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”畆ˆŤŤŽîᇁ@`f—ĂƒKƒCƒhƒ‰ƒCƒ“

ƒKƒCƒhƒ‰ƒCƒ“•ś’†‚Ě•śŒŁ”ԍ†‚Š‚çCŠY“–‚ˇ‚é•śŒŁƒŠƒXƒg‚ɃŠƒ“ƒN‚ľ‚Ä‚˘‚Ü‚ˇ


—Lž™×–EŠŕiSCCj

CQ1

—Lž™×–EŠŕ‚Ě”­ś—Ś‚đŒ¸­‚ł‚š‚é–Ú“I‚ĹŽ‡ŠOü–hŒä‚đs‚¤‚ą‚Ć‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

 

“ú–{l‚Ě’†‚Ĺ‚ŕF”’‚ŐF‘f’ž’…‚đ‹N‚ą‚ľ‚É‚­‚˘ƒXƒLƒ“ƒ^ƒCƒv‚ĚŽŇ

„§“x

B

Ž‡ŠOü–hŒä‚ŞŠŠ‚ß‚ç‚ę‚éB

 

ă‹LˆČŠO‚Ě“ú–{l‚̑唟‚đč‚ß‚éƒXƒLƒ“ƒ^ƒCƒv‚ĚŽŇ

„§“x

C1

Ž‡ŠOü–hŒä‚đl—ś‚ľ‚Ä‚ŕ‚悢‚ށC‚ť‚Ě—L‰vŤ‚Í•s–ž‚Ĺ‚ ‚éB

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


Ą‰đŕ

—Lž™×–EŠŕiSCCj‚Ě”­ś‚É‹­‚­‘ŠŠÖ‚ˇ‚é‚ƍl‚Ś‚ç‚ę‚Ä‚˘‚éˆöŽq‚́CŽ‡ŠOü‚ɑ΂ˇ‚éŒÂl‚Ě–hŒä”\‚𔽉f‚ˇ‚éƒXƒLƒ“ƒ^ƒCƒvC“úÄ‚Ż‚Ě’ö“xC”N—î‚Ĺ‚ ‚é1jB“úŒőŽ‡ŠOü‚Ö‚Ě”˜˜I‚Ĺ—eˆŐ‚É“úŒő”畆‰Ši”畆‚Ě”­Ôj‚đ‹N‚ą‚ˇ‚ށCF‘f’ž’…‚Í‹N‚ą‚č‚É‚­‚˘ƒXƒLƒ“ƒ^ƒCƒv‚đŽ‚ÂŽŇ‚ÍSCC ‚đ”­Ç‚ľ‚₡‚˘B‚Ü‚˝C…áv‚đ‹N‚ą‚ˇ‚悤‚Č‹­‚˘“úÄ‚Ż‚đŒJ‚č•Ô‚ľ‚˝ŽŇ‚Ě•ű‚ŞSCC ‚𐜂ś‚₡‚˘BƒI[ƒXƒgƒ‰ƒŠƒA‚Őś‚Ü‚ęˆç‚Á‚˝ŒQ‚Ć“r’†‚Ĺ‘ź‘‚Š‚çˆÚZ‚ľ‚˝ŒQ‚Ć‚đ”äŠr‚ˇ‚é‚ƁCSCC ‚Ě”­ś‚Ş‘OŽŇ‚ÍŒăŽŇ‚Ě3 ”{‘˝‚˘‚ą‚Ć‚ŞŽŚ‚ł‚ę‚Ä‚˘‚éB‚ą‚Ě‚ą‚Ć‚ć‚čCŽá”NŽŇ‚É‚¨‚Ż‚é‰ß“x‚Ě“úŒő”畆‰Š‚ŞSCC ‚Ě”­ś‚É‹­‚­ŠÖ—^‚ľ‚Ä‚˘‚é‚ą‚Ć‚ŞŽŚ´‚ł‚ę‚é2jB

ƒTƒ“ƒXƒNƒŠ[ƒ“Ü‚É‚ć‚é—\–hŒř‰Ę‚ɂ‚˘‚ẮCƒI[ƒXƒgƒ‰ƒŠƒAl‚đ‘ÎŰ‚Ć‚ľ‚āCSCC ‚Ě”­ś‚đƒAƒEƒgƒJƒ€‚Ć‚ˇ‚é1 Œ‚Ěƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒąiRCTj‚¨‚ć‚Ń“úŒőŠp‰ťÇ‚Ě”­ś‚đƒAƒEƒgƒJƒ€‚Ć‚ˇ‚é2 Œ‚ĚRCT ‚ŞŽŔŽ{‚ł‚ę‚Ä‚˘‚éBSCC ‚Ě”­ś‚đƒAƒEƒgƒJƒ€‚Ć‚ˇ‚鎎Œą‚ł́C•]‰ż‘ΏۮŇ1,383 l‚Ě“ŕCƒTƒ“ƒXƒNƒŠ[ƒ“Ü‚ĚŽg—p‚É‚ć‚Á‚Ä”­ś‚đ39“Œ¸­‚ł‚š‚é‚ą‚Ć‚ŞC‚Ü‚˝C“úŒőŠp‰ťÇ‚ɂ‚˘‚ẮC‚ť‚ę‚ź‚ę•]‰ż‘ΏۮŇ431 l‚¨‚ć‚Ń1,116 l‚Ě‚¤‚żC38“C24“Œ¸­‚ł‚š‚é‚ą‚Ć‚Ş‚Ĺ‚Ť‚˝‚Ć•ń‚ł‚ę‚Ä‚˘‚é3`5jB

‚ľ‚Š‚ľ‚Č‚Ş‚ç“ú–{l‚ɂ‚˘‚ẮCSCC ‚Ć“úŒőŽ‡ŠOü‚Ć‚ĚŠÖŒW‚đŽŚ‚ˇM—Š‚Ĺ‚Ť‚éƒf[ƒ^‚Í–R‚ľ‚˘BˆÜ“x‚Ɣ畆‚Ş‚ń”­ś‚Ć‚ĚŠÖŒW‚ɂ‚˘‚ẮC•şŒÉŒ§‰ÁźŽs‚ƉŤ“ęŒ§ˆÉ]“‡‚É‚¨‚Ż‚é“úŒőŠp‰ťÇ‚ĚœëŠł—Ś‚đ”äŠr‚ľ‚˝ƒRƒz[ƒgŒ¤‹†‚Ş‚ ‚éBlŒű10 –œl“–‚˝‚č‚ĚœëŠł—Ś‚͉ÁźŽs‚Ş144.2 lCˆÉ]“‡‚Ş696.8 l‚Ĺ‚ ‚čC‰Ť“ę‚Ě“úŒőŠp‰ťÇ‚ĚœëŠł—Ś‚Í•şŒÉ‚Ě5 ”{‚Ĺ‚ ‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é6jB‚Ü‚˝C“ú–{l‚ĚSCC ‚Ě60“‚Í“úŒő˜Io•”‚É”­ś‚ˇ‚é‚Ć•ń‚ł‚ę‚Ä‚¨‚čC”’l‚Ů‚Ç‚Ĺ‚Í‚Č‚˘‚ށC‚ť‚Ě”­ś‚ÉŽ‡ŠOü‚ŞŠÖ—^‚ľ‚Ä‚˘‚é‚ƍl‚Ś‚ç‚ę‚é7jB

ˆČă‚ć‚čC“ú–{l‚Ě‚Č‚Š‚ŐF”’‚ĹƒTƒ“ƒ^ƒ“i“úÄ‚Ż‚ō•‚­‚Č‚é‚ą‚Ɓj‚đ‚¨‚ą‚ľ‚É‚­‚˘ƒXƒLƒ“ƒ^ƒCƒv‚ĚŽŇ‚âŹŽ™‚́CƒTƒ“ƒXƒNƒŠ[ƒ“Ü‚đŽg—p‚ľ‰ß“x‚Ě“úŒő”˜˜I‚đ”đ‚Ż‚é‚ą‚Ć‚É‚ć‚Á‚ÄSCC ‚Ě”­ś‚Ş—\–h‚Ĺ‚Ť‚é‰Â”\Ť‚Ş‚ ‚čC—L‰v‚ƍl‚Ś‚ç‚ę‚éB‚ľ‚Š‚ľC“ú–{l‚̑唟‚đč‚ß‚é‚ť‚ęˆČŠO‚ĚƒXƒLƒ“ƒ^ƒCƒv‚̎҂ɑ΂ˇ‚鎇ŠOü–hŒä‚Ě—L‰vŤ‚Í•s–ž‚Ĺ‚ ‚éB

•śŒŁ

1j English DR, Armstrong BK, Kricker A, et al: Case-control study of sun exposure and squamous cell carcinoma of the skin, Int J Cancer, 1998; 77: 347-353.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Žs‹´łŒőFŒő‚Ɣ畆‚Ş‚ńC“ú”ç‰ďŽC1996; 106: 225-238. iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j Green A, Williams G, Neale R, et al: Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinomas of the skin: a randomised controlled trial, Lancet, 1999; 354: 723-729.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

4j Thompson SC, Jolley D, Marks R: Reduction of solar keratoses by regular sunscreen use, N Engl J Med, 1993; 329: 1147-1151.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

5j Darlington S, Williams G, Neale R, et al: A randomized controlled trial to assess sunscreen application and beta carotene supplementation in the prevention of solar keratoses, Arch Dermatol, 2003; 139: 451-455.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

6j Nagano T, Ueda M, Suzuki T, et al: Skin cancer screening in Okinawa, Japan, J Dermatol Sci, 1999; 19: 161-165.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j ÎŒ´˜a”VF“Œv’˛¸‚ć‚č‚Ý‚˝Ž‡ŠOü‚Ɣ畆‚Ş‚ńCŽ‡ŠOü‚̔畆áŠQ‚Ć‚ť‚Ě‘Îô, Biotherapy, 2005; 19: 411-416. iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ2

—Lž™×–EŠŕŠłŽŇ‚ɏp‘O‚Ě‰ć‘œŒŸ¸‚đs‚¤‚ą‚Ć‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

C1

ƒŠƒ“ƒpß“]ˆÚ‚đ‹N‚ą‚ľ‚₡‚˘ˆöŽq‚đŽ‚Âę‡‚âC—Šw“I‚É“]ˆÚ‚Ş‹^‚í‚ę‚éę‡C‚ ‚邢‚ÍŒ´”­‘ƒ‚ĚŠg‚Ş‚č‚đ•]‰ż‚ˇ‚éę‡‚ɂ́Cp‘O‚Ě‰ć‘œŒŸ¸‚đl—ś‚ľ‚Ä‚ŕ‚悢B

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


Ą‰đŕ

—Lž™×–EŠŕiSCCjŠłŽŇ‚̏p‘O‰ć‘œŒŸ¸‚ĆÄ”­—ŚCś‘ś—Ś‚Ć‚ĚŠÖ˜A‚đŒŸ“˘‚ľ‚˝–{Ši“I‚ČŒ¤‹†•ń‚Í‚Ý‚ç‚ę‚Č‚˘B

Motley ‚ç‚Ş’ńĽ‚ľ‚˝‰p‘‚ĚƒKƒCƒhƒ‰ƒCƒ“1j‚ł́CŒ´”­‘ƒ‘¤‚ĚˆöŽq‚Ć‚ľ‚čĔ­C‘gDŠŒŠi[•”‚ւ̐ZC_ŒoŽüˆÍZC•Ş‰ť“xjCŒ´”­‘ƒ‚ĚƒTƒCƒYi2 cm ˆČăjC‰đ–UŠw“I•”ˆĘiŽ¨CŒűOCŽč‘ŤC”S–Œ•”j‚ށC‚Ü‚˝hŽĺ‘¤‚ĚˆöŽq‚Ć‚ľ‚ĖƉu•s‘S‚Č‚Ç‚đ—L‚ˇ‚éę‡‚ރŠƒ“ƒpß“]ˆÚ‚ĚƒŠƒXƒN‚ÉŠÖŒW‚ˇ‚é‚Ć‚ł‚ę‚Ä‚˘‚éB‰ć‘œŒŸ¸‚đs‚¤Ç—á‚đ‘I‘đ‚ˇ‚éŰ‚ɂ́C‚ą‚ę‚ç‚ĚˆöŽq‚Ě—L–ł‚ŞŽQl‚É‚Č‚éB‚ľ‚Š‚ľC—Šw“I‚ɃŠƒ“ƒpß“]ˆÚ‚đ”F‚ß‚Č‚˘ŠłŽŇ‚ɑ΂ľ‚Ä‰ć‘œŒŸ¸‚đs‚¤‚ą‚Ć‚Ş—\Œă‚đ‰ü‘P‚ˇ‚é‚Š”Ű‚Š‚́CŒťŽž“_‚Ĺ‚Í•s–ž‚Ĺ‚ ‚éB

Barzilai ‚ç‚Í“Şčň•”SCC ‚Ě22 Ç—á‚đ‘ÎŰ‚Ć‚ľ‚˝Ç—áWĎŒ¤‹†‚đs‚Á‚Ä‚˘‚é2jB‚ť‚ĚŒ‹‰ĘCŽ¨‰ş‘B‚¨‚ć‚Ńčň•”ƒŠƒ“ƒpß‚Ö‚Ě‘gDŠw“I“]ˆÚ‚Í‚ť‚ę‚ź‚ę68“‚¨‚ć‚Ń45.5“‚ŁCöÝŤ•a•Ď‚Í36“‚¨‚ć‚Ń20“C‚Ü‚˝5 ”Nś‘ś—Ś‚Í“]ˆÚ‚ŞŽ¨‰ş‘B‚Ě‚Ý‚Ĺ‚Í60“Cčň•”ƒŠƒ“ƒpß‚Ě‚Ý‚Ĺ‚Í100“‚Ĺ‚ ‚é‚̂ɑ΂ľ‚āC—ź•ű‚É“]ˆÚ‚ľ‚˝ę‡‚É‚Í0“‚Ĺ‚ ‚é‚Ć•ń‚ľ‚Ä‚˘‚éBŽ¨‰ş‘B‚¨‚ć‚Ń‚ť‚ĚŽüˆÍƒŠƒ“ƒpß‚âčň•”ƒŠƒ“ƒpß‚͍ŏ‰‚É“]ˆÚ‚đ‹N‚ą‚ˇ•”ˆĘ‚Ć‚ľ‚ďd—v‚Ĺ‚ ‚čCƒŠƒ“ƒpß“]ˆÚ‚đ‹N‚ą‚ľ‚₡‚˘ˆöŽq‚đŽ‚ÂÇ—á‚É“Ż•”ˆĘ‚Ě‰ć‘œŒŸ¸‚đs‚¤‚ą‚Ƃ́CŽčp”͈͂âpŒă•úŽËü—Ă–@‚Ě“K”Ű‚ĚŒˆ’č‚É—L‰v‚Ĺ‚ ‚éB

