Multiple primary melanoma: the impact of atypical naevi and follow up
Multiple primary melanoma: the impact of atypical naevi and follow up
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DOI：
10.1111/j.1365-2133.2010.09961.x
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发表时间：
2010-12-01
影响因子：
10.3
通讯作者：
Lotti, T.
中科院分区：
文献类型：
--
作者：
de Giorgi, V.;Rossari, S.;Lotti, T.
背景我们特别鼓励黑色素瘤患者定期随访皮肤科医生，并定期进行全身皮肤检查，以发现新的色素性病变或发现现有痣的显著变化。目的（性别、年龄、常见痣和非典型痣的数量、家族史，与多发性原发性黑色素瘤（MPM）相关并研究定期随访与第二原发性黑色素瘤肿瘤厚度之间的关系。方法我们对MPM患者进行回顾性分析，以评估危险因素。第二个原发性黑色素瘤从2000年至2004年在意大利佛罗伦萨大学皮肤科诊所治疗的所有经组织病理学证实的黑色素瘤患者的数据库中选择发生第二原发性黑色素瘤的黑色素瘤患者的病历。从患者记录中挑选的医疗数据如下：病史、典型痣的数目、非典型痣的存在、Breslow厚度、黑色素瘤的Clark级别和组织型、黑色素瘤的部位和患者对6个月随访检查的依从性。（调整后的比值比3.28，95%置信区间1.35-7.44）。此外，在未参加随访的受试者中，我们注意到第二个黑色素瘤的厚度显著更高，平均厚度为1.22 mm，而认真遵守随访的患者的平均厚度为0.36 mm结论首次通过定期随访和未定期随访患者的第二黑色素瘤厚度水平的真实的比较，支持了该临床方法的有效性。从该分析中获得的结果表明，随访是早期发现黑色素瘤的有效方法。
Background Patients with melanoma are especially encouraged to have regular follow-up visits with their dermatologist and to perform total-body skin examination on a routine basis to identify new pigmented lesions or detect significant changes in existing naevi.Objectives To identify main risk factors (sex, age, number of common and atypical naevi, family history, phototype) associated with multiple primary melanomas (MPM) and to investigate the association between regular follow up and tumour thickness of a second primary melanoma.Methods We performed a retrospective analysis of patients with MPM in order to evaluate risk factors for developing a second primary melanoma. Medical records of patients with melanoma who developed a second primary melanoma were selected from a database of all patients with histopathologically confirmed melanoma treated at the dermatology clinic of the University of Florence, Italy, from 2000 to 2004. Medical data culled from the patient records were as follows: medical history, number of typical naevi, presence of atypical naevi, Breslow thickness, Clark level and histotype of the melanomas, site of the melanomas and patient adherence to 6-month follow-up examinations.Results The presence of atypical naevi was associated with a higher risk of developing MPM (adjusted odds ratio 3.28, 95% confidence interval 1.35-7.44). Moreover, in the subjects who did not attend follow up, we noted that the thickness of the second melanoma was significantly higher, with a mean thickness of 1.22 mm, in comparison with patients with a careful adherence to follow up in whom the mean thickness was 0.36 mm (P = 0.0189).Conclusions For the first time, the validity of this clinical approach has been supported by real comparison of thickness levels of second melanoma in patients with or without periodical follow up. Results obtained from this analysis show that follow up is an effective method for early detection of melanoma.