Lees V C, Briggs J C
Department of Plastic Surgery, Addenbrooke's Hospital, Cambridge, UK.
Br J Surg. 1991 Sep;78(9):1108-10. doi: 10.1002/bjs.1800780923.
After treatment for primary clinical Stage 1 invasive cutaneous malignant melanoma, 1086 patients were followed for a minimum of 5 years from initial operation. Patient data were retrieved from the unit's melanoma registry; 96 (8.8 per cent) were treated initially by incisional biopsy, 292 (26.9 per cent) by narrow margin excision biopsy and 698 (64.3 per cent) by wide margin excision. Logistic regression analysis was performed to assess the statistical significance of the association between the various factors. The method of initial biopsy was related to maximal tumour thickness, age, and sex. Incisional biopsy rendered 38 out of 96 (40 per cent) lesions not fully assessable on current histopathological criteria, significantly higher than for the other biopsy techniques (P less than 0.0001). Incisional biopsy did not adversely affect prognosis in terms of local recurrence and mortality. Prognosis was related to tumour thickness, age and sex of the patient, and not to biopsy technique. We recommend that all suspicious lesions should be submitted to excisional rather than incisional biopsy to avoid compromising the histological assessment, given the importance of maximal tumour thickness in determining treatment and prognosis.
对1086例原发性临床Ⅰ期浸润性皮肤恶性黑色素瘤患者进行治疗后，从初次手术开始至少随访5年。患者数据取自该科室的黑色素瘤登记处；96例（8.8%）最初接受了切取活检，292例（26.9%）接受了窄切缘切除活检，698例（64.3%）接受了宽切缘切除。进行逻辑回归分析以评估各种因素之间关联的统计学意义。初次活检方法与肿瘤最大厚度、年龄和性别有关。根据当前组织病理学标准，96例中的38例（40%）切取活检的病变无法完全评估，显著高于其他活检技术（P小于0.0001）。就局部复发和死亡率而言，切取活检对预后没有不利影响。预后与肿瘤厚度、患者年龄和性别有关，而与活检技术无关。鉴于肿瘤最大厚度在确定治疗和预后方面的重要性，我们建议所有可疑病变均应进行切除活检而非切取活检，以避免影响组织学评估。
