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Malignant melanoma Treatment

Malignant melanoma is the high Malignant and transferred quickly. At present, mainly Malignant melanoma treatment is Surgical, lesions resection as soon as possible, combined with chemotherapy, biological therapy, physiatry, radiotherapy, Immune therapy.

Surgical treatment:
1, surgical biopsy: malignant melanoma of the suspected persons, together with the lesion should be around 0.5cm ~ lcm of normal skin and subcutaneous tissue en bloc resection for pathological examination, as confirmed to be malignant melanoma, the in accordance with its depth of invasion, then decide whether it is necessary to add extensive resection line. Generally do not cut or forceps biopsy, unless the lesion has been the formation of ulcers, or lesions due to too large to be caused by a removal of disfigured or disabled and must be confirmed by pathology, but cut biopsy and radical operation must be more convergence in recent the better. Through biopsy of the lesion can understand the depth and extent of infiltration will help develop a more rational, more appropriate surgery program.

2, the resection scope of the primary lesion: the majority of scientists outside the thin tumor lesions, thickness ≤ 1mm, just outside the margin of resection of tumors and normal skin 1cm, thickness of the lesion should be more than 1mm from the edge of the tumor for a 3cm ~ 5cm wide excision. Located in the acral malignant melanoma, often need to refer to cut-off line operation.

3, regional lymphadenectomy:

1) Indications:

  • lesions ≤ 1mm thickness, the transfer rate is very low, preventive lymphadenectomy can not be expected to alter the long-term prognosis;
  • lesion thickness> 3.5cm ~ 4mm were concealed the possibility of distant metastasis high, long-term survival rate is relatively low (20% ~ 30%), even if preventive lymphadenectomy can not look at the survival rate will have a meaningful improvement. In spite of this, that as long as there is no distant metastasis can be found, they should do preventive lymphadenectomy were gone;
  • between the thickness of the lesions between these two categories, the rate of occult lymph node metastasis is very high, is to take measures to prevent lymphadenectomy of survival time is expected to raise the best target.

    2) the scope of regional lymphadenectomy: malignant melanoma of the head and neck for cervical lymphadenectomy, the primary foci were located in facial areas should focus on the removal of the parotid gland, the submental and submandibular triangle lymph node; such as lesions located in occipital, focusing on removal of carotid after lymph node triangle. Occurred in the malignant melanoma of upper limb to be axillary lymph node dissection line, there should be done in the lower limbs or groin inguinal lymphadenectomy. Occurred in the chest and abdomen were malignant melanoma for ipsilateral axillary or inguinal lymphadenectomy.

    4, palliative resection: a wide range of lesions associated with distant metastasis and not suitable for radical surgery, etc., and to the lifting of ulcer bleeding or pain, as long as the anatomical conditions permit, consideration may be given by the plot line or palliative resection surgery.

    Radiation therapy: In addition to some very early malignant melanoma freckle type of radiation treatment, and the other primary effect of the poor in general. Primary tumor and therefore do not use radiation therapy in general, and of metastatic lesions with radiation therapy. Currently used doses of radiation: The superficial lymph nodes, soft tissue and thoracic, abdominal, pelvic metastasis within each exposure ≥ 500cCy, week 2, the total 2000 ~ 4000cCy, on bone metastasis for each 200 ~ 400cCy , total more than 3000cCy.

    Chemotherapy:

    1, a single medication:

    1) nitrosourea drugs: The effect of certain melanoma. BCNU, MeCCNU, CCNU treatment.

    2) microphone Triazene amine (DTIC): DTIC is the treatment of melanoma most commonly used drugs. DTIC best effect, each dose of 350mg/m2, once a 6 days, 28 days for a treatment response rate was 35%.

    2, combination drug: malignant melanoma is not sensitive to chemotherapy, but the combination can increase efficiency, reduce toxicity, often combined with chemotherapy as follows:

    1) DAV program (DTIc, ACNu, VCR) the first choice for melanoma chemotherapy. Use method: DTIcloo ~ 200mg, iv d1 ~ 5ACNUl00mgiv d1VCR 2mg iv d1, every 21 days to repeat 1.
    2) DDBT program (DTIC, DDP, BCNU, TAM) Usage: DTIC220mg/m2, iv d1 ~ 3/3w, DDP 25mg/m2, iv d1 ~ 3w, BCNUl50mg/m2, intravenous d1/6w, TAM10mgPO , 2 / d. 52.5% efficient.
    (3) CBD Program (CCNU, BLM, DDP) Usage: CCNU 80mg/m2, oral, d1/6w, BLMl5u/m2, intravenous d3 ~ 7/6w, DDP 40mg/m2, iv d8/6w. 48 percent efficient.

    Immune therapy:

    Malignant melanoma subside on their own shows and the immune function. Bacillus Calmette-Guerin (BCG) in patients with melanoma will enable the body's lymphocytes concentrated in the tumor nodules, the patient to stimulate a strong immune response in order to effect the treatment of tumors. Scratch the skin can be used BCG law, intratumoral injection and oral. Small lesions on the local tumor with BCG injection for efficient up to 75% ~ 90%. In recent years, interferon beta, interleukin--2 (ILA-2) and lymphokine-activated killer cells (LAK cells), such as biological response modifier, certain positive results.

    • Submitted by Health Studies on Wed, 04/22/2009 - 16:05
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