Adam Y G, Efron G
Surgery. 1983 Apr;93(4):481-94.
Reliable cancer statistics reveal an unexplained increase in the incidence and rate of death from melanoma. Increased exposure to ultraviolet light does not seem to be a factor. Hormones may affect the incidence but do not influence survival. The recognition of the biologic evolution of different types of melanomas and the prognostic value of microstaging has had a major impact on the surgical management of cutaneous melanomas. Currently adequate excision is the only available curative treatment for melanoma and is most effective if performed on an early lesion. The extent of the excision should depend on the level of invasion and the bulk and location of the lesion. When clinically involved, dissection of the regional lymph nodes should be performed. The value of prophylactic node dissection of clinically uninvolved regional lymph nodes is unknown. Because of the low probability of regional lymph node involvement in thin lesions (less than 0.75 mm), prophylactic node dissection is not warranted. In contrast, there is a much higher incidence of spread to the regional lymph nodes reported in melanomas found to be thicker than 0.75 mm by microstaging. Prophylactic node dissection is probably worthwhile for these patients. Improved prospective randomized studies are needed to evaluate and determine the effectiveness of the various treatments that are being recommended.
可靠的癌症统计数据显示，黑色素瘤的发病率和死亡率出现了不明原因的上升。紫外线暴露增加似乎并非一个因素。激素可能会影响发病率，但不影响生存率。对不同类型黑色素瘤生物学演变的认识以及微分期的预后价值，对皮肤黑色素瘤的外科治疗产生了重大影响。目前，充分切除是黑色素瘤唯一可用的治愈性治疗方法，若在早期病变时进行则最为有效。切除范围应取决于浸润深度、病变的大小和位置。当临床上有累及情况时，应进行区域淋巴结清扫。对临床上未累及的区域淋巴结进行预防性清扫的价值尚不清楚。由于薄病变（小于0.75毫米）区域淋巴结受累的可能性较低，因此不建议进行预防性淋巴结清扫。相比之下，通过微分期发现厚度超过0.75毫米的黑色素瘤，其区域淋巴结转移的发生率要高得多。对这些患者来说，预防性淋巴结清扫可能是值得的。需要改进前瞻性随机研究，以评估和确定所推荐的各种治疗方法的有效性。
