Puleo Christopher A, Messina Jane L, Riker Adam I, Glass L Frank, Nelson Christopher, Cruse C Wayne, Johnson Timothy M, Sondak Vernon K
Cutaneous Oncology Division, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
Cancer Control. 2005 Oct;12(4):230-5. doi: 10.1177/107327480501200404.
As the incidence of melanoma increases, thin melanomas are being diagnosed at an increasingly frequent rate. Currently available prognostic factors are limited in their ability to reliably discriminate which patients will manifest regional nodal metastasis and would be identified early through sentinel node biopsy.
We summarized our experience with sentinel node biopsy for patients with cutaneous melanomas less than 1.00 mm in Breslow thickness, with evaluation of Clark level as a predictor of positive sentinel node metastasis.
Among the 409 patients identified, micrometastases were found in the sentinel node in 20 patients, for an overall incidence of nodal progression of 4.9%. A total of 252 (62%) were Clark level II or III (11 of whom had a positive sentinel node) and 157 (38%) were Clark level IV (9 of whom had a positive sentinel node). We reviewed the literature to identify reliable indicators that might be helpful in determining which patients with "thin melanomas" would be likely to manifest regional progression to warrant routinely undergoing a preoperative lymphoscintigraphy followed by a sentinel node biopsy.
Based on available data, patients with melanomas between 0.75 and 1.00 mm are appropriate candidates to be considered for sentinel node biopsy after discussing the likelihood of finding evidence of nodal progression, the risks of sentinel node biopsy (including the risk of a false-negative result), and the lack of proven survival benefit from any form of surgical nodal staging.
随着黑色素瘤发病率的上升，薄型黑色素瘤的诊断频率越来越高。目前可用的预后因素在可靠区分哪些患者会出现区域淋巴结转移以及哪些患者可通过前哨淋巴结活检早期识别方面能力有限。
我们总结了对 Breslow 厚度小于 1.00 mm 的皮肤黑色素瘤患者进行前哨淋巴结活检的经验，并评估 Clark 分级作为前哨淋巴结转移阳性的预测指标。
在纳入的 409 例患者中，20 例患者的前哨淋巴结发现微转移，淋巴结进展的总体发生率为 4.9%。共有 252 例（62%）为 Clark 分级 II 级或 III 级（其中 11 例前哨淋巴结阳性），157 例（38%）为 Clark 分级 IV 级（其中 9 例前哨淋巴结阳性）。我们回顾文献以确定可能有助于判断哪些“薄型黑色素瘤”患者可能出现区域进展从而需要常规进行术前淋巴闪烁显像并随后进行前哨淋巴结活检的可靠指标。
根据现有数据，在讨论发现淋巴结进展证据的可能性、前哨淋巴结活检的风险（包括假阴性结果的风险）以及任何形式的手术淋巴结分期均未证实有生存获益后，Breslow 厚度在 0.75 至 1.00 mm 之间的黑色素瘤患者是考虑进行前哨淋巴结活检的合适人选。
