JAMA Dermatol. 2014 May;150(5):522-5. doi: 10.1001/jamadermatol.2013.7127.
Tumor ulceration is an important prognostic factor for cutaneous melanoma (CM). Previous studies demonstrated that the proportion of ulcerated to nonulcerated CM rose with increasing tumor depth. These frequency-based studies, however, were not adjusted for the population at risk.
To determine the absolute incidence of ulcerated CM by tumor depth, stratified by sex and age at diagnosis.
DESIGN, SETTING, AND PARTICIPANTS: We compared ulcerated CM by tumor thicknesses (≤1.00, 1.01-2.00, 2.01-4.00, and ≥4.01 mm), stratified by sex among younger (10-39 years) and older (40-84 years) non-Hispanic whites in the National Cancer Institute's Surveillance, Epidemiology, and End Results database from 2004 through 2008. Types of CM included superficial spreading, nodular, and unclassified in 5106 cases among 3206 men and 1900 women.
Incidence of ulcerated CM by tumor depth for younger and older men and women.
The incidence of tumor ulceration was stable across all tumor depths among younger men and older women. Among younger women, it declined for the thickest lesions (0.08 per 100,000 for tumor depth ≥4.01 mm), although the trend was not statistically significant. In contrast, among older men, there was a statistically significant increase in ulceration for CM with a depth of approximately 1.4 per 100,000 for tumor depth of 2.00 mm or thicker.
Male sex is an age-specific effect modifier for ulcerated CM by tumor depth. Future studies and staging guidelines should consider the interaction among CM ulceration, thickness, sex, and age at diagnosis.
肿瘤溃疡是皮肤黑色素瘤（CM）的一个重要预后因素。先前的研究表明，溃疡性 CM 与非溃疡性 CM 的比例随着肿瘤深度的增加而上升。然而，这些基于频率的研究并没有根据风险人群进行调整。
通过肿瘤深度，按性别和诊断时的年龄，确定溃疡性 CM 的绝对发生率。
设计、设置和参与者：我们比较了 National Cancer Institute 的 Surveillance、Epidemiology、and End Results 数据库中 2004 年至 2008 年期间年轻（10-39 岁）和年长（40-84 岁）非西班牙裔白人中按肿瘤厚度分层的年轻（10-39 岁）和年长（40-84 岁）非西班牙裔白人中按肿瘤厚度分层的溃疡性 CM（≤1.00、1.01-2.00、2.01-4.00 和≥4.01 mm）的比例，包括 3206 名男性和 1900 名女性中的 5106 例浅表扩散型、结节型和未分类 CM。
年轻和年长男性和女性中肿瘤深度的溃疡性 CM 发生率。
在所有肿瘤深度中，年轻男性和年长女性的肿瘤溃疡发生率均保持稳定。在年轻女性中，最厚的病变（肿瘤深度≥4.01mm 时为每 10 万人 0.08 例）的发生率下降，但趋势不具有统计学意义。相比之下，在年长男性中，肿瘤厚度为 2.00mm 或更厚的 CM 的溃疡发生率有统计学意义的增加，约为每 10 万人 1.4 例。
男性是 CM 按肿瘤深度溃疡的年龄特异性效应修饰因子。未来的研究和分期指南应考虑 CM 溃疡、厚度、性别和诊断时年龄之间的相互作用。
