Departments of Dermatology, Chonnam National University Medical School, Gwangju, Korea.
Departments of Pathology, Chonnam National University Medical School, Gwangju, Korea.
Pigment Cell Melanoma Res. 2021 Nov;34(6):1094-1104. doi: 10.1111/pcmr.12983. Epub 2021 May 11.
The risk factors affecting acral melanoma metastasis and prognosis remain unclear. The study included 168 patients with invasive acral melanoma who were followed for ≥3 years. We evaluated patient demographics, stages, clinicopathological features, anatomic site of melanoma including nail versus volar surface, and degree of melanoma pigmentations, sentinel lymph node biopsy results, and the first metastasis sites. Of the 168 patients (mean age 64.5 years; 52.4% male), 43 (25.6%) had invasive melanoma without metastasis, 113 (67.3%) had invasive melanoma with a first lymph node metastasis, and 12 (7.1%) had invasive melanoma with invasive melanoma with a first distant metastasis. Advanced T stage, high mitotic rate, ulceration, and the degree of pigmentation were significant risk factors for metastasis. Amelanotic and mild pigmentation of acral melanoma was associated with first distant metastasis, whereas heavy pigmentation was associated with first lymph node metastasis. Advanced TNM stages, high mitotic rate, volar location (hazard ratio = 2.24, 95% confidence interval 1.18-4.26), and low-pigmentation (hazard ratio = 2.02, 95% confidence interval 1.17-3.49) were associated with melanoma-specific mortality.
影响肢端黑色素瘤转移和预后的危险因素仍不清楚。本研究纳入了 168 例侵袭性肢端黑色素瘤患者，这些患者的随访时间均≥3 年。我们评估了患者的人口统计学、分期、临床病理特征、黑色素瘤的解剖部位（包括指甲与掌面）以及黑色素瘤色素沉着程度、前哨淋巴结活检结果和首次转移部位。在这 168 例患者中（平均年龄 64.5 岁，52.4%为男性），43 例（25.6%）患者为无转移的侵袭性黑色素瘤，113 例（67.3%）患者为有首次淋巴结转移的侵袭性黑色素瘤，12 例（7.1%）患者为有首次远处转移的侵袭性黑色素瘤。晚期 T 分期、高有丝分裂率、溃疡和色素沉着程度是转移的显著危险因素。无色素性和轻度色素沉着的肢端黑色素瘤与首次远处转移有关，而重度色素沉着与首次淋巴结转移有关。晚期 TNM 分期、高有丝分裂率、掌面位置（危险比=2.24，95%置信区间 1.18-4.26）和低色素沉着（危险比=2.02，95%置信区间 1.17-3.49）与黑色素瘤特异性死亡率相关。
