Maize J C
J Am Acad Dermatol. 1983 Jun;8(6):857-63. doi: 10.1016/s0190-9622(83)80017-6.
The prognosis of localized malignant melanoma is related to several histologic features of the primary lesion. Growth pattern, level of invasion, and tumor thickness are currently most widely used in clinical practice, but other features, including ulceration, mitotic rate, density of the inflammatory response, evidence of partial regression, angioinvasion, cell type, cross-sectional profile, and amelanosis have been accorded prognostic significance in single factor analyses. Although stringently controlled prospective studies have yet to demonstrate the validity of these factors for the determination of optimal surgical treatment in individual cases, newer statistical methods of multivariate analysis have made possible assessment of the relative importance of each of these histologic characteristics. The most important and reproducible factor for predicting survival is maximum tumor thickness. Consensus also supports ulceration as another important, independent prognostic indicator, whereas growth pattern and level of invasion derive most of their prognostic value from a secondary correlation with tumor thickness. Mitotic rate may influence survival in the subgroup of patients with high-risk, thick melanomas.
局限性恶性黑色素瘤的预后与原发灶的若干组织学特征相关。生长方式、浸润深度和肿瘤厚度目前在临床实践中应用最为广泛，但其他特征，包括溃疡形成、有丝分裂率、炎症反应密度、部分消退证据、血管浸润、细胞类型、横断面形态及无黑色素形成，在单因素分析中已被认为具有预后意义。尽管严格对照的前瞻性研究尚未证实这些因素在确定个体病例最佳手术治疗方面的有效性，但更新的多变量分析统计方法已使评估这些组织学特征各自的相对重要性成为可能。预测生存的最重要且可重复的因素是肿瘤最大厚度。共识也支持溃疡形成是另一个重要的独立预后指标，而生长方式和浸润深度的大部分预后价值来自于与肿瘤厚度的次要相关性。有丝分裂率可能影响高危、厚黑色素瘤患者亚组的生存。
