NEW SURGICAL APPROACHES FOR THE MANAGEMENT OF MALIGNANT MELANOMA

该项目的主要目标是开发新的方法， 皮肤黑色素瘤外科治疗在这方面，一个主要的 关于早期淋巴结清扫是否能 临床阴性（不可触及的淋巴结提供任何治疗 与观察和后期解剖相比， 出现了临床上明显的淋巴结转移。因为只有20%的 患者将在选择性淋巴结转移时发现微转移 解剖，80%的此类患者将暴露于发病率， 他们无法从中获益的手术费用。 在这种情况下，淋巴映射和前哨淋巴结切除术（SLND）， 提出作为一种方法，病理分期区域淋巴结 不做选择性LND只有组织学证实 前哨淋巴结（NS）转移进行完全LND。因此，LND可以是 早期进行区域转移，可以完全避免 在没有区域参与的情况下，因此保留了那些无肿瘤的患者， SN根治性淋巴结清扫的发病率。这使得SLND成为一个理性的 替代常规选择性LND或淋巴结观察。研究 在世界各地的机构进行了验证， SN概念和SLND作为分期程序的准确性。 该提案的具体目标是继续研究 这些概念的发展，并确定这些技术是否提供 对黑色素瘤的生存有好处。 目标1-进行多中心试验，评估 术中淋巴结定位和选择性淋巴结切除术 临床I期黑色素瘤的管理。 目标2-通过以下方法提高前哨淋巴结识别的准确性 外科病理学技术的改进。 目标3-开发更灵敏和准确的方法， 患有系统性亚临床黑色素瘤微转移的患者，单独或 合并区域淋巴结转移。

The primary objective of this project is to develop new approaches to the surgical management of cutaneous melanoma. In this regard, a major controversy exists over whether early lymph node dissection in patients with clinically negative (non-palpable lymph nodes offers any therapeutic advantage over observation and later dissection when the patient has developed clinically obvious nodal metastases. Since only 20% of such patients will have micrometastases found at the time of elective node dissection, 80% of such patients will be exposed to the morbidity and expense of an operative procedure from which they can derive no benefit. In this context, lymphatic mapping and sentinel lymphadenectomy (SLND) was proposed as a method to pathologically stage the regional lymph nodes without performing elective LND. Only patients with histologically proven sentinel node (NS) metastasis undergo complete LND. Thus, LND can be undertaken earlier for regional metastasis, and can be avoided completely in the absence of regional involvement thus sparing those with tumor free SN the morbidity of radical node dissection. This makes SLND a rational alternative to routine elective LND or nodal observation. Studies performed at institutions across the world have verified the validity of the SN concept and accuracy of SLND as a staging procedure. The specific aims of the proposal are to continue research on the development of these concepts and determine whether the techniques provide a survival benefit for melanoma. Aim 1- Conduct a multi-center trial which evaluate the application for intraoperative lymphatic mapping and selective lymphadenectomy for the management of clinical stage I melanoma. Aim 2- Improve the accuracy of sentinel node identification by improvements in surgical pathology technology. Aim 3- Develop more sensitive and accurate methods for identifying patients with systematic subclinical melanoma micrometastases, alone or combined with regional nodal metastases.