Corsetti R L, Allen H M, Wanebo H J
Department of Surgery/Surgical Oncology, Roger Williams Medical Center, Providence, Rhode Island, USA.
Ann Surg Oncol. 2000 Jul;7(6):456-60. doi: 10.1007/s10434-000-0456-4.
Thin melanomas have become increasingly prevalent, and lesions 1 mm or less in thickness are frequently diagnosed. They are considered highly curable when treated with wide local excision alone with reported 5-year disease free survivals of 95% to 98%. However, thin Clark level III and IV melanomas may have an increased potential for metastasizing and late recurrence because of dermal lymphatics located at the interface of the papillary and reticular dermis. We have addressed this controversial area by reviewing the outcomes of patients with invasive thin (< or = 1.0 mm thick) melanomas.
We reviewed 415 invasive melanomas from 1983-1995 in the Rhode Island tumor registries which kept records of both tumor thickness and Clark levels. Sixty-eight (16.4%) of the 415 invasive melanomas were thin (< or = 1.0 mm in thickness) and were treated by wide local excision only. In situ lesions were excluded. Thirty-eight (56%) of the 68 thin melanomas were either Clark level III or IV.
Seven (18.4%) of the 38 level III and IV thin melanomas had a recurrence at a minimum follow-up of 36 months. Median time to recurrence was 52 months, and the average measured depth of tumor thickness was 0.84 mm. Only one (3.3%) of 30 level II melanomas recurred (P < .05).
Thin level III and IV melanomas are at increased risk for late recurrence when compared with all thin melanomas. Because there is effective adjuvant therapy with alpha interferon for patients with stage III melanoma to treat regional and systemic disease, and because sentinel lymph node biopsy (SLNB) offers minimal morbidity, we suggest using SLNB to accurately stage and treat all patients with thin melanoma that are high Clark levels that are at increased risk for metastases.
薄型黑色素瘤日益普遍，厚度为1毫米或更薄的病灶经常被诊断出来。单独采用广泛局部切除治疗时，它们被认为具有很高的治愈率，据报道5年无病生存率为95%至98%。然而，由于位于乳头层和网状真皮交界处的真皮淋巴管，薄型Clark III级和IV级黑色素瘤可能具有更高的转移和晚期复发潜力。我们通过回顾侵袭性薄型（厚度≤1.0毫米）黑色素瘤患者的治疗结果，探讨了这一有争议的领域。
我们回顾了罗德岛肿瘤登记处1983年至1995年期间的415例侵袭性黑色素瘤病例，这些病例记录了肿瘤厚度和Clark分级。415例侵袭性黑色素瘤中有68例（16.4%）为薄型（厚度≤1.0毫米），仅接受了广泛局部切除治疗。原位病变被排除在外。68例薄型黑色素瘤中有38例（56%）为Clark III级或IV级。
38例III级和IV级薄型黑色素瘤中有7例（18.4%）在至少36个月的随访中有复发。复发的中位时间为52个月，肿瘤厚度的平均测量深度为0.84毫米。30例II级黑色素瘤中只有1例（3.3%）复发（P < 0.05）。
与所有薄型黑色素瘤相比，薄型III级和IV级黑色素瘤晚期复发风险增加。由于对于III期黑色素瘤患者，α干扰素辅助治疗可有效治疗区域和全身疾病，且前哨淋巴结活检（SLNB）的发病率极低，我们建议对所有Clark分级高、转移风险增加的薄型黑色素瘤患者使用SLNB进行准确分期和治疗。