ˆę”Ę‚É“î•”‘gDE––˝_ŒoE“ŞŠW“ŕ‚ւ̐i“W“x‚đ‚Ý‚éę‡‚É‚ÍMRI ‚đ—p‚˘Cœ‚ւ̐Z‚Ě’ö“x‚⃊ƒ“ƒpß‚Ě•]‰ż‚Ě‚˝‚ß‚É‚ÍCT ƒXƒLƒƒƒ“‚đ—p‚˘‚é3jB‚Č‚¨CƒI[ƒXƒgƒ‰ƒŠƒA‚ĚƒKƒCƒhƒ‰ƒCƒ“‚ł́CƒŠƒ“ƒpß“]ˆÚ‚Ş‹^‚í‚ę‚éę‡‚́CCT ‚Č‚˘‚ľƒGƒR[‚É‚ć‚錟ő‚Ş‘Ă“–‚Ĺ‚ ‚éC‚Ć‚ł‚ę‚Ä‚˘‚é4jBNemzek ‚ç‚Í10 —á‚ĚSCC ‚đŠÜ‚Ţ19 —á‚Ě“Şčň•”Šŕ‚ĚÇ—áWĎŒ¤‹†‚đs‚˘CMRI ‚É‚ć‚é_ŒoŽüˆÍZ‚Ě—L–ł‚ĚŒŸo‚ɂ‚˘‚Ä‚ÍŠ´“x95“‚ƍ‚‚Š‚Á‚˝‚ށC_ŒoŽüˆÍZ‚̍L‚Ş‚č‚𐳊m‚É•]‰ż‚Ĺ‚Ť‚˝‚Š‚Ć‚˘‚¤“_‚ÉŠÖ‚ľ‚Ä‚ÍŠ´“x63“‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚Ä‚¨‚čCŘœ”ÍˆÍ‚ĚŒˆ’č‚ÉŰ‚ľ’ˆÓ‚Ş•K—v‚Ĺ‚ ‚é5jB

ˆČă‚ć‚čC‚ˇ‚ׂĂĚSCC ŠłŽŇ‚ɑ΂ľ‚Ä‰ć‘œŒŸ¸‚đs‚¤•K—v‚Í‚Č‚­CTd‚Č•a—đ’ŽŽć‚Ć—Šw“IŒŸ¸‚Ş—Dć‚ł‚ę‚éBMotley ‚ç‚ŞŽw“E‚ľ‚˝ƒŠƒ“ƒpß“]ˆÚ‚đ‹N‚ą‚ľ‚₡‚˘ˆöŽq‚đŽ‚Âę‡‚â1jCፍ­‚▝Ť‚̔畆’×ᇂ̍‡•š‚É‚ć‚Á‚ĐGf‚ލ˘“ď‚Čę‡‚ɂ́Cp‘O‚Ě‰ć‘œŒŸ¸‚͈Ŕ‘S‚Ȑ؏œ”ÍˆÍ‚ĚŒˆ’č‚Ě‚˝‚ß‚É—L‰v‚ƍl‚Ś‚ç‚ę‚é3, 6, 7jB‚Ü‚˝CÄ”­‚ĆŠÖ˜A‚ˇ‚éˆöŽq‚Ĺ‚ ‚é_ŒoŽüˆÍZ‚Ě—L–ł‚đp‘O‚É”cˆŹ‚ˇ‚é‚ą‚Ƃ́CpŒă•â•—Ă–@‚Ě“K”Ű‚đŒˆ‚ß‚éă‚Ĺ—L‰v‚ƍl‚Ś‚ç‚ę‚é8jB‰“Šu“]ˆÚ‚ĚŒŸő‚́C‚ˇ‚Ĺ‚ÉŠ‘ŽƒŠƒ“ƒpß“]ˆÚ‚Ş–ž‚ç‚Š‚ČŠłŽŇ‚ɂ‚˘‚ẮCŠ‘ŽƒŠƒ“ƒpß—Ěˆć‚ĚŞŽĄ“IŽčp‚Ě“K‰ž‚đŒˆ‚ß‚é‚˝‚ß‚É•K—v‚Ĺ‚ ‚é‚ŞC—\Œă‚̉ü‘P‚É‚Ç‚Ě’ö“xŠń—^‚ˇ‚é‚Š‚Í•s–ž‚Ĺ‚ ‚éBƒŠƒ“ƒpß“]ˆÚ‚Ě‚Č‚˘SCC ŠłŽŇ‚މ“Šu“]ˆÚ‚𔭐ś‚ˇ‚é‚ą‚Ć‚Í‹É‚ß‚Ä‹H‚Ĺ‚ ‚é‚̂ŁC‚ť‚ę‚Ş—Տ°“I‚É‹^‚í‚ę‚éę‡‚đœ‚ŤC‰“Šu“]ˆÚŒŸő‚Ě‚˝‚ß‚Ě‰ć‘œŒŸ¸‚Í’Ęís‚í‚Č‚˘B

•śŒŁ

1j Motley R, Kersey P, Lawrence C: Multiprofessional guidelines for the management of the patient with primary cutaneous squamous cell carcinoma, Br J Dermatol, 2002; 146: 18-25.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

2j Barzilai G, Greenberg E, Cohen-Kerem R, et al: Pattern of regional metastases from cutaneous squamous cell carcinoma of the head and neck, Otolaryngol Head Neck Surg, 2005; 132: 852-856.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j Mancuso AA: Diagnostic Imaging, In: Basal and Squamous Cell Skin Cancers of the Head and Neck, Weber RS, Miller MJ, Goepfert Hiedsj. Williams • Wilkins, Philadelphia, 1996, 79-113.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹VIj

4j Cancer council Australia/Australian cancer network 2008: Surgical treatment. Clinical practice guide. Basal cell carcinoma, squamous cell carcinomaiand related lesionsj-a guide to clinical management in Australia, 51-54.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

5j Nemzek WR, Hecht S, Gandour-Edwards R, et al: Perineural spread of head and neck tumors: how accurate is MR imaging? Am J Neuroradiol, 1998; 19: 701-706.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

6j Rowe DE, Carroll RJ, Day CL Jr: Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection, J Am Acad Dermatol, 1992; 26: 976-990.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

7j Leibovitch I, Huilgol SC, Selva D, et al: Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia I. Experience over 10 years, J Am Acad Dermatol, 2005; 53: 253-260.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

8j Williams LS, Mancuso AA, Mendenhall WM: Perineural spread of cutaneous squamous and basal cell carcinoma: CT and MR detection and its impact on patient management and prognosis, Int J Radiat Oncol Biol Phys, 2001; 49: 1061-1069.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ3

—Lž™×–EŠŕ‚ĚŒ´”­‘ƒ‚Í•a‘ƒ•Ó‰‚Š‚牽mm —Ł‚ľ‚Đ؏œ‚ˇ‚é‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

B

6 mm ˆČă—Ł‚ľ‚Đ؏œ‚ˇ‚é‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éB’჊ƒXƒNŒQi‰đŕ‚¨‚ć‚Ń•t2 ŽQĆj‚Ĺ‚ ‚é‚ą‚Ć‚ŞŠmŽŔ‚ČÇ—á‚Í4 mm ˆČă—Ł‚ľ‚Đ؏œ‚ˇ‚é‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éB

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Ą‰đŕ

—Lž™×–EŠŕiSCCj‚Ě‹ÇŠÄ”­—Ś‚Ć‚˘‚¤ŠĎ“_‚Š‚çŘœ”ÍˆÍ‚Ě•]‰ż‚đs‚Á‚Ä‚˘‚éƒVƒXƒeƒ}ƒeƒBƒbƒNEƒŒƒrƒ…[‚¨‚ć‚Ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒąiRCTj‚Í‘śÝ‚ľ‚Č‚˘BŠe‘‚ĚƒKƒCƒhƒ‰ƒCƒ“‚ł́CBrodland ‚ç‚Ě˜_•ś1j‚ŞŘœ”͈͂đÝ’股‚鍪‹’‚Ć‚ľ‚Ä‹“‚°‚ç‚ę‚é‚ą‚Ć‚Ş‘˝‚˘B‚ą‚ĚŒ¤‹†‚ÍMohs Žčp‚ÉŠî‚Ă‚­Ç—áWĎŒ¤‹†‚Ĺ‚ ‚čC111 Ç—á141 ŒÂ‚̔畆Œ´”­Ť‚̐ZŤSCC ‚đ‘ÎŰ‚Ć‚ľ‚āCpŒă15 ƒJŒŽŠÔŠĎŽ@‚ľ‚Ä‚˘‚éB’˜ŽŇ‚ç‚́CŽîᇌaC‘gDŠw“I•Ş‰ť“xC•”ˆĘCZ“x‚Č‚Ç‚đl—ś‚ľ‚āCŘœ”ÍˆÍ‚Ć‹ÇŠ§Œä—Ś‚Ć‚ĚŠÖ˜A‚đŒŸ“˘‚ľ‚˝B‚ť‚ĚŒ‹‰ĘCŘœƒ}[ƒWƒ“‚ÍĹ’áŒŔ4 mm •K—v‚Ĺ‚ ‚čC‚ł‚ç‚ÉŒa2 cm ˆČă‚Ě‚ŕ‚́C‘gDŠw“I•Ş‰ť“x‚ŞBroders ˆŤŤ“x•Ş—Ţ‚Ěgrade 2 ˆČă‚Ě‚ŕ‚́CƒnƒCƒŠƒXƒN—Ěˆći“Ş•”EŽ¨EŠááفE•@EŒűOj‚Ě‚ŕ‚́C”牺‚֐Z‚ľ‚Ä‚˘‚é‚ŕ‚̂ɂ‚˘‚ẮC6 mm ‚̐؏œ”͈͂ޕK—v‚Ĺ‚ ‚é‚ĆŒ‹˜_‚Ă‚Ż‚Ä‚˘‚éB

‰p‘‚ĚƒKƒCƒhƒ‰ƒCƒ“2j‚ł́CŒa2 cm –˘–ž‚Ĺ’áƒŠƒXƒNC‹ŤŠE–ž—Ä‚ČSCC ‚Í4 mm ‚̐؏œ”͈͂ɂć‚č95“‚ĚÇ—á‚ĹŠŽ‘S‚ɐ؏œ‚Ĺ‚Ť‚é‚Ć‚ľ‚Ä‚˘‚éB‚ć‚č‘ĺ‚Ť‚ČŽîᇁC‘gDŠw“I‚Égrade 2 ˆČăC”牺‚܂Ői“W‚ľ‚˝‚ŕ‚́CƒŠƒXƒN‚̍‚‚˘•”ˆĘi“Ş”çEŽ¨EŠááفE•@EŒűOj‚Ĺ‚Í6 mm ˆČă‚̐؏œ”ÍˆÍ‚đ„§‚ľ‚Ä‚˘‚éB

ƒI[ƒXƒgƒ‰ƒŠƒA‚ĚƒKƒCƒhƒ‰ƒCƒ“3j‚ł́CŒa2 cm –˘–ž‚̍‚•Ş‰ť‚ĚSCC ‚Ĺ‚ ‚ę‚΁CŘœ”͈Í4 mm ‚Ĺ95“‚ĚÇ—á‚Ĺ“KŘ‚ɐ؏œ‚Ĺ‚Ť‚é‚Ć‚ľ‚Ä‚˘‚éBŒa2 cm ’´‚ĚSCC ‚É‚Í10 mm ‚Ü‚Ĺ‚ĚŘœ”͈͂ޕK—v‚Ć‚Č‚čC‚ć‚č‘ĺ‚Ť‚Č‚ŕ‚Ě‚Í‚ł‚ç‚ɍL‚˘Řœ”͈͂đ—v‚ˇ‚é‚Ć‚ľ‚Ä‚˘‚éB

•Ä‘National Comprehensive Cancer NetworkiNCCNj‚ĚƒKƒCƒhƒ‰ƒCƒ“4j‚ł́CSCC ‚đ’჊ƒXƒNŒQ‚ƍ‚ƒŠƒXƒNŒQ‚É•Ş‚Żi•t2jCŘœ”͈͂͒჊ƒXƒNŒQ‚Ĺ‚Í4`6 mm ‚Ć‚ľC‚ƒŠƒXƒNŒQ‚Ě‚¤‚ż‘ĚŠ˛EŽlŽˆiL —Ěˆćj‚Ĺ‚Í10 mmC‚ť‚ęˆČŠO‚Ě‚ŕ‚Ě‚ÍMohs Žčp‚ŠCCPDMAicomplete circumferential peripheral and deep margin assessment with frozen or permanent sectionj‚đ„§‚ľC“Á‚ɐ؏œ”͈͂đ’č‚ß‚Ä‚˘‚Č‚˘B‚Č‚¨CSCC ŽüˆÍ‚̍g”Á‚ÍŽîᇂɊ܂߂Đ؏œ”͈͂đ‚Ć‚é‚悤‚É‹LÚ‚ł‚ę‚Ä‚˘‚éB

ˆČă‚ć‚čCŘœ”͈͂́C’჊ƒXƒNŒQ‚Ĺ‚Í4 mmC‚ƒŠƒXƒNŒQ‚Ĺ‚Í6 mm ˆČă10 mm ‚Ü‚Ĺ‚Ě•‚Ě’†‚Ĺ”ť’f‚ˇ‚ę‚΂悢‚ƍl‚Ś‚ç‚ę‚éB’჊ƒXƒNŒQ‚ƍ‚ƒŠƒXƒNŒQ‚Ć‚ĚŠ„‡‚ɂ‚˘‚ẮC‚ƒŠƒXƒNŒQ‚Ş‘S‘Ě‚Ě79“‚đč‚ß‚Ä‚˘‚˝‚Ƃ̉p‘‚Š‚ç‚Ě•ń‚Ş‚ ‚é5jBƒŠƒXƒNˆöŽq‚Ş1 ‚Â‚Ĺ‚ŕ‚ ‚ę‚΍‚ƒŠƒXƒNŒQ‚É“ü‚é‚ą‚Ć‚âC–{ƒKƒCƒhƒ‰ƒCƒ“‚É‚¨‚Ż‚郊ƒXƒNˆöŽq‚͉p‘‚ć‚č‘˝‚­Ý’č‚ł‚ę‚Ä‚˘‚é‚˝‚߁C‚ƒŠƒXƒNŒQ‚Ć•]‰ż‚ł‚ę‚銄‡‚͍X‚É‘˝‚­‚Č‚é‰Â”\Ť‚Ş‚ ‚éB‚ą‚Ě‚ą‚Ć‚Š‚çCŘœ”ÍˆÍ‚ÍĹ’áŒŔ6 mm ‚đŒ´‘Ľ‚Ć‚ľC’჊ƒXƒN‚Ĺ‚ ‚é‚ą‚Ć‚ŞŠmŽŔ‚ČÇ—á‚Ě‚ÝŘœ”͈͂đĹ’áŒŔ4 mm ‚Ć‚ľ‚Ä‚ŕ‚悢C‚Ć‚ˇ‚é•ű‚ŞŒťŽŔ“I‚Ĺ‚ ‚čC‚ť‚ę‚𔽉f‚ľ‚˝„§•ś‚Ć‚ľ‚˝B‚ŕ‚ż‚ë‚ńŘœ•W–{‚É‚¨‚Ż‚éÚ×‚Č’f’[‚Ě•]‰ż‚Í•K{‚Ĺ‚ ‚čCŽĄ–ü—Ś‚đ‚‚ß‚é‚˝‚ß‚É‚Í‚ć‚č‘ĺ‚Ť‚Ȑ؏œ”͈͂ޕK—v‚Ć‚Č‚éę‡‚Ş‚ ‚é‚ą‚Ć‚ŕ—ŻˆÓ‚ˇ‚ׂŤ‚Ĺ‚ ‚éB

