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CQ1

ƒƒ‰ƒm[ƒ}‚Ģ”­¶—\–h‚š–Ś“I‚Ę‚µ‚½Ž‡ŠOü–hŒä‚ĶŠ©‚ß‚ē‚ź‚é‚©

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C1

“ś–{l‚Å‚Ķƒƒ‰ƒm[ƒ}‚Ģ‰ß”¼”‚ŖŽˆ’[•”‚É”­¶‚µCŽ‡ŠOü‚ĢŠÖ—^‚Ķ­‚Č‚¢‚ʍl‚¦‚ē‚ź‚é‚ŖCƒTƒ“ƒXƒNƒŠ[ƒ“Ü‚Č‚Ē‚ÅŽ‡ŠOü–hŒä‚šs‚¤‚±‚Ę‚É‚ę‚č˜IŒõ•”‚Ģƒƒ‰ƒm[ƒ}‚Ģ”­¶—¦‚ŖŒø­‚·‚éŒXŒü‚Ķ‚ ‚邽‚߁CŽ‡ŠOü–hŒä‚šl—¶‚µ‚Ä‚ą‚ę‚¢B

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ƒƒ‰ƒm[ƒ}‚Ģ”­¶‚É‚Ķˆā“`“I”wŒi‚ĘŠĀ‹«ˆöŽq‚Ģ—¼ŽŅ‚Ŗd—v‚Å‚ ‚éB•\ŻŠg‘åŒ^ƒƒ‰ƒm[ƒ}‚Ģ”­¶‚Ŗ”¼”ˆČć‚šč‚ß‚é”’l‚Å‚Ķƒƒ‰ƒm[ƒ}‚Ģ‰Ę‘°—šCƒXƒLƒ“ƒ^ƒCƒvC—‘”Į‚Ģ–§“xC”ē•†EŠįE–Ń”Æ‚ĢF‚Č‚Ē‚Ģˆā“`“IˆöŽq‚Ę‚Ę‚ą‚ɁC¶ŠU‚š’Ź‚¶‚āi“Į‚ɏ¬Ž™Šśj‚Ģ‹­‚¢“śÄ‚Æ‚ĘC“śÄ‚Æ‚Ģ•p“xE‰ń”‚ŖŠėŒÆˆöŽq‚Å‚ ‚邱‚Ę‚Ŗ”•Ņ‚Ģƒƒ^ƒAƒiƒŠƒVƒX‚©‚ē–¾‚ē‚©‚É‚Č‚Į‚Ä‚«‚Ä‚¢‚é1`3jB

ˆź•ūCƒTƒ“ƒXƒNƒŠ[ƒ“Ü‚Č‚Ē‚ĢŽg—p‚É‚ę‚é“O’ź‚µ‚½¶ŠU‚É‚ķ‚½‚鎇ŠOü–hŒä‚Ŗƒƒ‰ƒm[ƒ}”­Ē‚Ģ—\–h‚É–š—§‚Ā‚©”Ū‚©‚É‚Ā‚¢‚Ä‚ĶC18 •Ņ‚ĢƒVƒXƒeƒ}ƒeƒBƒbƒNEƒŒƒrƒ…[‚ɂ﬎™Šś‚ĢƒTƒ“ƒXƒNƒŠ[ƒ“Ü‚ĢŽg—p‚Ŗƒƒ‰ƒm[ƒ}‚Ģ—\–h‚É–š—§‚Ā‚Ę‚¢‚¤Œ‹˜_‚Ķ“¾‚ē‚ź‚Č‚©‚Į‚½4jB‚µ‚©‚µC‚±‚ź‚ē‚ĢŒ¤‹†‚Ŗ‚Č‚³‚ź‚½ŽžŠś‚ĢƒTƒ“ƒXƒNƒŠ[ƒ“Ü‚Ģ–hŒä”\‚ĶŽå‚Ę‚µ‚ÄUVB ‚É‘Ī‚µ‚Ä‚Ģ‚Ż‚ÅUVA ‚É‘Ī‚·‚é–hŒä”\‚É–R‚µ‚­C‚±‚ź‚ē‚ĢƒTƒ“ƒXƒNƒŠ[ƒ“Ü‚š—p‚¢‚½17 •Ņ‚ĢƒVƒXƒeƒ}ƒeƒBƒbƒNEƒŒƒrƒ…[‚Å‚ąƒƒ‰ƒm[ƒ}‚Ģ—\–h‚É–š—§‚½‚Č‚©‚Į‚½‚±‚Ę‚©‚ēCUVA ‚Ŗƒƒ‰ƒm[ƒ}‚Ģ”­Ē‚ÉŠÖ—^‚·‚é‰Ā”\«‚šŽ¦“‚µ‚½•ń‚É—Æ‚Ü‚Į‚Ä‚¢‚½5jB

‹ß”N‚Ģbroad spectrum ƒTƒ“ƒXƒNƒŠ[ƒ“Ü‚ĶUVBCUVA ‚É‘Ī‚µ‚Ä‹¤‚É—D‚ź‚½–hŒä”\‚š—L‚µ‚Ä‚¢‚éB‚±‚ź‚ē‚šŽĄŪ‚ÉŽg—p‚µ‚½‚Ę‚±‚ėƒƒ‰ƒm[ƒ}‚Ģ”­¶ƒŠƒXƒN‚ʍl‚¦‚ē‚ź‚Ä‚¢‚鑽”‚ĢŒć“V«F‘f×–E•ź”Į‚Ģ”­¶‚Ŗ30`40“Œø­‚µ‚½‚Ę‚·‚郉ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚Ŗ‚ ‚é6jB‚³‚ē‚É”’l1,621 —į‚š‘ĪŪ‚Ébroad spectrum ƒTƒ“ƒXƒNƒŠ[ƒ“Ü‚š–ˆ“ś4 ”NŠŌ“h•z‚µ‚½ŒQ‚ʁCŽ©•Ŗ‚ĢŁ—Ź‚Å“K‹X“h•z‚·‚éŒQ‚š“h•zŒć10 ”NŠĻŽ@E”äŠr‚µ‚½ƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚Å‚ĶC–ˆ“ś“h•z‚µ‚½ŒQ‚Å‚Ķƒƒ‰ƒm[ƒ}‚Ģ”­¶—¦‚š50“—\–h‚Å‚«C“Į‚ɐZ«ƒƒ‰ƒm[ƒ}‚Å‚Ķ73“—\–h‚Å‚«‚½‚Ę•ń‚³‚ź‚Ä‚¢‚é7jB

ˆź•ūCƒqƒXƒpƒjƒbƒN‚ā•l‚Č‚Ē‚Ģ—LFlŽķ‚É‚Ø‚¢‚Ä‚ĶCƒƒ‰ƒm[ƒ}‚Ģ”­¶‚ĘŽ‡ŠOü”˜˜I‚šŠÖ˜A•t‚Æ‚é‰uŠw“I‚Č’²ø‚Ķ‘¶Ż‚µ‚Č‚¢8jB“ś–{l‚É‚Ø‚¢‚Ä‚ąCƒƒ‰ƒm[ƒ}‚Ģ–ń”¼”‚ŖŽˆ’[•”‚É”­¶‚·‚邽‚߁Cƒƒ‰ƒm[ƒ}‚Ģ”­¶‚ÉŠÖ‚·‚鎇ŠOü‚ĢŠÖ—^‚Ķ­‚Č‚¢‚ʍl‚¦‚ē‚ź‚é‚ŖC‹ß”N”’l‚É‚Ø‚Æ‚éƒTƒ“ƒXƒNƒŠ[ƒ“Ü‚Ģƒƒ‰ƒm[ƒ}—\–hŒų‰Ź‚É‚Ā‚¢‚ăGƒrƒfƒ“ƒXƒŒƒxƒ‹‚Ģ‚‚¢Œ¤‹†7j‚ŖoŒ»‚µ‚½‚½‚߁C„§“x‚šC1 ‚Ę‚µ‚½B

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1j Dennis LK, Vanbeek MJ, Beane Freeman LE, et al: Sunburns and Risk of Cutaneous Melanoma: Does age matter? A comprehensive meta-analysis, Ann Epidemiol, 2008; 18: 614-627.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

2j Gandini S, Sera F, Cattaruzza MS, et al: Meta-analysis of risk factors for cutaneous melanoma: Ⅲ. Family history, actinic damage and phenotypic factors, Eur J Cancer, 2005; 41: 2040-2059.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

3j Elwood JM, Jopson J: Melanoma and sun exposure: an overview of published studies, Int J Cancer, 1997; 73: 198-203.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

4j Dennis LK, Beane Freeman LE, VanBeek MJ: Sunscreen use and the risk for melanoma: a quantitative review, Ann Intern Med, 2003; 139: 966-978.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

5j Gorham ED, Mohr SB, Garland CF, et al: Do sunscreens increase risk of melanoma in populations residing at higher latitudes? Ann Epidemiol, 2007; 17: 956-963.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

6j Gallagher RP, Rivers JK, Lee TK, et al: Broad-spectrum sunscreen use and the development of new nevi in white children: a randomized controlled trial, JAMA, 2000; 283: 2955-2960.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

7j Green AC, Williams GM, Logan V, et al: Reduced melanoma after regular sunscreen use: randomized trial follow-up, J Clin Oncol, 2011; 29: 257-263.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

8j Eide MJ, Weinstock MA: Association of UV index, latitude, and melanoma incidence in nonwhite populations-US Surveillance, Epidemiology, and End ResultsiSEERj Program, 1992 to 2001, Arch Dermatol, 2005; 141: 477-481.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj


CQ2

‚Ł‚­‚ėiŒć“V«F‘f×–E•ź”Įj‚Ģ”‚Ŗ‘½‚¢ŽŅ‚É‘Ī‚µ‚ăƒ‰ƒm[ƒ}‚Ģ‘Šśf’f‚š–Ś“I‚Ę‚µ‚½’芜fŽ@‚ĶŠ©‚ß‚ē‚ź‚é‚©

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C1

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Œć“V«F‘f×–E•ź”Įiacquired melanocytic nevusGAMNj‚ĢŒĀ”‚Ęƒƒ‰ƒm[ƒ}”­¶ƒŠƒXƒN‚É‚Ā‚¢‚Ä‚ĶC‰¢•Ä”’l‚Å‘½”‚ĢĒ—į‘ĪĘŒ¤‹†‚ŖŽĄŽ{‚³‚źC‚¢‚ø‚ź‚ĢŒ¤‹†‚Å‚ąAMN ‚ĢŒĀ”‚Ŗ‘½‚¢‚Ęƒƒ‰ƒm[ƒ}”­¶‚ĢŠėŒÆ«‚Ŗ‚‚܂邱‚Ę‚ŖŽ¦‚³‚ź‚Ä‚¢‚éB‚±‚ź‚ē‚ĢŒ¤‹†‚Å’ˆÓ‚·‚ׂ«‚±‚Ę‚ĶC”’l‚Ģƒƒ‰ƒm[ƒ}‚Ķ‘命”‚Ŗ•\ŻŠg‘åŒ^•FŽīisuperficial spreading melanomaGSSMj‚Å‚ ‚邱‚ʁCAMN ‚š’ŹķŒ^•ź”Į‚ĘˆŁŒ^•ź”Įiatypical nevus, dysplastic nevusGANj‚É•Ŗ‚ƂčlŽ@‚µ‚Ä‚¢‚錤‹†‚Ŗ‘½‚¢‚±‚Ę‚Å‚ ‚éBAN ‚Ķ—Տ°“I‚É‘åŒ^C•s®‚Č”Įó•a•Ļ‚ŁC‘gDŠw“I‚É“Ę“Į‚ȉ”L‚Ŗ‚č‚Ģ•a‘ƒ‚Å‚ ‚é‚Ę‚³‚ź‚é‚ŖC‚»‚ĢŠT”O‚ʐf’fŠī€‚Ķ•K‚ø‚µ‚ąŠm—§‚³‚ź‚Ä‚¢‚Č‚¢B

ƒI[ƒXƒgƒ‰ƒŠƒA‚É‚Ø‚¢‚ăƒ‰ƒm[ƒ}244 —į‚Ę‘ĪĘ276 —į‚š’²ø‚µ‚½Œć‚ėŒü‚«Ē—į‘ĪĘŒ¤‹†‚Å‚ĶCAMN ‚š100 ŒĀˆČć—L‚·‚é—į‚Ģƒƒ‰ƒm[ƒ}”­¶ƒŠƒXƒN‚Ķ10 ŒĀˆČ‰ŗ‚ę‚č12 ”{‚‚¢‚±‚Ę‚ŖŽ¦‚³‚ź‚½1jBƒCƒMƒŠƒX‚É‚Ø‚¢‚ăƒ‰ƒm[ƒ}426 —į‚Ę‘ĪĘ416 —į‚š’²ø‚µ‚½Œć‚ėŒü‚«Ē—į‘ĪĘŒ¤‹†‚Å‚ĶCAN ‚š4 ŒĀˆČć—L‚·‚é—į‚ĶCAN ‚š—L‚³‚Č‚¢—į‚É”ä‚ׁCƒƒ‰ƒm[ƒ}”­¶‚ĢƒIƒbƒY”äiodds ratioGORj‚Ŗ28.7 ‚Ę‚«‚ķ‚߂č‚‚¢’l‚šŽ¦‚µ‚½iP ƒ 0.0001jB’ŹķŒ^‚ĢAMNiŒa2 mm ˆČćj‚É‚Ā‚¢‚Ä‚ąC100 ŒĀˆČć—L‚·‚é—į‚Ķ4 ŒĀ‚Ü‚Å‚Ģ—į‚É”ä‚ׁCOR ‚Ŗ7.7 ‚Ę—LˆÓ‚ɍ‚‚©‚Į‚½iP ƒ0.0001j2jBƒAƒƒŠƒJ‚É‚Ø‚¢‚ăƒ‰ƒm[ƒ}716 —į‚Ę‘ĪĘ1,014 —į‚š’²ø‚µ‚½Œć‚ėŒü‚«Ē—į‘ĪĘŒ¤‹†‚Å‚ĶC2 mm ˆČć‚ĢAMN ‚š25 ŒĀ—L‚·‚é—į‚Ģƒƒ‰ƒm[ƒ}”­¶‚ĢOR ‚š1 ‚Ę‚·‚é‚ʁC25`49 ŒĀ‚Å‚Ķ1.4C50`99 ‚Å‚Ķ3.0C100 ˆČć‚Å‚Ķ3.4 ‚Ę‚Č‚Į‚½3jBƒCƒ^ƒŠƒA‚É‚Ø‚¢‚ăƒ‰ƒm[ƒ}542 —įiSSM 391 —įCŒ‹ßŒ^•FŽī72 —įCŽˆ’[•FŽīiALMj22 —įj‚Ę‘ĪĘ538 —į‚š’²ø‚µ‚½Œć‚ėŒü‚«Ē—į‘ĪĘŒ¤‹†‚Å‚ĶCŒa2`6 mm ‚ĢAMN ‚ĢŒĀ”CŒa6 mm ’“‚ĢAMN ‚ĢŒĀ”‚ŖC‚»‚ź‚¼‚ź‚¢‚ø‚ź‚ą“Ę—§‚Ƀƒ‰ƒm[ƒ}”­¶ƒŠƒXƒN‚Ę‚Č‚čC“Į‚É‘OŽŅ‚Ŗ46 ŒĀˆČćCŒćŽŅ‚Ŗ5 ŒĀˆČć‚Ģ—į‚Å‚Ķ‚«‚ķ‚߂č‚‚¢—LˆÓ·‚š‚ą‚Į‚ăƒ‰ƒm[ƒ}”­¶ƒŠƒXƒN‚Ŗ‚‚¢‚±‚Ę‚ŖŽ¦‚³‚ź‚½4jB46 •Ņ‚šWŒv‚µ‚½Å‹ß‚Ģƒƒ^ƒAƒiƒŠƒVƒX‚Å‚ąAMNCAN ‹¤‚É‚»‚Ģ”‚Ŗ‘½‚­‚Č‚é‚Ł‚Ēƒƒ‰ƒm[ƒ}”­¶ƒŠƒXƒN‚Ŗ‚‚­‚Ȃ邱‚Ę‚ŖŽ¦‚³‚ź‚½5jB

“ś–{l‚É‚Ø‚Æ‚é‚Ł‚­‚ėiŒć“V«F‘f×–E•ź”Įj‚Ģ”‚Ęƒƒ‰ƒm[ƒ}”­¶ƒŠƒXƒN‚ĢŒ¤‹†‚ĶRokuhara ‚ē‚Ŗ•ń‚µ‚½ƒƒ‰ƒm[ƒ}82 —įiacral lentiginous melanomaGALM50 —įCnon-ALM32 —įj‚Ę‘ĪĘ600 —į‚š’²ø‚µ‚½Œć‚ėŒü‚«Ē—į‘ĪĘŒ¤‹†1 •Ņ‚Ģ‚Ż‚Å‚ ‚éB40`59 ĪC60`79 Ī‚Ģ—¼”N—īŒQ‚Ånon-ALM ŒQ‚Ŗ‘ĪĘŒQ‚É”ä‚×—LˆÓ‚É2 mm ˆČć‚ĢAMN ‚Ģ”‚Ŗ‘½‚­Cˆź•ūALM Š³ŽŅ‚Ę‘ĪĘŒQ‚ĢŠŌ‚É‚ĶAMN ‚Ģ”‚É—LˆÓ·‚Ķ‚Ż‚ē‚ź‚Č‚©‚Į‚½6jB

ˆČć‚ę‚č”’l‚Å‚ĶC‚Ł‚­‚ė‚Ģ”‚Ŗ50 ŒĀˆČć‚Ģź‡‚Ķ•\ŻŠg‘åŒ^ƒƒ‰ƒm[ƒ}‚š”­¶‚·‚éŠėŒÆ«‚Ŗ‚‚¢B“ś–{l‚Å‚Ķ‚‚¢ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹‚ĢŒ¤‹†‚Ķ‚Č‚¢‚ŖCƒƒ‰ƒm[ƒ}Š³ŽŅ‚É‚ĶAMN ‚Ģ”‚Ŗ‚‚¢ŒXŒü‚É‚ ‚邱‚Ę‚©‚ēCF”’iŽ‡ŠOü”˜˜I‚Å”ē•†‚ŖŌ‚­‚Ķ‚Č‚é‚ŖCF‘f’¾’…‚š‹N‚±‚³‚Č‚¢j‚ŁC‚Ł‚­‚ė‚Ģ”‚Ŗ50 ŒĀˆČć‚Ģź‡‚Ķ’芜fŽ@‚šl—¶‚µ‚Ä‚ą‚ę‚¢‚ʍl‚¦‚ē‚ź‚éB

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1j Grulich AE, Bataille V, Swerdlow AJ, et al: Naevi and pigmentary characteristics as risk factors for melanoma in a high-risk population: A case-control study in New South Wales, Australia, Int J Cancer, 1996; 67: 485-491.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Bataille V, Bishop JA, Sasieni P, et al: Risk of cutaneous melanoma in relation to the numbers, types and sites of nevi: A case-control study, Br J Cancer, 1996; 73: 1605-1611.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j Tucker MA, Halpern A, Holly FA, et al: Clinically recognized dysplastic nevi: A central risk factor for cutaneous melanoma, JAMA, 1997; 277: 1439-1444.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

4j Naldi L, Imberti GL, Parazzini F, et al: Pigmentary traits, modalities of sun reaction, history of sunburns, and melanocytic nevi as risk factors for cutaneous malignant melanoma in the Italian population: Results of a collaborative case-control study, Cancer, 2000; 88: 2703-2710.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Gandini S, Sera F, Cattaruzza MS, et al: Meta-analysis of risk factors for malignant melanoma: I. Common and atypical naevi, Eur J Cancer, 2005; 41: 28-44.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

6j Rokuhara S, Saida T, Oguchi M, et al: Number of acquired melanocytic nevi in patients with melanoma and control subjects in Japan: Nevus count is a significant risk factor for nonacral melanoma but not for acral melanoma, J Am Acad Dermatol, 2004; 50: 695-700.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ3

‹‘åŒ^ę“V«F‘f×–E•ź”Į‚É‘Ī‚µ‚ăƒ‰ƒm[ƒ}‚Ģ”­¶—\–h‚š–Ś“I‚Ę‚µ‚½—\–h“IŲœ‚ĶŠ©‚ß‚ē‚ź‚é‚©

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C1

‹‘åŒ^ę“V«F‘f×–E•ź”ĮŠ³ŽŅ‚Ŗƒƒ‰ƒm[ƒ}‚š”­¶‚·‚éŠėŒÆ«‚Ķ—LˆÓ‚ɍ‚‚­CŽį”N‚Å”­¶‚·‚邱‚Ę‚Ŗ‘½‚¢‚½‚߁CŠw“¶Šś‚ɏI—¹‚·‚é‚ꂤ‚Č—\–h“IŲœ‚šl—¶‚µ‚Ä‚ą‚ę‚¢B

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ę“V«F‘f×–E•ź”Į‚š¬l‚Å‚Ģ•a•Ļ‚ĢÅ‘åŒai¬Ž™‚Ģ•a•Ļ‚Å‚Ķ¬l‚ɐ¬’·‚µ‚½Ū‚ÉŒ©Ļ‚ą‚ē‚ź‚éÅ‘åŒaj‚Å•Ŗ‚ƁCŒa20 cm ˆČć‚Ģ‚ą‚Ģ‚š‘åŒ^‚Ę‚·‚éKopf ‚ē‚Ģ•Ŗ—Ž–@‚ŖL‚­—p‚¢‚ē‚ź‚Ä‚¢‚éB‚µ‚©‚µCu‹‘åŒ^v‚Ģ–¾Šm‚Č’č‹`‚Ķ‘¶Ż‚¹‚øCZaal ‚ē‚ĢƒVƒXƒeƒ}ƒeƒBƒbƒNEƒŒƒrƒ…[‚É‚ę‚ź‚Ī‹‘åŒ^ę“V«•ź”Į‚ĢƒTƒCƒY‚É‚Ā‚¢‚ď­‚Č‚­‚Ę‚ą7 ‚Ā‚ĢˆŁ‚Č‚é’č‹`‚ŖŽg—p‚³‚ź‚Ä‚¢‚é‚Ŗ1jCŽĄŪ‚É‚ĶŒa20 cm ˆČć‚š‹‘åŒ^ę“V«F‘f×–E•ź”Įilarge congenital melanocytic nevusFLCMNj‚Ę‚µ‚ÄŒŸ“¢‚µ‚½Œ¤‹†‚Ŗ‘½‚¢B

LCMN Š³ŽŅ‚Ŗƒƒ‰ƒm[ƒ}‚š”­¶‚·‚éŠėŒÆ«‚Ŗ‚‚¢‚±‚Ę‚Ķ”•Ņ‚ĢƒVƒXƒeƒ}ƒeƒBƒbƒNEƒŒƒrƒ…[‚Å–¾‚ē‚©‚É‚³‚ź‚Ä‚¢‚éBZaal ‚ē‚É‚ę‚é35 •Ņ‚ĢƒVƒXƒeƒ}ƒeƒBƒbƒNEƒŒƒrƒ…[‚É‚ę‚ź‚ĪCŠe•ń‚É‚ę‚Į‚č·‚Ŗ‚Ż‚ē‚ź‚é‚ą‚Ģ‚ĢCKopf ‚Ģ’č‹`‚Å‚ĢLCMN ‚©‚ēƒƒ‰ƒm[ƒ}‚Ŗ”­¶‚·‚镽‹ĻƒŠƒXƒN‚Ķ8.2“‚ŁC‚»‚Ģ•½‹Ļ”­¶”N—ī‚Ķ11.1 Ī‚Å‚ ‚Į‚½1jBWatt ‚ē‚É‚ę‚é8 •Ņ‚ĢƒVƒXƒeƒ}ƒeƒBƒbƒNEƒŒƒrƒ…[‚É‚ę‚ź‚ĪCLCMN 432 —į’†12 —įi2.8“j‚Ƀƒ‰ƒm[ƒ}‚Ŗ”­¶‚µ‚½2jBKrengel ‚ē‚É‚ę‚é14 •Ņ‚ĢƒVƒXƒeƒ}ƒeƒBƒbƒNEƒŒƒrƒ…[‚É‚ę‚ź‚ĪCLCMN 1,539 —į’†39 —įi2.5“j‚Ƀƒ‰ƒm[ƒ}‚Ŗ”­¶‚µC‚»‚Ģ•½‹Ļ”­Ē”N—ī‚Ķ15.5 Īi’†‰›’l7 Īj‚Å‚ ‚čC¬Ž™Šś‚©‚ēŽvtŠś‚ɂ؂Ƃ郁ƒ‰ƒm[ƒ}”­¶‚ĢƒŠƒXƒN‚Ķˆź”Źl‚É”ä‚ׂÄ465 ”{‚‚¢‚±‚Ę‚ŖŽ¦‚³‚ź‚½3jB‚±‚Ģ‚¤‚惁ƒ‰ƒm[ƒ}‚Ģ”­¶•”ˆŹ‚ÉŠÖ‚µ‚Ä‚ĶCLCMN “ą‚©‚ē‚Ŗ67“CLCMN ŠO‚Ģ”ē•†‚©‚ē‚Ŗ11“CŒ“”­•”ˆŹ‚Ŗ“Į’č‚Å‚«‚Č‚¢“]ˆŚ•a‘ƒ‚Ę‚µ‚ďoŒ»‚µ‚½‚ą‚Ģ‚Ŗ14“C”ē•†ˆČŠO‚Ģ”­Ēi_Œo”ē•†•FĒ‚É‚ę‚éj‚Ŗ8“‚ĘLCMN“ą‚Ģƒƒ‰ƒm[ƒ}”­¶‚Ŗ‘½‚¢‚ą‚Ģ‚ĢCLCMN ŠO‚Ģ”­¶‚ą‚ ‚邱‚Ę‚ŖŽ¦‚³‚ź‚½3jBZaal ‚ē‚É‚ę‚é‘å‚«‚³‚š–ā‚ķ‚Č‚¢ę“V«F‘f×–E•ź”Į‚ĢŒć‚ėŒü‚«ƒRƒz[ƒgŒ¤‹†‚Å‚ĶC•½‹Ļ4.7 ”N‚ĢŠĻŽ@ŠśŠŌi19,253l”Nj‚Å15 —į‚Ƀƒ‰ƒm[ƒ}‚Ŗ”­¶‚µC‘S•W€‰»œėŠ³”äioverall standardized incidence ratej‚Ķ12.2i95“ CIF9.6`15.3j‚ŁCƒƒ‰ƒm[ƒ}”­¶‚ĢƒŠƒXƒN‚Ķˆź”Źl‚É”ä‚ׂÄ51.6“‚‚¢‚±‚Ę‚ŖŽ¦‚³‚ź‚½4jB

