Griffiths R W, Briggs J C
Ann R Coll Surg Engl. 1985 Mar;67(2):75-8.
281 patients managed for primary clinical Stage I invasive cutaneous malignant melanoma at one Plastic Surgery Unit were followed up to a minimum of 10 years after primary surgical treatment. Sixty-three (23%) had received an initial biopsy procedure prior to definitive wide margin excisional surgery. One third of all lesions initially treated by so called incisional biopsy were rendered histologically unassessable on current histopathological criteria. Incisional biopsy significantly interfered with the accurate histopathological staging of the tumours. Of the assessable incisional biopsy specimens the majority were greater than 4.0 mm thick. When the incidences of local tumour recurrence and mortality were related specifically to maximal tumour thickness of the primary lesion, prognosis at minimum follow up of 10 years was not significantly different between patients treated initially by either incisional biopsy, minimal margin excisional biopsy or primary wide excisional surgery. Whether or not incisional biopsy adversely affects prognosis in cutaneous malignant melanoma, the technique should be avoided since it compromises accurate histopathological microstaging which represents one of our most valuable prognostic guides. Clinical doubt over the diagnosis of cutaneous malignant melanoma should be resolved by a total excisional biopsy of the lesion in question.
在一个整形外科单元接受原发性临床I期侵袭性皮肤恶性黑色素瘤治疗的281例患者，在接受初次手术治疗后至少随访了10年。六十三例（23%）患者在进行确定性的广泛边缘切除手术之前接受了初次活检。所有最初通过所谓的切开活检治疗的病变中，三分之一根据当前组织病理学标准在组织学上无法评估。切开活检显著干扰了肿瘤准确的组织病理学分期。在可评估的切开活检标本中，大多数厚度超过4.0毫米。当局部肿瘤复发和死亡率与原发性病变的最大肿瘤厚度具体相关时，在至少10年的随访中，最初接受切开活检、最小边缘切除活检或原发性广泛切除手术治疗的患者的预后没有显著差异。无论切开活检是否对皮肤恶性黑色素瘤的预后产生不利影响，都应避免使用该技术，因为它会影响准确的组织病理学微分期，而这是我们最有价值的预后指导之一。对于皮肤恶性黑色素瘤诊断的临床疑问，应通过对相关病变进行完整切除活检来解决。
