Malignant melanoma - 惡性黑色素瘤
約 2.5 公分（1 吋）× 1.5 公分（0.6 吋）的黑色素瘤
References
黑色素瘤是黑色素細胞惡性時形成的一種腫瘤。黑素細胞起源於神經嵴。這意味著黑色素瘤不僅可以在皮膚上生長，還可以在神經嵴細胞傳播的其他地方生長，例如胃腸道和大腦。 0 期黑色素瘤患者的五年存活率為 97%，而 IV 期黑色素瘤患者的五年存活率僅為 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， the European Dermatology Forum (EDF) , the European Association of Dermato-Oncology (EADO) , and the 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，因其與免疫系統的密切關係而引人注目。從免疫系統較弱的人中黑色素瘤的發生率增加、原始腫瘤中免疫細胞的存在及其向身體其他部位的擴散，以及免疫系統可以識別黑色素瘤細胞中發現的某些蛋白質的事實來看，這一點是顯而易見的。重要的是，增強免疫系統的治療在對抗黑色素瘤方面已顯示出希望。雖然使用免疫增強療法治療晚期黑色素瘤是一個相對較新的發展，但最近的研究表明，將這些療法與化療、放療或標靶分子治療相結合可以顯著改善預後。然而，這種免疫療法會引發一系列影響多種器官的免疫相關副作用，這可能會限制其使用。展望未來，治療晚期黑色素瘤的未來方法可能涉及針對特定免疫檢查點（如 PD1）的療法，或乾擾特定分子途徑（如 BRAF 和 MEK）的藥物。
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膚黑色素水平低的人（白人）暴露於紫外線。紫外線可能來自太陽或曬黑設備。痣較多、家庭成員有黑色素瘤病史、免疫功能較差的人罹患黑色素瘤的風險較高。
使用防曬霜並避免紫外線可以預防黑色素瘤。治療通常是透過手術切除。對於癌症稍大的患者，可以測試附近的淋巴結是否有擴散（轉移）。如果沒有發生轉移，大多數人都會被治癒。對於黑色素瘤擴散的患者，免疫療法、生物療法、放射療法或化學療法可以提高存活率。在美國，透過治療，局部疾病患者的五年存活率為 99%，疾病已擴散到淋巴結時的五年存活率為 65%，遠端擴散的患者的五年存活率為 25%。
黑色素瘤是最危險的皮膚癌類型。澳洲和紐西蘭的黑色素瘤發生率是世界上最高的。北歐和北美的黑色素瘤發生率也很高。黑色素瘤在亞洲、非洲和拉丁美洲的發生率則低得多。在美國，男性黑色素瘤的發生率是女性的 1.6 倍。
○ 體徵與症狀
黑色素瘤的早期症狀是現有痣的形狀或顏色改變。對於結節性黑色素瘤，它是皮膚上出現新的腫塊。在黑色素瘤的後期，痣可能會發癢、潰瘍或出血。
[A-Asymmetry] 形狀不對稱
[B-Borders] 邊框（有稜角不規則）
[C-Color] 顏色（雜色和不規則）
[D-Diameter] 直徑（大於6毫米=0.24英吋=大約是鉛筆橡皮擦的大小）
[E-Evolving] 隨著時間的推移而發展
cf) 脂漏性角化症可能符合部分或全部 ABCD 標準，並可能導致誤報。
早期黑色素瘤有可能發生轉移，但相對罕見；早期診斷的黑色素瘤中不到五分之一會發生轉移。腦轉移在轉移性黑色素瘤患者中很常見。轉移性黑色素瘤也會擴散到肝臟、骨骼、腹部或遠端淋巴結。
○ 診斷
查看相關區域是懷疑黑色素瘤最常見的方法。顏色或形狀不規則的痣通常被視為黑色素瘤的候選者。
醫生通常會檢查所有痣，包括直徑小於 6 毫米的痣。當由訓練有素的專家使用時，皮膚鏡檢查比單獨使用肉眼更有助於識別惡性病變。診斷是透過對任何有潛在癌變跡象的皮膚病變進行活檢來進行的。
○ 治療
#Mohs surgery
您的醫生可能會建議免疫療法，特別是如果您患有無法透過手術切除的 3 期或 4 期黑色素瘤。
#Ipilimumab [Yervoy]
#Pembrolizumab [Keytruda]
#Nivolumab [Opdivo]