Incidence of new and changed Nevi and melanomas detected using baseline images and dermoscopy in patients at high risk for melanoma
Incidence of new and changed Nevi and melanomas detected using baseline images and dermoscopy in patients at high risk for melanoma
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DOI：
10.1001/archderm.141.8.998
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发表时间：
2005-08-01
影响因子：
--
通讯作者：
Dowling, JP
中科院分区：
文献类型：
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作者：
Banky, JP;Kelly, JW;Dowling, JP
目的：通过基线全身摄影和皮肤镜检查，确定黑色素瘤高危人群中新发、改变和消退的色素痣和黑色素瘤的发生率。设计：对1992年1月1日至1997年12月31日期间接受基线皮肤摄影，并在1998年12月31日前至少有一次随访的黑色素瘤高危患者进行队列研究。地点：澳大利亚维多利亚州公立医院的皮肤科医生的私人诊所和一家公立医院的多学科黑色素瘤诊所。患者：共有309名患者至少有以下黑色素瘤危险因素中的一项：个人病史、家族史、主要观察指标：在研究间歇期发现和切除的新的、改变的和退化的痣和黑色素瘤的数量。而黑色素瘤的发生率增加(P=0.05)。基线时发育不良痣的数量与改变的痣(P<；001)和黑色素瘤(P=0.03)的发生率呈正相关。使用基线照相和皮肤镜检查与低活检率和早期发现黑色素瘤有关。与先前存在的黑色素痣相关的黑色素瘤的发展与基线摄影监测到的先前存在的皮损的改变没有直接关系。结论：黑色素痣是动态的，在所有新的和改变的黑素细胞病变中只有一小部分是黑色素瘤。与50岁以上的患者相比，50岁以下的患者黑色素瘤发生率较低，新发、改变和消退痣的发生率较高。在50岁以上的患者中，新的或改变的色素性病变更有可能是黑色素瘤。
objective: To determine the incidence of new, changed, and regressed nevi and melanomas in a cohort of patients at high risk for melanoma using baseline total body photography and dermatoscopy.Design: Cohort study of patients at high risk for melanoma who underwent baseline cutaneous photography between January 1, 1992, and December 31, 1997, and had at least I follow-up visit by December 31, 1998.Setting: Private practice rooms of I dermatologist in conjunction with a public hospital-based, multidisciplinary melanoma clinic in Victoria, Australia.Patients: A total of 309 patients who had at least I of the following risk factors for melanoma: personal history, family history, 100 or more nevi, or 4 or more dysplastic nevi.Main Outcome Measures: Number of new, changed, and regressed nevi and melanomas detected and excised during the study interval.Results: The incidence of new, changed, and regressed nevi decreased with increasing age (P < 001), whereas the incidence of melanomas increased (P=.05). The number of dysplastic nevi at baseline was positively associated with the incidence of changed nevi (P < 001) and melanomas (P=.03). The use of baseline photography and dermatoscopy was associated with low biopsy rates and early detection of melanomas. The development of melanoma in association with a preexisting nevus was not directly correlated with a change in a preexisting lesion monitored by baseline photography.Conclusions: Nevi are dynamic, and only a small percentage of all new and changed melanocytic lesions are melanomas. Patients younger than 50 years had a lower incidence of melanomas and a higher rate of new, changed, and regressed nevi when compared with patients older than 50 years. A new or changed pigmented lesion is more likely to be a melanoma in patients older than 50 years.