Gromet M A, Epstein W L, Blois M S
Cancer. 1978 Nov;42(5):2282-92. doi: 10.1002/1097-0142(197811)42:5<2282::aid-cncr2820420528>3.0.co;2-v.
To validate the supposition that thin malignant melanomas (less than 0.76 mm thick) of ordinarily low risk but with areas of regression may paradoxically metastasize, we observed 121 thin malignant melanomas over a six year period. Of these, 23 displayed readily apparent areas of regression, of which five (21.7%) metastasized. The incidence of metastases in their 98 counterparts without regression was 2.0% (2/98). The difference between the two is statistically significant (p = less than .01). Of the entire group of the two is statistically significant (p = less than .01). Of the entire group of thin melanomas, those with regression represented 19.0% (23/121) yet accounted for a disproportionate 71.4% (5/7) of all metastases. We conclude that regression is a relatively poor prognostic sign, whose occurrence within an otherwise thin melanoma represents a significant caveat to the current histologic staging system that equates thinness with low risk. We thus submit that patients whose malignant melanomas display regression be followed rigorously for evidence of metastases irrespective of the tumor's actual measured thickness or level of invasion.
通常低风险但伴有消退区域的薄型恶性黑色素瘤（厚度小于0.76毫米）可能反常地发生转移，我们在六年期间观察了121例薄型恶性黑色素瘤。其中，23例有明显的消退区域，其中5例（21.7%）发生了转移。其98例无消退的对应病例的转移发生率为2.0%（2/98）。两者之间的差异具有统计学意义（p＜0.01）。在整个薄型黑色素瘤组中，这两者之间的差异具有统计学意义（p＜0.01）。在整个薄型黑色素瘤组中，有消退的病例占19.0%（23/121），但在所有转移病例中所占比例却高达71.4%（5/7），不成比例。我们得出结论，消退是一个相对较差的预后指标，在原本薄型的黑色素瘤中出现消退对目前将薄度等同于低风险的组织学分期系统是一个重要的警示。因此，我们认为，无论恶性黑色素瘤的实际测量厚度或浸润程度如何，对有消退表现的患者都应严密随访有无转移迹象。
