malignant melanoma
Introduction
Introduction to malignant melanoma Malignant melanoma occurs in white races, and Australia's QueenS-Land is the world's most prevalent area of malignant melanoma. The incidence of malignant melanoma in China is not high, but due to the lack of understanding of the seriousness of doctors and patients, it is often too late at the time of treatment, and the treatment effect is extremely unsatisfactory. The disease occurs in 30 to 60 years old, and rare cases of juvenile malignant melanoma Spity have been reported in 13 cases, aged from 1.5 to 12 years old. The younger ones generally have a lower degree of malignancy and have a better prognosis after surgical resection. There is almost no difference in the sex of the disease. Only the lesions are related to gender. Most of the people in the trunk are male, and more women than men in the limbs. Especially the facial freckles type melanoma is more common in older women. basic knowledge Sickness ratio: 0.0001% Susceptible people: good at 30 to 60 years old Mode of infection: non-infectious Complications: retinal detachment glaucoma
Cause
Cause of malignant melanoma
Race (15%):
White hair, blue eyes, pale skin. White people are prone to suffering, black people or dark-skinned people are suffering from this disease. If it occurs, the skin of the palm is white. Most scholars believe that about half of malignant melanoma occurs on the basis of existing black sputum.
Dysplasia Syndrome (25%):
This is an autosomal genetic disease. The person with this disease is covered with large, flat, flat, irregular shape, meager, and different colors. One or more of them have malignant melanoma in most patients. Some people have This syndrome, but no genetic predisposition, should also be closely observed to be alert to the appearance of malignant melanoma.
Other factors (20%):
Sunburn, recently it has been pointed out that secondary sunburn (with blisters) is more effective than the general sun exposure in the cause of the disease. In addition, the disease is also associated with congenital amnesia.
Pathological typing
1. The superficial extension type, which accounts for about 70%, can be found anywhere on the body surface, first spreading outward along the superficial layer of the body surface, and expanding to the deeper layer of the skin in a longitudinal direction for a long time, that is, the so-called "vertical development period" of the disease.
2. Nodular type, about 15%, also seen in any part of the body surface, mainly in vertical development, invading the subcutaneous tissue, prone to lymphatic metastasis, more fatal.
3. The genital black sputum type, accounting for about 10%, occurs mostly in the palms, soles, nail beds and mucous membranes.
4. Freckle type, accounting for about 5%, occurs from the black freckles that have been stored for a long time in the face of the elderly. This type of growth in the horizontal direction can be extended to 2cm to 3cm or more.
5. Radiation-growth untyped malignant melanoma.
6. Malignant melanoma of malignant mite.
7. Malignant melanoma of the oral, vaginal, and anal mucosal origin.
8. A malignant melanoma with unknown origin.
9. A malignant melanoma that originates from blue sputum.
10. Visceral malignant melanoma.
11. Childhood malignant melanoma originating from intradermal fistula.
Growth mode
According to the way of tumor cell growth and diffusion, it can be divided into radiation growth period and vertical growth period. The growth of tumor cells along the basal layer of the epidermis and the dermal papilla layer is called radiant growth, which is common in freckles and superficial. The early stage of invasive and extremity malignant melanoma can last for several years. Because the primary tumor does not or rarely metastasize to the lymphatic during this period, a simple surgical resection can achieve better curative effect. To the dermis, when the subcutaneous tissue is deeply infiltrated, it is called vertical growth. The nodular melanoma can enter the vertical growth phase without radiation. In this period, lymph node metastasis is easy to occur.
Infiltration depth
A truly milestone in the study of malignant melanoma is the recognition that the risk and prognosis of metastasis are closely related to the thickness of the lesion and the level of invasion of the skin. Measuring the thickness of malignant melanoma lesions in millimeters is more accurate and in each pathology. It has become a standard for comparison between homes, and it has become the yardstick for estimating the risk of lymph node metastasis and judging the prognosis. At present, some famous medical centers in the world are very much infering the thickness of tumors directly measured by Breslow's eyepiece micrometer proposed in 1970. To estimate the prognosis, they divided the tumor thickness into 0.75mm, 0.75~1.5mm and >1.5mm3. Some authors divided the >1.5mm into several files to further observe the relationship between tumor thickness and prognosis. .
Prevention
Malignant melanoma prevention
Try to avoid sun exposure. The use of sun screen is an important primary prevention measure, especially for those at high risk, to strengthen education for the general public and professionals, to improve early morning, early detection, early diagnosis, early treatment, and more important .
(1) Depth of tumor invasion
Tumor thickness is closely related to prognosis. The therapeutic effect of 1442 cases of malignant melanoma reported by Balch et al. (1982) showed that the 5-year survival rate of 357 patients with primary lesion 0.75mm was 89%, and that of 4mm was only 25%.
(two) lymph node metastasis
The 5-year survival rate of patients with metastasis from 1 to 3 lymph nodes was 41% to 58%, and that of 4 or more metastases was 8% to 26%. Although lesion thickness and lymph node metastasis are important factors affecting prognosis, lymph nodes Transferring or not seems to have a greater impact on the prognosis.
(three) lesions
According to clinical analysis, the site of malignant melanoma is different, and the prognosis of the trunk is generally considered to be the worst, followed by the head and neck, and the limb is better.
