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Treatment of melanoma
Treatment of melanoma. Targeted drugs are drugs that attack cancer cells without harming normal cells.
Melanoma is a common skin tumor caused by the excessive proliferation of abnormal melanocytes. It is extremely malignant and accounts for a large portion of skin tumor deaths. It mostly occurs in the skin or mucous membranes close to the skin, but also in the pia mater and choroid. The incidence rate varies with race, region, and race. The incidence of whites is much higher than that of blacks. The incidence of whites living in Queensland, Australia is as high as 17/100,000. Sunlight exposure is a risk factor. The same risk factors include family history, occurrence of malignant moles, larger congenital melanocytic nevi, and dysplastic nevi syndrome.
The treatment method depends on the degree of cancer progression and physical condition. The degree of progression is shown in the following disease course classification table.
The course of the disease is classified according to the thickness of the tumor cells, whether there is lymph node or other organ metastasis. Melanoma can be divided into five stages: stage 0, stage I, stage II, stage III, and stage IV according to the course of the disease.
Melanoma determines the treatment method according to the course of the disease. Melanoma can spread to any organ of the body. For advanced melanoma, while surgical treatment is taken, it is also necessary to cooperate with medical treatment and radiotherapy.
The treatment method is shown below:
Surgery (surgical treatment)
Surgery is preferred for melanoma. If only the primary tumor that can be observed with the naked eye is removed, the possibility of recurrence is relatively high. Therefore, the principle of initial surgical treatment is to remove 1 to 2 cm beyond the primary tumor.
On the other hand, if the tumor is not determined to be benign or malignant, it is necessary to take the tissue to the pathology department for detailed diagnosis after the tumor is removed. If the diagnosis is determined to be malignant, the scope of resection must be expanded. As the disease progresses, there are multiple metastases (satellite foci) in the skin near the primary tumor, and more extensive resection is required.
After the operation, if the wound is too large to be sutured, part of the autologous skin needs to be transplanted. Usually, the root of the thigh (groin), the back of the ear, the front side of the thigh, and the back side are selected for transplantation.
At the same time as the operation, a sentinel lymph node biopsy (the lymph node to which cancer cells first metastasize) will also be done. If a lymph node metastasis is found, lymph node resection (lymph node dissection) is required. Symptoms such as swelling and numbness of hands and feet will appear after lymph node dissection. You can consult a doctor about countermeasures.
Through injection, intravenous drip, oral administration and other methods, the effect of killing cancer cells is achieved. In addition to the anticancer drugs that have been used to kill cancer cells, there are also many new options such as immune checkpoint inhibitors and targeted drugs.
Immune checkpoint inhibitors (immunotherapy)
In order to prevent cancer cells from being cleared by the immune system, they generally activate negative negative signals to suppress the immune response to pass the “immune checkpoint”, which is equivalent to pressing the brakes to the end. In this case, the car must be motionless, so the immune system treats cancer cells. No response, just turned a blind eye. “Immune checkpoint inhibitors” are a new class of anti-cancer drugs that release this brake. They inhibit cancer cells from suppressing the immune system, turning negative to positive, thus re-opening the body’s own immune system to fight cancer.
Immunotherapy is suitable for melanoma that cannot be operated or recurred after surgery. Patients with melanoma can usually use Opdivo preparations, Pembrolizumab preparations, and Ipilimumab preparations. 10~40% of patients have an effect (cancer cells shrink), the first use is effective, and then it can be used for a long time. However, immunosuppressive agents may cause side effects such as pneumonia, liver dysfunction, diarrhea, enteritis, skin diseases, endocrine disorders, nerve and muscle dysfunction, etc. These may appear several weeks or months after the end of the treatment, which requires attention.
Targeted drugs are drugs that attack cancer cells without harming normal cells. BRAF genetic variation is closely related to the progression of melanoma. After the variation is determined, the use of drugs such as dabrafenib, trametinib, and venomurafenib can inhibit the activity of BRAF . The proliferation and activation of T cells achieve the effect of inhibiting cancer cells, and more than half of patients get the expected effect (cancer shrinkage). However, the drug has drug resistance, so the more you use it, the less obvious the effect. Targeted drugs may bring side effects such as skin diseases and liver dysfunction, so you need to pay attention.
Anticancer agents (chemotherapy)
Chemotherapy is mainly to suppress the enlargement of visceral and lymph node metastasis, and to reduce the focus of the disease. Dacarbazine is a commonly used drug. While anticancer drugs kill cancer cells, they will also affect normal cells and have a series of side effects. The side effects are related to the degree of symptoms, the type and amount of anticancer agents, and personal differences. Generally, there are side effects such as leukopenia, thrombocytopenia, anemia, nausea, vomiting, loss of appetite, diarrhea, numbness of hands and feet, liver dysfunction, renal dysfunction, hair loss, fatigue and other side effects. While doing chemotherapy, it is also necessary to take certain preventive measures against possible side effects.
Interferon is a man-made drug with physiological activity that can inhibit the proliferation of some cancer cells and viruses. Patients with melanoma can inject interferon around the excision site and subcutaneously after the removal of the primary tumor to prevent recurrence. Patients with skin and subcutaneous metastases can be injected directly.
The side effect of interferon is fever, so it is necessary to give anti-fever medicine at the same time as the medication. At the same time, symptoms such as headache, anemia, loss of appetite, leukopenia, and liver dysfunction may also occur.
Radiation therapy uses high-energy X-rays and electronic rays to damage cancer cells and shrink them. Melanoma has low sensitivity to radiation, so radiation therapy should not be used. However, if there are other distant metastases to the brain and the whole body, radiation therapy can relieve the pain caused by metastasis and recurrence.
At the same time, for brain metastases, whole brain irradiation is usually used. For patients with few metastases and good general conditions, cyberknife therapy and gamma therapy are recommended.
Side effects such as skin diseases may occur in the area exposed to radiation. Oral antipruritic drugs, painkillers, and external application of ointment can alleviate the symptoms. After the irradiation, you will feel very relaxed.
Special radiation such as proton beam and heavy ion beam are also effective, but there are not many hospitals that can perform this treatment. Please consult a doctor before treatment.
(source:chinanet, reference only)