•śŒŁ

1j Brodland DG, Zitelli JA: Surgical margins for excision of primary cutaneous squamous cell carcinoma, J Am Acad Dermatol, 1992; 27: 241-248.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Motley R, Kersey P, Lawrence C: Multiprofessional guidelines for the management of the patient with primary cutaneous squmamous cell carcinoma, Br J Dermatol, 2002; 146: 18-25.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

3j Cancer council Australia/Australian cancer network 2008: Surgical treatment. Clinical practice guide, Basal cell carcinoma, squamous cell carcinomaiand related lesionsj-a guide to clinical management in Australia, 51-54.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

4j NCCN: Clinical practice guideline in oncology. Basal cell and squamous cell skin cancers. V.2. 2013, SCC-1-MS-25.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

5j Batchelor RJ, Stables GI: An audit of the management of cutaneous squamous cell carcinoma according to the multiprofessional guidelines, Br J Dermatol, 2006; 154: 1199-1219.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ4

—Lž™×–EŠŕ‚ĚŒ´”­‘ƒ‚ɑ΂ľ‚ÄMohs Žčp‚đs‚¤‚ą‚Ć‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

C1

Ž{p‚ɐ¸’Ę‚ľ‚Ä‚˘‚éˆăŽt‚Ş‚˘‚éŽ{Ý‚Ĺ‚Ís‚¤‚ą‚Ć‚đl—ś‚ľ‚Ä‚ŕ‚悢i2013 ”N12 ŒŽŒťÝ•ŰŒŻ“K—pŠOjB

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Ą‰đŕ

—Lž™×–EŠŕiSCCj‚ɑ΂ˇ‚éMohs Žčp‚Ć’Ęí‚ĚŠO‰Č“IŘœ‚̏pŒăŹŃ‚Ě”äŠr‚ÉŠÖ‚ľ‚ẮCRowe ‚ç‚É‚ć‚éÇ—áWĎŒ¤‹†‚Ş‚ ‚éB”Ţ‚ç‚Ě•ń‚ł́C5 ”NˆČă’ˇŠúŠĎŽ@‚ľ‚˝”畆Œ´”­‘ƒ‚ĚÄ”­—Ś‚́CŠO‰Č“IŘœŒQ‚Ĺ‚Í8.1“‚Ĺ‚ ‚é‚̂ɑ΂ľCMohs ŽčpŒQ‚Ĺ‚Í3.1“C‚Ü‚˝‹ÇŠÄ”­‚đ‹N‚ą‚ľ‚˝•a•Ď‚̏pŒăÄ”­—Ś‚́CŠO‰Č“IŘœŒQ‚Ĺ‚Í23.3“‚Ĺ‚ ‚é‚̂ɑ΂ľCMohs ŽčpŒQ‚Ĺ‚Í10.0“‚Ć’á‚Š‚Á‚˝B‚Ü‚˝_Œoe˜aŤ‚đŽŚ‚ˇÇ—á‚É‚¨‚Ż‚éÄ”­—Ś‚́CŠO‰Č“IŘœŒQ‚Ĺ‚Í47.2“‚Ĺ‚ ‚é‚̂ɑ΂ľCMohs ŽčpŒQ‚Ĺ‚Í0“‚Ĺ‚ ‚Á‚˝B‚ł‚ç‚ÉŽîᇌa‚Ş2 cm ˆČă‚ĚÇ—á‚ĚŽĄ–ü—Ś‚́CŠO‰Č“IŘœŒQ‚Ĺ‚Í58.3“‚Ĺ‚ ‚é‚̂ɑ΂ľCMohs ŽčpŒQ‚Ĺ‚Í74.8“‚ƍ‚‚Š‚Á‚˝BSCC ‚͍Ĕ­‚ˇ‚é‚Ć“]ˆÚ—Ś‚Ş30.3“‚ƍ‚‚­‚Č‚čC“]ˆÚŒă‚̐ś‘ś—Ś‚Í34.4“‚ƒቺ‚ˇ‚é‚̂ŁC’˜ŽŇ‚ç‚͏pŒă‚ĚÄ”­—Ś‚Ş’á‚˘Mohs Žčp‚đ„§‚ľ‚Ä‚˘‚é1jB

Ä”­—Ś‚Ş’á‚˘‚Ć‚˘‚¤Mohs Žčp‚Ě—˜“_‚́CLeibovitch ‚ç‚Ě•ń‚Ĺ‚ŕŠm”F‚ł‚ę‚Ä‚˘‚é2jB”Ţ‚ç‚Í1993`2002 ”N‚ÉMohs Žčp‚đŽó‚ŻCThe Australian Mohs surgery database ‚É“o˜^‚ł‚ę‚˝Ç—áiÇ—ᐔ1,263 —áC61.1“‚ޏ‰‰ńŽĄ—Ă—áC38.9“‚ލĔ­—áC96.5“‚Ş“Şčň•”Œ´”­SCCj‚ÉŠÖ‚ˇ‚éÇ—áWĎŒ¤‹†‚đŽŔŽ{‚ľ‚˝B‚ť‚ĚŒ‹‰ĘCÄ”­—á‚́C‰”­—á‚ć‚čĹ‘ĺŒaip ƒ 0.0001j‚âpŒăŒ‡‘š‚Ş‘ĺ‚Ť‚­ip ƒ 0.0001jCMohs Žčp‚̐؏œ‰ń”‚Ş‘˝‚­ip ƒ 0.0001jCp‘O‚Ě—Ő°“Iƒ}[ƒWƒ“‚đ’´‚Ś‚˝Z‚đŽŚ‚ˇÇ—á‚Ş‘˝‚Š‚Á‚˝ip  0.02jB‚ł‚ç‚ÉMohs ŽčpŒă‚Ě5 ”NŠÔ‚ĚÄ”­‚Í‘S‘Ě‚Ĺ3.9“i‰‰ńŒQ2.6“CÄ”­ŒQ5.9“j‚Ĺ‚ ‚čC“]ˆÚ‚𐜂ś‚˝Ç—á‚Í‚Ý‚ç‚ę‚Č‚Š‚Á‚˝BÄ”­‚ĆŠÖ˜A‚ˇ‚éŽĺ‚ČˆöŽq‚́CÄ”­‚Ě‘O—đCp‘O‚Ě—Ő°“Iƒ}[ƒWƒ“‚đ’´‚Ś‚˝Z‚ĆMohs Žčp‚̐؏œ‰ń”‚Ĺ‚ ‚Á‚˝iŽîᇂ̑śÝ•”ˆĘC‘gDŒ^C‰fŽž‚ĚƒTƒCƒYCpŒăŒ‡‘š‚Ć5 ”NŠÔ‚ĚÄ”­—Ś‚Ć‚ĚŠÔ‚ÉŠÖ˜A‚Í”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝jB‚ą‚ĚŽŽŒą‚ɂ͍‚ƒŠƒXƒNÇ—á‚Ş‘˝‚­ŠÜ‚Ü‚ę‚Ä‚˘‚˝‚É‚ŕ‚Š‚Š‚í‚炸CMohs Žčp‚É‚ć‚Á‚ċǏŠÄ”­—Ś‚Ş’á‚Š‚Á‚˝‚ą‚Ć‚Š‚çCŠŽ‘SŘœ‚̏d—vŤ‚ŞŽxŽ‚ł‚ę‚éB

ˆČă‚ć‚čCMohs Žčp‚͍Ĕ­—Ś‚Ş’á‚˘‚Ć‚˘‚¤—˜“_‚Ş‚ ‚čC’ʏí‚ĚŠO‰Č“IŘœ‚Ć”äŠr‚ľ‚Ä‚ć‚č—L‰v‚Ć‚˘‚Ś‚éB‚ľ‚Š‚ľ‚ť‚Ěˆę•ű‚ŁC‚ą‚Ě•ű–@‚Í•ĄŽG‚Ĺ‚ ‚čCŽč‹Z‚̏K“ž‚Ě‚˝‚ß‚É“ÁŽę‚ČŒP—ű‚đ—v‚ľC‚Ü‚˝ˆę˜A‚ĚŽ{p‚Ě‚˝‚ß‚ÉŽžŠÔ‚ƐlŽč‚đ—v‚ˇ‚é‚Ć‚˘‚¤Œ‡“_‚Ş‚ ‚čC–{–M‚Ĺ‚ÍL‚­•‹y‚ľ‚Ä‚˘‚Č‚˘B

•śŒŁ

1j Rowe DE, Caroll RJ, Day CL Jr: Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip, J Am Acad Dermatol, 1992; 26: 976-990.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

2j Leibovitch I, Huilgol SC, Selva D, et al: Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia I, Experience over 10 years, J Am Acad Dermatol, 2005; 53: 253-260.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ5

—Lž™×–EŠŕŠłŽŇ‚̐ś‘ś—Ś‚̉ü‘P‚đ–Ú“I‚Ć‚ľ‚Ä—\–h“IƒŠƒ“ƒpßŠs´‚đŽŔŽ{‚ˇ‚é‚ą‚Ć‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

C2

—Տ°“IˆÓ‹`‚Ş•s–ž‚Ĺ‚ ‚čCŠî–{“I‚É‚ÍŠŠ‚ß‚ç‚ę‚Č‚˘B

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Ą‰đŕ

Š‘ŽƒŠƒ“ƒpß“]ˆÚ‚𐜂ś‚Ä‚˘‚Č‚˘—Lž™×–EŠŕiSCCj‚ĚŽĄ—ÐŹŃ‚͗ǍD‚Ĺ‚ ‚é‚ą‚Ć‚Š‚çCƒŠƒ“ƒpß“]ˆÚ‚Ě—L–ł‚ޏd—v‚Č—\ŒăˆöŽq‚Ĺ‚ ‚é‚ą‚Ć‚ŞŽŚ´‚ł‚ę‚éB

‚í‚Ş‘‚É‚¨‚˘‚āC1987`1994 ”N‚É27 Ž{Ý‚Ĺ“o˜^‚ł‚ę‚˝SCC 1,082 —á‚Ě80 ƒJŒŽś‘ś—Ś‚́C•aŠú Ⅰ ‚Ş92“C•aŠúⅡ‚Ş82.6“‚Ĺ‚ ‚é‚̂ɑ΂ľC•aŠúⅢ‚Ě‚¤‚żŠ‘ŽƒŠƒ“ƒpß“]ˆÚ‚𔺂¤Ç—á‚Ĺ‚Í48“‚Ć’á‚­1jC‚ą‚ĚŒQ‚ɑ΂ˇ‚é—LŒř‚ČŽĄ—Ă–@‚ĚŠm—§‚Ş–]‚Ü‚ę‚éB‚ľ‚Š‚ľC—\–h“IƒŠƒ“ƒpßŠs´‚Ě—L‰vŤ‚ɂ‚˘‚Ă͏\•Ş‚ÉŒ¤‹†‚ł‚ę‚Ä‚¨‚炸C‚ť‚ĚˆÓ‹`‚Í–žŠm‚Ĺ‚Í‚Č‚˘2jB]—ˆ–{–M‚ł́CSCC ‚É‚ÍŒ´‘Ľ‚Ć‚ľ‚Ä—\–h“IƒŠƒ“ƒpßŠs´‚ÍŽ{s‚š‚¸C–ž‚ç‚Š‚ČƒŠƒ“ƒpß“]ˆÚ‚ސś‚ś‚˝ę‡‚ÉŞŽĄ“IŠs´‚ŞŽ{‚ł‚ę‚Ä—ˆ‚˝B‰˘•Ä‚ĚƒKƒCƒhƒ‰ƒCƒ“‚⃌ƒrƒ…[‚É‚¨‚˘‚Ä‚ŕ—\–h“IƒŠƒ“ƒpßŠs´‚Ě—L‰vŤ‚ɂ‚˘‚ÄŒž‹y‚ľ‚Ä‚˘‚é‚ŕ‚Ě‚Í‚Č‚˘B

ˆČă‚ć‚čCSCC ‚ɑ΂ˇ‚é—\–h“IƒŠƒ“ƒpßŠs´‚Ě—Ő°“IˆÓ‹`‚Í•s–ž‚Ĺ‚ ‚čCŠî–{“I‚ɐ„§‚Ĺ‚Ť‚Č‚˘B

’j‰đŕ•ś’†‚Ě•aŠú‚ÍŒ¤‹†ŠúŠÔ“–Žž‚ĚUICC •Ş—Ţ‚Ě‚ŕ‚Ě‚Ĺ‚ ‚čCŒťs‚Ě•aŠú•Ş—Ţ‚Ć‚ÍˆŮ‚Č‚é•”•Ş‚Ş‘˝‚˘B

•śŒŁ

1j ÎŒ´˜a”VF–{–M‚É‚¨‚Ż‚é”畆ˆŤŤŽîᇂ̓Œv‚Č‚ç‚Ń‚É—\ŒăˆöŽq‚ĚŒŸ“˘CSkin Cancer, 2005; 20: 234-248.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j North JH Jr, Spellman JE, Driscoll D, et al: Advanced cutaneous squamous cell carcinoma of the trunk and extremity: Analysis of prognostic factors, J Surg Oncol, 1997; 64: 212-217.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ6

—Lž™×–EŠŕŠłŽŇ‚ɃZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßśŒŸ‚đs‚¤‚ą‚Ć‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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C1

ƒŠƒ“ƒpßŽî’Ż‚Í‚Č‚˘‚Ş“]ˆÚ‚̉”\Ť‚ލ‚‚˘‚ƍl‚Ś‚ç‚ę‚éÇ—á‚ɂ́CƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßśŒŸ‚đl—ś‚ľ‚Ä‚ŕ‚悢i2013 ”N12 ŒŽŒťÝ•ŰŒŻ“K—pŠOjB

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Ą‰đŕ

—Lž™×–EŠŕiSCCj‚ɑ΂ˇ‚éƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßśŒŸ‚ɂ‚˘‚ẮC‰˘•Ä‚ĚƒŒƒrƒ…[‚Ş‚˘‚­‚‚Š‘śÝ‚ˇ‚éB

Renzi ‚ç‚ĚƒŒƒrƒ…[‚ł́C‰ß‹Ž83 —á‚̍‚ƒŠƒXƒN‚Ĺ—Ő°“I‚ɃŠƒ“ƒpßŽî’Ż‚Ě‚Č‚˘SCC ‚ɃZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßśŒŸ‚ލs‚í‚ęC14 —ái16.9“j‚Ş—zŤ‚Ĺ‚ ‚Á‚˝B‘˝dƒƒWƒXƒeƒBƒbƒN‰ń‹A•ŞÍ‚ł́CŽîᇂ̑傫‚ł‚ރZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpß‚Ě“]ˆÚ—Ś‚Ć‘ŠŠÖ‚ľ‚Ä‚˘‚˝iƒIƒbƒY”ä4.27Cp  0.026j1jB

