Kroon B B, Bergman W, Coebergh J W, Ruiter D J
Nederlands Kanker Instituut/Antoni van Leeuwenhoek ziekenhuis, afd. Chirurgie, Amsterdam.
Ned Tijdschr Geneeskd. 1997 Oct 18;141(42):2015-9.
The 'Guideline melanoma of the skin, second revised consensus' was published in March 1997. Some of the contents are cited: Over 1600 new melanomas are diagnosed in the Netherlands each year; by now the mean 5-year survival amounts to over 80%. In examination of a pigmented lesion a dermatoscope is a valuable tool. The recommended margin of the diagnostic excision was reduced from 5 mm to 2 mm of macroscopically normal skin round the lesion; the margins in definite excision are: 1 cm of normal skin for a Breslow thickness < or = 2 mm; 2 cm for a Breslow thickness > 2 and < or = 4 mm. A margin of at least 2 cm seems also justified for thicker melanomas. Elective (prophylactic) regional lymph node dissection is advised against. Sentinel node biopsy appears to be an attractive method to detect occult metastasis in regional nodes. In lymph node metastasis a (therapeutic) regional lymph node dissection should be performed. In case of inoperable tumourgrowth in an extremity regional isolated perfusion is indicated. Radiotherapy may be applied curatively (e.g. if surgery is not possible), palliatively (if desired in combination with hyperthermia) or postoperatively (if non-radical resection is suspected). Adjuvant systemic therapy in melanoma patients is still experimental; the earliest results of high doses of interferon alpha are encouraging. Atypical (dysplastic) naevi and congenital naevi are important risk factors for melanoma. No consensus was reached regarding prophylactic removal of all congenital naevi. Regarding the duration of the follow-up period, 5 years suffices in patients with a melanoma with a Breslow thickness < or = 1.5 mm (provided there are no histological signs of regression), while 10 years is required for melanomas with a Breslow thickness > 1.5 mm. The patient should be actively involved in the follow-up (inspection, palpation). Routine blood testing, roentgen examination or ultrasonography are considered to be useless. There are no indications that hormonal alterations during pregnancy or use of the pill stimulate the growth of micrometastases that may be present. Excessive exposure to ultraviolet rays is discouraged.
《皮肤黑色素瘤指南，第二次修订共识》于1997年3月发布。部分内容如下：荷兰每年有超过1600例新发黑色素瘤被诊断；目前5年平均生存率超过80%。在检查色素沉着病变时，皮肤镜是一种有价值的工具。诊断性切除推荐的切缘从病变周围肉眼可见正常皮肤的5毫米减少至2毫米；确定性切除的切缘为：Breslow厚度≤2毫米时，正常皮肤切缘为1厘米；Breslow厚度＞2毫米且≤4毫米时，切缘为2厘米。对于更厚的黑色素瘤，至少2厘米的切缘似乎也是合理的。不建议进行选择性（预防性）区域淋巴结清扫。前哨淋巴结活检似乎是检测区域淋巴结隐匿性转移的一种有吸引力的方法。出现淋巴结转移时，应进行（治疗性）区域淋巴结清扫。如果四肢出现无法手术切除的肿瘤生长，则应进行区域隔离灌注。放疗可用于根治性治疗（例如，如果无法进行手术）、姑息性治疗（如果希望与热疗联合使用）或术后治疗（如果怀疑切除不彻底）。黑色素瘤患者的辅助全身治疗仍处于试验阶段；高剂量α干扰素的初步结果令人鼓舞。非典型（发育异常）痣和先天性痣是黑色素瘤的重要危险因素。对于是否预防性切除所有先天性痣尚未达成共识。关于随访期的时长，Breslow厚度≤1.5毫米的黑色素瘤患者（前提是没有组织学消退迹象）随访5年就足够了，而Breslow厚度＞1.5毫米的黑色素瘤患者则需要随访10年。患者应积极参与随访（检查、触诊）。常规血液检查、X线检查或超声检查被认为是无用的。没有迹象表明怀孕期间的激素变化或服用避孕药会刺激可能存在的微转移灶生长。不鼓励过度暴露于紫外线。
