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1、“非诚勿扰”与恶性黑色素瘤非诚勿扰与恶性黑色素瘤课件catalogueWhat is malignant melanoma?Melanoma triggers and causesPrimary sitesClinical characteristicsEarly clinical performanceLate-stage clinical manifestationsPathological typeTreatment2010 melanoma field progress review非诚勿扰与恶性黑色素瘤课件Whatismalignantmelanoma?Malignantmelano
2、ma,alsoknownasmelanoma,istheoriginofepidermalmelanocyteornevusofmalignanttumors.Thediseasecanbeseenatanyage,moreseeninmiddle-agedandolder,womenslightlymorethanmen.非诚勿扰与恶性黑色素瘤课件MelanomatriggersandcausesAirpollutionTopursuebeautyThelackofmedicineknowledgeImmunedeficiencyAbusingtheestrogendrugsMalignan
3、ttransformationofblackmoleRacialgeneticfactorsTraumaandchronicstimulationfactors非诚勿扰与恶性黑色素瘤课件AirpollutionHarmfulultravioletlightandsomeharmfulmaterialintheairmakeadifferenceofhumanskin,causingmelanocyteabnormalexpression,triggermelanoma.非诚勿扰与恶性黑色素瘤课件Manypeopleinordertopursuethecleanskintousechemical
4、cosmetics,skinpollutioncausedbychemical,evensomeonewithchemicalmordantpurifyskinamole,stimulatestheexcessiveproliferationmelanocyte.Topursuebeauty非诚勿扰与恶性黑色素瘤课件RacialgeneticfactorsMalignantmelanomaoccurinthewhiterace.Fortheincidenceofworldeachyeartolessthan12/10million,butAustraliasQueenslandannualin
5、cidenceof16/10millionpopulation,itistheworldsleadinghighincidenceofmalignantmelanoma.AfricaandAsianpeoplerarelyhavethesickness.非诚勿扰与恶性黑色素瘤课件Primary sitesMalignantmelanoma90%occursintheskin,themostcommonintheback,metal-studded,leg,foot,toe,nailbed,scalpandsoon;afewoccursinvulvae,digestivetractandeyes
6、.非诚勿扰与恶性黑色素瘤课件EyelesionsandOrallesions脉络膜黑色素瘤口腔黑色素瘤非诚勿扰与恶性黑色素瘤课件Generallyspeakingmolessurfaceissmooth,melanomaofsurfaceiscoarser.Ifthesurfaceissmooth,andsuddenlybecomescoarseor,weshouldpayattentiontoit.Clinicalcharacteristics非诚勿扰与恶性黑色素瘤课件Ulcerationnotonlyisoneoftheimportantmelanomaclinicalmanifestat
7、ionswhichisdifferentfrommole,butalsohasthemeaningofprognosisthannoulcer.Patientsofmalignantmelanomagenerallyaretheold;theyouthorchildrenmelanomaarerare.非诚勿扰与恶性黑色素瘤课件EarlyclinicalperformanceColor:amoleincreaseinsize,pigmentordarkerorlighter,amoledeepen,shiny,appearcolorchanged.Edge:amoletoradiateouti
8、nmolesexpansion,appeararoundunevenindentedchange;becomeirregularorappearsatelliteformsmallamole,orseveralbirthmarkfusion,thesurfaceconcavo-convexinequality.Surface:rough;Oftencoarseandaccompaniedbyscaleformorflakedesquamation.Sometimeshavethedrainageoroozeblood,higherlesionscanface.非诚勿扰与恶性黑色素瘤课件Lesi
9、onssurroundingskin:canappearedemaorloseskinglossorbecomewhite,gray.Kakesthesia:amolewithoutitchingordiscomfortpain.regionallymphnodeenlargement,faintlyvisibleblue-black.早期临床表现非诚勿扰与恶性黑色素瘤课件Late-stageclinicalmanifestationsSpecialtype：asmallnodularlesionsite,theboundaryclear,nocoated,tan-whiteorgrey-bl
10、ue,qualityofamaterialissolid.Frecklestype:morefromtheprimarylesionsmalignantfreckles;surfacewasflat;theedgegreatirregularity;theepidermisoftumorblockwithfrecklessamples,thistypeoftenoccuronelderlyfacialfreckleslesions,whichisrelativelyrare.非诚勿扰与恶性黑色素瘤课件Spreadtype:itsappearanceisshalloweczemakind,and
11、itsjaggededgeisirregular,withblack,greyandpinkdisorderlycoloronthesurface.Nodulartype:tumornodulesareoutoftheskinsurface;thecolorisdarkbrown,grayredandrarelycolorless.Bumpsurfaceisshownmorecauliflowershape,polypoidorbacteriashape,oftenhappenulcers.非诚勿扰与恶性黑色素瘤课件PathologicaltypeSuperficialexpandablety
