Wang Steven Q, Kopf Alfred W, Koenig Karen, Polsky David, Nudel Kira, Bart Robert S
Department of Dermatology, University of Minnesota School of Medicine, Minneapolis, USA.
J Am Acad Dermatol. 2004 Jan;50(1):15-20. doi: 10.1016/s0190-9622(03)02794-4.
Many factors have been identified as important determinants that increase the risk of malignant melanoma (MM) developing. Patients with classic atypical mole syndrome (CAMS) have multiple such factors and are known to be at high risk for MMs developing.
We sought to evaluate the risk for newly diagnosed MMs developing in patients with CAMS and in a heterogeneous group of patients at high risk (ie, those with high-risk non-CAMS [HRNCAMS]) who had 1 or more risk factors: personal history of nonmelanoma skin cancers; family history of melanoma; biopsy specimen-confirmed dysplastic nevi; and meeting 1 or 2 of the 3 CAMS criteria. We also aimed to report our experience treating these patients at high risk with annual total cutaneous examination, total cutaneous photography, and dermoscopy.
Consecutive medical records from a private dermatology practice were reviewed. A total of 258 patients were selected who fulfilled the criteria of having: (1) total cutaneous photography as an aid for follow-up; (2) total cutaneous examination at least once per year; (3) at least 6 months of clinical follow-up; and (4) no personal history of melanomas. A total of 160 patients with CAMS and 98 with HRNCAMS were included in this study. The 10-year risk for MM developing in these 2 cohorts was computed using the Kaplan-Meier method.
In the CAMS cohort, 28 new MMs developed in 19 patients resulting in a cumulative 10-year risk of 14% (95% confidence interval: 7-20). In the HRNCAMS cohort, 10 new MMs developed in 9 patients, and the cumulative 10-year risk was 10% (95% confidence interval: 2-17). The difference between the 2 groups was not statistically significant (P=.91). The MMs diagnosed in both cohorts were either in situ or less than 1 mm in Breslow thickness. There were no MM metastases or MM-related deaths in either cohort during a mean follow-up period of 120 months for the CAMS and 98 months for the HRNCAMS group.
Both the patients with CAMS and HRNCAMS were at very high risk for MMs developing. The combination of total cutaneous photography, total cutaneous examination, and dermoscopy were used in treating our patients. No MM 1 mm or greater in thickness developed during follow-up in either group.
许多因素已被确定为增加恶性黑色素瘤（MM）发生风险的重要决定因素。患有经典非典型痣综合征（CAMS）的患者具有多种此类因素，并且已知其发生MM的风险很高。
我们试图评估CAMS患者以及一组异质性高危患者（即具有1个或更多风险因素的高危非CAMS [HRNCAMS]患者）发生新诊断MM的风险：非黑色素瘤皮肤癌个人史；黑色素瘤家族史；活检标本证实的发育异常痣；以及符合3项CAMS标准中的1项或2项。我们还旨在报告我们通过每年进行全皮肤检查、全皮肤摄影和皮肤镜检查来治疗这些高危患者的经验。
回顾了一家私立皮肤科诊所的连续病历。共选择了258例符合以下标准的患者：（1）进行全皮肤摄影以辅助随访；（2）每年至少进行一次全皮肤检查；（3）至少6个月的临床随访；（4）无黑色素瘤个人史。本研究共纳入160例CAMS患者和98例HRNCAMS患者。使用Kaplan-Meier方法计算这2个队列中发生MM的10年风险。
在CAMS队列中，19例患者发生了28例新的MM，累积10年风险为14%（95%置信区间：7%-20%）。在HRNCAMS队列中，9例患者发生了
