The work is devoted to the diagnosis of skin melanoma. The article reflects the main factors affecting the survival of patients. The basic principles of melanoma diagnostics are presented. Methods for diagnosing skin melanoma, including invasive and non-invasive methods, are described in detail and with justification. Of the non-invasive methods for diagnosing skin melanoma, the role of physical examination and dermatoscopy in case of suspected melanoma is emphasized. Of the instrumental methods of examination, the use of such research methods as ultrasound, computed tomography, magnetic resonance imaging, positron emission tomography is con sidered. From laboratory methods, methods of molecular genetic research and determination of skin melanoma biomark ers are presented. Of the invasive methods, the use of biopsy methods such as excisional and incisional biopsy is considered, with specification of indications and contraindications for their use. At the end of the work, the main requirements for the early diagnosis of skin melanoma are listed. In conclusion, the latest trends in the diagnosis of skin melanoma, new non-invasive methods and an algorithm for diagnosing skin melanoma are identified.
The article deals with the problems of surgical treatment of skin melanoma. Modern surgical treatment of skin melanoma includes various surgical interventions: wide excision of primary skin melanoma, amputation of the finger or disarticulation of the phalanx of the finger, resection of the auricle with its reconstruction, and other operations. The paper discusses the importance of assessing the state of regional lymph nodes in skin melanoma to decide whether to perform lymph node dissection. In addition to adequate excision of primary skin melanoma, to ensure the radicalness of surgical treatment, according to indications, lymph node dissection is performed in case of met astatic lesions of regional lymph nodes. A modern approach to detecting latent metastases involves performing a biopsy of sentinel lymph nodes. The information obtained is extremely important not only in assessing the damage to regional lymph nodes, determin ing the stage of the disease, but also in choosing the tactics of treatment and predicting the course of the tumor. Significant in the work is the conclusion that regional lymph node dissection is performed only in case of met astatic lesions of regional lymph nodes, confirmed morphologically. Accordingly, the best option is to perform regional lymph node dissection simultaneously with excision of primary skin melanoma. Prophylactic lymph node dissection for skin melanoma is not recommended. In conclusion, the latest trends in the surgical treatment of skin melanoma are indicated: an adequate reduction in the indentation and volume of operations when removing primary melanomas, an increase in the role of sentinel lymph node biopsy, the need for morphological verification of lymph node involvement in justifying lymph node dissection, and an increase in the number of metastasectomy.
In modern medicine, the fluorescent dye indocyanine green (ICG) is used in the diagnosis and treatment of many diseases, including malignant neoplasms. The use of ICG is primarily due to such positive properties of the drug as chemical resistance and photostability, unique traceability and high lymphotropicity. The ICG preparation, as a fluorescent contrast agent, is used in the diagnosis of many diseases, in particular to determine the fraction of cardiac output, the function of blood flow of parenchymal organs (liver, spleen) and in ophthalmology, to assess the blood supply of intestinal anastomoses and in angiography. ICG is used in oncology in the surgical treatment of tumors. The fluorescent image under the control of infrared radiation makes it possible to identify the structures to be removed (tumor tissue, lymph nodes). The role of the fluorescent dye ICG in the mapping of signaling lymph nodes in oncology is high. The technique is highly informative in identifying lymph nodes involved in the tumor process, to determine the stage of the tumor, prediction and selection of antitumor therapy. In addition, ICG is used in photodynamic and photothermal therapy of tumors. Due to its photosensitizing properties, ICG is used to generate forms of oxygen or heat in order to destroy tumor cells.
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