Ross ‚ç‚ĚƒVƒXƒeƒ}ƒeƒBƒbƒNEƒŒƒrƒ…[2j‚ł́Căč–ĺ‰A•”—ĚˆćŒ´”­‚ĚSCC Ç—á‚Ĺ‚Í585 —á’†139 —ái24“jC”ńăč–ĺ‰A•”—Ěˆć‚Ĺ82 —á’†17 —ái21“j‚ĚƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpß‚É“]ˆÚ‚Ş”F‚ß‚ç‚ę‚˝‚Ć‚ľ‚Ä‚˘‚éBƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpß‚đ“Ż’č‚Ĺ‚Ť‚Č‚Š‚Á‚˝‚Ě‚Íăč–ĺ‰A•”—Ěˆć‚Ĺ607 —á’†20 —ái3“jC”ńăč–ĺ‰A•”—Ěˆć85 —á’†4 —ái3“j‚Ĺ‚ ‚Á‚˝B‚Ü‚˝CƒŠƒ“ƒpßŠs´—á‚É‚¨‚Ż‚éƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßśŒŸ‚Ě‹U‰AŤ—Ś‚́Căč–ĺ‰A•”—Ěˆć213 —á’†8 —ái4“jE”ńăč–ĺ‰A•”—Ěˆć20 —á’†1 —ái5“j‚Ĺ‚ ‚Á‚˝‚Ć‚˘‚¤BRoss ‚ç‚ÍSCC ‚ɑ΂ˇ‚éƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßśŒŸ‚ސś‘ś—Ś‰ü‘P‚ÉŠń—^‚ˇ‚é‚Š”Ű‚Š‚ɂ‚˘‚ẮCƒRƒ“ƒgƒ[ƒ‹‚đ‚¨‚˘‚˝Œ¤‹†‚Ş•K—v‚ž‚Ć‚ľ‚Ä‚˘‚éB“Ż—l‚ɁC‰˘•Ä‚ĚƒKƒCƒhƒ‰ƒCƒ“‚⃌ƒrƒ…[‚É‚¨‚˘‚āC–{–@‚đŽŔŽ{‚ˇ‚é‚ą‚Ć‚É‚ć‚萜‘ś—Ś‚Şă¸‚ˇ‚é‚Š”Ű‚Š‚ɂ‚˘‚ÄŒž‹y‚ľ‚Ä‚˘‚é‚ŕ‚Ě‚Í‚Č‚˘B

‚í‚Ş‘‚É‚¨‚˘‚ẮC‘SgŠeŠ‚ĚSCC 9 —á’†1—á3jC‚Ü‚˝9 —á’†3 —ái1 —á‚Í—Ő°“I‚ɃŠƒ“ƒpßŽî’Ż‚ ‚čj‚ɃZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßśŒŸ—zŤ‚Ĺ‚ ‚Á‚˝‚Ć‚Ě•ń4j‚Ş‚ ‚é‚É‚ˇ‚Ź‚Č‚˘

ˆČă‚ć‚čCŒťŽž“_‚Ĺ‚ÍSCC ‚ɑ΂ˇ‚éƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßśŒŸ‚Ě—Ő°“IˆÓ‹`‚Í•s–ž‚Ĺ‚ ‚čC‚ą‚ę‚đŽŔŽ{‚ˇ‚é‚ą‚ƂŐś‘ś—Ś‚މü‘P‚ˇ‚é‚Ć‚˘‚¤‚‚˘…€‚ĚŞ‹’‚Í‘śÝ‚ľ‚Č‚˘B‚˝‚ž‚ľCSCC ‚Í“]ˆÚƒ‹[ƒg‚ŞŽĺ‚Ć‚ľ‚ăŠƒ“ƒpsŤ‚Ȃ̂ŁC—Šw“IŠŒŠ‚Č‚˘‚ľ‰ć‘œŒŸ¸‚Ĺ‚ÍƒŠƒ“ƒpß‚ÉˆŮí‚đ”F‚ß‚Č‚˘‚ŕ‚̂́C“]ˆÚ‚ĚƒŠƒXƒN‚ލ‚‚˘‚ƍl‚Ś‚ç‚ę‚éÇ—á‚ɂ́CƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßśŒŸ‚đl—ś‚ľ‚Ä‚ŕ‚悢BƒŠƒXƒN‚Ě•]‰ż‚ɂ́C‰p‘‚ĚƒKƒCƒhƒ‰ƒCƒ“5j‚ŞŽQl‚É‚Č‚é‚Ĺ‚ ‚낤iSCC-CQ2 ‰đŕ•śŽQĆjB‚Ü‚˝C‚ť‚Ě—Ő°“IˆÓ‹`‚ÉŠÖ‚ľ‚ẮC‰ČŠw“I‚ɏ\•Ş‚Ȑ¸“x‚Ĺ‚Ě•]‰ż‚Ş•K—v‚Ĺ‚ ‚éB

•śŒŁ

1j Renzi C, Caggiati A, Mannooranparampil TJ, et al: Sentinel lymph node biopsy for high risk cutaneous squamous cell carcinoma: case series and review of the literature, Eur J Surg Oncol, 2006; 25: 364-369.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Ross AS, Schmults CD: Sentinel lymph node biopsy in cutaneous squamous cell carcinoma: a systematic review of the English literature, Dermatol Surg, 2006; 32: 1309-1321.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

3j ”Ş‘ă@_C‰Í‡ŹŠCCŽR–k‚Žu‚Ů‚ŠF“–‰@‚É‚¨‚Ż‚é—Lž™×–EŠŕ‚ɑ΂ˇ‚ésentinel node biopsy ‚ĚŒŸ“˘C“ú”ç‰ďŽC2006 ; 116: 325-329.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

4j ‘ĺ’ːłŽ÷CŽRč@CCó‰zŒ’ŽĄ‚Ů‚ŠF”畆ˆŤŤŽîᇁi”ńˆŤŤ•FŽîj‚ɑ΂ˇ‚éƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßśŒŸCź“ú”畆C2006; 68: 532-537.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Motley R, Kersey P, Lawrence C: Multiprofessional guidelines for the management of the patient with primary cutaneous squmamous cell carcinoma, Br J Dermatol, 2002; 146: 18-25.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj


CQ7

—Lž™×–EŠŕ‚̉“Šu“]ˆÚ‘ƒ‚đŠO‰Č“I‚ɐ؏œ‚ˇ‚é‚ą‚Ć‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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C2

—Տ°“IˆÓ‹`‚ÍŘ–ž‚ł‚ę‚Ä‚˘‚Č‚˘‚̂ŁCŠî–{“I‚É‚ÍŠŠ‚ß‚ç‚ę‚Č‚˘B

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Ą‰đŕ

—Lž™×–EŠŕiSCCj‚ÉŠÖ‚ˇ‚éŠů‘ś‚ĚƒŒƒrƒ…[iCochrane LibraryCClinical EvidenceFissue 9CEvidence-based Dermatologyj‚â‰p‘‚¨‚ć‚ŃƒI[ƒXƒgƒ‰ƒŠƒA‚ĚƒKƒCƒhƒ‰ƒCƒ“‚ł́C‰“Šu“]ˆÚ‚̐؏œ‚ÉŠÖ‚ˇ‚é‹LÚ‚ť‚Ě‚ŕ‚Ě‚Ş‘śÝ‚ľ‚Č‚˘B

•Ä‘‚ĚNational Comprehensive Cancer NetworkiNCCNj‚ĚƒKƒCƒhƒ‰ƒCƒ“1j‚ŕ‚Ů‚Ú“Ż—l‚Ě—§ę‚đ‚Ć‚Á‚Ä‚˘‚éB‚˝‚ž‚ľC‚ą‚ĚƒKƒCƒhƒ‰ƒCƒ“‚ł́C‰“Šu“]ˆÚ—á‚ɑ΂ľ‚ẮC‘˝—Ěˆć‚̐ę–ĺ‰Ć‚Š‚ç‚Č‚éWŠw“I—Տ°ŽŽŒą‚ĚŽŔŽ{‚đl—ś‚ˇ‚ׂŤ‚Ĺ‚ ‚é‚Ć‹LÚ‚ł‚ę‚Ä‚¨‚čC“]ˆÚ‘ƒ‚̐؏œ‚ŕŠÉ˜a—Ă–@‚Ě‘I‘đŽˆ‚Ěˆę‚‚Ƃľ‚Ä‹“‚°‚ç‚ę‚é‚Š‚ŕ‚ľ‚ę‚Č‚˘B

ˆČă‚ć‚čCSCC ‚Ě“]ˆÚ‘ƒ‚ɑ΂ˇ‚éŠO‰Č“IŽĄ—ẤCŘœ‚Ş—eˆŐ‚ĹŠÉ˜a—Ă–@‚Ć‚ľ‚Ä—L‰vŤ‚ŞŠú‘Ň‚Ĺ‚Ť‚éę‡‚ÉŒŔ‚ç‚ę‚é‚Ĺ‚ ‚낤B

•śŒŁ

1j NCCN: Clinical practice guideline in oncology. Basal cell and squamous cell skin cancers. V.2. 2013, SCC-1-MS-25.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅵj


CQ8

Žčp•s”\‚Č—Lž™×–EŠŕ‚ĚŒ´”­‘ƒEŠ‘ŽƒŠƒ“ƒpß“]ˆÚE‰“Šu“]ˆÚ‚ɑ΂ľ‚ĉťŠw—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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C1

Žčp‚â•úŽËü—Ă–@‚ލ˘“ď‚ČÇ—á‚ɑ΂ˇ‚é‘ă‘Ö—Ă–@C‚ ‚邢‚͊ɘa—Ă–@‚Ć‚ľ‚ĉťŠw—Ă–@‚đs‚¤‚ą‚Ć‚đl—ś‚ľ‚Ä‚ŕ‚悢B

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Ą‰đŕ

—Lž™×–EŠŕiSCCj‚̐isŒ´”­‘ƒ‚ƏŠ‘ŽƒŠƒ“ƒpß“]ˆÚ‚ɑ΂ľ‚ẮC‰ťŠw—Ă–@‚Ş”äŠr“I‚‚˘‘tŒř—Ś‚đŽŚ‚ˇ‚Ć‚˘‚¤•Ą”‚ĚÇ—áWĎŒ¤‹†‚Ş‘śÝ‚ˇ‚éB‚˝‚ž‚ľC­”—á‚ɂ‚˘‚Ä‚Ě•ń‚Ş‚Ů‚Ć‚ń‚Ç‚Ĺ‚ ‚éB

Ikeda ‚ç‚́CƒŠƒ“ƒpß“]ˆÚ‚¨‚ć‚щ“Šu“]ˆÚÇ—á‚đŠÜ‚Ţ86 Ç—á‚Épeplomycin sulfate ’PÜ‚đ“Š—^‚ľC61.6“iŠŽ‘S‘tŒř23.3“C•”•Ş‘tŒř38.4“j‚Ě‘tŒř—Ś‚đ“ž‚Ä‚˘‚éiŒ´”­‘ƒCŠ‘ŽƒŠƒ“ƒpß“]ˆÚC‰“Šu“]ˆÚ‚Ě‘tŒř—Ś‚Í‚ť‚ę‚ź‚ęC68.5“C22.2“C10.0“j1jBGuthrie ‚ç‚́CŒ´”­‘ƒ7 Ç—á‚Écisplatin ‚Ćdoxorubicin ‚đ•š—p‚ľ‚˝‰ťŠw—Ă–@‚đŽŔŽ{‚ľC57.1“iŠŽ‘S‘tŒř2 —áC•”•Ş‘tŒř2 —áj‚Ě‘tŒř—Ś‚đ“ž‚Ä‚˘‚é2jB‚Ü‚˝Sadek ‚ç‚́CŽîᇌa‚ސ”cm ˆČă‚ĚŒ´”­‘ƒ13 Ç—á‚ɁCcisplatinC5-fluorouracilCbleomycin ‚Ě•š—p—Ă–@‚đŽŔŽ{‚ľC84.6“iŠŽ‘S‘tŒř4 —áC•”•Ş‘tŒř7 —áj‚Ě‘tŒř—Ś‚đ“ž‚Ä‚˘‚é3jB‚ł‚ç‚É’r“c‚ç‚́CƒŠƒ“ƒpß“]ˆÚ‚¨‚ć‚щ“Šu“]ˆÚÇ—á‚đŠÜ‚Ţ33 —á‚ÉCPT-11 ’PÜ‚đ“Š—^‚ľC39.4“‚Ě‘tŒř—ŚiŒ´”­‘ƒ38.5“CƒŠƒ“ƒpß“]ˆÚ60.0“C”x“]ˆÚ33.3“j‚đ“ž‚Ä‚˘‚é4jB

ˆę•űBurris ‚ç‚́CŽčpC•úŽËü—Ă–@C‘Sg‰ťŠw—Ă–@‚Ě“K‰ž‚Ě‚Č‚˘SCC 21 —á32 •a‘ƒ‚ɑ΂ľCcisplatin ‚Ćepinephrine ‚Ě‹ÇŠ’“ü—Ă–@‚đŽŔŽ{‚ľCŠŽ‘S‘tŒř—Ś37.5“i12/32j‚đ“ž‚˝‚ą‚Ć‚ć‚čCŠÉ˜a–Ú“I‚Ĺ‚ĚŽg—p‚đŠŠ‚ß‚Ä‚˘‚é5jB

ˆČă‚ć‚čCSCC ‚ɑ΂ľC‰ťŠw—Ă–@‚Í‚ ‚é’ö“x‚Ě‘tŒř—Ś‚đ—L‚ľCŽčp‚â•úŽËü—Ă–@‚ލ˘“ď‚ČÇ—á‚ɑ΂ˇ‚é‘ă‘Ö—Ă–@C‚ ‚邢‚͊ɘa—Ă–@‚Ć‚ľ‚Ä—L‰v‚Ĺ‚ ‚é‚Ć‚˘‚Ś‚悤B

‚Č‚¨CpŒă‰ťŠw—Ă–@‚É‚ć‚čÄ”­—Ś‚Ş’á‰ş‚ˇ‚éi‚ŕ‚ľ‚­‚͐ś‘ś—Ś‚މü‘P‚ˇ‚éjC‚ ‚邢‚͐is—á‚ɑ΂ˇ‚鉝Šw—Ă–@‚Őś‘ś—Ś‚މü‘P‚ˇ‚é‚Ć‚˘‚¤Ş‹’‚Í–R‚ľ‚­C‚ť‚̂悤‚Č–Ú“I‚ł̉ťŠw—Ă–@‚ĚˆÓ‹`‚Í•s–ž‚Ĺ‚ ‚éB

•śŒŁ

1j Ikeda S, Ishihara K, Matsunaka N: Peplomycin therapy for skin cancer in Japan, Drugs Exp Clin Res, 1986; 12: 247-255.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Guthrie TH Jr, Porubsky ES, Luxenberg MN, et al: Cisplatin-based chemotherapy in advanced basal and squamous cell carcinomas of the skin: results in 28 patients including 13 patients receiving multimodality therapy, J Clin Oncol, 1990; 8: 342-346.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

3j Sadek H, Azli N, Wendling JL, et al: Treatment of advanced squamous cell carcinoma of the skin with cisplatin, 5-fluorouracil, and bleomycin, Cancer, 1990; 66: 1692-1696.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

