Urist M M
Department of Surgery, University of Alabama at Birmingham 35294, USA.
Annu Rev Med. 1996;47:211-7. doi: 10.1146/annurev.med.47.1.211.
It is important to understand the management of patients with melanoma because of a rising incidence of this cancer in the United States. The most important prognostic factor is tumor thickness. Patients with early melanoma (thickness < 1.0 mm) have an excellent prognosis and are effectively treated with narrow local excision (1-cm radius). Those with advanced melanomas (tumor thickness > 4.0 mm) have a high risk of metastases and are treated with a wider local excision (2-3 cm). Controversies surrounding the management of patients with intermediate-thickness melanoma (thickness 1-4 mm) center on the issues of local excision and management of regional lymph nodes. Randomized trials have shown that a 2-cm radius of excision will minimize the risk for local recurrence. Although retrospective analyses have indicated a survival advantage for elective regional lymph node dissection, two randomized trials have not shown a benefit for the early removal of lymph nodes. Two more randomized trials are in progress. Techniques are now available to identify the sentinel lymph node, which will help to limit lymph node dissections to those patients with nodal metastases. Postoperative surveillance for recurrence is most effectively performed with a combination of patient self-examination and regular physician examinations rather than frequent X-rays and laboratory tests. Adjuvant therapy has not been proven effective for melanoma patients; however, many investigational trials are available.
由于美国黑色素瘤的发病率不断上升，了解黑色素瘤患者的治疗方法很重要。最重要的预后因素是肿瘤厚度。早期黑色素瘤（厚度<1.0毫米）患者预后良好，通过局部窄切除（半径1厘米）可有效治疗。晚期黑色素瘤（肿瘤厚度>4.0毫米）患者转移风险高，需进行更广泛的局部切除（2 - 3厘米）。围绕中度厚度黑色素瘤（厚度1 - 4毫米）患者治疗的争议集中在局部切除和区域淋巴结处理问题上。随机试验表明，2厘米半径的切除可将局部复发风险降至最低。尽管回顾性分析表明选择性区域淋巴结清扫有生存优势，但两项随机试验并未显示早期切除淋巴结有好处。另外两项随机试验正在进行中。现在有技术可识别前哨淋巴结，这将有助于将淋巴结清扫限制在有淋巴结转移的患者中。术后复发监测最有效的方法是患者自我检查和医生定期检查相结合，而不是频繁进行X光检查和实验室检查。辅助治疗尚未被证明对黑色素瘤患者有效；然而，有许多试验性研究。
