Department of Surgery, Vancouver General Hospital, University of British Columbia, 899 W 12th Avenue, Vancouver, BC V5Z 1M9, Canada; BC Cancer Agency, 600 W 10th Avenue, Vancouver, BC V5Z 4E6, Canada.
Department of Surgery, Vancouver General Hospital, University of British Columbia, 899 W 12th Avenue, Vancouver, BC V5Z 1M9, Canada.
J Plast Reconstr Aesthet Surg. 2024 Sep;96:111-113. doi: 10.1016/j.bjps.2024.07.018. Epub 2024 Jul 11.
Patients with thick cutaneous pT4 malignant melanoma are at high risk for metastatic disease, and optimal staging is poorly defined. This study examines the frequency and modality of pre-operative staging to provoke thought on optimal staging.
A retrospective study was performed of patients with clinical T4N0 melanoma diagnosed between 2015-2017. The modality (sentinel lymph node biopsy and/or imaging), timing, and findings of staging investigations were assessed.
One hundred thirty-six patients with pT4a or pT4b cutaneous melanoma and clinically negative regional lymph nodes were included. Forty patients underwent no staging. Thirty-six patients underwent pre-operative imaging, and of these, regional or distant disease was identified in seven patients (19%). Another 36 patients underwent upfront sentinel lymph node biopsy concurrently with wide local excision. A positive sentinel lymph node biopsy was found in eight (22%) of these patients, of which two had regional or distant metastatic disease on postoperative imaging. Of 16 who underwent a sentinel lymph node biopsy after negative pre-operative imaging, three had a positive sentinel lymph node biopsy.
Staging is non-standardized and underutilized in patients with thick melanoma. With evolving systemic treatment options, a well-defined approach to staging, with consideration for pre-operative imaging in pT4 patients, is essential for high-risk patients.
皮肤厚度 T4 期恶性黑色素瘤患者存在发生转移性疾病的高风险，且其最佳分期方法尚未明确。本研究旨在通过评估术前分期的频率和模式，以探讨最佳分期方法。
对 2015 年至 2017 年间诊断为临床 T4N0 黑色素瘤的患者进行回顾性研究。评估分期检查的模式（前哨淋巴结活检和/或影像学检查）、时间和结果。
本研究共纳入 136 例皮肤厚度 T4a 或 T4b 黑色素瘤且临床淋巴结阴性的患者。其中 40 例未进行分期。36 例行术前影像学检查，7 例（19%）患者发现局部或远处疾病。另 36 例行前哨淋巴结活检联合广泛局部切除术。其中 8 例（22%）患者的前哨淋巴结活检呈阳性，术后影像学检查发现 2 例患者存在局部或远处转移。16 例术前影像学检查阴性后行前哨淋巴结活检的患者中，有 3 例呈阳性。
对于厚型黑色素瘤患者，分期方法不规范且应用不足。鉴于系统治疗方法的不断发展，对于高危患者，有必要采用明确的分期方法，考虑对 T4 期患者进行术前影像学检查。