4j ’r“cd—YCÎŒ´˜a”VC‘ĺ‰Y••F‚Ů‚ŠF—Lž™×–EŠŕ‚¨‚ć‚ŃˆŤŤ•FŽî‚ɑ΂ˇ‚鉖Ž_ƒCƒŠƒmƒeƒJƒ“iCPT-11j‚ĚŒăŠú‘ćⅡ‘ŠŽŽŒąCSkin Cancer, 1993; 8: 503-513.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

5j Burris HA III, Vogel CL, Castro D, et al: Intratumoral cisplatin/epinephrine-injectable gel as a palliative treatment for accessible solid tumors: a multicenter pilot study, Otolaryngol Head Neck Surg, 1998; 118: 496-503. iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj


CQ9

—Lž™×–EŠŕ‚ɑ΂ľ‚ÄŞŽĄ“I•úŽËü—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

B

Žčp—Ă–@‚Ş“K‰ž‚Ć‚Č‚ç‚Č‚˘—Lž™×–EŠŕ‚ɑ΂ľ‚Ä‚ÍŞŽĄ“I•úŽËü—Ă–@‚đs‚¤‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éB

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


Ą‰đŕ

—Lž™×–EŠŕiSCCj‚͏Š‘ŽƒŠƒ“ƒpß“]ˆÚ‚≓Šu“]ˆÚ‚𐜂ś‚é‰Â”\Ť‚Í’á‚­CŽčp‚đŠî–{‚Ć‚ˇ‚é‹ÇŠ—Ă–@‚É‚ć‚č90“ˆČă‚ĚÇ—á‚ĹŽĄ–ü‚ŞŠú‘Ň‚ł‚ę‚é1, 2jBŽčp—Ă–@‚É‚ć‚é‹@”\’ቺ‚␎—eŤ’ቺ‚Ş–â‘č‚Ć‚Č‚éÇ—á‚âC“ŕ‰Č“I——R‚ĹŽčp˘“ď‚ČÇ—á‚Č‚Ç‚Ĺ‚ÍŞŽĄ“I•úŽËü—Ă–@‚ލl—ś‚ł‚ę‚é1`4jB

‘Šú—á‚É‚¨‚Ż‚é•úŽËü—Ă–@‚̐ŹŃ‚͗ǍD‚Ĺ‚ ‚čCT1 •a•Ď‚Ĺ‚Í93“CT2 •a•Ď‚Ĺ‚Í65`85“‚ĚÇ—á‚Ĺ‹ÇŠ§Œä‚Ş“ž‚ç‚ę‚é‚ŞCT3`4 •a•Ď‚Ĺ‚Í50`60“’ö“x‚É‚Ć‚Ç‚Ü‚é2, 5`7jBŠç–Ę‚Č‚Ç‚Ě•”ˆĘ‚É”­ś‚ľ“KŘ‚Ȑ؏œ’f’[‚đŠm•Ű‚ˇ‚é‚ą‚Ć‚Ş˘“ď‚ČÇ—áC‚—îŽŇ‚ĹŽčp˘“ď‚ČÇ—áC‘˝”­•a‘ƒCRŒŒđ–ň‚đ“ŕ•ž‚ľ‚Ä‚˘‚éÇ—áCƒPƒƒCƒh‘ĚŽż‚ĚÇ—á‚É‚¨‚˘‚Ä‚Í•úŽËü—Ă–@‚ލl—ś‚ł‚ę‚é7jB‚ľ‚Š‚ľCŽ¨‰ş‘B‚ɐZ‚ľ‚˝Ç—á‚⃊ƒ“ƒpß“]ˆÚ—áC_ŒoŽüˆÍZ‚𐜂ś‚˝Ç—á‚Ĺ‚Í•úŽËü—Ă–@Œă‚̐ŹŃ‚Í•s—Ç‚Ĺ‚ ‚萜‘ś—Ś‚Í17`46“‚Ĺ‚ ‚é8`12jB“Şčň•”—ĚˆćCăč–ĺC‰ď‰A•”‚ć‚č”­ś‚ľ‚˝ŽîᇁC”M‚▝Ť’×ᇂ𔭐ś•ę’n‚Ć‚ľ‚˝ŽîᇁCÄ”­•a‘ƒC–Ɖu•s‘Só‘Ô‚ĚÇ—á‚Č‚Ç‚Ĺ‚ÍƒŠƒ“ƒpß“]ˆÚ‚̉”\Ť‚Ş’Ęí‚ć‚č‚‚˘‚˝‚ß‰ć‘œf’f‚đ—p‚˘‚ĐTd‚É•]‰ż‚ˇ‚ׂŤ‚Ĺ‚ ‚é7, 13jB

•\ÝŤŽîᇂɂ͎ĺ‚É“dŽqü‚Ş—p‚˘‚ç‚ęC•\–ʐü—Ę‚Ş“KŘ‚Ȑü—Ę‚É‚Č‚é‚悤ƒ{[ƒ‰ƒXŢ‚Č‚Ç‚đ—p‚˘‚éBŽîᇂ̐i“W”͈͂â[‚ł‚É‚ć‚Á‚Ä‚Í’´‚ˆłX ü‚đ‘g‚ݍ‡‚í‚š‚ÄŽĄ—Ă‚ˇ‚é6jBNCCN * 1j‚ĚƒKƒCƒhƒ‰ƒCƒ“‚ł́C2 cm –˘–ž‚ĚŽîᇂɑ΂ľ‚Ă̓}[ƒWƒ“1`1.5 cm ‚đ‚‚Ż‚˝ĆŽË–ě‚Ĺ64 Gy/32 •ŞŠ„/ 6`6.4 TŠÔC55 Gy/20 •ŞŠ„/4 TŠÔC50 Gy/15 •ŞŠ„/3 TŠÔC35 Gy/5 •ŞŠ„/5 “úŠÔ‚ĚƒXƒPƒWƒ…[ƒ‹‚ސ„§‚ł‚ę‚Ä‚˘‚éBŽîᇌa2 cm ˆČă‚Ěę‡‚É‚Í1.5`2.0 cm ‚Ěƒ}[ƒWƒ“‚đ‚‚Ż‚˝ĆŽË–ě‚Ĺ66 Gy/33 •ŞŠ„/6`6.6 TŠÔ‚Ü‚˝‚Í55 Gy/20 •ŞŠ„/4 TŠÔ‚ĚƒXƒPƒWƒ…[ƒ‹‚ސ„§‚ł‚ę‚Ä‚˘‚éB‚Ü‚˝C—ĚˆćƒŠƒ“ƒpß‚đŠÜ‚ß‚˝L”ÍˆÍ‚ĚĆŽË‚đs‚¤ę‡‚␎—eŤ‚đ“Á‚ɏdŽ‹‚ˇ‚éę‡‚ɂ́C1 ‰ńü—Ę‚Ć‚ľ‚Ä2 Gy ‚đ—p‚˘‚Ä’Ęí•ŞŠ„ĆŽË‚đs‚¤‚Ě‚Ş–]‚Ü‚ľ‚˘Bčň•”Šs´p‚đŽ{s‚ľ‚Č‚˘ę‡‚ɂ̓Šƒ“ƒpß“]ˆÚ•”‚É‚Í66`70 Gy/33`35 •ŞŠ„/6.6`7 TŠÔ‚đĆŽË‚ˇ‚éB

•úŽËü—Ă–@‚Ě”ń“K‰ž‚Ć‚ľ‚ẮCŠî’ę×–E•ę”ÁÇŒóŒQCF‘fŤŠŁ”çÇCánćҏó•\”ç”­ˆçˆŮíÇC‹­”çÇ‚đ‚Í‚ś‚ß‚Ć‚ˇ‚éäPŒ´•aC“Ż•”ˆĘ‚ÉĆŽË‚ĚŠů‰‚Ş‚ ‚éÇ—á‚Č‚Ç‚Ş‹“‚°‚ç‚ęC•úŽËü—Ă–@‚É‚ć‚é“ńŽŸ”­‚Ş‚ń‚âd“Ä‚Č—LŠQŽ–Ű‚ސś‚ś‚é‰Â”\Ť‚ލ‚‚˘iNCCNjB‚Ü‚˝C60 Î–˘–ž‚ĚŠłŽŇ‚ɑ΂ľ‚Ä‚ŕ“ńŽŸ”­‚Ş‚ń‚đl—ś‚ľ‰Â”\‚ČŒŔ‚č•úŽËü—Ă–@‚Í”đ‚Ż‚é‚ׂŤ‚Ć‚ł‚ę‚Ä‚˘‚éB

’1jNCCNFNational Comprehensive Cancer NetworkiVersion 2. 2013j

’2j‰đŕ•ś’†‚Ě•aŠú‚ÍŒ¤‹†ŠúŠÔ“–Žž‚ĚUICC •Ş—Ţ‚Ě‚ŕ‚Ě‚Ĺ‚ ‚čCŒťs‚Ě•aŠú•Ş—Ţ‚Ć‚ÍˆŮ‚Č‚é•”•Ş‚Ş‘˝‚˘B

•śŒŁ

1j Alam M, Ratner D: Cutaneous squamous-cell carcinoma, N Engl J Med, 2001; 344: 975-983.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

2j Rowe DE, Carroll RJ, Day CL Jr: Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection, J Am Acad Dermatol, 1992; 26: 976-990.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

3j Kwan W, Wilson D, Moravan V: Radiotherapy for locally advanced basal cell and squamous cell carcinomas of the skin, Int J Radiat Oncol Biol Phys, 2004; 60: 406-411.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

4j Lansbury L, Leonardi-Bee J, Perkins W, et al: Interventions for non-metastatic squamous cell carcinoma of the skin, Cochrane Database Syst Rev, 2010; 4: CD007869.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

5j Fleming ID, Amonette R, Monaghan T, Fleming MD: Principles of management of basal and squamous cell carcinoma of the skin, Cancer, 1995; 75: 699-704.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

6j Lovett RD, Perez CA, Shapiro SJ, Garcia DM: External irradiation of epithelial skin cancer, Int J Radiat Oncol Biol Phys, 1990; 19: 235-242.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j Robin M, Bruce B, Richard B: Clinical Practice Guide Basal cell carcinoma, squamous cell carcinomaiand related lesionsj-a guide to clinical management in Australia. 2008.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

8j Audet N, Palme CE, Gullane PJ, et al: Cutaneous metastatic squamous cell carcinoma to the parotid gland: analysis and outcome, Head Neck, 2004; 26: 727-732.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

9j McCord MW, Mendenhall WM, Parsons JT, et al: Skin cancer of the head and neck with clinical perineural invasion, Int J Radiat Oncol Biol Phys, 2000; 47: 89-93.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

10j McNab AA, Francis IC, Benger R, Crompton JL: Perineural spread of cutaneous squamous cell carcinoma via the orbit. Clinical features and outcome in 21 cases, Ophthalmology, 1997; 104: 1457-1462.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

11j Taylor BW Jr, Brant TA, Mendenhall NP, et al: Carcinoma of the skin metastatic to parotid area lymph nodes, Head Neck, 1991; 13: 427-433.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

12j Chfng S, Maitra A, Allison RS, et al: Parotid and cervical nodal status predict prognosis for patients with head and neck metastatic cutaneous squamous cell carcinoma, J Surg Oncol, 2008; 98: 101-105.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

13j Moore BA, Weber RS, Prieto V, et al: Lymph node metastases from cutaneous squamous cell carcinoma of the head and neck, Laryngoscope, 2005; 115: 1561-1567.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ10

—Lž™×–EŠŕ‚ɑ΂ľ‚ďpŒă•úŽËü—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

B

Ä”­‚ĚŠëŒŻŤ‚ލ‚‚˘Ç—á‚ɑ΂ľ‚Ă͏pŒă•úŽËü—Ă–@‚đs‚¤‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éB

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


Ą‰đŕ

—Lž™×–EŠŕiSCCj‚Ě‘˝‚­‚ÍŒ´”­•”ˆĘ‚É‚Ć‚Ç‚Ü‚čŽčp—Ă–@‚𒆐S‚Ć‚ľ‚˝‹ÇŠ—Ă–@‚É‚ć‚č–ń90“‚ĚÇ—á‚ŞŽĄ–ü‚ˇ‚é1, 2jBŽĄ–ü‚đ–ÚŽw‚ľ‚˝Žčp—Ă–@‚đs‚¤‚˝‚ß‚É‚Í“KŘ‚Ȑ؏œ’f’[‚đŠm•Ű‚ˇ‚é‚ą‚Ć‚Şd—v‚Ĺ‚ ‚é‚ŞC“KŘ‚Ȑ؏œ’f’[‚ŞŠm•Ű‚ł‚ę‚Č‚Š‚Á‚˝ę‡‚É‚Í–ń”ź”‚ĚÇ—á‚Ĺ‹ÇŠÄ”­‚ސś‚ś‚é3jB‚Ü‚˝C‘ź‚ĚÄ”­‚ĚŠëŒŻˆöŽq‚Ć‚ľ‚āCT4 Ç—áC‹}‘Ź‚É‘‘傡‚éŽîᇁCÄ”­—áC_ŒoŽüˆÍZ—áCƒŠƒ“ƒpß“]ˆÚ—ái“Á‚ɁCčň•”‚Ĺ‚Í2 ŒÂˆČă‚Ě“]ˆÚCăüâ|‚â‘lŒa•”‚Ĺ‚Í3 ŒÂˆČăCŒa3 cm ˆČă‚ĚƒŠƒ“ƒpß“]ˆÚC”í–ŒŠOZCŽ¨‰ş‘B“ŕƒŠƒ“ƒpß“]ˆÚC”畆Zj‚Č‚Ç‚Ş‹“‚°‚ç‚ę‚Ä‚˘‚éBpŒăĆŽË‚Ě“K‰ž‚Ć‚ľ‚ẮCŘœ’f’[—zŤ—áC_ŒoZCŽ¨‰ş‘BZ‚Č‚Ç‚Şl‚Ś‚ç‚ęCÄ”­—Ś‚đŒ¸­‚ł‚š‚é‚˝‚߂ɏpŒă•úŽËü—Ă–@‚đl—ś‚ˇ‚é2, 4`12jBpŒă•úŽËü—Ă–@‚Ě—Ő°“IˆÓ‹`‚Í‘OŒü‚ŤŽŽŒą‚ĹŒŸŘ‚ł‚ę‚˝‚ą‚Ć‚Í‚Č‚­CƒI[ƒXƒgƒ‰ƒŠƒA‚Ćƒjƒ…[ƒW[ƒ‰ƒ“ƒh‚𒆐S‚Ć‚ľ‚˝ƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒąPOST StudyiTrans Tasman Radiation Oncology GroupGTROG 05.01j‚ސis’†‚Ĺ‚ ‚čCpŒă—Ă–@‚Ć‚ľ‚ẲťŠw—Ă–@“ŻŽž•š—p•úŽËü—Ă–@‚Ć•úŽËü—Ă–@’P“Ć‚Ě”äŠr‚ĚŒ‹‰Ę‚Ş‘Ň‚˝‚ę‚é13jB

