Tchernev Georgi
Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria; Onkoderma, Private Clinic for Dermatologic Surgery, Sofia, Bulgaria.
Open Access Maced J Med Sci. 2017 Oct 14;5(6):810-812. doi: 10.3889/oamjms.2017.199. eCollection 2017 Oct 15.
For the first time, but again, we propose the idea of a one-step melanoma surgery as a "golden, unified standard" that should be at least discussed and, possibly accepted shortly as the "gold standard" for the treatment of patients with skin melanomas. Critical points or comments have been made to the current melanoma's treatment approach, which has been "transcendently followed" for years and which, according to some colleagues, is not logically justified. This approach needs serious changes, the only goal of which is to achieve a better outlook for the patients. Although the proposed by us approach is not even a possible option in the European and American recommendations for the treatment of melanoma, it finds widespread use (or acceptability) in clinical practice in the form of specific, individually informed consent. Guidelines are not mandatory, and standards are not always met. Whether "good medical practices" will prevail as a logic and stereotype of clinical behaviour, whether they will be finally recognised and whether they will find an extra international response is unclear at the moment. However, the fact that they are enforced with success, indirectly speaks that the "wave of change" is already rising and the hope is to "remove the debris" and illogically justified decisions often defined by the American dermatological school as "expert". The choice of right solutions lies in following the logic, as well as in its simplicity. Often these decisions are in front of our eyes, but we look at the distant horizons: "Do we want to be discoverers?" Without even trying to give a simple answer to the question: "Aren't the treasures very often in front of us?"
我们再次首次提出将一步式黑色素瘤手术作为“黄金统一标准”的理念,这一标准至少应得到讨论,并可能很快被接受为皮肤黑色素瘤患者治疗的“金标准”。有人对目前黑色素瘤的治疗方法提出了关键点或评论,这种方法多年来一直被“盲目遵循”,而且据一些同事说,在逻辑上是不合理的。这种方法需要重大改变,其唯一目标是为患者带来更好的前景。尽管我们提出的方法在欧美黑色素瘤治疗建议中甚至都不是一个可行的选择,但它在临床实践中以特定的、个体化的知情同意书的形式得到了广泛应用(或可接受性)。指南并非强制性的,标准也并非总能得到满足。目前尚不清楚“良好医疗实践”是否会作为临床行为的逻辑和刻板模式盛行,是否最终会得到认可,以及是否会得到额外的国际回应。然而,它们成功实施这一事实间接表明“变革浪潮”已经涌起,希望是“清除残渣”以及那些常被美国皮肤科流派定义为“专家”的不合逻辑且不合理的决策。正确解决方案的选择在于遵循逻辑以及其简单性。这些决策往往就在我们眼前,但我们却看向遥远的地平线:“我们想成为发现者吗?”甚至都没有试着简单回答这个问题:“宝藏不常常就在我们眼前吗?”