Odet te Regional Cancer Cent re, Toronto, ON.
Program in Evidence-Based Care, Hamilton, ON.
Curr Oncol. 2019 Aug;26(4):e541-e550. doi: 10.3747/co.26.4885. Epub 2019 Aug 1.
For patients who are diagnosed with early-stage cutaneous melanoma, the principal therapy is wide surgical excision of the primary tumour and assessment of lymph nodes. The purpose of the present guideline was to update the 2010 Cancer Care Ontario guideline on wide local excision margins and sentinel lymph node biopsy (slnb), including treatment of the positive sentinel node, for melanomas of the trunk, extremities, and head and neck.
Using Ovid, the medline and embase electronic databases were systematically searched for systematic reviews and primary literature evaluating narrow compared with wide excision margins and the use of slnb for melanoma of the truck and extremities and of the head and neck. Search timelines ran from 2010 through week 25 of 2017.
Four systematic reviews were chosen for inclusion in the evidence base. Where systematic reviews were available, the search of the primary literature was conducted starting from the end date of the search in the reviews. Where systematic reviews were absent, the search for primary literature ran from 2010 forward. Of 1213 primary studies identified, 8 met the inclusion criteria. Two randomized controlled trials were used to inform the recommendation on completion lymph node dissection.Key updated recommendations include:■ Wide local excision margins should be 2 cm for melanomas of the trunk, extremities, and head and neck that exceed 2 mm in depth.■ slnb should be offered to patients with melanomas of the trunk, extremities, and head and neck that exceed 0.8 mm in depth.■ Patients with sentinel node metastasis should be considered for nodal observation with ultrasonography rather than for completion lymph node dissection.
Recommendations for primary excision margins, sentinel lymph node biopsy, and completion lymph node dissection in patients with cutaneous melanoma have been updated based on the current literature.
对于诊断为早期皮肤黑色素瘤的患者，主要治疗方法是广泛切除原发肿瘤，并评估淋巴结。本指南的目的是更新 2010 年安大略省癌症护理指南中关于广泛局部切除边缘和前哨淋巴结活检（SLNB）的内容，包括处理阳性前哨淋巴结，适用于躯干、四肢和头颈部的黑色素瘤。
使用 Ovid，系统地在 Ovid 循证医学数据库、medline 和 embase 电子数据库中搜索评价与广泛切除边缘相比，窄切缘和 SLNB 用于躯干和四肢黑色素瘤和头颈部黑色素瘤的系统评价和原始文献。搜索时间线从 2010 年运行至 2017 年第 25 周。
选择了 4 项系统评价纳入证据基础。有系统评价的情况下，从综述的搜索结束日期开始进行原始文献的搜索。没有系统评价的情况下，从 2010 年开始进行原始文献的搜索。在确定的 1213 项原始研究中，有 8 项符合纳入标准。两项随机对照试验被用于提供关于完成淋巴结清扫术的建议。更新的关键推荐包括：
对于深度超过 2 毫米的躯干、四肢和头颈部黑色素瘤，广泛局部切除边缘应为 2 厘米。
对于深度超过 0.8 毫米的躯干、四肢和头颈部黑色素瘤，应向患者提供 SLNB。
对于前哨淋巴结转移的患者，应考虑使用超声进行淋巴结观察，而不是进行完成淋巴结清扫术。
根据现有文献，更新了躯干、四肢和头颈部皮肤黑色素瘤患者的主要切除边缘、前哨淋巴结活检和完成淋巴结清扫术的建议。
