Department of Dermatology, Royal Perth Hospital, Perth, Western Australia, Australia.
Australas J Dermatol. 2009 Nov;50(4):257-60. doi: 10.1111/j.1440-0960.2009.00554.x.
Malignant melanoma is a major contributor to Australian morbidity and mortality. In this era of resource rationalisation, we seek to address the issue of whether routine full-skin examination by a dermatologist, rather than focussed examination of flagged lesions, will increase melanoma diagnosis. A retrospective chart review was undertaken between 1 July 2007 and 30 June 2008 in a private dermatology group practice in order to ascertain the number and characteristics of incidentally detected melanomas on routine skin examination. A total of 94 melanomas were detected during this 12-month period. Of these, 57 (60.6%) were incidentally detected by the dermatologist, 41 (71.9%) were in situ melanomas and 16 (28.1%) were invasive melanoma. Of the invasive lesions, 15 (94%) were 'thin' (less than 1.0 mm Breslow thickness). The majority of melanomas were found in men, and were distributed in areas of high cumulative sun exposure. Nine (9.6%) lesions were clinically misdiagnosed by the dermatologists and picked up on histopathology. This audit reaffirms the usefulness of routine full-skin examination by dermatologists in detecting de novo melanoma as part of the global strategy in reducing the burden of melanoma in Australia.
恶性黑素瘤是导致澳大利亚发病率和死亡率的主要原因之一。在资源合理化的时代，我们试图探讨皮肤科医生进行全面皮肤检查（而非针对标记病变进行集中检查）是否会增加黑色素瘤的诊断率。我们对 2007 年 7 月 1 日至 2008 年 6 月 30 日期间的一家私人皮肤科医生小组的病历进行了回顾性分析，以确定常规皮肤检查中偶然发现的黑色素瘤的数量和特征。在这 12 个月期间共发现了 94 例黑色素瘤。其中，57 例（60.6%）是皮肤科医生偶然发现的，41 例（71.9%）为原位黑色素瘤，16 例（28.1%）为侵袭性黑色素瘤。在侵袭性病变中，15 例（94%）为“薄”（厚度小于 1.0mm）。大多数黑色素瘤发生于男性，分布在累积日照量较高的区域。有 9 例（9.6%）病变被皮肤科医生临床误诊，并在组织病理学检查中发现。本次审计再次证实了皮肤科医生进行全面皮肤检查作为减少澳大利亚黑色素瘤负担的全球策略的一部分，对检测新发黑色素瘤的有用性。
