EXPERIENCE WITH 998 CUTANEOUS MELANOMAS OF THE HEAD AND NECK OVER 30 YEARS
EXPERIENCE WITH 998 CUTANEOUS MELANOMAS OF THE HEAD AND NECK OVER 30 YEARS
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DOI：
10.1016/0002-9610(91)90138-4
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发表时间：
1991-10-01
影响因子：
3
通讯作者：
MCCARTHY, WH
中科院分区：
文献类型：
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作者：
OBRIEN, CJ;COATES, AS;MCCARTHY, WH
在1960至1990年间，共有998名患者在悉尼黑色素瘤单位接受头颈部皮肤黑色素瘤的治疗。其中男性595例，女性403例，中位年龄53岁。最常见的原发部位是面部(47%)，其次是颈部(29%)、头皮(14%)和耳朵(10%)。组织学类型：浅表性播散型30%，结节性黑色素瘤28%，恶性雀斑16%，其他26%。所有患者均接受手术治疗。52%的患者伤口一期闭合，45%的患者切除边缘小于或等于2厘米。共有152名患者接受治疗性颈淋巴清扫术，234名患者接受择期颈淋巴清扫术。总体局部复发率为13%，这与肿瘤厚度和Clark水平的增加有显著影响。颈淋巴清扫术后颈部复发率为24%，腮腺复发率为14%。全组黑色素瘤的5年生存率为77%，10年生存率为66%。通过单变量分析，生存率与年龄、肿瘤厚度、溃疡、解剖部位、组织学阳性结节和远处转移的存在显著不同。恶性雀斑黑色素瘤的诊断和选择性淋巴清扫似乎都能提高存活率。经多因素分析，除选择性淋巴结清扫术失去其有利影响外，所有这些因素仍是显著的预后因素。
Between 1960 and 1990, a total of 998 patients were treated at the Sydney Melanoma Unit for cutaneous melanoma of the head and neck. There were 595 male and 403 female patients, with a median age of 53 years. The most common primary lesion site was the face (47%), followed by the neck (29%), scalp (14%), and ear (10%). Histologic types were as follows: superficial spreading 30%, nodular melanoma 28%, lentigo maligna melanoma 16%, and other 26%. All patients underwent surgical treatment. Primary closure of wounds was achieved in 52% of patients, and excision margins were 2 cm or less in 45%. A total of 152 patients had therapeutic neck dissections, and 234 had elective neck dissections.The overall local recurrence rate was 13%, and this was significantly influenced by increasing tumor thickness and Clark level. The recurrence rate in the neck after neck dissection was 24%, and the rate of parotid recurrence was 14%.Melanoma-specific survival was 77% at 5 years and 66% at 10 years for the entire group. By univariate analysis, survival varied significantly with age, tumor thickness, ulceration, anatomic sub-site, histologically positive nodes, and the presence of distant metastases. A diagnosis of lentigo maligna melanoma and elective lymph node dissection both appeared to improve survival. With multivariate analysis, all of these factors remained significant prognostic factors except elective node dissection, which lost its beneficial influence.