Department of Dermatology, Second University of Naples, Via S. Pansini, 5-80131 Naples, Italy.
Br J Dermatol. 2010 Feb 1;162(2):267-73. doi: 10.1111/j.1365-2133.2009.09416.x. Epub 2009 Jul 20.
Recent evidence suggests that melanoma is a family of different tumours with varying abilities to grow and metastasize. Trends in melanoma epidemiology show a strong increase in the incidence of thin melanoma, with no corresponding increase in mortality or incidence of thick melanoma. We initially evaluated five cases and found that none had baseline features suggestive of melanoma; excision was performed based on slight changes visible only in side-by-side comparisons of dermoscopic images.
To assess the clinico-dermoscopic features and the growth patterns of melanomas that were excised after a follow-up of 1 year or more due to their inconspicuous features at the baseline consultation.
In a multicentre, retrospective study of histopathologically confirmed melanomas excised after follow-up, we analysed dermoscopic images obtained at the initial consultation and compared them with images obtained at the last follow-up consultation. Images were analysed and graded using standard algorithms and scored for changes in size, symmetrical or asymmetrical structural change, and development of new melanoma-specific criteria. An overall score reflecting the amount of change was calculated for each lesion.
Our series consisted of 103 melanomas. After a median follow-up of 20 months, most lesions were still in situ or early invasive (median Breslow thickness of 0.48 mm), with only three lesions showing tumour thickness of 1 mm or more. The most frequent baseline characteristics were asymmetrical pigmentation (78.6% of lesions), reticular overall pattern (62.1%), and regression features (35.9%). Most melanomas (58.3%) showed minor to moderate changes over time, with < 2 mm size increase, with asymmetrical structural change, and without development of new melanoma-specific criteria. Major changes were visible only after a mean follow-up of 33 months.
This study provides evidence for the existence of a subgroup of slow-growing melanomas, which may explain the increase in the incidence of thin melanoma, despite stable rates of thick melanoma and melanoma-associated mortality.
最近的证据表明，黑色素瘤是一组具有不同生长和转移能力的不同肿瘤。黑色素瘤流行病学趋势显示，薄型黑色素瘤的发病率显著增加，而厚型黑色素瘤的死亡率或发病率并无相应增加。我们最初评估了 5 例病例，发现这些病例在基线时均无明显的黑色素瘤特征；由于在皮损镜检图像的并排比较中仅能观察到轻微变化，故对这些病例进行了切除。
评估因基线时特征不明显而在随访 1 年以上后切除的黑色素瘤的临床-皮损镜检特征和生长模式。
在一项多中心、回顾性研究中，我们分析了组织病理学确诊的黑色素瘤在随访后切除的病例，分析了初始就诊时获得的皮损镜检图像，并将其与最后一次随访时获得的图像进行比较。使用标准算法对图像进行分析和分级，并对大小、对称或不对称结构变化以及新出现的黑色素瘤特异性标准进行评分。为每个病变计算反映变化量的总评分。
我们的系列研究共包括 103 例黑色素瘤。在中位随访 20 个月后，大多数病变仍处于原位或早期浸润（中位 Breslow 厚度为 0.48mm），只有 3 例病变的肿瘤厚度达到 1mm 或更厚。最常见的基线特征是不对称性色素沉着（78.6%的病变）、网状整体模式（62.1%）和退行性特征（35.9%）。大多数黑色素瘤（58.3%）随时间发生轻微至中度变化，病变大小增加<2mm，出现不对称性结构变化，且无新出现的黑色素瘤特异性标准。仅在平均随访 33 个月后才可见明显的变化。
本研究为存在一组生长缓慢的黑色素瘤提供了证据，这可能解释了尽管厚型黑色素瘤和黑色素瘤相关死亡率稳定，但薄型黑色素瘤的发病率仍在增加的原因。
