Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Eur Acad Dermatol Venereol. 2022 Dec;36(12):2379-2387. doi: 10.1111/jdv.18470. Epub 2022 Aug 5.
There is little understanding regarding the long-term natural history of melanocytic nevi among adults.
The objective of the study was to describe the long-term natural history of individual nevi located on the torso of high-risk patients.
All patients attending Memorial Sloan Kettering Cancer Center (MSKCC) who underwent two total body photography (TBP) sessions 15+ years apart were included ('retrospective' group). To account for a potential selection bias, we also included consecutive patients who had TBP 15+ years ago and consented to undergo follow-up TBP ('prospective' group). We compared baseline and follow-up torso images on the TBPs and evaluated the number of total, new and disappearing nevi; number of seborrheic keratoses and actinic keratoses; each nevus' diameter at both time points; each nevus' colour change; the presence of clinical atypia; and when dermoscopy was available, the dermoscopic features at each time point.
One hundred six patients were included in the study. Although the average age of the patients was 40 at baseline TBP, most patients developed new nevi between imaging sessions (median 16.4 years) with an average of 2.6 (SD = 4.8) nevi per participant. The average number of disappearing nevi was 0.3 (SD = 0.6). In addition, 62/106 (58%) patients had an absolute increase, and 9/106 (8%) patients had an absolute decrease in their total nevus count. Roughly half (49%: 1416/2890) of the nevi that could be evaluated at both time points increased in diameter by at least 25%. Only 6% (159/2890) of nevi shrunk in diameter by at least 25%. Patients with a history of melanoma had a higher rate of disappearing nevi, and their nevi were more likely to grow. Most nevi demonstrated no significant dermoscopic changes.
High-risk patients acquire new nevi throughout life with very few nevi disappearing over time. Contrary to prior reports, most nevi in adults increase in diameter, while few nevi shrink.
成年人黑素细胞痣的长期自然史知之甚少。
本研究旨在描述高危患者躯干上单个痣的长期自然史。
所有在纪念斯隆凯特琳癌症中心（MSKCC）接受两次全身摄影（TBP）检查，且两次检查相隔 15 年以上的患者均被纳入（“回顾性”组）。为了弥补潜在的选择偏倚，我们还纳入了 15 年前接受 TBP 检查且同意进行随访 TBP 的连续患者（“前瞻性”组）。我们比较了 TBP 上的基线和随访躯干图像，并评估了总痣、新痣和消失痣的数量；脂溢性角化病和光化性角化病的数量；两次检查时每个痣的直径；每个痣的颜色变化；临床异型的存在；以及当有皮肤镜检查时，每个时间点的皮肤镜特征。
本研究共纳入 106 例患者。虽然基线 TBP 时患者的平均年龄为 40 岁，但大多数患者在两次影像学检查之间（中位数 16.4 年）出现新痣，平均每位患者有 2.6（SD=4.8）个新痣。平均消失痣数量为 0.3（SD=0.6）个。此外，62/106（58%）例患者总痣数绝对增加，9/106（8%）例患者总痣数绝对减少。在两次时间点均可评估的痣中，约有一半（49%：1416/2890）的痣直径至少增加了 25%。只有 6%（159/2890）的痣直径至少缩小了 25%。有黑色素瘤病史的患者消失痣的比例较高，且其痣更易生长。大多数痣无明显皮肤镜变化。
高危患者一生中会不断长出新痣，且随着时间的推移，很少有痣会消失。与之前的报告相反，大多数成人的痣直径增大，而很少有痣直径缩小。
