Greiff Lennart, Skogvall-Svensson Ingela, Carneiro Ana, Hafström Anna
Department of ORL, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden.
Department of Clinical Sciences, Lund University, Lund, Sweden.
Acta Otolaryngol. 2021 Mar;141(3):309-319. doi: 10.1080/00016489.2020.1851395. Epub 2021 Feb 13.
It is unclear if a non-radical diagnostic biopsy entails a higher risk for metastasis and poorer survival for patients with cutaneous head and neck melanoma (cHNM).
AIMS/OBJECTIVES: To assess whether or not initial diagnostic biopsy modality and radicality (clear, positive, or narrow histopathological margins) influence recurrence and survival in patients with cHNM.
Histopathological radicality of initial diagnostic biopsies and outcome for 368 consecutive cHNM patients, clinically asymptomatic of metastatic disease and referred to a tertiary care academic center for sentinel lymph node staging from 2004 through 2018, were retrospectively analyzed.
Patients with positive ( = 133) or narrow (0.1-0.5 mm) ( = 34) histopathological margins had significantly worse loco-regional (=.004) and distant control (=.004) as well as lower overall (=.017) and melanoma specific (=.0002) survival than 201 patients with clear margins. Multivariate analysis indicated positive or narrow histopathological margins as independent negative prognostic factors for melanoma specific survival (HR 2.16, =.015), together with deeper Breslow (HR 1.17, =.00001) and ulceration (HR 2.49, =.003).
Non-radical primary diagnostic biopsies increase the risk for metastatic disease and impair survival in cHNM. Accordingly, radical melanoma diagnostic procedures should be encouraged in the head and neck region when possible.
对于皮肤头颈黑色素瘤（cHNM）患者，非根治性诊断活检是否会带来更高的转移风险和更差的生存率尚不清楚。
评估初始诊断活检方式及根治性（切缘清晰、阳性或狭窄的组织病理学切缘）是否会影响cHNM患者的复发及生存。
回顾性分析了2004年至2018年间连续收治的368例cHNM患者的初始诊断活检的组织病理学根治性及预后情况，这些患者临床上无转移疾病症状，被转诊至一家三级医疗学术中心进行前哨淋巴结分期。
组织病理学切缘阳性（n = 133）或狭窄（0.1 - 0.5毫米）（n = 34）的患者，其局部区域控制（P =.004）和远处控制（P =.004）明显较差，总生存率（P =.017）和黑色素瘤特异性生存率（P =.0002）也低于201例切缘清晰的患者。多变量分析表明，阳性或狭窄的组织病理学切缘是黑色素瘤特异性生存的独立阴性预后因素（HR 2.16，P =.015），此外还有更深的Breslow深度（HR 1.17，P =.00001）和溃疡（HR 2.49，P =.003）。
非根治性原发性诊断活检会增加cHNM患者发生转移性疾病的风险并损害其生存。因此，在可能的情况下，应鼓励对头颈部区域采用根治性黑色素瘤诊断程序。
