What Are the Pros and Cons of Chemotherapy for Melanoma?

The incidence of skin malignant melanoma (malignant melanoma) is gradually increasing. In the United States, malignant melanoma is the fastest growing malignant tumor. At the same time, skin malignant melanoma accounts for only 5% of all skin malignancies, and more than 75% of patients have died of malignant melanoma. It can be seen that malignant melanoma is a highly lethal tumor.

Melanoma

Right!

The incidence of skin malignant melanoma (malignant melanoma) is gradually increasing. In the United States, malignant melanoma is the fastest growing malignant tumor. At the same time, skin malignant melanoma accounts for only 5% of all skin malignancies, and more than 75% of patients have died of malignant melanoma. It can be seen that malignant melanoma is a highly lethal tumor.

Chinese name

Melanoma

Foreign name

Most melanomas are balck or brown

Scientific name

Skin malignant melanoma (malignant melanoma)

Features

Color changes. The edges are uneven.

treatment method

Surgical treatment

Skin malignant melanoma is a highly malignant tumor. Compared with various other malignant tumors, malignant tumors are easier to detect early. Malignant melanoma is mostly primary, but it is not uncommon for long-term pigmented skin lesions to turn into melanoma. Traumatic injuries, repeated friction, laser, freezing, and chemical caustic eliminators can cause malignant changes. When the thickness of the tumor is less than 0.75mm, the correct treatment survival rate can reach 90-95%. Once the thickness exceeds 4mm, the 5-year survival rate is about 30%. The treatment of advanced malignant melanoma is still a very difficult problem. Primary malignant melanoma appears as skin nodular or radiative growth lesions. Can be brownish yellow, brown, blue, pink, black, normal skin texture disappears, edges can be jagged, lesions can be locally raised, secondary ulcers, bleeding and pain. Satellite nodules can appear in the later stages, and regional lymph node enlargement can occur in lymph node metastasis.

The following conditions often indicate early malignant changes in pigmented skin lesions: Color changes. The edges are uneven. The lesions bulge and increase rapidly in the short term. The surface is not smooth, scaling, exudation, bleeding. Local pain.

(A) surgical treatment

1. Biopsy surgery: For patients with suspected malignant melanoma, the lesion should be removed along with the surrounding normal skin and subcutaneous fat from 0.5cm to 1cm, and the pathological examination will be performed. If it is confirmed as malignant melanoma, then based on the depth of infiltration, decide whether to Complementary extensive resection is required. Excision or clamp biopsy is generally not performed, unless the lesion has ulcer formation, or because the lesion is too large, a pathological confirmation must be performed first to cause disfiguration or disability, but the biopsy must be closer to the radical surgery. The better. In a set of prospective analysis, the World Health Organization's Collaborative Evaluation and Evaluation Center for Malignant Melanoma believed that resection biopsy not only had no adverse effect on the prognosis, but also could understand the depth and extent of lesion infiltration through biopsy, which is conducive to the formulation of more reasonable and appropriate surgical plans .

2. Resection range of primary lesions: The old point of view is that when removing lesions, 5 cm of normal skin must be removed. Most extratumor scientists treat thin lesions with a thickness of 1mm, and only remove 1cm of normal skin outside the margin of the tumor, and those with a thickness of more than 1mm should perform extensive resections 3cm to 5cm from the edge of the tumor. Malignant melanoma at the extremities often requires amputation (toe) surgery.

3 Regional lymphadenectomy

(1) Indications: Most oncologists in the United States have the following treatment attitudes: those with a lesion thickness 1mm have a very low metastasis rate, and preventive lymphadenectomy cannot be expected to change the long-term prognosis; lesion thickness> 3. The possibility of occult distant metastasis is high in 5cm to 4mm, and the long-term survival rate is relatively low (20% to 30%). Even if prophylactic lymphadenectomy is performed, it is difficult to expect a meaningful survival rate. improve. Nevertheless, as long as there are no distant metastases to be investigated, many people should be involved in preventive lymphadenectomy; For lesions with a thickness between the above two types, the occult lymph node metastasis rate is quite high, which is for prevention Sexual lymphadenectomy is expected to improve the best target for survival.

(2) Scope of regional lymph node removal: When cervical lymph node removal is performed for head and neck malignant melanoma, those with primary tumors on the face should focus on removing the lymph nodes in the parotid gland, subcondylar and submandibular triangles; if the lesions are in the occipital region, focus on clearance Lymph nodes in the posterior cervical triangle. Malignant melanoma that occurs in the upper limbs requires axillary lymph node removal. Those who develop in the lower limbs should undergo inguinal or iliac inguinal lymph node removal. Malignant melanomas that occurred in the thorax and abdomen were used for ipsilateral axillary or groin lymphadenectomy, respectively.

4 Palliative resection: For patients with large lesions and distant metastases that are not suitable for radical surgery, in order to relieve ulcer bleeding or pain, as long as the anatomical conditions permit, you can consider deductive surgery or palliative resection.

(Two) radiation therapy

Except for some very early freckled malignant melanomas, which are effective for radiation therapy, they are generally not effective for other primary lesions. Therefore, radiation therapy is generally not used for primary lesions, but radiation therapy for metastatic lesions. At present, the commonly used radiation dose is: for superficial lymph nodes, soft tissues and metastases in the thoracic cavity, abdominal cavity, and pelvic cavity, each exposure is 500cCy, twice a week, the total amount is 2000 4000cCy, and the bone metastases are 200 400cCy. , The total amount is more than 3000cCy.

