小结
定义
病史和体格检查
关键诊断因素
- altered pigmented lesion (ABCDE signs)
- melanocytic lesion that does not resemble surrounding melanocytic nevi ("ugly duckling")
- spontaneous bleeding or ulceration of a pigmented lesion
- constitutional symptoms
- nail sign: persistent single-nail melanonychia striata
- nail sign: Hutchinson sign
- atypical dermoscopy findings
- fixed lymphadenopathy
- in-transit metastases
危险因素
- sun exposure
- family history of melanoma
- personal history of melanoma
- personal history of skin cancer (including actinic damage)
- history of atypical nevi
- Fitzpatrick skin type I or II (white skin)
- red or blond hair color
- high freckle density
- sun bed use
- light eye color
- increased numbers of benign-appearing melanocytic nevi
- large congenital nevi
- immunosuppression
- xeroderma pigmentosum
诊断性检查
首要检查
- dermoscopy
- skin biopsy
- immunohistochemistry
需考虑的检查
- sentinel lymph node biopsy
- chest/abdominal/pelvic CT scan
- whole-body PET scan
- brain imaging (CT or MRI)
- BRAF mutational analysis
- NRAS mutational analysis
- serum lactate dehydrogenase (LDH)
新兴检查
- CDKN2A mutational analysis
治疗流程
early stage melanoma (melanoma in situ, stage I, stage II)
stage III melanoma with negative sentinel nodes
stage III melanoma with positive sentinel nodes
stage III melanoma with clinically positive nodes: resectable
stage III melanoma with satellite/in-transit metastases: limited resectable disease
stage III melanoma with satellite/in-transit metastases: borderline resectable or unresectable disease
stage IV metastatic melanoma
撰稿人
作者
Yin Wu, MRCP(UK), PhD
Wellcome Trust Clinical Research Career Development Fellow and Honorary Consultant Medical Oncologist
Peter Gorer Department of Immunobiology
King's College London
Department of Medical Oncology
Guy's and St Thomas' NHS Foundation Trust
London
UK
利益声明
YW is funded by the Wellcome Trust, and consults for PersonGen Therapeutics, and Biotherapeutics.
Amanda Fitzpatrick, MRCP(UK), PhD
Medical Oncologist and Honorary Senior Lecturer
Guy's Cancer Centre
King's College
London
UK
利益声明
AF declares she has no competing interests.
Pablo Fernandez-Peñas, MD, PhD, FACD
Professor of Dermatology
The University of Sydney
Sydney
Australia
利益声明
PF-P declares that he has no competing interests with the topic Melanoma. PF-P has advisory roles with Amgen, Boehringer Ingelheim, Bristol Meyers Squibb, Leo, Novartis, Lilly, Abbvie, Janssen, Celgene (psoriasis, atopic eczema, hidradenitis), Roche, Merck Sharp & Dohme, Sun Pharmaceuticals, Novartis, and Sanofi. He has been paid to do research for Incyte Europe Sarl, and clinical trials for Arena, Akaal Pharma, Xoma, Kyowa Hakko Kirin, AbbVie, OncoSec, Lilly, CSL Behring, Boehringer Ingelheim, Pfizer, mRage, Eisai, Jiansu Hengrui, Bristol-Myers Squibb, Sun Pharma, Novartis, Roche, Galderma, Regeneron, UCB, GlaxoSmithKline, and Amgen.
Agradecimientos
Dr Yin Wu, Dr Amanda Fitzpatrick, and Dr Pablo Fernandez-Peñas would like to gratefully acknowledge Dr Prachi Bhave, Dr Robyn P.M. Saw, Dr Sophie E. Papa, Dr Alexander M. Menzies, Dr Philip Friedlander, Dr Hobart W. Walling, and Dr Brian L. Swick, previous contributors to this topic.
Divulgaciones
PB has received honoraria from Bristol-Myers Squibb, MSD and Novartis and sponsorship from MSD and Novartis. RPMS is on the advisory board for Novartis, MSD, and Qbiotics and has previously been on the advisory board for Amgen; he has received honoraria from BMS and Novartis. SEP has received honoraria from BMS, MSD, and Novartis to attend conferences; she has participated in advisory boards for BMS, MSD, Amgen, Roche, and GSK. AMM has received honoraria from Novartis and BMS; he is on the advisory boards of MSD and Chugai. PF is a consultant for Genentech. HWW and BLS declare that they have no competing interests.
Revisores por pares
David Cassarino, MD, PhD
Assistant Professor
Department of Pathology and Laboratory Medicine
University of California
Los Angeles
CA
Divulgaciones
DC declares that he has no competing interests.
James DeBloom, MD
Dermatologist/Dermatologic Surgeon
President of the South Carolina Skin Cancer Center
Greenville
SC
Divulgaciones
JB declares that he has no competing interests.
Mai Brooks, MD, FACS
Associate Director
JCCC Women's Cancers Program Area
Jonsson Comprehensive Cancer Center at UCLA
Los Angeles
CA
Divulgaciones
MB declares that she has no competing interests.
Karol Sikora, MA, MBBCh, PhD, FRCR, FRCP, FFPM
Medical Director
CancerPartnersUK
London
UK
Divulgaciones
KS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referencias
Artículos principales
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: melanoma - cutaneous [internet publication].Texto completo
National Institute for Health and Care Excellence. Melanoma: assessment and management. Jul 2022 [internet publication].Texto completo
Michielin O, van Akkooi ACJ, Ascierto PA, et al. Cutaneous melanoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2019 Dec 1;30(12):1884-901.Texto completo Resumen
Seth R, Agarwala SS, Messersmith H, et al. Systemic therapy for melanoma: ASCO guideline update. J Clin Oncol. 2023 Oct 20;41(30):4794-820.Texto completo Resumen
Vogelbaum MA, Brown PD, Messersmith H, et al. Treatment for brain metastases: ASCO-SNO-ASTRO guideline. J Clin Oncol. 2022 Feb 10;40(5):492-516.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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- Pigmented basal cell carcinoma
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