Cecchi R, Buralli L, Innocenti S, Seghieri G, De Gaudio C
Department of Dermatology, Pistoia Hospital, Pistoa, Italy.
J Eur Acad Dermatol Venereol. 2007 Jul;21(6):758-61. doi: 10.1111/j.1468-3083.2006.02072.x.
Lymphatic mapping/sentinel lymph node biopsy (LM/SLNB) have become routine techniques for staging the regional lymph nodes in early stage melanoma, yet their role in the management of thick (= 4 mm) melanoma is debated. The aim of the present study is to review our experience with LM/SLNB in a series of patients with thick primary melanoma, to evaluate its utility in this melanoma subset.
Thirty patients (18 men and 12 women; mean age 70.6 years; median 75 years) with thick primary melanoma underwent LM/SLNB, using both radioisotope and blue dye. The statistical tests were performed by using SAS software for Windows, version 8.2.
The primary tumour sites were head/neck (n = 5; 16.6%), trunk (n = 10; 33.3%), and extremities (n = 15; 50%). Tumour thickness ranged from 4 to 17 mm (mean 5.14 mm; median 4.5 mm). Ulceration was observed in 23 (76.6%) tumours. Eleven patients (36.6%) had at least a positive sentinel lymph node (SLN). The mean follow-up was 27.3 months (median 26 months; range 5-63 months). Patients without SLN metastases had a 5-year disease-free survival rate of 78.9%, vs. 18.2% for patients with SLN metastases (P = 0.0121 by log rank test). The 5-year overall survival rate for patients without SLN metastases was 89.5%, whereas patients with SLN metastases had a 5-year overall survival rate of 36.4% (P = 0.0272 by log rank test).
Our retrospective analysis indicates that the SLN status is predictive of recurrence and survival in patients with thick melanoma, and LM/SLNB should be routinely performed in this subset of melanoma patients.
淋巴绘图/前哨淋巴结活检（LM/SLNB）已成为早期黑色素瘤区域淋巴结分期的常规技术，但其在厚（≥4mm）黑色素瘤治疗中的作用仍存在争议。本研究的目的是回顾我们在一系列原发性厚黑色素瘤患者中进行LM/SLNB的经验，评估其在这一黑色素瘤亚组中的效用。
30例原发性厚黑色素瘤患者（18例男性，12例女性；平均年龄70.6岁；中位数75岁）接受了LM/SLNB，同时使用了放射性同位素和蓝色染料。使用Windows版SAS软件8.2进行统计检验。
原发肿瘤部位为头颈部（n = 5；16.6%）、躯干（n = 10；33.3%）和四肢（n = 15；50%）。肿瘤厚度为4至17mm（平均5.14mm；中位数4.5mm）。23例（76.6%）肿瘤出现溃疡。11例患者（36.6%）至少有一个前哨淋巴结（SLN）阳性。平均随访时间为27.3个月（中位数26个月；范围5 - 63个月）。无SLN转移的患者5年无病生存率为78.9%，而有SLN转移的患者为18.2%（对数秩检验P = 0.0121）。无SLN转移的患者5年总生存率为89.5%，而有SLN转移的患者5年总生存率为36.4%（对数秩检验P = 0.0272）。
我们的回顾性分析表明，SLN状态可预测厚黑色素瘤患者的复发和生存情况，LM/SLNB应在这一黑色素瘤患者亚组中常规进行。
