Section of Dermatology, Department of Medical Sciences, University of Turin, via Cherasco 23, 10126, Turin, Italy; Section of Dermatologic Surgery, Department of Oncology and Haematology via Cherasco 23, AOU Città della Salute e della Scienza di Torino, 10126, Turin, Italy.
Br J Dermatol. 2013 Dec;169(6):1240-5. doi: 10.1111/bjd.12586.
The prognostic significance of regression in primary melanoma has been debated over the past few years. Once it was considered to be a negative prognostic factor, as it may have prevented proper melanoma thickness measurement, therefore affecting the staging of the tumours. For this reason, it was considered to be an indication for sentinel lymph node biopsy (SLNB) in melanoma < 1 mm.
To ascertain the utility of SLNB in thin melanoma and to clarify the role of regression in disease-free survival (DFS) and overall survival (OS) in our series.
We analysed data collected from 1693 consecutive patients with AJCC (American Joint Committee on Cancer) stage I-II melanoma.
Globally, SLNB was performed in 656 out of 1693 patients. Regression was present in 349 patients and 223 of them were characterized by thin lesions. SLNB was performed in 104 cases of thin melanoma with regression. The majority of regional lymph node metastases were observed in patients who did not undergo SLNB (89 out of 132). Among the remaining 43 'false negative' patients only three showed regression in the primary. Using the Cox multivariate model, histological regression maintained a significant protective role [hazard ratio (HR) 0·62, P = 0·012 for DFS; HR 0·43, P = 0·008 for OS] when corrected for the principal histopathological and clinical features, despite SLNB.
We confirmed that regression alone should not be a reason to perform SLNB in thin melanoma and, on the contrary, it can be considered a favourable prognostic factor in patients with AJCC stage I-II melanoma.
近年来，原发性黑色素瘤消退的预后意义一直存在争议。过去，它被认为是一个负面的预后因素，因为它可能会妨碍对黑色素瘤厚度的正确测量，从而影响肿瘤的分期。出于这个原因，它被认为是 1 毫米以下黑色素瘤前哨淋巴结活检（SLNB）的指征。
确定 SLNB 在薄型黑色素瘤中的应用，并阐明我们的研究中消退对无病生存率（DFS）和总生存率（OS）的作用。
我们分析了来自 1693 例 AJCC（美国癌症联合委员会）I-II 期黑色素瘤连续患者的数据。
全球范围内，1693 例患者中有 656 例行 SLNB。349 例患者存在消退，其中 223 例为薄病变。在 104 例有消退的薄型黑色素瘤中进行了 SLNB。大多数区域淋巴结转移发生在未行 SLNB 的患者中（132 例中有 89 例）。在其余 43 例“假阴性”患者中，只有 3 例原发灶有消退。使用 Cox 多因素模型，在对主要组织病理学和临床特征进行校正后，组织学消退仍然具有显著的保护作用[DFS 的危险比（HR）为 0.62，P=0.012；OS 的 HR 为 0.43，P=0.008]，尽管进行了 SLNB。
我们证实，单独的消退不应该成为在薄型黑色素瘤中进行 SLNB 的原因，相反，它可以被认为是 AJCC I-II 期黑色素瘤患者的一个有利的预后因素。
