22

457

4

4 22.49 22.11

4 22.11

radial grow phase

vertical grow phase

22.50

malignant melanomaMM

b.

d. c.

a.

22.49Clark

Hodgkin Hodgkin Hodgkin Hodgkin 90Hodgkin Hodgkin Hodgkin Hodgkin Hodgkin 22.6

Ann Arbor Costwolds

1 1Waldeyer

22

12

E

AB386 10

X 10 cm 1/3E 1CSPS

ListerTA,etal.JClinOncol198971630

http://www.derm-hokudai.jp/textbook/index.html

45822

22

satellite lesion

ABCDE 5 ABCDE

rule 22.12

amelanotic melanoma

C

lark

102

22.11 4

22.12ABCDE

A Asymmetry

B Borderlineirregularity

C Colorvariegation

D Diameterenlargement6mm

E Elevationofsurface

22

459

1,500 2,000

10 20

22.50melanomaabcd klmnop

a b c d e f ha b c d e f gg h ii jj kk ll mm nn oo ppa b c d e f ha b c d e f gg h ii jj kk ll mm nn oo ppa b c d e f ha b c d e f gg h ii jj kk ll mm nn oo ppa b c d e f ha b c d e f gg h ii jj kk ll mm nn oo pp

a b c d e f ha b c d e f gg h ii jj kk ll mm nn oo ppa b c d e f ha b c d e f gg h ii jj kk ll mm nn oo ppa b c d e f ha b c d e f gg h ii jj kk ll mm nn oo ppa b c d e f ha b c d e f gg h ii jj kk ll mm nn oo ppa b c d e f ha b c d e f gg h ii jj kk ll mm nn oo pp

a b c d e f ha b c d e f gg h ii jj kk ll mm nn oo ppa b c d e f ha b c d e f gg h ii jj kk ll mm nn oo ppa b c d e f ha b c d e f gg h ii jj kk ll mm nn oo ppa b c d e f ha b c d e f gg h ii jj kk ll mm nn oo pp

a b c d e f ha b c d e f gg h ii jj kk ll mm nn oo ppa b c d e f ha b c d e f gg h ii jj kk ll mm nn oo ppa b c d e f ha b c d e f gg h ii jj kk ll mm nn oo pp

46022

22

22.51

22.11

B

reslow

Breslows tumor thickness

Clark

parallel ridge patternatypical pigment net-

22.51

22.13 TNM

T tumorthickness /

Tis

T1 1 mm a 1/mm2b 1/mm2

T2 1.01 2.0 mm ab

T3 2.01 4.0 mm ab

pT4 4.0 mm ab

N

N0

N1 1 amicrometastasisbmacrometastasis

N2 2 3 amicrometastasisbmacrometastasisc in-transit

N3 4 in-transit

M LDHlactatedehydrogenase

M0

M1a

M1b

M1c

micrometastasis macrometastasis AJCC/UICC,2010.BalchCM,etal:JClinOncol27:6199,20092010413

22

461

work3

S-100 HMB-45 MART-1Melan

A

TNM 22.13

22.14CTPET

MEMO

5-S-

cysteinyl dopa5-S-CD1 p.11

Spitz

2 mm

1 cm

22.14AJCC/UICC2010

T N M T N M

Stage0 Tis N0 M0 Stage0 Tis N0 M0

StageA T1a N0 M0 StageA T1a N0 M0

StageB T1bT2aN0N0

M0M0 StageB

T1bT2a

N0N0

M0M0

StageA T2bT3aN0N0

M0M0 StageA

T2bT3a

N0N0

M0M0

StageB T3bT4aN0N0

M0M0 StageB

T3bT4a

N0N0

M0M0

StageC T4b N0 M0 StageC T4b N0 M0

Stage anyT N N0 M0

StageA T1a-4aT1a-4aN1aN2a

M0M0

StageB

T1b-4bT1b-4bT1a-4aT1a-4aT1a-4a

N1aN2aN1bN2bN2c

M0M0M0M0M0

StageC

T1b-4bT1b-4bT1b-4banyT

N1bN2bN2cN3

M0M0M0M0

Stage anyT anyN M1 Stage anyT anyN M1

0A

2010414

sentinel lymph node biopsy

46222

22

2 cm

Stage B

DAVFeron

IFN-b 22.15IFN-b 1 1

Stage

30

QOL

Stage 0

5 100957050

10

22.15 DAVFeron

day

1 2 3 4 5 6 7 8 9 10

80140 mg/m2 1 hr

5080 mg/m2 30 min

0.50.8 mg/m2 30 min

b 300 IU/body

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