Chaput Laura, Laurent Emeline, Pare Arnaud, Sallot Aurélie, Mourtada Youssef, Ossant Frédéric, Vaillant Loïc, Patat Frédéric, Machet Laurent
Department of Dermatology, CHRU de Tours, France.
Department of Epidemiology, CHRU de Tours, France.
Eur J Dermatol. 2018 Apr 1;28(2):202-208. doi: 10.1684/ejd.2018.3298.
Surgical margins of melanoma vary from 5 mm to 1 or 2 cm depending on histology thickness (Breslow). This approach usually requires two surgical steps: excisional biopsy and further re-excision according to histology thickness. A previous systematic review showed that measuring melanoma thickness with high-resolution ultrasound imaging equipment correlates well with histological measurement of melanoma thickness. Therefore, we routinely determined tumour sonographic thickness in order to perform surgery as a single step.
To determine the proportion of patients who receive one-step surgery with adequate margins based on sonographic measurement of melanoma thickness and identify the reasons for differences between these two measurements.
A retrospective series of patients with melanoma, in which thickness was measured by ultrasound (20 MHz) from April 2007 to December 2015 prior to surgery.
Ninety-nine melanomas were treated, of which 78 were removed in a single step with surgical margins based on sonometric thickness measurements; 71 of these (91%, 95% CI: 82-96) did not require re-excision, five had excessive margins, and two had insufficient margins. The correlation between the histometric and sonometric measurements was good; r=0.88. Significant absolute difference between sonometric and histometric measurements was associated with thickness, ulceration, and size of tumours, based on bivariate analysis. Thickness remained the only significant factor based on multivariate analysis.
Measuring the thickness of melanoma with high-resolution ultrasound imaging equipment makes it possible to remove the melanoma in a single step with adequate margins in at least 82% of the cases in routine care.
黑色素瘤的手术切缘根据组织学厚度（ Breslow 厚度）不同而在 5 毫米至 1 或 2 厘米之间变化。这种方法通常需要两个手术步骤：切除活检以及根据组织学厚度进行进一步的再次切除。先前的一项系统评价表明，使用高分辨率超声成像设备测量黑色素瘤厚度与黑色素瘤厚度的组织学测量结果具有良好的相关性。因此，我们常规测定肿瘤的超声厚度，以便一步完成手术。
确定基于黑色素瘤超声厚度测量接受一步手术且切缘足够的患者比例，并找出这两种测量方法之间差异的原因。
回顾性分析一系列黑色素瘤患者，这些患者在 2007 年 4 月至 2015 年 12 月手术前通过超声（20 兆赫）测量厚度。
共治疗了 99 例黑色素瘤，其中 78 例根据超声厚度测量结果一步切除，切缘足够；其中 71 例（91%，95%可信区间：82 - 96）无需再次切除，5 例切缘过大，2 例切缘不足。组织学测量与超声测量之间的相关性良好；r = 0.88。基于双变量分析，超声测量与组织学测量之间的显著绝对差异与肿瘤的厚度、溃疡和大小有关。基于多变量分析，厚度仍然是唯一的显著因素。
在常规护理中，使用高分辨率超声成像设备测量黑色素瘤厚度使得至少 82%的病例能够一步切除黑色素瘤且切缘足够。