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1j Zaal LH, Mooi WJ, Sillevis Smitt JH, et al: Classification of congenital melanocytic naevi and malignant transformation: A review of the literature, Br J Plast Surg, 2004; 57: 707-719.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

2j Watt AJ, Kotsis SV, Chung KC: Risk of melanoma arising in large congenital melanocytic nevi: A systematic review, Plast Reconstr Surg, 2004; 1168-1174.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

3j Krengel S, Hauschild A, Schafer T: Melanoma risk in congenital melanocytic naevi: a systematic review, Br J Dermatol, 2006; 155: 1-8.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

4j Zaal LH, Mooi WJ, Klip H, et al: Risk of malignant transformation of congenital melanocytic nevi: A retrospective nationwide study from The Netherlands, Plast Reconstr Surg, 2005; 116: 1902-1909.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Marghoob AA, Agero AL, Benvenuto-Andrade C, Dusza SW: Large congenital melanocytic nevi, risk of cutaneous melanoma, and prophylactic surgery, J Am Acad Dermatol, 2006; 54: 868-870.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

6j Kinsler VA, Chong WK, Aylett SE, Atherton DJ: Complications of congenital melanocytic naevi in children: analysis of 16 yearsf experience and clinical practice, Br J Dermatol, 2008; 159: 907-914.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ4

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A

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Carli ‚ē‚ĶCF‘f«•a•Ļ‚Ģź–åŠO—ˆ‚Å913 •a•Ļ‚šƒ‰ƒ“ƒ_ƒ€‰»‚µ‚ÄŒŸ“¢‚µC“÷ŠįŠŒ©‚Ģ‚Ż‚É”ä‚ׂāCƒ_[ƒ‚ƒXƒRƒs[ŠŒ©‚š‰Į‚¦‚Ä”»’č‚·‚é‚ʁCƒƒ‰ƒm[ƒ}‚Ģ‘Šś•a•Ļ‚ŖŒų—¦“I‚ÉŒŸo‚Å‚«‚āC•s—v‚Ȑ¶ŒŸ‚Ŗ—LˆÓ‚ÉŒø­‚·‚邱‚Ę‚š•ń‚µ‚Ä‚¢‚é5jBHaenssle ‚ē‚ĶCƒƒ‰ƒm[ƒ}‚ĢƒnƒCƒŠƒXƒNŠ³ŽŅ530 l‚Ģ7,001 ŒĀ‚ĢƒNƒ‰[ƒN•ź”Įiatypical nevusGANj‚š—Տ°ŠŒ©C’Źķ‚Ģƒ_[ƒ‚ƒXƒRƒs[ŠĻŽ@C‚Č‚ē‚Ń‚ÉƒfƒWƒ^ƒ‹ƒ_[ƒ‚ƒXƒRƒs[iƒ_[ƒ‚ƒXƒRƒs[ŠŒ©‚šƒfƒWƒ^ƒ‹‚É‹L˜^C•Ū‘¶‚µ‚Ä‚Ø‚«CŠŒ©‚Ģ•Ļ‰»‚š”äŠrCŒŸ“¢‚Å‚«‚é‹@Šķ‚š—p‚¢‚é•ū–@j‚É‚Ä‘OŒü‚«‚É•½‹Ļ32.2 ƒJŒŽŠŌŒo‰ßŠĻŽ@‚µ‚½B‚±‚ĢŠŌ‚ɉ½‚ē‚©‚Ģ‹^‚ķ‚µ‚¢ŠŒ©‚š’ę‚·‚é‚ꂤ‚É‚Č‚Į‚½637 •a‘ƒ‚šŲœ‚µ‚½‚Ę‚±‚ėC‚¤‚æ53 •a‘ƒi8.3“j‚Ŗƒƒ‰ƒm[ƒ}‚Å‚ ‚Į‚½‚Ę•ń‚µ‚Ä‚¢‚é6jB‚±‚ĢŒ¤‹†‚Å‚ĶCƒfƒWƒ^ƒ‹ƒ_[ƒ‚ƒXƒRƒs[‚É‚ę‚Į‚ăƒ‰ƒm[ƒ}‚ĢŒŸo‚Ŗ17“Œüć‚µC18 •a‘ƒ‚ĶƒfƒWƒ^ƒ‹ƒ_[ƒ‚ƒXƒRƒs[‚ĢŠŒ©‚Ģ•Ļ‰»‚Ģ‚Ż‚É‚ę‚Į‚ÄŒŸo‚Å‚«‚½‚Ę‚¢‚¤B‚Ę‚­‚ɁCfamilial atypical mole melanoma syndromeiƒNƒ‰[ƒN•ź”Į‚Ęƒƒ‰ƒm[ƒ}‚š‰Ę‘°«‚É‘½”­‚·‚éĒŒóŒQj‚āatypical mole syndromeiƒNƒ‰[ƒN•ź”Į‚Ŗ‘½”­‚·‚éŽŅj‚Ę‚¢‚Į‚½ƒnƒCƒŠƒXƒNŠ³ŽŅ‚Å‚Ģƒƒ‰ƒm[ƒ}ŒŸo‚É—L—p‚Å‚ ‚Į‚½BƒfƒWƒ^ƒ‹ƒ_[ƒ‚ƒXƒRƒs[‚ĶƒnƒCƒŠƒXƒNŠ³ŽŅ‚Å‚ĢƒNƒ‰[ƒN•ź”Į‚ĢƒtƒHƒ[ƒAƒbƒv‚Ęƒƒ‰ƒm[ƒ}‚Ģ‘ŠśŒŸo‚É–š—§‚Ā‚Ę‚¢‚¦‚éB

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ˆČć‚ę‚čCƒ_[ƒ‚ƒXƒRƒs[‚Ķ‚±‚Ģf’f–@‚ɏKn‚µ‚½ŽŅ‚Ŗ—p‚¢‚ź‚ĪCƒƒ‰ƒm[ƒ}‚Ģ‘Šśf’f‚É‘å‚¢‚É–š—§‚Ā‚Ę‚¢‚¦‚éB

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1j Bafounta ML, Beauchet A, Aegerter P, et al: Is dermoscopyiepiluminescence microscopyjuseful for the diagnosis of melanoma? Results of a meta-analysis using techniques adapted to the evaluation of diagnostic tests, Arch Dermatol, 2001; 137: 1343-1350.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

2j Kittler H, Pehamberger H, Wolff K, et al: Diagnostic accuracy of dermoscopy, Lancet Oncol, 2002; 3: 159-165.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

3j Vestergaard ME, Macaskill P, Holt PE, et al: Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting, Br J Dermatol, 2008; 159: 669-676.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

4j Troyanova P: A beneficial effect of a short-term formal training course in epiluminescence microscopy on the diagnostic performance of dermatologists about cutaneous malignant melanoma, Skin Res Technol, 2003; 9: 269-273.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

5j Carli P, Giorgi V, Chiarugi A, et al: Addition of dermoscopy to conventional naked-eye examination in melanoma screening: A randomized study, J Am Acad Dermatol, 2004; 50: 683-689.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

6j Haenssle HA, Krueger U, Vente C, et al: Results from an observational trial: Digital epiluminescence microscopy follow-up of atypical nevi increases the sensitivity and the chance of success of conventional dermoscopy in detecting melanoma, J Invest Dermatol, 2006; 126: 980-985.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

7j Saida T, Miyazaki A, Oguchi S, et al: Significance of dermoscopic patterns in detecting malignant melanoma on acral volar skin: Results of a multi-center study in Japan, Arch Dermatol, 2004; 140: 1233-1238.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ5

ƒƒ‰ƒm[ƒ}‚Ģ‘Šśf’f‚š–Ś“I‚Ę‚µ‚½ŒŒ“Žīį‡ƒ}[ƒJ[‘Ŗ’č‚ĶŠ©‚ß‚ē‚ź‚é‚©

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C2

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ƒƒ‰ƒm[ƒ}‚ĢŒŒ“Žīį‡ƒ}[ƒJ[‚Ę‚µ‚Ä‚ĶCLDHCS100-ƒĄCmelanoma inhibitory activityiMIAjCneuron-specific enolaseiNSEjCƒƒ‰ƒjƒ“‘ćŽÓŽY•Ø‚Å‚ ‚é5-S-cysteinyldopai5-SCDj‚Č‚Ē‚Ŗ’m‚ē‚ź‚Ä‚¢‚é‚ŖC‚±‚ź‚ē‚Ķˆź”Ź‚ɐisŠś‚ĢŠ³ŽŅŒŒ“‚Å‚Ģ‚ŻˆŁķ’l‚šŽ¦‚µC‘Šśf’f‚É—L—p‚Å‚ ‚é‚Ę‚Ģ•ń‚Ķ‚Č‚¢1, 2jB

–{–M‚É‚Ø‚¢‚Ä‚ĶŒŒ“5-S-CD ‚ŖŠO’ŒŸøi2013 ”N12 ŒŽŒ»Ż•ŪŒÆ“K—pŠOj‚Ę‚µ‚Ä‘Ŗ’č‰Ā”\‚Å‚ ‚é‚ŖC‚ā‚Ķ‚葁Šś‚É‚ĶˆŁķ’l‚šŽ¦‚³‚øCtįŠQCL-dopa “ą•žC‰ÄŠśCƒAƒKƒŠƒNƒXŪŽę‚Č‚Ē‚Å‹U—z«‚ʂȂ邱‚Ę‚Ŗ‚ ‚é‚Ģ‚ÅŒ‹‰Ź‚Ģ‰šŽß‚É‚Ķ’ˆÓ‚Ŗ•K—v‚Å‚ ‚éB

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1j Brochez L, Naeyaert JM: Serological markers for melanoma, Br J Dermatol, 2000; 143: 256-268.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ij

2j Mouawad R, Spano JP, Khayat D: Old and new serological biomarkers in melanoma: where we are in 2009, Melanoma Res, 2010; 20: 67-76.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ VIj


CQ6

ƒƒ‰ƒm[ƒ}Œ“”­‘ƒ‚É‚Ø‚Æ‚étumor thickness ‚Ģp‘O•]‰æ‚Ģ‚½‚ߍ‚Žü”gƒGƒR[‚āMRI ‚ĢŽĄŽ{‚ĶŠ©‚ß‚ē‚ź‚é‚©

 

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‚Žü”gƒGƒR[i20`100 MHzj‚Ķƒƒ‰ƒm[ƒ}‚Ģtumor thickness ‚š”äŠr“I³Šm‚É—\‘Ŗ‚Å‚«‚邽‚߁C‚»‚ĢŽĄŽ{‚šl—¶‚µ‚Ä‚ą‚ę‚¢B

 

MRI

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C2

MRI ‚Å‚Ķtumor thickness ‚Ģ‘Ŗ’čŒė·‚Ŗ¶‚¶‚邱‚Ę‚Ŗ‚ ‚邽‚߁C‚»‚ĢŽĄŽ{‚ĶŠ©‚ß‚ē‚ź‚Č‚¢B

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‹@Šķ‚š—p‚¢‚ďp‘O‚Étumor thickness ‚š•]‰æ‚·‚邱‚Ę‚ĶC¶ŒŸ‚šs‚¤‚±‚Ę‚Č‚µ‚ÉT •Ŗ—Ž‚š—\‘Ŗ‚Å‚«‚é“_‚ňӋ`‚Ŗ‚ ‚éB

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ˆź”Ź‚É20 MHz ‚Ģ‚Žü”gƒGƒR[‚š—p‚¢‚½tumor thickness ‚Ģ•]‰æ‚É‚Ā‚¢‚Ä‚ĶC•””‚Ģ‘OŒü‚«ƒRƒz[ƒgŒ¤‹†‚Ø‚ę‚ŃƒVƒXƒeƒ}ƒeƒBƒbƒNEƒŒƒrƒ…[‚ŁCp‘O‚Ģ‚Žü”gƒGƒR[‚Å‚Ģ‘Ŗ’č’l‚ĘŽĄŪ‚Ģ•W–{‚Ģtumor thickness ‚Ę‚Ģ‘ŠŠÖŒW”‚šŽZo‚µC‘ŠŠÖŒW”‚Ŗ‚’l‚Å‚ ‚Į‚½‚Ę•ń‚³‚ź‚Ä‚¢‚é1`3jB‚µ‚©‚µ1 mm ˆČ‰ŗ‚Ģtumor thickness ‚É‚Ā‚¢‚Ä‚ĶC20 MHz ƒGƒR[‚Å‚Ķ‚»‚Ģ‰š‘œ“x‚©‚ē•]‰æ‚Ŗ¢“ļ‚Å‚ ‚莥Ū‚Ģ•W–{‚Ģtumor thickness ‚Ę‚ĢŒė·‚Ŗ‘å‚«‚­‚Č‚éB‹ß”N“oź‚µ‚½75`100 MHz ‚Ģ‚Žü”gƒGƒR[‚É‚ę‚é‘OŒü‚«ƒRƒz[ƒgŒ¤‹†‚Å‚»‚ĢŒė·‚Ķ‚³‚ē‚ɏ¬‚³‚­‚Č‚é‚Ę•ń‚³‚ź‚Ä‚¢‚é‚Ŗ4, 5jC–{–M‚Å‚Ķ‹@ŠķŽ©‘Ģ‚Ŗ‚Ü‚¾•‹y‚µ‚Ä‚¢‚Č‚¢B

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1j Hoffmann K, Jung J, el Gammal S, Altmeyer P: Malignant melanoma in 20-MHz B scan sonography, Dermatology, 1992; 185: 49-55.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Lassau N, Lamuraglia M, Koscielny S, et al: Prognostic value of angiogenesis evaluated with high-frequency and colour Doppler sonography for preoperative assessment of primary cutaneous melanomas: correlation with recurrence after a five year follow-up period, Cancer Imaging, 2006; 6: 24-29.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j Machet L, Belot V, Naouri M, et al: Preoperative measurement of thickness of cutaneous melanoma using highresolution 20 MHz ultrasound imaging: A monocenter prospective study and systematic review of the literature, Ultrasound Med Biol, 2009; 35: 1411-1420.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

4j Guitera P, Li LX, Crotty K, et al: Melanoma histological Breslow thickness predicted by 75-MHz ultrasonography, Br J Dermatol, 2008; 159: 364-369.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Gambichler T, Moussa G, Bahrenberg K, et al: Preoperative ultrasonic assessment of thin melanocytic skin lesions using a 100-MHz ultrasound transducer: a comparative study, Dermatol Surg, 2007; 33: 818-824.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

6j Salmhofer W, Rieger E, Soyer HP, et al: Influence of skin tention and formalin fixation on sonographic measurement of tumor thickness, J Am Acad Dermatol, 1996; 34: 34-39.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

7j Hayashi K, Koga H, Uhara H, Saida T: High-frequency 30-MHz sonography in preoperative assessment of tumor thickness of primary melanoma: usefulness in determination of surgical margin and indication for sentinel lymph node biopsy, Int J Clin Oncol, 2009; 14: 426-430.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

8j ”Ŗ“c®lCāˆäG²C‚“c@ŽĄ‚Ł‚©Fˆ««•FŽī‚Ģp‘O•]‰æ‚É‚Ø‚Æ‚éMRI ‚Ģ—L—p«FŒ“”­‘ƒ‚ĢŒś‚³‚Ģ‘Ŗ’č‚É‚ę‚é•aŠś‚Ģ„’čC“ś–{”ē•†‰ČŠw‰ļŽC1995 ; 105 : 1837-1843.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ7

ƒƒ‰ƒm[ƒ}‚ĢŒ“”­‘ƒ‚É•”•Ŗ¶ŒŸiincisional biopsyj‚šs‚Į‚Ä‚ą‚ę‚¢‚©

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C1

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ƒƒ‰ƒm[ƒ}Œ“”­‘ƒ‚É‚Ā‚¢‚āC‘SŲœ¶ŒŸiexcisional biopsyj‚·‚é‚Ę’Pƒ–Dk‚Ŗ•s‰Ā”\‚Č‘åŒ^•a•Ļ‚Ģź‡‚āCŠē–Ź‚āŽč¶E‘«’ź‚Č‚Ē‚Ģ•a•Ļ‚Å’Pƒ–Dk‚Ŗ“ļ‚µ‚¢ź‡‚Č‚Ē‚ɁCf’f‚Ętumor thickness Šm’č‚Ģ‚½‚߁C•”•Ŗ¶ŒŸ‚š‘I‘š‚µ‚Ä‚ę‚¢‚©”Ū‚©‚Ŗ–ā‘č‚É‚Č‚éB]—ˆ•”•Ŗ¶ŒŸ‚É‚ę‚čƒƒ‰ƒm[ƒ}×–E‚Ŗ[•”‚ɉŸ‚µž‚Ü‚ź‚āC‹ĒŠÄ”­CƒŠƒ“ƒpß“]ˆŚ‚ā‰“Šu“]ˆŚ‚ĢŠėŒÆ«‚Ŗ‚‚Ü‚é‚ʍl‚¦‚ē‚ź‚Ä‚«‚½B

Pflugfelder ‚ē‚É‚ę‚é9 •Ņ‚ĢƒVƒXƒeƒ}ƒeƒBƒbƒNEƒŒƒrƒ…[‚Ģ‚¤‚æC7 •Ņi‘Ē—į”5,017 —įC‘SŲœ¶ŒŸŒQ3,629 —įC•”•Ŗ¶ŒŸŒQ1,365 —įj‚É‚Ø‚¢‚Ä‘SŲœ¶ŒŸŒQ‚Ę•”•Ŗ¶ŒŸŒQŠŌ‚É‹ĒŠÄ”­—¦C¶‘¶—¦‚ɍ·‚Ķ‚Č‚©‚Į‚½1jBˆź•ū“Ŗčņ•”Œ“”­Ē—į‚šŒŸ“¢‚µ‚½Œć‚ėŒü‚«Ē—į‘ĪŪŒ¤‹†1 •Ņ‚ŁC‘SŲœ¶ŒŸŒQ79 —įC•”•Ŗ¶ŒŸŒQ48 —į‚Å‚Ģ‘½•Ļ—Ź‰šĶ‚É‚Ä•”•Ŗ¶ŒŸŒQ‚Ģ¶‘¶—¦‚Ŗ’į‰ŗ‚µ‚½‚Ę‚·‚é•ń2j‚Ŗ‚ ‚é‚ŖC•źW’c‚Ŗ­‚Č‚¢ć‚É•”•Ŗ¶ŒŸŒQ‚Ģ”N—ī‚Ŗ—LˆÓ‚ɍ‚‚­iƒƒ‰ƒm[ƒ}‚Ģ—\Œć•s—ĒˆöŽq‚Ę‚³‚ź‚Ä‚¢‚éjCmatched control study ‚Å‚Ķ‚Č‚¢‚±‚Ę‚ŖŽw“E‚³‚ź‚Ä‚¢‚é1jB‹ß”N‚Ģ•ń‚Å‚ąMolenkamp ‚ē‚ĢŒć‚ėŒü‚«Ē—į‘ĪŪŒ¤‹†3jCMartin ‚ē‚Ģ‘OŒü‚«ƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±4jCBong ‚ē‚ĢŒć‚ėŒü‚«ƒP[ƒXƒRƒ“ƒgƒ[ƒ‹Œ¤‹†5j‚Ķ‚»‚ź‚¼‚ź471 —įC1,776 —įC761 —į‚Ę‘å‹K–ĶĒ—į‚É‚ę‚錤‹†‚ŁC‹ĒŠÄ”­—¦C5 ”N¶‘¶—¦‚Ę‚ą—¼ŒQŠŌ‚É—LˆÓ·‚Ŗ‚Č‚©‚Į‚½‚Ę•ń‚³‚ź‚Ä‚¢‚éB

ˆź•ū‚Å•”•Ŗ¶ŒŸ‚ĢŒ‡“_‚Ę‚µ‚āC‘gDf’f‚Ģø“x’į‰ŗ‚Ŗ‹“‚°‚ē‚ź‚é6, 7jBTumor thickness ‚ŐŲœ”ĶˆĶ‚Ø‚ę‚ŃƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpß¶ŒŸ‚Ģ“K‰ž‚ŖŒˆ’č‚·‚鍔“ś‚É‚Ø‚¢‚āC•”•Ŗ¶ŒŸ‚Å‚ĶŽīį‡‘S‘Ģ‚Ģ‘gD\’z‚šŠĻŽ@‚Å‚«‚øtumor thickness ‚Ŗ’į‚­Œ©Ļ‚ą‚ē‚ź‚āCŠg‘åŲœ‚Ģ”ĶˆĶ‚Ŗ•s‘«‚µ‚½‚čCŒć“śƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpß¶ŒŸ‚Ŗ•K—v‚Ę‚Č‚é‚Ø‚»‚ź‚ą‚ ‚éB

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ˆČć‚ę‚čC•”•Ŗ¶ŒŸ‚Ķ‹ĒŠÄ”­—¦C¶‘¶—¦‚ɉe‹æ‚µ‚Č‚¢‚Ę‚¢‚¤ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹‚Ķ”äŠr“I‚‚¢‚½‚߁Cs‚Į‚Ä‚ą–ā‘č‚Č‚¢‚ʍl‚¦‚ē‚ź‚éB‚µ‚©‚µ•a—f’fŽž‚ÉŽīį‡‘S‘Ģ‚Ģ‘gD\’z‚ŖŠĻŽ@‚Å‚«‚é‘SŲœ¶ŒŸ‚Ģ—˜“_‚šl—¶‚·‚é‚ʁC‘SŲœ¶ŒŸ‚Ŗ¢“ļ‚ȏź‡‚É‚Ģ‚Ż“K‰ž‚·‚ׂ«‚ʍl‚¦‚ē‚ź‚邽‚߁C„§“x‚ĶC1 ‚Ę‚µ‚½B

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1j Pflugfelder A, Weide B, Eigentler TK, et al: Incisional biopsy and melanoma prognosis: Fact and cotroversies, Clin Dermatol, 2010; 28: 316-318.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

2j Austin JR, Byers RM, Brown WD, et al: Influence of biopsy on the prognosis of cutaneous melanoma of the head and neck, Head Neck, 1996; 18: 107-117.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j Molenkamp BG, Sluijter BJ, Oosterhof B, et al: Non-radical diagnostic biopsies do not negatively influence melanoma patient survival, Ann Surg Oncol, 2007; 14: 1424-1430.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

4j Martin RC 2nd, Scoggins CR, Ross MI, et al: Is incisional biopsy of melanoma harmful? Am J Surg, 2005: 190: 913-917.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Bong JL, Herd RM, Hunter JA: Incisional biopsy and melanoma prognosis, J Am Acad Dermatol, 2002; 46: 690-694.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

6j Pariser RJ, Divers A, Nassar A: The relationship between biopsy technique and uncertainty in the histopathologic diagnosis of melanoma, Dermatol Online J, 1999; 5: 4.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j Witheiler DD, Cockerell CJ: Sensitivity of diagnosis of malignant melanoma: a clinicopathologic study with a critical assessment of biopsy techniques, Exp Dermatol, 1992; 1: 170-175.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

8j McKenna DB, Lee RJ, Prescott RJ, et al: The time from diagnostic excision biopsy to wide local excision for primary cutaneous malignant melanoma may not affect patient survival, Br J Dermatol, 2002; 147: 48-54.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

9j McKenna DB, Lee RJ, Prescott RJ, et al: A retrospective observational study of primary cutaneous malignant melanoma patients treated with excision only compared with excision biopsy followed by wider local excision, Br J Dermatol, 2004; 150: 523-530.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ8

ƒƒ‰ƒm[ƒ}‚Ģ“]ˆŚ‘ƒŒŸo‚Ģ‚½‚ß‚Ģp‘O‰ę‘œŒŸø‚ĶŠ©‚ß‚ē‚ź‚é‚©

 

—Տ°•aŠś0iin situj

„§“x

C2

‹¹•”X üC’“‰¹”gŒŸøCCTCPET ‚Č‚Ē‚šŽĄŽ{‚·‚邱‚Ę‚ĶŠ©‚ß‚ē‚ź‚Č‚¢B

 

—Տ°•aŠś Ⅰ‚©‚ēⅡB

„§“x

C1

‹¹•”X üC’“‰¹”gŒŸøCCTCPET ‚Č‚Ē‚šŽĄŽ{‚·‚邱‚Ę‚šl—¶‚µ‚Ä‚ą‚ę‚¢‚ŖCˆź—„‚ÉŽĄŽ{‚·‚邱‚Ę‚ĶŠ©‚ß‚ē‚ź‚Č‚¢B

 

—Տ°•aŠśⅡC ‚©‚ēⅢ

„§“x

B

‹¹•”X üC’“‰¹”gŒŸøCCTCPET ‚Č‚Ē‚šŠ‘®ƒŠƒ“ƒpß‚ĢˆŹ’u‚ʉ“Šu“]ˆŚ‚ĢƒŠƒXƒN‚ɉž‚¶‚ďĒ—į‚²‚Ę‚É‘I‘š‚µ‚ÄŽĄŽ{‚·‚邱‚Ę‚ŖŠ©‚ß‚ē‚ź‚éB

