恶性黑色素瘤【31页】

.,“非诚勿扰”与恶性黑色素瘤,.,catalogue,Whatismalignantmelanoma?MelanomatriggersandcausesPrimarysitesClinicalcharacteristicsEarlyclinicalperformanceLate-stageclinicalmanifestationsPathologicaltypeTreatment2010melanomafieldprogressreview,.,Whatismalignantmelanoma?,Malignantmelanoma,alsoknownasmelanoma,istheoriginofepidermalmelanocyteornevusofmalignanttumors.Thediseasecanbeseenatanyage,moreseeninmiddle-agedandolder,womenslightlymorethanmen.,.,Melanomatriggersandcauses,AirpollutionTopursuebeautyThelackofmedicineknowledgeImmunedeficiencyAbusingtheestrogendrugsMalignanttransformationofblackmoleRacialgeneticfactorsTraumaandchronicstimulationfactors,.,Airpollution,Harmfulultravioletlightandsomeharmfulmaterialintheairmakeadifferenceofhumanskin,causingmelanocyteabnormalexpression,triggermelanoma.,.,Manypeopleinordertopursuethecleanskintousechemicalcosmetics,skinpollutioncausedbychemical,evensomeonewithchemicalmordantpurifyskinamole,stimulatestheexcessiveproliferationmelanocyte.,Topursuebeauty,.,Racialgeneticfactors,Malignantmelanomaoccurinthewhiterace.Fortheincidenceofworldeachyeartolessthan12/10million,butAustraliasQueenslandannualincidenceof16/10millionpopulation,itistheworldsleadinghighincidenceofmalignantmelanoma.AfricaandAsianpeoplerarelyhavethesickness.,.,Primarysites,Malignantmelanoma90%occursintheskin,themostcommonintheback,metal-studded,leg,foot,toe,nailbed,scalpandsoon;afewoccursinvulvae,digestivetractandeyes.,.,EyelesionsandOrallesions,脉络膜黑色素瘤,口腔黑色素瘤,.,Generallyspeakingmolessurfaceissmooth,melanomaofsurfaceiscoarser.Ifthesurfaceissmooth,andsuddenlybecomescoarseor,weshouldpayattentiontoit.,Clinicalcharacteristics,.,Ulcerationnotonlyisoneoftheimportantmelanomaclinicalmanifestationswhichisdifferentfrommole,butalsohasthemeaningofprognosisthannoulcer.Patientsofmalignantmelanomagenerallyaretheold;theyouthorchildrenmelanomaarerare.,.,Earlyclinicalperformance,Color:amoleincreaseinsize,pigmentordarkerorlighter,amoledeepen,shiny,appearcolorchanged.Edge:amoletoradiateoutinmolesexpansion,appeararoundunevenindentedchange;becomeirregularorappearsatelliteformsmallamole,orseveralbirthmarkfusion,thesurfaceconcavo-convexinequality.Surface:rough;Oftencoarseandaccompaniedbyscaleformorflakedesquamation.Sometimeshavethedrainageoroozeblood,higherlesionscanface.,.,Lesionssurroundingskin:canappearedemaorloseskinglossorbecomewhite,gray.Kakesthesia:amolewithoutitchingordiscomfortpain.regionallymphnodeenlargement,faintlyvisibleblue-black.,早期临床表现,.,Late-stageclinicalmanifestations,Specialtype：asmallnodularlesionsite,theboundaryclear,nocoated,tan-whiteorgrey-blue,qualityofamaterialissolid.Frecklestype:morefromtheprimarylesionsmalignantfreckles;surfacewasflat;theedgegreatirregularity;theepidermisoftumorblockwithfrecklessamples,thistypeoftenoccuronelderlyfacialfreckleslesions,whichisrelativelyrare.,.,Spreadtype:itsappearanceisshalloweczemakind,anditsjaggededgeisirregular,withblack,greyandpinkdisorderlycoloronthesurface.Nodulartype:tumornodulesareoutoftheskinsurface;thecolorisdarkbrown,grayredandrarelycolorless.Bumpsurfaceisshownmorecauliflowershape,polypoidorbacteriashape,oftenhappenulcers.,.,Pathologicaltype,Superficialexpandabletype:about70%,itisvisibleatsurfaceanywhere;goalongthesurfacetoexpand,andthenexpandtothedepth,calledtheverticaldevelopment.,.,nodulartype:about15%,verticaldevelopment;penetratetosubcutaneoustissue;pronetolymphnodemetastases;evenmoredeadly.,.,Ephelidestype:about5%,itprimaryoccurinoldpeoplefacialskinwhereblackfreckleslongstand;thistypedohorizontalgrowthandenlarge2cm3cmormorearound.,.,Extremityblackmoletype:about10%thathappensatpalms,foot,nailbedandmucousmembranes.,.,Treatment,Surgicaltreatment:earlycircumscribedprimaryfocishouldbecarriedoutextensively;thescopeshouldbeapartfromtheprimaryfoci35cm;theprimaryfocishouldbeexcisedtosubcutaneoustissueandmusclemembrane;whentouchthelymphnodeenlargement,generallyspeakingshouldmakelymphnodeclean;aftertheoperation,adjuvantchemotherapyandimmunetherapyisnecessary.,.,Biologicalimmunetherapy:biologicalimmunetherapyviathevariousbiologicalagentsandbiotechnologymeanstoenhanceimmunityandanti-cancerabilitytosuppressandkillcancercells;atpresent,immunecellssuchasDCcells,CIKcellhaveappliedtoclinicaltherapy,whichgainsgoodeffects;biologicalimmunetherapyisthemosteffective,securityadjuvanttherapies.,人类黑色素瘤抗原,.,Radiotherapy:Inadditiontosomeveryearlyfrecklestypeofmalignantmelanomaareeffective,otherprimaryfocigenerallyhavepoorcurativeeffect.Sowedidnotuseradiationtherapytocuretheprimaryfoci,andmetastasisadoptradiotherapy.,.,Endocrinetherapy:anti-estrogendrugsmakesomecasesevenotherdrugtreatmentfailurecasesgetcurativeeffect,andmaketheillnesstoalleviate.,.,Chemicaltreatment:Singledrug:)亚硝脲类药物:havecertaineffectofmelanoma.氮烯咪胺(DTIC):DTIChasmadethetreatmentofmelanomaforwardonestep,becomethemostwidelyuseddrugs.Eachdosefor350mg/m2,repeat6days,28daysforoneperiodoftreatment,efficientrateis35%.,.,Combination:combinationcanimprovetheefficient,reducetoxicityreaction.DAVcase(DTIc、ACNu、VCR):thefirstchoiceformelanomachemotherapyregimens.Thepreparationmethod:DTIcloo200mg,5ACNUl00mgivd1VCR2mgivd121days,eachivd1repeated1time.,.,DDBTcase(DTIC、DDP、BCNU、TAM)Method:DTIC220mg/m2,I.V.d13/3w,DDP25mg/m2,i.v.gttd13w,BCNUl50mg/m2,I.V.d1/6w,TAM10mgPO,2/d.Efficientrateis52.5%.CBDcase(CCNU、BLM、DDP)Method:CCNU80mg/m2,oral,d1/6w,BLMl5u/m2,I.V.d37/6w,DDP40mg/m2,I.V.d8/6w.Efficientrateis48%.,.,2010melanomafieldprogressreviewmelanomatreatmentfinallyusherasilverlining,ResistancetoCTLA-4singleresistanceagainstgeneticmutationsand(B-RAFandC-KIT)smallmoleculartargeteddrugs,whichprolongthesurvivalofadvancedmelanomapatientsandachieveremarkablebreakthrough.Itispossibleforthetreatmentofadvancedmelanomapatientsbringthoroughrevolution.,.,In