Malignant melanoma - 惡性黑色素瘤
約 2.5 公分（1 吋）× 1.5 公分（0.6 吋）大小的黑色素瘤
relevance score : -100.0%
References黑色素瘤是由惡性黑色素細胞形成的腫瘤。黑色素細胞起源於神經嵴。因此，黑色素瘤不僅可在皮膚上發展，亦可在神經嵴細胞分布的其他部位出現，如胃腸道和大腦。0期黑色素瘤患者的五年存活率為 97%，而 IV 期則約為 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) 是一種高度危險的皮膚腫瘤，導致 90% 的皮膚癌死亡。為了解決這個問題，European Dermatology Forum (EDF)、European Association of Dermato‑Oncology (EADO) 以及 European Organization for Research and Treatment of Cancer (EORTC) 的專家進行了合作。
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.
黑色素瘤是一種皮膚癌，因與免疫系統的密切關係而備受關注。免疫功能較弱者罹患黑色素瘤的機率較高；原發腫瘤中常可見免疫細胞，且這些細胞可隨腫瘤擴散至全身；此外，免疫系統能辨識黑色素瘤細胞表面的特定蛋白質。這些事實顯示免疫系統在黑色素瘤發展中的重要性。 目前，增強免疫系統的治療已在對抗黑色素瘤方面展現出希望。雖然免疫增強療法用於晚期黑色素瘤仍屬較新領域，但最新研究指出，將免疫療法與化療、放療或標靶分子治療結合，可顯著改善預後。然而，免疫療法可能引發涉及多個器官的免疫相關副作用，限制其使用。 展望未來，治療晚期黑色素瘤的策略可能包括針對特定免疫檢查點（如 PD1）的藥物，或干擾特定分子通路（如 BRAF 與 MEK）的治療。
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.
黑色素瘤的主要危險因素是皮膚色素較少（白人）的人長期暴露於紫外線，紫外線來源可為太陽或曬黑設備。痣較多、家族有黑色素瘤病史、免疫功能較差者罹患風險亦較高。
使用防曬霜並避免過度紫外線曝露可降低發病風險。治療通常以手術切除為主。對於較大的腫瘤，會檢查鄰近淋巴結是否有轉移。若未發生轉移，多數患者可獲治癒。對於已轉移的黑色素瘤，免疫療法、生物療法、放射療法或化學療法可提升存活率。根據美國資料，局部疾病患者的五年存活率為 99%，癌症已擴散至淋巴結時為 65%，遠端轉移者則為 25%。
黑色素瘤是最危險的皮膚癌類型。澳洲與紐西蘭的發生率居世界之首，北歐與北美亦相對較高；而在亞洲、非洲及拉丁美洲則較低。美國男性的發生率約為女性的 1.6 倍。
○ 體徵與症狀
早期症狀包括既有痣的形狀或顏色改變；結節性黑色素瘤則表現為皮膚上出現新腫塊。晚期時，痣可能發癢、潰瘍或出血。
[A‑Asymmetry] 形狀不對稱
[B‑Borders] 邊緣不規則
[C‑Color] 顏色不均勻
[D‑Diameter] 直徑 >6 mm（約 0.24 吋，約等於鉛筆橡皮擦大小）
[E‑Evolving] 隨時間變化
cf) 脂漏性角化症可能符合部分或全部 ABCD 標準，易造成誤報。
早期黑色素瘤雖有可能轉移，但相對罕見；在早期診斷的病例中，不到五分之一會發生轉移。腦部是轉移性黑色素瘤常見的部位，此外亦可擴散至肝臟、骨骼、腹部或遠端淋巴結。
○ 診斷
懷疑黑色素瘤時，首先會檢視可疑區域。顏色或形狀不規則的痣通常被視為疑似黑色素瘤。醫師會檢查所有痣，包括直徑小於 6 mm 的痣。由受過專業訓練的醫師使用皮膚鏡檢查，較僅靠肉眼更能辨識惡性病變。最終診斷需對有癌變嫌疑的皮膚病變進行活檢。
○ 治療
#Mohs surgery
若患者為無法手術切除的第 3 期或第 4 期黑色素瘤，醫師可能會建議免疫療法。
#Ipilimumab [Yervoy]
#Pembrolizumab [Keytruda]
#Nivolumab [Opdivo]