pŒăĆŽË‚Ć‚ľ‚Ä‚ĚŽŠ“KƒXƒPƒWƒ…[ƒ‹‚Í–ž‚ç‚Š‚Ĺ‚Í‚Č‚˘‚ށCŽ¨‰ş‘B—Ěˆć‚ɐi“W‚ľ‚˝Ç—á‚É‚¨‚˘‚Ä‚Í1 ‰ń2 Gy ŠˇŽZ‚ŏ­‚Č‚­‚Ć‚ŕ‘ü—Ę60 Gy ˆČă‚̐ü—Ę‚đ“Š—^‚ˇ‚é‚ą‚Ć‚Ş•K—v‚ƍl‚Ś‚ç‚ę‚Ä‚˘‚é10, 13jBNCCN ’1j‚ĚƒKƒCƒhƒ‰ƒCƒ“‚ł́CpŒăĆŽË‚Ć‚ľ‚Ä50 Gy/20 •ŞŠ„/4 TŠÔC‚Ü‚˝‚Í60 Gy/30 •ŞŠ„/6 TŠÔ‚ĚĆŽËƒXƒPƒWƒ…[ƒ‹‚ސ„§‚ł‚ę‚Ä‚˘‚éBŠ‘ŽƒŠƒ“ƒpß—Ěˆć‚đŠÜ‚ß‚˝L‚˘”͈͂đĆŽË‚ˇ‚éę‡‚ɂ́C’x”­Ť—LŠQŽ–Ű‚đl—ś‚ľ1 ‰ńü—Ę‚Í1.8`2 Gy ‚đ—p‚˘‚Ä’Ęí•ŞŠ„ĆŽË‚ōs‚¤‚ą‚Ć‚Ş–]‚Ü‚ľ‚˘B

pŒăĆŽË‚ÉŠÜ‚ß‚é‚ׂŤ”͈͂Ɋւľ‚Ä‚ŕ“ˆęŒŠ‰đ‚Í‚˘‚Ü‚ž‚Č‚˘‚ށC“Şčň•”—Ěˆć‚ĚŽîᇁC–Ť‰ŠÇ‚â’×ᇂ𔭐ś•ę’n‚Ć‚ľ‚˝ŽîᇁC–Ɖu•s‘Só‘Ô‚ĚŠłŽŇ‚Č‚Ç‚Ĺ‚ÍŠ‘ŽƒŠƒ“ƒpß“]ˆÚ‚𐜂ś‚é‰Â”\Ť‚ލ‚‚˘‚ƍl‚Ś‚ç‚ę‚Ä‚˘‚é3jB‚Ü‚˝CŘœ’f’[‚Ş•s\•Ş‚ČÇ—á‚Ĺ‚ÍŒ´”­•”ˆĘ‚đC‚Ü‚˝‘˝”­ƒŠƒ“ƒpß“]ˆÚ‚â”í–ŒŠOZ—á‚Ĺ‚ÍŠ‘ŽƒŠƒ“ƒpß—Ěˆć‚đŠÜ‚ß‚˝•úŽËü—Ă–@‚đl—ś‚ˇ‚é10, 11, 14jB

pŒăĆŽË‚Ć‚ÍˆŮ‚Č‚é‚ŞCisŠúÇ—á‚É‚¨‚Ż‚éÇóŠÉ˜a‚Ě‚˝‚ß‚Ě•úŽËü—Ă–@‚ŕ—LŒř‚Ĺ‚ ‚č–ń”ź”‚ĚÇ—á‚ŏǏóŠÉ˜a‚Ş“ž‚ç‚ę‚é12jB‰“Šu“]ˆÚ—á‚Ĺ‚ ‚Á‚Ä‚ŕCśŠˆ‚ĚŽż‚ĚŒüă‚¨‚ć‚ŃˆŰŽ‚đ–Ú“I‚Ć‚ľ‚˝•úŽËü—Ă–@‚ŞŒŸ“˘‚ł‚ę‚éB

’1jNCCNFNational Comprehensive Cancer NetworkiVersion 2. 2013j

’2j‰đŕ•ś’†‚Ě•aŠú‚ÍŒ¤‹†ŠúŠÔ“–Žž‚ĚUICC •Ş—Ţ‚Ě‚ŕ‚Ě‚Ĺ‚ ‚čCŒťs‚Ě•aŠú•Ş—Ţ‚Ć‚ÍˆŮ‚Č‚é•”•Ş‚Ş‘˝‚˘B

•śŒŁ

1j Alam M, Ratner D: Cutaneous squamous-cell carcinoma, N Engl J Med, 2001; 344: 975-983.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

2j Rowe DE, Carroll RJ, Day CL Jr: Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection, J Am Acad Dermatol, 1992; 26: 976-990.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

3j Robin M, Bruce B, Richard B: Clinical Practice Guide Basal cell carcinoma, squamous cell carcinomaiand related lesionsj-a guide to clinical management in Australia. 2008.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

4j Tavin E, Persky M: Metastatic cutaneous squamous cell carcinoma of the head and neck region, Laryngoscope, 1996; 106: 156-158.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j McNab AA, Francis IC, Benger R, Crompton JL: Perineural spread of cutaneous squamous cell carcinoma via the orbit. Clinical features and outcome in 21 cases, Ophthalmology, 1997; 104: 1457-1462.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

6j Kraus DH, Carew JF, Harrison LB: Regional lymph node metastasis from cutaneous squamous cell carcinoma, Arch Otolaryngol Head Neck Surg, 1998; 124: 582-587.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j Taylor BW Jr, Brant TA, Mendenhall NP, et al: Carcinoma of the skin metastatic to parotid area lymph nodes, Head Neck, 1991; 13: 427-433.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

8j Veness MJ, Palme CE, Smith M, et al: Cutaneous head and neck squamous cell carcinoma metastatic to cervical lymph nodesinonparotidj: a better outcome with surgery and adjuvant radiotherapy, Laryngoscope, 2003; 113: 1827-1833.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

9j McCord MW, Mendenhall WM, Parsons JT, et al: Skin cancer of the head and neck with clinical perineural invasion, Int J Radiat Oncol Biol Phys, 2000; 47: 89-93.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

10j Chen AM, Grekin RC, Garcia J, et al: Radiation therapy for cutaneous squamous cell carcinoma involving the parotid area lymph nodes: dose and volume considerations, Int J Radiat Oncol Biol Phys, 2007; 69: 1377-1380.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

11j Han A, Ratner D: What is the role of adjuvant radiotherapy in the treatment of cutaneous squamous cell carcinoma with perineural invasion? Cancer, 2007; 109: 1053-1059.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

12j Jackson JE, Dickie GJ, Wiltshire KL, et al: Radiotherapy for perineural invasion in cutaneous head and neck carcinomas: toward a risk-adapted treatment approach, Head Neck, 2009; 31: 604-610.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

13j Lansbury L, Leonardi-Bee J, Perkins W, et al: Interventions for non-metastatic squamous cell carcinoma of the skin, Cochrane Database Syst Rev, 2010; 4: CD007869.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

14j Moore BA, Weber RS, Prieto V, et al: Lymph node metastases from cutaneous squamous cell carcinoma of the head and neck, Laryngoscope, 2005; 115: 1561-1567.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ11

—Lž™×–EŠŕŠłŽŇ‚̐ś‘ś—Ś‰ü‘P‚đ–Ú“I‚Ć‚ľ‚ďpŒă‚É’čŠú“I‚Č‰ć‘œŒŸ¸‚đs‚¤‚ą‚Ć‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

C2

—Տ°“IˆÓ‹`‚Ş•s–ž‚Ĺ‚ ‚čCŠî–{“I‚É‚ÍŠŠ‚ß‚ç‚ę‚Č‚˘B

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


Ą‰đŕ

—Lž™×–EŠŕiSCCj‚Ě‹ÇŠÄ”­‚Ć“]ˆÚ‚Ě95“‚́CŽĄ—ĂŒă5 ”NˆČ“ŕ‚ɏoŒť‚ˇ‚é‚Ć‚˘‚¤1jB‚ľ‚˝‚Ş‚Á‚āC­‚Č‚­‚Ć‚ŕ‚ą‚ĚŠúŠÔ‚́CÄ”­E“]ˆÚ‚Ěƒ`ƒFƒbƒN‚Ě‚˝‚ߌo‰ßŠĎŽ@‚ˇ‚é‚ą‚Ƃ́C“Á‚ɍ‚ƒŠƒXƒNŒQ‚É‚¨‚˘‚Ä‘Ă“–‚ƍl‚Ś‚ç‚ę‚éB‚ľ‚Š‚ľCpŒă‚ĚŒo‰ßŠĎŽ@‚É‚¨‚˘‚āC’čŠú“I‚Č‰ć‘œŒŸ¸‚ލĔ­E“]ˆÚ‚Ě‘Šú”­ŒŠ‚ÉŠń—^‚ľCś‘ś—Ś‚Şă¸‚ˇ‚é‚Š”Ű‚Š‚đ–ž‚ç‚Š‚É‚ľ‚˝•ń‚Í‘śÝ‚ľ‚Č‚˘B

SCC ‚ĚÄ”­E“]ˆÚC‚¨‚ć‚ѐVś•a•Ď‚Ě‘Šú”­ŒŠ‚đ–Ú“I‚Ć‚ľ‚˝’čŠú“I‰ć‘œŒŸ¸‚ĚˆÓ‹`‚͒Ⴂ‚ƍl‚Ś‚ç‚ę‚éB‚Ţ‚ľ‚ëCŠłŽŇ‚Ě‘i‚Ś‚đ—Ç‚­•ˇ‚ŤCŒ´”­‘ƒ•”‚ƏŠ‘ŽƒŠƒ“ƒpß—Ěˆć‚đ’š”J‚ɐfŽ@‚ľCĹŒă‚É“Á‚É“úŒő˜Io•”‚ɐVś•a•Ď‚Ş‚Č‚˘‚Š‚đŠĎŽ@‚ˇ‚é‚ą‚Ć‚Şd—v‚Ĺ‚ ‚éB‚Ü‚˝ŠłŽŇŽŠg‚É‚ć‚ég‘ĚŒŸő‚Ě‹łˆç‚ŕ•š‚š‚ÄŽŔŽ{‚ˇ‚ׂŤ‚Ĺ‚ ‚é1, 2jB

•śŒŁ

1j Motley R, Kersey P, Lawrence C: Multiprofessional guidelines for the management of the patient with primary cutaneous squamous cell carcinoma, Br J Dermatol, 2002; 146: 18-25.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

2j NCCN: Clinical practice guideline in oncology. Basal cell and squamous cell skin cancers. V.2. 2013, SCC-D 3 of 3.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅵj


CQ12

“úŒőŠp‰ťÇ‚ĚŽĄ—Â͉˝‚ŞŠŠ‚ß‚ç‚ę‚é‚Š

 

ŠO‰Č“IŘœ

„§“x

B

Šp‰ť‚ŞŒ°’˜‚Č•a•ĎC^”ç“ŕ‚ւ̐Z‚Ş‹^‚í‚ę‚éę‡CŽčpˆČŠO‚ĚŽĄ—Ă‚ĹŒř‰Ę‚Ş“ž‚ç‚ę‚Č‚Š‚Á‚˝Ç—á‚ɂ‚˘‚Ä‚Í‘gDŠw“I‚ČŠm”F‚ĚˆÓ–Ą‚ŕŠÜ‚ß‚ÄŠO‰Č“I‚Ȑ؏œ‚ŞŠŠ‚ß‚ç‚ę‚éB

 

“€Œ‹—Ă–@

„§“x

B

‰t‘Ě’‚‘f‚É‚ć‚é“€Œ‹—Ă–@‚ÍŠČ•Ö‚Ĺ—LŒř‚ČŽĄ—Ă–@‚Ć‚ľ‚ÄŠŠ‚ß‚ç‚ę‚éB

 

Photodynamic therapyiPDTj

„§“x

B

Photodynamic therapyiPDTj‚͍L”͈͂ɑśÝ‚ˇ‚é‘˝”­Ť‚Ě•a•Ď‚ĚŽĄ—Ă‚Ć‚ľ‚ÄŠŠ‚ß‚ç‚ę‚éi2013 ”N12 ŒŽŒťÝ•ŰŒŻ“K—pŠOjB

 

ƒCƒ~ƒLƒ‚ƒh

„§“x

B

ƒCƒ~ƒLƒ‚ƒh‚ÍŽčp‚â“€Œ‹—Ă–@‚đs‚˘‚É‚­‚˘‘˝”­Ť•a•Ď‚Č‚Ç‚ĚŽĄ—Ă‚Ć‚ľ‚ÄŠŠ‚ß‚ç‚ę‚éB

 

5-FU “îp

„§“x

B

5-FU “îp‚Í‘˝”­‚ˇ‚é”–‚˘•a•Ď‚ĚŽĄ—Ă‚Ć‚ľ‚ÄŠŠ‚ß‚ç‚ę‚éB

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Ą‰đŕ

“úŒőŠp‰ťÇ‚Í–Ť“I‚Č“úŒőŽ‡ŠOü‚Ě”˜˜I‚É‚ć‚Á‚Ä”­ś‚ľ‚˝ă”ç“ŕŠŕ‚ŁCŠç–Ę‚ĆŽč”w‚ɍD”­‚ˇ‚éB

“úŒőŠp‰ťÇ‚ĚŽĄ—Ă•ű–@‚É‚ÍŽčpC“€Œ‹—Ă–@C“d‹CÄŽÜC’YŽ_ƒKƒXƒŒ[ƒU[CphotodynamictherapyiPDTjC5-FU ‚âƒCƒ~ƒLƒ‚ƒh‚Č‚Ç‚Ě“îpŠO—p—Ă–@‚Č‚Ç‚Ş‚ ‚éB‚ą‚ę‚ç‚ĚŽĄ—Ă–@‚Ě‘I‘đ‚ɂ‚˘‚ẮC•a‘ƒ‚ĆŠłŽŇ‘¤‚Ě—vˆö‚ÉŠî‚Ă‚˘‚˝ƒKƒCƒhƒ‰ƒCƒ“‚ޏ”ŠO‘‚Š‚ç’ńˆÄ‚ł‚ę‚Ä‚˘‚éBƒKƒCƒhƒ‰ƒCƒ“–ˆ‚É‘˝­‚̍ˇ‚đ”F‚ß‚é‚ŞCŠî–{“I‚É‚Í’P”­‚Ĺ‚ ‚ę‚Γ€Œ‹—Ă–@‚âŠO—p—Ă–@C‘˝”­‚ľ‚Ä‚˘‚éę‡‚Í“€Œ‹—Ă–@CŠO—p—Ă–@CPDT ‚đCŠp‰ť‚Ş‹­‚˘•a•Ď‚â‘ź‚ĚŽĄ—Ă‚É”˝‰ž‚ľ‚Č‚Š‚Á‚˝•a‘ƒ‚â^”ç“ŕZ‚Ş‹^‚í‚ę‚éę‡‚Č‚Ç‚É‚ÍŽčp‚đ‘I‘đ‚ˇ‚é‚Ć‚˘‚¤•űj‚ވę”Ę“I‚Ĺ‚ ‚é1`5jB“úŒőŠp‰ťÇ‚ɂ‚˘‚Ä‚Í‘˝‚­‚ĚŽĄ—Ă–@‚Ş‘śÝ‚ˇ‚é‚˝‚߁C‚Ü‚¸ˆăŽt‚ÍŽĄ—Ă‘O‚ÉŠłŽŇ‚ɑ΂ľ‚Ä•Ą”‚ĚŽĄ—Ă–@‚ɂ‚˘‚Äŕ–ž‚ˇ‚ׂŤ‚Ĺ‚ ‚éB^”ç“ŕZ‚Ş‹^‚í‚ę‚é•a‘ƒ‚ÉŽčpˆČŠO‚ĚŽĄ—Ă‚đs‚¤ę‡‚́CŽĄ—Ă‘O‚ɐśŒŸ‚Ĺ•a—‘gDŠw“I‚ČŠm”F‚đs‚¤B

