除。对于厚度超过 1 毫米的肿瘤，常规进行前哨淋巴结活检作为分期手术，尽管目前尚无生存获益。对于厚度超过 1.5 毫米和 II 期至 III 期黑色素瘤的患者，可以作为辅助治疗提供干扰素-α治疗，因为这种治疗可以增加无复发生存。然而，缺乏明确的生存获益和毒性的存在限制了其在实践中的应用。在远处转移的情况下，必须彻底考虑所有手术治疗的选择。在没有手术选择的情况下，建议采用全身药物治疗，但迄今为止，反应率较低。治疗决策应由黑色素瘤团队和知情患者在充分讨论各种选择后做出。
