Thin melanomas - Predictive lethal characteristics from a 30-year clinical experience
Thin melanomas - Predictive lethal characteristics from a 30-year clinical experience
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DOI：
10.1097/01.sla.0000090446.63327.40
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发表时间：
2003-10-01
影响因子：
9
通讯作者：
Seigler, HF
中科院分区：
文献类型：
--
作者：
Kalady, MF;White, RR;Seigler, HF
背景数据：在过去的30年中，我们的机构在超过10，000例皮肤黑色素瘤患者中观察到约15%的患者存在淋巴结或转移性疾病，其中薄（45岁; P = 0.05）和Breslow厚度（>0.75 mm; P = 0.008）是显著的阴性预后特征。在具有这3种高风险特征的患者中，19.7%发展为晚期疾病（似然比6.3;与非高风险患者相比，P = 0.007）。这一组的淋巴结复发率是对照组的两倍多。复发患者的10年生存率显著降低（82%对45%; P < 0.0001）。令人惊讶的是，无论是溃疡，也不是克拉克水平预测先进的diseases.Conclusions：薄黑色素瘤是潜在的致命病变。长期随访确定了肿瘤在0.75 mm和1.0 mm之间的老年男性的高风险人群，其复发疾病的风险接近20%。传统上接受的阴性预后因素，如溃疡和不一致的克拉克水平是不能预测转移，在这个群体。考虑到复发性疾病的预后不良，我们建议进行密切的临床评估和随访，以最大限度地提高准确的分期和治疗选择。
Background Data: In following > 10,000 patients with cutaneous melanoma over the past 30 years, our institution has observed nodal or metastatic disease in approximately 15% of patients with a thin (45 years; P = 0.05), and Breslow thickness (>0.75 mm; P = 0.008) as significant negative prognostic characteristics. Of patients with these 3 high-risk characteristics, 19.7% developed advanced disease (likelihood ratio 6.3; P = 0.007 versus nonhigh-risk patients). This group had more than twice the incidence of nodal recurrences. Patients with recurrence had significantly decreased 10-year survival (82% versus 45%; P < 0.0001). Surprisingly, neither ulceration nor Clark level predicted advanced disease.Conclusions: Thin melanomas are potentially lethal lesions. Longterm follow-up identified a high-risk population of older males with tumors between 0.75 mm and 1.0 mm whose risk of recurrent disease approaches 20%. Traditionally accepted negative prognostic factors such as ulceration and discordant Clark levels are not predictive for metastasis in this population. Given the poor prognosis associated with recurrent disease, we recommend close clinical evaluation and follow-up to maximize accurate staging and therapeutic options.