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恶性黑色素瘤的诊断热点

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  • 1.华中科技大学同济医学院附属协和医院皮肤科,湖北 武汉 430022
    2.华中科技大学同济医学院附属武汉中心医院皮肤科,湖北 武汉 430014

收稿日期: 2023-06-03

  网络出版日期: 2023-11-17

Hot spots in diagnosis of malignant melanoma

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  • 1. Department of Dermatology, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Hubei Wuhan 430022, China
    2. Department of Dermatology, Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Wuhan 430014, China

Received date: 2023-06-03

  Online published: 2023-11-17

摘要

全球的恶性黑色素瘤(黑色素瘤)发病率从1990年的2.01/10万增加到2019年的3.75/10万。黑色素瘤在中国的发病率和死亡率低于全球平均水平,但近年来其发病率的增长速度(3%~5%)是中国恶性肿瘤发病率中增长最快的,每年新发黑色素瘤患者达2~3万例。黑色素瘤易侵袭和转移,Ⅳ期患者的5年生存率仅为4.6%。早期诊断与治疗,能极大地改善黑色素瘤患者的预后。目前恶性黑色素瘤诊断热点包括视诊辅助工具、人工智能辅助诊断、组织学诊断及鉴别诊断等。视诊辅助工具可用于筛查黑色素瘤,皮肤镜和皮肤共聚焦技术(皮肤CT),诊断黑色素瘤灵敏度可分别为61%及100%;人工智能为基础诊断黑色素瘤比单纯的人工智能或医师诊断准确率更高,可将黑色素瘤诊断准确率从55.6%提高至75.0%。组织学诊断二代测序技术的不断进步,尚缺乏适用于所有黑色素瘤的客观的、高重复性免疫组织化学标志,但随着黑色素瘤基因组学的研究逐渐深入,BRAF V600E、NRAS突变已经应用于临床诊治及预后评估。黑色素瘤侵袭性强,许多患者确诊时即为晚期,因此,我国黑色素瘤诊疗需重视多学科诊疗团队模式,并促进建立在多学科共识基础上的诊疗原则和指南。

本文引用格式

吴娜明, 李军, 陶娟 . 恶性黑色素瘤的诊断热点[J]. 诊断学理论与实践, 2023 , 22(03) : 215 -220 . DOI: 10.16150/j.1671-2870.2023.03.02

Abstract

The global incidence of melanoma increased from 2.01/ 100 000 in 1990 to 3.75/100 000 in 2019. The incidence and mortality rate of malignant melanoma in China is lower than that of the global average, but in recent years, its incidence rate has increased (3% to 5%). Malignant melanoma is the fastest growing malignant tumor in China, and new melanoma patients reach 20 000 to 30 000 cases every year. Melanoma is prone to invasion and metastasis, and the 5-year survival rate of stage IV patients is only 4.6%. Early diagnosis and treatment can greatly improve the prognosis of patients with malignant melanoma. At present, the hot spots in the diagnosis of malignant melanoma include visual aid, artificial intelligence-assisted diagnosis, histological diagnosis and differential diagnosis. Visual AIDS can be used to screen for melanoma, and dermoscopy and skin confocal technology (CT) can diagnose melanoma with sensitivity of 61% and 100%, respectively. AI based diagnosis of malignant melanoma is more accurate than that of artificial intelligence alone or doctors, and can improve the diagnosis accuracy of malignant melanoma from 55.6% to 75.0%. With the continuous progress of second-generation sequencing technology in histology diagnosis, there is still a lack of objectively and highly repeatable immunohistochemical markers applicable to all melanomas. However, with the development of melanoma genomics research, BRAF V600E and NRAS mutations have been applied in clinical diagnosis, treatment and prognosis assessment. Malignant melanoma is highly invasive, and many patients are in the advanced stage when diagnosed. Therefore, the diagnosis and treatment of melanoma in China should pay attention to the multidisciplinary diagnosis and treatment team model, and promote the diagnosis and treatment principles and guidelines based on multidisciplinary consensus.

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