Shors A R, Kim S, White E, Argenyi Z, Barnhill R L, Duray P, Erickson L, Guitart J, Horenstein M G, Lowe L, Messina J, Rabkin M S, Schmidt B, Shea C R, Trotter M J, Piepkorn M W
Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Br J Dermatol. 2006 Nov;155(5):988-93. doi: 10.1111/j.1365-2133.2006.07466.x.
The risk of malignant melanoma associated with histologically dysplastic naevi (HDN) has not been defined. While clinically atypical naevi appear to confer an independent risk of melanoma, no study has evaluated the extent to which HDN are predictive of melanoma.
To estimate the risk of melanoma associated with HDN. Secondarily, the risk associated with number of naevi and large naevi is estimated.
We enrolled 80 patients with newly diagnosed melanoma along with 80 spousal controls. After obtaining information on melanoma risk factors and performing a complete cutaneous examination, the most clinically atypical naevus was biopsied in both cases and controls. Histological dysplasia was then assessed independently by 13 dermatopathologists (0, no dysplasia; 1, mild dysplasia; 2, moderate dysplasia; 3, severe dysplasia). The dermatopathologists were blinded as to whether the naevi were from melanoma subjects or controls. Multivariate analyses were performed to determine if there was an independent association between the degree of histological dysplasia in naevi and a personal history of melanoma.
In persons with naevi receiving an average score of > 1 (i.e. naevi considered to have greater than mild histological dysplasia), there was an increased risk of melanoma [odds ratio (OR) 2.60, 95% confidence interval (CI) 0.99-6.86] which persisted after adjustment for confounders (OR 3.99, 95% CI 1.02-15.71). Very few dermatopathologists reliably graded naevi of subjects with melanoma as being more dysplastic than naevi of control subjects. Among the entire group, the interobserver reliability associated with grading histological dysplasia in naevi was poor (weighted kappa 0.28).
HDN do appear to confer an independent risk of melanoma. However, this result may add more to our biological understanding of melanoma risk than to clinical assessment of risk, because HDN assessed by a single pathologist generally cannot be used to assess risk of melanoma. Future studies should be directed at establishing reproducible, predictive criteria for grading naevi.
与组织学发育异常痣（HDN）相关的恶性黑色素瘤风险尚未明确。虽然临床上非典型痣似乎会增加黑色素瘤的独立风险，但尚无研究评估HDN对黑色素瘤的预测程度。
估计与HDN相关的黑色素瘤风险。其次，估计与痣数量和大痣相关的风险。
我们招募了80例新诊断的黑色素瘤患者以及80名配偶对照。在获取黑色素瘤风险因素信息并进行全面的皮肤检查后，对病例组和对照组中最具临床非典型性的痣进行活检。然后由13名皮肤病理学家独立评估组织学发育异常情况（0级，无发育异常；1级，轻度发育异常；2级，中度发育异常；3级，重度发育异常）。皮肤病理学家对痣是来自黑色素瘤患者还是对照者不知情。进行多变量分析以确定痣的组织学发育异常程度与黑色素瘤个人病史之间是否存在独立关联。
在平均评分>1（即被认为具有大于轻度组织学发育异常的痣）的痣患者中，黑色素瘤风险增加[比值比（OR）2.60，95%置信区间（CI）0.99 - 6.86]，在对混杂因素进行调整后该风险仍然存在（OR 3.99，95% CI 1.02 - 15.71）。很少有皮肤病理学家能可靠地将黑色素瘤患者的痣分级为比对照者的痣发育异常更严重。在整个组中，与痣的组织学发育异常分级相关的观察者间可靠性较差（加权kappa 0.28）。
HDN似乎确实会增加黑色素瘤的独立风险。然而，这一结果可能更多地是增加了我们对黑色素瘤风险的生物学理解，而非对风险的临床评估，因为由单一病理学家评估的HDN通常不能用于评估黑色素瘤风险。未来的研究应致力于建立可重复的、预测性的痣分级标准。
