机械应力在足底黑素瘤形成中的作用：72 例中国足底黑素瘤患者的回顾性分析及荟萃分析。

The role of mechanical stress in the formation of plantar melanoma: a retrospective analysis of 72 chinese patients with plantar melanomas and a meta-analysis.

机构信息

Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

J Eur Acad Dermatol Venereol. 2020 Jan;34(1):90-96. doi: 10.1111/jdv.15933. Epub 2019 Oct 8.

DOI:10.1111/jdv.15933

PMID:31494985

Abstract

BACKGROUND

Weightbearing areas of sole were reported to be significantly more vulnerable to melanoma than non-weightbearing areas. Few studies have investigated the role that mechanical stress plays in increasing the incidence of plantar melanoma (PM).

OBJECTIVE

This study aims to investigate the potential role of mechanical stress in the formation of PM and evaluate the association of mechanical stress with certain pathological features of melanoma by using meta-analysis.

METHODS

We analysed the distribution pattern of 72 PM lesions in Chinese patients and compared their incidence and demographic and clinicopathological features based on sites with different stress exposure.

RESULTS

The most common region with a PM was the heel, followed by the forefoot, plantar aspect of the toes, lateral midfoot (LM) and arch. Both the heel and forefoot were significantly associated with a higher incidence of melanoma than the arch. A high density of lesions was observed in the posterior half of the heel and the lateral forefoot. Despite subtle differences in the contour maps of the density of lesions based on sex and age, different groups showed the same primary distribution tendency. The comparison between weightbearing and non-weightbearing areas revealed no significant difference in sex, age, lateralization, clinical pigmentation, Breslow depth or ulceration. However, the meta-analysis revealed that melanoma on weightbearing areas manifested as invasive melanoma at the time of diagnosis more frequently than cases on non-weightbearing areas (OR = 0.300 [95% CI, 0.092-0.977]; P = 0.046).

CONCLUSION

Weightbearing areas indicating mechanical stress are correlated with a higher number of plantar melanoma compared with non-weightbearing areas and also show a tendency to be involved by invasive melanomas at the time of diagnosis more frequently than non-weightbearing areas.

摘要

背景

据报道，足底承重区比非承重区更容易受到黑色素瘤的侵袭。很少有研究探讨机械应力在增加足底黑色素瘤（PM）发病率方面的作用。

目的

本研究旨在通过Meta 分析探讨机械应力在 PM 形成中的潜在作用，并评估机械应力与黑色素瘤某些病理特征的相关性。

方法

我们分析了 72 例中国患者 PM 病变的分布模式，并根据不同的应力暴露部位比较了其发生率、人口统计学和临床病理特征。

结果

最常见的 PM 部位是足跟，其次是前足、足底趾部、中足外侧（LM）和足弓。足跟和前足的黑色素瘤发病率明显高于足弓。足跟后段和前外侧足的病变密度较高。尽管基于性别和年龄的病变密度轮廓图存在细微差异，但不同组表现出相同的主要分布趋势。承重区和非承重区的比较显示，性别、年龄、侧化、临床色素沉着、Breslow 深度或溃疡无显著差异。然而，Meta 分析显示，承重区的黑色素瘤在诊断时表现为侵袭性黑色素瘤的频率高于非承重区（OR=0.300[95%CI，0.092-0.977]；P=0.046）。