Zuluaga-Sepúlveda María Alejandra, Arellano-Mendoza Ivonne, Ocampo-Candiani Jorge
Servicio de Dermatología, Hospital Universitario Dr. José E. González, Monterrey, Nuevo LeónMéxico.
Servicio de Dermatología, Hospital General de México Dr. Eduardo Liceaga, México D.F., México.
Cir Cir. 2016 Jan-Feb;84(1):77-84. doi: 10.1016/j.circir.2015.06.020. Epub 2015 Aug 12.
Melanoma is a common cutaneous tumour. It is of great importance due to its increasing incidence and aggressive behaviour, with metastasis to lymph nodes and internal organs. When suspecting melanoma, excisional biopsy should be performed to obtain complete histological information in order to determine the adverse factors such as ulceration, mitosis rate, and Breslow depth, which influence preoperative staging and provide data for sentinel lymph biopsy decision making. The indicated management for melanoma is wide local excision, observing recommended and well-established excision margins, depending on Breslow depth and anatomical location of the tumour. Therapeutic lymphadenectomy is recommended for patients with clinically or radiologically positive lymph nodes. This article reviews surgical treatment of melanoma, adverse histological factors, sentinel lymph node biopsy, and radical lymphadenectomy. Details are presented on special situations in which management of melanoma is different due to the anatomical location (plantar, subungual, lentigo maligna), or pregnancy.
黑色素瘤是一种常见的皮肤肿瘤。由于其发病率不断上升且具有侵袭性,可转移至淋巴结和内部器官,因此具有重要意义。怀疑有黑色素瘤时,应进行切除活检以获取完整的组织学信息,从而确定诸如溃疡、有丝分裂率和 Breslow 深度等不良因素,这些因素会影响术前分期并为前哨淋巴结活检决策提供数据。黑色素瘤的指定治疗方法是广泛局部切除,根据 Breslow 深度和肿瘤的解剖位置,遵循推荐的、既定的切除边缘。对于临床或影像学检查显示淋巴结阳性的患者,建议进行治疗性淋巴结清扫术。本文综述了黑色素瘤的手术治疗、不良组织学因素、前哨淋巴结活检和根治性淋巴结清扫术。详细介绍了因解剖位置(足底、甲下、恶性雀斑样痣)或妊娠而导致黑色素瘤治疗不同的特殊情况。