(Three) chemotherapy

1. Single medication

(1) nitrosoureas: have a certain effect on melanoma. According to comprehensive literature reports, BCNU treated 122 cases of melanoma with an effective rate of 18%, MeCCNU treated 108 cases with an effective rate of 17%, and CCNU treated 133 cases with an effective rate of 13%.

(2) Azentimine (DTIC): Due to the appearance of DTIC, the treatment of melanoma has taken a step forward and become the most widely used drug. GaiIanl reported that DTIC had the best effect, treating 28 cases of melanoma with a dose of 350 mg / m2 for 6 days, and 28 days as a course of treatment, with an effective rate of 35%.

2. Combined use: Malignant melanoma is not very sensitive to chemotherapy, but combined use can improve the effectiveness and reduce the toxicity. Commonly used combined chemotherapy is as follows:

(1) DAV (DTIc, ACNu, VCR) is the first chemotherapy regimen for melanoma. Medication method: DTIcloo 200mg, iv d1 5ACNU100mgiv d1VCR 2mg iv d1, repeated once every 21 days.

(2) DDBT scheme (DTIC, DDP, BCNU, TAM) Usage: DTIC220mg / m2, intravenous injection d1 3 / 3w, DDP 25mg / m2, intravenous drip d1 3w, BCNUl50mg / m2, intravenous injection d1 / 6w, TAM10mgPO , 2 / d. The effective rate is 52.5%.

(3) CBD protocol (CCNU, BLM, DDP) usage: CCNU 80mg / m2, oral, d1 / 6w, BLM15u / m2, intravenous injection d3 ~ 7 / 6w, DDP 40mg / m2, intravenous injection d8 / 6w. Effective rate is 48%.

(IV) Immunotherapy

The spontaneous regression of malignant melanoma is related to the immune function of the body. BCG can make lymphocytes in melanoma patients concentrate on tumor nodules, stimulate patients to produce a strong immune response, and achieve the effect of treating tumors. BCG can be applied by skin scratching, intratumoral injection and oral administration. Intratumoral injection of BCG into small local lesions, the effective rate can reach 75% to 90%. In recent years, trials of biological response modifiers such as interferon, interleukin-2 (ILA-2) and lymphokine-activated killer cells (LAK cells) have been made, and certain effects have been achieved.

(V) Nutrition treatment

All health problems are related to nutrition, and tumors are no exception. More and intensive vitamins and minerals needed by the body, especially the intake of vitamin C and vitamin E, the amount must be large, this can be gradually improved.

prevention

Avoid sunlight as much as possible. The use of sun screens is an important first-level preventive measure, especially for those at high risk. It is important to strengthen the education of the general public and professionals, and improve three early, early detection, early diagnosis, and early treatment. It is even more important. .

[Prognosis]

(I) Depth of tumor invasion. Tumor thickness is closely related to prognosis. An analysis of the efficacy of 1442 cases of malignant melanoma reported by Balch et al. (1982). The 5-year survival rate of 357 patients with primary lesions 0.75 mm was 89% and 4 mm. Only 25%.

(2) Comprehensive literature on lymph node metastasis: The 5-year survival rate of patients with metastasis in 1 to 3 lymph nodes is 41% to 58%, and that in patients with more than 4 metastases is 8% to 26%. Although the lesion thickness and lymph node metastasis both affect the prognosis Important factors, but the presence or absence of lymph node metastasis seems to have a greater impact on prognosis.

(C) the location of the lesion According to clinical analysis, the efficacy of malignant melanoma varies according to the location of the site. It is generally believed that the prognosis of the trunk is the worst, followed by the head and neck, and the limb is better.

(IV) Surgical method According to the standard of wide resection range proposed by Morton, the resection range of lesion thickness 0.75mm is 2cm 3cm from the tumor edge, thickness> 0.75mm and 3cm 4cm when the thickness is 4mm, and the thickness is greater than 4mm. Extensive resection of the tumor margin 5cm can reduce the local recurrence rate. Improper local resection makes the local recurrence rate as high as 27% to 57%. Once a local recurrence occurs, it is difficult to perform a very thorough extensive resection; the same is true for the treatment of regional lymph nodes. Often promote tumor spread to the whole body.

(5) The prognosis of juvenile malignant melanoma with rare age and sex is better, and the prognosis of patients with malignant melanoma under 45 years old is better than that of older patients. The prognosis of female patients is significantly better than that of males.

Melanoma, also known as malignant melanoma, should be distinguished from similar diseases. This disease is mostly seen in adults over 30 years of age. It occurs more frequently in the skin of the feet, vulva and around the anus. It can be malignant in the beginning, but usually results from malignant nevus. The rates of recurrence and metastasis of melanoma are high, and the prognosis is poor. What are the factors affecting the prognosis of melanoma?

1. Related to tumor invasion depth According to the World Health Organization's follow-up of a group of malignant melanin, the prognosis is closely related to tumor thickness. The 5-year survival rate was 89% for tumors 0.75 mm, and only 25% for patients 4 mm.

2. Lymph node metastasis: The 5-year survival rate of those without lymph node metastasis was 77%, while those with lymph node metastasis were only 31%. Survival is also related to how much lymph nodes metastasize.

3 The location of the malignant melanoma at the lesion site is related to the prognosis. The worst prognosis occurred in the trunk, with a 5-year survival rate of 41%; the head was next, with a 5-year survival rate of 53%; the limbs were better, the 5-year survival rate was 57% in the lower limbs, and 60 in the upper limbs. %; Melanoma that occurs in the mucosa has a worse prognosis.

4 Age and gender