非诚勿扰与恶性黑色素瘤.ppt

非诚勿扰”与恶性黑色素瘤1编辑pptcatalogueWhat is malignant melanoma?Melanoma triggers and causesPrimary sitesClinical characteristicsEarly clinical performanceLate-stage clinical manifestationsPathological typeTreatment2010 melanoma field progress review2编辑pptWhatismalignantmelanoma?Malignantmelanoma,alsoknownasmelanoma,istheoriginofepidermalmelanocyteornevusofmalignanttumors.Thediseasecanbeseenatanyage,moreseeninmiddle-agedandolder,womenslightlymorethanmen.3编辑pptMelanomatriggersandcausesAirpollutionTopursuebeautyThelackofmedicineknowledgeImmunedeficiencyAbusingtheestrogendrugsMalignanttransformationofblackmoleRacialgeneticfactorsTraumaandchronicstimulationfactors4编辑pptAirpollution Harmful ultraviolet light and some harmful material in the air make a difference of human skin,causing melanocyte abnormal expression,trigger melanoma.5编辑pptMany people in order 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.Topursuebeauty6编辑pptRacialgeneticfactorsMalignantmelanomaoccurinthewhiterace.Fortheincidenceofworldeachyeartolessthan12/10million,butAustraliasQueenslandannualincidenceof16/10millionpopulation,itistheworldsleadinghighincidenceofmalignantmelanoma.AfricaandAsianpeoplerarelyhavethesickness.7编辑pptPrimary sitesMalignantmelanoma90%occursintheskin,themostcommonintheback,metal-studded,leg,foot,toe,nailbed,scalpandsoon;afewoccursinvulvae,digestivetractandeyes.8编辑pptEyelesionsandOrallesions脉络膜黑色素瘤口腔黑色素瘤9编辑pptGenerallyspeakingmolessurfaceissmooth,melanomaofsurfaceiscoarser.Ifthesurfaceissmooth,andsuddenlybecomescoarseor,weshouldpayattentiontoit.Clinicalcharacteristics10编辑pptUlcerationnotonlyisoneoftheimportantmelanomaclinicalmanifestationswhichisdifferentfrommole,butalsohasthemeaningofprognosisthannoulcer.Patientsofmalignantmelanomagenerallyaretheold;theyouthorchildrenmelanomaarerare.11编辑pptEarlyclinicalperformanceColor:amoleincreaseinsize,pigmentordarkerorlighter,amoledeepen,shiny,appearcolorchanged.Edge:amoletoradiateoutinmolesexpansion,appeararoundunevenindentedchange;becomeirregularorappearsatelliteformsmallamole,orseveralbirthmarkfusion,thesurfaceconcavo-convexinequality.Surface:rough;Oftencoarseandaccompaniedbyscaleformorflakedesquamation.Sometimeshavethedrainageoroozeblood,higherlesionscanface.12编辑pptLesionssurroundingskin:canappearedemaorloseskinglossorbecomewhite,gray.Kakesthesia:amolewithoutitchingordiscomfortpain.regionallymphnodeenlargement,faintlyvisibleblue-black.早期临床表现13编辑pptLate-stageclinicalmanifestationsSpecialtype：asmallnodularlesionsite,theboundaryclear,nocoated,tan-whiteorgrey-blue,qualityofamaterialissolid.Frecklestype:morefromtheprimarylesionsmalignantfreckles;surfacewasflat;theedgegreatirregularity;theepidermisoftumorblockwithfrecklessamples,thistypeoftenoccuronelderlyfacialfreckleslesions,whichisrelativelyrare.14编辑pptSpreadtype:itsappearanceisshalloweczemakind,anditsjaggededgeisirregular,withblack,greyandpinkdisorderlycoloronthesurface.Nodulartype:tumornodulesareoutoftheskinsurface;thecolorisdarkbrown,grayredandrarelycolorless.Bumpsurfaceisshownmorecauliflowershape,polypoidorbacteriashape,oftenhappenulcers.15编辑pptPathologicaltypeSuperficialexpandabletype:about70%,itisvisibleatsurfaceanywhere;goalongthesurfacetoexpand,andthenexpandtothedepth,calledtheverticaldevelopment.16编辑pptnodulartype:about15%,verticaldevelopment;penetratetosubcutaneoustissue;pronetolymphnodemetastases;evenmoredeadly.17编辑pptEphelidestype:about5%,itprimaryoccurinoldpeoplefacialskinwhereblackfreckleslongstand;thistypedohorizontalgrowthandenlarge2cm3cmormorearound.18编辑pptExtremityblackmoletype:about10%thathappensatpalms,foot,nailbedandmucousmembranes.19编辑pptTreatmentSurgicaltreatment:earlycircumscribedprimaryfocishouldbecarriedoutextensively;thescopeshouldbeapartfromtheprimaryfoci35cm;theprimaryfocishouldbeexcisedtosubcutaneoustissueandmusclemembrane;whentouchthelymphnodeenlargement,generallyspeakingshouldmakelymphnodeclean;aftertheoperation,adjuvantchemotherapyandimmunetherapyisnecessary.20编辑pptBiologicalimmunetherapy:biologicalimmunetherapyviathevariousbiologicalagentsandbiotechnologymeanstoenhanceimmunityandanti-cancerabilitytosuppressandkillcancercells;atpresent,immunecellssuchasDCcells,CIKcellhaveappliedtoclinicaltherapy,whichgainsgoodeffects;biologicalimmunetherapyisthemosteffective,securityadjuvanttherapies.人类黑色素瘤抗原21编辑pptRadiotherapy:Inadditiontosomeveryearlyfrecklestypeofmalignantmelanomaareeffective,otherprimaryfocigenerallyhavepoorcurativeeffect.Sowedidnotuseradiationtherapytocuretheprimaryfoci,andmetastasisadoptradiotherapy.22编辑pptEndocrinetherapy:anti-estrogendrugsmakesomecasesevenotherdrugtreatmentfailurecasesgetcurativeeffect,andmaketheillnesstoalleviate.23编辑pptChemicaltreatment: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 one period of treatment,efficient rate is 35%.24编辑ppt 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 iv d1 repeated 1 time.25编辑pptDDBT case(DTICDDBT case(DTIC、DDPDDP、BCNUBCNU、TAM)TAM)Method:Method:DTIC220mg/m2,I.V.d1 3/3w,DTIC220mg/m2,I.V.d1 3/3w,DDP 25mg/m2,i.v.gtt d1 3w,BCNUl DDP 25mg/m2,i.v.gtt d1 3w,BCNUl 50mg/m2,I.V.d1/6w,TAM 10mgPO,2/50mg/m2,I.V.d1/6w,TAM 10mgPO,2/d.Efficient rate is 52.5%.d.Efficient rate is 52.5%.CBD case(CCNUCBD case(CCNU、BLMBLM、DDP)DDP)Method:Method:CCNU 80mg/m2,oral,d1/6w,CCNU 80mg/m2,oral,d1/6w,BLMl 5u/m2,I.V.d3 7/6w,DDP BLMl 5u/m2,I.V.d3 7/6w,DDP 40mg/m2,I.V.d8/6w.Efficient rate is 40mg/m2,I.V.d8/6w.Efficient rate is 48%.48%.26编辑ppt2010melanomafieldprogressreviewmelanoma treatment finally usher a silver liningResistancetoCTLA-4singleresistanceagainstgeneticmutationsand(B-RAFandC-KIT)smallmoleculartargeteddrugs,whichprolongthesurvivalofadvancedmelanomapatientsandachieveremarkablebreakthrough.Itispossibleforthetreatmentofadvancedmelanomapatientsbringthoroughrevolution.27编辑pptInadvancedmelanomachemotherapy,itisstillthegoldstandardthatDacarbazine(达卡巴嗪),butefficientrateisonly8%12%.Manybiologicalchemotherapyormoremedicinechemotherapyperiodclinicalstudieshasshowedhighefficientrate.Butperiodcontrolledstudyofoverallsurvivalshowshaventexceededsingle-agentDacarbazine(达卡巴嗪).28编辑pptAmericanODayreportarandomizedcontrolledclinicalresearchaboutperiod,itsresulthassignificance.ThestudyprovedtargetedimmunetherapydrugsIpilimumabtoprolongperiodmelanomapatientssurvival.IpilimumabblockadethecombinationCTLA4withB7whichcanremoveanti-tumorimmunosuppression,thus,itreallymobilizespecificityanti-tumorimmuneresponse.29编辑ppt30编辑pptTHE END!THE END!31编辑ppt