Second primary melanomas in a cohort of 977 melanoma patients within the first 5 years of monitoring
Second primary melanomas in a cohort of 977 melanoma patients within the first 5 years of monitoring
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DOI：
10.1016/j.jaad.2019.08.074
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发表时间：
2020-02-01
影响因子：
13.8
通讯作者：
Ioannides, Dimitrios
中科院分区：
文献类型：
--
作者：
Lallas, Aimilios;Apalla, Zoe;Ioannides, Dimitrios
背景：在回顾性研究中，第二原发性黑色素瘤（SPM）在2%-20%的黑色素瘤患者中发展。很少有证据表明全身摄影（TBP）和数字皮肤镜记录（DDD）对检测SPMs的有用性。目的：主要目的是量化SPMs发生的风险和时间。次要目的是确定SPM的危险因素，并评估TBP和DDD对SPM检测的有用性。方法：该前瞻性队列包括最近诊断为黑色素瘤的患者，这些患者接受了长达5年的连续临床和皮肤镜检查。进行生命表分析和Kaplan-Meier生存分析。构建多变量Cox模型以确定影响结果的因素。结果：977例患者中有46例（4.7%）发生SPM。生命表分析显示SPM的5年累积风险为8.0%。高痣数、公平的光型和职业性日晒是SPM的有效预测因子。在所有新发黑色素瘤中，17.3%通过临床和皮镜检查诊断，48.1%通过TBP诊断，34.6%通过DDD诊断。局限性：所有患者都遵循相同的方案和与顺序皮肤镜成像相关的诊断偏差。结论：在该队列中，黑色素瘤患者在5年内发生SPM的风险为8%。TBP和DDD对SPM的早期发现有显著作用。
Background: In retrospective studies, a second primary melanoma (SPM) develops in 2%-20% of melanoma patients. Scarce evidence exists on the usefulness of total-body photography (TBP) and digital dermatoscopic documentation (DDD) for detecting SPMs.Objective: The primary aim was to quantify the risk and investigate the time of occurrence of SPMs. Secondary aims were to identify risk factors for SPM and to assess the usefulness of TBP and DDD for SPM detection.Methods: This prospective cohort included patients with recently diagnosed melanoma that underwent sequential clinical and dermatoscopic examinations for up to 5 years. Life table analysis and Kaplan-Meier survival analysis were performed. Multivariate Cox models were constructed to identify factors affecting the outcome.Results: An SPM developed in 46 of 977 (4.7%) patients. Life table analysis revealed a 5-year cumulative risk of 8.0% for SPM. High nevus count, fair phototype, and occupational sun exposure were potent predictors of SPM. Of all new melanomas, 17.3% were diagnosed by clinical and dermatoscopic examination, 48.1% by TBP, and 34.6% by DDD.Limitations: All patients followed the same protocol and diagnostic bias associated with sequential dermatoscopic imaging.Conclusion: In this cohort, melanoma patients were at 8% risk of an SPM developing within 5 years. TBP and DDD significantly contributed to the early detection of SPM.