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Klinicznie jawne węzły chłonne

Zmiany satelitarne i/lub zmiany in-transit

Biopsja podejrzanych węzłów chłonnych

Biopsja lub usunięcie podejrzanych zmian (jeśli biopsja niemożliwa) oraz biopsja klinicznie jawnych węzłów chłonnych

Badania obrazowe (ocena stopnia zaawansowania TNM)

Badania obrazowe (ocena stopnia zaawansowania TNM)

Radykalne (szerokie) wycięcie zmiany pierwotnej oraz limfadenektomia terapeutyczna (do rozważenia leczenie przedoperacyjne immunoterapią skojarzoną)

Zmiany możliwe do chirurgicznego leczenia radykalnego

Brak możliwości chirurgicznego leczenia radykalnego

Oznaczenie mutacji BRAF

Oznaczenie mutacji BRAF

Radykalne usunięcie zmian satelitarnych / in transit ± limfadenektomia (jeśli zajęte lokoregionalne węzły chłonne)

Leczenie uzupełniające: immunoterapia (BRAF±) lub terapia systemowa (BRAF+)

Dalsze leczenie indywidualne, zależnie od odpowiedzi na leczenie miejscowe, systemowe

Obserwacja (zgodna ze stopniem zaawansowania) FG U\FLQ\

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Leczenie miejscowe (chirurgia, RT, T-VEG, izolowana perfuzja kończynowa, elektrochemioterapia, leczenie systemowe)

Copyright © 2023-2026 Via Medica

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Copyright © 2023-2026 Via Medica

Czerniaki – stopień IV lub III nieoperacyjny

Badania obrazowe (ocena stopnia zaawansowania choroby), ewentualna biopsja w celu potwierdzenia rozsiewu, LDH, oznaczenie mutacji BRAF, jeżeli nie było wykonane wcześniej

Zmiany ograniczone, pojedyncze, resekcyjne

Zmiany rozsiane, liczne, nieresekcyjne

Przerzuty do OUN nieobecne

Przerzuty do OUN obecne

Leczenie systemowe: immunoterapia (BRAF±) lub terapia systemowa (BRAF+)

Chirurgiczne usunięcie zmian przerzutowych

Postępowanie zespołowe

Ocena możliwości leczenia chirurgicznego radykalnego

Leczenie systemowe: immunoterapia (BRAF±)

Leczenie systemowe, resekcja, radioterapia, leczenie objawowe

Brak możliwości chirurgicznego leczenia radykalnego

Chirurgiczne radykalne usunięcie zmian przerzutowych

Leczenie systemowe BRAF–

BRAF+

2. linia

Immunoterapia (ipilimumab – leczenie nierefundowane), chemioterapia, badania kliniczne

Immunoterapia (ipilimumab – leczenie nierefundowane) iBRAF/iMEK

3. linia

2. linia

Immunoterapia (ipilimumab – leczenie nierefundowane) iBRAF/iMEK

1. linia

1. linia

Immunoterapia (niwolumab, pembrolizumab, niwolumab/ipilimumab, niwolumab/relatlimab przy ekspresji PD-L1 < 1%)

3. linia

iBRAF/iMEK, chemioterapia, badania kliniczne

Immunoterapia (niwolumab, pembrolizumab, niwolumab/ipilimumab, niwolumab/relatlimab przy ekspresji PD-L1 < 1%)

2. linia

Immunoterapia (niwolumab, pembrolizumab)

1. linia

iBRAF/iMEK

Obserwacja: badania obrazowe w zależności od lokalizacji zmian przerzutowych, okresowa ocena LDH

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