Abstract:
Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumor and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts\' experience. The diagnosis of melanoma can be made clinically and shall always be confirmed with dermatoscopy. If a melanoma is suspected, a histopathological examination is always required. Sequential digital dermatoscopy and full body photography can be used in high-risk patients to improve the detection of early melanoma. Where available, confocal reflectance microscopy can also improve clinical diagnosis in special cases. Melanoma shall be classified according to the 8th version of the American Joint Committee on Cancer classification. Thin melanomas up to 0.8 mm tumor thickness do not require further imaging diagnostics. From stage IB onwards, examinations with lymph node sonography are recommended, but no further imaging examinations. From stage IIC onwards whole-body examinations with computed tomography (CT) or positron emission tomography CT (PET-CT) in combination with brain magnetic resonance imaging are recommended. From stage III and higher, mutation testing is recommended, particularly for BRAF V600 mutation. It is important to provide a structured follow-up to detect relapses and secondary primary melanomas as early as possible. There is no evidence to define the frequency and extent of examinations. A stage-based follow-up scheme is proposed which, according to the experience of the guideline group, covers the optimal requirements, but further studies may be considered. This guideline is valid until the end of 2024.
摘要:
皮肤黑色素瘤(CM)可能是最危险的皮肤肿瘤形式,并导致90%的皮肤癌死亡率。来自欧洲皮肤病学论坛(EDF)的多学科专家的独特合作,欧洲皮肤肿瘤协会(EADO)和欧洲癌症研究和治疗组织(EORTC)成立,对CM诊断和治疗提出建议,基于系统的文献综述和专家的经验。黑色素瘤的诊断可以在临床上进行,并且应始终通过皮肤镜检查来确认。如果怀疑是黑色素瘤,总是需要进行组织病理学检查。顺序数字皮肤镜和全身摄影可用于高危患者,以提高早期黑色素瘤的检测。如有,在特殊情况下,共聚焦反射显微镜还可以改善临床诊断。黑色素瘤应根据美国癌症分类联合委员会的第8版进行分类。肿瘤厚度高达0.8mm的薄黑素瘤不需要进一步的成像诊断。从IB阶段开始,建议进行淋巴结超声检查,但没有进一步的影像学检查。从IIC阶段开始,建议使用计算机断层扫描(CT)或正电子发射断层扫描CT(PET-CT)结合脑磁共振成像进行全身检查。从第三阶段和更高的阶段,建议进行突变测试,特别是对于BRAFV600突变。重要的是提供结构化的随访以尽早检测复发和继发性原发性黑素瘤。没有证据可以定义检查的频率和范围。提出了一种基于阶段的后续方案,根据指导小组的经验,涵盖了最佳要求,但可以考虑进一步的研究。该指南有效期至2024年底。