Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia.
Ann Surg Oncol. 2012 Mar;19(3):1024-33. doi: 10.1245/s10434-011-2058-8. Epub 2011 Sep 13.
0.6-12.7% of patients with primary cutaneous melanoma will develop additional melanomas. Pathologic features of tumors in patients with multiple primary cutaneous melanomas have not been well described. In this large, international, multicenter, case-control study, we compared the clinicopathologic features of a subsequent melanoma with the preceding (usually the first) melanoma in patients with multiple primary cutaneous melanomas, and with those of melanomas in patients with single primary cutaneous melanomas.
Multiple primary melanoma (cases) and single primary invasive melanoma (controls) patients from the Genes, Environment and Melanoma (GEM) study were included if their tumors were available for pathologic review and confirmed as melanoma. Clinicopathologic characteristics of invasive subsequent and first melanomas in cases and invasive single melanomas in controls were compared.
A total of 473 pairs comprising a subsequent and a first melanoma and 1,989 single melanomas were reviewed. Forward stepwise regression modeling in 395 pairs with complete data showed that, compared with first melanomas, subsequent melanomas were more commonly contiguous with a dysplastic nevus, more prevalent on the head/neck and legs than other sites, and thinner. Compared with single primary melanomas, subsequent melanomas were more likely to be associated with a contiguous dysplastic nevus, more prevalent on the head/neck and legs, and thinner. The same differences were observed when subsequent melanomas were compared with single melanomas. First melanomas were more likely than single melanomas to have associated solar elastosis and no observed mitoses.
Thinner subsequent than first melanomas suggest earlier diagnosis, perhaps due to closer clinical scrutiny. The association of subsequent melanomas with dysplastic nevi is consistent with the latter being risk factors or risk markers for melanoma.
0.6-12.7%的原发性皮肤黑素瘤患者会发展出额外的黑素瘤。多发性原发性皮肤黑素瘤患者肿瘤的病理特征尚未得到很好的描述。在这项大型的国际多中心病例对照研究中，我们比较了多发性原发性皮肤黑素瘤患者中随后发生的黑素瘤与先前（通常是第一个）黑素瘤的临床病理特征，并与单发性原发性皮肤黑素瘤患者的黑素瘤进行了比较。
如果肿瘤可用于病理检查并确认为黑素瘤，则将来自基因、环境和黑素瘤（GEM）研究的多发性原发性黑素瘤（病例）和单发性原发性浸润性黑素瘤（对照）患者纳入研究。比较了病例中侵袭性随后和第一黑素瘤以及对照中侵袭性单黑素瘤的临床病理特征。
共回顾了 473 对包括随后和第一个黑素瘤以及 1989 个单黑素瘤的肿瘤。在具有完整数据的 395 对中进行的正向逐步回归模型显示，与第一个黑素瘤相比，随后的黑素瘤更常见与发育不良痣连续存在，更常见于头/颈部和腿部而不是其他部位，并且更薄。与单发性原发性黑素瘤相比，随后的黑素瘤更有可能与连续的发育不良痣相关，更常见于头/颈部和腿部，并且更薄。当将随后的黑素瘤与单发性黑素瘤进行比较时，也观察到了相同的差异。与单发性黑素瘤相比，第一个黑素瘤更可能与日光弹性纤维相关，且没有观察到有丝分裂。
与第一个黑素瘤相比，随后的黑素瘤更薄，这表明更早的诊断，这可能是由于更密切的临床检查。随后的黑素瘤与发育不良痣的关联与后者作为黑素瘤的危险因素或风险标志物一致。
