| Popis: |
Melanoma is an aggressive skin malignancy whose incidence is on the rise, partly due to an increase in sun exposure and tanning practices and partly due to improved detection. Classically it presents as a pigmented lesion with many of the following features: asymmetry, border irregularity, color variegation, and diameter greater than 6 mm. The major subtypes are superficial spreading melanoma, nodular melanoma, acral-lentiginous melanoma, and lentigo maligna melanoma. Excisional biopsy is recommended for diagnosis and staging. Melanomas are preferably treated by surgical resection, and reconstruction of the defect is delayed until negative margins are confirmed on final pathology. Sentinel lymph node biopsy can be considered, as biopsy-based neck dissection improves disease-free survival in patients with intermediate-thickness melanomas who have nodal metastasis. It remains an open question whether micrometastasis mandates completion neck dissection. Patients with stage IIB, stage IIC, or stage III melanoma are candidates for adjuvant therapy with interferon or peginterferon. Those with distant metastases may undergo immunotherapy with interleukin-2 or with antibodies to CTLA-4 or PD-1, while stage IV patients with a BRAF mutation are candidates for BRAF inhibitors or MEK inhibitors. |
