Department of Dermatology, Hospital Clinic of Barcelona, Barcelona, Spain.
Acta Derm Venereol. 2021 Mar 31;101(3):adv00425. doi: 10.2340/00015555-3780.
Several studies have suggested that naevus-associated melanomas differ from de novo melanomas, being thinner and with less ulceration; however, the prognostic implication is unclear. The objective of this study was to describe clinicopathological, genetic and survival characteristics of de novo and naevus-associated melanomas in a cohort of primary invasive cutaneous melanomas over a 20-year period. Of the 2,227 patients included in the study, 509 (22.86%) had naevus-associated melanomas. Compared with patients with de novo melanoma, they were younger, with a fairer phototype and a higher naevus count, tumours were predominantly the superficial spreading subtype, American Joint Committee on Cancer stage I, located on the trunk, and there were fewer signs of invasiveness (thinner Breslow index, less ulceration, lower mitotic index and less satellitosis). Germline mutation-al status did not show any significant association. As determined through univariate analysis, overall surviv-al was significantly better in patients with naevus- associated melanoma (hazard ratio 0.64; 95% confidence interval 0.51-0.80, p < 0.001), but multivariate analysis did not support this prognostic indication (hazard ratio 0.94; 95% confidence interval 0.75-1.18, p < 0.606). Despite this, we conclude that naevus- associated and de novo melanomas should be considered as different subtypes of melanoma.
一些研究表明，痣相关黑色素瘤与新发黑色素瘤不同，它们更薄，溃疡更少；然而，其预后意义尚不清楚。本研究的目的是描述 20 年来一组原发性侵袭性皮肤黑色素瘤中痣相关和新发黑色素瘤的临床病理、遗传和生存特征。在研究中纳入的 2227 名患者中，有 509 名（22.86%）患有痣相关黑色素瘤。与新发黑色素瘤患者相比，痣相关黑色素瘤患者更年轻，肤色更浅，痣更多，肿瘤主要为浅表扩散型，美国癌症联合委员会（AJCC）分期为 I 期，位于躯干，侵袭性迹象更少（Breslow 指数更薄、溃疡更少、有丝分裂指数更低和卫星现象更少）。胚系突变状态没有显示出任何显著关联。通过单因素分析确定，痣相关黑色素瘤患者的总生存率明显更好（风险比 0.64；95%置信区间 0.51-0.80，p<0.001），但多因素分析不支持这种预后提示（风险比 0.94；95%置信区间 0.75-1.18，p<0.606）。尽管如此，我们得出结论，痣相关和新发黑色素瘤应被视为不同的黑色素瘤亚型。
