个性化的一步黑色素瘤手术和过时/现行的皮肤黑色素瘤外科治疗指南:事实与争议

Q4 Medicine
G. Tchernev, N. Oliveira, L. Kandathil, I. Terziev, I. Lozev, S. Chernin, I. Pidakev, J. Patterson
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引用次数: 0

摘要

摘要一步黑色素瘤手术(OSMS)是一种创新的、个性化的皮肤黑色素瘤外科治疗方法,它不仅遵循AJCC和EJC推荐的全切除领域,而且比这些指南具有显著优势;即在单个外科会话内进行该过程。皮肤黑色素瘤的个性化手术治疗指南可用于疾病的任何阶段。这些新引入的指南的理想目的/目标是减少局部和远处复发的次数,并在后续阶段阻止黑色素瘤的发展。根据AJCC/EJC指南,组织学决定了后续或第二次手术干预的程度,与此相反,个性化一步黑色素瘤手术的主要起点是完全不同的,并且基于复杂的最终评估,包括:1)有利于皮肤黑色素瘤的临床和皮肤镜特征,2)术前超声测定肿瘤厚度,如果可能,3)共聚焦显微镜的传导。新创建的OSMS指南的另一个重要和创新的建议是要求术前测量和随后组织病理学确定的手术切缘之间的绝对互惠。迄今为止,根据先前制定的指南(AJCC/EJC),缺乏这种互惠性,这严重质疑了医学领域共享的关于切除区域大小的数据的可靠性。介绍了三名疑似黑色素细胞病变的患者,并讨论了个性化一步黑色素瘤手术与两步黑色素癌手术(AJCC/EJC)的适用性、优缺点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Personalised Оne Step Melanoma Surgery and the Outdated/Current Guidelines for Surgical Treatment of Cutaneous Melanoma: Facts and Controversies
Abstract One step melanoma surgery (OSMS) is an innovative, personalized approach to the surgical treatment of cutaneous melanoma, which not only follows the total resection fields recommended by AJCC and EJC, but also has a significant advantage over these guidelines; namely, conduction of the procedure within a single surgical session. Guidelines for personalized surgical treatment of cutaneous melanoma can be used at any stage of the disease. The ideal purposes/goals of these newly introduced guidelines are to reduce the number of locoregional and distant recurrences and to stop the advancement of melanomas in a subsequent stage. In contrast to the histology, which under AJCC/EJC guidelines determines the extent of the subsequent or second surgical intervention, the leading starting points for personalized one step melanoma surgery are completely different and based on a complex final assessment, including: 1) clinical and dermatoscopic characteristics in favor of cutaneous melanoma, 2) preoperative ultrasound determination of tumor thickness, and, if possible, 3) the conduction of confocal microscopy. Another important and innovative proposal of the newly created OSMS guidelines is the requirement of absolute reciprocity between the preoperatively measured and subsequent histopathologically established surgical margins. The lack of such reciprocity under previously established guidelines (AJCC/EJC) till the present moment seriously calls into question the reliability of the data shared in the medical field concerning the size of resection fields. Three patients with suspected melanocytic lesions are presented and the applicability, advantages, and disadvantages of the personalized one step melanoma surgery versus two step melanoma surgery (AJCC/EJC) are discussed.
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来源期刊
Acta Medica Bulgarica
Acta Medica Bulgarica Medicine-Medicine (all)
CiteScore
0.30
自引率
0.00%
发文量
33
审稿时长
25 weeks
期刊介绍: About 30 years ago - in 1973, on the initiative of the Publishing House „Medicine and Physical Culture", namely its former director Mr. Traian Ivanov, the Ministry of Health set up and accepted to subsidize a new medical magazine that was to be published only in the English language and had to reflect the status and the achievements of the Bulgarian medical science. Thus the language barrier was overcome and stable relations were established with the international medical society, large libraries, and university centers. The famous internationally known scientist professor Assen A. Hadjiolov was elected edition-in-chief by the first editorial staff and the magazine was named Acta Medica Bulgarica.
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