Lichte V, Breuninger H, Metzler G, Haefner H M, Moehrle M
Department of Dermatology, Universitätsklinikum Tübingen, Eberhard-Karls-Universität, Liebermeisterstr. 25, D-72076 Tübingen, Germany.
Br J Dermatol. 2009 Mar;160(3):591-9. doi: 10.1111/j.1365-2133.2008.08954.x. Epub 2008 Nov 25.
Patients with acral lentiginous melanoma (ALM) seem to have a poor prognosis. ALMs represent 4-10% of cutaneous melanomas in white populations. Surgery is mostly based on conventional histological evaluation. With micrographic surgery, continuously spreading tumours can be excised with smaller excision margins for better cosmesis and function.
Clinical parameters and surgical strategies influencing the prognosis of patients with ALM were evaluated.
Two hundred and forty-one patients (44% male, 56% female) with stage I/II ALM were recorded during 1980-2006. One hundred and thirty-three patients underwent complete histology of three-dimensional excision margins (3D histology) using the paraffin technique. Risk factors for disease-specific and recurrence-free survival were estimated.
Patients were aged 26-87 years (median 63) with median tumour thickness of 2.0 mm. The median follow-up was 41 months. Multivariate analysis identified ulceration, conventional histology and tumour thickness as risk factors for recurrence-free and disease-specific survival. Using 3D histology, excision margins were significantly smaller (median 7 vs. 20 mm) without an increased risk of local recurrences. Patients with 3D histology had a 5-year survival of 81% compared with 63% with conventional histology. Retrospective analysis with immunohistological methods (anti-Melan-A) could improve the diagnostic specificity in detecting further melanocytic cell nests.
Clinical and surgical risk factors seem to have different influences on the outcome of ALM. 3D histology allows reduction of excision margins by two-thirds without an increased risk of local recurrences and with better prognosis. 3D immunohistology could be a valuable diagnostic tool to reduce the rate of local recurrences.
肢端雀斑样痣黑色素瘤（ALM）患者的预后似乎较差。在白种人群中，ALM占皮肤黑色素瘤的4%-10%。手术大多基于传统组织学评估。借助显微外科手术，可切除持续扩散的肿瘤，且切除边缘更小，以实现更好的美容效果和功能。
评估影响ALM患者预后的临床参数和手术策略。
记录了1980年至2006年间241例I/II期ALM患者（男性44%，女性56%）。133例患者采用石蜡技术对三维切除边缘进行了完整组织学检查（三维组织学）。评估了疾病特异性生存和无复发生存的危险因素。
患者年龄在26至87岁之间（中位数63岁），肿瘤厚度中位数为2.0毫米。中位随访时间为41个月。多变量分析确定溃疡、传统组织学和肿瘤厚度为无复发生存和疾病特异性生存的危险因素。采用三维组织学时，切除边缘显著更小（中位数7毫米对20毫米），且局部复发风险未增加。采用三维组织学的患者5年生存率为81%，而采用传统组织学的患者为63%。采用免疫组织化学方法（抗黑色素A）进行回顾性分析可提高检测其他黑素细胞巢的诊断特异性。
临床和手术危险因素似乎对ALM的预后有不同影响。三维组织学可将切除边缘减少三分之二，且不增加局部复发风险，预后更好。三维免疫组织化学可能是降低局部复发率的有价值诊断工具。
