Harris M N, Shapiro R L, Roses D F
Department of Surgery, New York University School of Medicine, New York, USA.
Cancer. 1995 Jan 15;75(2 Suppl):715-25. doi: 10.1002/1097-0142(19950115)75:2+<715::aid-cncr2820751416>3.0.co;2-y.
The diagnosis of malignant melanoma is based on clinical grounds and a properly performed biopsy, preferably excision, so that the type of melanoma and the thickness can be assessed by methods described by Clark and Breslow. These facilitate clinical and pathologic staging. Excisions with conservative margins for thin lesions (less than 1.0 mm in thickness) and more extensive margins for thicker lesions are appropriate. The issue of elective lymph node dissection is controversial. Most authors agree it is not indicated for lesions less than 1.0 mm thick and may offer little advantage for lesions greater than 4.0 mm thick. Several retrospective studies show a survival advantage in patients with "intermediate" thickness melanomas who may have occult nodal metastases. However, there are prospective randomized clinical trials supporting the concept that positive lymph nodes are a manifestations of systemic disease, and survival is equivalent in patients who have subsequent therapeutic lymph node dissections. A procedure using intraoperative lymphatic mapping and selective lymphadenectomy may identify those patients who are likely to benefit from lymphadenectomy.
恶性黑色素瘤的诊断基于临床依据和正确实施的活检，最好是切除活检，以便能通过克拉克（Clark）和布雷斯洛（Breslow）描述的方法评估黑色素瘤的类型和厚度。这些方法有助于临床和病理分期。对于薄病变（厚度小于1.0毫米）进行切缘保守的切除，对于厚病变进行更广泛切缘的切除是合适的。选择性淋巴结清扫问题存在争议。大多数作者认为，对于厚度小于1.0毫米的病变不建议进行淋巴结清扫，而对于厚度大于4.0毫米的病变，淋巴结清扫可能益处不大。几项回顾性研究表明，对于可能存在隐匿性淋巴结转移的“中等”厚度黑色素瘤患者，生存率有优势。然而，有前瞻性随机临床试验支持这样的观点，即阳性淋巴结是系统性疾病的表现，后续接受治疗性淋巴结清扫的患者生存率相当。一种使用术中淋巴管造影和选择性淋巴结切除术的方法可能会识别出那些可能从淋巴结切除术中获益的患者。
