Aldrink Jennifer H, Selim M Angelica, Diesen Diana L, Johnson Jeffrey, Pruitt Scott K, Tyler Douglas S, Seigler Hilliard F
Department of Surgery, Duke University Medical Center, Durham, NC, USA.
J Pediatr Surg. 2009 Aug;44(8):1514-21. doi: 10.1016/j.jpedsurg.2008.12.003.
Differentiating pigmented skin lesions from malignant melanoma in the pediatric population has been a challenge. Despite guidelines describing clinical features and histopathologic criteria to distinguish these lesions, misdiagnoses still occur. We report our experience over 30 years in a pediatric population with malignant melanoma.
We performed a retrospective review of 150 pediatric patients treated for malignant melanoma between 1973 and 2007 at our institution. Outcomes measured included age, Breslow thickness, Clark level of invasion, tumor location, local and distant failure rates, and overall survival.
One hundred fifty pediatric patients were evaluated. The mean age was 15.1 years. The mean Breslow thickness was 2.05 mm and corresponding Clark level of invasion was 3.47. There were 43 known recurrences (29%); 29 distant, 14 nodal, and 7 local. Overall survival was 84% with a mean follow-up of 8.5 years. Sixteen patients (10.7%) were incorrectly diagnosed on initial pathologic examination. Overall survival in the misdiagnosed group was 66%.
Pigmented skin lesions in the pediatric population represent a diagnostic challenge to pathologists and clinicians. Improvements in diagnostic techniques with rigorous characterization, as well as increased physician awareness, should lead to a reduction in errors of diagnosis.
鉴别儿童人群中的色素沉着性皮肤病变与恶性黑色素瘤一直是一项挑战。尽管有指南描述了区分这些病变的临床特征和组织病理学标准，但误诊仍时有发生。我们报告了我们在30年里对儿童恶性黑色素瘤患者的治疗经验。
我们对1973年至2007年在我们机构接受恶性黑色素瘤治疗的150例儿科患者进行了回顾性研究。测量的结果包括年龄、 Breslow厚度、Clark浸润水平、肿瘤位置、局部和远处失败率以及总生存率。
对150例儿科患者进行了评估。平均年龄为15.1岁。平均Breslow厚度为2.05mm，相应的Clark浸润水平为3.47。有43例已知复发（29%）；29例远处复发、14例淋巴结复发和7例局部复发。总生存率为84%，平均随访8.5年。16例患者（10.7%）在初次病理检查时被误诊。误诊组的总生存率为66%。
儿童人群中的色素沉着性皮肤病变对病理学家和临床医生来说是一个诊断挑战。通过严格的特征描述改进诊断技术以及提高医生的认识，应能减少诊断错误。
