Janz Tyler A, Neskey David M, Nguyen Shaun A, Lentsch Eric J
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States; University of Central Florida College of Medicine, Orlando, FL, United States.
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States.
Am J Otolaryngol. 2018 Sep-Oct;39(5):631-635. doi: 10.1016/j.amjoto.2018.06.007. Epub 2018 Jun 8.
To evaluate the frequency of brain metastasis at the time of diagnosis for patients with cutaneous head and neck melanoma (CHNM).
Patients in the Surveillance, Epidemiology, and End Results (SEER) database were included from 2010 to 2014 based on a diagnosis of CHNM using ICD O-3 histology codes and primary site location documentation. Patients were also included if they had a "yes" or "no" documented in the "Mets at Dx-Brain" category.
In this study, 46 out of 19,066 (0.2%) patients diagnosed with CHNM presented with brain metastasis at diagnosis. Of the 19,066 patients, 14,124 (74.1%) were male. Caucasian race was noted in 18,299 cases (96.0%). 16.8% of patients with AJCC 7 Stage IV/M1 CHNM had brain metastasis at the time of diagnosis as compared to 0% in Stage I-III/M0 lesions (p < .001).
The 2018 NCCN guidelines recommend healthcare providers consider ordering a baseline brain MRI for patients with stage IIIC or greater melanoma. This study demonstrates the very low frequency of brain metastasis at time of diagnosis in patients with CHNM and supports the NCCN recommendations demonstrating that only very advanced stages of CHNM require baseline brain imaging.
评估头颈部皮肤黑色素瘤（CHNM）患者诊断时脑转移的发生率。
根据国际疾病分类肿瘤学第三版（ICD O - 3）组织学编码和原发部位定位记录，纳入监测、流行病学和最终结果（SEER）数据库中2010年至2014年诊断为CHNM的患者。若“诊断时脑转移”类别记录为“是”或“否”，这些患者也被纳入。
在本研究中，19066例诊断为CHNM的患者中有46例（0.2%）在诊断时出现脑转移。在这19066例患者中，14124例（74.1%）为男性。18299例（96.0%）为白种人。美国癌症联合委员会（AJCC）第7版IV/M1期CHNM患者中有16.8%在诊断时发生脑转移，而I - III/M0期病变患者这一比例为0%（p<0.001）。
2018年美国国立综合癌症网络（NCCN）指南建议医疗服务提供者考虑为IIIC期及以上黑色素瘤患者开具基线脑部磁共振成像（MRI）检查。本研究表明CHNM患者诊断时脑转移的发生率非常低，并支持NCCN的建议，即仅非常晚期的CHNM需要进行基线脑部成像检查。
