Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline - Update 2012
Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline - Update 2012
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DOI：
10.1016/j.ejca.2012.06.013
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发表时间：
2012-10-01
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（EDF），欧洲皮肤肿瘤学协会（EADO）和欧洲癌症研究和治疗组织（EORTC）的多学科专家组成了一个独特的合作，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。临床诊断和分期是基于AJCC系统。切掉CM时留有一到两厘米的安全余量。前哨淋巴结清扫术（SLND）是肿瘤厚度超过1 mm的患者的常规分期手术，尽管这种方法还没有明确的生存益处。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（DFS）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。BRAF抑制剂，如用于BRAF突变患者的vemurafenib以及CTLA-4抗体ipilimumab，除了常规化疗外，还提供了新的治疗机会。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)2012爱思唯尔有限公司出版
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 (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. Diagnosis is made clinically and staging is based upon the AJCC system. CMs are excised with one to two centimetre safety margins. Sentinel lymph node dissection (SLND) is routinely offered as a staging procedure in patients with tumours more than 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 (DFS) 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. BRAF inhibitors like vemurafenib for BRAF mutated patients as well as the CTLA-4 antibody ipilimumab offer new therapeutic opportunities apart from conventional chemotherapy. Therapeutic decisions in stage IV patients should be primarily made by an interdisciplinary oncology team ('tumour board'). (C) 2012 Published by Elsevier Ltd.