Clinical size is a poor predictor of invasion in melanoma of the lentigo maligna type.
Clinical size is a poor predictor of invasion in melanoma of the lentigo maligna type.
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DOI：
10.1016/j.jaad.2020.10.023
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发表时间：
2021-05
影响因子：
13.8
通讯作者：
Nehal KS
中科院分区：
文献类型：
--
作者：
Navarrete-Dechent C;Aleissa S;Connolly K;Hibler BP;Dusza SW;Rossi AM;Lee E;Nehal KS
在完整的组织病理学分析之前，没有明确的临床因素来预测恶性雀斑样痣型（LM）黑色素瘤的隐匿性侵袭风险。评估临床大小是否是LM浸润和亚临床扩展的预测因子。在2006年至2019年的前瞻性维护数据库中记录了LM的连续病例。在初始评价期间记录患者和肿瘤数据。“LM临床面积”以平方毫米（长×宽）计算。所有患者均行分期切除术。共纳入600名患者。平均年龄为65.9岁（SD 12.3;范围27 - 95岁）; 62.8%（n=377）为男性。原位病变的平均LM临床面积为128.32 mm 2，浸润性病变为200.14 mm（p=0.1）。基于分位数回归，完全切除所需的中位边界随着LM临床面积的增加而增加。在三级癌症中心进行的研究，可能存在转诊偏倚和更复杂的病例。LM可以呈现不同的临床大小，这可能与亚临床扩展相关;然而，通过LM临床面积不能很好地估计浸润的存在。在这项研究中，600例LM患者接受分期切除治疗，病变直径和面积与浸润的存在相关性很小;然而，较大的病变需要更宽的手术切缘。由于LM病变是不可预测的，临床评估是具有挑战性的;仔细的术前计划和边缘控制技术是必要的。
There are no well-defined clinical factors to predict the risk of occult invasion in melanoma of the lentigo maligna type (LM) prior to complete histopathologic analysis. To evaluate whether clinical size was a predictor of invasion in LM and subclinical extension. Consecutive cases of LM were recorded in a prospectively maintained database from 2006 to 2019. Patient and tumor data were recorded during initial evaluation. ‘LM clinical area’ was calculated in square millimeters (length × width). All patients were treated with staged excision. We included 600 patients. Mean age was 65.9 years (SD 12.3; range 27 – 95 years); 62.8% (n=377) were males. The mean LM clinical area was 128.32 mm2 for in situ lesions vs 200.14 mm for invasive lesions (p=0.1). Based on quantile regression, the median margin required for complete removal increased with LM clinical area. study performed in a tertiary cancer center with possible referral bias and more complex cases. LM can present with variable clinical size which may correlate with subclinical extension; however, the presence of invasion is not well estimated by LM clinical area. In this study of 600 patients with LM treated with staged excision, lesion diameter and area were poorly associated with the presence of invasion; however, larger lesions required wider surgical margins. Since LM lesions are unpredictable and clinical assessment is challenging; careful pre-surgical planning and margin controlled techniques are necessary.