Karakousis C P
Division of Surgical Oncology, Millard Fillmore Hospital, State University of New York at Buffalo, USA.
Surg Clin North Am. 1996 Dec;76(6):1299-312. doi: 10.1016/s0039-6109(05)70516-8.
The surgical treatment of the primary melanoma site has been made more rational through correlations of rates of local control with various margins of resection in the context of the dominant prognostic indicator for localized melanoma, the thickness of the primary lesion. It is now known that for lesions less than 1 mm in thickness, a 1-cm margin is satisfactory. For lesions 1 to 4 mm thick, a 2-cm margin is adequate according to the results of a multi-institutional, randomized, surgical trial. Lesions thicker than 4 mm should be treated with a margin larger than 2 cm where the anatomy permits, although the main concern for these lesions is their high propensity for distant dissemination. Elective dissection has not been shown to alter survival significantly in prospective randomized trials. Surgical treatment of distant metastases is indicated for the palliation of a symptomatic lesion, for example, solitary brain metastasis or gastrointestinal metastases.
通过将局部控制率与各种切除边缘相关联，在原发性黑色素瘤的主要预后指标——原发性病变厚度的背景下，原发性黑色素瘤部位的手术治疗变得更加合理。现在已知，对于厚度小于1mm的病变，1cm的边缘是令人满意的。根据一项多机构、随机、外科试验的结果，对于厚度为1至4mm的病变，2cm的边缘是足够的。对于厚度超过4mm的病变，在解剖结构允许的情况下应采用大于2cm的边缘进行治疗，尽管这些病变主要关注的是其远处转移的高倾向。在前瞻性随机试验中，选择性清扫尚未显示能显著改变生存率。远处转移的手术治疗适用于缓解有症状的病变，例如孤立性脑转移或胃肠道转移。
