Ingkaninanda Patlada, Visessiri Yingluck, Rutnin Suthinee
J Med Assoc Thai. 2015 Aug;98(8):820-7.
To present the clinicopathological characteristics of cutaneous melanoma in Thai patients and to define the possible clinicopathological prognostic factors.
A retrospective study of primary cutaneous melanoma in Thai patients in Ramathibodi Hospital between January 2007 and December 2012 was conducted. All medical records and skin biopsies were reviewed for demographic data and histopathologicalfeatures. Univariate and multivariate analysis for overall survival, and prognostic factors, according to clinical and histopathological features were performed.
Fourty-three patients with pathologically confirmed primary cutaneous melanoma were identified and reviewed. The median age of onset was 58 years, with male:female ratio was 1:1.05. Acral lentiginous melanoma (ALM) was the most common type (76.7%). The majority of patients had clinical stage 11 (56.1%). Histologically, the median tumor thickness was 2.9 mm, 88.2% had Clark's level IV and V, 47.1% were ulcerated, and 76.5% had dermal mitotic rate of ≥ 1 mitoses/mm. The 5-year overall survival rates was 38.3%. Univariate analysis demonstrated that clinical stage IV Breslow's thickness of > 3 mm, and dermal mitotic rate of ≥ 3 mitoses/mm2 were bad prognostic factors. Multivariate analysis demonstrated that advanced clinical staging (stage III and IV), Breslow's thickness of > 3 mm, ulceration, palmoplantar or subungual site, and histologic subtype of ALM were the independent risk factors for poor prognosis.
Most patients with cutaneous melanoma in Thai patients had the histologic subtype of ALM and were diagnosed with locally advanced disease (stage II). The prognosis depends on clinical staging, Breslow's thickness, ulceration, primary location of tumor and histologic subtype.
阐述泰国患者皮肤黑色素瘤的临床病理特征，并确定可能的临床病理预后因素。
对2007年1月至2012年12月在拉玛蒂博迪医院的泰国原发性皮肤黑色素瘤患者进行回顾性研究。查阅所有病历和皮肤活检样本，获取人口统计学数据和组织病理学特征。根据临床和组织病理学特征，对总生存期和预后因素进行单因素和多因素分析。
确定并回顾了43例经病理证实的原发性皮肤黑色素瘤患者。发病年龄中位数为58岁，男女比例为1:1.05。肢端雀斑样痣黑色素瘤（ALM）是最常见的类型（76.7%）。大多数患者临床分期为Ⅱ期（56.1%）。组织学上，肿瘤厚度中位数为2.9mm，88.2%为克拉克Ⅳ级和Ⅴ级，47.1%有溃疡形成，76.5%真皮有丝分裂率≥1个/平方毫米。5年总生存率为38.3%。单因素分析表明，临床Ⅳ期、 Breslow厚度>3mm以及真皮有丝分裂率≥3个/平方毫米是不良预后因素。多因素分析表明，临床分期进展（Ⅲ期和Ⅳ期）、Breslow厚度>3mm、溃疡形成、掌跖或甲下部位以及ALM组织学亚型是预后不良的独立危险因素。
泰国皮肤黑色素瘤患者大多具有ALM组织学亚型，且诊断为局部晚期疾病（Ⅱ期）。预后取决于临床分期、Breslow厚度、溃疡形成、肿瘤原发部位和组织学亚型。