12、pe:about70%,itisvisibleatsurfaceanywhere;goalongthesurfacetoexpand,andthenexpandtothedepth,calledtheverticaldevelopment.非诚勿扰与恶性黑色素瘤课件nodulartype:about15%,verticaldevelopment;penetratetosubcutaneoustissue;pronetolymphnodemetastases;evenmoredeadly.非诚勿扰与恶性黑色素瘤课件Ephelidestype:about5%,itprimaryoccurinold
13、peoplefacialskinwhereblackfreckleslongstand;thistypedohorizontalgrowthandenlarge2cm3cmormorearound.非诚勿扰与恶性黑色素瘤课件Extremityblackmoletype:about10%thathappensatpalms,foot,nailbedandmucousmembranes.非诚勿扰与恶性黑色素瘤课件TreatmentSurgicaltreatment:earlycircumscribedprimaryfocishouldbecarriedoutextensively;thescope
14、shouldbeapartfromtheprimaryfoci35cm;theprimaryfocishouldbeexcisedtosubcutaneoustissueandmusclemembrane;whentouchthelymphnodeenlargement,generallyspeakingshouldmakelymphnodeclean;aftertheoperation,adjuvantchemotherapyandimmunetherapyisnecessary.非诚勿扰与恶性黑色素瘤课件Biologicalimmunetherapy:biologicalimmunethe
15、rapyviathevariousbiologicalagentsandbiotechnologymeanstoenhanceimmunityandanti-cancerabilitytosuppressandkillcancercells;atpresent,immunecellssuchasDCcells,CIKcellhaveappliedtoclinicaltherapy,whichgainsgoodeffects;biologicalimmunetherapyisthemosteffective,securityadjuvanttherapies.人类黑色素瘤抗原非诚勿扰与恶性黑色素
16、瘤课件Radiotherapy:Inadditiontosomeveryearlyfrecklestypeofmalignantmelanomaareeffective,otherprimaryfocigenerallyhavepoorcurativeeffect.Sowedidnotuseradiationtherapytocuretheprimaryfoci,andmetastasisadoptradiotherapy.非诚勿扰与恶性黑色素瘤课件Endocrinetherapy:anti-estrogendrugsmakesomecasesevenotherdrugtreatmentfai
17、lurecasesgetcurativeeffect,andmaketheillnesstoalleviate.非诚勿扰与恶性黑色素瘤课件Chemicaltreatment: Single drug: )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 o
18、ne period of treatment, efficient rate is 35%. 非诚勿扰与恶性黑色素瘤课件 Combination: combination can improve the efficient, reduce 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
19、iv d1 repeated 1 time.非诚勿扰与恶性黑色素瘤课件DDBT case (DTIC、DDP、BCNU、TAM) Method:DTIC220mg/m2, I.V. d1 3/3w, DDP 25mg/m2, i.v.gtt d1 3w, 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
20、. d8/6w. Efficient rate is 48%. 非诚勿扰与恶性黑色素瘤课件2010melanomafieldprogressreviewmelanoma treatment finally usher a silver liningResistancetoCTLA-4singleresistanceagainstgeneticmutationsand(B-RAFandC-KIT)smallmoleculartargeteddrugs,whichprolongthesurvivalofadvancedmelanomapatientsandachieveremarkablebrea
21、kthrough.Itispossibleforthetreatmentofadvancedmelanomapatientsbringthoroughrevolution.非诚勿扰与恶性黑色素瘤课件Inadvancedmelanomachemotherapy,itisstillthegoldstandardthatDacarbazine(达卡巴嗪),butefficientrateisonly8%12%.Manybiologicalchemotherapyormoremedicinechemotherapyperiodclinicalstudieshasshowedhighefficientr
22、ate.Butperiodcontrolledstudyofoverallsurvivalshowshaventexceededsingle-agentDacarbazine(达卡巴嗪).非诚勿扰与恶性黑色素瘤课件AmericanODayreportarandomizedcontrolledclinicalresearchaboutperiod,itsresulthassignificance.ThestudyprovedtargetedimmunetherapydrugsIpilimumabtoprolongperiodmelanomapatientssurvival.IpilimumabblockadethecombinationCTLA4withB7whichcanremoveanti-tumorimmunosuppression,thus,itreallymobilizespecificityanti-tumorimmuneresponse.非诚勿扰与恶性黑色素瘤课件非诚勿扰与恶性黑色素瘤课件THE END!THE END!非诚勿扰与恶性黑色素瘤课件
