Önefäldt Daniel, Zommorodi Sayid, Falk Delgado Alberto
Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital; Uppsala, Sweden.
Akademiskt Centrum Plastikkirurgi; Stockholm, Sweden.
J Plast Reconstr Aesthet Surg. 2022 Sep;75(9):3398-3405. doi: 10.1016/j.bjps.2022.04.093. Epub 2022 Jun 20.
Cutaneous malignant melanoma (CMM) is one of the most common causes of cancer-related death in Sweden. There is increasing evidence that localisation of the primary CMM lesion differs between sexes and is associated with different outcomes. However, definitive convincing data is lacking.
To describe changes in the distribution of CMM anatomical location over time according to sex and determine differences in mortality by location.
This is a retrospective nation-wide cohort study of all patients diagnosed with CMM in Sweden between 2004 and 2018. Hazard ratios (HRs) were calculated using a multivariate cox regression model adjusting for age, sex, T-stage, multiple melanomas and comorbidities.
A total of 68,666 patients were included. In males, trunk CMM was the most common location (51% of all male CMM), with an increasing proportion over time. In females, lower extremity CMM had the largest proportion in 2004 (33%) followed by trunk CMM (27%). By 2018, trunk CMM became more common than lower extremity CMM in females. Upper and lower extremity CMMs had lower HR for all-cause mortality compared with trunk CMM (0.896 and 0.887, respectively, p<0.001), while head and neck CMM had higher HR compared with trunk CMM (1.090, p<0.001). Males had greater risk than females (HR 1.352, p<0.001).
Head and neck CMMs were associated with increased risk of all-cause mortality, while both upper and lower extremity CMMs were associated with decreased risk. Both sexes had increasing proportions of trunk and upper extremity CMM over time, with corresponding decreases in lower extremity and, head and neck CMM.
皮肤恶性黑色素瘤（CMM）是瑞典癌症相关死亡的最常见原因之一。越来越多的证据表明，原发性CMM病变的部位在性别之间存在差异，并且与不同的预后相关。然而，缺乏确凿可信的数据。
描述CMM解剖位置分布随时间根据性别发生的变化，并确定不同部位的死亡率差异。
这是一项对2004年至2018年期间在瑞典被诊断为CMM的所有患者进行的全国性回顾性队列研究。使用多变量Cox回归模型计算风险比（HRs），该模型对年龄、性别、T分期、多发黑色素瘤和合并症进行了调整。
共纳入68666例患者。在男性中，躯干CMM是最常见的部位（占所有男性CMM的51%），且随时间推移比例不断增加。在女性中，2004年下肢CMM所占比例最大（33%），其次是躯干CMM（27%）。到2018年，躯干CMM在女性中比下肢CMM更常见。与躯干CMM相比，上肢和下肢CMM的全因死亡率HR较低（分别为0.896和0.887，p<0.001），而头颈部CMM的HR高于躯干CMM（1.090，p<0.001）。男性的风险高于女性（HR 1.352，p<0.001）。
头颈部CMM与全因死亡率风险增加相关，而上肢和下肢CMM均与风险降低相关。随着时间的推移，两性的躯干和上肢CMM比例均增加，下肢以及头颈部CMM相应减少。
