Correlation Between Appropriate Use Criteria and the Frequency of Subclinical Spread or Reconstruction With a Flap or Graft for Melanomas Treated With Mohs Surgery With Melanoma Antigen Recognized by T Cells 1 Immunostaining.
Correlation Between Appropriate Use Criteria and the Frequency of Subclinical Spread or Reconstruction With a Flap or Graft for Melanomas Treated With Mohs Surgery With Melanoma Antigen Recognized by T Cells 1 Immunostaining.
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适当使用标准与使用 T 细胞识别的黑色素瘤抗原进行莫氏手术治疗的黑色素瘤的皮瓣或移植物亚临床扩散或重建的频率之间的相关性 1 免疫染色。
DOI：
10.1097/dss.0000000000000693
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Miller,ChristopherJ
中科院分区：
文献类型：
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作者：
Etzkorn,JeremyR;Sobanko,JosephF;Shin,ThuzarM;Elenitsas,Rosalie;Chu,EmilyY;Gelfand,JoelM;Margolis,DavidJ;Newman,JasonG;Goldbach,Hayley;Miller,ChristopherJ
Mohs显微摄影手术（MMS）治疗黑色素瘤已公布的适当使用标准（AUC）是基于共识的意见。目的评估已公布的AUC是否能通过检测亚临床扩散或在皮瓣或移植物重建前确认清晰的显微边缘来鉴别黑色素瘤，MMS可能对患者有益。材料与方法对556例患者中的591例黑色素瘤进行回顾性队列研究，评估当前AUC（解剖位置、复发状态和肿瘤分期）与亚临床扩散或皮瓣或移植物重建的相关性。结果头部、颈部、生殖器、手、脚或胫前腿的原子位置与亚临床扩散的频率显著升高相关(优势比（or） 1.89, p=。0280)和皮瓣或移植物重建(or 10.3, p=。0001)。与原发病变相比，复发黑色素瘤有更高的亚临床扩散频率(OR 1.78, p=。0104)和皮瓣或移植物重建(or 1.67, p=。0217)。亚临床扩散和皮瓣或移植物重建的频率在原位和侵袭性黑色素瘤之间没有差异。结论解剖位置和复发情况是鉴别黑色素瘤可能受益于MMS的有效标准。肿瘤分期不是一个有用的标准，因为MMS对侵袭性和原位黑色素瘤的亚群都有类似的益处。
BACKGROUNDPublished appropriate use criteria (AUC) for Mohs micrographic surgery (MMS) for melanoma are based on consensus opinion.OBJECTIVETo evaluate whether published AUC identify melanomas for which MMS may benefit patients by detecting subclinical spread or confirming clear microscopic margins before flap or graft reconstruction.MATERIALS AND METHODSRetrospective cohort study of 591 melanomas in 556 patients evaluating the correlation between current AUC (anatomic location, recurrent status, and tumor stage) and subclinical spread or reconstruction with a flap or graft.RESULTSAnatomic location on the head, neck, genitalia, hands, feet, or pretibial leg was associated with a significantly higher frequency of subclinical spread (odds ratio (OR) 1.89, p=. 0280) and flap or graft reconstruction (OR 10.3, p=. 0001). Compared with primary lesions, recurrent melanomas had a higher frequency of subclinical spread (OR 1.78, p=. 0104) and reconstruction with a flap or graft (OR 1.67, p=. 0217). The frequencies of subclinical spread and flap or graft reconstruction did not differ between in situ and invasive melanomas.CONCLUSIONAnatomic location and recurrent status are useful criteria to identify melanomas that may benefit from MMS. Tumor stage is not a useful criterion, as MMS has similar benefits for subsets of both invasive and in situ melanomas.