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


”‰šą

p‘O‚É‰ę‘œŒŸø‚šs‚¤Å‘å‚Ģ–Ś“I‚ĶCŽ”—Ć•ūj‚Ģ•ĻX‚É‚Ā‚Č‚Ŗ‚éöŻ“I‚Č“]ˆŚ‚šŒŸo‚·‚邱‚Ę‚Å‚ ‚éBTumor thickness ‚ŖŒś‚­‚Č‚é‚ɏ]‚¢“]ˆŚ‚š¶‚¶‚éŠm—¦‚ąćø‚·‚邱‚Ę‚©‚ēC‰ę‘œŒŸø‚É‚ę‚é—˜‰v‚Ŗ‹U—z«‚Č‚Ē‚Ģ•s—˜‰v‚šć‰ń‚é‚ĘŽv‚ķ‚ź‚étumor thickness ˆČć‚Ģ•a•Ļ‚É‘Ī‚µ‚Ä‚Ģ‚Ż‰ę‘œŒŸø‚šs‚¤‚±‚Ę‚ŖŠ©‚ß‚ē‚ź‚é1jB

‹¹•”X üŒŸø‚Ķ‹U—z«‚Ŗ‘½‚­C^‚Ģ”x“]ˆŚ‚ŖŒŸo‚³‚ź‚éŠm—¦‚Ķ0.1“‚Ę•ń‚³‚ź‚Ä‚Ø‚čCtumor thickness 4.0 mm ˆČ‰ŗ‚ĢŠ³ŽŅ‚É”x“]ˆŚ‚šŒŸo‚·‚邽‚ß‚ĢƒXƒNƒŠ[ƒjƒ“ƒOŒŸø‚Ę‚µ‚čs‚¤‚±‚Ę‚Ķ„§‚³‚ź‚Č‚¢2jB’“‰¹”gŒŸø‚Ķƒƒ^ƒAƒiƒŠƒVƒX‚É‚Ø‚¢‚āCGf‚ę‚č‚ąƒŠƒ“ƒpß“]ˆŚ‚ĢŒŸo”\‚Ŗ—D‚ź‚Ä‚¢‚邱‚Ę‚ŖŽ¦‚³‚ź‚Ä‚¢‚é3jBGf‚Ę’“‰¹”gŒŸø‚š‘g‚Ż‡‚ķ‚¹‚é‚ĘPETipositron emission tomographyj‚ę‚č‚ą—Տ°“IƒŠƒ“ƒpß“]ˆŚ‚ĢŒŸo—¦‚Ŗ‚‚Ü‚é‚Ę‚¢‚¤•ń‚ą‚ ‚é4jB

•aŠśⅢ‚Ģƒƒ‰ƒm[ƒ}Š³ŽŅ‚É‚Ø‚¢‚ÄCT ‚É‚ę‚Į‚ėՏ°Ēó‚Ģ‚Č‚¢öŻ“I‚ȉ“Šu“]ˆŚ‚ŖŒ©‚Ā‚©‚éŠm—¦‚ĶCƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpß¶ŒŸ‚Ŗ—z«‚Å‚ ‚Į‚½ŽŅ‚Å‚Ķ0.5`3.7“5`7jC—Տ°“IŠ‘®ƒŠƒ“ƒpßŽī’Æ‚Ģ‚ ‚銳ŽŅ‚Å‚Ķ4.2`15.7“‚Å‚ ‚é8`10jB‚µ‚½‚Ŗ‚Į‚ÄCT ‚š—Տ°•aŠś Ⅰ‚©‚ēⅢ‚ĢŠ³ŽŅ‘Sˆõ‚ɃXƒNƒŠ[ƒjƒ“ƒO“I‚ɏp‘OŒŸø‚Ę‚µ‚čs‚¤‚±‚Ę‚ĶC“]ˆŚŒŸo‚ĢŠ““x‚Ę‹U—z«‚Ģ•p“x‚©‚ē‚Ż‚Đ„§‚³‚ź‚øCŒĀX‚ĢĒ—į‚²‚Ę‚É“]ˆŚ‚ĢƒŠƒXƒN‚ɉž‚¶‚ÄŒŸ“¢‚·‚é•K—v‚Ŗ‚ ‚éBPET ‚ĶCƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpß“]ˆŚ‚ĢŒŸo—Ķ‚Ķ’į‚¢‚Ŗ11jC•aŠś‚Ŗi‚ń‚¾Ē—į‚É‚Ø‚Æ‚éöŻ“I“]ˆŚ‘ƒ‚ĢŒŸo”\—Ķ‚Å‚Ķ—D‚ź‚Ä‚¢‚é‚Ģ‚ÅCT ‚Å‚Ķ•]‰æ‚Ŗ“ļ‚µ‚¢ŽlŽˆ‚šŠÜ‚ß‚½‘Sg‚Ģ“]ˆŚ‚šŒŸõ‚·‚é‚É‚Ķ—L—p‚Å‚ ‚é12jB

—Տ°•aŠś•Ź‚ÉŒŸ“¢‚µ‚½ź‡C—Տ°•aŠś0iin situj‚Ģ•a•Ļ‚Å‚ĶŠ‘®ƒŠƒ“ƒpß“]ˆŚ‚Ø‚ę‚Ń–³Ēó‚Ģ‰“Šu“]ˆŚ‚šŒŸo‚·‚é–Ś“I‚Å‰ę‘œŒŸø‚šs‚¤•K—v‚Ķ‚Č‚¢B

—Տ°•aŠśⅠ ‚©‚ēⅡB ‚Ģƒƒ‰ƒm[ƒ}Š³ŽŅ‚ŁC‰ę‘œŒŸø‚Å•`o‚³‚ź‚é‚ꂤ‚ȏŠ‘®ƒŠƒ“ƒpß“]ˆŚ‚Ü‚½‚Ķ‰“Šu“]ˆŚ‚ŖŒ©‚Ā‚©‚éŠm—¦‚Ķ’į‚­C—Տ°“I‚É“]ˆŚ‚šŽ¦“‚·‚鏊Œ©‚Ŗ–³‚¢Ē—į‚É‘Ī‚µ‚Ĉź—„‚É‰ę‘œŒŸø‚šs‚¤•K—v‚Ķ‚Č‚¢BŠ‘®ƒŠƒ“ƒpß“]ˆŚ‚ĢŒŸo‚šŽŽ‚Ż‚鏼‡‚Ķ’“‰¹”gŒŸø‚ŖŠ©‚ß‚ē‚ź‚éB

—Տ°•aŠśⅡC ‚©‚ēⅢ‚Ģƒƒ‰ƒm[ƒ}Š³ŽŅ‚Å‚ĶCĒ—į‚²‚Ę‚ÉŠ‘®ƒŠƒ“ƒpß‚ĢˆŹ’u‚ʉ“Šu“]ˆŚ‚ĢƒŠƒXƒN‚ɉž‚¶‚½‘Sg‰ę‘œŒŸøŒv‰ę‚š‚½‚Ă邱‚Ę‚ŖŠ©‚ß‚ē‚ź‚éB

‚Č‚ØC‰¢•Ä‚Å‚Ķ¶ŒŸ‚Åtumor thickness ‚šŠm”F‚µ‚ėՏ°•aŠś‚ɉž‚¶‚½‰ę‘œŒŸø‚šŒŸ“¢‚·‚é‚ŖC“ś–{‚Å‚Ķ‘«’źE’Ü•”‚Ģ•a•Ļ‚Ŗ‘½‚¢‚½‚߁Ctumor thickness ‚š—\‘z‚µ‚ÄŒ“”­•”ˆŹŲœ‘O‚É‰ę‘œŒŸø‚šs‚¤‚±‚Ę‚Ŗ‘½‚­CŒ‹‰Ź“I‚ɉߏč‚ȏp‘O‰ę‘œŒŸø‚É‚Č‚éŒXŒü‚Ŗ‚ ‚éB

ˆź”Ź“I‚É‰ę‘œŒŸø‚Ö‚ĢƒAƒNƒZƒX‚Ŗ‚ę‚¢“ś–{‚Å‚ĶCŒĀX‚ĢŠ³ŽŅ‚ĢŠī‘bŽ¾Š³•]‰æ‚ąŒ“‚Ė‚ĉ¢•Ä‚ĢƒKƒCƒhƒ‰ƒCƒ“‚Ģ“ą—e‚š’“‚¦‚é‰ę‘œŒŸø‚Ŗs‚ķ‚ź‚Ä‚¢‚é‚ŖC‚±‚ź‚Ü‚Å“ś–{lŠ³ŽŅ‚É‚Ā‚¢‚Ä‰ę‘œŒŸø‚É‚Ø‚Æ‚é‹U—z«‚Ģ–ā‘č‚āˆć—ĆŒoĻ“IŠĻ“_‚©‚ēŒŸ“¢‚šs‚Į‚½•ń‚Ķ‚Č‚¢B

•¶Œ£

1j Yancovitz M, Finelt N, Warycha MA, et al: Role of radiologic imaging at the time of initial diagnosis of stage T1b-T3b melanoma, Cancer, 2007; 110: 1107-1114.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Terhune MH, Swanson N, Johnson TM: Use of chest radiography in the initial evaluation of patients with localized melanoma, Arch Dermatol, 1998; 134: 569-572.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j Bafounta ML, Beauchet A, Chagnon S, et al: Ultrasonography or palpation for detection of melanoma nodal invasion: a meta-analysis, Lancet Oncol, 2004; 5: 673-680.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

4j Hafner J, Schmid MH, Kempf W, et al: Baseline staging in cutaneous malignant melanoma, Br J Dermatol, 2004; 150: 677-686.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Aloia TA, Gershenwald JE, Andtbacka RH, et al: Utility of computed tomography and magnetic resonance imaging staging before completion lymphadenectomy in patients with sentinel lymph node-positive melanoma, J Clin Oncol, 2006; 24: 2858-2865.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

6j Gold JS, Jaques DP, Busam KJ, et al: Yield and predictors of radiologic studies for identifying distant metastases in melanoma patients with a positive sentinel lymph node biopsy, Ann Surg Oncol, 2007; 14: 2133-2140.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j Miranda EP, Gertner M, Wall J, et al: Routine imaging of asymptomatic melanoma patients with metastasis to sentinel lymph nodes rarely identifies systemic disease, Arch Surg, 2004; 139: 831-836.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

8j Kuvshinoff BW, Kurtz C, Coit DG: Computed tomography in evaluation of patients with stage Ⅲ melanoma, Ann Surg Oncol, 1997; 4: 252-258.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

9j Buzaid AC, Tinoco L, Ross MI, et al: Role of computed tomography in the staging of patients with local-regional metastases of melanoma, J Clin Oncol, 1995; 13: 2104-2108.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

10j Johnson TM, Fader DJ, Chang AE, et al: Computed tomography in staging of patients with melanoma metastatic to the regional nodes, Ann Surg Oncol, 1997; 4: 396-402.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

11j Jiménez-Requena F, Delgado-Bolton RC, Fernández-Pérez C, et al: Meta-analysis of the performance ofi18jF-FDG PET in cutaneous melanoma, Eur J Nucl Med Mol Imaging, 2010; 37: 284-300.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

12j Bastiaannet E, Oyen WJ, Meijer S, et al: Impact ofm18Fn fluorodeoxyglucose positron emission tomography on surgical management of melanoma patients, Br J Surg, 2006; 93: 243-249.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ9

ƒƒ‰ƒm[ƒ}‚ĢŒ“”­‘ƒ‚ĶC“÷Šį“I‚Č•a‘ƒ•Ó‰‚©‚ē‰½cm —£‚µ‚ĐŲœ‚·‚邱‚Ę‚ŖŠ©‚ß‚ē‚ź‚é‚©

 

In situ •a•Ļ

„§“x

C1

ƒƒ‰ƒm[ƒ}Œ“”­‘ƒ‚šŠO‰Č“IŲœ‚·‚éŪ‚Ģ•a‘ƒ•Ó‰‚©‚ē‚Ģ‹——£‚Ķ3`5 mm ‚Ŗl—¶‚³‚ź‚éB

 

Tumor thickness … 1 mm

„§“x

A

ƒƒ‰ƒm[ƒ}Œ“”­‘ƒ‚šŠO‰Č“IŲœ‚·‚éŪ‚Ģ•a‘ƒ•Ó‰‚©‚ē‚Ģ‹——£‚Ķ1 cm ‚Ŗ‹­‚­Š©‚ß‚ē‚ź‚éB

 

Tumor thickness@1.01`2.0 mm

„§“x

A

ƒƒ‰ƒm[ƒ}Œ“”­‘ƒ‚šŠO‰Č“IŲœ‚·‚éŪ‚Ģ•a‘ƒ•Ó‰‚©‚ē‚Ģ‹——£‚Ķ1`2 cm ‚Ŗ‹­‚­Š©‚ß‚ē‚ź‚éB

 

Tumor thickness@2.01 ` 4.0 mm

„§“x

A

ƒƒ‰ƒm[ƒ}Œ“”­‘ƒ‚šŠO‰Č“IŲœ‚·‚éŪ‚Ģ•a‘ƒ•Ó‰‚©‚ē‚Ģ‹——£‚Ķ2 cm ‚Ŗ‹­‚­Š©‚ß‚ē‚ź‚éB

 

Tumor thickness „ 4.0 mm

„§“x

B

ƒƒ‰ƒm[ƒ}Œ“”­‘ƒ‚šŠO‰Č“IŲœ‚·‚éŪ‚Ģ•a‘ƒ•Ó‰‚©‚ē‚Ģ‹——£‚Ķ2 cm ‚ŖŠ©‚ß‚ē‚ź‚éB

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


”‰šą

ƒƒ‰ƒm[ƒ}‚ĢŒ“”­‘ƒ‚É‘Ī‚·‚é•W€“I‚©‚ĀM—Š«‚Ģ‚‚¢Ž”—Ć‚ĶL”ĶˆĶ‚ĢŲœ‚Å‚ ‚éB‚±‚ĢL”ĶˆĶŲœ‚É‚ę‚č‹ĒŠÄ”­‚ĢŒø­‚ā¶‘¶—¦‚Ģ‰ü‘P‚Č‚Ē‚ŖŠś‘Ņ‚³‚ź‚é‚ŖC‘¼•ūCŲœŒć‚ĢÄŒš‚É‚ĶA”ē‚ā”ē•Ł‚É‚ę‚éÄŒš‚Ŗ•K—v‚ʂȂ邱‚Ę‚ą‚ ‚čC‹@”\“I‚ ‚é‚¢‚Ķ®—e“I‚Č–ā‘č‚āpŒć‡•¹Ē‚Ŗ‘‰Į‚·‚é‰Ā”\«‚Ŗ‚‚Ü‚éB‚±‚ź‚Ü‚Å“KŲ‚ȐŲœƒ}[ƒWƒ“‚šŒˆ’č‚·‚邽‚߂ɁC‚³‚Ü‚“‚܂ȐŻ’č‚ŏĒ—į‘ĪĘŒ¤‹†‚āƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚Ŗs‚ķ‚ź‚Ä‚«‚½B

2002 ”N‚Ģƒƒ^ƒAƒiƒŠƒVƒX‚É‚Ø‚¢‚āC1`2 cm ƒ}[ƒWƒ“‚Ę3`5 cm ƒ}[ƒWƒ“‚Å‚ĢŲœ‚Ŗ”äŠr‚³‚źC5 ”N¶‘¶—¦‚Ø‚ę‚Ń5 ”N–³•a¶‘¶—¦‚É—LˆÓ·‚Ģ‚Č‚¢‚±‚Ę‚ŖŽ¦‚³‚ź‚½1jB•Ź‚Ģƒƒ^ƒAƒiƒŠƒVƒX‚Å‚ĶCŒ“”­‘ƒ‚ĢÅ‘åŲœƒ}[ƒWƒ“‚Ķ2 cm ‚š’“‚¦‚Č‚¢‚±‚Ę‚Ŗ–]‚Ü‚µ‚­C2 cm ‚Ę1 cm ‚š”äŠr‚µ‚½ƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚Ķs‚ķ‚ź‚Ä‚¢‚Č‚¢‚Ģ‚ŁCŲœƒ}[ƒWƒ“‚Ķ2 cm ‚Ŗ–]‚Ü‚µ‚¢‚ĘŒ‹˜_•t‚Æ‚Ä‚¢‚é2jBNational Intergroup Trial ‚Å‚ĶCtumor thickness ‚Ŗ1.0 ` 4.0 mm ‚Ģ468 —į‚š–³ģˆ×‚É2 cm ‚Ę4 cm ƒ}[ƒWƒ“‚ÉŠ„‚č•t‚ƁCŒo‰ßŠĻŽ@ŠśŠŌ‚Ģ’†‰›’l‚Ŗ10 ”N‚ĢŒ‹‰ŹC‹ĒŠÄ”­C–³•a¶‘¶C‘S¶‘¶‚É‚Ø‚¢‚Ä—¼ŽŅ‚ɍ·‚Ŗ‚Č‚¢‚±‚Ę‚š•ń‚µ‚½3jBTumor thickness ‚Ŗ2 mm ˆČ‰ŗ‚ĢĒ—į‚Å‚ĶCŲœƒ}[ƒWƒ“‚ʐ¶‘¶—¦‚ĢŠŌ‚É‘ŠŠÖŠÖŒW‚Ķ‚Č‚­CŒ“”­‘ƒ‚ĢŲœƒ}[ƒWƒ“‚š1 cm ˆČć‚Ę‚·‚ź‚ĪC‹ĒŠÄ”­—¦‚É‚ą‰e‹æ‚Ģ‚Č‚¢‚±‚Ę‚ŖŽ¦‚³‚ź‚½4jBTumor thickness ‚Ŗ4.0 mm ‚š’“‚¦‚éĒ—į‚ÉŒĄ‚Į‚½‘OŒü‚«‚Ģƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚Ķs‚ķ‚ź‚Ä‚Ø‚ē‚øC2 cm ƒ}[ƒWƒ“‚Ŗ“K“–‚Å‚ ‚é‚Ę‚¢‚¤ƒRƒz[ƒgŒ¤‹†‚Ŗ‚ ‚é‚Ģ‚Ż‚Å‚ ‚é5jBIn situ •a•Ļ‚É‚Ā‚¢‚Ä‚ąC‘OŒü‚«‚Ģƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚Ķs‚ķ‚ź‚Ä‚¢‚Č‚¢‚ŖC3 mm ƒ}[ƒWƒ“‚Ę3 mm ‚š’“‚¦‚éƒ}[ƒWƒ“‚Å‚Ģ”äŠr‚É‚Ø‚¢‚Ä‹ĒŠÄ”­—¦‚É—LˆÓ·‚Ŗ‚Č‚¢‚±‚Ę‚Ŗ•ń‚³‚ź‚Ä‚Ø‚čC3 mm ƒ}[ƒWƒ“‚Å‚ĢŲœ‚Ŗ„§‚³‚ź‚é6jB‚µ‚©‚µCŠē–Ź‚Ģin situ •a•Ļ‚ōőåŒa‚Ŗ2 cm ˆČć‚Ģź‡‚Ķ5 mm ˆČć‚Ģƒ}[ƒWƒ“‚Å‚ąÄ”­‚·‚邱‚Ę‚Ŗ‚ ‚é6jB

ˆČć‚ę‚čC①in situ •a•Ļ‚ĢŲœƒ}[ƒWƒ“‚Ķ3`5 mmiŠē–Ź‚ōőåŒa‚Ŗ2 cm ˆČć‚Ģ•a•Ļ‚Ķ5 mm ˆČćjC②tumor thickness ‚Ŗ1 mm ˆČ‰ŗ‚Ģ•a•Ļ‚Å‚Ķ1 cmC③tumor thickness ‚Ŗ1`2mm ‚Å‚Ķ1`2 cmC④tumor thickness ‚Ŗ2`4 mm ‚Å‚Ķ2 cmC⑤tumor thickness ‚Ŗ4 mm ‚š’“‚¦‚é•a•Ļ‚ÉŠÖ‚µ‚Ä2 cm ‚Ŗ„§‚³‚ź‚éB‚½‚¾‚µCŲœƒ}[ƒWƒ“‚ĶCŒĀX‚ĢĒ—į‚Ģ‰š–UŠw“IˆŹ’u‚ā®—e–Ź‚ąl—¶‚·‚éB‰š–UŠw“I‚É2 cm ƒ}[ƒWƒ“‚ĢŠm•Ū‚Ŗ¢“ļ‚ȏź‡‚ą‚ ‚čC1`2 cm ‚Ģ”ĶˆĶ‚Å‚ą‹–—e‚³‚ź‚éBIn situ •a•Ļ‚Å‚Ķć‹L‚Ģ‚ꂤ‚ɐŲœ‚Ŗ•W€“IŽ”—Ć‚Ęl‚¦‚ē‚ź‚é‚ŖCpŒć‡•¹Ē‚ā®—e–Ź‚šl—¶‚µ‚Ä‘SŲœ‚Ŗ¢“ļ‚ȏź‡CÅ‹ß‚Å‚ĶŽ”—Ć‚ĢƒIƒvƒVƒ‡ƒ“‚Ę‚µ‚ăCƒ~ƒLƒ‚ƒhŠO—p‚ą•ń‚³‚ź‚Ä‚¢‚éB‚µ‚©‚µŒ»Žž“_‚Å‚Ķ’·ŠśŒo‰ß‚É‚Ø‚Æ‚éÄ”­‚Ģ—L–³‚Ŗ–¾‚ē‚©‚É‚Č‚Į‚Ä‚¢‚Č‚¢‚½‚ߎčp‚É‘ć‚ķ‚鎔—Ć–@‚Ę‚µ‚Đ„§‚Ķ‚³‚ź‚Č‚¢7jB

‚Č‚Ø[•”‚ĢŲœ’f’[‚ĶCN“ü‚Ģ[‚³‚ɉž‚¶‚ÄŒˆ’č‚·‚éBN“ü‚Ŗ^”ē“ą‚Ü‚Å‚Ģ•a•Ļ‚Ķ”ē‰ŗŽ‰–b‘gD‘S‘w‚šŠÜ‚߂ĐŲœ‚·‚éB‰ŗ°‚Ģ‹Ų–Œ‚š•t‚ƂĐŲœ‚·‚é‚Ę—\Œć‚Ŗ‰ü‘P‚·‚é‚Ę‚¢‚¤ƒf[ƒ^‚Ķ‚Č‚¢8, 9jB

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1j Lens MB, Dawes M, Goodacre T, et al: Excision margins in the treatment of primary cutaneous melanoma: a systematic review of randomized controlled trials comparing narrow vs wide excision, Archives of Surgery, 2002; 137: 1101-1105.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

2j Haigh PI, DiFronzo LA, McCready DR: Optimal excision margins for primary cutaneous melanoma: a systematic review and meta-analysis, Can J Surg, 2003; 46: 419-426.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

3j Balch CM, Soong SJ, Smith T, et al: Long-term results of a prospective surgical trial comparing 2 cm vs. 4 cm excision margins for 740 patients with 1-4 mm melanomas, Ann Surg Oncol, 2001; 8: 101-108.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

4j McKinnon JG, Starritt EC, Scolyer RA, et al: Histopathologic excision margin affects local recurrence rate: analysis of 2681 patients with melanomas ƒ or  2 mm thick, Ann Surg, 2005; 241: 326-333.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Heaton KM, Sussman JJ, Gershenwald JE, et al: Surgical margins and prognostic factors in patients with thicki„ 4 mmj primary melanoma, Ann Surg Oncol, 1998; 5: 322-328.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

6j Bartoli C, Bono A, Clemente C, et al: Clinical diagnosis and therapy of cutaneous melanoma in situ, Cancer, 1996; 77: 888-892.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j Cotter MA, McKenna JK, Bowen GM: Treatment of lentigo maligna with imiquimod before staged excision, Dermatol Surg, 2008: 34: 147-151.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

8j Kenady DE, Brown BW, McBride CM: Excision of underlying fascia with a primary malignant melanoma: effect on recurrence and survival rates, Surgery, 1982; 92: 615-618.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

9j Sondergaard K, Schou G: Therapeutic and clinico-pathological factors in the survival of 1,469 patients with primary cutaneous malignant melanoma in clinical stage I. A multivariate regression analysis, Virchows Arch A Pathol Anat Histopathol, 1985; 408: 249-258.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ10

“÷Šį“Ii—Տ°“IjƒŠƒ“ƒpß“]ˆŚ‚Ŗ‚Č‚­‚©‚Ā‰“Šu“]ˆŚ‚Ģ‚Č‚¢ƒƒ‰ƒm[ƒ}‚É‘Ī‚µ‚āCƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpß¶ŒŸisentinel lymph node biopsyG SLNBj‚ĶŠ©‚ß‚ē‚ź‚é‚©

 

Tumor thickness … 0.75 mm

„§“x

C2

SLNB ‚šs‚¤‚±‚Ę‚ĶŠ©‚ß‚ē‚ź‚Č‚¢B

 

Tumor thickness@0.76`1.0 mm

„§“x

C1

Œś‚³0.76 mm ˆČć‚Å‚ĶSLNB ‚šl—¶‚µ‚Ä‚ę‚¢B“Į‚É’×į‡‚Ŗ‚ ‚鏼‡C”N—ī‚Ŗ40 ĪˆČ‰ŗC¶ŒŸ‘gD‚Ģ[•”’f’[‚Ŗ—z«CƒŠƒ“ƒpŠĒZ‚š”F‚ß‚éź‡CClark ƒŒƒxƒ‹ⅣˆČćC‚ ‚é‚¢‚Ķ1ŒĀ/mm2 ˆČć‚ĢŠj•Ŗ—ō‘œ‚Ģ‚¢‚ø‚ź‚©‚Ŗ‚³‚ē‚É‚ ‚ź‚ĪSLNB ‚šl—¶‚·‚éB

