Melanoma and Sarcomas Unit, Veneto Institute of Oncology, Padova, ItalyDepartment of Oncological and Surgical Sciences, University of Padova, Padova, ItalyImmunology and Molecular Oncology Unit, Veneto Institute of Oncology, Padova, ItalyPathology Unit, Veneto Institute of Oncology, Padova, ItalyDermatology Unit, University of Padova, Padova.
J Eur Acad Dermatol Venereol. 2014 Jan;28(1):58-64. doi: 10.1111/jdv.12055. Epub 2012 Dec 6.
Multiple primary melanomas (MPM) occur in up to 20% of melanoma patients, and subsequent tumours seem to have a favourable histopathological pattern.
A prospectively collected cohort of 194 patients with MPM was retrospectively reviewed to investigate clinical and histopathological features of first and subsequent melanomas.
Patients with MPM who were diagnosed at our Department (1985-2011) and who attended at least a follow-up control yearly were identified.
The number of nevi was <10, 10-50 and >50 in 8.7%, 41% and 50.3% of patients respectively. Histopathological dysplastic nevi have been diagnosed in 105 patients. During a median follow-up of 58 months, 159 (81.9%), 24 (12.3%), 7 (3.6%) and 4 (2%) patients developed 2, 3, 4 and ≥ 5 melanomas, respectively. The median time to second primary melanoma was 45 months. The second primary melanoma was diagnosed within 1-year and after 5-year from the first melanoma in 36.6% and 17.3% of patients respectively. First and second primary melanomas were in situ in 41 (21%) and 104 (54%) patients respectively (P < 0.001). Among patients with ≥ 2 invasive melanomas (N = 80), median tumour thickness and ulceration of first and second primaries were 0.91 and 0.44 mm (P <0.001), and 32% and 7.7% (P = 0.001) respectively.
Subsequent melanomas occurred within 1-year from the appearance of the first melanoma in 36% of patients with MPM, while a late melanoma diagnosis was detected in 17% of cases. Second primary melanoma had favourable histopathological features. Our findings support long-term skin surveillance to detect subsequent melanomas at an early stage.
多达 20%的黑色素瘤患者会发生多发原发性黑色素瘤（MPM），且后续肿瘤似乎具有有利的组织病理学模式。
回顾性分析了一组前瞻性收集的 194 例 MPM 患者，以研究首发和后继黑色素瘤的临床和组织病理学特征。
确定了在我院（1985-2011 年）诊断为 MPM 且每年至少接受一次随访检查的患者。
患者的痣数分别为<10、10-50 和>50 的占 8.7%、41%和 50.3%。105 例患者被诊断为组织学异型性痣。在中位随访 58 个月时，分别有 159（81.9%）、24（12.3%）、7（3.6%）和 4（2%）例患者发展了 2、3、4 和≥5 个黑色素瘤，第二原发性黑色素瘤的中位诊断时间为 45 个月。第二原发性黑色素瘤在首发黑色素瘤后 1 年和 5 年内被诊断分别占患者的 36.6%和 17.3%。第一和第二原发性黑色素瘤原位癌分别占 41（21%）和 104（54%）（P<0.001）。在≥2 例侵袭性黑色素瘤患者（N=80）中，首发和第二原发黑色素瘤的肿瘤厚度和溃疡中位数分别为 0.91 和 0.44mm（P<0.001），32%和 7.7%（P=0.001）。
在 MPM 患者中，36%的患者首发黑色素瘤后 1 年内出现后续黑色素瘤，17%的患者检测到晚期黑色素瘤诊断。第二原发性黑色素瘤具有有利的组织病理学特征。我们的研究结果支持长期皮肤监测，以便在早期发现后续黑色素瘤。
