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
relevance score : -100.0%
References黑色素瘤是由黑色素细胞恶性转化形成的肿瘤。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生长，还可在神经嵴细胞分布的其他部位出现，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 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) 和 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浸润，并且肿瘤可向身体其他部位转移；此外，免疫系统能够识别黑色素瘤细胞表面的某些蛋白质。这些事实表明，免疫系统在黑色素瘤发生和进展中发挥重要作用。 重要的是，增强免疫系统的治疗已显示出对抗黑色素瘤的希望。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，免疫疗法可能引发一系列影响多器官的免疫相关副作用，限制了其使用范围。 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）的疗法，或干扰特定分子通路（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.
黑色素瘤的主要危险因素是皮肤色素较少（如白人）的人长期暴露于紫外线，紫外线来源可为阳光或日光浴设备。痣数量多、家族中有黑色素瘤史、免疫功能低下者的风险亦较高。
使用防晒霜并避免紫外线照射是预防黑色素瘤的有效措施。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已有转移（扩散）。若未转移，大多数患者可获得治愈。对于已转移的患者，免疫疗法、生物疗法、放射疗法或化疗可提升生存率。美国数据显示，局部疾病患者的五年生存率为 99%，转移至淋巴结者为 65%，远处转移者为 25%。
黑色素瘤是最具危险性的皮肤癌。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
早期黑色素瘤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的肿块。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（有棱角）
[C‑Color] 颜色不均匀或杂色
[D‑Diameter] 直径 >6 毫米（约 0.24 英寸，约等于铅笔橡皮擦的大小）
[E‑Evolving] 随时间变化
cf) 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，但相对少见；在早期诊断的病例中，转移率不足 20%。脑转移在转移性黑色素瘤患者中较常见，亦可扩散至肝脏、骨骼、腹部或远处淋巴结。
○ 诊断
对可疑区域的检查是怀疑黑色素瘤的首要方法。颜色或形状异常的痣通常被视为潜在黑色素瘤。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肉眼观察更有助于识别恶性病变。最终诊断需对可疑皮肤病变进行活检。
○ 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]