Warycha Melanie A, Christos Paul J, Mazumdar Madhu, Darvishian Farbod, Shapiro Richard L, Berman Russell S, Pavlick Anna C, Kopf Alfred W, Polsky David, Osman Iman
Department of Dermatology, New York University School of Medicine, New York, NY 10016, USA.
Cancer. 2008 Dec 15;113(12):3341-8. doi: 10.1002/cncr.23955.
Nodular melanoma (NM) may be biologically aggressive compared with the more common superficial spreading melanoma (SSM), with recent data suggesting underlying genetic differences between these 2 subtypes. To better define the clinical behavior of NMs, the authors compared their clinical and histopathologic features to those of SSMs at their institution, a tertiary referral center, over 3 decades.
A total of 1,684 patients diagnosed with 1,734 melanomas were prospectively enrolled. Of these, 1,143 patients (69% SSM, 11% NM, 20% other) were diagnosed between 1972 and 1982; 541 patients (54% SSM, 23% NM, 23% other) were diagnosed between 2002 and the present. Differences between the features of NM and SSM within each time period as well as changes over time were analyzed.
The authors found that SSMs are now diagnosed as thinner lesions (P < .0001) with a low incidence of histologic ulceration (P < .0001), whereas there was no significant change in the median tumor thickness or ulceration status of NMs over time (P = .10, P = .30, respectively). The median age at diagnosis of NM, however, did significantly increase over time (51 years to 63 years, P < .01). The median duration of NMs was reported to be only 5 months compared with 9 months in SSM patients.
The authors' data suggest that improvements have been made in the early detection of SSM but not NM. Modifications of current screening practices, including increased surveillance of high-risk patients with an emphasis on the "E" for "evolution" criterion of the ABCDE acronym used for early detection of melanoma, are thus warranted.
与更常见的浅表扩散性黑色素瘤（SSM）相比，结节性黑色素瘤（NM）在生物学上可能更具侵袭性，最近的数据表明这两种亚型之间存在潜在的基因差异。为了更好地界定NM的临床行为，作者在其所在的一家三级转诊中心，对超过30年期间NM和SSM的临床及组织病理学特征进行了比较。
前瞻性纳入了1684例诊断为1734例黑色素瘤的患者。其中，1143例患者（69%为SSM，11%为NM，20%为其他类型）于1972年至1982年期间确诊；541例患者（54%为SSM，23%为NM，23%为其他类型）于2002年至今确诊。分析了每个时间段内NM和SSM特征之间的差异以及随时间的变化。
作者发现，现在诊断出的SSM病灶更薄（P <.0001），组织学溃疡发生率较低（P <.0001），而NM的中位肿瘤厚度或溃疡状态随时间没有显著变化（分别为P =.10，P =.30）。然而，NM的中位诊断年龄随时间显著增加（从51岁增至63岁，P <.01）。据报告，NM的中位病程仅为5个月，而SSM患者为9个月。
作者的数据表明，SSM的早期检测有了改善，但NM没有。因此，有必要对当前的筛查做法进行调整，包括加强对高危患者的监测，重点关注用于黑色素瘤早期检测的ABCDE首字母缩写中的“E”（演变）标准。
