Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke · 2006
[Malignant melanoma--diagnosis and treatment].
Аннотация на английскомСтатьяОбзорНазвание и аннотация: Перевод пока не подготовлен
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Jacobsen Kari Dolven, Fosså Sophie D, Aamdal Steinar
Аннотация
BACKGROUND: Malignant melanoma is one of the most common forms of cancer in young adults in Norway. Early diagnosis and treatment is of vital importance for the prognosis.
MATERIAL AND METHODS: The article is based on articles obtained from Medline and PubMed and from the Norwegian guidelines for the treatment of malignant melanoma.
RESULTS AND INTERPRETATION: The depth of invasion of the melanoma is the most important prognostic factor. The thicker the primary tumour, the less chance there is of patient survival. Patients with a localized tumour should be controlled regularly for up to five years. Primary tumours, local recurrences and metastases should be treated by surgery whenever possible. Radical lymph node dissection should be performed in patients with regional lymph node metastases with the intention of curing the patient. There is no curative chemotherapy for metastatic disease. Dacarbazine has been the most used medication for many years. The treatment is effective for about 10 - 20 % of the patients, but the response does not last for long and the treatment does not prolong survival time. Isolated limb perfusion with melphalan and TNF-alpha (tumour necrosis factor-alpha) gives high response rates in patients with metastatic disease localised in the extremities, but the treatment is only palliative. Radiation therapy has been useful in selected patients postoperatively (e.g. after removed local recurrence) and in palliation of metastatic disease. Several clinical studies with chemotherapy, immunotherapy, vaccines and combinations are ongoing. Of preventive measures, avoiding sunburn is of particular importance.
MATERIAL AND METHODS: The article is based on articles obtained from Medline and PubMed and from the Norwegian guidelines for the treatment of malignant melanoma.
RESULTS AND INTERPRETATION: The depth of invasion of the melanoma is the most important prognostic factor. The thicker the primary tumour, the less chance there is of patient survival. Patients with a localized tumour should be controlled regularly for up to five years. Primary tumours, local recurrences and metastases should be treated by surgery whenever possible. Radical lymph node dissection should be performed in patients with regional lymph node metastases with the intention of curing the patient. There is no curative chemotherapy for metastatic disease. Dacarbazine has been the most used medication for many years. The treatment is effective for about 10 - 20 % of the patients, but the response does not last for long and the treatment does not prolong survival time. Isolated limb perfusion with melphalan and TNF-alpha (tumour necrosis factor-alpha) gives high response rates in patients with metastatic disease localised in the extremities, but the treatment is only palliative. Radiation therapy has been useful in selected patients postoperatively (e.g. after removed local recurrence) and in palliation of metastatic disease. Several clinical studies with chemotherapy, immunotherapy, vaccines and combinations are ongoing. Of preventive measures, avoiding sunburn is of particular importance.