Urist M M, Balch C M, Soong S, Shaw H M, Milton G W, Maddox W A
Cancer. 1985 Mar 15;55(6):1398-402. doi: 10.1002/1097-0142(19850315)55:6<1398::aid-cncr2820550639>3.0.co;2-a.
Risk factors associated with local recurrences were analyzed from a series of 3445 clinical Stage I melanoma patients. In single-factor analysis, tumor thickness, ulceration, and increasing age were highly significantly predictive of recurrence (p less than 0.00001). After 5 years of follow-up, local recurrence rates were 0.2% for tumors less than 0.76 mm thick, 2.1% for tumors 0.76 to 1.49 mm thick, 6.4% for tumors 1.5 to 3.99 mm thick, and 13.2% for tumors 4.0 mm or greater in thickness. Ulcerated melanomas recurred more often than nonulcerated lesions (11.5% versus 1.9%). When analyzed as a continuous variable, increasing age increased the risk of local failure. In multifactorial analysis, all of these three factors remained independently predictive of local recurrence. Recurrences were more common with nodular melanomas (5.6%) compared to superficial spreading (2.5%) or lentigo maligna melanoma (2.5%), but this difference did not reach statistical significance (P = 0.115). Lower extremity (4.7%) and head and neck lesions (4.4%) recurred more frequently than upper extremity (1.6%) or trunk (1.2%) melanomas (P = 0.0217). The highest recurrence rates were observed in patients with melanomas located on the foot (11.6%) and hand (11.1%). The safety of conservative margins for the excision of low-risk melanomas was demonstrated in a review of 1151 consecutive patients with melanomas less than 1 mm thick where only one local recurrence was observed. Sixty-two percent of these patients had resection margins of 2 cm or less. In 95 patients local recurrence developed as the first site of relapse and were treated with surgical excision. The median survival for this group was 3 years, whereas 20% of this group survived 10 years. These data demonstrate that: (1) the risk of local recurrence rises with increasing tumor thickness, presence of ulceration, and age; (2) melanomas less than 1 mm thick have a very low local recurrence rate, even when excised with margins of 2 cm or less; and (3) local recurrence is a poor prognostic sign because regional and systemic metastases subsequently develop in many patients.
对3445例临床I期黑色素瘤患者进行分析，以确定与局部复发相关的危险因素。单因素分析显示，肿瘤厚度、溃疡形成及年龄增长对复发具有高度显著的预测性（p<0.00001）。随访5年后，肿瘤厚度小于0.76mm者局部复发率为0.2%，0.76至1.49mm者为2.1%，1.5至3.99mm者为6.4%，厚度4.0mm及以上者为13.2%。溃疡型黑色素瘤比非溃疡型更易复发（11.5%对1.9%）。年龄增长作为连续变量分析时，会增加局部复发风险。多因素分析中，这三个因素均独立地对局部复发具有预测性。结节型黑色素瘤复发率（5.6%）高于浅表扩散型（2.5%）或恶性雀斑样痣型黑色素瘤（2.5%），但差异无统计学意义（P=0.115）。下肢（4.7%）及头颈部病变（4.4%）比上肢（1.6%）或躯干（1.2%）黑色素瘤更易复发（P=0.0217）。足部（11.6%）及手部（11.1%）黑色素瘤患者复发率最高。回顾1151例连续的肿瘤厚度小于1mm的黑色素瘤患者，显示低危黑色素瘤切除时采用保守切缘是安全的，仅观察到1例局部复发。这些患者中62%切缘为2cm或更小。95例患者局部复发为首个复发部位，接受手术切除治疗。该组患者中位生存期为3年，20%存活达10年。这些数据表明：（1）局部复发风险随肿瘤厚度增加、溃疡形成及年龄增长而升高；（2）肿瘤厚度小于1mm的黑色素瘤局部复发率很低，即使切缘为2cm或更小；（3）局部复发是预后不良的标志，因随后许多患者会发生区域及全身转移。
