Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma.
Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma.
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评估前哨淋巴结活检对原发性皮肤促纤维增生性黑色素瘤的作用。
DOI：
10.1002/cncr.21635
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Gershenwald,JeffreyE
中科院分区：
文献类型：
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作者：
Pawlik,TimothyM;Ross,MerrickI;Prieto,VictorG;Ballo,MatthewT;Johnson,MarcellaM;Mansfield,PaulF;Lee,JeffreyE;Cormier,JaniceN;Gershenwald,JeffreyE
前哨淋巴结活检(SLNB)在结缔组织增生性黑色素瘤(DM)治疗中的作用尚不明确。本研究的目的是评价SLNB在皮肤黑色素瘤治疗中的应用。方法总共1850例皮肤黑色素瘤患者接受了广泛的局部切除和SLNB。结果在1850例患者中，65例(3.5%)合并有DM。其中单纯糖尿病46例(70.8%)，混合型糖尿病19例(29.2%)。单纯糖尿病患者肿瘤厚度中位数为3.5 mm，溃疡发生率为6.5%。与单纯DM患者相比，混合DM和非DM患者的原发肿瘤较薄(中位数分别为0.001 mm和1.5 mm)，更容易溃烂(分别为27.7%和21.3%，P<；0.05比单纯DM)。尽管混合型糖尿病(15.8%)和非糖尿病(17.5%)患者SLN阳性的发生率相似，但单纯DM患者SLN阳性的可能性(2.2%)较非DM和混合型DM患者低(P均<0.01)。中位随访2.9年，单纯DM患者无一例复发。结论单纯DM患者原发肿瘤较厚，SLN阳性率明显低于非DM患者。虽然混合型糖尿病患者的治疗方法应该与其他黑色素瘤患者相似，但单纯糖尿病患者不太可能有区域淋巴结转移疾病，因此可能不需要SLNB。癌症2006年。©2006美国癌症协会。
BACKGROUNDThe role of sentinel lymph node biopsy (SLNB) in the treatment of desmoplastic melanoma (DM) remains undefined. The purpose of this study was to evaluate the use of SLNB for DM.METHODSIn all, 1850 patients with cutaneous melanoma underwent wide local excision and SLNB. Patients with DM were identified and stratified as ‘pure’ DM or ‘mixed’ DM (i.e., DM associated with at least one other common histologic subtype).RESULTSOf the 1850 patients, 65 (3.5%) had DM. Of these, 46 (70.8%) had pure DM and 19 (29.2%) had mixed DM. Patients with pure DM had a median tumor thickness of 3.5 mm and 6.5% were ulcerated. Compared with patients with pure DM, patients with either mixed DM or non‐DM (n= 1785) had thinner primary tumors (median, 1.7 mm and 1.5 mm, respectively, eachP< 0.001 vs. pure DM) that were more likely to be ulcerated (27.7% and 21.3%, respectively, eachP< 0.05 vs. pure DM). Although the incidence of a positive SLN was similar in patients with mixed DM (15.8%) and non‐DM (17.5%), patients with pure DM were less likely to have a positive SLN (2.2%) (eachP< 0.01 vs. non‐DM and mixed DM). At a median follow‐up of 2.9 years, no patient with pure DM had recurred.CONCLUSIONSDespite having thicker primary tumors, patients with pure DM have a lower incidence of positive SLNs compared with patients with non‐DM. Whereas the treatment approach for patients with mixed DM should be similar to that of other melanoma patients, patients with pure DM are unlikely to have metastatic disease in regional lymph nodes and SLNB may not be warranted. Cancer 2006. © 2006 American Cancer Society.