Boland M R, Prichard R S, Bass G A, Al-Hilli Z, Levendale A, Gibbons D, Sheahan K, Kirby B, McDermott E W, Evoy D
Departments of General Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland,
Ir J Med Sci. 2015 Jun;184(2):511-5. doi: 10.1007/s11845-014-1157-5. Epub 2014 Jun 11.
Surgery remains the mainstay of treatment for malignant melanoma. Despite previous studies examining the surgical interval (SI) between the diagnostic excision biopsy (DEB) and definitive surgical management there remains few guidelines regarding an optimal time interval. The aim of this study was to determine the SI between DEB and definitive surgery and elucidate factors associated with delays in management of malignant melanoma.
A retrospective study of 107 consecutive patients who had a DEB and subsequent wide local excision between January 2011 and June 2012 was performed. Mode of referral and dates of diagnostic biopsy/definitive surgery were documented. Patient demographics and tumour characteristics were reviewed.
The mean age was 59.6 years, and male:female ratio was 1:1.3. Median duration of the SI was 41 ± 27 days (range 6-137 days). The SI was increased when dermatologists performed the DEB as opposed to general surgeons (p = 0.035). The anatomic location of the lesion predicted the SI, with lesions of the head/neck undergoing definitive excision 48 ± 32.3 days after DEB vs. 37.5 ± 22.6 days for all other sites (p = 0.001). Neither demographic factors nor histopathological prognostic features affected the SI. Reasons for a prolonged SI included referrals to different services and time for pre-operative planning.
Significant variations were noted in the SI predominantly accounted for by mode of referral and location of the malignant melanoma. Further investigation is required to elucidate factors affecting the SI and its subsequent effect on patient outcomes.
手术仍然是恶性黑色素瘤治疗的主要手段。尽管先前有研究探讨了诊断性切除活检（DEB）与确定性手术治疗之间的手术间隔（SI），但关于最佳时间间隔的指南仍然很少。本研究的目的是确定DEB与确定性手术之间的SI，并阐明与恶性黑色素瘤治疗延迟相关的因素。
对2011年1月至2012年6月期间连续107例接受DEB并随后进行广泛局部切除的患者进行了回顾性研究。记录了转诊方式以及诊断性活检/确定性手术的日期。回顾了患者的人口统计学和肿瘤特征。
平均年龄为59.6岁，男女比例为1:1.3。SI的中位持续时间为41±27天（范围6 - 137天）。与普通外科医生相比，皮肤科医生进行DEB时SI会延长（p = 0.035）。病变的解剖位置可预测SI，头颈部病变在DEB后48±32.3天进行确定性切除，而其他所有部位为37.5±22.6天（p = 0.001）。人口统计学因素和组织病理学预后特征均未影响SI。SI延长的原因包括转诊至不同科室以及术前规划所需时间。
SI存在显著差异，主要由转诊方式和恶性黑色素瘤的位置所致。需要进一步研究以阐明影响SI的因素及其对患者预后的后续影响。
