Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline - Update 2012
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- 作者：Claus Garbe ; Ketty Peris ; Axel Hauschild ; Philippe Saiag ; Mark Middleton ; Alan Spatz ; Jean-Jacques Grob ; Josep Malvehy ; Julia Newton-Bishop ; Alex ; er Stratigos ; Hubert Pehamberger ; Alex ; er M. Eggermont
- 关键词：Cutaneous melanoma ; Tumour thickness ; Excisional margins ; Sentinel lymph node dissection ; Interferon-¦Á ; Adjuvant treatment ; Metastasectomy ; Systemic treatment
- 刊名：European Journal of Cancer
- 出版年：2012
- 出版时间：October, 2012
- 年：2012
- 卷：48
- 期：15
- 页码：2375-2390
- 全文大小：286 K
文摘
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-¦Á 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¡¯).