Murray C S, Stockton D L, Doherty V R
Department of Dermatology, 1st Floor Lauriston Building, Royal Infirmary of Edinburgh, 1 Lauriston Place, Edinburgh EH3 9YP, UK.
Br J Dermatol. 2005 Jan;152(1):104-9. doi: 10.1111/j.1365-2133.2005.06409.x.
Considerable resources have been channelled into primary and secondary prevention of cutaneous melanoma over the past 20 years. These efforts have been associated with a significant increase in the proportion of thin, good prognosis lesions and this is felt to be the principal reason for the current overall improvement in melanoma survival.
Analysis of Scottish Melanoma Group (SMG) data was carried out to identify the proportion of thick melanomas presenting over time. SMG data were used to characterize the patients presenting with thick melanoma.
Using data from the SMG database 915 patients (392 male and 523 female) first diagnosed with invasive melanoma > or = 3.5 mm thick in the two decades between 1979 and 1998, inclusive, were identified. The patients were from regions designated South-east Scotland, Tayside, Grampian and Highland, which together form half of all Scottish cases.
The analysis shows that, although the proportion of thick, poor prognosis melanomas has decreased over time, the number presenting per year has not significantly altered. In the first decade, 50.5% of registrations were thick lesions and these fell to 31.0% in the second decade. In the first decade there were 419 cases (173 male), median age 66 years (range 5-99). Fifty-five patients were under the age of 40 years. Two hundred and twelve melanomas were nodular, 116 superficial spreading (SSM), 34 acral and 26 lentigo maligna melanoma. Sixty-nine patients had either lymph node involvement or distant spread at presentation. Despite a 93.3% increase in the total number of melanoma registrations by the end of the second decade, there was relatively little change in the absolute numbers of thick lesions. The total number of thick lesions was 496 (220 male), an increase of 18.4%. Median age was greater, at 70 years (range 1-98), and 31 patients were under the age of 40 years. Nodular was still the commonest type but its proportion had dropped significantly compared with the first decade, with a corresponding increase in SSM and acral types.
Over a 20-year period there was little change in the absolute number of patients presenting with thick melanoma each year, though these form a diminishing proportion of the rising number of total melanomas. This thick melanoma group is characterized by an increasingly older age group and a changing type profile, nodular and SSM being the most common types. This work suggests that the resources currently directed at public and professional education on melanoma are having no effect on this group of patients and that alternative strategies may need to be considered.
在过去20年里，大量资源被投入到皮肤黑色素瘤的一级和二级预防中。这些努力使得薄型、预后良好的病变比例显著增加，这被认为是目前黑色素瘤生存率总体提高的主要原因。
对苏格兰黑色素瘤研究组（SMG）的数据进行分析，以确定厚黑色素瘤随时间推移的发病比例。利用SMG的数据来描述厚黑色素瘤患者的特征。
使用SMG数据库的数据，确定了1979年至1998年（含）这二十年间首次被诊断为厚度≥3.5mm的侵袭性黑色素瘤的915名患者（392名男性和523名女性）。这些患者来自指定的苏格兰东南部、泰赛德、格兰扁和高地地区，这些地区的病例总数占苏格兰所有病例的一半。
分析表明，尽管预后较差的厚黑色素瘤比例随时间有所下降，但每年的发病数量并未显著改变。在第一个十年中，50.5%的登记病例为厚病变，在第二个十年中这一比例降至31.0%。在第一个十年中有419例（173名男性），中位年龄为66岁（范围为5 - 99岁）。55名患者年龄在40岁以下。212例黑色素瘤为结节型，116例为浅表扩散型（SSM），34例为肢端型，26例为恶性雀斑样痣型黑色素瘤。69名患者在初诊时伴有淋巴结受累或远处转移。尽管到第二个十年末黑色素瘤登记总数增加了93.3%，但厚病变的绝对数量变化相对较小。厚病变总数为496例（220名男性），增加了18.4%。中位年龄更大，为70岁（范围为1 - 98岁），31名患者年龄在40岁以下。结节型仍然是最常见的类型，但其比例与第一个十年相比显著下降，SSM型和肢端型相应增加。
在20年的时间里，每年厚黑色素瘤患者的绝对数量变化不大，尽管在黑色素瘤总数不断上升的情况下，这些患者所占比例在下降。这个厚黑色素瘤群体的特征是年龄越来越大，类型分布不断变化，结节型和SSM型是最常见的类型。这项研究表明，目前针对黑色素瘤的公众和专业教育资源对这组患者没有效果，可能需要考虑其他策略。