(four) surgical methods
According to the standard of extensive resection range proposed by Morton, the resection range of lesion thickness 0.75mm is 2cm3cm from the edge of the tumor, thickness is 0.75mm and 4mm is 3cm4cm, thickness>4mm is 5cm from the edge of the tumor. Excision, which can reduce the local recurrence rate, inappropriate local resection, so that the local recurrence rate is as high as 27% to 57%, and it is difficult to perform a thorough resection after a local recurrence; the treatment of regional lymph nodes is also a Regional lymph node dissection, which does not meet the specifications, often promotes the spread of tumors throughout the body.
(5) Age and gender
The rare prognosis of juvenile malignant melanoma is better. 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 men.
Complication
Malignant melanoma complications Complications, retinal detachment, glaucoma
If the tumor is located in the macular area, the patient may have visual distortion or vision loss in the early stage of the military. For example, there is no symptom in the peripheral part of the fundus. According to the tumor growth, there are two limitations, the former and the former. The localized manifestations are spherical bulges that protrude into the vitreous cavity, and there is often exudative retinal detachment around; diffuse people develop along the choroidal level, which is generally increased and the bulge is not obvious, easily missed or misdiagnosed, and prone to occur. Extraocular and systemic metastases can be transferred to the sclera, optic nerve, liver, lung, kidney and brain, and the prognosis is very poor, due to exudate, pigment and tumor cells blocking the anterior chamber, tumor compression vortex vein, or Major hemorrhage caused by tumor necrosis, etc., causes secondary glaucoma. In tumor growth, endophthalmitis or total ocular inflammation can be caused by high necrosis of the tumor, which is also called camouflage syndrome.
Symptom
Symptoms of malignant melanoma Common symptoms Edema pigmented skin lesions Skin anterior chamber pigmentation
In order to carefully examine the skin lesions, good light and hand-held magnifying glass are essential. The following changes in pigmented skin lesions often suggest the possibility of early malignant melanoma:
1 color: Most malignant melanomas have brown, black, red, white or blue mixed unevenness. In case of skin color changes, special vigilance should be taken.
2 edge: often jagged changes in a zigzag, resulting in the spread of the tumor to the surrounding or self-degeneration.
3 surface: not smooth, often rough with scaly or flaky desquamation, sometimes with exudate or oozing, the lesion can be higher than the leather surface.
4The skin around the lesion may have edema or loss of original skin luster or white, gray, 5 paresthesia: local itching often, burning or tenderness, when the above changes occur, it is strongly suggested that there is malignant melanoma, you can It is no exaggeration to say that if there is any change in skin sputum, a biopsy should be performed to remove malignant melanoma.
Examine
Examination of malignant melanoma
Early diagnosis is sometimes difficult. It is necessary to ask in detail the medical history, family history, detailed systemic and eye examinations. In addition, scleral transillumination, ultrasound, FFA, CT and MRI should be performed to make a diagnosis. If necessary, a biopsy is needed for histopathological examination to further confirm the diagnosis.
Histopathology: Melanocytes are abnormally proliferating, forming some cell nests in the epidermis or in the epidermis-dermis boundary. These cell nests vary in size and can fuse with each other. The size and shape of melanocytes in the nest, as well as the shape of the nucleus, vary to varying degrees. Mitosis (including abnormal mitosis) is more common than benign pigmented nevi, with pigmented granules in the cytoplasm of tumor cells. In invasive malignant melanoma, tumor cells infiltrate into the dermis or subcutaneous tissue. Immunohistochemical staining: tumor cells were positive for S100, positive for HMB45, and positive for MelanA.
Diagnosis
Diagnosis and diagnosis of malignant melanoma
This disease should be distinguished from benign borderline tumors. For suspected skin lesions, the ABCDE standard can be used for judgment. A (Asymmey) represents asymmetry, B (Borderirregularity) represents boundary irregularity, C (Colorvariegation) represents color diversity, D (Diameter>6mm) represents a diameter greater than 6 mm, and E (Elevation, evolving) represents skin lesion bulging and progression. If the lesion is highly suspected of malignant melanoma in accordance with ABCDE criteria, a biopsy is required for histopathological examination to further confirm the diagnosis. However, some subtypes such as nodular melanoma lesions cannot be judged by the ABCDE criteria.
Pathological classification:
1. Invasion depth grading Clark (1969) after studying the relationship between the depth of invasion of melanoma and prognosis, the melanoma was divided into 5 grades according to the depth of invasion. The higher the grade, the worse the prognosis.
Grade I: Tumor cells are restricted to the epidermis above the basement membrane.
Grade II: Tumor cells break through the basement membrane and invade the dermal papilla.
Grade III: The tumor cells are filled with the dermal papilla layer and further invade downward, but not to the dermal reticular layer.
Grade IV: Tumor cells have invaded the dermal reticular layer.
Grade V: The tumor cells have passed through the dermal reticular layer and invaded the subcutaneous fat layer.
2. Vertical thickness grading Breslow (1970) studied the relationship between the vertical thickness of melanoma and prognosis. According to the thickest part of the melanoma measured by the eyepiece micrometer (from the granular layer to the deepest part of the melanoma), the melanoma was divided into two. Level 5:
Less than 0.75 skin malignant melanoma, 0.76 to 1.50 skin malignant melanoma, 1.51 to 3.00 skin malignant melanoma, 3.01 to 4.50 skin malignant melanoma, and greater than 4.50 skin malignant melanoma. The greater the thickness, the worse the prognosis. This microscopic fractionation method has been widely adopted in the future and has proven to be of great value in judging prognosis.
