Malignant melanoma - 恶性黑色素瘤
黑色素瘤大小约为 2.5厘米（1英寸）×1.5厘米（0.6英寸）
relevance score : -100.0%
References黑色素瘤是由黑色素细胞恶性增生形成的肿瘤。黑色素细胞起源于神经嵴，这意味着黑色素瘤不仅可以在皮肤上出现，还可在神经嵴来源的其他部位生长，如胃肠道和大脑。I 期黑色素瘤患者的五年生存率约为 97%，而 IV 期患者的五年生存率仅约为 10%。
A melanoma is a tumor produced by the malignant transformation of melanocytes. Melanocytes are derived from the neural crest; consequently, melanomas, although they usually occur on the skin, can arise in other locations where neural crest cells migrate, such as the gastrointestinal tract and brain. The five-year relative survival rate for patients with stage 0 melanoma is 97%, compared with about 10% for those with stage IV disease.
A melanoma is a tumor produced by the malignant transformation of melanocytes. Melanocytes are derived from the neural crest; consequently, melanomas, although they usually occur on the skin, can arise in other locations where neural crest cells migrate, such as the gastrointestinal tract and brain. The five-year relative survival rate for patients with stage 0 melanoma is 97%, compared with about 10% for those with stage IV disease.
Cutaneous melanoma (CM) 是一种高度危险的皮肤肿瘤，导致约 90% 的皮肤癌死亡。为了解决这个问题，European Dermatology Forum (EDF)、European Association of Dermato-Oncology (EADO) 和 European Organization for Research and Treatment of Cancer (EORTC) 的专家进行了合作。
Cutaneous melanoma (CM) is a highly dangerous type of skin tumor, responsible for 90% of skin cancer deaths. To address this, experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization for Research and Treatment of Cancer (EORTC) had collaborated.
Cutaneous melanoma (CM) is a highly dangerous type of skin tumor, responsible for 90% of skin cancer deaths. To address this, experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization for Research and Treatment of Cancer (EORTC) had collaborated.
黑色素瘤是一种皮肤癌，因其与免疫系统的密切关系而备受关注。免疫功能较弱的人群中黑色素瘤的发病率更高，原发肿瘤中常可见免疫细胞，且肿瘤可向身体其他部位转移；免疫系统还能识别黑色素瘤细胞中表达的某些蛋白质。由此可见，增强免疫系统的治疗在对抗黑色素瘤方面展现出希望。虽然免疫增强疗法用于晚期黑色素瘤仍属相对新颖的进展，但最新研究表明，将其与化疗、放疗或靶向分子治疗联合使用，可显著改善预后。然而，这类免疫疗法可能引发涉及多器官的免疫相关副作用，限制其使用。展望未来，治疗晚期黑色素瘤的策略可能包括针对特定免疫检查点（如PD1）的药物，或干扰特定分子通路（如BRAF和MEK）的治疗方案。
Melanoma is one of the most immunologic malignancies based on its higher prevalence in immune-compromised patients, the evidence of brisk lymphocytic infiltrates in both primary tumors and metastases, the documented recognition of melanoma antigens by tumor-infiltrating T lymphocytes and, most important, evidence that melanoma responds to immunotherapy. The use of immunotherapy in the treatment of metastatic melanoma is a relatively late discovery for this malignancy. Recent studies have shown a significantly higher success rate with combination of immunotherapy and chemotherapy, radiotherapy, or targeted molecular therapy. Immunotherapy is associated to a panel of dysimmune toxicities called immune-related adverse events that can affect one or more organs and may limit its use. Future directions in the treatment of metastatic melanoma include immunotherapy with anti-PD1 antibodies or targeted therapy with BRAF and MEK inhibitors.
Melanoma is one of the most immunologic malignancies based on its higher prevalence in immune-compromised patients, the evidence of brisk lymphocytic infiltrates in both primary tumors and metastases, the documented recognition of melanoma antigens by tumor-infiltrating T lymphocytes and, most important, evidence that melanoma responds to immunotherapy. The use of immunotherapy in the treatment of metastatic melanoma is a relatively late discovery for this malignancy. Recent studies have shown a significantly higher success rate with combination of immunotherapy and chemotherapy, radiotherapy, or targeted molecular therapy. Immunotherapy is associated to a panel of dysimmune toxicities called immune-related adverse events that can affect one or more organs and may limit its use. Future directions in the treatment of metastatic melanoma include immunotherapy with anti-PD1 antibodies or targeted therapy with BRAF and MEK inhibitors.
主要风险因素是皮肤色素较少（白人）的人长期暴露于紫外线，紫外线来源可为阳光或晒黑设备。痣较多、家族有黑色素瘤病史、免疫功能低下者的发病风险亦较高。
使用防晒霜并避免紫外线照射可降低黑色素瘤的发生风险。治疗通常采用手术切除。对于较大的肿瘤，可检查邻近淋巴结是否转移。若未出现转移，大多数患者可获得治愈。对于已转移的黑色素瘤，免疫疗法、生物疗法、放射疗法或化疗可提高生存率。在美国，局部疾病患者的五年生存率为 99%，疾病已扩散至淋巴结时的五年生存率为 65%，远处转移患者的五年生存率为 25%。
黑色素瘤是最危险的皮肤癌类型。澳大利亚和新西兰的发病率居世界首位，北欧和北美次之。亚洲、非洲和拉丁美洲的发病率则相对较低。美国男性的发病率约为女性的 1.6 倍。
○ 体征和症状
早期表现为已有痣的形状或颜色改变；结节性黑色素瘤则表现为皮肤上出现新生肿块。晚期时，痣可能出现瘙痒、溃疡或出血。
[A‑Asymmetry] 形状不对称
[B‑Borders] 边缘不规则
[C‑Color] 颜色杂乱不均
[D‑Diameter] 直径大于 6 毫米（约 0.24 英寸），相当于铅笔橡皮擦的大小
[E‑Evolving] 随时间变化
注：脂溢性角化病可能符合部分或全部 ABCD 标准，易导致误报。
早期黑色素瘤虽有转移可能，但相对罕见；在早期诊断的病例中，转移率不足 20%。转移性黑色素瘤常累及脑、肝、骨骼、腹部及远处淋巴结。
○ 诊断
对可疑区域进行检查是最常见的筛查方法。颜色或形状不规则的痣通常被视为黑色素瘤的候选。医生会检查所有痣，包括直径小于 6 毫米的痣。经训练的专家使用皮肤镜检查比单纯肉眼检查更有助于识别恶性病变。最终诊断需对有潜在癌变迹象的皮肤病变进行活检。
○ 治疗
#Mohs surgery
对于无法通过手术根治的 III 期或 IV 期黑色素瘤，医生可能会推荐免疫疗法。
#Ipilimumab [Yervoy]
#Pembrolizumab [Keytruda]
#Nivolumab [Opdivo]