Reschke Robin, Dumann Konstantin, Ziemer Mirjana
Department of Dermatology, Allergology and Venereology, University Medical Center, 04103 Leipzig, Germany.
J Clin Med. 2022 Apr 5;11(7):2026. doi: 10.3390/jcm11072026.
Most patients with high-risk melanomas develop metastasis within the first few years after diagnosis. However, late recurrence of melanoma is seen in patients that metastasize more than 10 years after the primary diagnosis; a metastasis after 15 years is considered an ultra-late recurrence. It is critical to better understand the clinical and biological characteristics of this subset of melanoma patients in order to offer an individual treatment plan and prevent metastasis.
We retrospectively analyzed melanoma patients with recurrence ≥10 years after a primary diagnosis documented between 1993 and 2012 at the skin cancer center of the University Medical Center Leipzig, Germany. We conducted a comprehensive review of the literature and compared the results with our data. Available archived primary melanoma tissue was investigated with a seven-marker immunohistochemical signature (immunoprint) previously validated to reliably identify high-risk patients within stages IB-III.
Out of 36 analyzed patients, a third metastasized ultra-late (≥15 years). The mean age at initial diagnosis was 51 years, with women being diagnosed comparatively younger than men. The largest proportion of patients with late recurrence had primary melanomas located on the trunk. The immunoprint signature of the available primary melanomas allowed the accurate prediction of a high risk. However, it is difficult to draw a definitive conclusion from the small number of cases that could be analyzed with immunoprint ( = 2) in this study. Apart from the primary tumor characteristics, the laboratory values at time of metastasis, comorbidities and outcome are also shown.
Late and ultra-late recurrent melanomas seem not to differ from melanomas in general, apart from a distinctly higher proportion of lower leg localizations in ultra-late recurrent melanomas. The immunoprint signature may help to identify high-risk primary tumors at the time of initial diagnosis. However, apart from the risk profile of the primary tumor, it seems that individual immune surveillance can control residual tumor cells for more than a decade. Advanced age and increasing comorbidities may contribute to a disturbed immunological balance.
大多数高危黑色素瘤患者在确诊后的头几年内会发生转移。然而，在初次诊断10年以上发生转移的患者中可见黑色素瘤的晚期复发；15年后发生转移被认为是超晚期复发。为了提供个体化治疗方案并预防转移，更好地了解这部分黑色素瘤患者的临床和生物学特征至关重要。
我们回顾性分析了1993年至2012年间在德国莱比锡大学医学中心皮肤癌中心记录的初次诊断后复发≥10年的黑色素瘤患者。我们对文献进行了全面综述，并将结果与我们的数据进行了比较。利用先前经验证可在IB-III期可靠识别高危患者的七标记免疫组化特征（免疫印记）对现有的存档原发性黑色素瘤组织进行研究。
在36例分析患者中，三分之一发生超晚期转移（≥15年）。初次诊断时的平均年龄为51岁，女性诊断时相对比男性年轻。晚期复发患者中最大比例的原发性黑色素瘤位于躯干。现有原发性黑色素瘤的免疫印记特征能够准确预测高风险。然而，在本研究中，很难从少数可用免疫印记分析的病例（n = 2）中得出明确结论。除了原发性肿瘤特征外，还展示了转移时的实验室值、合并症和结局。
晚期和超晚期复发性黑色素瘤似乎与一般黑色素瘤没有差异，只是超晚期复发性黑色素瘤中小腿部位的比例明显更高。免疫印记特征可能有助于在初次诊断时识别高危原发性肿瘤。然而，除了原发性肿瘤的风险特征外，似乎个体免疫监视可以在十多年内控制残留肿瘤细胞。高龄和合并症增加可能导致免疫平衡紊乱。
