Kim Elizabeth, Obermeyer Isaac, Rubin Nathan, Khariwala Samir S
Department of Otolaryngology-Head and Neck Surgery University of Minnesota Minneapolis Minnesota USA.
Biostatistics Core, Masonic Cancer Center University of Minnesota Minneapolis Minnesota USA.
Laryngoscope Investig Otolaryngol. 2020 Dec 16;6(1):109-115. doi: 10.1002/lio2.509. eCollection 2021 Feb.
While regression is a commonly reported microscopic feature of melanoma, its prognostic significance is unclear.
To examine the impact of regression on sentinel node status and the likelihood of recurrence in primary cutaneous melanoma of the head and neck.
Retrospective analysis of 191 adults who underwent surgical management for primary cutaneous melanoma of the head and neck between May 2002 and March 2019.
Tertiary academic center.
Patients appropriate for the study were identified by the Academic Health Center Information Exchange using a list of current procedural terminology codes. One hundred and ninety-one cases of invasive melanoma of the head and neck were included from 830 patients identified. Clinical features assessed for each patient included age, sex, location of primary lesion, date of diagnosis, and current disease status (alive with or without disease). Histologic features assessed were histological melanoma subtype (nodular vs non-nodular), Breslow thickness, Clark level, presence/absence of ulceration, mitotic rate per square millimeter, and regression. If applicable, sentinel lymph node biopsy (SLNB) status, date of recurrence, interval treatments, and date of death related to melanoma were recorded. Exclusion criteria included melanoma outside the anatomic parameters of head and neck, ocular or choroidal melanoma, mucosal melanoma, metastatic melanoma to the head or neck with no known primary tumor, melanoma of the head or neck with no surgical intervention, and non-melanoma skin cancers of the head and neck.
INTERVENTION/EXPOSURE: Surgery for cutaneous melanoma of the head and neck.
The association between presence of regression and Breslow thickness, sentinel node status, and recurrence.
Of the 191 patients identified, 30.9% were female and 69.1% were male with a mean age at diagnosis of 62.6 (range 20-97) years. Mean Breslow thickness was 1.2 mm in those with regression and 2.0 mm in those without regression. In patients with regression, 17.6% had a positive sentinel node, and 13.0% experienced a recurrence. In patients without regression, 26.5% had a positive sentinel node, and 31.4% experienced a recurrence. When adjusted for other factors above, regression was not associated with positive sentinel node (odds ratio [OR] = 0.59, 95% confidence interval [CI] = 0.13-2.00) or recurrence (OR = 0.33, CI = 0.07-1.01). Mitotic rate >2 was associated with recurrence (OR = 2.71, CI = 1.11-6.75, = .03).
Patients with presence of regression had thinner melanomas and trended toward decreased rates of sentinel node positivity and recurrence, suggesting regression may not be a negative prognostic indicator in patients with cutaneous melanoma of the head and neck.
虽然消退是黑色素瘤常见的微观特征，但其预后意义尚不清楚。
探讨消退对前哨淋巴结状态及头颈部原发性皮肤黑色素瘤复发可能性的影响。
对2002年5月至2019年3月间接受手术治疗的191例头颈部原发性皮肤黑色素瘤成人患者进行回顾性分析。
三级学术中心。
通过学术健康中心信息交换，使用当前程序术语代码列表确定适合该研究的患者。从830例被识别的患者中纳入191例头颈部侵袭性黑色素瘤病例。评估的每位患者的临床特征包括年龄、性别、原发灶位置、诊断日期和当前疾病状态（有或无疾病存活）。评估的组织学特征为组织学黑色素瘤亚型（结节性与非结节性）、Breslow厚度、Clark分级、有无溃疡、每平方毫米有丝分裂率和消退情况。若适用，记录前哨淋巴结活检（SLNB）状态、复发日期、间隔治疗及与黑色素瘤相关的死亡日期。排除标准包括头颈部解剖参数以外的黑色素瘤、眼或脉络膜黑色素瘤、黏膜黑色素瘤、无已知原发肿瘤的头颈部转移性黑色素瘤、未接受手术干预的头颈部黑色素瘤以及头颈部非黑色素瘤皮肤癌。
干预/暴露：头颈部皮肤黑色素瘤手术。
消退的存在与Breslow厚度、前哨淋巴结状态和复发之间的关联。
在191例被识别的患者中，30.9%为女性，69.1%为男性，诊断时的平均年龄为62.6岁（范围20 - 97岁）。有消退的患者平均Breslow厚度为1.2毫米，无消退的患者为2.0毫米。有消退的患者中，17.6%前哨淋巴结阳性，13.0%出现复发。无消退的患者中，26.5%前哨淋巴结阳性，31.4%出现复发。在对上述其他因素进行校正后，消退与前哨淋巴结阳性（比值比[OR]=0.59，95%置信区间[CI]=0.13 - 2.00）或复发（OR = 0.33，CI = 0.07 - 1.01）无关。有丝分裂率>2与复发相关（OR = 2.71，CI = 1.11 - 6.75，P = 0.03）。
有消退的患者黑色素瘤较薄，前哨淋巴结阳性率和复发率有下降趋势，提示消退可能不是头颈部皮肤黑色素瘤患者的不良预后指标。
