1、,“非诚勿扰”与恶性黑色素瘤,catalogue,What is malignant melanoma?Melanoma triggers and causesPrimary sitesClinical characteristicsEarly clinical performanceLate-stage clinical manifestationsPathological typeTreatment2010 melanoma field progress review,What is malignant melanoma?,Malignant melanoma, also known as
2、 melanoma, is the origin of epidermal melanocyte or nevus of malignant tumors.The disease can be seen at any age, more seen in middle-aged and older, women slightly more than men.,Melanoma triggers and causes,Air pollutionTo pursue beautyThe lack of medicine knowledgeImmune deficiencyAbusing the est
3、rogen drugsMalignant transformation of black moleRacial genetic factors Trauma and chronic stimulation factors,Air pollution,Harmful ultraviolet light and some harmful material in the air make a difference of human skin, causing melanocyte abnormal expression, trigger melanoma.,Many people in order
4、to pursue the clean skin to use chemical cosmetics, skin pollution caused by chemical, even someone with chemical mordant purify skin a mole, stimulates the excessive proliferation melanocyte.,To pursue beauty,Racial genetic factors,Malignant melanoma occur in the white race. For the incidence of wo
5、rld each year to less than 1 2/10 million, but Australias Queensland annual incidence of 16/10 million population, it is the worlds leading high incidence of malignant melanoma. Africa and Asian people rarely have the sickness.,Primary sites,Malignant melanoma 90 % occurs in the skin, the most commo
6、n in the back, metal-studded ,leg, foot, toe, nail bed, scalp and so on ; a few occurs in vulvae, digestive tract and eyes.,Eye lesionsand Oral lesions,脉络膜黑色素瘤,口腔黑色素瘤, Generally speaking moles surface is smooth, melanoma of surface is coarser. If the surface is smooth, and suddenly becomes coarse or
7、 , we should pay attention to it.,Clinical characteristics,Ulceration not only is one of the important melanoma clinical manifestations which is different from mole, but also has the meaning of prognosis than no ulcer.Patients of malignant melanoma generally are the old; the youth or children melano
8、ma are rare .,Early clinical performance,Color: a mole increase in size, pigment or darker or lighter, a mole deepen, shiny, appear color changed . Edge: a mole to radiate out in moles expansion, appear around uneven indented change; become irregular or appear satellite form small a mole, or several
9、 birthmark fusion, the surface concavo-convex inequality .Surface: rough; Often coarse and accompanied by scale form or flake desquamation. Sometimes have the drainage or ooze blood, higher lesions can face .,Lesions surrounding skin :can appear edema or lose skin gloss or become white, gray.Kakesth
10、esia: a mole without itching or discomfort pain. regional lymph node enlargement, faintly visible blue-black .,早期临床表现,Late-stage clinical manifestations,Special type ：a small nodular lesion site, the boundary clear, no coated, tan-white or grey-blue, quality of a material is solid. Freckles type :mo
11、re from the primary lesions malignant freckles ; surface was flat; the edge great irregularity ; the epidermis of tumor block with freckles samples , this type often occur on elderly facial freckles lesions , which is relatively rare.,Spread type : its appearance is shallow eczema kind, and its jagg
12、ed edge is irregular ,with black, grey and pink disorderly color on the surface . Nodular type: tumor nodules are out of the skin surface; the color is dark brown, gray red and rarely colorless. Bump surface is shown more cauliflower shape, polypoid or bacteria shape, often happen ulcers .,Pathologi
13、cal type,Superficial expandable type: about 70%, it is visible at surface anywhere ; go along the surface to expand, and then expand to the depth , called the vertical development.,nodular type: about 15%,vertical development; penetrate to subcutaneous tissue; prone to lymph node metastases; even mo
14、re deadly.,Ephelides type :about 5%,it primary occur in old people facial skin where black freckles long stand; this type do horizontal growth and enlarge 2cm 3cm or more around.,Extremity black mole type: about 10% that happens at palms, foot, nail bed and mucous membranes.,Treatment,Surgical treat
15、ment : early circumscribed primary foci should be carried out extensively; the scope should be apart from the primary foci 3 5cm ; the primary foci should be excised to subcutaneous tissue and muscle membrane ; when touch the lymph node enlargement, generally speaking should make lymph node clean; a
16、fter the operation ,adjuvant chemotherapy and immune therapy is necessary .,Biological immune therapy :biological immune therapy via the various biological agents and biotechnology means to enhance immunity and anti-cancer ability to suppress and kill cancer cells; at present, immune cells such as D
17、C cells, CIK cell have applied to clinical therapy, which gains good effects; biological immune therapy is the most effective, security adjuvant therapies.,人类黑色素瘤抗原,Radiotherapy: In addition to some very early freckles type of malignant melanoma are effective, other primary foci generally have poor
18、curative effect. So we did not use radiation therapy to cure the primary foci, and metastasis adopt radiotherapy.,Endocrine therapy : anti-estrogen drugs make some cases even other drug treatment failure cases get curative effect, and make the illness to alleviate.,Chemical treatment : Single drug:
19、)亚硝脲类药物: have certain effect of melanoma. 氮烯咪胺(DTIC): DTIC has made the treatment of melanoma forward one step, become the most widely used drugs. Each dose for 350mg/m2, repeat 6 days, 28 days for one period of treatment, efficient rate is 35%., Combination: combination can improve the efficient, r
20、educe toxicity reaction. DAV case (DTIc、ACNu、VCR): the first choice for melanoma chemotherapy regimens. The preparation method: DTIcloo 200mg, 5ACNUl00mgiv d1VCR 2mg iv d1 21 days, each iv d1 repeated 1 time.,DDBT case (DTIC、DDP、BCNU、TAM) Method:DTIC220mg/m2, I.V. d1 3/3w, DDP 25mg/m2, i.v.gtt d1 3w
21、, BCNUl 50mg/m2, I.V. d1/6w, TAM 10mgPO, 2 / d. Efficient rate is 52.5%. CBD case (CCNU、BLM、DDP) Method: CCNU 80mg/m2, oral, d1/6w, BLMl 5u/m2, I.V. d3 7/6w, DDP 40mg/m2, I.V. d8/6w. Efficient rate is 48%.,2010 melanoma field progress review melanoma treatment finally usher a silver lining,Resistanc
22、e to CTLA - 4 single resistance against genetic mutations and (B - RAF and C - KIT) small molecular targeted drugs ,which prolong the survival of advanced melanoma patients and achieve remarkable breakthrough. It is possible for the treatment of advanced melanoma patients bring thorough revolution.,
23、In advanced melanoma chemotherapy , it is still the gold standard that Dacarbazine(达卡巴嗪), but efficient rate is only 8 % 12%. Many biological chemotherapy or more medicine chemotherapy period clinical studies has showed high efficient rate. But period controlled study of overall survival shows haven
24、t exceeded single-agent Dacarbazine(达卡巴嗪).,American ODay report a randomized controlled clinical research about period, its result has significance. The study proved targeted immune therapy drugs Ipilimumab to prolong period melanoma patients survival. Ipilimumab blockade the combination CTLA4 with B7 which can remove anti-tumor immunosuppression, thus ,it really mobilize specificity anti-tumor immune response.,THE END!,
