原位恶性黑素瘤和恶性黑素瘤的分期切除与莫氏显微外科手术对比

Staged excision versus Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma.

作者信息

Walling Hobart W, Scupham Richard K, Bean Andrew K, Ceilley Roger I

出版信息

J Am Acad Dermatol. 2007 Oct;57(4):659-64. doi: 10.1016/j.jaad.2007.02.011.

DOI:10.1016/j.jaad.2007.02.011

PMID:17870430

Abstract

BACKGROUND

Lentigo maligna (LM) is a relatively common tumor with increasing prevalence and substantial morbidity. A variety of treatment modalities are available, though margin-control surgery offers the highest cure rate. We were interested in comparing long-term outcomes of Mohs micrographic surgery (MMS) versus staged excision with permanent sections (SE) for treating LM or LM melanoma (LMM).

METHODS

Comparative study consisting of retrospective chart review from our private practice.

RESULTS

Fifty-seven patients (31 male, 26 female, mean age at diagnosis 69.1 +/- 10.1 years) were treated in our office for LM (50) or LMM (9) between January 1986 and December 2001. Forty-one tumors (71%) were located on the head and neck. Fifty-three of the 59 tumors (90%) were primary, and 6/59 (10%) were recurrent at the time of initial treatment. Forty-one tumors (36 LM, 5 LMM) were treated with SE, and 18 (14 LM, 4 LMM) were treated with MMS. The mean preoperative lesion size (1.5 +/- 0.2 cm2 for SE; 1.2 +/- 0.4 cm2 for MMS), mean postoperative defect size (7.1 +/- 1 cm2 for SE; 7.1 +/- 1.4 cm2 for MMS), and the ratio of postoperative defect to preoperative lesion size (7.9-fold increase for SE, 11.2-fold increase for MMS) were similar between the cohorts. Mean number of stages for clear margins were similar, with 1.8 +/- 0.2 stages (range: 1-7) for SE and 2.0 +/- 0.2 stages (range: 1-4) for MMS; clear margins were obtained in one or two stages in 85% of cases for SE and in 67% for MMS. Three recurrences (3/41; 7.3%) occurred in the SE group while 6 recurrences (6/18; 33%) occurred in the MMS group (P < .025). The mean follow-up duration was 95 months (range: 60-240) in the SE group and 117.5 months (range: 61-157) in the MMS group.

LIMITATIONS

Results are limited to a single practice site and fewer patients underwent MMS compared to SE. Patients were not randomized as cases were ascertained retrospectively.

CONCLUSION

Staged excision of LM and LMM is associated with a significantly lower recurrence rate with no difference in surgical defect size compared to MMS. To our knowledge, this is the first study directly comparing these two surgical techniques for managing this form of melanoma. Our extended follow-up duration exceeds that of most previous reports.

摘要

背景

恶性雀斑样痣（LM）是一种相对常见的肿瘤，其患病率呈上升趋势，且发病率较高。虽然有多种治疗方式可供选择，但边缘控制手术的治愈率最高。我们有兴趣比较莫氏显微外科手术（MMS）与分期切除并送永久切片（SE）治疗LM或LM黑色素瘤（LMM）的长期疗效。

方法

通过回顾我们私人诊所的病历进行比较研究。

结果

1986年1月至2001年12月期间，我们诊所共治疗了57例患者（31例男性，26例女性，诊断时平均年龄69.1±10.1岁），其中LM患者50例，LMM患者9例。41个肿瘤（71%）位于头颈部。59个肿瘤中有53个（90%）为原发性，6/59（10%）在初始治疗时为复发性。41个肿瘤（36例LM，5例LMM）接受了SE治疗，18个肿瘤（14例LM，4例LMM）接受了MMS治疗。两组患者术前病变平均大小（SE组为1.5±0.2 cm²；MMS组为1.2±0.4 cm²）、术后缺损平均大小（SE组为7.1±1 cm²；MMS组为7.1±1.4 cm²）以及术后缺损与术前病变大小的比值（SE组增加7.9倍，MMS组增加11.2倍）相似。切缘阴性的平均分期相似，SE组为1.8±0.2期（范围：1 - 7期），MMS组为2.0±0.2期（范围：1 - 4期）；85%的SE组病例和67%的MMS组病例在一或两个阶段获得切缘阴性。SE组发生3例复发（3/41；7.3%），而MMS组发生6例复发（6/18；33%）（P < 0.025）。SE组的平均随访时间为95个月（范围：60 - 240个月），MMS组为117.5个月（范围：61 - 157个月）。