Sander B, Karlsson P, Rosdahl I, Westermark P, Boeryd B
Department of Environment and Health, Faculty of Health Sciences, University of Linköping, Sweden.
Int J Cancer. 1999 Mar 1;80(5):646-51. doi: 10.1002/(sici)1097-0215(19990301)80:5<646::aid-ijc2>3.0.co;2-h.
To assess whether there has been a change in histological features and prognostic factors of primary cutaneous malignant melanoma (CMM) in young individuals in Sweden, an unselected, population-based study was undertaken; 177 cases of primary CMM in persons below 20 years of age were reported to the Swedish National Cancer Registry between 1973 and 1992. In 87% of the cases, original tumor tissue was available for histo-pathological review. The original diagnosis was verified in 88% (n = 126) of these cases. All tumors had histological features similar to adult CMM; 17% had an associated precursor lesion. Superficial spreading melanoma (SSM) was the most common sub-type, constituting 20/36 cases in the first decade and 59/90 in the second. Corresponding figures for nodular melanoma (NM) were 11/36 and 23/90. Only 5 melanomas in situ were diagnosed. In girls, the mean thickness of SSM decreased from 1.5 to 0.6 mm (p < 0.001). Overall mortality was 10%, 22% in the group with CMM diagnosed 0-15 years of age and 8% in individuals 15-19 years. Fatal CMM cases diagnosed below 15 years of age (n = 4) were NM > 1.6 mm thick and in subjects 15-19 years (n = 9) 44% of fatal tumors were NM with a mean thickness of 2.2 mm. Breslow index was the single most important prognostic factor. However, when known prognostic factors were adjusted for in a Cox regression analysis, young age remained an independent risk factor, with a relative death rate of 0.21 for individuals aged 15-19 compared with children < 15 years of age.
为评估瑞典年轻人群原发性皮肤恶性黑色素瘤（CMM）的组织学特征和预后因素是否发生了变化，我们开展了一项基于人群的非选择性研究；1973年至1992年间，177例20岁以下的原发性CMM病例被报告至瑞典国家癌症登记处。87%的病例有原始肿瘤组织可用于组织病理学复查。其中88%（n = 126）的病例经复查证实了原诊断。所有肿瘤的组织学特征均与成人CMM相似；17%伴有前驱病变。浅表扩散性黑色素瘤（SSM）是最常见的亚型，在第一个十年的36例病例中占20例，在第二个十年的90例病例中占59例。结节性黑色素瘤（NM）的相应数字分别为11/36和23/90。仅诊断出5例原位黑色素瘤。在女孩中，SSM的平均厚度从1.5毫米降至0.6毫米（p < 0.001）。总体死亡率为10%，0至15岁诊断为CMM的组中为22%，15至19岁个体中为8%。15岁以下诊断为致命性CMM的病例（n = 4）为厚度> 1.6毫米的NM，15至19岁的病例（n = 9）中44%的致命肿瘤为NM，平均厚度为2.2毫米。 Breslow指数是唯一最重要的预后因素。然而，在Cox回归分析中对已知预后因素进行校正后，年轻仍然是一个独立的危险因素，15至19岁个体的相对死亡率为0.21，而15岁以下儿童为1。
