Uliasz Annemarie, Lebwohl Mark
John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA.
Int J Dermatol. 2007 Jun;46(6):575-7. doi: 10.1111/j.1365-4632.2007.02704.x.
As the incidence of cutaneous melanoma continues to rise, more individuals will be at risk for developing second primary melanomas. We hypothesize that patient education and follow-up surveillance will lead to the early detection of subsequent primary melanomas as demonstrated by a decrease in Breslow thickness at diagnosis.
A computer-based investigation was performed to identify patients who had developed a second primary melanoma following treatment of in situ and American Joint Commission on Cancer (AJCC) Stage I or II melanoma. Patients are routinely educated on the increased risk of developing a second primary lesion and characteristic clinical features of melanoma. Patient surveillance was performed on a regular basis. Differences in Breslow thickness between the initial and subsequent primary melanomas were analyzed by a paired t-test.
Among 877 individuals identified in the Mount Sinai School of Medicine Department of Dermatopathology database with in situ or AJCC Stage I or II melanoma, 111 developed a second primary melanoma. The mean thickness was 0.239 +/- 0.661 mm for the initial melanoma and 0.1135 +/- 0.319 mm for the subsequent melanoma. By paired t-test, the difference in tumor thickness was statistically significant (P = 0.019).
Upon analysis of our data, subsequent primary cutaneous melanomas were found to be significantly thinner than initial primary melanomas at the time of diagnosis. This suggests that earlier diagnosis may be the result of patient education and careful follow up. Counselling on the risk of developing a second primary melanoma, education regarding clinical characteristics of melanoma, and routine lifelong follow up should be provided to all patients diagnosed with a cutaneous melanoma.
随着皮肤黑色素瘤的发病率持续上升，更多人将面临发生第二原发性黑色素瘤的风险。我们假设，通过患者教育和随访监测，将能早期发现后续原发性黑色素瘤，这可通过诊断时Breslow厚度的降低得以证明。
进行了一项基于计算机的调查，以识别原位癌以及美国癌症联合委员会（AJCC）I期或II期黑色素瘤治疗后发生第二原发性黑色素瘤的患者。对患者进行常规教育，告知其发生第二原发性病变的风险增加以及黑色素瘤的特征性临床特征。定期对患者进行监测。通过配对t检验分析初始原发性黑色素瘤与后续原发性黑色素瘤之间Breslow厚度的差异。
在西奈山医学院皮肤病理学数据库中识别出的877例原位癌或AJCC I期或II期黑色素瘤患者中，有111例发生了第二原发性黑色素瘤。初始黑色素瘤的平均厚度为0.239±0.661毫米，后续黑色素瘤的平均厚度为0.1135±0.319毫米。通过配对t检验，肿瘤厚度差异具有统计学意义（P = 0.019）。
通过对我们的数据进行分析，发现后续原发性皮肤黑色素瘤在诊断时明显比初始原发性黑色素瘤薄。这表明早期诊断可能是患者教育和仔细随访的结果。应向所有诊断为皮肤黑色素瘤的患者提供关于发生第二原发性黑色素瘤风险的咨询、黑色素瘤临床特征的教育以及终身常规随访。
