Goldman L I
Surg Gynecol Obstet. 1978 May;146(5):779-82.
This review of 117 melanomas occurring in 115 patients treated by a single surgeon suggests the appropriateness of the therapeutic decisions to be mentioned based upon tumor behavior, determined by microstaging. Local control of level II lentigo maligna melanoma was achieved, in most instances, by local excision with visibly free margins and primary closure. In most of the other instances of melanoma, adequate local control was accomplished by wide three-dimensional excision, 5 centimeter margins--closure usually required grafting. Minor amputation was performed with satisfactory results in those patients with appropriate lesions in the volar-subungual area. Regional lymphadenectomy in patients with level IV and V disease in whom the tumors drained to a single node basin revealed occult metastases in 25 per cent of the patients and, therefore, appears warranted as prophylactic treatment. Preliminary data on recurrences suggest that the frequency of the recurrence paralleled the biologic aggressiveness of the tumor, determined by microstaging in association with the presence or the absence of lymph node metastases.
对由一位外科医生治疗的115例患者中发生的117例黑色素瘤进行的这项回顾表明，基于由微分期确定的肿瘤行为，所提及的治疗决策是恰当的。在大多数情况下，通过可见切缘阴性的局部切除和一期缝合实现了Ⅱ级恶性雀斑样痣黑色素瘤的局部控制。在大多数其他黑色素瘤病例中，通过5厘米切缘的广泛三维切除实现了充分的局部控制——通常需要植皮来闭合伤口。对于掌侧甲下区域有合适病变的患者，进行了小截肢，结果令人满意。对肿瘤引流至单个淋巴结区域的Ⅳ级和Ⅴ级疾病患者进行区域淋巴结清扫，发现25%的患者有隐匿性转移，因此，作为预防性治疗似乎是必要的。关于复发的初步数据表明，复发频率与由微分期以及有无淋巴结转移所确定的肿瘤生物学侵袭性平行。
