Department of Plastic Surgery, St John's Hospital, Livingston, West Lothian, EH54 6PP, Scotland, UK.
J Plast Reconstr Aesthet Surg. 2012 Oct;65(10):1396-402. doi: 10.1016/j.bjps.2012.04.019. Epub 2012 May 1.
Between the years 2000-2010, 195 patients were diagnosed with ≥4 mm Breslow thickness malignant melanoma in our unit. Median follow-up was 36.8 months. 49% of patients were male and 51% were female. Median age was 74 years. The commonest melanoma type was nodular (55%). The commonest tumour location was on the extremity (45%). 64% of tumours were ulcerated. Median mitotic rate was 9. Median Breslow thickness was 7 mm 66 patients underwent sentinel lymph node biopsy. 44 (67%) patients had negative results and the remaining 22 (33%) patients were positive for metastatic melanoma. There was no statistically significant correlation between any of the patient or tumour variables (age, sex, melanoma type, melanoma site, Clark level, Breslow thickness, mitotic rate, ulceration) and sentinel lymph node status. Patients with Breslow thickness melanoma of <6 mm had a significantly better 5-year disease free and overall survival compared with those patients with >6 mm Breslow thickness melanoma (63.5% vs. 32.9%; P=0.004 and 73.9% vs. 54.7%; P=0.02 respectively). Recurrence rate was 50% in those with positive sentinel lymph node biopsy compared to 23% in those with negative results. Distant recurrence was the commonest in both groups. 5-year disease free survival was 64.1% in the SLNB -ve group and 35.4% in the SLNB +ve group (P=0.01). There was no significant difference in overall survival between the SLNB -ve and SLNB +ve groups (70.3% vs. 63.7% respectively; P=0.66). We conclude that sentinel lymph node biopsy in our unit has provided no survival benefit in those with thick melanoma over the past 10 years but is an important predictor of recurrence free survival. Breslow thickness remains an important predictor of disease free and overall survival in thick melanoma.
在 2000 年至 2010 年间，我们单位诊断出 195 名 Breslow 厚度≥4 毫米的恶性黑色素瘤患者。中位随访时间为 36.8 个月。49%的患者为男性，51%为女性。中位年龄为 74 岁。最常见的黑色素瘤类型为结节型（55%）。最常见的肿瘤部位是四肢（45%）。64%的肿瘤有溃疡。平均有丝分裂率为 9。平均 Breslow 厚度为 7 毫米。66 名患者接受了前哨淋巴结活检。44 名（67%）患者结果为阴性，其余 22 名（33%）患者前哨淋巴结有转移性黑色素瘤。患者或肿瘤的任何变量（年龄、性别、黑色素瘤类型、肿瘤部位、Clark 分级、Breslow 厚度、有丝分裂率、溃疡）与前哨淋巴结状态均无统计学显著相关性。Breslow 厚度<6 毫米的黑色素瘤患者的 5 年无病生存率和总生存率明显优于 Breslow 厚度>6 毫米的黑色素瘤患者（63.5% vs. 32.9%；P=0.004 和 73.9% vs. 54.7%；P=0.02）。在前哨淋巴结活检阳性的患者中，复发率为 50%，而在前哨淋巴结活检阴性的患者中，复发率为 23%。两组中最常见的是远处复发。SLNB-ve 组的 5 年无病生存率为 64.1%，SLNB+ve 组为 35.4%（P=0.01）。SLNB-ve 组和 SLNB+ve 组的总生存率无显著差异（分别为 70.3%和 63.7%；P=0.66）。我们的结论是，在过去的 10 年中，前哨淋巴结活检在我们单位并没有为厚黑色素瘤患者提供生存获益，但它是无复发生存的重要预测因素。Breslow 厚度仍然是厚黑色素瘤无病和总生存率的重要预测因素。
