Ortolani C, Paz R A
Hospital Privado de Comunidad, Mar del Plata, Argentina.
Medicina (B Aires). 1992;52(1):23-9.
A study of 80 consecutive cutaneous malignant melanomas in 78 patients older than 60 years, with an average of 73 (60-93), is presented. The following data were considered: age, sex, localization, stage, other synchronous or metachronous malignant tumors, excluded basal cell epitheliomas, histological type and depth of cutaneous invasion according to Clark's levels and Breslow's measure. The follow up lasted 1 to 156 months with an average of 39 months. All patients were treated by surgical removal of the cutaneous lesion or the regional lymph node metastases, if they appeared. No prophylactic lymph node dissections were performed. There were 45 women and 33 men. The histological type was superficial spreading (ES) in 17 women and 7 men; nodular (NOD) in 18 and 16; lentigo maligna melanoma (LM) in 4 and 4 and acral in 7 and 7. Relations between sex, localization, histological type and actuarial survival curves can be observed in Figs. 5, 6, 7, 8 and Tables 1, 2. Even considering the shortcomings of this retrospective analysis and a relatively short follow up for melanomas, this study points out that the thickness of the lesion became prognostically significant in relation to survival, beyond 3.7 mm (p < 0.001); but when the tumors were thinner, this group of patients showed other causes of death (MPOC) with a greater frequency than those related to tumoral progression (MPM) (p < 0.001) and that maybe this should be taken into account when planning treatment for melanomas in elderly patients. Other malignant synchronous or metachronous tumors were found in 19% of the patients (Table 2).
本文报告了一项针对78名60岁以上患者的80例连续性皮肤恶性黑色素瘤的研究，患者平均年龄为73岁（60 - 93岁）。研究考虑了以下数据：年龄、性别、肿瘤部位、分期、其他同时性或异时性恶性肿瘤（基底细胞上皮瘤除外）、组织学类型以及根据克拉克分级和布雷斯洛测量法得出的皮肤浸润深度。随访时间为1至156个月，平均39个月。所有患者均接受了皮肤病变或区域淋巴结转移灶（如有）的手术切除，未进行预防性淋巴结清扫。其中女性45例，男性33例。组织学类型方面，浅表扩散型（ES）在17名女性和7名男性中出现；结节型（NOD）在18名女性和16名男性中出现；恶性雀斑样痣黑色素瘤（LM）在4名女性和4名男性中出现；肢端型在7名女性和7名男性中出现。性别、肿瘤部位、组织学类型与精算生存曲线之间的关系见图5、6、7、8以及表1、2。尽管本回顾性分析存在局限性且黑色素瘤随访时间相对较短，但该研究指出，病变厚度超过3.7mm时，其对生存的预后意义显著（p < 0.001）；但当肿瘤较薄时，该组患者出现其他死亡原因（MPOC）的频率高于肿瘤进展相关原因（MPM）（p < 0.001），在为老年黑色素瘤患者制定治疗方案时可能应考虑这一点。19%的患者发现有其他同时性或异时性恶性肿瘤（表2）。