 

Tumor thickness@1.01`4.0 mm

„§“x

B

SLNB ‚É‚ę‚čƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßisentinel lymph nodeGSLNj‚ĢŒ°”÷‹¾“I“]ˆŚ‚š‘Šś‚É”­Œ©‚µC‚»‚ĢƒŠƒ“ƒpß—Ģˆę‚šŠs“‚·‚邱‚Ę‚É‚ę‚čƒŠƒ“ƒpß“]ˆŚ‚Ģ‚ ‚銳ŽŅ‚Ģ—\Œć‚Ŗ‰ü‘P‚³‚ź‚邱‚Ę‚©‚ēCSLNB ‚šs‚¤‚±‚Ę‚ŖŠ©‚ß‚ē‚ź‚éB

 

Tumor thickness „ 4.0 mm

„§“x

C1

SLNB ‚šs‚¤ˆÓ‹`‚Ķ–¾Šm‚É‚Č‚Į‚Ä‚¢‚Č‚¢‚ŖC¢ŠE“I‚É‚ą‘½‚­‚ĢŽ{Ż‚ōs‚ķ‚ź‚Ä‚¢‚錻ó‚©‚ēCŒ»Žž“_‚Å‚ĶSLNB ‚šl—¶‚µ‚Ä‚ę‚¢B

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1jSLNB ‚ĢˆÓ‹`

SLNB ‚ĶC“÷Šį“Ii—Տ°“IjƒŠƒ“ƒpß“]ˆŚ‚Ģ‚Č‚¢ƒƒ‰ƒm[ƒ}‚É‚Ø‚¢‚āC—\–h“IƒŠƒ“ƒpßŠs“‚É”ä‚ׂę‚č’įNP‚Å‚ ‚čCŒ»Ż‚Å‚Ķ•aŠśŒˆ’č‚É‚Ø‚¢‚Ä‚Ł‚Ś•K{‚Č‹Z–@‚Å‚ ‚éB‚Ü‚½SLN ‚Ģ“]ˆŚ‚Ģ—L–³‚Ŗ¶‘¶‚ɉe‹æ‚š‹y‚Ś‚·d—v‚ČˆöŽq‚Å‚ ‚éBF‘f–@‚ɃVƒ“ƒ`ƒOƒ‰ƒtƒB[‚ĘƒKƒ“ƒ}ƒvƒ[ƒu‚š•¹—p‚·‚邱‚Ę‚É‚ę‚čSLN ‚Ģ“Æ’č—¦‚Ķ93`99.5“‚Ę”ńķ‚ɍ‚‚¢1jB‚½‚¾‚µCSLNB ‚šˆĄ‘SC³Šm‚ɍs‚¤‚½‚ß‚É‚Ķƒ‰[ƒjƒ“ƒOƒJ[ƒu‚Ŗ‚ ‚é‚Ę‚³‚źC“Į‚É“Ŗčņ•”—Ģˆę‚Å‚ĶŽč‹Z‚Ŗ“ļ‚µ‚¢‚½‚߁C\•Ŗ‚ČŒoŒ±‚šĻ‚ń‚¾Ž{ŻCpŽŅ‚É‚ę‚Į‚čs‚ķ‚ź‚é‚ׂ«‚Å‚ ‚ė‚¤B

SLN ‚ĢŒ°”÷‹¾“I“]ˆŚ—z«—¦‚ĶŒ“”­Žīį‡‚ĢŒś‚³‚É”ä—į‚µ‚ďćø‚·‚éBMD Anderson Cancer Center ‚Ģƒf[ƒ^‚É‚ę‚ź‚ĪCSLN ‚Ģ“]ˆŚ—z«—¦‚ĶCŒ“”­Žīį‡‚ĢŒś‚³‚Ŗ1.5 mm ˆČ‰ŗ‚Å4.8“C1.5 ` 4 mm ‚Å19.2“C4 mm ‚š’“‚¦‚鏼‡‚Å34.4“‚Å‚ ‚Į‚½2jB‰FŒ“‚ē‚É‚ę‚é–{–M‚Ģ‘½Ž{Ż‹¤“ÆŒ¤‹†‚Å‚ĶCthickness ‚ĘSLN ‚Ģ“]ˆŚ—¦‚ĶCT1F11.3 “CT2F21.0 “CT3F34.0 “CT4F62.4“‚Å‚ ‚čCin situ ‚Å‚Ķ“]ˆŚ‚Ķ”F‚ß‚ē‚ź‚øC‹ĒŠis—į‚Å‚Ķ‚—¦‚É“]ˆŚ‚Ŗ‚Ż‚ē‚ź‚Ä‚¢‚é3jB

2jtumor thickness … 1.0 mm ‚Ģƒƒ‰ƒm[ƒ}‚É‘Ī‚·‚éSLNB

Tumor thickness ‚Ŗ1.0 mm ˆČ‰ŗ‚Ģƒƒ‰ƒm[ƒ}‚Å‚ĶC‰¢•Ä‚Ģƒf[ƒ^‚É‚ę‚é‚ĘSLN ‚Ģ“]ˆŚ—z«—¦‚Ķ2`5“’ö“x‚Å‚ ‚čC–{–M‚Å‚Ķ11.3“‚Å‚ ‚Į‚½3jBWright ‚ē‚ĶC631 —į‚š‰šĶ‚µCSLN ‚É“]ˆŚ‚Č‚µ‚Ę“]ˆŚ‚ ‚č‚Å‚Ķ10 ”Nƒƒ‰ƒm[ƒ}“ĮˆŁ“I¶‘¶—¦‚É—LˆÓ·‚š”F‚߁i98“ vs 83“Cp ƒ .001jC‚±‚Ģ‘w‚É‚Ø‚¢‚Ä‚ąSLN ‚Ģ“]ˆŚ‚Ŗd—v‚Č—\ŒćˆöŽq‚Å‚ ‚é‚Ę‚µ‚Ä‚¢‚é4jBSLN “]ˆŚ‚ÉŠÖ‚ķ‚éˆöŽq‚Ę‚µ‚āC‚¢‚­‚Ā‚©‚ĢƒRƒz[ƒgŒ¤‹†‚ę‚č5`7jCŒś‚³0.75 mm ˆČćCClark ƒŒƒxƒ‹IV ˆČćC’×į‡‚Ŗ‘¶Ż‚·‚鏼‡CZ•”ˆŹ‚ĢŠj•Ŗ—ō‚Ŗ1 ŒĀ/mm2 ˆČćC¶ŒŸ‘gD‘œ‚Ģ[•”’f’[—z«CƒŠƒ“ƒpŠĒZ‚Č‚Ē‚Ŗl‚¦‚ē‚źC‚±‚ź‚ē‚ĢŠŒ©‚Ŗ‚ ‚鏼‡‚ĶSNB ‚šl—¶‚µ‚Ä‚ę‚¢‚ʍl‚¦‚éB

3jtumor thickness ‚Ŗ1.01 ` 4.0 mm ‚Ģƒƒ‰ƒm[ƒ}‚É‘Ī‚·‚éSLNB

’†ŠŌ‘w‚ĢŒś‚³‚Ģƒƒ‰ƒm[ƒ}‚É‚Ā‚¢‚āCSLNB ‚Ŗ¶‘¶—¦‚š‰ü‘P‚·‚é‚©‚Ē‚¤‚©‚šŒŸ“¢‚·‚邽‚߂ɁC‰¢•Ä‚ĢŽå—v‚Čƒƒ‰ƒm[ƒ}Ž”—ĆŽ{Ż‚ɂă‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±iMulticenter Selective Lymphadenectomy Trial-IFMSLT-Ij‚Ŗs‚ķ‚ź‚½B‚±‚ĢŽŽŒ±‚Å‚ĶŒ“”­Žīį‡‚ĢŒś‚³‚Ŗ1.2`3.5 mm ‚Ģ1,269 —į‚šCSLNB Ž{s769 —į‚ĘŒ“”­‘ƒŲœ‚Ģ‚ŻipŒć‚Ģ’芜“IŠĻŽ@‚ŃŠƒ“ƒpß“]ˆŚ‚ŖoŒ»‚µ‚½Žž“_‚ÅŠs“j500 —į‚Ģ2 ŒQ‚ɐU‚č•Ŗ‚Æ‚½B‚»‚Ģ’†ŠŌ‰šĶ‚ĢŒ‹‰ŹC5 ”N–³•a¶‘¶—¦‚Ķ‘OŽŅ‚Ŗ78.3 } 1.3“CŒćŽŅ‚Ŗ73.1 } 2.1“‚ÅSLNB ŒQ‚Ŗ—LˆÓ‚É—D‚ź‚Ä‚¢‚½ip  0.009CŽ€–SŠėŒÆ—¦F0.74jBSLN ‚Ģ“]ˆŚ—z«—¦‚Ķ16.0“CŒo‰ßŠĻŽ@ŒQ‚ĢƒŠƒ“ƒpßÄ”­—¦‚Ķ15.6“‚Å‚Ł‚Ś“Æ“™‚Å‚ ‚Į‚½BŠ‘®ƒŠƒ“ƒpß‚É‚Ø‚Æ‚é“]ˆŚ—z«ƒŠƒ“ƒpß‚Ģ•½‹ĻŒĀ”‚ĶCSLNB ŒQ‚Å1.4 ŒĀCŠĻŽ@ŒQ‚Å3.3 ŒĀ‚Å—LˆÓ‚ÉŒćŽŅ‚Ŗ‚‚­ip ƒ 0.001jCŠĻŽ@ŠśŠŌ’†‚ɂ؂Ƃ郊ƒ“ƒpß“]ˆŚ‚Ģis‚ŖŽ¦“‚³‚ź‚½B“]ˆŚ—z«—į‚Ģ5 ”N¶‘¶—¦‚ĶSLNB ŒQ‚Ŗ72.3 } 4.6“CŠĻŽ@ŒQ‚Ŗ52.4 } 5.9“‚Å‘OŽŅ‚Ŗ—LˆÓ‚É—D‚ź‚Ä‚¢‚½ip  0.004CŽ€–SHRF0.51j8jB‚±‚Ģ¬Ń‚Ķ’†ŠŌ‘w‚ĢŒś‚³‚Ģƒƒ‰ƒm[ƒ}‚É‚Ø‚¢‚ÄSLNB ‚Ę‚»‚ĢŒ‹‰Ź‚ÉŠī‚Ć‚­’¼Œć‚ĢŠ‘®ƒŠƒ“ƒpßŠs“‚Ŗ—\Œć‚Ģ‰ü‘P‚ÉŒq‚Ŗ‚邱‚Ę‚šŽ¦“‚µ‚Ä‚¢‚éBÅIŒ‹‰Ź‚Ŗ‚Ü‚¾o‚Ä‚¢‚Č‚¢‚½‚ßSLNB ‚Ģ¶‘¶‚É‘Ī‚·‚éƒCƒ“ƒpƒNƒg‚Ķ–¾‚ē‚©‚É‚Ķ‚Č‚Į‚Ä‚¢‚Č‚¢‚ŖC•aŠśŒˆ’č‚ĘSLN ‚Ģ“]ˆŚ‚Ģ—L–³‚Ŗd—v‚Č—\ŒćˆöŽq‚Å‚ ‚邱‚Ę‚©‚ēC‰“Šu“]ˆŚ‚Ģ‚Č‚¢’†ŠŌ‘w‚ĢŒś‚³‚Ģƒƒ‰ƒm[ƒ}‚É‘Ī‚µ‚ÄSLNB ‚šs‚¤‚±‚Ę‚Ŗ„§‚³‚ź‚éB

4jtumor thickness „ 4 mm ‚Ģƒƒ‰ƒm[ƒ}‚É‘Ī‚·‚éSLNB

Tumor thickness ‚Ŗ4 mm ’“‚Ģƒƒ‰ƒm[ƒ}‚Å‚ĶC‚·‚łɐöŻ“I“]ˆŚ‚š‚«‚½‚µ‚Ä‚¢‚é‰Ā”\«‚Ŗ‚‚¢‚ʍl‚¦‚ē‚ź‚éˆź•ū‚ŁCSLN ‚É“]ˆŚ‚Ŗ‚Č‚¢Ē—į‚Ķ“]ˆŚ—į‚É”ä‚ׂė\Œć—ĒD‚Ę‚·‚é•ń‚Ŗ‚ ‚č9, 10jB—LŒų«‚É‚Ā‚¢‚Ä‚ĶŒ‹˜_‚Ŗ‚Å‚Ä‚¢‚Č‚¢B‚µ‚©‚µC¢ŠE“I‚É‚ą‘½‚­‚ĢŽ{Ż‚ōs‚ķ‚ź‚Ä‚¢‚錻ó‚ąŠÓ‚ŻCŒ»Žž“_‚Å‚ĶŒ¤‹†“I‚ÉSLNB ‚Ŗl—¶‚³‚ź‚Ä‚ą‚ę‚¢B

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1j Kapteijn BA, Nieweg OE, Liem I, et al: Localizing the sentinel node in cutaneous melanoma: gamma probe detection versus blue dye, Ann Surg Oncol, 1997; 4: 156-160.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Gershenwald JE, Thompson W, Mansfield PF, et al: Multiinstitutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage Ⅰ or Ⅱ melanoma patients, J Clin Oncol, 1999; 17: 976-983.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j ‰FŒ“@‹vCŽR–{–¾ŽjC“Œ“Ė•v‚Ł‚©Fƒƒ‰ƒm[ƒ}‚ĢŒ“”­‘ƒ‚ĢŒś‚³‚ĘƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpß‚Ģ“]ˆŚ—¦‚É‚Ā‚¢‚Ä‚ĢŒŸ“¢C“ś”ē‰ļŽC2008 ; 118 : 3083-3088.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

4j Wright BE, Scheri RP, Ye X, et al: Importance of sentinel lymph node biopsy in patients with thin melanoma, Arch Surg, 2008; 143: 892-899; discussion 899-900.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Bleicher RJ, Essner R, Foshag LJ, et al Role of sentinel lymphadenectomy in thin invasive cutaneous melanomas, J Clin Oncol, 2003; 21: 1326-1331.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

6j Ranieri JM, Wagner JD, Wenck S, et al: The prognostic importance of sentinel lymph node biopsy in thin mela noma, Ann Surg Oncol, 2006; 13: 927-932.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j Wong SL, Brady MS, Busam KJ, Coit DG: Results of sentinel lymph node biopsy in patients with thin melanoma, Ann Surg Oncol, 2006; 13: 302-309.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

8j Morton DL, Thompson JF, Cochran AJ, et al: Sentinel-node biopsy or nodal observation in melanoma, N Engl J Med, 2006; 355: 1307-1317.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

9j Gershenwald JE, Mansfield PF, Lee JE, Ross MI: Role for lymphatic mapping and sentinel lymph node biopsy in patients with thicki„or4 mmj primary melanoma, Ann Surg Oncol, 2000; 7: 160-165.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

10j Ferrone CR, Panageas KS, Busam K, et al: Multivariate prognostic model for patients with thick cutaneous melanoma: importance of sentinel lymph node status, Ann Surg Oncol, 2002; 9: 637-645.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ11

ƒƒ‰ƒm[ƒ}‚ĢŠ‘®ƒŠƒ“ƒpß“]ˆŚ‚É‘Ī‚µ‚ăŠƒ“ƒpßŠs“p‚šs‚¤‚±‚Ę‚ĶŠ©‚ß‚ē‚ź‚é‚©

 

“÷Šį“Ii—Տ°“IjƒŠƒ“ƒpß“]ˆŚ‚š”F‚߂郁ƒ‰ƒm[ƒ}

„§“x

B

ƒŠƒ“ƒpßŠs“p‚šs‚¤‚±‚Ę‚ŖŠ©‚ß‚ē‚ź‚éB

 

ƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßisentinel lymph nodeGSLNj“]ˆŚ—z«‚Ģƒƒ‰ƒm[ƒ}

„§“x

C1

ƒŠƒ“ƒpßŠs“p‚šs‚¤‚±‚Ę‚šl—¶‚·‚éB

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1j“÷Šį“Ii—Տ°“IjƒŠƒ“ƒpß“]ˆŚĒ—į‚É‘Ī‚·‚éŖŽ”“IƒŠƒ“ƒpßŠs“p

Š‘®ƒŠƒ“ƒpß‚ÉŽī’Æ‚Ŗ”F‚ß‚ē‚ź‚鏼‡‚ ‚é‚¢‚Ķ‰ę‘œŒŸø‚ɂăŠƒ“ƒpß“]ˆŚ‚Ŗ‹^‚ķ‚ź‚鏼‡i“÷Šį“I‚ ‚é‚¢‚Ķ—Տ°“IƒŠƒ“ƒpß“]ˆŚj‚ŁC‘gDŠw“I‚Ƀƒ‰ƒm[ƒ}‚Ģ“]ˆŚ‚ŖŠm”F‚³‚ź‘¼‚ɉ“Šu“]ˆŚ‚ĢŠŒ©‚Ŗ”F‚ß‚ē‚ź‚Č‚¢ź‡‚É‚ĶCŽī’Æ‚µ‚½ƒŠƒ“ƒpß‚Ę‚»‚ĢŽüˆĶ‚ĢŠ‘®ƒŠƒ“ƒpß‚šŲœ‚·‚éŖŽ”“IƒŠƒ“ƒpßŠs“p‚šs‚¤‚±‚Ę‚Ŗ„§‚³‚ź‚éBKarakousis1j‚ĢƒŒƒrƒ…[‚É‚ę‚ź‚ĪCŖŽ”“IƒŠƒ“ƒpßŠs“pŒć‚Ģ5 ”N¶‘¶—¦‚Ķ19`38“C•½‹Ļ26“‚Å‚ ‚čC‘gDŠw“I‚É“]ˆŚ—z«‚ĢƒŠƒ“ƒpß‚Ģ”CƒŠƒ“ƒpß‚Ģ”ķ–ŒŠOZ‚Ģ—L–³‚Ŗ—\Œć‚š‹K’č‚·‚éÅ‚ąd—v‚ČˆöŽq‚Å‚ ‚Į‚½B‚Ü‚½ŖŽ”“IƒŠƒ“ƒpßŠs“pŒć‚ĢŠ‘®ƒŠƒ“ƒpß‹ĒŠÄ”­—¦‚Ķ0.8`52“‚Å‚ ‚Į‚½B‚±‚Ģ‚ꂤ‚ɏŠ‘®ƒŠƒ“ƒpß‹ĒŠÄ”­‚š¶‚¶‚éƒOƒ‹[ƒv‚Ŗ‚ ‚éˆź•ūCŖŽ”“IƒŠƒ“ƒpßŠs“p‚šs‚¤‚±‚Ę‚É‚ę‚č—ĒD‚Č—\Œć‚Ŗ“¾‚ē‚ź‚éƒOƒ‹[ƒv‚ą‚ ‚邱‚Ę‚ŖŽ¦‚³‚ź‚Ä‚¢‚éBŖŽ”“IƒŠƒ“ƒpßŠs“pŽ{sŠ³ŽŅ‚É‚Ø‚Æ‚é—\Œć•s—ĒˆöŽq‚Ę‚µ‚āC‚—īC‘ĢŠ²‚Ü‚½‚Ķ“Ŗčņ•”‚ĢŒ“”­C3 ŒĀ‚ę‚č‘½‚­‚ĢƒŠƒ“ƒpß“]ˆŚCƒŠƒ“ƒpß‚Ģ”ķ–ŒŠOZ‚Č‚Ē‚Ŗ“Æ’č‚³‚ź‚Ä‚¢‚é2, 3jB

ˆČć‚Ģ‚ꂤ‚ɏŠ‘®ƒŠƒ“ƒpß“]ˆŚ‚É‘Ī‚·‚éŖŽ”“IƒŠƒ“ƒpßŠs“p‚É‚ę‚Į‚Ä–ń1/3 ‚ĢŠ³ŽŅ‚Ģ¶‘¶‚É Šń—^‚Å‚«‚é‰Ā”\«‚Ŗ‚ ‚č‘¼‚É—LŒų‚ČŽ”—Ć–@‚ŖŽ¦‚³‚ź‚Ä‚¢‚Č‚¢Œ»ó‚Å‚ĶC‘Sgó‘Ō‚Ģ‹–‚·Š³ŽŅ‚É‚Ø‚¢ ‚čŖŽ”“IƒŠƒ“ƒpßŠs“p‚šl—¶‚·‚ׂ«‚Ę‚¢‚¦‚éB

2jSLN “]ˆŚĒ—į‚É‘Ī‚·‚郊ƒ“ƒpßŠs“p‚Ę—\–h“IƒŠƒ“ƒpßŠs“p

SLN “]ˆŚ‚Ŗ”F‚ß‚ē‚ź‚鏼‡iŒ°”÷‹¾“IƒŠƒ“ƒpß“]ˆŚjCSLN ˆČŠO‚ĢƒŠƒ“ƒpßinon-SLNj‚É‘gDŠw“IƒŠƒ“ƒpß“]ˆŚ‚š”F‚߂銄‡‚ĶŠCŠO‚Ģƒf[ƒ^‚Å‚Ķ15`20“4, 5j–{–M‚ĢŒ¤‹†‚Å‚Ķ–ń25“‚Å‚ ‚邱‚Ę‚©‚ē6jCŽc‚č‚ĢŠ‘®ƒŠƒ“ƒpß‚É‘Ī‚µ‚ăŠƒ“ƒpßŠs“p‚šs‚¤‚±‚Ę‚šl—¶‚·‚éB–ń25“‚Ę‚¢‚¤non-SLN “]ˆŚ—¦‚©‚ēl‚¦‚ÄŽc‚č‚Ģ–ń75“‚ĢŠ³ŽŅ‚ŃŠƒ“ƒpßŠs“‚šČ—Ŗ‚Å‚«‚é‰Ā”\«‚ą‚ ‚é‚ŖC‚Ē‚Ģ‚ꂤ‚ȏĒ—į‚ÉČ—Ŗ‰Ā”\‚©‚Ŗ–¾‚ē‚©‚É‚³‚ź‚Ä‚¢‚Č‚¢‚½‚߁CŒ»Žž“_‚Å‚ĶƒŠƒ“ƒpßŠs“‚šČ—Ŗ‰Ā”\‚Ę‚·‚éŖ‹’‚É‚Ķ‚Č‚ē‚Č‚¢BŒ»ŻCSLN ‚Ģ‘gDŠw“I‚ ‚é‚¢‚Ķ•ŖŽq¶•ØŠw“I“]ˆŚiRT-PCR —z«j—į‚É‘Ī‚µ‚āCƒŠƒ“ƒpßŠs“‚šs‚¤ŒQ‚ĘŒo‰ßŠĻŽ@ŒQ‚É•Ŗ‚Ƃ郉ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±iMulticenter Selective Lymphadenectomy Trial-ⅡFMSLT-Ⅱj‚Ŗs‚ķ‚ź‚Ä‚Ø‚čC‚»‚ĢŒ‹‰Ź‚Ŗ‘Ņ‚½‚ź‚éB

‚Č‚ØƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpß¶ŒŸisentinel lymph node biopsyGSLNBj‚Ŗ•‹y‚µ‚½Œ»ŻC—Տ°“IƒŠƒ“ƒpß“]ˆŚ‚š”F‚ß‚Č‚¢ƒƒ‰ƒm[ƒ}‚É‘Ī‚µ‚Ä‚©‚Ā‚čs‚ķ‚ź‚Ä‚¢‚½—\–h“IƒŠƒ“ƒpßŠs“piSLNB‚šs‚ķ‚ø‚ɃŠƒ“ƒpßŠs“p‚šs‚¤‚±‚ʁj‚ĶC‚»‚Ģ—L—p«‚šŽxŽ‚·‚éŖ‹’‚É–R‚µ‚­7jŒ»Ż‚Å‚ĶŠ©‚ß‚ē‚ź‚Č‚¢B

3jƒŠƒ“ƒpßŠs“”ĶˆĶ

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4jƒŠƒ“ƒpßŠs“p‚Ģ‡•¹Ē

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1j Karakousis CP: Therapeutic node dissections in malignant melanoma, Ann Surg Oncol, 1998; 5: 473-482.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

2j Pidhorecky I, Lee RJ, Proulx G, et al: Risk factors for nodal recurrence after lymphadenectomy for melanoma, Ann Surg Oncol, 2001; 8: 109-115.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j Meyer T, Merkel S, Gohl J, et al : Lymph node dissection for clinically evident lymph node metastases of malignant melanoma, Eur J Surg Oncol, 2002; 28: 424-430.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

4j Cascinelli N, Bombardieri E, Bufalino R, et al: Sentinel and nonsentinel node status in stage ⅠB and Ⅱ melanoma patients: two-step prognostic indicators of survival, J Clin Oncol, 2006; 24: 4464-4471.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Lee JH, Essner R, Torisu-Itakura H, et al: Factors predictive of tumor-positive nonsentinel lymph nodes after tumor-positive sentinel lymph node dissection for melanoma, J Clin Oncol, 2004: 22: 3677-3684.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

6j “Œ“Ė•vC‹gģŽü²C“”Œ“‹KL‚Ł‚©F”ē•†ˆ««Žīį‡‚É‚Ø‚Æ‚éSentinel Node Navigation SurgeryCŠą‚ʉ»—ƁC2005 ; 32 : 1191-1194.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j Lens MB, Dawes M, Goodacre T, Newton-Bishop JA: Elective lymph node dissection in patients with melanoma: systematic review and meta-analysis of randomized controlled trials, Arch Surg, 2002; 137: 458-461.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

8j Coit DG, Brennan MF: Extent of lymph node dissection in melanoma of the trunk or lower extremity, Arch Surg, 1989; 124: 162-166.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ12

