Elder D E, Guerry D, Heiberger R M, LaRossa D, Goldman L I, Clark W H, Thompson C J, Matozzo I, Van Horn M
Plast Reconstr Surg. 1983 Jan;71(1):66-72. doi: 10.1097/00006534-198301000-00015.
Cutaneous malignant melanoma has traditionally been treated by "wide" local excision with a 5-cm margin of normal skin about the tumor. The rationale of wide excision for melanoma has never been clearly defined, but the procedure is known to be effective in preventing local recurrence. We studied 105 patients who had 109 primary melanomas in 1977 and related margin width of the definitive excision to the presence of satellites, to the subsequent development of local recurrence and in-transit metastases, and to survival. Survival was not dependent on margin width, and there were no incidences of local recurrence. Satellitosis and in-transit cutaneous metastasis indicate that a melanoma is capable of local recurrence; these phenomena occurred only in tumors whose thickness (Breslow) was greater than 2.0 mm. These data provide a rationale for wide excision of "thick" melanomas and support more modest local therapy for thin cutaneous melanoma.
传统上，皮肤恶性黑色素瘤的治疗方法是进行“广泛”的局部切除，即在肿瘤周围保留5厘米的正常皮肤边缘。黑色素瘤广泛切除的理论依据从未得到明确界定，但已知该手术在预防局部复发方面是有效的。我们研究了1977年患有109例原发性黑色素瘤的105名患者，并将最终切除的边缘宽度与卫星灶的存在、随后局部复发和皮下转移的发生情况以及生存率进行了关联。生存率并不取决于边缘宽度，且未发生局部复发。卫星灶形成和皮下转移表明黑色素瘤能够局部复发；这些现象仅发生在厚度（ Breslow ）大于2.0毫米的肿瘤中。这些数据为“厚”黑色素瘤的广泛切除提供了理论依据，并支持对薄皮肤黑色素瘤采用更为适度的局部治疗。
