Wollina Uwe
Department of Dermatology and Allergology, Municipal Hospital Dresden, Dresden, Germany.
Dermatol Ther. 2022 Dec;35(12):e15966. doi: 10.1111/dth.15966. Epub 2022 Nov 16.
Cutaneous melanoma is the major cause of mortality from all skin cancers. The treatment has been revolutionized in recent years by introduction of immunotherapy and targeted therapy for melanoma patients Stages III and IV. Therefore, the role of surgery in melanoma treatment needs to be redefined. In this narrative review, we will focus on surgery for diagnosis, treatment of primary tumor, and metastases in the era of new and effective medical treatment options. Neoadjuvant therapy is currently investigated in several trials. Surgery for treatment-resistant metastases is another field of interest. In conclusion, surgery remains a cornerstone for diagnosis and treatment of primary melanoma. Therapeutic lymphadenectomy has lost importance while surgery in sentinel lymph node diagnostics and metastasectomy are useful in a tailored individual approach of combined treatments. There is a trend to less invasive surgical procedures.
皮肤黑色素瘤是所有皮肤癌致死的主要原因。近年来，针对III期和IV期黑色素瘤患者引入免疫疗法和靶向疗法，使治疗发生了革命性变化。因此，手术在黑色素瘤治疗中的作用需要重新定义。在这篇叙述性综述中，我们将聚焦于在新的有效药物治疗选择时代，手术在诊断、原发性肿瘤治疗及转移灶治疗中的应用。目前多项试验正在研究新辅助治疗。针对治疗抵抗性转移灶的手术是另一个受关注的领域。总之，手术仍然是原发性黑色素瘤诊断和治疗的基石。治疗性淋巴结清扫术的重要性已降低，而前哨淋巴结诊断和转移灶切除术在个体化联合治疗方案中很有用。手术有向微创方向发展的趋势。
