Author/Editor | Planinšek, Franc; Arnež, Zoran M | |
Title | Kirurško zdravljenje malignega melanoma | |
Translated title | Surgical treatment of malignant melanoma | |
Type | članek | |
Source | Radiol Oncol | |
Vol. and No. | Letnik 33, št. Suppl 1 | |
Publication year | 1999 | |
Volume | str. S40-4 | |
Language | slo | |
Abstract | Although the incidence and the mortality rates of malignant melanoma (MM) have been increasing worldwide and in Slovenija for the last several decades, the survival rates are improving. The apparent contradiction may be expained by the increase in early diagnnosis of MM. If detected early in its clinical course MM can be cured by a simple surgical excision in majority of patients. The decision about the margins of the surgical excision of the primary melanoma site has been made more rational through correlations of rates of local control with different margins of resection in relation to the domianant prognostic factor for localized melanoma, the thickness of the lesion. When possible, primary closure of the post-excisional defect should be performed. If primary closure is impossible, the wound may be closed by split or full thickness skin grafting, local, regional or free flaps. Elective dissection has not been shown in prospective randomized trials to alter survival significantly. Surgical treatment of distant metastases is indicated only as palliation of a solitary symptomatic lesion (brain metastases, lung or gastrointestinal metastases). | |
Summary | Incidenca in umrljivost zaradi malignega melanoma (MM) rasteta v svetu in pri nas. Kljub temu je prognoza bolezni danes boljša zaradi zgodnejšega odkrivanja MM. MM je v zgodnjem kliničnem obdobju ozdravljiv s preprostim kirurškim izrezom sumljivo spremenjenega tkiva z varnostnim robom. Primerjava debeline tumorja in uspešnosti lokalnega nadzora bolezni ob izrezih različno širokega varnostnega pasu je zožila varnostni pas iz prejšnjih 5 in več cm ("široka ali razširjena ekscizija") na 1 do 2 cm. Zato lahko danes pri večini bolnikov z malignim melanomom zapremo nastalo tkivno vrzel po odstranitvi tumorja zgolj z neposrednim šivom rane, le redko pa s prostimi kožnimi presadki in lokalnimi, oddaljenimi ali prostimi režnji. Izbirna (elektivna) odstranitev področnih bezgavk ni smiselna. Za terapevtsko odstranitev področnih bezgavk se odločimo pri pozitivni varovalni bezgavki oz. pri na otip povečanih regionalnih bezgavkah brez znakov sistemskega razsoja. Osamljene (solitarne) oddaljene zasevke odstranimo izjemoma in le v tistih primerih, ko postanejo simptomatski. (npr.zvišan intrakranialni tlak, mehanska ovira v prehodnosti cevastih organov, motnje dihanja, pojav zlatenice). | |
Descriptors | MELANOMA SKIN NEOPLASMS LYMPH NODE EXCISION |