Cox N H, Jones S K, MacKie R M
Department of Dermatology, Glasgow University.
Q J Med. 1987 Aug;64(244):661-70.
Four hundred and eighteen cases of primary cutaneous malignant melanoma of the head and neck were registered with the Scottish Melanoma Group between 1979 and 1985. Distribution of histogenetic types of melanoma was lentigo maligna melanoma 50 per cent, superficial spreading melanoma 24 per cent, nodular melanoma 20 per cent, unclassifiable 6 per cent. Annual registrations of all types increased over the seven-year period but were less for lentigo maligna melanoma than for the other types. Patients with lentigo maligna melanoma were older, and those with superficial spreading melanoma younger, than the overall average. These two features support the hypothesis that the former may be more closely related to cumulative sunlight exposure than are other histogenetic types of melanoma. The sex ratio (F:M) was 1.7:1 for lentigo maligna melanoma, 1.5:1 for superficial spreading melanoma, but 1:1 for nodular melanoma. All types of melanoma were seen most commonly on the cheek. The proportion of lentigo maligna melanoma on the cheek was significantly greater than nodular melanoma or superficial spreading melanoma. Superficial spreading melanoma was significantly increased in frequency on the neck and scalp, and nodular melanoma on the ear. Melanomas of the scalp were significantly more frequent in male patients than female. The anatomical site distribution of nodular melanoma showed considerable differences between the sexes: nodular melanoma of the ear or neck occurred more commonly in male patients and nodular melanoma of the cheek was significantly more frequent in female patients. Five-year mortality data for head and neck melanoma derived from patients registered between 1979 and 1981 revealed that mortality was greater in male than in female patients, but there was no significant difference in prognosis between the three histogenetic types of melanoma when these were stratified according to tumour thickness.
1979年至1985年间，苏格兰黑色素瘤研究组登记了418例头颈部原发性皮肤恶性黑色素瘤病例。黑色素瘤组织发生类型的分布情况为：恶性雀斑样痣黑色素瘤占50%，浅表扩散性黑色素瘤占24%，结节性黑色素瘤占20%，无法分类的占6%。在这七年期间，所有类型的年度登记病例数均有所增加，但恶性雀斑样痣黑色素瘤的增加幅度小于其他类型。恶性雀斑样痣黑色素瘤患者的年龄比总体平均年龄大，而浅表扩散性黑色素瘤患者的年龄则比总体平均年龄小。这两个特征支持了这样一种假设，即前者可能比其他组织发生类型的黑色素瘤与累积日光暴露的关系更为密切。恶性雀斑样痣黑色素瘤的性别比（女：男）为1.7:1，浅表扩散性黑色素瘤为1.5:1，而结节性黑色素瘤为1:1。所有类型的黑色素瘤最常见于脸颊。脸颊上恶性雀斑样痣黑色素瘤的比例显著高于结节性黑色素瘤或浅表扩散性黑色素瘤。浅表扩散性黑色素瘤在颈部和头皮的发生率显著增加，而结节性黑色素瘤在耳部的发生率较高。头皮黑色素瘤在男性患者中比女性更为常见。结节性黑色素瘤的解剖部位分布在性别上存在显著差异：耳部或颈部的结节性黑色素瘤在男性患者中更为常见，而脸颊部的结节性黑色素瘤在女性患者中显著更为常见。对1979年至1981年间登记的头颈部黑色素瘤患者的五年死亡率数据显示，男性患者的死亡率高于女性患者，但根据肿瘤厚度分层时，三种组织发生类型的黑色素瘤在预后方面没有显著差异。