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In-transit “]ˆŚ‚É‘Ī‚µ‚Ä—LŒų‚ČŽ”—Ć‚Ŗ‚Č‚¢Œ»ó‚É‚Ø‚¢‚āC’P”­‚ ‚é‚¢‚Ķ”ŒĀ‚Ģin-transit “]ˆŚ‚Å‚ ‚ź‚Ī‚Ü‚ø‚ĶŠO‰Č“IŲœ‚šl—¶‚·‚éB‚±‚ĢŪŲœƒ}[ƒWƒ“‚šL‚­‚Ę‚éˆÓ‹`‚Ķ–R‚µ‚­Š®‘SŲœ‚Å‚«‚ź‚Ī‚ę‚¢BŲœŒŸ‘Ģ‚Ģ•a—ŒŸø‚Å’f’[—z«‚Ę‚Č‚čÄŲœ‚Ŗ¢“ļ‚ȏź‡‚É‚Ķ•śŽĖüŽ”—Ć‚ąl—¶‚·‚é1jBŽ{Ż‚É‚ę‚Į‚Ä—\–h“I‚ ‚é‚¢‚ĶŖŽ”“I‚ÉŒ“”­‘ƒ‚©‚ēŠ‘®ƒŠƒ“ƒpß—Ģˆę‚Ü‚Å‚ĢƒŠƒ“ƒp—¬‚šl—¶‚µ‚½˜A‘±“I‚Č‘gDŠs“p‚Å‚ ‚ésubtotal integumentectomy ‚ąs‚ķ‚ź‚邱‚Ę‚Ŗ‚ ‚é‚Ŗ2, 3jC‚»‚Ģ—L—p«‚É‚Ā‚¢‚Ä‚Ķ–¾Šm‚Å‚Ķ‚Č‚¢B‚µ‚©‚µŒ»ó‚Å‚Ķ‘ęˆź‘I‘š‚ĶŠO‰Č“IŲœ‚Å‚ ‚é‚Ģ‚ŁC“K‰ž‚š\•ŖŒŸ“¢‚µ‚½ć‚Å–{–@‚šs‚¤‚±‚Ę‚Ķl—¶‚µ‚Ä‚ą‚ę‚¢B

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‹}‘¬‚É‘‘å‚·‚鏼‡‚Ü‚½‚Ķ‘½”­‚·‚éŽlŽˆ‚Ģin-transit “]ˆŚ‚É‚ĶC–ņ•Ø‚šŽg—p‚µ‚½ŽlŽˆ‰·”MŸó—¬‚šs‚¤•ū–@‚ą‚ ‚éB’¼ŚŠ³‘¤ŽlŽˆ‚Ģ“®Ć–¬‚ÖƒJƒjƒ…ƒŒ[ƒVƒ‡ƒ“‚šs‚¢C‘ĢŠOzŠĀ‘•’u‚ɐŚ‘±‚µŸó—¬‚·‚éisolated limb perfusioniILPj‚ĘILP ‚É”ä‚ׂĐNP‚Ŗ­‚Č‚¢isolated limb infusioniILIj‚Ŗ‚ ‚éBILP ‚ĶlHS”x‘•’u‚šŽg—p‚µ‚Č‚Æ‚ź‚Ī‚Č‚ē‚øCNP‚Ģ‘å‚«‚Č•ū–@‚Å‚ ‚é‚ŖCŠCŠO‚©‚ē‚Ķ‚»‚Ģ—LŒų«‚É‚Ā‚¢‚ăVƒXƒeƒ}ƒeƒBƒbƒNEƒŒƒrƒ…[‚Ŗ•ń‚³‚ź‚Ä‚¢‚é5jBŒćŽŅ‚ĢILI ‚Ķ“Į‚ɉŗŽˆ‚É‘Ī‚µ‚Ä‘Ī‘¤iŒ’‘¤j‚Ģ‘å‘Ś“®Ć–¬‚ę‚čƒJƒe[ƒeƒ‹‚š“ü‚ź‚ă|ƒ“ƒsƒ“ƒO‚ş󗬂·‚é•ū–@‚Å‚ ‚čCILP ‚É”ä‚×’įNP‚©‚ĀŽå‚Émelphalan ‚š—p‚¢‚邱‚Ę‚É‚ę‚č‘tŒų—¦90“ˆČćiŠ®‘S‘tŒų—¦60`70“j‚Ę‚¢‚¤‚‚¢‹ĒŠ§Œä—¦‚Ŗ•ń‚³‚ź‚Ä‚¢‚é6jB‚µ‚©‚µ–{–M‚Å‚Ķ‚±‚ź‚ē‚ĢŽ”—Ć‚Ķ‚±‚ź‚Ü‚Å‚Ł‚Ę‚ń‚Ēs‚ķ‚ź‚Ä‚¢‚Č‚¢B‚»‚Ģ‘¼•śŽĖüŽ”—Ć‚āƒCƒ~ƒLƒ‚ƒhCCO2 ƒŒ[ƒU[Ž”—ƁC‘Sg‰»Šw—Ć–@‚Č‚Ē‚ąŽ”—Ć‚Ģ‘I‘šŽˆ‚Ę‚µ‚Ä•ń‚³‚ź‚Ä‚¢‚é‚ŖŒ»Žž“_‚Å•]‰æ‚Ķ¢“ļ‚Å‚ ‚éB

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1j Hayes AJ, Clark MA, Harries M, Thomas JM: Management of in-transit metastases from cutaneous malignant melanoma, Br J Surg, 2004; 91: 673-682.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j ‰ĮŒū“ÖŽmCĪŒ“@„C‘ŒūMˆź‚Ł‚©FSubtotal integumentectomy ‚šs‚Į‚½ˆ««•FŽī19 —į, Skin Cancer, 2006 ; 21 : 53-57.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

3j “”ąVNOC’†‘ŗ‘בåCĪ’Ė—m“T‚Ł‚©FSubtotal integumentectomy ‚šŽ{s‚µ‚½in-transit “]ˆŚ‚š—L‚·‚鈫«•FŽī‚Ģ4 —į, Skin Cancer, 2009 ; 24 : 272-277.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

4j ĪŒ“˜a”VFHuman Fibroblast InterferoniHuIFN- ƒĄj‚É‚ę‚é”ē•†ˆ««Žīį‡‚É‘Ī‚·‚é—Տ°Œ¤‹†C“ś–{ŠąŽ”—ĆŠw‰ļC1983 ; 18 : 41-53.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Lens MB, Dawes M: Isolated limb perfusion with melphalan in the treatment of malignant melanoma of the extremities: a systematic review of randomised controlled trials, Lancet Oncol, 2003; 4: 359-364..iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

6j Thompson JF, Kam PC: Isolated limb infusion for melanoma: a simple but effective alternative to isolated limb perfusion, J Surg Oncol, 2004; 88: 1-3.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ13

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1j OfBrien CJ, Coates AS, Petersen-Schaefer K, et al: Experience with 998 cutaneous melanomas of the head and neck over 30 years, Am J Surg, 1991; 162: 310-314.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Ang KK, Peters LJ, Weber RS, et al: Postoperative radiotherapy for cutaneous melanoma of the head and neck region, Int J Radiat Oncol Biol Phys, 1994; 30: 795-798.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

3j Moncrieff MD, Martin R, OfBrien CJ, et al: Adjuvant postoperative radiotherapy to the cervical lymph nodes in cutaneous melanoma: is there any benefit for high-risk patients? Ann Surg Oncol, 2008; 15: 3022-3027.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

4j Temam S, Mamelle G, Marandas P, et al: Postoperative radiotherapy for primary mucosal melanoma of the head and neck, Cancer, 2005; 103: 313-319.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Ballo MT, Bonnen MD, Garden AS, et al: Adjuvant irradiation for cervical lymph node metastases from melanoma, Cancer, 2003; 97: 1789-1796.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

6j Dummer R, Hauschild A, Guggenheim M, et al: Melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up, Ann Oncol, 2010; 21iSuppl 5j: v194-197.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

7j Burmeister BH, Mark Smithers B, Burmeister E, et al: A prospective Phase Ⅱ study of adjuvant postoperative radiation therapy following nodal surgery in malignant melanoma-Trans Tasman Radiation Oncology Group iTROGj Study 96.06, Radiother Oncol, 2006; 81: 136-142.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

8j Guadagnolo BA, Zagars GK: Adjuvant radiation therapy for high-risk nodal metastases from cutaneous melanoma, Lancet Oncol, 2009; 10: 409-416.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

9j Testori A, Rutkowski P, Marsden J, et al: Surgery and radiotherapy in the treatment of cutaneous melanoma, Ann Oncol, 2009; 20iSuppl 6j: vi22-29.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

10j Krengli M, Masini L, Kaanders JH, et al: Radiotherapy in the treatment of mucosal melanoma of the upper aerodigestive tract: analysis of 74 cases. A Rare Cancer Network study, Int J Radiat Oncol Biol Phys, 2006; 65: 751-759.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

11j Garbe C, Peris K, Hauschild A, et al: Diagnosis and treatment of melanoma: European consensus-based interdisciplinary guideline, Eur J Cancer, 2010; 46: 270-283.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj


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1j Veronesi U, Adamus J, Aubert C, et al: A randomized trial of adjuvant chemotherapy and immunotherapy in cutaneous melanoma, N Engl J Med, 1982; 307: 913-916.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

2j Kirkwood JM, Strawderman MH, Ernstoff MS, et al: Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684, J Clin Oncol, 1996; 14: 7-17.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

3j Kirkwood JM, Ibrahim JG, Sondak VK, et al: High- and low-dose interferon alfa-2b in high-risk melanoma: first analysis of intergroup trial E1690/S9111/C9190, J Clin Oncol, 2000; 18: 2444-2458.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

4j Kirkwood JM, Manola J, Ibrahim J, et al: A pooled analysis of eastern cooperative oncology group and intergroup trials of adjuvant high-dose interferon for melanoma, Clin Cancer Res, 2004; 10: 1670-1677.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

5j Mocellin S, Lens MB, Pasquali S, Chiarion Sileni V: Interferon alpha for the adjuvant treatment of cutaneous melanomaiReviewj, The Cochrane Library, 2013; Issue 6.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

6j Cascinelli N, Belli F, MacKie RM, et al: Effect of long-term adjuvant therapy with interferon alpha-2a in patients with regional node metastases from cutaneous melanoma: a randomised trial, Lancet, 2001; 358: 866-869.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

7j Grob JJ, Dreno B, de la Salmoniere P, et al: Randomised trial of interferon alpha-2a as adjuvant therapy in resected primary melanoma thicker than 1.5 mm without clinically detectable node metastases. French Cooperative Group on Melanoma, Lancet, 1998; 351: 1905-1910.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

8j Pehamberger H, Soyer HP, Steiner A, et al: Adjuvant interferon alfa-2a treatment in resected primary stage Ⅱ cutaneous melanoma. Austrian Malignant Melanoma Cooperative Group, J Clin Oncol, 1998; 16: 1425-1429.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

9j Hancock BW, Wheatley K, Harris S, et al: Adjuvant interferon in high-risk melanoma: the AIM HIGH Study-United Kingdom Coordinating Committee on Cancer Research randomized study of adjuvant low-dose extended-duration interferon Alfa-2a in high-risk resected malignant melanoma, J Clin Oncol, 2004; 22: 53-61.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

10j Eggermont AM, Suciu S, MacKie R, et al: Post-surgery adjuvant therapy with intermediate doses of interferon alfa 2b versus observation in patients with stage ⅡB/Ⅲ melanomaiEORTC 18952j: randomised controlled trial, Lancet, 2005; 366: 1189-1196.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

11j Hansson J, Aamdal S, Bastholt L, et al: Two different durations of adjuvant therapy with intermediate-dose interferon alfa-2b in patients with high-risk melanomaiNordic IFN trialj: a randomised phase 3 trial, Lancet Oncol, 2011; 12: 144-152.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

12j Eggermont AM, Suciu S, Santinami M, et al: Adjuvant therapy with pegylated interferon alfa-2b versus observation alone in resected stage Ⅲ melanoma: final results of EORTC 18991, a randomised phase Ⅲ trial, Lancet, 2008; 372: 117-126.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

13j Sondak VK, Liu PY, Tuthill RJ, et al: Adjuvant immunotherapy of resected, intermediate-thickness, node-negative melanoma with an allogeneic tumor vaccine: overall results of a randomized trial of the Southwest Oncology Group, J Clin Oncol, 2002; 20: 2058-2066.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

14j Hersey P, Coates AS, McCarthy WH, et al: Adjuvant immunotherapy of patients with high-risk melanoma using vaccinia viral lysates of melanoma: results of a randomized trial, J Clin Oncol, 2002; 20: 4181-4190.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

15j Yamamoto A, Ishihara K: Clinical study of DAV { IFN-beta therapyicombination adjuvant therapy with intravenous DTIC, ACNU and VCR, and local injection of IFN-betajfor malignant melanoma, Int J Immunother, 1996; 12: 73-78.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

16j “”ąVNOC‘å’Ė“”’jF“ś–{”ē•†ˆ««Žīį‡Šw‰ļ”ē•†Šą—\Œć“Œv’²øˆĻˆõ‰ļˆ««•FŽī‘S‘’ĒÕ’²øƒOƒ‹[ƒvFpŒć•ā•—Ć–@iDAVFeronCƒtƒFƒƒ“—Ć–@CƒtƒFƒƒ“ˆŪŽ—Ć–@j‚Ķˆ««•FŽīƒXƒe[ƒWⅡEⅢŠ³ŽŅ‚Ģ—\Œć‚š‰ü‘P‚·‚é‚©@831 —į‚Ģ‰šĶC“ś”ē‰ļŽC2012 ; 122 : 2305-2311.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

17j •ĄģŒ’“ń˜YC ’ē“c@VC ŽRč’¼–ēFupŒć•ā•—Ć–@iDAVFeronCƒtƒFƒƒ“—Ć–@CƒtƒFƒƒ“ˆŪŽ—Ć–@j‚Ķˆ««•FŽīƒXƒe[ƒWⅡEⅢŠ³ŽŅ‚Ģ—\Œć‚š‰ü‘P‚·‚é‚©@831 —į‚Ģ‰šĶv‚Ö‚ĢŽæ–āC“ś”ē‰ļŽC2013 ; 123 : 155. iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅵj

18j Matsumoto T, Yokota K, Sawada M, et al: Postoperative DAV-IFN-beta therapy does not improve survival rates of stage Ⅱ and stage Ⅲ melanoma patients significantly, J Eur Acad Dermatol Venereol, 2013; 27: 1514-1520.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


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1j Barth A, Wanek LA, Morton DL: Prognostic factors in 1,521 melanoma patients with distant metastases, J Am Coll Surg, 1995; 181: 193-201.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Essner R, Lee JH, Wanek LA, et al: Contemporary surgical treatment of advanced-stage melanoma, Arch Surg, 2004; 139: 961-966, discussion 6-7.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j Fletcher WS, Pommier RF, Lum S, et al: Surgical treatment of metastatic melanoma, Am J Surg, 1998; 175: 413-417.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

4j Meyer T, Merkel S, Goehl J, et al: Surgical therapy for distant metastases of malignant melanoma, Cancer, 2000; 89: 1983-1991.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Karakousis CP, Velez A, Driscoll DL, et al: Metastasectomy in malignant melanoma, Surgery, 1994; 115: 295-302.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

6j Ollila DW, Stern SL, Morton DL: Tumor doubling time: a selection factor for pulmonary resection of metastatic melanoma, J Surg Oncol, 1998; 69: 206-211.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j Gorenstein LA, Putnam JB, Natarajan G, et al: Improved survival after resection of pulmonary metastases from malignant melanoma, Ann Thorac Surg, 1991; 52: 204-210.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

8j Leo F, Cagini L, Rocmans P, et al: Lung metastases from melanoma: when is surgical treatment warranted? Br J Cancer, 2000; 83: 569-572.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

9j ¼ąV@ˆ»CŽRč’¼–ēCŽR–{–¾Žj‚Ł‚©Fˆ««•FŽī‚Ģ”x“]ˆŚ‚É‘Ī‚·‚éŠO‰Č—Ć–@‚Ģ—L—p«C“ś”ē‰ļŽC2006; 116 : 1187-1193.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

10j Wronski M, Arbit E: Surgical treatment of brain metastases from melanoma: a retrospective study of 91 patients, J Neurosurg, 2000; 93: 9-18.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

11j Zacest AC, Besser M, Stevens G, et al: Surgical management of cerebral metastases from melanoma: outcome in 147 patients treated at a single institution over two decades, J Neurosurg, 2002; 96: 552-558.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

12j Ollila DW, Essner R, Wanek LA, et al: Surgical resection for melanoma metastatic to the gastrointestinal tract, Arch Surg, 1996; 131: 975-979, 979-980.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

13j Agrawal S, Yao TJ, Coit DG: Surgery for melanoma metastatic to the gastrointestinal tract, Ann Surg Oncol, 1999; 6: 336-344.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

14j Ricaniadis N, Konstadoulakis MM, Walsh D, et al: Gastrointestinal metastases from malignant melanoma, Surg Oncol, 1995; 4: 105-110.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

15j Rose DM, Essner R, Hughes TM, et al: Surgical resection for metastatic melanoma to the liver: the John Wayne Cancer Institute and Sydney Melanoma Unit experience, Arch Surg, 2001; 136: 950-955.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

16j Haigh PI, Essner R, Wardlaw JC, et al: Long-term survival after complete resection of melanoma metastatic to the adrenal gland, Ann Surg Oncol, 1999; 6: 633-639.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

17j de Wilt JH, McCarthy WH, Thompson JF: Surgical treatment of splenic metastases in patients with melanoma, J Am Coll Surg, 2003; 197: 38-43.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


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ƒƒ‰ƒm[ƒ}‚ĢŠĢ“]ˆŚ‚É‘Ī‚·‚éŠĢ“®–¬‰»Šw—Ć–@‚ ‚é‚¢‚Ķ‰»ŠwĒš—Ć–@‚Ģ‘tŒų—¦‚Ķ20`70“‚Å‚ ‚čC‘tŒųŠśŠŌ’†‰›’l‚Ķ”ƒJŒŽ‚©‚ē1 ”N’ö“xC¶‘¶ŠśŠŌ’†‰›’l‚Ķ”ƒJŒŽ`2 ”N’ö“x‚Ę•ń‚³‚ź‚Ä‚¢‚é1`13jB‘Sg“I‰»Šw—Ć–@‚É‚ę‚éŠĢ“]ˆŚŠ³ŽŅ‚Ģ¶‘¶ŠśŠŌ’†‰›’l‚ĶŠT‚Ė”‚©ŒŽ’ö“x‚Å‚ ‚é‚Ģ‚ŁC“K—pĒ—į‚š‘I‘š‚·‚ź‚ĪCŠĢ“®–¬‰»Šw—Ć–@‚ ‚é‚¢‚Ķ‰»ŠwĒš—Ć–@‚É‚ę‚Į‚摶ŠśŠŌ‚Ģ‰„’·‚šŠś‘Ņ‚Å‚«‚é‰Ā”\«‚Ŗ‚ ‚é14jB‚½‚¾‚µC–{—Ć–@‚Ģ“K—p‚ĶŽå‚Ę‚µ‚Ä“]ˆŚ‚ŖŠĢ‘Ÿ‚ÉŒĄ‹Ē‚µ‚Ä‚¢‚銳ŽŅ‚Å‚ ‚čC1 ‘ŸŠķ“]ˆŚ‚Ę‚¢‚¤—Ē‚¢—\ŒćˆöŽq‚šŽ‚Į‚Ä‚¢‚éBƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚ąs‚ķ‚ź‚Ä‚¢‚Č‚¢‚Ģ‚ŁC–{—Ć–@‚Ģ¶‘¶ŠśŠŌ‰„’·Œų‰Ź‚ĶŒ»Žž“_‚Å‚ĶŠmŲ‚³‚ź‚Ä‚¢‚Č‚¢15jBŠĢ“®–¬‰»Šw—Ć–@‚ā‰»ŠwĒš—Ć–@‚Ģ‘€ģ‚ĶNP‚š”ŗ‚¤‚ŖC—LŠQ”½‰ž‚Ķ‘Sg“I‰»Šw—Ć–@‚É”äŠr‚·‚é‚ĘŒy“x‚ČŒXŒü‚Ŗ‚ ‚éB

ŠĢ“®–¬‰»Šw—Ć–@‚ ‚é‚¢‚Ķ‰»ŠwĒš—Ć–@‚Ŗ“K—p‚Ę‚Č‚éšŒ‚Ę‚µ‚Ä’č‚Ü‚Į‚½‚ą‚Ģ‚Ķ‚Č‚¢‚ŖCˆź”Ź‚ÉŠĢ‘ŸˆČŠO‚Ģ‘ŸŠķ‚É“]ˆŚ‚Ŗ‚Č‚¢‚©C‚ ‚Į‚Ä‚ą“]ˆŚ‘ƒ‚Ŗ§Œä‚³‚ź‚Ä‚¢‚鏼‡‚Ŗ“K—p‚Ę‚Č‚éB‚±‚ź‚ē‚ĢšŒ‚š–ž‚½‚·‚Ģ‚ĶŽå‚ÉŠį‹…Œ“”­ƒƒ‰ƒm[ƒ}‚Ģź‡‚Å‚ ‚č16jC”ē•†Œ“”­‚Ģź‡‚Ķ‰“Šu“]ˆŚ‚ŖŠĢ‘Ÿ‚ÉŒĄ‹Ē‚·‚邱‚Ę‚Ķ‹H‚Å‚ ‚é1jB‚Č‚ØC“]ˆŚ‘ƒ‚ŖŒĄ‹Ē‚µ‚Ä‚¢‚é—į‚Å‚ĶCŠO‰ČŲœ‚ąl—¶‚·‚é•K—v‚Ŗ‚ ‚éB

“®’–ņÜ‚Ę‚µ‚Ä‚ĶC‰¢•Ä‚Å‚Ķ’PÜ‚ÅcisplatinCfotemustineC1,3-bisi2-chloroethylj-1-nitrosoureaiBCNUjCmelphalan ‚š—p‚¢‚½‚čCcisplatin ‚ācarboplatin ‚Ę‘¼Ü‚Ģ•¹—p‚Ŗs‚ķ‚ź‚é1`8, 10`13jB–{–M‚Å‚ĶŽå‚Ę‚µ‚Äcisplatin ’PÜ‚Ģ“®’‚Ŗs‚ķ‚ź‚Ä‚¢‚é9jB

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1j Feldman ED, Pingpank JF, Alexander HR Jr: Regional treatment options for patients with ocular melanoma metastatic to the liver, Ann Surg Oncol, 2004; 11: 290-297.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

2j Bedikian AY, Legha SS, Mavligit G, et al: Treatment of uveal melanoma metastatic to the liver: a review of the M.D. Anderson Cancer Center experience and prognostic factors, Cancer, 1995; 76: 1665-1670.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j Mavligit GM, Charnsangavej C, Carrasco CH, et al: Regression of ocular melanoma metastatic to the liver after hepatic arterial chemoembolization with cisplatin and polyvinyl sponge, JAMA, 1988; 260: 974-976.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

4j Leyvraz S, Spataro V, Bauer J, et al: Treatment of ocular melanoma metastatic to the liver by hepatic arterial chemotherapy, J Clin Oncol, 1997; 15: 2589-2595.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Becker JC, Terheyden P, Kampgen E, et al: Treatment of disseminated ocular melanoma with sequential fotemustine, interferon alpha, and interleukin 2, Br J Cancer, 2002; 87: 840-845.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

6j Patel K, Sullivan K, Berd D, et al: Chemoembolization of the hepatic artery with BCNU for metastatic uveal melanoma: results of a Phase Ⅱ study, Melanoma Res, 2005; 15: 297-304.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j Cantore M, Fiorentini G, Aitini E, et al: Intra-arterial hepatic carboplatin-based chemotherapy for ocular melanoma metastatic to the liver. Report of a Phase Ⅱ study, Tumori, 1994; 80: 37-39.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

8j Melichar B, Dvorak J, Jandik P, et al: Intraarterial chemotherapy of malignant melanoma metastatic to the liver, Hepatogastroenterology, 2001; 48: 1711-1715.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

9j “”‘ņNOCŽRč’¼–ēCŽR–{–¾ŽjFm‰šą/ “ĮWny”ē•†ˆ««Žīį‡Ž”—ĆÅ‘Oüzƒƒ‰ƒm[ƒ}ŠĢ“]ˆŚ‚ĢTAE —Ć–@, Derma, 2003 ; 77 : 38-43.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

10j Sharma KV, Gould JE, Harbour JW, et al: Hepatic arterial chemoembolization for management of metastatic melanoma, AJR Am J Roentgenol, 2008; 190: 99-104.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

11j Dayani PN, Gould JE, Brown DB, et al: Hepatic metastasis from uveal melanoma: angiographic pattern predictive of survival after hepatic arterial chemoembolization, Arch Ophthalmol, 2009; 127: 628-632.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

12j Schuster R, Lindner M, Wacker F, et al: Transarterial chemoembolization of liver metastases from uveal melanoma after failure of systemic therapy: toxicity and outcome, Melanoma Res, 2010; 20: 191-196.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

13j Gupta S, Bedikian AY, Ahrar J, et al: Hepatic artery chemoembolization in patients with ocular melanoma metastatic to the liver: response, survival, and prognostic factors, Am J Clin Oncol, 2010; 33: 474-480..iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

14j Manola J, Atkins M, Ibrahim J, Kirkwood J: Prognostic factors in metastatic melanoma: a pooled analysis of Eastern Cooperative Oncology Group trials, J Clin Oncol, 2000; 18: 3782-3793.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

15j Eton O, Legha SS, Moon TE, et al: Prognostic factors for survival of patients treated systemically for disseminated melanoma, J Clin Oncol, 1998; 16: 1103-1111.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

16j Rietschel P, Panageas KS, Hanlon C, et al: Variates of survival in metastatic uveal melanoma, J Clin Oncol, 2005; 23: 8076-8080.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ17

