Division of Surgical Oncology, Department of Surgery, University of Nebraska Medical Center, 986880 Nebraska Medical Center, Omaha, NE, 68198-6880, USA.
Curr Oncol Rep. 2022 Nov;24(11):1425-1432. doi: 10.1007/s11912-022-01289-x. Epub 2022 Jun 3.
To review and update surgeons about the evolving complexities in the surgical management of melanoma including lymph node staging and treatment.
Primary resection with adequate margins continues to be the standard of care for localized cutaneous melanoma. Sentinel lymph node biopsy is confirmed to be a powerful tool due to its prognostic value and informative guidance for adjuvant treatments and surveillance. Due to the lack of benefit in melanoma-specific survival and distant metastasis-free survival, completion lymph node dissection is not performed routinely after a positive sentinel lymph node biopsy. Neoadjuvant systemic treatment approaches for advanced loco-regional disease show promise in phase I and II clinical trial data, and phase III studies. The surgical management of cutaneous melanoma continues to evolve with further de-escalation of the extent of excision of primary melanomas and the management of lymph node disease.
回顾并更新外科医生在黑色素瘤手术管理方面的不断发展的复杂性，包括淋巴结分期和治疗。
对于局限性皮肤黑色素瘤，原发灶的充分切除仍然是标准的治疗方法。前哨淋巴结活检由于其预后价值和对辅助治疗及监测的信息指导，已被证实是一种强有力的工具。由于在黑色素瘤特异性生存和远处无转移生存方面没有获益，因此在阳性前哨淋巴结活检后不常规进行淋巴结清扫术。新辅助全身治疗方法治疗局部区域晚期疾病在 I 期和 II 期临床试验数据以及 III 期研究中显示出前景。随着原发性黑色素瘤切除范围的进一步缩小以及淋巴结疾病的处理，皮肤黑色素瘤的外科治疗仍在不断发展。
