Pereda C, Traves V, Requena C, Serra-Guillén C, Llombart B, Sanmartín O, Guillén C, Nagore E
Servicio de Dermatología, Valencia, Spain.
Actas Dermosifiliogr. 2013 Apr;104(3):220-6. doi: 10.1016/j.ad.2012.06.006. Epub 2012 Sep 5.
Acral lentiginous melanomas -the melanomas most commonly found on the distal portions of the limbs- have usually reached more advanced stages than other types of melanoma when diagnosed. Our aim was to describe the clinical presentation of these tumors.
Retrospective, descriptive, observational study of cases recorded in the database of the Instituto Valenciano de Oncología. In telephone interviews the patients answered a questionnaire on the presenting features of the lesion, on the presence of signs and symptoms included in the Glasgow 7-point checklist and the ABCDEs of melanoma, and on diagnostic delay attributable to patient or physician.
In the interviews with the 23 patients who responded to the questionnaire, we detected a diagnostic delay of more than 1 year attributable to the patient (delay in seeking care) in 30.4% of the cases. Diagnostic delay of more than 1 year attributable to the physician (failure to suspect the diagnosis) was identified in 20%. The most frequent reasons for consulting a physician about a lesion were changes in size, changes in color, bleeding, or failure to heal. In 20% of the cases the evaluating physician did not order histology for over a year.
Diagnostic delay is a significant problem in acral lentiginous melanoma and may be attributable either to patients or to physicians' failure to recognize warning signs. Melanoma prevention campaigns should place more emphasis on the possibility of melanomas appearing on the palms and, particularly, on the soles.
肢端雀斑样痣黑色素瘤——最常见于四肢远端的黑色素瘤——在诊断时通常比其他类型的黑色素瘤处于更晚期阶段。我们的目的是描述这些肿瘤的临床表现。
对瓦伦西亚肿瘤研究所数据库中记录的病例进行回顾性、描述性、观察性研究。通过电话访谈，患者回答了一份关于病变呈现特征、格拉斯哥7分检查表和黑色素瘤ABCDE法中体征和症状的存在情况，以及患者或医生导致的诊断延迟的问卷。
在对23名回答问卷的患者进行的访谈中，我们发现30.4%的病例中患者导致诊断延迟超过1年（寻求治疗延迟）。20%的病例中发现医生导致诊断延迟超过1年（未怀疑诊断）。因病变咨询医生的最常见原因是大小改变、颜色改变、出血或不愈合。20%的病例中，评估医生一年多未进行组织学检查。
诊断延迟是肢端雀斑样痣黑色素瘤的一个重要问题，可能归因于患者或医生未识别警示信号。黑色素瘤预防活动应更加强调黑色素瘤出现在手掌尤其是脚底的可能性。