‰“Šu“]ˆŚ‚š—L‚·‚郁ƒ‰ƒm[ƒ}Š³ŽŅ‚É‘Ī‚µ‚ďĒóŠÉ˜a‚š–Ś“I‚É•śŽĖü—Ć–@‚šŽĄŽ{‚·‚邱‚Ę‚ĶŠ©‚ß‚ē‚ź‚é‚©

 

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B

‰“Šu“]ˆŚ‚š—L‚·‚郁ƒ‰ƒm[ƒ}Š³ŽŅ‚É‘Ī‚µ•śŽĖü—Ć–@‚šs‚¤‚±‚Ę‚Å”¼”ˆČć‚ĢĒ—į‚ŏĒóŠÉ˜aŒų‰Ź‚Ŗ“¾‚ē‚ź‚邽‚ߊ©‚ß‚ē‚ź‚éB

 

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‚±‚ź‚܂сƒ‰ƒm[ƒ}‚Ķ•śŽĖüŠ“Žó«‚Ŗ’į‚¢‚ʍl‚¦‚ē‚ź‚Ä‚«‚½‚ŖCŠÉ˜a“I•śŽĖü—Ć–@‚šs‚¤‚±‚Ę‚ÅÄ”­E“]ˆŚ•a‘ƒ‚É”ŗ‚¤Ēó‚Ģ–ń”¼”‚ŖŠÉ˜a‚³‚ź‚邱‚Ę‚ŖŽ¦‚³‚ź‚Ä‚¢‚é1`4jB”ē•†•a•Ļ‚āƒŠƒ“ƒpß“]ˆŚC“ą‘Ÿ“]ˆŚ‚É‘Ī‚·‚é•śŽĖü—Ć–@‚É‚ę‚č•”•ŖŠ°‰šˆČć‚ĢŽīį‡k¬Œų‰Ź‚Ŗ–ń6 Š„‚ĢĒ—į‚Å“¾‚ē‚ź‚邱‚Ę‚ŖŽ¦‚³‚ź‚Ä‚Ø‚čC“Į‚É1 ‰ńü—Ź‚š4 Gy ˆČć‚ɍ‚‚ß‚½ĘŽĖƒXƒPƒWƒ…[ƒ‹‚Å—ĒD‚Ę‚³‚ź‚é3`6jB‚µ‚©‚µCŽüˆĶ‘ŸŠķ‚Ģ‘Ļ—eü—Ź‚šl—¶‚µĘŽĖƒXƒPƒWƒ…[ƒ‹‚šŒˆ’č‚·‚邱‚Ę‚Ŗd—v‚Å‚ ‚éB•śŽĖü¶•ØŠw“I‚É‚Ķƒƒ‰ƒm[ƒ}‚Ķ’x”­”½‰ž‘gD‚É•Ŗ—Ž‚³‚źC•śŽĖü—Ć–@Œć‚Ģk¬‚Ŗ‘¼ŠąŽī‚É”ä‚×’x‚­Ēó‚Ģ‹Ł‹}«‚Č‚Ē‚ąl—¶‚µ‚½Ž”—Ć•ūj‚ĢŒˆ’č‚Ŗ•K—v‚Å‚ ‚é3jB“]ˆŚ‚Ü‚½‚ĶÄ”­‚Ģ618 •a•Ļ‚É‘Ī‚µ•śŽĖü—Ć–@‚šs‚¢49“‚ÉŠ®‘SŠ°‰š‚Ŗ“¾‚ē‚źC‚»‚Ģ•a‘ƒ‚Ģ‘½‚­‚Ķ’·Šś‚É‚ķ‚½‚čÄ‘ˆ«‚·‚邱‚Ę‚Č‚­Œo‰ß‚µ‚½‚Ę‚Ģ•ń‚ą‚ ‚é7jB

ˆź•ūCœ“]ˆŚ‚ā”]“]ˆŚ—į‚Å‚ĶĘŽĖƒXƒPƒWƒ…[ƒ‹‚É‚ę‚鎔—ĆŒų‰Ź‚Ķ‚ ‚Ü‚č‰e‹æ‚³‚ź‚Č‚¢‚±‚Ę‚ŖŽ¦‚³‚ź‚Ä‚¢‚é8, 9jB“Į‚É—L’ɐ«œ“]ˆŚ‚É‘Ī‚µ‚Ä‚ĶC8 Gy 1 ‰ńĘŽĖ‚Ę30 Gy/10 •ŖŠ„/2 TŠŌ‚ĢĘŽĖƒXƒPƒWƒ…[ƒ‹‚É‚ę‚éˆį‚¢‚Ķ‚Č‚­C–ń7 Š„‚ĢĒ—į‚ŏĒóŠÉ˜aŒų‰Ź‚Ŗ“¾‚ē‚ź‚éB‘½”­«”]“]ˆŚ‚É‘Ī‚µ‚Ä‚ĶC–{–M‚Å‚Ķ‘S”]ĘŽĖ‚Ę‚µ‚Ä30 Gy/10 •ŖŠ„/2 TŠŌ‚ĢƒXƒPƒWƒ…[ƒ‹‚Ŗ•p—p‚³‚źC–ń”¼”‚ĢĒ—į‚Åįu’É‚Ģ‰ü‘P‚ā‰^“®_ŒoįŠQ‚Ģ‰ü‘P‚Ŗ“¾‚ē‚ź‚é5, 10, 11j

’P”­‚Ģ”]“]ˆŚ‚É‘Ī‚µ‚Ä‚ĶŽčp‚ā’čˆŹĘŽĖ‚Ę‘S”]ĘŽĖ‚Ģ•¹—p—Ć–@‚Ŗ—p‚¢‚ē‚ź”äŠr“I—ĒD‚Ȑ¬Ń‚Ŗ“¾‚ē‚ź‚Ä‚¢‚é5, 9`14jB“Į‚ɁCŽį”NŽŅ‚ŁC“ŖŠWŠO•a•Ļ‚Ŗ‚Č‚­C‰‰ńŽ”—Ć‚©‚ē“]ˆŚoŒ»‚Ü‚Å‚ĢŠśŠŌ‚Ŗ’·‚¢Ē—į‚É‚Ø‚¢‚Ä‚Ķ’·Šś¶‘¶‚ŖŠś‘Ņ‚³‚źĻ‹É“I‚ȉī“ü‚Ŗs‚ķ‚ź‚é11jB

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1j Sause WT, Cooper JS, Rush S, et al: Fraction size in external beam radiation therapy in the treatment of melanoma, Int J Radiat Oncol Biol Phys, 1991; 20: 429-432.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

2j Overgaard J, von der Maase H, Overgaard M: A randomized study comparing two high-dose per fraction radiation schedules in recurrent or metastatic malignant melanoma, Int J Radiat Oncol Biol Phys, 1985; 11: 1837-1839.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

3j Seegenschmiedt MH, Keilholz L, Altendorf-Hofmann A, et al: Palliative radiotherapy for recurrent and metastatic malignant melanoma: prognostic factors for tumor response and long-term outcome: a 20-year experience, Int J Radiat Oncol Biol Phys, 1999; 44: 607-618.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

4j Corry J, Smith JG, Bishop M, Ainslie J: Nodal radiation therapy for metastatic melanoma, Int J Radiat Oncol Biol Phys, 1999; 44: 1065-1069.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Ewend MG, Carey LA, Brem H: Treatment of melanoma metastases in the brain, Semin Surg Oncol, 1996; 12: 429-435.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

6j Katz HR: The results of different fractionation schemes in the palliative irradiation of metastatic melanoma, Int J Radiat Oncol Biol Phys, 1981; 7: 907-911.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j Overgaard J: The role of radiotherapy in recurrent and metastatic malignant melanoma: a clinical radiobiological study, Int J Radiat Oncol Biol Phys, 1986; 12: 867-872.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

8j Konefal JB, Emami B, Pilepich MV: Analysis of dose fractionation in the palliation of metastases from malignant melanoma, Cancer, 1988; 61: 243-246.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

9j Rate WR, Solin LJ, Turrisi AT: Palliative radiotherapy for metastatic malignant melanoma: brain metastases, bone metastases, and spinal cord compression, Int J Radiat Oncol Biol Phys, 1988; 15: 859-864.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

10j Patchell RA, Tibbs PA, Regine WF, et al: Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial, JAMA, 1998; 280: 1485-1489.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

11j Fife KM, Colman MH, Stevens GN, et al: Determinants of outcome in melanoma patients with cerebral metastases, J Clin Oncol, 2004; 22: 1293-1300.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

12j Mori Y, Kondziolka D, Flickinger JC, et al: Stereotactic radiosurgery for cerebral metastatic melanoma: facto affecting local disease control and survival, Int J Radiat Oncol Biol Phys, 1998; 42: 581-589.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

13j Zacest AC, Besser M, Stevens G, et al: Surgical management of cerebral metastases from melanoma: outcome in 147 patients treated at a single institution over two decades, J Neurosurg, 2002; 96: 552-558.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

14j Hagen NA, Cirrincione C, Thaler HT, DeAngelis LM: The role of radiation therapy following resection of single brain metastasis from melanoma, Neurology, 1990; 40: 158-160.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ18

Ųœ•s”\‚ȉ“Šu“]ˆŚ‚š—L‚·‚郁ƒ‰ƒm[ƒ}Š³ŽŅ‚É‘Ī‚µ‚ď]—ˆ‚Ģ‚Ŗ‚ń–ņ•Ø—Ć–@‚ĶŠ©‚ß‚ē‚ź‚é‚©

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C1

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’PÜ‚Å‚ĶCtemozolomide3jCcarmustineiBCNUjCfotemustine4jCcisplatiniCDDPjCcarboplatiniCBDCAjCvinblastineiVLBjCvindesineCpaclitaxeliPTXjCdocetaxelC ‚—p—Źinterleukin-2iIL-2j5jCinterferon-ƒæiIFN-ƒæj6j‚Č‚Ē‚Ŗ—p‚¢‚ē‚ź‚½B‘½Ü•¹—p‰»Šw—Ć–@‚Å‚ĶBOLD —Ć–@ibleomycinCvincristineClomustineCDTICj7jCCVD —Ć–@iCDDP { VLB {DTICj8jCDTIC { tamoxifen9jC–{–M‚Å‚ĢDAC-Tam —Ć–@‚É‘Š“–‚·‚éDartmouth regimeniDTIC { BCNU { CDDP { tamoxifenj10jCPTX { CBDCA11j‚Č‚Ē‚Ŗ—p‚¢‚ē‚ź‚½B‰»Šw—Ć–@Ü‚ĘIL-2 ‚āIFN-ƒæ‚š‘g‚Ż‡‚ķ‚¹‚鐶•Ø‰»Šw—Ć–@‚Å‚ĶC“ÆŽž•¹—p—Ć–@‚Ę‚µ‚āCDTIC { IFN-ƒæ{tamoxifen12jCCVD —Ć–@{ IL-2 { IFNƒæ13j‚Č‚Ē‚ŖC˜A‘±“I•¹—p—Ć–@‚Ę‚µ‚āCDTIC { CDDP{ tamoxifen ‚Ɉų‚«‘±‚¢‚ÄIL-2 ‚ĘIFN-ƒæ‚š“Š—^‚·‚é•ū–@14jCCVD —Ć–@‚Ɉų‚«‘±‚¢‚ÄIL-2 ‚ĘIFN-ƒæ‚š“Š—^‚·‚é•ū–@15jC‚Č‚Ē‚Ŗ—p‚¢‚ē‚ź‚½B

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1j Hill GJ 2nd, Krementz ET, Hill HZ: Dimethyl triazeno imidazole carboxamide and combination therapy for melanoma. IV. Late results after complete response to chemotherapyiCentral Oncology Group protocols 7130, 7131, and 7131Aj, Cancer, 1984; 53: 1299-1305.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Eigentler TK, Caroli UM, Radny P, Garbe C: Palliative therapy of disseminated malignant melanoma: a systematic review of 41 randomised clinical trials, Lancet Oncol, 2003; 4: 748-759.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

3j Middleton MR, Grob JJ, Aaronson N, et al: Randomized phase Ⅲ study of temozolomide versus dacarbazine in the treatment of patients with advanced metastatic malignant melanoma, J Clin Oncol, 2000; 18: 158-166.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

4j Avril MF, Aamdal S, Grob JJ, et al: Fotemustine compared with dacarbazine in patients with disseminated malig nant melanoma: a phase Ⅲ study, J Clin Oncol, 2004; 22: 1118-1125.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

5j Atkins MB, Kunkel L, Sznol M, Rosenberg SA: High-dose recombinant interleukin-2 therapy in patients with metastatic melanoma: long-term survival update, Cancer J Sci Am, 2000; 6iSuppl 1j: S11-14.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

6j Dummer R, Garbe C, Thompson JA, et al: Randomized dose-escalation study evaluating peginterferon alfa-2a in patients with metastatic malignant melanoma, J Clin Oncol, 2006; 24: 1188-1194.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

7j Vuoristo MS, Hahka-Kemppinen M, Parvinen LM, et al: Randomized trial of dacarbazine versus bleomycin, vincristine, lomustine and dacarbazineiBOLDjchemotherapy combined with natural or recombinant interferonalpha in patients with advanced melanoma, Melanoma Res, 2005; 15: 291-296.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

8j Legha SS, Ring S, Papadopoulos N, et al: A prospective evaluation of a triple-drug regimen containing cisplatin, vinblastine, and dacarbazineiCVDj for metastatic melanoma, Cancer, 1989; 64: 2024-2029.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

9j Cocconi G, Bella M, Calabresi F, et al: Treatment of metastatic malignant melanoma with dacarbazine plus tamoxifen, N Engl J Med, 1992; 327: 516-523.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

10j Chapman PB, Einhorn LH, Meyers ML, et al: Phase Ⅲ multicenter randomized trial of the Dartmouth regimen versus dacarbazine in patients with metastatic melanoma, J Clin Oncol, 1999; 17: 2745-2751.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

11j Rao RD, Holtan SG, Ingle JN, et al: Combination of paclitaxel and carboplatin as second-line therapy for patients with metastatic melanoma, Cancer, 2006; 106: 375-382.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

12j Falkson CI, Ibrahim J, Kirkwood JM, et al: Phase Ⅲ trial of dacarbazine versus dacarbazine with interferon alpha-2b versus dacarbazine with tamoxifen versus dacarbazine with interferon alpha-2b and tamoxifen in patients with metastatic malignant melanoma: an Eastern Cooperative Oncology Group study, J Clin Oncol, 1998; 16: 1743-1751.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

13j Atkins MB, Hsu J, Lee S, et al: Phase Ⅲ trial comparing concurrent biochemotherapy with cisplatin, vinblastine, dacarbazine, interleukin-2, and interferon alfa-2b with cisplatin, vinblastine, and dacarbazine alone in patients with metastatic malignant melanomaiE3695j: a trial coordinated by the Eastern Cooperative Oncology Group, J Clin Oncol, 2008; 26: 5748-5754.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

14j Rosenberg SA, Yang JC, Schwartzentruber DJ, et al: Prospective randomized trial of the treatment of patients with metastatic melanoma using chemotherapy with cisplatin, dacarbazine, and tamoxifen alone or in combination with interleukin-2 and interferon alfa-2b, J Clin Oncol, 1999; 17: 968-975.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

15j Eton O, Legha SS, Bedikian AY, et al: Sequential biochemotherapy versus chemotherapy for metastatic melanoma: results from a phase Ⅲ randomized trial, J Clin Oncol, 2002; 20: 2045-2052.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

16j Crosby T, Fish R, Coles B, et al: Systemic treatments for metastatic cutaneous melanoma, Cochrane Database Syst Rev, 2009; Issue 3.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

17j Sasse AD, Sasse EC, Clark LGO, et al: Chemoimmunotherapy versus chemotherapy for metastatic malignant melanoma, Cochrane Database Syst Rev, 2009; Issue 1.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj


CQ19

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ƒƒ‰ƒm[ƒ}‚Ģ”­¶E‘B‚ÉŠÖ‚ķ‚é•ŖŽq‚É‚Ķ‘½‚­‚Ģ•ń‚Ŗ‚ ‚é‚ŖCŒ»Ż‚Ģ‚Ę‚±‚ėBRAFEMEKEKIT ‚š•W“I‚Ę‚µ‚½‘jŠQÜ‚Ģ—Տ°ŽŽŒ±‚ŖŠˆ”­‚ɐi‚ß‚ē‚ź‚Ä‚¢‚éBBRAF ‚šŠÜ‚Žƒ}ƒ‹ƒ`ƒLƒi[ƒ[‘jŠQÜ‚Å‚ ‚ésorafenib ‚Å‚ĶCDTIC } sorafenib ‚Ģ‘ęⅡ‘ŠRCT3j ‚ācarboplatin { paclitaxeliPTXj} sorafenib ‚Ģ‘ęⅢ‘ŠRCT4j, 5j‚ŖŽĄŽ{‚³‚ź‚½‚ŖC‚¢‚ø‚ź‚ą¶–½—\Œć‚É‘Ī‚·‚ésorafenib‚Ģćę‚¹Œų‰Ź‚ĶŽ¦‚³‚ź‚Č‚©‚Į‚½BŒoŒū‚ĢV600E •ĻˆŁBRAF ƒLƒi[ƒ[‘jŠQÜ‚Å‚ ‚évemurafenib ‚ĶC‘ęⅠ ‘ŠŽŽŒ±‚ÅBRAFV600E •ĻˆŁ‚š—L‚·‚鈫«•FŽī‚É–ń8 Š„‚Ģ‘tŒų—¦‚šŽ¦‚µ‚Ä’–Ś‚³‚ź‚½6jB‚»‚ĢŒć‚ĢDTIC vs vemurafenib ‚Ģ‘ęⅢ‘ŠRCT ‚Å‚ąvemurafenib “Š—^ŒQ‚ɂ؂Ƃ鐶–½—\Œć‰ü‘PŒų‰Ź‚ŖŽ¦‚³‚ź7jC2011 ”N8 ŒŽ‚ɕč‘FDA ‚ɏ³”F‚³‚ź‚Ä‚¢‚éB“Æ—l‚ÉBRAF ‘jŠQÜ‚Å‚ ‚édabrafenib ‚Å‚ąDTIC vs dabrafenib ‚Ģ‘ęⅢ‘ŠRCT ‚Ŗs‚ķ‚źCdabrafenib “Š—^ŒQ‚ɂ؂Ƃ鐶–½—\Œć‰ü‘PŒų‰Ź‚ŖŽ¦‚³‚ź‚½8jBMEK ‘jŠQÜ‚Å‚ ‚étrametinib ‚Å‚ĶCDTIC ‚ ‚é‚¢‚ĶPTX ‚É‚ę‚鉻Šw—Ć–@vs trametinib ‚Ģ‘ęⅢ‘ŠRCT ‚Ŗs‚ķ‚źCtrametinib “Š—^ŒQ‚ɂ؂Ƃ鐶–½—\Œć‰ü‘PŒų‰Ź‚ŖŽ¦‚³‚ź‚½9jBŒ»Żdabrafenib ‚Ętrametinib ‚Ģ•¹—p‚É‚ę‚é—Տ°ŽŽŒ±‚Ŗi‚ß‚ē‚ź‚Ä‚¢‚éBKIT ‘jŠQÜ‚Å‚ ‚éimatinib ‚Å‚ĶCKIT ˆā“`Žq•ĻˆŁ‚ā‘•‚Ģ—L–³‚šŽQ‰ĮšŒ‚Ę‚¹‚ø‚ÉŽĄŽ{‚µ‚½‘ęⅡ‘ŠŽŽŒ±‚Å‚Ķ–¾‚ē‚©‚Č—Õ°Œų‰Ź‚Ķ“¾‚ē‚ź‚Č‚©‚Į‚½‚ą‚Ģ‚Ģ10`12jCKIT ˆā“`Žq•ĻˆŁ‚š—L‚·‚éĒ—į‚Å‚Ģ‘tŒų—į12j‚āKIT ˆā“`Žq•ĻˆŁ‚ā‘•‚šŽQ‰ĮšŒ‚Ę‚µ‚½‘ęⅡ‘ŠŽŽŒ±‚É‚Ø‚Æ‚éˆź’č‚Ģ—Տ°Œų‰Ź‚ŖŽ¦‚³‚ź‚Ä‚¢‚é13`15jB

ˆČć‚Ģ‚ꂤ‚ɁC‚±‚ź‚Ü‚Å—LŒų‚ČŽč’i‚Ŗ‘¶Ż‚µ‚Č‚©‚Į‚½ƒƒ‰ƒm[ƒ}‚Ģ–ņ•Ø—Ć–@‚Ķ‘å‚«‚Ȑi‰»‚š‹‚°‚Ā‚Ā‚ ‚čC”Œć‚ąV‹K–ņÜ‚ā—LŒų‚Č•¹—p—Ć–@‚ĢŠJ”­‚ÉŠś‘Ņ‚Ŗ‚©‚©‚éB

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1j Hodi FS, OfDay SJ, McDermott DF, et al: Improved survival with ipilimumab in patients with metastatic melanoma, N Engl J Med, 2010; 363: 711-723.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

2j Robert C, Thomas L, Bondarenko I, et al: Ipilimumab plus dacarbazine for previously untreated metastatic melanoma, N Engl J Med, 2011; 364: 2517-2526.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

3j McDermott DF, Sosman JA, Gonzalez R, et al: Double-blind randomized Phase Ⅱ study of the combination of sorafenib and dacarbazine in patients with advanced melanoma: a report from the 11715 Study Group, J Clin Oncol, 2008; 26: 2178-2185.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

4j Hauschild A, Agarwala SS, Trefzer U, et al: Results of a phase Ⅲ, randomized, placebo- controlled study of sorafenib in combination with carboplatin and paclitaxel as second-line treatment in patients with unresectable stage Ⅲ or stage IV melanoma, J Clin Oncol, 2009; 27: 2823-2830.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

5j Flaherty KT, Lee SJ, Zhao F, et al: Phase Ⅲ Trial of Carboplatin and Paclitaxel With or Without Sorafenib in Metastatic Melanoma, J Clin Oncol, 2013; 31: 373-379.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

6j Flaherty KT, Puzanov I, Kim KB, et al: Inhibition of mutated, activated BRAF in metastatic melanoma, N Engl J Med, 2010; 363: 809-819.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j Chapman PB, Hauschild A, Robert C, et al: Improved survival with vemurafenib in melanoma with BRAF V600E mutation, N Engl J Med, 2011; 364: 2507-2516.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

8j Hauschild A, Grob JJ, Demidov LV, et al: Dabrafenib in BRAF-mutated metastatic melanoma: a multicentre, open-label, phase 3 randomised controlled trial, Lancet, 2012; 380: 358-365.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

9j Flaherty K T, Robert C, Hersey P, et al: Improved survival with MEK inhibition in BRAF-mutated melanoma, N Engl J Med, 2012; 367: 107-114.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

10j Ugurel S, Hildenbrand R, Zimpfer A, et al: Lack of clinical efficacy of imatinib in metastatic melanoma, Br J Cancer, 2005; 92: 1398-1405.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

11j Wyman K, Atkins MB, Prieto V, et al: Multicenter Phase Ⅱ trial of high-dose imatinib mesylate in metastatic melanoma: significant toxicity with no clinical efficacy, Cancer, 2006; 106: 2005-2011.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

12j Kim KB, Eton O, Davis DW, et al: Phase Ⅱ trial of imatinib mesylate in patients with metastatic melanoma, Br J Cancer, 2008; 99: 734-740.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

13j Carvajal RD, Antonescu CR, Wolchok JD, et al: KIT as a therapeutic target in metastatic melanoma, JAMA, 2011; 305: 2327-2334.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

14j Guo J, Si L, Kong Y, et al: Phase Ⅱ, open-label, single-arm trial of imatinib mesylate in patients with metastatic melanoma harboring c-Kit mutation or amplification, J Clin Oncol, 2011; 29: 2904-2909.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

15j Hodi FS, Corless CL, Giobbie-Hurder A, et al: Imatinib for melanomas harboring mutationally activated or amplified KIT arising on mucosal, acral, and chronically sun-damaged skin, J Clin Oncol, 2013; 31: 3182-3190.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ20

Žčp‚Å•a•Ļ‚š‘SŲœ‚Å‚«‚½Š³ŽŅ‚É‘Ī‚µ‚Ē芜“I‚Č‘Sg‰ę‘œŒŸø‚ĶŠ©‚ß‚ē‚ź‚é‚©

 

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’芜“I‚Č‘Sg‰ę‘œŒŸø‚ĶŠ©‚ß‚ē‚ź‚Č‚¢B

 

•aŠś Ⅰ‚©‚ēⅡB

„§“x

C1

’芜“I‚Č‘Sg‰ę‘œŒŸø‚šs‚¤‚±‚Ę‚šl—¶‚µ‚Ä‚ą‚ę‚¢‚Ŗˆź—„‚ÉŽĄŽ{‚·‚邱‚Ę‚ĶŠ©‚ß‚ē‚ź‚Č‚¢BŒŸø€–Ś‚ĘŒŸøŠŌŠu‚É‚Ā‚¢‚Ä‚ĶŠ³ŽŅ‚²‚Ę‚ÉŒŸ“¢‚šs‚¤B

 

•aŠśⅡC ‚©‚ēⅢ

„§“x

B

–³ĒŒó«‚ĢƒŠƒ“ƒpß“]ˆŚ‚Ģ•]‰æ‚ʉ“Šu“]ˆŚ‚š”­Œ©‚·‚é–Ś“I‚ŁC’芜“I‚Č‘Sg‰ę‘œŒŸø‚šŽĄŽ{‚· ‚邱‚Ę‚ŖŠ©‚ß‚ē‚ź‚éBŒŸø€–Ś‚ĘŒŸøŠŌŠu‚É‚Ā‚¢‚Ä‚ĶŠ³ŽŅ‚²‚Ę‚ÉŒŸ“¢‚šs‚¤B

