Kovalyshyn Ivanka, Dusza Stephen W, Siamas Katherine, Halpern Allan C, Argenziano Giuseppe, Marghoob Ashfaq A
Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA.
Arch Dermatol. 2011 Nov;147(11):1269-75. doi: 10.1001/archdermatol.2011.181. Epub 2011 Jul 18.
To compare melanoma characteristics and detection patterns in new vs established patients in a pigmented lesion clinic at Memorial Sloan-Kettering Cancer Center (MSKCC) during a 10-year period.
Single-center historical cohort study.
Academic practice of 2 dermatologists with expertise in the management of pigmented skin lesions.
The study included 394 patients diagnosed with cutaneous melanoma at MSKCC between 1998 and 2008. For the purposes of this study, we separated patients into 2 groups: established patients, defined as patients who have received professional services in a pigmented lesion clinic at MSKCC for at least 3 months, vs new patients, defined as patients new to our practice.
Melanoma histologic characteristics and patterns of melanoma detection in established vs new patients.
Established patients had more in situ disease (70% vs 57%; P < .001) and thinner invasive melanomas (0.45 mm vs 0.82 mm; P = .002) and were less likely to present with negative prognostic attributes such as ulceration and dermal mitoses compared with new patients. In new patients, 63% of melanomas were physician detected vs 82% in established patients; 18% of all melanomas were patient detected. Dermatologist-detected melanomas were thinner compared with self-detected melanomas. The majority of self-detected melanomas were noted by patients because of change (64%). The overall benign to malignant biopsy ratio over the 10-year period was 5.4:1.
Physician-based screening leads to higher rates of physician-detected melanoma and detection of thinner melanoma.
比较在纪念斯隆凯特琳癌症中心（MSKCC）色素沉着病变诊所10年期间新患者与老患者的黑色素瘤特征及检测模式。
单中心历史性队列研究。
由2名擅长色素沉着性皮肤病变管理的皮肤科医生开展的学术实践。
该研究纳入了1998年至2008年间在MSKCC被诊断为皮肤黑色素瘤的394例患者。为了本研究的目的，我们将患者分为两组：老患者，定义为在MSKCC色素沉着病变诊所接受专业服务至少3个月的患者；新患者，定义为新加入我们诊所的患者。
老患者与新患者黑色素瘤的组织学特征及黑色素瘤检测模式。
与新患者相比，老患者原位疾病更多（70%对57%；P <.001），侵袭性黑色素瘤更薄（0.45 mm对0.82 mm；P =.002），且出现溃疡和真皮有丝分裂等不良预后特征的可能性更小。在新患者中，63%的黑色素瘤由医生检测出，而老患者中这一比例为82%；所有黑色素瘤中有18%是患者自己检测出的。皮肤科医生检测出的黑色素瘤比患者自己检测出的更薄。大多数患者自己检测出的黑色素瘤是因为外观变化（64%）而被发现的。10年期间总体良性与恶性活检比例为5.4:1。
基于医生的筛查导致医生检测出黑色素瘤的比例更高，且能检测出更薄的黑色素瘤。
