Malignant melanoma of the trunk: A Retrospective review of 1128 patiens
Malignant melanoma of the trunk: A Retrospective review of 1128 patiens
复制标题
躯干恶性黑色素瘤：1128 例患者的回顾性分析
作者：
I. Ariel
在1935-1975年期间，在纽约帕克医疗集团的3，305例恶性黑色素瘤患者中，有1，128例（34%）躯干黑色素瘤。胸壁皮肤黑色素瘤646例（占所有黑色素瘤的20%），腹壁黑色素瘤482例（占15%）。在超过10年前接受治疗的646例患者中，138例不确定，因为他们仅在咨询或有血源性播散性黑色素瘤证据时才被发现。在确定的516例患者中，148例在10年后没有黑色素瘤的证据，绝对10年生存率为29%。所有死亡或失访的患者均被视为死于黑色素瘤。在386例胸壁黑色素瘤患者中，296例确定，其中88例（30%）存活了10年。在260例腹壁黑色素瘤患者中，220例确定，60例（27%）在治疗后10年存活良好。在340名男性中，有74名（22%）存活了10年，远低于148名女性的32%。254名患者中存在先前的痣，导致10年生存率为45%，远高于116名患者的痣新发，其中27%的患者存活了10年。在50例浅表性黑色素瘤患者中，34例（68%）存活了10年。386例浸润性黑色素瘤患者的10年生存率为22%。I期患者的10年生存率为59%。在262例II期患者中，10年生存率降至14%，而60例III期患者的10年生存率为7%。胸壁黑色素瘤和腹壁黑色素瘤的情况相同。在122例I期黑色素瘤患者中进行了选择性淋巴结清扫，在42例（34%）中观察到黑色素瘤的显微镜证据。淋巴结阳性患者的10年生存率为38%。在62例患者中，没有进行选择性淋巴结清扫，26例（42%），转移的临床证据后来发展。其中6例（23%）在治疗性淋巴结清扫术后存活了10年。我们得出结论，深度超过1 ml（Breslow分类）或Clark‐Mihm分类中的III级、IV级和V级的黑色素瘤，有必要进行选择性区域淋巴结清扫。进一步的研究是必要的，以确定浅表（II级）黑色素瘤的确切治疗程序。I级黑色素瘤不应包括在转移性恶性黑色素瘤的报告中。
Of 3,305 patients with malignant melanoma seen at the Pack Medical Group, New York, during the period from 1935–1975, there were 1,128 (34%) melanomas of the trunk. There were 646 melanomas of the skin of the chest wall (20% of all melanomas) and 482 melanomas of the abdominal wall (15%). Of 646 patients treated more than ten years ago, 138 were indeterminate as they were seen only in consultation or with evidence of blood‐borne disseminated melanoma. Of the determinate 516 patients, 148 are free of evidence of melanoma after ten years, giving an absolute ten‐year survival rate of 29%. All patients who died or who were lost to followup were considered to have died from the melanoma. Of 386 patients with melanoma of the thoracic wall, 296 were determinate, of which 88 (30%) have survived the ten‐year period. Of the 260 patients with melanoma of the abdominal wall, 220 were determinate and 60 (27%) are alive and well ten years post treatment. Of 340 males, 74 survived the ten‐year period (22%), much lower than the 32% ten‐year survival of the 148 females. A preceding mole which existed in 254 patients resulted in a ten‐year survival rate of 45%, much higher than the 116 patients whose moles arose de novo, of which 27% survived the ten year period. Of fifty patients with superficial melanomas, 34 (68%) survived ten years. The ten‐year survival of 386 patients with infiltrating melanomas was 22%. The ten‐year survival for patients in Stage I was 59%. Of 262 patients in Stage II, the ten‐year survival rate decreased to 14% and for the 60 patients in Stage III, the ten‐year survival rate was 7%. The situation was the same for melanomas of the chest wall as well as for the abdominal wall. Elective node dissection was performed in 122 patients with Stage I melanoma and in 42 (34%), microscopic evidence of melanoma was observed. The ten‐year survival of patients with positive nodes was 38%. In 62 patients, no elective node dissection was performed and in 26 (42%), clinical evidence of metastases developed later. Of these, six (23%) survived the ten year period after a therapeutic lymph node dissection. We conclude that melanomas over 1 ml in depth (Breslow's classification), or Levels III, IV and V in Clark‐Mihm's classification, elective regional lymph node dissection is warranted. Further studies are necessary to determine the exact treatment procedures for the superficial (Level II) melanomas. Level I melanomas should not be included in a report of metastasizing malignant melanoma.