Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
J Am Acad Dermatol. 2019 May;80(5):1292-1298. doi: 10.1016/j.jaad.2019.01.012. Epub 2019 Jan 14.
Amelanotic malignant melanoma (AMM) is challenging to diagnose. Clinical risk factors for AMM are not well defined.
To investigate clinicopathologic, misdiagnosis, and survival differences between patients with AMM and those with pigmented malignant melanoma (PMM).
A cross-sectional retrospective medical record review at a tertiary academic medical center.
A total of 933 patients with melanoma with known presenting tumor color were identified (342 with AMM vs 591 with PMM). AMM was associated with older age, history of nonmelanoma skin cancer, and red hair, whereas AMM was inversely associated with a family history of melanoma, more than 50 nevi, and a history of dysplastic nevi. Compared with PMM, AMM was more likely to be located on the head and/or neck, had more aggressive pathologic features (greater Breslow depth and/or mitoses, ulceration, nodular subtype), and was less likely to be associated with a precursor nevus or regression. Finally, patients with AMM were more likely to be misdiagnosed than were patients with PMM (25% vs 12% clinically and 12% vs 7% pathologically), and they had poorer melanoma-specific survival (5-year overall survival rate, 0.77 [95% confidence interval, 0.72-0.82] vs 0.84 [95% confidence interval, 0.80-0.87]).
Retrospective study design, single-institutional study.
Greater clinician awareness, lower biopsy thresholds, and increased patient education may be useful to enhance AMM detection in patients with certain characteristics.
无色素性恶性黑色素瘤（AMM）的诊断具有挑战性。AMM 的临床危险因素尚未明确。
探讨 AMM 患者与色素性恶性黑色素瘤（PMM）患者之间的临床病理、误诊和生存差异。
对一家三级学术医疗中心的回顾性横断面病历进行回顾。
共确定了 933 例已知初诊肿瘤颜色的黑色素瘤患者（342 例 AMM 与 591 例 PMM）。AMM 与年龄较大、非黑色素瘤皮肤癌病史和红头发有关，而 AMM 与黑色素瘤家族史、超过 50 个痣和发育不良痣病史呈负相关。与 PMM 相比，AMM 更可能位于头部和/或颈部，具有更具侵袭性的病理特征（Breslow 深度和/或有丝分裂、溃疡、结节型），与前驱痣或退化的相关性较低。最后，与 PMM 相比，AMM 患者更有可能被误诊（临床误诊率为 25%比 12%，病理误诊率为 12%比 7%），且黑色素瘤特异性生存率较低（5 年总生存率，0.77[95%置信区间，0.72-0.82]比 0.84[95%置信区间，0.80-0.87]）。
回顾性研究设计，单机构研究。
提高临床医生的认识、降低活检门槛和加强患者教育可能有助于提高某些特征患者 AMM 的检出率。
