The European approach to in-transit melanoma lesions
The European approach to in-transit melanoma lesions
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DOI：
10.1080/02656730701816402
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发表时间：
2008-05-01
影响因子：
3.1
通讯作者：
Hoekstra, H. J.
中科院分区：
文献类型：
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作者：
Hoekstra, H. J.
黑色素瘤的生物学行为是不可预测的。百分之三到百分之五的黑色素瘤患者会出现转移性病变，复发的中位时间在 13 到 16 个月之间。复发时，隐匿性淋巴结转移（临床区域淋巴结阴性）的风险高达 50%。途中病变的风险取决于肿瘤生物学，而不取决于区域淋巴结的手术方法。下肢中途病变的高发可能是由于重力和淋巴引流延迟造成的。有限病变的治疗方法是局部切除、激光消融、冷冻手术，而位于肢体的多个转移性病变或大块病变可以通过局部化疗、治疗性孤立肢体灌注或输注美法仑或美法仑和肿瘤坏死因子（TNF）α的组合来成功治疗。如果局部区域治疗或基于达卡巴嗪的全身治疗失败，目前正在研究疫苗、抗体和基因治疗的新型全身治疗策略。
The biological behavior of melanoma is unpredictable. Three to five per cent of melanoma patients will develop in-transit lesions and the median time to recurrence ranges between 13-16 months. At the time of recurrence the risk of occult nodal metastasis, with clinically negative regional lymph nodes, is as high as 50%. The risk of in-transit lesions depends on the tumor biology and not on the surgical approach to the regional lymph nodes. The high incidence of in-transit lesions at the lower limb may be caused by the gravity and delayed lymphatic drainage. The treatment of limited disease is local excision, laser ablation, cryosurgery, while multiple in-transit lesions or bulky disease located in a limb can be successfully treated with regional chemotherapy, a therapeutic isolated limb perfusion or infusion with melphalan or a combination of melphalan and tumor necrosis factor (TNF) alpha. If local regional treatment or systemic dacarbazine based systemic treatment fails, novel systemic treatment strategies with vaccines, antibodies and gene therapy are currently investigated.