‰t‘Ě’‚‘f‚đ—p‚˘‚˝“€Œ‹—Ă–@‚ÍŠČ•Ö‚Ĺ‚ ‚čC“úŒőŠp‰ťÇ‚ɑ΂ˇ‚é—LŒř‚ČŽĄ—Ă–@‚Ĺ‚ ‚éB“€Œ‹—Ă–@‚Ě—LŒřŤ‚ɂ‚˘‚ẮCPDT ‚Č‚Ç‚Ć‚Ě”äŠrŽŽŒą‚ĚŒ‹‰Ę‚Ĺ‚ÍŠŽ‘SÁŽ¸—Śi12`24 TŒăj‚Í70“‘OŒă‚Ć•ń‚ł‚ę‚Ä‚˘‚é6, 7jB“€Œ‹ŽžŠÔ‚â“€Œ‹Žž‚ĚŠł•”‚̉ˇ“x‚ŞŞŽĄ—Ś‚ɉe‹ż‚đ—^‚Ś‚é‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚˘‚éB“€Œ‹ŽžŠÔ‚Ş5 •bˆČ‰ş‚Ĺ‚ĚŠŽ‘SÁŽ¸—ŚiŒa5 mm ˆČă‚Ě•a•ĎC1 mm ƒ}[ƒWƒ“C3 ƒJŒŽŒă‚É•]‰żj‚Í39“‚Ĺ‚ ‚Á‚˝‚̂ɑ΂ľC20 •bˆČă‚Ĺ‚Í83“‚ž‚Á‚˝‚Ć•ń‚ł‚ę‚Ä‚˘‚é8jB‚Ü‚˝C“€Œ‹—Ă–@Žž‚ĚŠł•”‚̉ˇ“x‚đ| 5 “xˆČ‰ş‚É‚ľ‚˝ę‡i36 –ź‚Ě180 ‚Ě”–‚˘•a•ĎCŽĄ—Ă6 TŒă‚Ě•]‰żj‚ĚŠŽ‘SÁŽ¸—Ś‚Í100“‚Ć•ń‚ł‚ę‚Ä‚˘‚é9jBŽ{pŽž‚Ě’É‚Ý‚Ş–â‘č‚Ĺ‚ ‚čCŽĄ–üŒă‚Éፍ­‚âF‘f’EŽ¸‚ŞŽc‚é‚ą‚Ć‚Ş‚ ‚éBŽĄ—ĂŒă‚ŕÄ”­‚Ě—L–ł‚ɂ‚˘‚Ä’čŠú“I‚ȐfŽ@‚Ş•K—v‚Ĺ‚ ‚éB

Šp‰ť‚ŞŒ°’˜‚Č•a•ĎC^”ç“ŕ‚ւ̐Z‚Ş‹^‚í‚ę‚éę‡CŽčpˆČŠO‚ĚŽĄ—Ă‚ĹŒř‰Ę‚Ş“ž‚ç‚ę‚Č‚Š‚Á‚˝•a‘ƒ‚ɂ‚˘‚Ä‚Í‘gDŠw“I‚ČŠm”F‚ĚˆÓ–Ą‚ŕŠÜ‚ß‚ÄŠO‰Č“I‚Ȑ؏œ‚ŞŠŠ‚ß‚ç‚ę‚éBƒ}[ƒWƒ“1 mm ‚Ő؏œ‚ľ‚˝ę‡‚Ě1 ”NŒă‚Ě‹ÇŠÄ”­—Ś‚Í4“‚Ĺ‚ ‚Á‚˝‚Ć‚Ě•ń‚Ş‚ ‚é10jB

PDT ‚͍L”͈͂ɑśÝ‚ˇ‚é‘˝”­Ť‚Ě“úŒőŠp‰ťÇ‚ɑ΂ľ‚Ä—LŒř‚ČŽĄ—Ă–@‚Ĺ‚ ‚éB“€Œ‹—Ă–@‚âŠO—p—Ă–@‚Ć‚Ě—D—ň‚ÉŠÖ‚ˇ‚éƒf[ƒ^‚͏\•Ş‚Ĺ‚Í‚Č‚˘‚ށCPDT ‚Í“€Œ‹—Ă–@‚É”ä‚ׂĎĄ—ĂŒă‚̐Ž—eŤ‚ɂ‚˘‚ďŸ‚é‚Ć‚Ě•ń‚Ş‚ ‚é6, 7jB5-FU ‚Ć‚Ě—L‰vŤ‚̍ˇ‚ÍŠm”F‚ł‚ę‚Ä‚˘‚Č‚˘BƒCƒ~ƒLƒ‚ƒh‚ɑ΂ľ‚Ä‚Í’†“™“xˆČă‚ĚŒú‚Ý‚Ě‚ ‚é•a•Ď‚É‚ÍPDT ‚Ě•ű‚ޏŸ‚é‚Ć‚Ě•ń‚Ş‚Č‚ł‚ę‚Ä‚˘‚é7jB–{–M‚ĹPDT ‚đs‚Ś‚éŽ{Ý‚ÍŒŔ‚ç‚ę‚Ä‚˘‚éB

ƒCƒ~ƒLƒ‚ƒh5“‚ÍŽčp‚â“€Œ‹—Ă–@‚đs‚˘‚É‚­‚˘‘˝”­Ť•a•Ď‚Č‚Ç‚É“K‰ž‚Ć‚Č‚éBT3 ‰ńC16 TŠÔŠO—p‚ĹŠŽ‘SÁŽ¸—Ś‚Í45`57“in  100 ˆČă‚ĚÇ—áWĎŒ¤‹†3 Œj‚Ć•ń‚ł‚ę‚Ä‚˘‚é11jB–{–M‚Ĺ‚ÍŠç–Ę‚Ć“Ă“Ş•”‚Ě•a•Ď‚Ě‚Ý‚É•ŰŒŻ“K—p‚Ĺ‚ ‚éB

5-FU “îp‚Í0.5“‚Š5“”Z“x‚Ĺ1 “ú2 ‰ńC4 TŠO—p‚Ĺ‚ĚŠŽ‘SÁŽ¸—Ś‚Í43`96“‚Ć•ń‚ł‚ę‚Ä‚˘‚é12jB‘˝”­‚ˇ‚é”–‚˘•a•Ď‚É“K‰ž‚Ć‚Č‚éB

•śŒŁ

1j Clinical Practice Guide, Basal cell carcinoma, squamous cell carcinomaiand related lesionsj-a guide to clinical management in Australia, Cancer Council Australia/Australian Camcer Network 2008.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

2j Stockfleth E, Ferrandiz C, Grob JJ, et al: Development of a treatment algorithm for actinic keratoses: a European Consensus, Eur J Dermatol, 2008; 18: 651-659.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

3j de Berker D, McGregor JM, Hughes BR: Guidelines for the management of actinic keratoses, Br J Dermatol, 2007; 156: 222-230.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

4j Rossi R, Calzavara-Pinton PG, Giannetti A, et al: Italian guidelines and therapeutic algorithm for actinic keratoses, G Ital Dermatol Venereol, 2009; 144: 713-723.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

5j Guidelines for the diagnosis and treatment of cutaneous squamous cell carcinoma and precursor lesions. Guidelines, Rev Stomatol Chir Maxillofac, 2010; 111: 228-237.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

6j Szeimies RM, Karrer S, Radakovic-Fijan S, et al: Photodynamic therapy using topical methyl 5-aminolevulinate compared with cryotherapy for actinic keratosis: A prospective, randomized study, J Am Acad Dermatol, 2002; 47: 258-262.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

7j Fayter D, Corbett M, Heirs M, et al: A systematic review of photodynamic therapy in the treatment of pre-can cerous skin conditions, Barrettfs oesophagus and cancers of the biliary tract, brain, head and neck, lung, oesophagus and skin, Health Technol Assess, 2010; 14: 1-288.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

8j Goldberg LH, Kaplan B, Vergilis-Kalner I, Landau J: Liquid nitrogen: temperature control in the treatment of actinic keratosis, Dermatol Surg, 2010; 36: 1956-1961.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

9j Thai KE, Fergin P, Freeman M, et al: A prospective study of the use of cryosurgery for the treatment of actinic keratoses, Int J Dermatol, 2004; 43: 687-692.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

10j œAŁ—ž“ńC•x‘şšDC•ÎŒb”üŽqC‰ĄŽR—mŽqF“úŒőŠp‰ťÇ‚Ě‘¤•ű’f’[—zŤ—á‚ɂ‚˘‚Ä‚ĚŒŸ“˘CSkin Cancer, 2010; 25: 85-89.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

11j Krawtchenko N, Roewert-Huber J, Ulrich M, et al: A randomised study of topical 5“ imiquimod vs. topical 5-fluorouracil vs. cryosurgery in immunocompetent patients with actinic keratoses: a comparison of clinical and histological outcomes including 1-year follow-up, Br J Dermatol, 2007; 157iSuppl 2j: 34-40.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

12j Askew DA, Mickan SM, Soyer HP, Wilkinson D: Effectiveness of 5-fluorouracil treatment for actinic keratosis\a systematic review of randomized controlled trials, Int J Dermatol, 2009; 48: 453-463.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj


CQ13

ƒ{[ƒGƒ“•a‚ĚŽĄ—Â͉˝‚ŞŠŠ‚ß‚ç‚ę‚é‚Š

 

ŠO‰Č“IŘœ

„§“x

B

1`4 mm ’ö“x—Ł‚ľ‚Đ؏œ‚ˇ‚é‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éB

 

“€Œ‹—Ă–@

„§“x

B

Řœ‚ލ˘“ď‚Čę‡‚͉t‘Ě’‚‘f‚É‚ć‚é“€Œ‹—Ă–@‚đs‚¤‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éB

 

Photodynamic therapyiPDTj

„§“x

B

Photodynamic therapyiPDTj‚đs‚¤‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éi2013 ”N12 ŒŽŒťÝ•ŰŒŻ“K—pŠOjB

 

5-FU “îp

„§“x

B

5-FU “îp‚đŠO—p‚ˇ‚é‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éB

 

ƒCƒ~ƒLƒ‚ƒh

„§“x

B

ƒCƒ~ƒLƒ‚ƒh‚đŠO—p‚ˇ‚é‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éi2013 ”N12 ŒŽŒťÝ•ŰŒŻ“K—pŠOjB

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•śŒŁ

1j Cox NH, Eedy DJ, Morton CA; Therapy Guidelines and Audit Subcommittee, British Association of Dermatologists: Guidelines for management of Bowenfs disease: 2006 update, Br J Dermatol, 2007; 156: 11-21.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

2j Basal cell and squamous cell skin cancers. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology 2010.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

3j Clinical Practice Guide, Basal cell carcinoma, squamous cell carcinomaiand related lesionsj-a guide to clinical management in Australia, Cancer Council Australia/Australian Cancer Network 2008.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

4j mGuidelines for the diagnosis and treatment of cutaneous squamous cell carcinoma and precursor lesions. Guidelines n, Rev Stomatol Chir Maxillofac, 2010; 111: 228-237.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

5j œAŁ—ž“ńC•x‘şšDC•ÎŒb”üŽqC‰ĄŽR—mŽqF“úŒőŠp‰ťÇ‚Ě‘¤•ű’f’[—zŤ—á‚ɂ‚˘‚Ä‚ĚŒŸ“˘, Skin Cancer, 2010; 25 : 85-89.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

6j Thestrup-Pedersen K, Ravnborg L, Reymann F: Morbus Bowen. A description of the disease in 617 patients, Acta Derm Venereol, 1988; 68: 236-239.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j Leibovitch I, Huilgol SC, Selva D, et al: Cutaneous squamous carcinoma in situiBowenfs diseasej: treatment with Mohs micrographic surgery, J Am Acad Dermatol, 2005; 52: 997-1002.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

8j Holt PJ: Cryotherapy for skin cancer: results over a 5-year period using liquid nitrogen spray cryosurgery, Br J Dermatol, 1988; 119: 231-240.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

9j Morton CA, Whitehurst C, Moseley H, et al: Comparison of photodynamic therapy with cryotherapy in the treatment of Bowenfs disease, Br J Dermatol, 1996; 135: 766-771.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

10j Morton C, Horn M, Leman J, et al: Comparison of topical methyl aminolevulinate photodynamic therapy with cryotherapy or Fluorouracil for treatment of squamous cell carcinoma in situ: Results of a multicenter randomized trial, Arch Dermatol, 2006; 142: 729-735.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

11j Ahmed I, Berth-Jones J, Charles-Holmes S, et al: Comparison of cryotherapy with curettage in the treatment of Bowenfs disease: a prospective study, Br J Dermatol, 2000; 143: 759-766.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

12j Fayter D, Corbett M, Heirs M, et al: A systematic review of photodynamic therapy in the treatment of precancerous skin conditions, Barrettfs oesophagus and cancers of the biliary tract, brain, head and neck, lung, oesophagus and skin, Health Technol Assess, 2010; 14: 1-288.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

13j Salim A, Leman JA, McColl JH, et al: Randomized comparison of photodynamic therapy with topical 5-fluorouracil in Bowenfs disease, Br J Dermatol, 2003; 148: 539-543.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

14j Perrett CM, McGregor JM, Warwick J, et al: Treatment of post-transplant premalignant skin disease: a randomized intrapatient comparative study of 5-fluorouracil cream and topical photodynamic therapy, Br J Dermatol, 2007; 156: 320-328.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

15j Bargman H, Hochman J: Topical treatment of Bowenfs disease with 5-Fluorouracil, J Cutan Med Surg, 2003; 7: 101-105.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

16j Sturm HM: Bowenfs disease and 5-fluorouracil, J Am Acad Dermatol, 1979; 1: 513-522.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

17j Patel GK, Goodwin R, Chawla M, et al: Imiquimod 5“ cream monotherapy for cutaneous squamous cell carcinoma in situiBowenfs diseasej: a randomized, doubleblind, placebo-controlled trial, J Am Acad Dermatol, 2006; 54: 1025-1032.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj


