Thompson John F, Scolyer Richard A, Kefford Richard F
Surgery (Melanoma and Surgical Oncology), University of Sydney, Melanoma Institute Australia and Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, New South Wales.
Aust Fam Physician. 2012 Jul;41(7):470-3.
The incidence of melanoma in Australia continues to rise. Early diagnosis and management before the melanoma has metastasised provides the best opportunity for a favourable outcome.
This article discusses the management of melanoma once a clinical diagnosis has been made.
If melanoma is suspected, initial excision biopsy is recommended. Wide excision margins are then based on reported tumour thickness. Sentinel lymph node biopsy provides important prognostic information and a probable survival benefit for patients with intermediate thickness melanomas. Other staging tests are not indicated in patients with clinically localised primary melanomas. Complete lymph node dissection is required if microscopic or macroscopic disease is present in regional nodes. Intransit metastases are best managed at specialist melanoma treatment centres. For patients with widespread systemic metastases, new drug treatments including BRAF inhibitors and anti-CTLA4 antibodies are prolonging survival, but unfortunately most patients ultimately relapse.
澳大利亚黑色素瘤的发病率持续上升。在黑色素瘤发生转移之前进行早期诊断和治疗，能为获得良好预后提供最佳机会。
本文讨论临床诊断黑色素瘤后的治疗方法。
如果怀疑是黑色素瘤，建议进行初次切除活检。然后根据报告的肿瘤厚度确定广泛切除边缘。前哨淋巴结活检可为中等厚度黑色素瘤患者提供重要的预后信息，并可能带来生存益处。对于临床局限性原发性黑色素瘤患者，不建议进行其他分期检查。如果区域淋巴结存在微小或肉眼可见的病变，则需要进行完整的淋巴结清扫。对于发生途中转移的患者，最好在专业的黑色素瘤治疗中心进行治疗。对于广泛发生全身转移的患者，包括BRAF抑制剂和抗CTLA4抗体在内的新药物治疗可延长生存期，但不幸的是，大多数患者最终会复发。
