Anwar Sumadi Lukman, Cahyono Roby, Budiman Heru Yudanto, Avanti Widya Surya, Harahap Wirsma Arif, Aryandono Teguh
Division of Surgical Oncology - Department of Surgery, Dr Sardjito Hospital / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia.
Department of Radiology, Dr Sardjito Hospital / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia.
Ann Med Surg (Lond). 2020 Dec 16;61:132-138. doi: 10.1016/j.amsu.2020.12.004. eCollection 2021 Jan.
Acral lentiginous and mucosal melanoma that represent lesions without cumulative sun-induced damages account for 65% of melanomas among Asians but constitute only 5% in Caucasians. The distinct clinical manifestations might influence the clinical course, response to treatment, and outcomes. Factors associated with the prognosis of high-risk resected melanoma in Asians are still rarely reported.
Clinical, histological determinants of non-distant metastatic melanoma patients who underwent complete resection in 2014-9 were analyzed.
Mucosal melanoma, nodular melanoma, and acral lentiginous melanoma accounted for 45.1%, 40.2%, and 14.2% of total melanoma cases (N = 82), respectively. Among cutaneous melanomas, all patients were diagnosed with Breslow's depth more than 4 mm (T4), 51% with ulceration, 95.6% with diameter more than 6 mm, 59% with lympho-vascular invasion, and 74% with regional lymph node infiltration. In mucosal melanomas, 78.3% were diagnosed in advanced stages, 14.5% with regional spread to lymph nodes and 77% with regional infiltration beyond mucosa. Lesions with ulceration were associated with higher risk of distant metastasis (OR 3.003, 95%CI:1.01-9.09). Infiltration into regional lymph node was associated with shorter overall survival (median survivals were 17 vs 23.4 months, Mantel-Cox test = 0.049). Patients diagnosed at Breslow T4 were also associated with poorer overall survival than T1-3 (median survivals were 23 vs 32 months, Mantel-Cox test = 0.047).
The majority of melanoma patients in our population were diagnosed in advanced stages with a higher risk for recurrence and progression into distant metastasis. Regional lymph node involvement and thicker tumor (T4) were associated with poor prognosis.
肢端雀斑样痣型和黏膜黑色素瘤代表无累积日光诱导损伤的病变，在亚洲人中占黑色素瘤的65%，而在白种人中仅占5%。不同的临床表现可能会影响临床病程、对治疗的反应及预后。关于亚洲高危切除黑色素瘤预后相关因素的报道仍然很少。
分析2014年至2019年接受根治性切除的非远处转移性黑色素瘤患者的临床和组织学决定因素。
黏膜黑色素瘤、结节性黑色素瘤和肢端雀斑样痣型黑色素瘤分别占黑色素瘤总病例数（N = 82）的45.1%、40.2%和14.2%。在皮肤黑色素瘤患者中，所有患者均诊断为Breslow深度超过4mm（T4），51%有溃疡，95.6%直径超过6mm，59%有淋巴管浸润，74%有区域淋巴结浸润。在黏膜黑色素瘤中，78.3%诊断为晚期，14.5%有区域淋巴结转移，77%有黏膜外区域浸润。有溃疡的病变远处转移风险更高（OR 3.003，95%CI：1.01 - 9.09）。区域淋巴结浸润与总生存期缩短相关（中位生存期分别为17个月和23.4个月，Mantel - Cox检验 = 0.049）。诊断为Breslow T4的患者总生存期也比T1 - 3患者差（中位生存期分别为23个月和32个月，Mantel - Cox检验 = 0.047）。
我们研究人群中的大多数黑色素瘤患者诊断为晚期，复发和远处转移进展风险较高。区域淋巴结受累和肿瘤较厚（T4）与预后不良相关。
