DiFronzo L A, Wanek L A, Morton D L
Roy E. Coats Research Laboratories, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA.
Cancer. 2001 Apr 15;91(8):1520-4. doi: 10.1002/1097-0142(20010415)91:8<1520::aid-cncr1160>3.0.co;2-6.
Rising health care costs have caused providers to question the benefit of regular follow-up after treatment for patients with early stage cutaneous melanoma. The authors hypothesized that routine reassessment and careful education of these patients would facilitate earlier diagnosis of a subsequent second primary melanoma, as reflected by reduced thickness of that lesion.
A prospective melanoma data base was used to identify patients who developed a second primary melanoma after treatment for American Joint Committee on Cancer (AJCC) Stage I or II cutaneous melanoma. After excision of the initial primary melanoma, all patients underwent routine biannual follow-up for new primary lesions. Follow-up consisted of a questionnaire and a complete skin examination by a physician. In addition, patients were regularly educated regarding the increased risk of developing a second melanoma. A paired t test was used to examine AJCC stage, thickness, and level of invasion of the initial melanoma compared with the second primary melanoma.
Of 3310 patients with AJCC Stage I or II melanoma, 114 patients (3.4%) developed a second primary melanoma. AJCC staging of both first and second melanomas was available in 82 patients (72%). When the AJCC stages of first and second melanomas were compared, 39 of 82 patients (48%) had lower stage second primary lesions, and 41 (50%) had same-stage second primary lesions. The mean tumor thickness was 1.32 +/- 1.02 mm for the initial melanoma, decreasing to 0.63 +/- 0.52 mm for the second melanoma; in fact, tumor thickness increased in only 4 of 51 patients (8%) whose records contained data for both first and second melanomas. Similarly, the level of invasion decreased in 60% of patients, remained the same in 27% of patients, and increased in only 13% of patients. By paired t test, the differences in AJCC stage, tumor thickness, and level of invasion between first and second melanomas were each highly significant (P = 0.0001).
In this study, the second primary melanoma in patients with a prior cutaneous melanoma was significantly thinner than the initial primary lesion. This is evidence that careful follow-up and patient education allow earlier diagnosis. All patients diagnosed with cutaneous melanoma should be counseled regarding the risks of second melanoma and should undergo lifelong follow-up at biannual intervals.
不断上涨的医疗保健费用促使医疗服务提供者质疑早期皮肤黑色素瘤患者治疗后定期随访的益处。作者推测，对这些患者进行常规重新评估和认真教育将有助于更早诊断后续的第二原发性黑色素瘤，这表现为该病变厚度的减小。
使用前瞻性黑色素瘤数据库来识别在接受美国癌症联合委员会（AJCC）I期或II期皮肤黑色素瘤治疗后发生第二原发性黑色素瘤的患者。在切除初始原发性黑色素瘤后，所有患者均接受常规半年一次的新原发性病变随访。随访包括一份问卷和由医生进行的全面皮肤检查。此外，还定期对患者进行关于发生第二原发性黑色素瘤风险增加的教育。采用配对t检验来比较初始黑色素瘤与第二原发性黑色素瘤的AJCC分期、厚度和浸润水平。
在3310例AJCC I期或II期黑色素瘤患者中，114例（3.4%）发生了第二原发性黑色素瘤。82例患者（72%）可获得第一和第二黑色素瘤的AJCC分期。比较第一和第二黑色素瘤的AJCC分期时，82例患者中有39例（48%）第二原发性病变分期较低，41例（50%）第二原发性病变分期相同。初始黑色素瘤的平均肿瘤厚度为l.32±1.02mm，第二黑色素瘤降至0.63±0.52mm；实际上，在记录中有第一和第二黑色素瘤数据的51例患者中，仅4例（8%）肿瘤厚度增加。同样，60%的患者浸润水平降低，27%的患者浸润水平不变，仅13%的患者浸润水平增加。通过配对t检验，第一和第二黑色素瘤在AJCC分期、肿瘤厚度和浸润水平上的差异均具有高度显著性（P = 0.0001）。
在本研究中，既往有皮肤黑色素瘤患者的第二原发性黑色素瘤明显比初始原发性病变薄。这证明认真随访和患者教育能实现更早诊断。所有被诊断为皮肤黑色素瘤的患者均应接受关于第二原发性黑色素瘤风险的咨询，并应每半年进行一次终身随访。