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


”‰šą

ƒƒ‰ƒm[ƒ}Š³ŽŅ‚ĢŒ“”­‘ƒŽ”—ĆŒć‚É‚Ķ’芜“I‚ČŒo‰ßŠĻŽ@‚Ŗs‚ķ‚ź‚éB‚»‚ĢŽå–Ś“I‚ĶŽ”—ƉĀ”\‚Č“]ˆŚ‚ā‹ĒŠÄ”­‚š‘Šś‚É”­Œ©‚·‚邱‚Ę‚É‚ ‚é‚ŖCŒo‰ßŠĻŽ@‚ĢÅ“K‚ČŠŌŠu‚ā•ū–@‚ÉŠÖ‚µ‚Ä‚Ķ¢ŠE’†‚ĢŠe‹@ŠÖ‚Ŗģ¬‚µ‚½f—ĆƒKƒCƒhƒ‰ƒCƒ“‚É‚Ø‚¢‚Ä‚ąƒRƒ“ƒZƒ“ƒTƒX‚Ŗ“¾‚ē‚ź‚Ä‚¢‚Č‚¢Bˆź”Ź“IŽ–ŽĄ‚Ę‚µ‚āCƒƒ‰ƒm[ƒ}‚ĢÄ”­“]ˆŚ‚ĶpŒć‘Šś‚ɐ¶‚¶‚邱‚Ę‚Ŗ‘½‚­CpŒć5 ”N‚šŒo‰ß‚·‚é‚ĘƒŠƒXƒN‚Ķ‰ŗ‚Ŗ‚é‚ą‚Ģ‚ĢpŒć10 ”N‚š‰ß‚¬‚Ä‚ąÄ”­“]ˆŚ‚š¶‚¶‚邱‚Ę‚Ŗ‚ ‚éB

Œo‰ßŠĻŽ@•ū–@‚ÉŠÖ‚µ‚Ä‚Ķ‘½”‚ĢŒ¤‹†‚Ŗs‚ķ‚ź‚Ä‚Ø‚č1jC‰‰ńÄ”­‚Ģ50`85“‚Ķ‹ĒŠ`Š‘®ƒŠƒ“ƒpß‚É‹N‚«C”­Œ©‚ĢŒ_‹@‚Ę‚µ‚Ä‚Ķ–{l‚ ‚é‚¢‚ĶˆćŽt‚É‚ę‚éGf‚Ŗ‚Ł‚Ę‚ń‚Ē‚Å‚ ‚邱‚Ę‚ŖŽ¦‚³‚ź‚Ä‚¢‚é2, 3jB‰¢•Ä‚Å‚ĶŠ‘®ƒŠƒ“ƒpß“]ˆŚ‚Ģ‘Šś”­Œ©‚É’“‰¹”gŒŸø‚Ģ—L—p«‚ŖŽ¦“‚³‚ź‚Ä‚¢‚é4jBˆź•ūC‹¹•”X üŽB‰e‚Ķˆź•”‚ĢŠ³ŽŅ‚É‚Ø‚¢‚Ä”x“]ˆŚ”­Œ©‚ĢŒ_‹@‚ʂȂ肤‚é‚ŖC‹U—z«‚Ŗ‘½‚­¶‘¶—¦‚Ģ‰ü‘P‚ĶŲ–¾‚³‚ź‚Ä‚¢‚Č‚¢5, 6jB

Garbe ‚ē7j‚ŖŽĄŽ{‚µ‚½‘OŒü‚«—Տ°Œ¤‹†‚Å‚Ķ•aŠś•Ź‚É6`12 ƒJŒŽ–ˆ‚ɐfŽ@CƒŠƒ“ƒpß‚Ģ’“‰¹”gŒŸøC‹¹•”X üC• •”’“‰¹”gŒŸøCŒŒ‰tŒŸø‚Č‚Ē‚ŖŽ{s‚³‚ź‚½B‚»‚ĢŒ‹‰ŹC“]ˆŚ”­Œ©‚ĢŒ_‹@‚ĶfŽ@47“CƒŠƒ“ƒpß’“‰¹”g13.7“C‹¹•”X ü5.5“C• •”’“‰¹”g3.7“CCT23.7“CŒŒ‰tŒŸø1.4“CƒVƒ“ƒ`ƒOƒ‰ƒtƒB[1.4“‚Å‚ ‚Į‚½‚Ę•ń‚³‚ź‚Ä‚¢‚éB‚±‚ĢŒ¤‹†‚Å‚ĶCT ‚Ķƒ‹[ƒ`ƒ“‚É‚Ķs‚ķ‚ź‚Ä‚¢‚Č‚¢‚ŖCƒŠƒ“ƒpß’“‰¹”gŒŸø‚Å”­Œ©‚³‚ź‚½“]ˆŚ‚Ģ71“CfŽ@‚Å‚Ģ56“CCT ‚Å‚Ģ30“‚ŖŽ”—ƉĀ”\‚Č‘Šś“]ˆŚ‚Å‚ ‚čC“]ˆŚ‚Ģ‘Šś”­Œ©ŒQ‚ʔӊś”­Œ©ŒQ‚Å‚Ķ¶‘¶—¦‚É—LˆÓ·‚Ŗ”F‚ß‚ē‚ź‚Ä‚¢‚éB

Īˆä‚ē8j‚Ģ“ś–{l‚š‘ĪŪ‚Ę‚µ‚½Ē—įWĻŒ¤‹†‚Å‚ĶC142 –¼‚ĢpŒćŠ³ŽŅ‚Ģ‚¤‚æAJCC/UICC2002 •Ŗ—Ž‚Åstage ⅡCⅢ‚ĢĒ—į‚ŏ­‚Č‚­‚Ę‚ą1 ”N‚É1 ‰ńCT ƒXƒLƒƒƒ“C67Ga ƒVƒ“ƒ`ƒOƒ‰ƒtƒB[CPET ‚Ģ‚¢‚ø‚ź‚©‚šŽ{s‚µ‚½B‰‰ń“]ˆŚ‚Ŗ‰ę‘œ‚Å”­Œ©‚³‚ź‚½ŒQi16 —įj‚ĘŽ©ŠoĒó‚Ü‚½‚ĶfŽ@‚Å”­Œ©‚³‚ź‚½ŒQi28 —įj‚Ģ‰‰ńŽčp‚©‚ē‚Ģ¶‘¶ŠśŠŌ‚ĢŠŌ‚É—LˆÓ·‚Ķ‚Ż‚ē‚ź‚Č‚©‚Į‚½ip  0.27jB

CT ‚ÉŠÖ‚µ‚Ä‚ĶC‘å•”•Ŗ‚Ŗ“]ˆŚ‚Ģ‹^‚ķ‚ź‚éĒ—į‚É‚Ģ‚ŻŽ{s‚³‚ź‚½Œć‚ėŒü‚«Œ¤‹†‚Å‚ ‚č9, 10jC’芜“IŒŸø‚É‚ę‚Į‚摶—¦‚Ŗ‰ü‘P‚·‚é‚©”Ū‚©‚Ķ•s–¾‚Å‚ ‚éBŒ»Žž“_‚Å‚Ķ’“‰¹”gŒŸø‚Ģ—L—p«‚ĶŽ¦“‚³‚ź‚é‚ą‚Ģ‚ĢC’芜“I‚Č’“‰¹”gŒŸø‚Ŗ¶‘¶—¦‚Ģ‰ü‘P‚É‚Ā‚Č‚Ŗ‚邱‚Ę‚šŽ¦‚·–¾Šm‚ȍŖ‹’‚Ķ‘¶Ż‚µ‚Č‚¢B

•¶Œ£

1j Francken AB, Bastiaannet E, Hoekstra HJ: Follow-up in patients with localised primary cutaneous melanoma, Lancet Oncol, 2005; 6: 608-621.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

2j Francken AB, Shaw HM, Accortt NA, et al: Detection of first relapse in cutaneous melanoma patients: implications for the formulation of evidence-based follow-up guidelines, Ann Surg Oncol, 2007; 14: 1924-1933.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j Mooney MM, Kulas M, McKinley B, et al: Impact on survival by method of recurrence detection in stage Ⅰ and Ⅱ cutaneous melanoma, Ann Surg Oncol, 1998; 5: 54-63.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

4j Bafounta ML, Beauchet A, Chagnon S, et al: Ultrasonography or palpation for detection of melanoma nodal invasion: a meta-analysis, Lancet Oncol, 2004; 5: 673-680.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

5j Morton RL, Craig JC, Thompson JF: The role of surveillance chest X-rays in the follow-up of high-risk melanoma patients, Ann Surg Oncol, 2009; 16: 571-577.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

6j Tsao H, Feldman M, Fullerton JE, et al: Early detection of asymptomatic pulmonary melanoma metastases by routine chest radiographs is not associated with improved survival, Arch Dermatol, 2004; 140: 67-70.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j Garbe C, Paul A, Kohler-Spath H, et al: Prospective evaluation of a follow-up schedule in cutaneous melanoma patients: recommendations for an effective follow-up strategy, J Clin Oncol, 2003; 21: 520-529.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

8j Īˆä‹M”VC”Ŗ“c®lC“”–{W‰pC’|Œ“˜a•FFˆ««•FŽīŠ³ŽŅ‚ĢpŒćŒo‰ßŠĻŽ@F‰ę‘œŒŸø‚ĢˆÓ‹`‚É‚Ā‚¢‚Ä‚ĢŒŸ“¢C“ś”ē‰ļŽC2008 ; 118 : 397-402.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

9j Johnson TM, Fader DJ, Chang AE, et al: Computed tomography in staging of patients with melanoma metastatic to the regional nodes, Ann Surg Oncol, 1997; 4: 396-402.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

10j Kuvshinoff BW, Kurtz C, Coit DG: Computed tomography in evaluation of patients with stage Ⅲ melanoma, Ann Surg Oncol, 1997; 4: 252-258.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ21

pŒćƒƒ‰ƒm[ƒ}Š³ŽŅ‚É‘Ī‚µ‚čĔ­E“]ˆŚ‘Šś”­Œ©‚Ģ‚½‚ß‚ĢŠ³ŽŅ‹³ˆē‚šs‚¤‚±‚Ę‚ĶŠ©‚ß‚ē‚ź‚é‚©

„§“x

B

pŒćƒƒ‰ƒm[ƒ}Š³ŽŅ‚ŖŽ©•Ŗ‚Ģ”ē•†‚É‘Ī‚·‚é’芜“IŽ©ŒČŒŸøiself skin examinationGSSEj ‚šs‚¤‚ʐ¶‘¶—¦‚Ŗ‰ü‘P‚·‚é‰Ā”\«‚Ŗ‚ ‚é‚Ģ‚ŁCŠ³ŽŅ‹³ˆē‚šs‚¤‚±‚Ę‚ĶŠ©‚ß‚ē‚ź‚éB

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”‰šą

pŒćƒƒ‰ƒm[ƒ}Š³ŽŅ‚É‹³ˆē‚šs‚¤‘ęˆź‚Ģ–Ś“I‚ĶÄ”­E“]ˆŚ‚Ģ‘Šś”­Œ©‚Å‚ ‚éBÄ”­E“]ˆŚ‚ĶCŠ³ŽŅ‚ą‚µ‚­‚ĶˆćŽt‚É‚ę‚鎋fEGf‚Å”­Œ©‚³‚ź‚邱‚Ę‚ŖÅ‚ą‘½‚¢1, 2jB

Dalal ‚ē‚ĶƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpß¶ŒŸ‚Ŗ‰A«‚Å‚ ‚Į‚½•aŠś Ⅰ‚Ü‚½‚ĶⅡ‚ĢŠ³ŽŅ‚É‚Ø‚¢‚ătƒHƒ[ƒAƒbƒv’†‚ɍĔ­‚µ‚½ź‡C”­Œ©•ū–@‚Ģˆį‚¢‚É‚ę‚é1 ”N¶‘¶—¦‚ĶCŽ©ŒČfŽ@‚É‚ę‚é”­Œ©F79“CˆćŽt‚ĢfŽ@‚É‚ę‚é”­Œ©F76“CˆćŽt‚Ģ‰ę‘œŒŸø‚É‚ę‚é”­Œ©F45“CŠ³ŽŅ‚ĢŽ©ŠoĒó‚É‚ę‚é”­Œ©26“‚Ģ‡‚É’į‰ŗ‚·‚邱‚Ę‚š•ń‚µ‚½2jB

Berwick ‚ē‚ŖSSE ‚Ģ—L—p«‚šŒŸ“¢‚µ‚½‚Ę‚±‚ė3jCƒƒ‰ƒm[ƒ}‚É‚ę‚鎀–S‚É‘Ī‚·‚éC³ƒIƒbƒY”ä‚ŖCŒ“”­‘ƒ‚ĢpŒć‚ɒ芜“I‚ČSSE ‚šs‚Į‚½ŒQ‚Å‚Ķs‚ķ‚Č‚©‚Į‚½ŒQ‚É‘Ī‚µ‚Ä0.37i95“M—Š‹ęŠŌ0.16`0.84j‚Å‚ ‚Į‚½B‚±‚ĢŒ‹‰Ź‚ĶSSE ‚ŖŒ“”­‘ƒpŒćƒƒ‰ƒm[ƒ}Š³ŽŅ‚ĢŽ€–S‚š63“Œø­‚³‚¹‚é‰Ā”\«‚šŽ¦‚µ‚Ä‚¢‚éB‚µ‚©‚µ‚±‚ĢŒ¤‹†‚ĶƒoƒCƒAƒX‚āŒš—ˆöŽq‚Ģ’²®‚Ŗ‚Č‚³‚ź‚Ä‚¢‚Č‚¢‚½‚߁CŒ‹‰Ź‚Ģ‰šŽß‚É‚Ķ’ˆÓ‚Ŗ•K—v‚Å‚ ‚éB

‰¢•Ä‚É‚Ø‚Æ‚éSSE ‚ĶCƒp[ƒgƒi[‚Ģ‹¦—Ķ‚ą“¾‚Ä‚Š‚ĘŒŽ‚É1 ‰ń‹¾‚šŽg—p‚µ‚Ä‘Sg‚Ģ”ē•†•\–Ź‚šŠĻŽ@‚µCŒ“”­•”ˆŹ‚©‚ēŠ‘®ƒŠƒ“ƒpß‚Ģ‚Ż‚Å‚Č‚­‘Sg‚Ģ”ē•†‚šG‚čCƒŠƒ“ƒpß‚ĢŽī’Æ‚āŒ‹ß‚Ģ—L–³‚šŒŸõ‚·‚é‚ą‚Ģ‚Å‚ ‚éB“ś–{‚É‚Ø‚¢‚Ä‚ąpŒćŠ³ŽŅ‚É‘Ī‚µ‚ĐGf–@‚šŠÜ‚ß‚½“KŲ‚ČSSE ‚šŽw“±‚·‚邱‚Ę‚Ŗ–]‚Ü‚ź‚éB

•¶Œ£

1j Garbe C, Paul A, Kohler-Spath H, et al: Prospective evaluation of a follow-up schedule in cutaneous melanoma patients: recommendations for an effective followup strategy, J Clin Oncol, 2003; 21: 520-529.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Moore Dalal K, Zhou Q, Panageas KS, et al: Methods of detection of first recurrence in patients with stage Ⅰ/Ⅱ primary cutaneous melanoma after sentinel lymph node biopsy, Ann Surg Oncol, 2008; 15: 2206-2214.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j Berwick M, Begg CB, Fine JA, et al: Screening for cutaneous melanoma by skin self-examination, J Natl Cancer Inst, 1996; 88: 17-23.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

