Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline - Update 2016
Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline - Update 2016
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DOI：
10.1016/j.ejca.2016.05.005
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发表时间：
2016-08-01
影响因子：
8.4
通讯作者：
Eggermont, Alexander M.
中科院分区：
文献类型：
--
作者：
Garbe, Claus;Peris, Ketty;Eggermont, Alexander M.
皮肤黑色素瘤（CM）是潜在的最危险的皮肤肿瘤形式，导致90%的皮肤癌死亡率。来自欧洲皮肤病学论坛、欧洲皮肤肿瘤学协会和欧洲癌症研究和治疗组织的多学科专家组成了一个独特的合作小组，根据系统的文献综述和专家的经验，对CM的诊断和治疗提出建议。诊断是临床使用皮肤镜和分期是基于AJCC系统。CM切除时留有1-2 cm的安全裕度。前哨淋巴结清扫术通常作为肿瘤厚度>1 mm患者的分期手术，尽管该方法尚未明确生存益处。干扰素-α治疗可以作为辅助治疗提供给患有II期和III期黑素瘤的患者，因为这种治疗至少增加了无病生存期，并且不太清楚总生存期（OS）时间。然而，该治疗与显著的毒性相关。在远处转移中，必须彻底考虑所有手术治疗方案。在没有手术选择的情况下，需要进行全身治疗。对于一线治疗，特别是BRAF野生型患者，应考虑单独使用PD-1抗体或与CTLA-4抗体联合使用的免疫治疗。BRAF抑制剂如达拉非尼和维罗非尼与MEK抑制剂曲美替尼和考比替尼联合用于BRAF突变患者应作为一线或二线治疗提供。IV期患者的治疗决定应主要由跨学科肿瘤学团队（“肿瘤委员会”）做出。(C)2016爱思唯尔有限公司版权所有
Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumour and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organisation of Research and Treatment of Cancer was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. Diagnosis is made clinically using dermoscopy and staging is based upon the AJCC system. CMs are excised with 1-2 cm safety margins. Sentinel lymph node dissection is routinely offered as a staging procedure in patients with tumours >1 mm in thickness, although there is as yet no clear survival benefit for this approach. Interferon-alpha treatment may be offered to patients with stage II and III melanoma as an adjuvant therapy, as this treatment increases at least the disease-free survival and less clear the overall survival (OS) time. The treatment is however associated with significant toxicity. In distant metastasis, all options of surgical therapy have to be considered thoroughly. In the absence of surgical options, systemic treatment is indicated. For first-line treatment particularly in BRAF wildtype patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies should be considered. BRAF inhibitors like dabrafenib and vemurafenib in combination with the MEK inhibitors trametinib and cobimetinib for BRAF mutated patients should be offered as first or second line treatment. Therapeutic decisions in stage IV patients should be primarily made by an interdisciplinary oncology team ('Tumour Board'). (C) 2016 Elsevier Ltd. All rights reserved.