Pavlidis Efstathios T, Pavlidis Theodoros E
2Prodedeutic Department of Surgery, Hippocration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54642, Greece.
World J Clin Oncol. 2022 Oct 24;13(10):861-865. doi: 10.5306/wjco.v13.i10.861.
The incidence of cutaneous melanoma appears to be increasing worldwide and this is attributed to solar radiation exposure. Early diagnosis is a challenging task. Any clinically suspected lesion must be assessed by complete diagnostic excision biopsy (margins 1-2 mm); however, there are other biopsy techniques that are less commonly used. Melanomas are characterized by Breslow thickness as thin (< 1 mm), intermediate (1-4 mm) and thick (> 4 mm). This thickness determines their biological behavior, therapy, prognosis and survival. If the biopsy is positive, a wide local excision (margins 1-2 cm) is finally performed. However, metastasis to regional lymph nodes is the most accurate prognostic determinant. Therefore, sentinel lymph node biopsy (SLNB) for diagnosed melanoma plays a pivotal role in the management strategy. Complete lymph node clearance has undoubted advantages and is recommended in all cases of positive SLN biopsy. A PET-CT (positron emission tomography-computed tomography) scan is necessary for staging and follow-up after treatment. Novel targeted therapies and immunotherapies have shown improved outcomes in advanced cases.
皮肤黑色素瘤的发病率在全球范围内似乎呈上升趋势，这归因于太阳辐射暴露。早期诊断是一项具有挑战性的任务。任何临床疑似病变都必须通过完整的诊断性切除活检（切缘1 - 2毫米）进行评估；然而，还有其他一些较少使用的活检技术。黑色素瘤根据 Breslow 厚度分为薄型（<1毫米）、中间型（1 - 4毫米）和厚型（>4毫米）。这种厚度决定了它们的生物学行为、治疗方法、预后和生存率。如果活检呈阳性，最终要进行广泛局部切除（切缘1 - 2厘米）。然而，区域淋巴结转移是最准确的预后决定因素。因此，对于已确诊的黑色素瘤，前哨淋巴结活检（SLNB）在管理策略中起着关键作用。完全淋巴结清扫具有毋庸置疑的优势，在所有前哨淋巴结活检阳性的病例中均建议进行。治疗后分期和随访需要进行PET - CT（正电子发射断层扫描 - 计算机断层扫描）扫描。新型靶向治疗和免疫治疗在晚期病例中已显示出更好的疗效。
