Huisarts en wetenschap

, Volume 56, Issue 6, pp 290–294 | Cite as

Chirurgische behandeling melanomen

  • Kevin Wevers
  • Lukas Been
  • Harald Hoekstra
Nascholing
  • 112 Downloads

Samenvatting

Wevers KP, Been LB, Hoekstra HJ. Chirurgische behandeling van melanomen. Huisarts Wet 2013;56(6):290-4.

De incidentie van het melanoom blijft stijgen in Nederland. In diagnostiek en behandeling speelt chirurgie een belangrijke rol. De eerste diagnostische excisie, die meestal in de eerste lijn wordt uitgevoerd, is van groot belang voor het verdere beleid. Bij vastgestelde maligniteit volgt in de tweede lijn altijd een therapeutische re-excisie. De resectiemarge die de chirurg daarbij aanhoudt, hangt af van de zogeheten breslowdikte.

Bij een breslowdikte > 1 mm vindt re-excisie plaats in combinatie met een schildwachtklierprocedure. Bij een ‘positieve’ schildwachtklier volgt in principe een aanvullende lymfeklierdissectie. Het moet echter nog komen vast te staan of deze procedure ook daadwerkelijk de overleving verbetert. Als er al hematogene metastasen zijn, is chirurgisch ingrijpen (metastasectomie) in sommige gevallen nog mogelijk, maar de vijfjaarsoverleving van deze procedure is slechts 20-40%.

In de follow-up kijkt men vooral naar complicaties van de behandeling (wondinfectie, seroom, wondrandnecrose) en naar mogelijke locoregionale recidieven (de meeste worden ontdekt bij zelfcontrole door de patiënt). Vooral liesklierdissectie en aanvullende radiotherapie kunnen leiden tot complicaties die een snelle behandeling vereisen.

Abstract

Wevers KP, Been LB, Hoekstra HJ. Chirurgische behandeling van melanomen. Huisarts Wet 2013;56(6):290-4.

The incidence of cutaneous melanoma is rising in the Netherlands. Surgery is the cornerstone in the treatment (and staging) of melanoma. The diagnostic excision is often performed by the general practitioner, in which adequate effectuation is very important. A therapeutic re-excision is performed to increase local control. The resection margins are based on the Breslow thickness of the primary melanoma. In melanomas with a Breslow thickness of > 1 mm, a sentinel lymph node biopsy can be performed, providing the patient and physician with valuable prognostic information. In case of a positive sentinel lymph node or clinically apparent lymph node metastases, a lymph node dissection is performed. In sentinel-node positive patients, the pending MSLT-II trial should establish whether lymph node dissection improves survival compared to nodal observation using ultrasound. In case of hematogenous dissemination, highly selected patients with resectable metastases can undergo complete metastasectomy, which can lead to a 5-year survival of 20-40%. Follow-up of melanoma patients is aimed at postoperative complications (infection, seroma, necrosis), and detection of recurrent disease. For the general practitioner it is important to know that postoperative wound complications after lymph node dissections (with or without radiation therapy) are frequent and need prompt treatment.

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Copyright information

© Bohn, Stafleu van Loghum 2013

Authors and Affiliations

  • Kevin Wevers
    • 1
  • Lukas Been
    • 1
  • Harald Hoekstra
    • 1
  1. 1.afdeling Chirurgische oncologieUMC GroningenGroningenThe Netherlands

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