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ŠCŠO‚ĚƒKƒCƒhƒ‰ƒCƒ“‚Ĺ‚ŕCŒo‰ßŠĎŽ@‚ˇ‚é‚Ě‚Ĺ‚Í‚Č‚­C‘Šú‚Ě‘SŘœ‚đŠŠ‚ß‚Ä‚˘‚é5, 6jB•a•Ď‚Ě‘ĺ‚Ť‚ł‚␎—e–ʁCŠłŽŇ‚Ě—‰đ‚Ş“ž‚ç‚ę‚Č‚˘‚Č‚Ç‚Ě——R‚Ĺ‘Šú‚É‘S“Eo‚Ĺ‚Ť‚Č‚˘ę‡‚́CpŒă‚Ě•a•Ď‚Ě‘‘ĺ‚ɂ‚˘‚Ă̑Ήž‚𐎂Ś‚˝ă‚ŁC‘S‘̍\’z‚Ě‚í‚Š‚é‚悤‚Č•”•ŞśŒŸ‚đŽ{s‚ˇ‚ą‚Ć‚Ş–]‚Ü‚ľ‚˘B•a—‘gDŠw“I‚ÉŒo‰ßŠĎŽ@‚މ”\‚Ć”ť’f‚ľ‚˝ę‡‚Ĺ‚ŕC•a•Ď‚Ě‹}‘Ź‚Č‘‘ĺ‚Ş‚ ‚é‰Â”\Ť‚đŕ–ž‚ľCŽc‘ś•a•Ď‚Ě‘ŢkŒXŒü‚ŞŠm”F‚Ĺ‚Ť‚é‚Ü‚Ĺ‚ÍT‚Ɉę“x’ö“x‚͐fŽ@‚ľ‚āCTd‚É‚ť‚ĚŒo‰ß‚đ’Ç‚¤•K—v‚Ş‚ ‚éB

•śŒŁ

1j Schwartz RA: Keratoacanthoma: A clinico-pathologic enigma, Dermatol Surg, 2004; 30: 326-333.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅵj

2j Hodak E, Jones RE, Ackerman AB: Solitary keratoacanthoma is a squamous-cell carcinoma: Three examples with metastasis, Am J Dermatopathol, 1993; 15: 332-342.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅴj

3j ˆŔâVáÁˆęC–Ř‘ş“SéFƒPƒ‰ƒgƒAƒJƒ“ƒg[ƒ}\Ĺ‹ß‚Ě˜b‘čC”畆•af—ÁC2010; 32: 600-606. iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅵj

4j Schwartz RA: Keratoacanthoma, J Am Acad Dermatol, 1994; 30: 1-19.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅵj

5j Clinical Practice Guide, Basal cell carcinoma, squamous cell carcinomaiand related lesionsj-a guide to clinical management in Australia, Cancer Council Australia/Australian Cancer Network 2008.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

6j Guidelines for the diagnosis and treatment of squamous cell carcinoma and precursor lesions, Guidelines Ann Dermatol Venereol, 2009; 136: S177-S186.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

SCC@CQ1`CQ14 ˆę——
CQ   „§“x „§•ś
  1. 1D—Lž™×–EŠŕ‚Ě”­ś—Ś‚đŒ¸­‚ł‚š‚é–Ú“I‚ĹŽ‡ŠOü–hŒä‚đs‚¤‚ą‚Ć‚ÍŠŠ‚ß‚ç‚ę‚é‚Š
“ú–{l‚Ě’†‚Ĺ‚ŕF”’‚ŐF‘f’ž’…‚đ‹N‚ą‚ľ‚É‚­‚˘ƒXƒLƒ“ƒ^ƒCƒv‚ĚŽŇ B Ž‡ŠOü–hŒä‚ŞŠŠ‚ß‚ç‚ę‚éB
ă‹LˆČŠO‚Ě“ú–{l‚̑唟‚đč‚ß‚éƒXƒLƒ“ƒ^ƒCƒv‚ĚŽŇ C1 Ž‡ŠOü–hŒä‚đl—ś‚ľ‚Ä‚ŕ‚悢‚ށC‚ť‚Ě—L‰vŤ‚Í•s–ž‚Ĺ‚ ‚éB
  1. 2D—Lž™×–EŠŕŠłŽŇ‚ɏp‘O‚Ě‰ć‘œŒŸ¸‚đs‚¤‚ą‚Ć‚ÍŠŠ‚ß‚ç‚ę‚é‚Š
  C1 ƒŠƒ“ƒpß“]ˆÚ‚đ‹N‚ą‚ľ‚₡‚˘ˆöŽq‚đŽ‚Âę‡‚âC—Šw“I‚É“]ˆÚ‚Ş‹^‚í‚ę‚éę‡C‚ ‚邢‚ÍŒ´”­‘ƒ‚ĚŠg‚Ş‚č‚đ•]‰ż‚ˇ‚éę‡‚ɂ́Cp‘O‚Ě‰ć‘œŒŸ¸‚đl—ś‚ľ‚Ä‚ŕ‚悢B
  1. 3D—Lž™×–EŠŕ‚ĚŒ´”­‘ƒ‚Í•a‘ƒ•Ó‰‚Š‚牽mm —Ł‚ľ‚Đ؏œ‚ˇ‚é‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚é‚Š
  B 6 mm ˆČă—Ł‚ľ‚Đ؏œ‚ˇ‚é‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éB’჊ƒXƒNŒQi‰đŕ‚¨‚ć‚Ń•Ę•\ŽQĆj‚Ĺ‚ ‚é‚ą‚Ć‚ŞŠmŽŔ‚ČÇ—á‚Í4mm ˆČă—Ł‚ľ‚Đ؏œ‚ˇ‚é‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éB
  1. 4D—Lž™×–EŠŕ‚ĚŒ´”­‘ƒ‚ɑ΂ľ‚ÄMohs Žčp‚đs‚¤‚ą‚Ć‚ÍŠŠ‚ß‚ç‚ę‚é‚Š
  C1 Ž{p‚ɐ¸’Ę‚ľ‚Ä‚˘‚éˆăŽt‚Ş‚˘‚éŽ{Ý‚Ĺ‚Ís‚¤‚ą‚Ć‚đl—ś‚ľ‚Ä‚ŕ‚悢i2013 ”N12 ŒŽŒťÝ•ŰŒŻ“K—pŠOjB
  1. 5D—Lž™×–EŠŕŠłŽŇ‚̐ś‘ś—Ś‚̉ü‘P‚đ–Ú“I‚Ć‚ľ‚Ä—\–h“IƒŠƒ“ƒpßŠs´‚đŽŔŽ{‚ˇ‚é‚ą‚Ć‚ÍŠŠ‚ß‚ç‚ę‚é‚Š
  C2 —Տ°“IˆÓ‹`‚Ş•s–ž‚Ĺ‚ ‚čCŠî–{“I‚É‚ÍŠŠ‚ß‚ç‚ę‚Č‚˘B
  1. 6D—Lž™×–EŠŕŠłŽŇ‚ɃZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßśŒŸ‚đs‚¤‚ą‚Ć‚ÍŠŠ‚ß‚ç‚ę‚é‚Š
  C1 ƒŠƒ“ƒpßŽî’Ż‚Í‚Č‚˘‚Ş“]ˆÚ‚̉”\Ť‚ލ‚‚˘‚ƍl‚Ś‚ç‚ę‚éÇ—á‚ɂ́CƒZƒ“ƒ`ƒlƒ‹ƒŠƒ“ƒpßśŒŸ‚đl—ś‚ľ‚Ä‚ŕ‚悢i2013 ”N12 ŒŽŒťÝ•ŰŒŻ“K—pŠOjB
  1. 7D—Lž™×–EŠŕ‚̉“Šu“]ˆÚ‘ƒ‚đŠO‰Č“I‚ɐ؏œ‚ˇ‚é‚ą‚Ć‚ÍŠŠ‚ß‚ç‚ę‚é‚Š
  C2 —Տ°“IˆÓ‹`‚ÍŘ–ž‚ł‚ę‚Ä‚˘‚Č‚˘‚̂ŁCŠî–{“I‚É‚ÍŠŠ‚ß‚ç‚ę‚Č‚˘B
  1. 8DŽčp•s”\‚Č—Lž™×–EŠŕ‚ĚŒ´”­‘ƒEŠ‘ŽƒŠƒ“ƒpß“]ˆÚE‰“Šu“]ˆÚ‚ɑ΂ľ‚ĉťŠw—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š
  C1 Žčp‚â•úŽËü—Ă–@‚ލ˘“ď‚ČÇ—á‚ɑ΂ˇ‚é‘ă‘Ö—Ă–@C‚ ‚邢‚͊ɘa—Ă–@‚Ć‚ľ‚ĉťŠw—Ă–@‚đs‚¤‚ą‚Ć‚đl—ś‚ľ‚Ä‚ŕ‚悢B
  1. 9D—Lž™×–EŠŕ‚ɑ΂ľ‚ÄŞŽĄ“I•úŽËü—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š
  B Žčp—Ă–@‚Ş“K‰ž‚Ć‚Č‚ç‚Č‚˘—Lž™×–EŠŕ‚ɑ΂ľ‚Ä‚ÍŞŽĄ“I•úŽËü—Ă–@‚đs‚¤‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éB
  1. 10D—Lž™×–EŠŕ‚ɑ΂ľ‚ďpŒă•úŽËü—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š
  B Ä”­‚ĚŠëŒŻŤ‚ލ‚‚˘Ç—á‚ɑ΂ľ‚Ă͏pŒă•úŽËü—Ă–@‚đs‚¤‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚é
  1. 11D—Lž™×–EŠŕŠłŽŇ‚̐ś‘ś—Ś‰ü‘P‚đ–Ú“I‚Ć‚ľ‚ďpŒă‚É’čŠú“I‚Č‰ć‘œŒŸ¸‚đs‚¤‚ą‚Ć‚ÍŠŠ‚ß‚ç‚ę‚é‚Š
  C2 —Տ°“IˆÓ‹`‚Ş•s–ž‚Ĺ‚ ‚čCŠî–{“I‚É‚ÍŠŠ‚ß‚ç‚ę‚Č‚˘B
  1. 12D“úŒőŠp‰ťÇ‚ĚŽĄ—Â͉˝‚ŞŠŠ‚ß‚ç‚ę‚é‚Š
ŠO‰Č“IŘœ B Šp‰ť‚ŞŒ°’˜‚Č•a•ĎC^”ç“ŕ‚ւ̐Z‚Ş‹^‚í‚ę‚éę‡CŽčpˆČŠO‚ĚŽĄ—Ă‚ĹŒř‰Ę‚Ş“ž‚ç‚ę‚Č‚Š‚Á‚˝Ç—á‚ɂ‚˘‚Ä‚Í‘gDŠw“I‚ČŠm”F‚ĚˆÓ–Ą‚ŕŠÜ‚ß‚ÄŠO‰Č“I‚Ȑ؏œ‚ŞŠŠ‚ß‚ç‚ę‚éB
“€Œ‹—Ă–@ B ‰t‘Ě’‚‘f‚É‚ć‚é“€Œ‹—Ă–@‚ÍŠČ•Ö‚Ĺ—LŒř‚ČŽĄ—Ă–@‚Ć‚ľ‚ÄŠŠ‚ß‚ç‚ę‚éB
Photodynamic therapyiPDTj B Photodynamic therapyiPDTj‚͍L”͈͂ɑśÝ‚ˇ‚é‘˝”­Ť‚Ě•a•Ď‚ĚŽĄ—Ă‚Ć‚ľ‚ÄŠŠ‚ß‚ç‚ę‚éi2013 ”N12 ŒŽŒťÝ•ŰŒŻ“K—pŠOjB
ƒCƒ~ƒLƒ‚ƒh B ƒCƒ~ƒLƒ‚ƒh‚ÍŽčp‚â“€Œ‹—Ă–@‚đs‚˘‚É‚­‚˘‘˝”­Ť•a•Ď‚Č‚Ç‚ĚŽĄ—Ă‚Ć‚ľ‚ÄŠŠ‚ß‚ç‚ę‚éB
5-FU “îp B 5-FU “îp‚Í‘˝”­‚ˇ‚é”–‚˘•a•Ď‚ĚŽĄ—Ă‚Ć‚ľ‚ÄŠŠ‚ß‚ç‚ę‚éB
  1. 13Dƒ{[ƒGƒ“•a‚ĚŽĄ—Â͉˝‚ŞŠŠ‚ß‚ç‚ę‚é‚Š
ŠO‰Č“IŘœ B 1`4mm ’ö“x—Ł‚ľ‚Đ؏œ‚ˇ‚é‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éB
“€Œ‹—Ă–@; B Řœ‚ލ˘“ď‚Čę‡‚͉t‘Ě’‚‘f‚É‚ć‚é“€Œ‹—Ă–@‚đs‚¤‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éB
Photodynamic therapyiPDTj; B Photodynamic therapyiPDTj‚đs‚¤‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éi2013 ”N12 ŒŽŒťÝ•ŰŒŻ“K—pŠOjB
5-FU “îp B 5-FU “îp‚đŠO—p‚ˇ‚é‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éB
ƒCƒ~ƒLƒ‚ƒh B ƒCƒ~ƒLƒ‚ƒh‚đŠO—p‚ˇ‚é‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éi2013 ”N12 ŒŽŒťÝ•ŰŒŻ“K—pŠOjB
  1. 14D—Տ°“I‚É’P”­ŤƒPƒ‰ƒgƒAƒJƒ“ƒg[ƒ}‚đ‹^‚Á‚˝‚Ć‚Ť‚ɂǂ̂悤‚ȏ‰Šú‘Ήž‚ŞŠŠ‚ß‚ç‚ę‚é‚Š
  B •a—‘gDŠw“I‚ɐf’f‚đŒŸ“˘‚ˇ‚é‚˝‚߂ɁC‚Ĺ‚Ť‚éŒŔ‚葁Šú‚É‘S“Eo‚ˇ‚é‚ą‚Ć‚đŠŠ‚ß‚éB‘S“Eo‚ލ˘“ď‚Čę‡‚ɂ́C‘S‘̍\’z‚Ş‚í‚Š‚é‚悤‚Č•”•ŞśŒŸ‚Őf’f‚đŒŸ“˘‚ˇ‚é‚ą‚Ć‚đŠŠ‚ß‚éB
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  • ”­ś•”ˆĘ‚Ć’źŒa

    Šçi頰EŠzˆČŠOjE‰A•”EŽč‘Ť‚Ĺ6 mm ˆČă
    “ށE頰EŠzEčň•”E‘Oăřœ•”‚Ĺ10 mm ˆČă
    ‘ĚŠ˛EŽlŽˆi‘Oăřœ•”CŽč‘Ť‚đœ‚­j‚Ĺ20 mm ˆČă

  • —Տ°ŠŒŠ

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    –Ɖu—}§ó‘Ô
    Ä”­—á
    ‹}‘Ź‚Č‘‘ĺ
    ‹ŤŠE•s‘N–ž
    _ŒoÇó‚ ‚č

  • ‘gDŠw“IŠŒŠ

    ’†`’á•Ş‰ť
    adenoid, adenosquamous, desmoplastic type
    [’B“x‚ރŒƒxƒ‹Ⅳi–ԏó‘w‚ɐN“üjˆČă
    Žîᇌú‚Ş2 mm ˆČă
    _ŒoE–ŹŠÇZ

* ă‹L‚Ěˆę‚‚łŕŠY“–‚ˇ‚éę‡‚͍‚ƒŠƒXƒNŒQ‚Ć‚ľCˆę‚‚ŕŠY“–‚ľ‚Č‚˘ę‡‚Ě‚Ý’áƒŠƒXƒNŒQ‚Ć‚ˇ‚éB
iNCCNFClinical practice guideline in oncology. Basal cell and squamous cell skin cancers. V.2. 2013, SCC-A ‚ć‚čˆę•”‰ü•Ďj