Malignant melanoma - 恶性黑色素瘤
约 2.5 厘米（1 英寸）× 1.5 厘米（0.6 英寸）的黑色素瘤
References
黑色素瘤是黑色素细胞恶性时形成的一种肿瘤。黑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生长，还可以在神经嵴细胞传播的其他地方生长，例如胃肠道和大脑。 0 期黑色素瘤患者的五年生存率为 97%，而 IV 期黑色素瘤患者的五年生存率仅为 10% 左右。
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 90% 的皮肤癌死亡。为了解决这个问题， the European Dermatology Forum (EDF) , the European Association of Dermato-Oncology (EADO) , and the 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引人注目。从免疫系统较弱的人中黑色素瘤的发生率增加、原始肿瘤中免疫细胞的存在及其向身体其他部位的扩散，以及免疫系统可以识别黑色素瘤细胞中发现的某些蛋白质的事实来看，这一点是显而易见的。重要的是，增强免疫系统的治疗在对抗黑色素瘤方面已显示出希望。虽然使用免疫增强疗法治疗晚期黑色素瘤是一个相对较新的发展，但最近的研究表明，将这些疗法与化疗、放疗或靶向分子治疗相结合可以显着改善预后。然而，这种免疫疗法会引发一系列影响多种器官的免疫相关副作用，这可能会限制其使用。展望未来，治疗晚期黑色素瘤的未来方法可能涉及针对特定免疫检查点（如 PD1）的疗法，或干扰特定分子途径（如 BRAF 和 MEK）的药物。
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.
黑色素瘤的主要原因是皮肤黑色素水平低的人（白人）暴露于紫外线。紫外线可能来自太阳或晒黑设备。痣较多、家庭成员有黑色素瘤病史、免疫功能较差的人患黑色素瘤的风险较高。
使用防晒霜并避免紫外线可以预防黑色素瘤。治疗通常是通过手术切除。对于癌症稍大的患者，可以测试附近的淋巴结是否有扩散（转移）。如果没有发生转移，大多数人都会被治愈。对于黑色素瘤已扩散的患者，免疫疗法、生物疗法、放射疗法或化疗可以提高生存率。在美国，通过治疗，局部疾病患者的五年生存率为 99%，疾病已扩散到淋巴结时的五年生存率为 65%，远处扩散的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黑色素瘤发病率是世界上最高的。北欧和北美的黑色素瘤发病率也很高。黑色素瘤在亚洲、非洲和拉丁美洲的发病率要低得多。在美国，男性黑色素瘤的发病率是女性的 1.6 倍。
○ 体征和症状
黑色素瘤的早期症状是现有痣的形状或颜色发生变化。对于结节性黑色素瘤，它是皮肤上出现新的肿块。在黑色素瘤的后期，痣可能会发痒、溃疡或出血。
[A-Asymmetry] 形状不对称
[B-Borders] 边框（有棱角不规则）
[C-Color] 颜色（杂色和不规则）
[D-Diameter] 直径（大于6毫米=0.24英寸=大约是铅笔橡皮擦的大小）
[E-Evolving] 随着时间的推移而发展
cf) 脂溢性角化病可能符合部分或全部 ABCD 标准，并可能导致误报。
早期黑色素瘤有可能发生转移，但相对罕见；早期诊断的黑色素瘤中不到五分之一会发生转移。脑转移在转移性黑色素瘤患者中很常见。转移性黑色素瘤也可以扩散到肝脏、骨骼、腹部或远处淋巴结。
○ 诊断
查看相关区域是怀疑黑色素瘤的最常见方法。颜色或形状不规则的痣通常被视为黑色素瘤的候选者。
医生通常会检查所有痣，包括直径小于 6 毫米的痣。当由训练有素的专家使用时，皮肤镜检查比单独使用肉眼更有助于识别恶性病变。诊断是通过对任何有潜在癌变迹象的皮肤病变进行活检来进行的。
○ 治疗
#Mohs surgery
您的医生可能会建议免疫疗法，特别是如果您患有无法通过手术切除的 3 期或 4 期黑色素瘤。
#Ipilimumab [Yervoy]
#Pembrolizumab [Keytruda]
#Nivolumab [Opdivo]