Division of Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine,- Jacksonville 653-1 West 8th, Street, Jacksonville, FL 32209, USA.
Division of Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine,- Jacksonville 653-1 West 8th, Street, Jacksonville, FL 32209, USA.
Oral Maxillofac Surg Clin North Am. 2022 May;34(2):221-234. doi: 10.1016/j.coms.2021.12.001.
The rates of melanoma continue to rise, with recent estimates have shown that 18% to 22% of new melanoma cases occur within the head and neck in the United States each year. The mainstay of treatment of nonmetastatic primary melanomas of the head and neck includes the surgical resection and management of regional disease as indicated. Thorough knowledge of the classification and staging of melanoma is paramount to evaluate prognosis, determine the appropriate surgical intervention, and assess eligibility for adjuvant therapy and clinic trials. The traditional clinicopathologic classification of melanoma is based on morphologic aspects of the growth phase and distinguishes 4 of the most common subtypes as defined by the World Health Organization: superficial spreading, nodular, acral lentiginous, and lentigo maligna melanoma. The data used to derive the AJCC TNM Categories are based on superficial spreading melanoma and nodular subtypes. Melanoma is diagnosed histopathologically following initial biopsy that will assist with classifying the tumor to guide treatment. Classification is based on tumor thickness and ulceration (T stage, Breslow Staging), Regional Lymph Node Involvement (N Stage), and presence of metastasis (M Stage). Tumor thickness (Breslow thickness) and ulceration are 2 independent prognostic factors that have been shown to be the strongest predictors of survival and outcome. Clark level of invasion and mitotic rate are no longer incorporated into the current AJCC staging system, but still have shown to be important prognostic factors for cutaneous melanoma. For patients with metastatic (Stage IV) disease Lactate Dehydrogenase remains an independent predictor of survival. The Maxillofacial surgeon must remain up to date on the most current management strategies in this patient population. Classification systems and staging provide the foundation for clinical decision making and prognostication for the Maxillofacial surgeon when caring for these patients.
黑素瘤的发病率持续上升，最近的估计显示，每年美国有 18%至 22%的新黑素瘤病例发生在头颈部。头颈部非转移性原发性黑素瘤的主要治疗方法包括手术切除和根据需要治疗局部疾病。彻底了解黑素瘤的分类和分期对于评估预后、确定适当的手术干预以及评估辅助治疗和临床试验的资格至关重要。黑素瘤的传统临床病理分类基于生长阶段的形态学方面，将最常见的 4 种亚型按世界卫生组织的定义区分开来：浅表扩散型、结节型、肢端雀斑样黑素瘤和黏膜恶性雀斑样黑素瘤。用于推导 AJCC TNM 类别的数据基于浅表扩散型和结节型。在初始活检后，通过组织病理学诊断黑素瘤，这将有助于对肿瘤进行分类，以指导治疗。分类基于肿瘤厚度和溃疡（T 分期、Breslow 分期）、区域淋巴结受累（N 分期）和转移（M 分期）。肿瘤厚度（Breslow 厚度）和溃疡是 2 个独立的预后因素，已被证明是生存和预后的最强预测因素。Clark 浸润深度和有丝分裂率不再纳入当前的 AJCC 分期系统，但仍被证明是皮肤黑素瘤的重要预后因素。对于转移性（IV 期）疾病患者，乳酸脱氢酶仍然是生存的独立预测因素。颌面外科医生必须了解该患者群体中最新的治疗策略。分类系统和分期为颌面外科医生在治疗这些患者时提供了临床决策和预后的基础。
