Fontaine Dan, Parkhill Winston, Greer Wenda, Walsh Noreen
Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhaousie University, Halifax, Nova Scotia, Canada.
Am J Dermatopathol. 2003 Oct;25(5):371-6. doi: 10.1097/00000372-200310000-00002.
Whether partial regression of a primary melanoma has an adverse impact on prognosis is controversial. As an indirect mechanism of addressing this question we drew a correlation between the histopathological characteristics of 107 cutaneous melanomas and the presence of sub-clinical metastasis in corresponding sentinel lymph nodes. Partial regression of the primary tumor, defined as focal replacement of the lesion by a scar, unrelated to a previous biopsy, was observed in 20 (19%) cases in the group as a whole. Excluding cases in which an accurate Breslow thickness of the primary melanoma could not be established and/or the presence of a capsular nevus was detected in the sentinel node, a total of 97 remained. Seventeen cases (Breslow thickness 0.63-9.7; mean 2.4 mm) showed partial regression and 80 (Breslow thickness 0.25-7.00; mean 1.8 mm) were devoid of regression. Of the 17 cases with regression 5 (29%) had nodal metastasis (by histopathology and/or molecular analysis) and of the 80 cases without regression 23 (29%) had nodal metastasis (by one or both evaluations). Our data reveals no association between partial regression of the primary melanoma and sentinel node involvement by the disease. The Breslow thickness proved to be the only significant independent variable related to nodal metastasis. Of interest, ulceration of the primary lesion was significantly associated with nodal disease on univariate, but not on multivariate, analysis. While acknowledging that the cohort size may lack the statistical power to demonstrate subtle associations, our data supports the known relevance of tumor thickness and ulceration to regional lymph node metastasis and thereby, to outcome of melanoma in its early stages, but fails to support a similar role for partial regression.
原发性黑色素瘤的部分消退是否会对预后产生不利影响，这一点存在争议。作为解决这个问题的一种间接机制，我们对107例皮肤黑色素瘤的组织病理学特征与相应前哨淋巴结中是否存在亚临床转移进行了相关性分析。在整个研究组中，20例（19%）病例观察到原发性肿瘤的部分消退，定义为病变被瘢痕局灶性取代，且与先前活检无关。排除无法确定原发性黑色素瘤准确 Breslow 厚度和/或在前哨淋巴结中检测到包膜痣的病例后，共剩下97例。17例（Breslow 厚度0.63 - 9.7；平均2.4mm）出现部分消退，80例（Breslow 厚度0.25 - 7.00；平均1.8mm）未出现消退。在17例有消退的病例中，5例（29%）有淋巴结转移（通过组织病理学和/或分子分析），在80例无消退的病例中，23例（29%）有淋巴结转移（通过一项或两项评估）。我们的数据显示原发性黑色素瘤的部分消退与疾病累及前哨淋巴结之间没有关联。Breslow 厚度被证明是与淋巴结转移相关的唯一显著独立变量。有趣的是，在单因素分析中，原发性病变的溃疡与淋巴结疾病显著相关，但在多因素分析中并非如此。虽然承认队列规模可能缺乏显示细微关联的统计效力，但我们的数据支持肿瘤厚度和溃疡与区域淋巴结转移的已知相关性，从而支持其在黑色素瘤早期阶段对预后的影响，但不支持部分消退具有类似作用。
