Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
J Am Acad Dermatol. 2017 Aug;77(2):341-348. doi: 10.1016/j.jaad.2017.03.018.
Detecting a more advanced stage of the primary melanoma after wide local excision and reconstruction can complicate patient counseling about prognosis, management of surgical margins, and indications for sentinel lymph node biopsy.
To identify the frequency of and risk factors associated with upstaging after wide local excision of primary melanoma.
Retrospective, single center, cross-sectional study of 1332 consecutive in situ to stage T4a melanomas treated with wide local excision.
The overall rate of upstaging of melanoma was 3.9% (52/1332). After multivariate analysis, the greatest risk factor for upstaging was anatomic location on the head, neck, hands, feet, genitals, or pretibial leg (odds ratio [OR] 7.06, P < .001) followed by extension of the melanoma to the base of the biopsy specimen (OR 3.42, P < .001); the need for multiple preoperative scouting biopsies (OR 1.89, P = .004); older age (OR 1.03 per year, P = .002); and nonlentigo maligna histologic subtype (OR 3.6, P = .002).
This was a single-site, retrospective observational study.
Clinicopathologic characteristics, particularly anatomic location on the head, neck, hands, feet, genitals, or pretibial leg and subtotal diagnostic biopsies, identify melanomas with an increased risk for upstaging.
在广泛局部切除和重建后检测原发性黑色素瘤的更晚期，可能会使患者的预后咨询、手术边缘管理和前哨淋巴结活检的适应证复杂化。
确定广泛局部切除原发性黑色素瘤后分期升级的频率和相关危险因素。
回顾性、单中心、横断面研究了 1332 例连续的原位至 T4a 黑色素瘤患者，均接受了广泛局部切除。
黑色素瘤分期升级的总发生率为 3.9%（52/1332）。多因素分析后，分期升级的最大危险因素是头、颈、手、脚、生殖器或小腿前区的解剖位置（比值比[OR] 7.06，P<.001），其次是黑色素瘤向活检标本基底延伸（OR 3.42，P<.001）；需要多次术前探查活检（OR 1.89，P=.004）；年龄较大（OR 每年增加 1.03，P=.002）；非黏膜恶性黑色素瘤组织学亚型（OR 3.6，P=.002）。
这是一项单站点、回顾性观察性研究。
临床病理特征，特别是头、颈、手、脚、生殖器或小腿前区的解剖位置和不完全诊断性活检，可以识别分期升级风险增加的黑色素瘤。
