Roses D F, Harris M N, Rigel D, Carrey Z, Friedman R, Kopf A W
Ann Surg. 1983 Jul;198(1):65-9. doi: 10.1097/00000658-198307000-00013.
A total of 672 consecutive patients with clinical stage I and stage II primary cutaneous malignant melanoma were treated by excision of 3.0 to 5.0 cm of surrounding skin down to and including the underlying fascia when the lesion exceeded 0.5 mm thickness (Breslow measurement). More conservative margins were taken in locations where such excisions would result in significant cosmetic or functional morbidity and for thinner lesions (less than 0.5 mm). Seven of 658 patients with clinical stage I disease (1.1%) and three of 14 patients with clinical stage II disease (21.4%) developed histologically verified local metastases within 5 cm of the primary excision scar or skin graft. Fifteen patients with stage I disease developed in-transit metastases (2.3%) at a site more than 5.0 cm proximal to the surgical scar or skin graft but not beyond the regional nodal group. Two patients with stage II disease who had developed local metastases also developed in-transit metastases (14.3%). No patient with a lesion less than 1.0 mm thick has had a local recurrence. Nine of the ten patients (90%) who developed local metastases and 12 of the 17 patients (70.6%) who developed in-transit metastases have also developed systemic metastases to date. Local and in-transit metastases following such definitive excision is a significant indicator of disseminated systemic metastatic melanoma.
共有672例连续的临床I期和II期原发性皮肤恶性黑色素瘤患者接受了治疗，当病变厚度超过0.5 mm（ Breslow测量法）时，切除周围3.0至5.0 cm的皮肤直至并包括深筋膜。在进行此类切除会导致明显的美容或功能损害的部位以及较薄病变（小于0.5 mm）时，采用了更保守的切缘。658例临床I期疾病患者中有7例（1.1%）和14例临床II期疾病患者中有3例（21.4%）在原发切除瘢痕或皮肤移植部位5 cm范围内出现了经组织学证实的局部转移。15例I期疾病患者在手术瘢痕或皮肤移植部位近端超过5.0 cm但未超出区域淋巴结组的部位发生了移行转移（2.3%）。2例已发生局部转移的II期疾病患者也发生了移行转移（14.3%）。病变厚度小于1.0 mm的患者均未出现局部复发。发生局部转移的10例患者中有9例（90%）以及发生移行转移的17例患者中有12例（70.6%）迄今为止也发生了全身转移。这种根治性切除后的局部和移行转移是播散性全身转移性黑色素瘤的一个重要指标。
