Mohs 显微外科手术与广泛局部切除术治疗头颈部黑素瘤的总生存率提高。

Improved overall survival of melanoma of the head and neck treated with Mohs micrographic surgery versus wide local excision.

机构信息

Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.

出版信息

J Am Acad Dermatol. 2020 Jan;82(1):149-155. doi: 10.1016/j.jaad.2019.08.059. Epub 2019 Aug 29.

DOI:10.1016/j.jaad.2019.08.059

PMID:31473297

Abstract

BACKGROUND

Optimal surgical management for melanoma of the head and neck remains controversial.

OBJECTIVE

Assess outcomes for melanomas of the head and neck treated with Mohs micrographic surgery (MMS) versus wide local excision (WLE) from the National Cancer Database.

METHODS

Head and neck melanoma data from the National Cancer Database from years 2004-2015 were analyzed.

RESULTS

In total, 50,397 cases of head and neck melanoma were reviewed; 3510 (7%) were treated with MMS and 46,887 (93%) with WLE. After controlling for potential confounding variables, patients treated with MMS were more likely than patients treated with WLE to survive after 5 years (hazard ratio [HR] 1.181, 95% confidence interval [CI] 1.083-1.288; P < .001). Factors associated with a statistically significant survival disadvantage included male sex (HR 1.287, 95% CI 1.242-1.357; P = 0), tumor ulceration (HR 1.687, 95% CI 1.616-1.760; P = 0), and positive surgical margins (HR 1.395, 95% CI 1.306-1.490; P = 0). Patient survival was inversely proportional to tumor Breslow depth.

LIMITATIONS

Database study, limited number of MMS treated melanomas.

CONCLUSION

MMS is a valid treatment option for melanoma of the head and neck; National Cancer Database data suggests that MMS might confer a survival benefit over WLE.

摘要

背景

头颈部黑素瘤的最佳手术治疗仍存在争议。

目的

评估国家癌症数据库中头颈部黑素瘤患者接受Mohs 显微外科手术（MMS）与广泛局部切除术（WLE）的治疗效果。

方法

分析国家癌症数据库 2004 年至 2015 年间的头颈部黑素瘤数据。

结果

共回顾了 50397 例头颈部黑素瘤病例，其中 3510 例（7%）接受 MMS 治疗，46887 例（93%）接受 WLE 治疗。在控制了潜在的混杂变量后，与接受 WLE 治疗的患者相比，接受 MMS 治疗的患者在 5 年后存活的可能性更高（风险比[HR]1.181，95%置信区间[CI]1.083-1.288；P<0.001）。与统计学上显著的生存劣势相关的因素包括男性（HR 1.287，95% CI 1.242-1.357；P=0）、肿瘤溃疡（HR 1.687，95% CI 1.616-1.760；P=0）和阳性切缘（HR 1.395，95% CI 1.306-1.490；P=0）。患者的生存与肿瘤 Breslow 深度呈反比。