Fogarty Gerald B, Hong Angela, Economides Alex, Guitera Pascale
Melanoma Institute Australia, Poche Centre, Crows Nest, Australia.
Genesis Cancer Care, Mater Hospital, Crows Nest, Australia.
Dermatol Res Pract. 2018 Jul 15;2018:7439807. doi: 10.1155/2018/7439807. eCollection 2018.
Lentigo maligna (LM) is a form of melanoma in situ that occurs on exposed, sun-damaged skin; LM can progress to invasive melanoma. Conventional surgical treatment is the preferred management option as it is usually a one-treatment episode and generates a histopathology report that records completion of excision. Some patients may not be surgical candidates due to comorbidities, patient preference, impact on function, and cosmesis or they have failed surgery with a positive margin. Other therapies, including radiotherapy (RT) and topical medicines, may then become appropriate. There is a currently accruing multi-institutional randomized trial of imiquimod versus definitive RT for this population (NCT02394132). This review is about the experience from the centre that has generated the trial and enrolled the most patients to date. The purpose of the review is to pass on experience to other centers who may want to join the trial, especially to supplement the experience of local radiation oncologists. The review covers decisions that need to be made in RT planning and treatment and how to manage side effects and other common scenarios including LM in immunosuppressed patients and in poorly vascularised tissue, after surgery, of the eyelid and of mucous membrane (mouth and nose) that are in the radiation field.
恶性雀斑样痣（LM）是一种原位黑色素瘤，发生于暴露且受阳光损伤的皮肤；LM可进展为侵袭性黑色素瘤。传统手术治疗是首选的治疗方案，因为它通常只需一次治疗，并能生成一份记录切除完成情况的组织病理学报告。由于合并症、患者偏好、对功能和美容的影响，一些患者可能不适合手术，或者手术切缘阳性导致手术失败。此时，其他治疗方法，包括放射治疗（RT）和局部用药，可能就变得合适。目前正在进行一项针对该人群的咪喹莫特与根治性RT的多机构随机试验（NCT02394132）。本综述基于开展该试验并至今招募患者最多的中心的经验。综述的目的是将经验传授给可能想要加入该试验的其他中心，尤其是补充当地放射肿瘤学家的经验。综述涵盖了RT计划和治疗中需要做出的决策，以及如何处理副作用和其他常见情况，包括免疫抑制患者、血供较差组织、手术后、眼睑以及放射野内黏膜（口腔和鼻腔）部位的LM。
