“非誠勿擾”與惡性黑色素瘤惡性黑色素瘤專家講座第1頁catalogueWhatismalignantmelanoma?MelanomatriggersandcausesPrimarysitesClinicalcharacteristicsEarlyclinicalperformanceLate-stageclinicalmanifestationsPathologicaltypeTreatmentmelanomafieldprogressreview惡性黑色素瘤專家講座第2頁Whatismalignantmelanoma?Malignantmelanoma,alsoknownasmelanoma,istheoriginofepidermalmelanocyteornevusofmalignanttumors.

Thediseasecanbeseenatanyage,moreseeninmiddle-agedandolder,womenslightlymorethanmen.

惡性黑色素瘤專家講座第3頁MelanomatriggersandcausesAirpollutionTopursuebeautyThelackofmedicineknowledgeImmunedeficiencyAbusingtheestrogendrugsMalignanttransformationofblackmoleRacialgeneticfactorsTraumaandchronicstimulationfactors

惡性黑色素瘤專家講座第4頁AirpollutionHarmfulultravioletlightandsomeharmfulmaterialintheairmakeadifferenceofhumanskin,causingmelanocyteabnormalexpression,triggermelanoma.

惡性黑色素瘤專家講座第5頁

Manypeopleinordertopursuethecleanskintousechemical

cosmetics,skinpollutioncausedbychemical,evensomeonewithchemicalmordantpurifyskinamole,stimulatestheexcessiveproliferationmelanocyte.Topursuebeauty惡性黑色素瘤專家講座第6頁RacialgeneticfactorsMalignantmelanomaoccurinthewhiterace.Fortheincidenceofworldeachyeartolessthan1~2/10million,butAustralia'sQueenslandannualincidenceof16/10millionpopulation,itistheworld‘sleadinghighincidenceofmalignantmelanoma.AfricaandAsianpeoplerarelyhavethesickness.惡性黑色素瘤專家講座第7頁P(yáng)rimarysitesMalignantmelanoma90%occursintheskin,themostcommonintheback,metal-studded,leg,foot,toe,nailbed,scalpandsoon;afewoccursinvulvae,digestivetractandeyes.惡性黑色素瘤專家講座第8頁Eyelesions

andOrallesions脈絡(luò)膜黑色素瘤口腔黑色素瘤惡性黑色素瘤專家講座第9頁◆Generallyspeakingmolessurfaceissmooth,melanomaofsurfaceiscoarser.Ifthesurfaceissmooth,andsuddenlybecomescoarseor,weshouldpayattentiontoit.

Clinicalcharacteristics

惡性黑色素瘤專家講座第10頁◆Ulcerationnotonlyisoneoftheimportantmelanomaclinicalmanifestationswhichisdifferentfrommole,butalsohasthemeaningofprognosisthannoulcer.◆Patientsofmalignantmelanomagenerallyaretheold;theyouthorchildrenmelanomaarerare.惡性黑色素瘤專家講座第11頁EarlyclinicalperformanceColor:amoleincreaseinsize,pigmentordarkerorlighter,amoledeepen,shiny,appearcolorchanged.Edge:amoletoradiateoutinmolesexpansion,appeararoundunevenindentedchange;becomeirregularorappearsatelliteformsmallamole,orseveralbirthmarkfusion,thesurfaceconcavo-convexinequality.Surface:rough;Oftencoarseandaccompaniedbyscaleformorflakedesquamation.Sometimeshavethedrainageoroozeblood,higherlesionscanface.惡性黑色素瘤專家講座第12頁Lesionssurroundingskin:canappearedemaorloseskinglossorbecomewhite,gray.Kakesthesia:amolewithoutitchingordiscomfortpain.regionallymphnodeenlargement,faintlyvisibleblue-black

.早期臨床表現(xiàn)惡性黑色素瘤專家講座第13頁Late-stageclinicalmanifestations＊Specialtype：asmallnodularlesionsite,theboundaryclear,nocoated,tan-whiteorgrey-blue,qualityofamaterialissolid.＊Frecklestype:morefromtheprimarylesionsmalignantfreckles;surfacewasflat;theedgegreatirregularity;theepidermisoftumorblockwithfrecklessamples,thistypeoftenoccuronelderlyfacialfreckleslesions,whichisrelativelyrare.

惡性黑色素瘤專家講座第14頁＊Spreadtype:itsappearanceisshalloweczemakind,anditsjaggededgeisirregular,withblack,greyandpinkdisorderlycoloronthesurface.

