What Is Nodular Melanoma?

Nodular malignant black, first appearing as raised plaques or nodules, black or blue-black, can cause ulcers, or raised cauliflower-like, can metastasize early.

Nodular malignant

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Nodular malignant black, first appearing as raised plaques or nodules, black or blue-black, can cause ulcers, or raised cauliflower-like, can metastasize early.

Chinese name

Nodular malignant

Overview

Onset of raised plaques or nodules

Symptoms

Begins with raised plaque nodules or deep nodules

Precursors

Crust formation on the surface; bleeding often on the affected area

Begins with raised plaques, nodules or deep nodules, black or blue-black. Because of its rapid growth, the discovery was a raised nodule. It grows quickly afterwards, and can develop ulcers or bulges such as mushrooms or cauliflowers. Migration often occurs earlier. Those who received treatment before metastasis had a 5-year survival rate of 50% to 60%.

Malignant black has a higher degree of malignancy, more metastasis, and a more serious prognosis. Therefore, early diagnosis and timely and reasonable treatment are an important research topic. The current treatment is still not ideal, and early local surgical resection is still the best way to fight for cure. Chemotherapy is only suitable for advanced patients. Immunotherapy is still in the experimental stage.

Nodular Malignant Surgery

It is generally believed that tumors should be widely resected, and the extent of resection depends on the type and location of the tumor. The National Institutes of Health meeting recommended that early malignant resection or biopsy should include 0.5 cm of normal skin around the lesion. The depth should include subcutaneous tissue. Some people have suggested that the range of resection should include 5 to 8 cm of normal skin around the tumor in those who grow rapidly. After a large excision, skin grafting is often required. Nodular malignant surgery requires deep fascia. Acromosis requires severance or amputation of the joints.

Nodular malignant local lymphadenectomy

Early stage tumors have not clinically exhibited local lymph node metastasis. Some people have also advocated prophylactic resection. Some people have observed that patients with dark skin on the extremities have undergone local lymph node preventive resection. 90% of pathological sections can be found in pathological sections. It is also believed that when the depth of tumor invasion reaches the deep dermis, lymph node resection should be performed. At present, the indications for lymph node surgical resection are as follows: the primary tumor is close to the lymph node; the primary tumor is located at a site with a poor prognosis; the primary tumor is large and bulged or ulcerated; the primary tumor invades the dermis Deep.

Nodular malignant chemotherapy

It is suitable for patients with advanced metastasis. Many drugs have been tried in the past. However, the long-term effect is disappointing whether it is applied alone or in combination. Only some patients have relieved symptoms and prolonged survival after chemotherapy. In recent years, it has been mainly used in combination and rarely used alone.

Nodular malignant immunotherapy

There are many ways and it is still in trial. There are several methods that have a certain clinical effect: two patients with malignant tumors undergo cross-transplantation of tumors at the same time, and then cross-injection of lymphocytes. Some people used this method to treat 26 cases, 7 cases were effective, 2 cases were completely remissioned; another group of treatments were also 26 cases, 5 cases were effective, and 1 case was completely relieved. In the future, improvements were made on this basis. Using cultured malignant melanocytes as described above, a total of 12 cases were treated, 3 cases were effective, and 2 cases were completely relieved. Inject BCG into the malignant melanoma and make a delayed hypersensitivity reaction to DNCB skin to determine its immune response. DNCB-positive patients with BCG-injected tumor nodules can be absorbed and regressed, and some metastatic tumor nodules without BCG-injected can also be resolved at the same time, but those with negative DNCB-response have poor results. The whole blood of the patient with spontaneous relief of malignant melanoma was transfused to another patient with malignant melanoma, and the condition was relieved for more than 5 years. It was observed that pigs were immunized with tumor cells from malignant patients, and then two patients were treated with pig lymphocytes. One patient did not cause an adverse reaction to xenogeneic lymphocytes and had temporary regression of subcutaneous metastatic tumors; the other patient had tumors. Massive necrosis occurs and the blood vessels supplying the tumor form thrombi. In the above method, the former two are more promising. In recent years, LAK cells, interferon, and interleukin-2 are being tested for immunotherapy, which has a certain effect.

Nodular Malignant Radiation Therapy

It is of great value for reducing the symptoms of compression caused by visceral metastases. Radiation therapy for central nervous system metastatic lesions in combination with systemic corticosteroids is also effective. Pain caused by bone metastases was significantly relieved after radiotherapy.

In short, the current treatment of malignant melancholia is still not ideal. Patients in stage to take a relatively thorough surgical resection to strive for cure; patients in stage to metastasis use comprehensive therapy in order to achieve relief, prolong survival time and alleviate patient suffering.

In recent years, Banzet has put forward comprehensive treatment opinions for reference only, but the types and doses of chemotherapy drugs should be carefully selected:

In patients with stage to who have a single malignant lesion and no lymph node metastasis, surgical resection is recommended, and immunotherapy (such as LAK cell injection) is used throughout the body.

Patients with stage to are treated with surgery as the basic treatment and combined with chemotherapy after diagnosis. If the lesion is in the limb, it is suitable for intra-arterial administration for chemotherapy, which can be performed before surgery, and then intra-arterial chemotherapy. If it is not suitable for intra-arterial administration, systemic chemotherapy is used. The principle of systemic chemotherapy is long-term intermittent therapy with multiple chemotherapeutic drugs. The following drugs and dosages are generally used: vinblastine, 6 mg / m2 body surface area; triethylene thiotepine 6 mg / m2 body surface area; methotrexate (MTX) 15 mg / m2 body surface area. The method was intravenously administered once every 2 weeks and changed to once every 4 weeks after 3 months. After each injection, methylbenzide was orally administered daily for 8 days.

Patients with stage who only see local metastasis of skin or lymph nodes, but no disseminated skin and visceral metastasis, the treatment principle is the same as above. Before surgery, DTIC (dimethyltrichloroenylimidazolamide) was administered intra-arterially. For those with visceral metastasis but no skin metastasis, the following drugs are combined: Cyclophosphamide 1g / m2 body surface area, administered intravenously every 4 weeks; Vincristine 0.6mg / m2 body surface area, administered intravenously once a week; Bleomycin 18mg / m2 body surface area, intramuscular injection once a week; methyl CCNU, which is 1- (2-chloroethyl) -3- (4-methyl-cycloethyl) -1-nitroso Urea, 200 mg / m2 body surface area, once every 4 weeks. Patients with metastases to the skin and internal organs, in addition to the above treatment, can be injected with BCG in the nodule. Extremity melanoma can still be used as an intraarterial infusion chemotherapy drug.