Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
J Am Acad Dermatol. 2017 Apr;76(4):707-713. doi: 10.1016/j.jaad.2016.10.049. Epub 2017 Jan 7.
Subclinical spread of in situ melanoma occurs at a wide frequency, ranging from 12% to 71%.
To identify clinical factors associated with subclinical spread of in situ melanoma.
We used a retrospective, cross-sectional study of 674 consecutive in situ melanomas to examine 627 patients treated with Mohs surgery and melanoma antigen recognized by T cells 1 immunostaining. The presence of subclinical spread was correlated with clinical characteristics. Univariate and multivariate logistic regression analyses were performed to generate odds ratios (ORs) and 95% confidence intervals (CIs).
Both univariate and multivariate analyses demonstrated significantly increased odds for subclinical spread of in situ melanomas when they were located on the head or neck, at acral sites, or on the pretibial leg (OR 1.97, 95% CI 1.41-3.40); in persons with a history of prior treatment (OR 2.77, 95% CI 1.74-4.420); melanomas of preoperative size >1 cm (OR 1.74, 95% CI 1.23-2.46, P = .002); or in persons ≥60 years old (OR 1.47, 95% CI 1.01-2.13, P = .042). A count prediction model demonstrated that the risk for subclinical spread increased with the number of clinical risk factors.
We used a single-site, retrospective study design.
Clarifying the risk factors for subclinical spread might help to refine triage of in situ melanomas to the appropriate surgical techniques for margin assessment prior to reconstruction.
原位黑素瘤的亚临床扩散频率广泛，为 12%至 71%。
确定与原位黑素瘤亚临床扩散相关的临床因素。
我们对 674 例连续的原位黑素瘤进行了回顾性、横断面研究，共检查了 627 例接受 Mohs 手术和黑色素瘤抗原识别 T 细胞 1 免疫染色的患者。将亚临床扩散的存在与临床特征相关联。进行了单变量和多变量逻辑回归分析，以生成优势比（OR）和 95%置信区间（CI）。
单变量和多变量分析均表明，当原位黑素瘤位于头颈部、肢端部位或小腿前侧、既往有治疗史、术前大小>1cm 或患者年龄≥60 岁时，其亚临床扩散的可能性显著增加（OR 分别为 1.97、2.77、1.74、1.74，95%CI 分别为 1.41-3.40、1.74-4.420、1.23-2.46、1.01-2.13，P 均<0.05）。计数预测模型表明，亚临床扩散的风险随临床危险因素数量的增加而增加。
我们使用了单站点、回顾性研究设计。
阐明亚临床扩散的风险因素可能有助于在重建前对适当的手术技术进行边缘评估，从而对原位黑素瘤进行分诊。
