Multiple primary melanomas: Implications for screening and follow-up programs for melanoma
Multiple primary melanomas: Implications for screening and follow-up programs for melanoma
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DOI：
10.1007/bf02316806
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发表时间：
1997-01-01
影响因子：
3.7
通讯作者：
Reintgen, DS
中科院分区：
文献类型：
--
作者：
Brobeil, A;Rapaport, D;Reintgen, DS
背景：与正常人群相比，一旦个人被诊断为恶性黑色素瘤，他们发展成另一种黑色素瘤的风险增加。方法：通过对2,600名连续登记的黑色素瘤患者的电子病历数据库进行回顾查询，以确定强化随访方案对随后诊断的原发黑色素瘤的疾病阶段的影响。结果：67名患者(2.6%)在就诊时或2个月内(同步)诊断出另一种黑色素瘤，另有44名患者(1.7%)在随访期内(异时性)发展为第二种原发黑色素瘤。在44例被诊断为异时性病变的患者中，第一次侵袭性黑色素瘤的Breslow平均厚度为2.27 mm，第二次侵袭性黑色素瘤的Breslow平均厚度为0.90 mm。第一个诊断的黑色素瘤平均厚3.8毫米(p=0.008)。初始黑色素瘤的平均克拉克水平高于后来诊断的黑色素瘤的平均水平(p=0.002)。最初的黑色素瘤有23%是溃烂的，而第二原发灶中只有一个显示出这种不利的预后因素(p=0.002)。结论：一旦个体被诊断为黑色素瘤，他们就是被诊断为其他原发部位黑色素瘤的高危人群，应该被置于包括全面皮肤检查的强化随访方案中。
Background: Once individuals are diagnosed with malignant melanoma, they are at an increased risk of developing another melanoma when compared with the normal population.Methods: To determine the impact of an intensive follow-up protocol on the stage of disease at diagnosis of subsequent primary melanomas, a retrospective query was performed of an electronic medical record database of 2,600 consecutively registered melanoma patients.Results: Sixty-seven patients (2.6%) had another melanoma diagnosed at the time of presentation to the clinic or within 2 months (synchronous) and another 44 patients (1.7%) developed a second primary melanoma during the follow-up period (metachronous). For the 44 patients diagnosed with metachronous lesions, the Breslow mean tumor thickness for the first invasive melanoma was 2.27 mm compared with 0.90 mm for the second melanoma. The first melanomas diagnosed are thicker by an average of 3.8 mm (p = 0.008). The mean Clark level for the initial melanoma was greater than the mean level for subsequently diagnosed melanomas (p = 0.002). Twenty-three percent of the initial melanomas were ulcerated, whereas only one of the second primary lesions showed this adverse prognostic factor (p = 0.002).Conclusions: Once individuals are diagnosed with melanoma, they are in a high-risk population for having other primary site melanomas diagnosed and should be placed in an intensive follow-up protocol consisting of a complete skin examination.