Surgery and radiotherapy in the treatment of cutaneous melanoma.
Surgery and radiotherapy in the treatment of cutaneous melanoma.
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DOI：
10.1093/annonc/mdp257
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发表时间：
2009-08
期刊：
影响因子：
--
通讯作者：
Eggermont AM
中科院分区：
文献类型：
--
作者：
Testori A;Rutkowski P;Marsden J;Bastholt L;Chiarion-Sileni V;Hauschild A;Eggermont AM
对原发性黑色素瘤和区域淋巴结转移以及很少发生的远处转移进行充分的手术治疗是唯一确定的治疗方法。原发性黑色素瘤的手术治疗包括 1-2 厘米边缘切除和一期闭合。推荐的活检方法是切除活检，切缘2毫米，并有少量皮下脂肪。在特定情况下（非常大的病变或某些解剖区域），全层切开或穿孔活检可能是可以接受的。前哨淋巴结活检为临床上未受影响的区域淋巴结且无远处转移的患者提供了准确的分期信息，尽管生存益处尚未得到证实。如果前哨淋巴结活检呈阳性或临床检测到区域淋巴结转移（可触及、细胞学或组织病理学阳性），则需要根治性切除受累盆地的淋巴结。对于可切除的局部/途中复发，建议切除边缘清晰的肿瘤。对于大量或不可切除的四肢中途转移瘤，应考虑单独肢体灌注或输注美法仑。远处转移手术的决定应根据个人情况而定。放射治疗被认为是特定恶性雀斑样黑色素瘤患者的一种治疗选择，以及特定区域转移性疾病患者的辅助治疗。放射疗法也适用于姑息治疗，尤其是骨转移和脑转移。
Adequate surgical management of primary melanoma and regional lymph node metastasis, and rarely distant metastasis, is the only established curative treatment. Surgical management of primary melanomas consists of excisions with 1–2 cm margins and primary closure. The recommended method of biopsy is excisional biopsy with a 2 mm margin and a small amount of subcutaneous fat. In specific situations (very large lesions or certain anatomical areas), full-thickness incisional or punch biopsy may be acceptable. Sentinel lymph node biopsy provides accurate staging information for patients with clinically unaffected regional nodes and without distant metastases, although survival benefit has not been proved. In cases of positive sentinel node biopsy or clinically detected regional nodal metastases (palpable, positive cytology or histopathology), radical removal of lymph nodes of the involved basin is indicated. For resectable local/in-transit recurrences, excision with a clear margin is recommended. For numerous or unresectable in-transit metastases of the extremities, isolated limb perfusion or infusion with melphalan should be considered. Decisions about surgery of distant metastases should be based on individual circumstances. Radiotherapy is indicated as a treatment option in select patients with lentigo maligna melanoma and as an adjuvant in select patients with regional metastatic disease. Radiotherapy is also indicated for palliation, especially in bone and brain metastases.
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影响因子：
9
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