＊Nodulartype:tumornodulesareoutoftheskinsurface;thecolorisdarkbrown,grayredandrarelycolorless.Bumpsurfaceisshownmorecauliflowershape,polypoidorbacteriashape,oftenhappenulcers.惡性黑色素瘤專家講座第15頁P(yáng)athologicaltypeSuperficialexpandabletype:about70%,itisvisibleatsurfaceanywhere;goalongthesurfacetoexpand,andthenexpandtothedepth,calledthe"verticaldevelopment".

惡性黑色素瘤專家講座第16頁nodulartype:about15%,verticaldevelopment;penetratetosubcutaneoustissue;pronetolymphnodemetastases;evenmoredeadly.惡性黑色素瘤專家講座第17頁Ephelidestype:about5%,itprimaryoccurinoldpeoplefacialskinwhereblackfreckleslongstand;thistypedohorizontalgrowthandenlarge2cm~3cmormorearound.惡性黑色素瘤專家講座第18頁Extremityblackmoletype:about10%thathappensatpalms,foot,nailbedandmucousmembranes.惡性黑色素瘤專家講座第19頁Treatment☆Surgicaltreatment:earlycircumscribedprimaryfocishouldbecarriedoutextensively;thescopeshouldbeapartfromtheprimaryfoci3～5cm;theprimaryfocishouldbeexcisedtosubcutaneoustissueandmusclemembrane;whentouchthelymphnodeenlargement,generallyspeakingshouldmakelymphnodeclean;aftertheoperation,adjuvantchemotherapyandimmunetherapyisnecessary

.惡性黑色素瘤專家講座第20頁☆Biologicalimmunetherapy:biologicalimmunetherapyviathevariousbiologicalagentsandbiotechnologymeanstoenhanceimmunityandanti-cancerabilitytosuppressandkillcancercells;atpresent,immunecellssuchasDCcells,CIKcellhaveappliedtoclinicaltherapy,whichgainsgoodeffects;biologicalimmunetherapyisthemosteffective,securityadjuvanttherapies.人類黑色素瘤抗原惡性黑色素瘤專家講座第21頁Radiotherapy:Inadditiontosomeveryearlyfrecklestypeofmalignantmelanomaareeffective,otherprimaryfocigenerallyhavepoorcurativeeffect.Sowedidnotuseradiationtherapytocuretheprimaryfoci,andmetastasisadoptradiotherapy.惡性黑色素瘤專家講座第22頁☆Endocrinetherapy:

anti-estrogendrugsmakesomecasesevenotherdrugtreatmentfailurecasesgetcurativeeffect,andmaketheillnesstoalleviate.惡性黑色素瘤專家講座第23頁☆Chemicaltreatment:

⒈Singledrug:⑴)亞硝脲類藥品:havecertaineffectofmelanoma.⑵氮烯咪胺(DTIC):DTIChasmadethetreatmentofmelanomaforwardonestep,becomethemostwidelyuseddrugs.Eachdosefor350mg/m2,repeat6days,28daysforoneperiodoftreatment,efficientrateis35%.

惡性黑色素瘤專家講座第24頁⒉Combination:combinationcanimprovetheefficient,reducetoxicityreaction.⑴DAVcase(DTIc、ACNu、VCR):thefirstchoiceformelanomachemotherapyregimens.

Thepreparationmethod:DTIcloo~200mg,5ACNUl00mgivd1VCR2mgivd1~21days,eachivd1repeated1time.

惡性黑色素瘤專家講座第25頁⑵DDBTcase(DTIC、DDP、BCNU、TAM)

Method:DTIC220mg/m2,I.V.d1~3/3w,DDP25mg/m2,i.v.gttd1~3w,BCNUl50mg/m2,I.V.d1/6w,TAM10mgPO,2/d.Efficientrateis52.5%.⑶CBDcase(CCNU、BLM、DDP)

Method:CCNU80mg/m2,oral,d1/6w,BLMl5u/m2,I.V.d3~7/6w,DDP40mg/m2,I.V.d8/6w.Efficientrateis48%.

惡性黑色素瘤專家講座第26頁melanomafieldprogressreview

melanomatreatmentfinallyusherasilverlining

﹡ResistancetoCTLA-4singleresistanceagainstgeneticmutationsand(B-RAFandC-KIT)smallmoleculartargeteddrugs,whichprolongthesurvivalofadvancedmelanomapatientsandachieveremarkablebreakthrough.Itispossibleforthetreatmentofadvancedmelanomapatientsbringthoroughrevolution.惡性黑色