Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
Eur J Cancer. 2022 Jul;170:236-255. doi: 10.1016/j.ejca.2022.03.008. Epub 2022 May 12.
Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumor and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. The diagnosis of melanoma can be made clinically and shall always be confirmed with dermatoscopy. If a melanoma is suspected, a histopathological examination is always required. Sequential digital dermatoscopy and full body photography can be used in high-risk patients to improve the detection of early melanoma. Where available, confocal reflectance microscopy can also improve clinical diagnosis in special cases. Melanoma shall be classified according to the 8th version of the American Joint Committee on Cancer classification. Thin melanomas up to 0.8 mm tumor thickness do not require further imaging diagnostics. From stage IB onwards, examinations with lymph node sonography are recommended, but no further imaging examinations. From stage IIC onwards whole-body examinations with computed tomography (CT) or positron emission tomography CT (PET-CT) in combination with brain magnetic resonance imaging are recommended. From stage III and higher, mutation testing is recommended, particularly for BRAF V600 mutation. It is important to provide a structured follow-up to detect relapses and secondary primary melanomas as early as possible. There is no evidence to define the frequency and extent of examinations. A stage-based follow-up scheme is proposed which, according to the experience of the guideline group, covers the optimal requirements, but further studies may be considered. This guideline is valid until the end of 2024.
皮肤黑素瘤(CM)是最危险的皮肤肿瘤形式,导致 90%的皮肤癌死亡。来自欧洲皮肤病学会(EDF)、欧洲皮肤肿瘤学会(EADO)和欧洲癌症研究与治疗组织(EORTC)的多学科专家进行了独特的合作,根据系统文献回顾和专家经验,就 CM 的诊断和治疗提出建议。黑素瘤的诊断可以通过临床进行,并且应始终通过皮肤镜检查来确认。如果怀疑是黑色素瘤,则始终需要进行组织病理学检查。连续数字皮肤镜和全身摄影可用于高危患者,以提高早期黑色素瘤的检测率。在有条件的情况下,共聚焦反射显微镜也可以在特殊情况下改善临床诊断。黑素瘤应根据第 8 版美国癌症联合委员会分类进行分类。厚度不超过 0.8mm 的薄黑素瘤不需要进一步的成像诊断。从 IB 期开始,建议对淋巴结进行超声检查,但不需要进一步的成像检查。从 IIC 期开始,推荐全身 CT 或正电子发射断层 CT(PET-CT)检查,并结合脑磁共振成像。从 III 期及以上,建议进行突变检测,特别是 BRAF V600 突变。提供结构化的随访以尽早发现复发和继发性原发性黑色素瘤非常重要。目前没有证据可以确定检查的频率和范围。建议根据指南小组的经验提出一种基于分期的随访方案,该方案涵盖了最佳要求,但可能需要进一步研究。本指南有效期至 2024 年底。
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