ƒƒ‰ƒm[ƒ}@CQ1`CQ21 ˆź——
CQ   „§“x „§•¶
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  C1 “ś–{l‚Å‚Ķƒƒ‰ƒm[ƒ}‚Ģ‰ß”¼”‚ŖŽˆ’[•”‚É”­¶‚µCŽ‡ŠOü‚ĢŠÖ—^‚Ķ­‚Č‚¢‚ʍl‚¦‚ē‚ź‚é‚ŖCƒTƒ“ƒXƒNƒŠ[ƒ“Ü‚Č‚Ē‚ÅŽ‡ŠOü–hŒä‚šs‚¤‚±‚Ę‚É‚ę‚č˜IŒõ•”‚Ģƒƒ‰ƒm[ƒ}‚Ģ”­¶—¦‚ŖŒø­‚·‚éŒXŒü‚Ķ‚ ‚邽‚ߤŽ‡ŠOü–hŒä‚šl—¶‚µ‚Ä‚ą‚ę‚¢B
  1. 2D‚Ł‚­‚ėiŒć“V«F‘f×–E•ź”Įj‚Ģ”‚Ŗ‘½‚¢ŽŅ‚É‘Ī‚µ‚ăƒ‰ƒm[ƒ}‚Ģ‘Šśf’f‚š–Ś“I‚Ę‚µ‚½’芜fŽ@‚ĶŠ©‚ß‚ē‚ź‚é‚©
  C1 F”’‚Å‚Ł‚­‚ė‚Ģ”‚Ŗ50 ŒĀˆČć‚Ģź‡’芜fŽ@‚šl—¶‚µ‚Ä‚ą‚ę‚¢B
  1. 3D‹‘åŒ^ę“V«F‘f×–E•ź”Į‚É‘Ī‚µ‚ăƒ‰ƒm[ƒ}‚Ģ”­¶—\–h‚š–Ś“I‚Ę‚µ‚½—\–h“IŲœ‚ĶŠ©‚ß‚ē‚ź‚é‚©
  C1 ‹‘åŒ^ę“V«F‘f×–E•ź”ĮŠ³ŽŅ‚Ŗƒƒ‰ƒm[ƒ}‚š”­¶‚·‚éŠėŒÆ«‚Ķ—LˆÓ‚ɍ‚‚­CŽį”N‚Å”­¶‚·‚邱‚Ę‚Ŗ‘½‚¢‚½‚߁CŠw“¶Šś‚ɏI—¹‚·‚é‚ꂤ‚Č—\–h“IŲœ‚šl—¶‚µ‚Ä‚ą‚ę‚¢B
  1. 4Dƒƒ‰ƒm[ƒ}‚Ģ‘Šśf’f‚š–Ś“I‚Ę‚µ‚½ƒ_[ƒ‚ƒXƒRƒs[‚ĢŽg—p‚ĶŠ©‚ß‚ē‚ź‚é‚©
  A ƒ_[ƒ‚ƒXƒRƒs[‚ɏKn‚µ‚½ˆćŽt‚Ŗ—p‚¢‚ź‚Īƒƒ‰ƒm[ƒ}‚Ģ‘Šśf’f‚É–š—§‚Ā‚Ģ‚ŁCŽg—p‚š‹­‚­Š©‚ß‚éB
  1. 5Dƒƒ‰ƒm[ƒ}‚Ģ‘Šśf’f‚š–Ś“I‚Ę‚µ‚½ŒŒ“Žīį‡ƒ}[ƒJ[‘Ŗ’č‚ĶŠ©‚ß‚ē‚ź‚é‚©
  C2 ƒƒ‰ƒm[ƒ}‚Ģ‘Šśf’f‚š–Ś“I‚Ę‚µ‚½ŒŒ“Žīį‡ƒ}[ƒJ[‘Ŗ’č‚ĶŠ©‚ß‚ē‚ź‚Č‚¢B
  1. 6Dƒƒ‰ƒm[ƒ}Œ“”­‘ƒ‚É‚Ø‚Æ‚étumor thickness ‚Ģp‘O•]‰æ‚Ģ‚½‚ߍ‚Žü”gƒGƒR[‚āMRI ‚ĢŽĄŽ{‚ĶŠ©‚ß‚ē‚ź‚é‚©
‚Žü”gƒGƒR[ C1 ‚Žü”gƒGƒR[i20 ` 100MHzj ‚Ķƒƒ‰ƒm[ƒ}‚Ģtumor thickness ‚š”äŠr“I³Šm‚É—\‘Ŗ‚Å‚«‚邽‚߁C‚»‚ĢŽĄŽ{‚šl—¶‚µ‚Ä‚ą‚ę‚¢B
MRI C2 MRI ‚Å‚Ķtumor thickness ‚Ģ‘Ŗ’čŒė·‚Ŗ¶‚¶‚邱‚Ę‚Ŗ‚ ‚邽‚߁C‚»‚ĢŽĄŽ{‚ĶŠ©‚ß‚ē‚ź‚Č‚¢B
  1. 7Dƒƒ‰ƒm[ƒ}‚ĢŒ“”­‘ƒ‚É•”•Ŗ¶ŒŸiincisional biopsyj‚šs‚Į‚Ä‚ą‚ę‚¢‚©
  C1 ‘SŲœ¶ŒŸ‚Ŗ¢“ļ‚Č‘å‚«‚Č•a•Ļ‚Å‚Ķ•”•Ŗ¶ŒŸ‚šs‚Į‚Ä‚ą‚ę‚¢B
  1. 8Dƒƒ‰ƒm[ƒ}‚Ģ“]ˆŚ‘ƒŒŸo‚Ģ‚½‚ß‚Ģp‘O‰ę‘œŒŸø‚ĶŠ©‚ß‚ē‚ź‚é‚©
—Տ°•aŠś0iin situj C2 ‹¹•”X üC’“‰¹”gŒŸøCCTCPET ‚Č‚Ē‚šŽĄŽ{‚·‚邱‚Ę‚ĶŠ©‚ß‚ē‚ź‚Č‚¢B
—Տ°•aŠśI ‚©‚ēIIB C1 ‹¹•”X üC’“‰¹”gŒŸøCCTCPET ‚Č‚Ē‚šŽĄŽ{‚·‚邱‚Ę‚šl—¶‚µ‚Ä‚ą‚ę‚¢‚ŖCˆź—„‚ÉŽĄŽ{‚·‚邱‚Ę‚ĶŠ©‚ß‚ē‚ź‚Č‚¢B
—Տ°•aŠśIIC ‚©‚ēIII B ‹¹•”X üC’“‰¹”gŒŸøCCTCPET ‚Č‚Ē‚šŠ‘®ƒŠƒ“ƒpß‚ĢˆŹ’u‚ʉ“Šu“]ˆŚ‚ĢƒŠƒXƒN‚ɉž‚¶‚ďĒ—į‚²‚Ę‚É‘I‘š‚µ‚ÄŽĄŽ{‚·‚邱‚Ę‚ŖŠ©‚ß‚ē‚ź‚éB
  1. 9Dƒƒ‰ƒm[ƒ}‚ĢŒ“”­‘ƒ‚ĶC“÷Šį“I‚Č•a‘ƒ•Ó‰‚©‚ē‰½cm—£‚µ‚ĐŲœ‚·‚邱‚Ę‚ŖŠ©‚ß‚ē‚ź‚é‚©
In situ •a•Ļ C1 ƒƒ‰ƒm[ƒ}Œ“”­‘ƒ‚šŠO‰Č“IŲœ‚·‚éŪ‚Ģ•a‘ƒ•Ó‰‚©‚ē‚Ģ‹——£‚Ķ3`5mm ‚Ŗl—¶‚³‚ź‚é
Tumor thickness … 1.0mm A ƒƒ‰ƒm[ƒ}Œ“”­‘ƒ‚šŠO‰Č“IŲœ‚·‚éŪ‚Ģ•a‘ƒ•Ó‰‚©‚ē‚Ģ‹——£‚Ķ1cm ‚Ŗ‹­‚­Š©‚ß‚ē‚ź‚éB
Tumor thickness 1.01 ` 2.0mm A ƒƒ‰ƒm[ƒ}Œ“”­‘ƒ‚šŠO‰Č“IŲœ‚·‚éŪ‚Ģ•a‘ƒ•Ó‰‚©‚ē‚Ģ‹——£‚Ķ1 ` 2cm ‚Ŗ‹­‚­Š©‚ß‚ē‚ź‚éB
Tumor thickness 2.01 ` 4.0mm A ƒƒ‰ƒm[ƒ}Œ“”­‘ƒ‚šŠO‰Č“IŲœ‚·‚éŪ‚Ģ•a‘ƒ•Ó‰‚©‚ē‚Ģ‹——£‚Ķ2cm ‚Ŗ‹­‚­Š©‚ß‚ē‚ź‚éB
Tumor thickness „ 4.0mm B ƒƒ‰ƒm[ƒ}Œ“”­‘ƒ‚šŠO‰Č“IŲœ‚·‚éŪ‚Ģ•a‘ƒ•Ó‰‚©‚ē‚Ģ‹——£‚Ķ2cm ‚ŖŠ©‚ß‚ē‚ź‚éB
  1. 10D“÷Šį“Ii—Տ°“IjƒŠƒ“ƒpß“]ˆŚ‚Ŗ‚Č‚­‚©‚Ā‰“Šu“]ˆŚ‚Ģ‚Č‚¢ƒƒ‰ƒm[ƒ}‚É‘Ī‚µ‚āCƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpß¶ŒŸisentinel lymphnode biopsyGSLNBj‚ĶŠ©‚ß‚ē‚ź‚é‚©
Tumor thickness … 0.75mm C2 SLNB ‚šs‚¤‚±‚Ę‚ĶŠ©‚ß‚ē‚ź‚Č‚¢B
Tumor thickness 0.76 ` 1.0mm C1 Œś‚³0.76mm ˆČć‚Å‚ĶSLNB ‚šl—¶‚µ‚Ä‚ę‚¢B“Į‚É’×į‡‚Ŗ‚ ‚鏼‡C”N—ī‚Ŗ40 ĪˆČ‰ŗC¶ŒŸ‘gD‚Ģ[•”’f’[‚Ŗ—z«CƒŠƒ“ƒpŠĒZ‚š”F‚ß‚éź‡CClark ƒŒƒxƒ‹IV ˆČćC‚ ‚é‚¢‚Ķ1 ŒĀ/mm2 ˆČć‚ĢŠj•Ŗ—ō‘œ‚Ģ‚¢‚ø‚ź‚©‚Ŗ‚³‚ē‚É‚ ‚ź‚ĪSLNB ‚šl—¶‚·‚éB
Tumor thickness 1.01 ` 4.0mm B SLNB ‚É‚ę‚čƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßisentinel lymph nodeGSLNj‚ĢŒ°”÷‹¾“I“]ˆŚ‚š‘Šś‚É”­Œ©‚µC‚»‚ĢƒŠƒ“ƒpß—Ģˆę‚šŠs“‚·‚邱‚Ę‚É‚ę‚čƒŠƒ“ƒpß“]ˆŚ‚Ģ‚ ‚銳ŽŅ‚Ģ—\Œć‚Ŗ‰ü‘P‚³‚ź‚邱‚Ę‚©‚ēCSLNB ‚šs‚¤‚±‚Ę‚ŖŠ©‚ß‚ē‚ź‚éB
Tumor thickness „ 4.0mm C1 SLNB ‚šs‚¤ˆÓ‹`‚Ķ–¾Šm‚É‚Č‚Į‚Ä‚¢‚Č‚¢‚ŖC¢ŠE“I‚É‚ą‘½‚­‚ĢŽ{Ż‚ōs‚ķ‚ź‚Ä‚¢‚錻ó‚©‚ēCŒ»Žž“_‚Å‚ĶSLNB ‚šl—¶‚µ‚Ä‚ę‚¢B
  1. 11Dƒƒ‰ƒm[ƒ}‚ĢŠ‘®ƒŠƒ“ƒpß“]ˆŚ‚É‘Ī‚µ‚ăŠƒ“ƒpßŠs“p‚šs‚¤‚±‚Ę‚ĶŠ©‚ß‚ē‚ź‚é‚©
“÷Šį“Ii—Տ°“IjƒŠƒ“ƒpß“]ˆŚ‚š”F‚߂郁ƒ‰ƒm[ƒ} B ƒŠƒ“ƒpßŠs“p‚šs‚¤‚±‚Ę‚ŖŠ©‚ß‚ē‚ź‚éB
ƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßisentinellymph nodeGSLNj “]ˆŚ—z«‚Ģƒƒ‰ƒm[ƒ} C1 ƒŠƒ“ƒpßŠs“p‚šs‚¤‚±‚Ę‚šl—¶‚·‚éB
  1. 12Dƒƒ‰ƒm[ƒ}‚Ģin-transit“]ˆŚ‚É‘Ī‚µ‚Ä‚Ē‚Ģ‚ꂤ‚ČŽ”—Ć‚ŖŠ©‚ß‚ē‚ź‚é‚©
ŠO‰Č“IŲœ C1 Š®‘SŲœ‰Ā”\‚Č’P”­‚ ‚é‚¢‚Ķ”ŒĀ‚Ģintransit “]ˆŚ‚ĶŠO‰Č“IŲœ‚šl—¶‚µ‚Ä‚ą‚ę‚¢B
ƒCƒ“ƒ^[ƒtƒFƒƒ“ƒĄ‹Ē’ C1 ƒCƒ“ƒ^[ƒtƒFƒƒ“ƒĄ‹Ē’—Ć–@‚š’P“Ę‚ ‚é‚¢‚Ķ‘¼Ž”—Ć‚Ę•¹—p‚µ‚čs‚¤‚±‚Ę‚Ķl—¶‚µ‚Ä‚ą‚ę‚¢B
‰·”MŽlŽˆŸó—¬isolated limb perfusioniILPj ‚ ‚é‚¢‚Ķisolated limb infusioniILIj C1 ŽlŽˆ‚Ģin-transit “]ˆŚ‚É‘Ī‚·‚éILP ‚ĘILI ‚Ķ‚»‚Ģ—LŒų«‚ÉŠÖ‚·‚éŠCŠO‚©‚ē‚Ģ•ń‚Ŗ‚ ‚č–{Ž”—Ć‚šs‚¤‚±‚Ę‚šl—¶‚µ‚Ä‚ą‚ę‚¢B‚½‚¾‚µŒ»Žž“_‚ō‘“ą‚ÅŽ{s‰Ā”\‚ČŽ{Ż‚Ķ‚Č‚¢i2013 ”N12 ŒŽŒ»Ż•ŪŒÆ“K—pŠOjB
  1. 13Dƒƒ‰ƒm[ƒ}‚ĢŠ‘®ƒŠƒ“ƒpßŠs“Œć‚ɏpŒć•śŽĖü—Ć–@‚šs‚¤‚±‚Ę‚ĶŠ©‚ß‚ē‚ź‚é‚©
  C1 Š‘®ƒŠƒ“ƒpßŠs“Œć‚Ģ•śŽĖü—Ć–@‚šˆź—„‚ɍs‚¤‚±‚Ę‚Ķ„§‚³‚ź‚Č‚¢‚ŖC•sŠ®‘SŲœ—į‚Č‚Ē‚Å‚ĶpŒć•śŽĖü—Ć–@‚šs‚¤‚±‚Ę‚šl—¶‚µ‚Ä‚ą‚ę‚¢B
  1. 14DŽčp‚ÅŠ®‘SŲœ‚Ŗ“¾‚ē‚ź‚½ƒƒ‰ƒm[ƒ}Š³ŽŅ‚É‘Ī‚µ‚ďpŒć•ā•—Ć–@‚ĶŠ©‚ß‚ē‚ź‚é‚©
  C1`C2 ¶–½—\Œć‚Ģ‰ü‘P‚ŖŲ–¾‚³‚ź‚½•›ģ—p‚ÉŒ©‡‚¤pŒć•ā•—Ć–@‚Ķ‘¶Ż‚µ‚Č‚¢‚½‚߁C‘SŠ³ŽŅ‚É‰ęˆź“I‚ɍs‚¤‚±‚Ę‚ĶŠ©‚ß‚ē‚ź‚Č‚¢B–{–M‚Å‚ĶDAVFeron —Ć–@‚āƒtƒFƒƒ“—Ć–@‚Ŗ•p—p‚³‚ź‚Ä‚«‚½‚ŖCŽĄŽ{‚ĢŖ‹’‚Ķ–R‚µ‚¢‚½‚ߌ©ž‚Ü‚ź‚é—L‰v«‚Ę•›ģ—p‚š\•Ŗą–¾‚µ‚½ć‚ÅŒĀX‚ĢŠ³ŽŅ–ˆ‚É“K‰ž‚ŖŒˆ‚ß‚ē‚ź‚é‚ׂ«‚Å‚ ‚éB
  1. 15Dƒƒ‰ƒm[ƒ}‚Ģ‰“Šu“]ˆŚ‘ƒ‚É‘Ī‚µ‚ÄŠO‰Č“IŲœ‚ĶŠ©‚ß‚ē‚ź‚é‚©
  B ‰“Šu“]ˆŚ‚Ŗ’P”­‚ÅŠ®‘SŲœ‚Ŗ‰Ā”\‚ȏź‡‚É‚ĶC‚»‚Ģ“]ˆŚ‘ƒ‚ĢŲœ‚É‚ę‚čŠ³ŽŅ‚Ģ¶‘¶ŠśŠŌ‚Ŗ‰„’·‚·‚é‰Ā”\«‚Ŗ‚ ‚éB‚Ü‚½C‰“Šu“]ˆŚ‘ƒ‚ĢŲœ‚ŖĒóŠÉ˜a‚É—L‰v‚Č‚±‚Ę‚Ŗ‚ ‚é‚Ģ‚ÅŠ©‚ß‚ē‚ź‚éB
  1. 16Dƒƒ‰ƒm[ƒ}‚ĢŠĢ“]ˆŚ‚É‘Ī‚µCŠĢ“®–¬‰»Šw—Ć–@‚ ‚é‚¢‚ĶŠĢ“®–¬‰»ŠwĒš—Ć–@‚ĶŠ©‚ß‚ē‚ź‚é‚©
  C1 “]ˆŚ‚ŖŠĢ‘Ÿ‚ÉŒĄ‹Ē‚µ‚Ä‚¢‚é‚©C‘¼‘ŸŠķ‚Ģ“]ˆŚ‘ƒ‚Ŗ‚ę‚­ƒRƒ“ƒgƒ[ƒ‹‚³‚ź‚Ä‚¢‚鏼‡‚É‚ĶCŠĢ“]ˆŚ‚É‘Ī‚·‚éŠĢ“®–¬‰»Šw—Ć–@‚ ‚é‚¢‚ĶŠĢ“®–¬‰»ŠwĒš—Ć–@‚ĶĒóŠÉ˜a‚É—L‰v‚Č‚Ģ‚ÅŽĄŽ{‚šl—¶‚µ‚Ä‚ą‚ę‚¢B
  1. 17D‰“Šu“]ˆŚ‚š—L‚·‚郁ƒ‰ƒm[ƒ}Š³ŽŅ‚É‘Ī‚µ‚ďĒóŠÉ˜a‚š–Ś“I‚É•śŽĖü—Ć–@‚šŽĄŽ{‚·‚邱‚Ę‚ĶŠ©‚ß‚ē‚ź‚é‚©
‰“Šu“]ˆŚi”]“]ˆŚˆČŠOj‚É‘Ī‚·‚é•śŽĖüŽ”—Ć B ‰“Šu“]ˆŚ‚š—L‚·‚郁ƒ‰ƒm[ƒ}Š³ŽŅ‚É‘Ī‚µ•śŽĖü—Ć–@‚šs‚¤‚±‚Ę‚Å”¼”ˆČć‚ĢĒ—į‚ŏĒóŠÉ˜aŒų‰Ź‚Ŗ“¾‚ē‚ź‚邽‚ߊ©‚ß‚ē‚ź‚éB
”]“]ˆŚ‚É‘Ī‚·‚é•śŽĖüŽ”—Ć B ‘S”]ĘŽĖ‚Ŗ•p—p‚³‚ź‚é‚Ŗ“]ˆŚŒĀ”‚Ŗ­‚Č‚­‘Sgó‘Ō—ĒD‚ȏĒ—į‚Å‚Ķ’čˆŹĘŽĖ‚ŖŠ©‚ß‚ē‚ź‚éB
  1. 18DŲœ•s”\‚ȉ“Šu“]ˆŚ‚š—L‚·‚郁ƒ‰ƒm[ƒ}Š³ŽŅ‚É‘Ī‚µ‚ď]—ˆ‚Ģ‚Ŗ‚ń–ņ•Ø—Ć–@‚ĶŠ©‚ß‚ē‚ź‚é‚©
  C1 ƒ_ƒJƒ‹ƒoƒWƒ“iDTICj’P“Ę—Ć–@‚ĢŽĄŽ{‚šl—¶‚µ‚Ä‚ą‚ę‚¢‚ŖC¶–½—\Œć‚Ģ‰ü‘P‚ĶŲ–¾‚³‚ź‚Ä‚¢‚Č‚¢B
  1. 19DŲœ•s”\‚ȉ“Šu“]ˆŚ‘ƒ‚š—L‚·‚郁ƒ‰ƒm[ƒ}Š³ŽŅ‚É‘Ī‚µ‚Ä•ŖŽq•W“I–ņ‚š‚Ķ‚¶‚ß‚Ę‚µ‚½V‹K‚ĢŽ”—Ć–@‚Ģ—Տ°ŽŽŒ±‚ĶŠ©‚ß‚ē‚ź‚é‚©
  B V‹K‚ĢŽ”—Ć–@‚Ģ’†‚É‚Ķ¶–½—\Œć‚Ģ‰ü‘P‚ŖŲ–¾‚³‚ź‚½—L–]‚Č–ņ•Ø—Ć–@‚ą‘¶Ż‚·‚邽‚߁C—Տ°ŽŽŒ±‚Ę‚µ‚čs‚ķ‚ź‚鏼‡‚ÉŒĄ‚芩‚ß‚ē‚ź‚éB
  1. 20DŽčp‚Å•a•Ļ‚š‘SŲœ‚Å‚«‚½Š³ŽŅ‚É‘Ī‚µ‚Ē芜“I‚Č‘Sg‰ę‘œŒŸø‚ĶŠ©‚ß‚ē‚ź‚é‚©
•aŠś0iin situj C2 ’芜“I‚Č‘Sg‰ę‘œŒŸø‚ĶŠ©‚ß‚ē‚ź‚Č‚¢B
•aŠśI ‚©‚ēIIB C1 ’芜“I‚Č‘Sg‰ę‘œŒŸø‚šs‚¤‚±‚Ę‚šl—¶‚µ‚Ä‚ą‚ę‚¢‚Ŗˆź—„‚ÉŽĄŽ{‚·‚邱‚Ę‚ĶŠ©‚ß‚ē‚ź‚Č‚¢BŒŸø€–Ś‚ĘŒŸøŠŌŠu‚É‚Ā‚¢‚Ä‚ĶŠ³ŽŅ‚²‚Ę‚ÉŒŸ“¢‚šs‚¤B
•aŠśIIC ‚©‚ēIII B –³ĒŒó«‚ĢƒŠƒ“ƒpß“]ˆŚ‚Ģ•]‰æ‚ʉ“Šu“]ˆŚ‚š”­Œ©‚·‚é–Ś“I‚ŁC’芜“I‚Č‘Sg‰ę‘œŒŸø‚šŽĄŽ{‚·‚邱‚Ę‚ŖŠ©‚ß‚ē‚ź‚éBŒŸø€–Ś‚ĘŒŸøŠŌŠu‚É‚Ā‚¢‚Ä‚ĶŠ³ŽŅ‚²‚Ę‚ÉŒŸ“¢‚šs‚¤B
  1. 21DpŒćƒƒ‰ƒm[ƒ}Š³ŽŅ‚É‘Ī‚µ‚čĔ­E“]ˆŚ‘Šś”­Œ©‚Ģ‚½‚ß‚ĢŠ³ŽŅ‹³ˆē‚šs‚¤‚±‚Ę‚ĶŠ©‚ß‚ē‚ź‚é‚©
  B pŒćƒƒ‰ƒm[ƒ}Š³ŽŅ‚ŖŽ©•Ŗ‚Ģ”ē•†‚É‘Ī‚·‚é’芜“IŽ©ŒČŒŸøiself skin examinationGSSEj‚šs‚¤‚ʐ¶‘¶—¦‚Ŗ‰ü‘P‚·‚é‰Ā”\«‚Ŗ‚ ‚é‚Ģ‚ŁCŠ³ŽŅ‹³ˆē‚šs‚¤‚±‚Ę‚ĶŠ©‚ß‚ē‚ź‚éB
•t1@‘ę7 ”ÅAJCC ”ē•†ƒƒ‰ƒm[ƒ}•aŠś•Ŗ—Ž2009

TFŒ“”­Žīį‡

TX FŒ“”­Žīį‡‚Ģ•]‰æ•s”\i—įC‘~ą¦Ųœicurettagej‚³‚ź‚½‚čd“x‚É‘Žk‚µ‚½ƒƒ‰ƒm[ƒ}j

T0 FŒ“”­Žīį‡‚Ŗ‚Č‚¢

Tis FMelanoma in situ

T1a FŒś‚³1.0 mm ˆČ‰ŗ‚ŁC’×į‡*‚Č‚µ‚©‚ĀŠj•Ŗ—ō‘œ**‚Ŗƒ 1/ mm2

T1b FŒś‚³1.0 mm ˆČ‰ŗ‚ŁC’×į‡‚ ‚č‚Ü‚½‚ĶŠj•Ŗ—ō‘œ‚Ŗ† 1/ mm2

T2a FŒś‚³‚Ŗ1.01`2.0 mm ‚ŁC’×į‡‚Č‚µ

T2b FŒś‚³‚Ŗ1.01`2.0 mm ‚ŁC’×į‡‚ ‚č

T3a FŒś‚³‚Ŗ2.01`4.0 mm ‚ŁC’×į‡‚Č‚µ

T3b FŒś‚³‚Ŗ2.01`4.0 mm ‚ŁC’×į‡‚ ‚č

T4a FŒś‚³‚Ŗ4.0 mm ‚š’“‚¦‚āC’×į‡‚Č‚µ

T4b FŒś‚³‚Ŗ4.0 mm ‚š’“‚¦‚āC’×į‡‚ ‚č

* ’×į‡‚Ę‚Ķ’¼‹ß‚ĢŠO‚Ü‚½‚ĶŠO‰Č“INP‚Ŗ‚Č‚­C•a—‘gDŠw“I‚ÉˆČ‰ŗ‚ĢŠŒ©‚Ŗ‘g‚Ż‡‚ķ‚³‚ź‚ÄŠĻŽ@‚³‚ź‚éó‘Ō‚Ę’č‹`•t‚Æ‚ē‚ź‚éF•\”ē‘S‘w‚ĢŒ‡‘¹iŠp‘w‚ĘŠī’ź–Œ‚ĢŒ‡‘¹‚šŠÜ‚ŽjC”½‰ž«•Ļ‰»‚ĢŲ‹’i—į‚¦‚ĪƒtƒBƒuƒŠƒ“’¾’…‚āD’†‹…jCŽü•Ó•\”ē‚Ģäɔ–‰»EŒ‡—Ž‚Ü‚½‚Ķ”½‰ž«”ģŒśB

** 1 mm2 ‚ ‚½‚č‚Ģ×–E•Ŗ—ō”imitotic ratejBƒƒ‰ƒm[ƒ}‚Ģ^”ē•a•Ļ“ą‚ōłą×–E•Ŗ—ō‚Ģ‘½‚¢—ĢˆęiƒzƒbƒgƒXƒ|ƒbƒgj‚š’T‚µC400 ”{‚ĢŽ‹–ģ‚ŃzƒbƒgƒXƒ|ƒbƒg“ą‚Ģ×–E•Ŗ—ō”‚š”‚¦‚½‚Ģ‚æ‚ɃzƒbƒgƒXƒ|ƒbƒgŽü•Ó‚Ģ—Ģˆę‚ɈŚ“®‚µCŠĻŽ@Ž‹–ģ–ŹĻ‚Ŗ‡Œv1 mm2 ‚É‚Č‚Į‚½Žž“_‚ŏI—¹‚·‚éBƒ 1/ mm2 ‚Ķ0/ mm2 ‚Ę“Æ‹`B


NFŠ‘®ƒŠƒ“ƒpß

NXFŠ‘®ƒŠƒ“ƒpß‚Ģ•]‰æ•s”\i—įC•Ź‚Ģ——R‚ÅˆČ‘O‚É“Eo‚³‚ź‚Ä‚¢‚éj

N0FŠ‘®ƒŠƒ“ƒpß“]ˆŚCsatellite*Cin-transit “]ˆŚ**‚š”F‚ß‚Č‚¢

N1F1 ŒĀ‚ĢƒŠƒ“ƒpß“]ˆŚ

- N1aFŒ°”÷‹¾“I“]ˆŚ***

- N1bF“÷Šį“I“]ˆŚ****

N2F2`3 ŒĀ‚ĢƒŠƒ“ƒpß“]ˆŚC‚Ü‚½‚ĶƒŠƒ“ƒpß“]ˆŚ‚š”ŗ‚ķ‚Č‚¢satellite ‚Ü‚½‚Ķin-transit “]ˆŚ

- N2aF2`3 ŒĀ‚ĢŒ°”÷‹¾“I“]ˆŚ

- N2bF2`3 ŒĀ‚Ģ“÷Šį“I“]ˆŚ

- N2cFƒŠƒ“ƒpß“]ˆŚ‚š”ŗ‚ķ‚Č‚¢Csatellite ‚Ü‚½‚Ķin-transit “]ˆŚ

N3F4 ŒĀˆČć‚ĢƒŠƒ“ƒpß‚Ö‚Ģ“]ˆŚCŒŻ‚¢‚É–ü’…‚µ‚½ƒŠƒ“ƒpß“]ˆŚCƒŠƒ“ƒpß“]ˆŚ‚š”ŗ‚¤satellite ‚Ü‚½‚Ķintransit “]ˆŚ

* satelliteF Œ“”­•”ˆŹ‚©‚ē2cm ˆČ“ą‚É‘¶Ż‚µC “÷Šį“I‚Ü‚½‚ĶŒ°”÷‹¾Šw“I‚ÉŠm”F‚³‚ź‚é”ń˜A‘±«•a‘ƒBmicrosatellitei’¼Œa0.05 mm ‚š’“‚¦‚é“]ˆŚ×–E‘ƒ‚ŁCüˆŪ‰»‚Ü‚½‚Ķ‰ŠĒ‚š”ŗ‚ķ‚Č‚¢³ķ^”ē‚É‚ę‚Į‚Ä–¾—Ä‚É•Ŗ—£‚³‚ź‚Ä‚Ø‚čCŽå‚½‚éZ«‚ĢŒ“”­‘ƒ‚©‚ē0.3 mm ˆČć—£‚ź‚Ä‚¢‚é‚ą‚Ģj‚šŠÜ‚ŽB

** in transit “]ˆŚFŒ“”­•”ˆŹ‚©‚ē2cm ‚š‰z‚¦‚®ƒŠƒ“ƒpß—Ģˆę‚Ę‚ĢŠŌ‚Ģ”ē•†E”ē‰ŗ‘gD‚É“÷Šį“I‚Ü‚½‚ĶŒ°”÷‹¾Šw“I‚ÉŠm”F‚³‚ź‚é”ń˜A‘±«•a‘ƒ

*** Œ°”÷‹¾“I“]ˆŚ‚ĶƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpß¶ŒŸi‚ʍs‚ķ‚ź‚½‚Č‚ē‚Īˆų‚«‘±‚­Š‘®ƒŠƒ“ƒpßŠs“j‚ĢŒ‹‰Ź‚©‚ēŒˆ’č‚³‚ź‚é

**** “÷Šį“I“]ˆŚ‚ĶCŽ”—Ć“IƒŠƒ“ƒpßŠs“‚É‚ę‚Į‚ďŲ–¾‚³‚ź‚½“]ˆŚCGf‚Ü‚½‚Ķ‰ę‘œŒŸø‚ŗՏ°“I‚ÉŒŸo‰Ā”\‚ČƒŠƒ“ƒpß“]ˆŚC‚Ü‚½‚ĶƒŠƒ“ƒpß“]ˆŚ‚ŖL”Ķ‚Č”ķ–ŒŠOZ‚šŽ¦‚µ‚½Žž‚Ę’č‹`‚³‚ź‚é


MF‰“Šu“]ˆŚ

M0F‰“Šu“]ˆŚ‚š”F‚ß‚Č‚¢

M1F‰“Šu“]ˆŚ‚ ‚č

- M1aFŠ‘®ƒŠƒ“ƒpß‚š’“‚¦‚é”ē•†C”ē‰ŗ‚Ü‚½‚ĶƒŠƒ“ƒpß“]ˆŚ

- M1bF”x“]ˆŚ

- M1cF‚»‚Ģ‘¼‚Ģ‘ŸŠķ“]ˆŚC‚Ü‚½‚Ķ“]ˆŚ•”ˆŹ‚É‚©‚©‚ķ‚ē‚øŒŒ“LDH ˆŁķ‚’l‚šŽ¦‚·ź‡


‘ę7 ”Ł@AJCC ”ē•†ƒƒ‰ƒm[ƒ}•aŠś•Ŗ—Ž
—Տ°•aŠś•Ŗ—Ž* •a—•aŠś•Ŗ—Ž**
Stage 0 Tis N0 M0 0 Tis N0 M0
Stage IA T1a N0 M0 IA T1a N0 M0
Stage IB T1b
T2a

N0

N0

M0

M0

IB T1b
T2a

N0

N0

M0

M0

Stage IIA T2b
T3a

N0

N0

M0

M0

IIA

T2b

T3a

N0

N0

M0

M0

Stage IIB T3b
T4a

N0

N0

M0

M0

IIB T3b
T4a

N0

N0

M0

M0

Stage IIC T4b N0 M0 IIC T4b N0 M0
Stage III Any T ≥ N1 M0 IIIA T1-4a
T1-4a
N1a
N2a

M0

M0

        IIIB

T1-4b

T1-4b
T1-4a
T1-4a
T1-4a

N1a
N2a
N1b
N2b
N2c

M0

M0

M0

M0

M0

        IIIC T1-4b
T1-4b
T1-4b
Any T
N1b
N2b
N2c
N3

M0

M0

M0

M0

Stage IV Any T Any N M1 IV Any T Any N M1

* —Տ°•aŠś•Ŗ—Ž‚ĶŒ“”­‘ƒ‚ĢŒ°”÷‹¾“IƒXƒe[ƒWƒ“ƒO‚Ę“]ˆŚ‘ƒ‚Ģ—Տ°/ ‰ę‘œ•]‰æ‚©‚ē\¬‚³‚ź‚éB’Źķ‚ĶŒ“”­‘ƒ‚Ģ‘SŲœ‚ʏŠ‘®ƒŠƒ“ƒpß‚Ø‚ę‚щ“Šu“]ˆŚ‚É‚Ā‚¢‚ėՏ°“I•]‰æ‚Ģ‚Ģ‚æ‚É—p‚¢‚ē‚ź‚éB

** •a—•aŠś•Ŗ—Ž‚ĶŒ“”­‘ƒ‚ĢŒ°”÷‹¾“IƒXƒe[ƒWƒ“ƒO‚ʏŠ‘®ƒŠƒ“ƒpß‚Ģ•”•Ŗ“I/ Š®‘SƒŠƒ“ƒpßŲœŒć‚Ģ•a—Œ‹‰Ź‚©‚ē\¬‚³‚ź‚éB•a—•aŠś0 ‚Ü‚½‚ĶIA ‚Ķœ‚­G‚±‚ź‚ē‚ĢŠ³ŽŅ‚ĶƒŠƒ“ƒpß•a•Ļ‚Ģ•a—•]‰æ‚Ŗ•s—v‚Å‚ ‚éB