Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA.
Dermatol Surg. 2011 Aug;37(8):1080-8. doi: 10.1111/j.1524-4725.2011.02015.x. Epub 2011 Jun 2.
The American Joint Committee on Cancer recently added mitotic rate (MR) to their seventh edition staging system for melanomas, which went into effect on January 1, 2010. MR has replaced the Clark level of invasion for T1 melanomas. Dermatologists and dermatopathologists should be aware of these new guidelines.
To clarify how MR may be used to determine the prognosis of thin melanomas and to identify patients with thin melanomas who would be candidates for a sentinel lymph node biopsy (SLNB).
Reports in the literature were reviewed regarding mitotic rate in thin melanomas and the use of MR for prognosis and as an indication for SLNB.
Multiple studies have shown MR to be a significant prognostic factor, surpassing Clark level of invasion, in patients with thin melanomas. SLNB is the best prognostic method for staging T1b (<1 mm thick with MR ≥1 or ulceration), T2, T3, and T4 melanomas, and SLNB should be discussed and offered to these patients.
Multiple studies support the use of MR in staging for thin melanomas, and patients with a high MR should be considered for SLNB.
美国癌症联合委员会（AJCC）最近在其 2010 年 1 月 1 日生效的第七版黑色素瘤分期系统中加入了有丝分裂率（MR）。MR 取代了 T1 黑色素瘤的 Clark 侵袭水平。皮肤科医生和皮肤病理学家应该了解这些新的指南。
阐明 MR 如何用于确定薄型黑色素瘤的预后，并确定哪些薄型黑色素瘤患者适合进行前哨淋巴结活检（SLNB）。
回顾了文献中关于薄型黑色素瘤中的有丝分裂率以及 MR 用于预后和作为 SLNB 指征的报告。
多项研究表明，MR 是薄型黑色素瘤患者的一个重要预后因素，超过了 Clark 侵袭水平。SLNB 是 T1b（厚度<1mm，MR≥1 或溃疡）、T2、T3 和 T4 黑色素瘤分期的最佳预后方法，应向这些患者讨论并提供 SLNB。
多项研究支持在薄型黑色素瘤的分期中使用 MR，MR 较高的患者应考虑进行 SLNB。
