Department of Allergology and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Pathology, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands.
J Eur Acad Dermatol Venereol. 2019 Dec;33(12):2291-2295. doi: 10.1111/jdv.15814. Epub 2019 Oct 17.
Melanoma patients with intra-nodal nevi (INN) and without melanoma metastasis in the sentinel lymph node biopsy (SLNB) are generally treated as patients with negative SLNB. However, diagnosis of INN may be difficult and nodal melanoma metastases may falsely be regarded as INN.
Our aim was to evaluate the clinical significance of INN in the SLNB in patients with primary cutaneous melanoma on a nationwide level in The Netherlands by comparing survival between three groups: patients with INN and without nodal melanoma metastasis (INN group), patients without INN and without nodal melanoma metastasis (negative SLNB group) and patients with nodal melanoma metastasis irrespective of INN (positive SLNB group).
Data were obtained from 'PALGA', the Dutch Nationwide Network and Registry of Histopathology and Cytopathology, yielding a cohort of adults with histologically proven, primary, invasive cutaneous melanoma patients in The Netherlands diagnosed between 2000 and 2014 who underwent SLNB. Clinical and pathological variables were extracted from the pathology text files. Differences between patients with INN, negative SLNB and positive SLNB were analysed using Kaplan-Meier analysis.
A total of 11 274 patients were eligible for inclusion. The prevalence of INN in the SLNB was 5.0%. Melanomas with INN had similar median Breslow thickness compared to melanomas with negative SLNB and were more frequently located on trunk and upper limbs and observed in younger patients compared to melanomas with negative and positive SLNB. Overall survival of patients with INN showed no significant difference compared with negative SLNB (median follow-up of 5.7 years of all patients).
As there seems to be no difference in overall survival between patients with INN and negative SLNB, the diagnosis of INN seems to be reliable. Current practice to treat patients with INN as patients with negative SLNB appears to be appropriate.
在淋巴结活检（SLNB）中，有内淋巴结痣（INN）且无黑色素瘤转移的黑色素瘤患者通常被视为 SLNB 阴性患者。然而，INN 的诊断可能存在困难，且淋巴结黑色素瘤转移可能被错误地视为 INN。
我们旨在通过比较三组患者的生存情况，即 INN 且无淋巴结黑色素瘤转移患者（INN 组）、无 INN 且无淋巴结黑色素瘤转移患者（SLNB 阴性组）和无论是否存在 INN 均有淋巴结黑色素瘤转移患者（SLNB 阳性组），评估 INN 在荷兰全国范围内原发性皮肤黑色素瘤 SLNB 中的临床意义。
数据来自荷兰全国病理和细胞病理学网络和注册处“PALGA”，该研究纳入了 2000 年至 2014 年间诊断为原发性、侵袭性皮肤黑色素瘤的成年患者队列，这些患者接受了 SLNB 且有组织学证实。从病理文本文件中提取临床和病理变量。使用 Kaplan-Meier 分析比较 INN、SLNB 阴性和 SLNB 阳性患者之间的差异。
共有 11 274 例患者符合纳入标准。SLNB 中 INN 的患病率为 5.0%。与 SLNB 阴性黑色素瘤相比，INN 黑色素瘤的 Breslow 厚度中位数相似，且更常位于躯干和上肢，且 INN 黑色素瘤患者比 SLNB 阴性和 SLNB 阳性黑色素瘤患者更年轻。与 SLNB 阴性患者相比，INN 患者的总体生存率无显著差异（所有患者中位随访时间为 5.7 年）。
由于 INN 患者与 SLNB 阴性患者的总体生存率无差异，因此 INN 的诊断似乎是可靠的。目前将 INN 患者视为 SLNB 阴性患者的治疗方法似乎是合适的。
