I’m sure you’ve seen the movie “Do Not Disturb 2” starring Ge You will be alerted to the pigmented moles on your body, is my pigmented mole benign or malignant? Will the pigmented mole on my body become malignant? What are the chances of malignancy? I will present the latest research progress of melanoma international below.
Melanoma is a malignant tumor arising from melanocytes in the skin and other organs, and its incidence has continued to increase in recent years. Its high malignancy, early onset of metastasis, and high mortality rate make early diagnosis and early treatment important, and early diagnosis can significantly reduce mortality. Sunlight exposure is the main risk factor for the development of melanoma.
Clinical diagnosis.
Melanoma is a unique cancer, most of which presents pigmented and occurs on the skin surface, and the disease can be detected early. However, there are still important diagnostic barriers. Common moles and other benign pigmented lesions are confused and reduce the diagnosis of melanoma. The pathologic diagnosis of melanoma is sometimes challenging, and the lack of clear molecular diagnostic and prognostic stratification factors leads to a significant risk of overdiagnosis.
The core of the clinical diagnosis of melanoma remains the history taking and whole body skin examination. Clinical symptoms of cutaneous melanoma, including bleeding, pruritus, pressure pain, and ulceration, are generally age-related, with younger patients typically presenting with pruritus, color changes and enlarged lesions, and older patients typically presenting with ulceration of the lesions, usually suggesting a poor prognosis. Suspicious lesions can be judged by ABCDE criteria: A (Asymmey) for asymmetry, B (Borderirregularity) for border irregularity, C (Colorvariegation) for color diversification, D (Diameter>6mm) for diameter greater than 6mm, and E (Elevation, evolving) for lesion elevation. evolving) represents lesion elevation and progression. If the lesions meet the ABCDE criteria, melanoma is highly suspected and a biopsy is needed for histopathological examination to further confirm the diagnosis. However, some subtypes, such as nodular melanoma, cannot be judged by ABCDE criteria.
Histopathologic staging.
The current clinical histologic staging of melanoma uses the Clark staging, which includes four types: malignant freckled nevus-like melanoma (LMM); superficial diffuse melanoma; limbal freckle-like melanoma, mucosal melanoma; and nodular melanoma (NM). Among all Asians with malignant melanoma, extremity freckle-like melanoma and mucosal melanoma, which occur in less sun-exposed areas, account for 72% of all malignant melanomas.
Adjuvant diagnostic devices.
Several ancillary diagnostic techniques are currently available to aid in the diagnosis of malignant melanoma. For example, dermoscopy, continuous digital dermoscopic imaging and digital body photography. Dermoscopy has been shown to improve the diagnostic accuracy of primary malignant cutaneous melanoma compared to visual inspection and to reduce unnecessary biopsies of benign skin tumors.
Treatment.
1. Localized melanoma and localized regional melanoma.
Surgical excision is the standard treatment option for primary cutaneous melanoma without clinical regional lymph node involvement (i.e., localized melanoma, or localized regional melanoma if the patient has positive regional lymph nodes). Two aspects need to be considered when planning the procedure: the margins of the melanoma and the method of regional lymph node dissection. Other skin lesions, regional lymph node lesions (lymph node enlargement), satellite foci, signs and symptoms of distant metastases must be detected preoperatively, as any such findings can alter the treatment plan.
2. Local treatment of distant metastatic melanoma and distant metastases.
For patients with distant metastases to visceral or non-visceral organs, a histologically confirmed diagnosis and a complete staging study are required. Re-staging usually includes MRI of the brain (or CT scan with venous control), as well as whole-body PET-CT or CT of the chest, abdomen, and pelvis to obtain imaging data on the most common metastatic sites of melanoma.
Unlike localized melanoma, surgery is not usually an option for advanced metastatic melanoma. However, for limited metastases in soft tissue or a single visceral organ, the multidisciplinary treatment team should discuss the feasibility of complete resection of the metastases after determining tumor characteristics (e.g., tumor kinetics). However, for most patients, surgery for distant metastases is palliative and, only in rare cases, curative. Common indications for palliative surgery or radiotherapy are brain metastases, bleeding or obstruction after small bowel metastases, and symptomatic lesions (skin, subcutaneous tissue, lymph nodes, or bone). Patients with isolated metastases (including the brain) may occasionally obtain long-term postoperative control.
3. Systemic treatment.
(1) Eprilimumab (ipilimumab) has been approved in North America, Europe and Australia for patients with inoperable or metastatic melanoma (3 mg/Kg administered 4 times at 3-week intervals).
②Two oral BRAF inhibitors (virofinib and darafenib) have been widely used in North America, Europe and Australia for the treatment of metastatic melanoma with BRAFV600 mutations.
The most advanced of these is the acquisition of tumor-derived T cells, which are expanded in vitro for a period of time and then transfused back, which is known as tumor-infiltrating lymphocyte (TIL) ACT. ACT has demonstrated antitumor activity in patients with advanced melanoma. The most advanced ACT therapy is TIL, with a response rate of more than 50% to treatment in patients with advanced melanoma.
④ Albumin-bound paclitaxel, the only improved PFS (progression-free survival) this could be an additional option.