Brown C D, Zitelli J A
Dermatol Surg. 1995 Apr;21(4):285-90. doi: 10.1111/j.1524-4725.1995.tb00174.x.
The prognosis and treatment of true local cutaneous recurrent malignant melanoma is presently unknown. We define this entity as melanoma bearing an in situ component that recurs contiguous with the scar of the primary excision. Although previously uncommon, the incidence of true local recurrent melanoma may rise due to the recent use of more narrow margins for excision of thin primary melanoma.
We hypothesized that there is a difference in prognosis between true local cutaneous recurrent melanoma versus local recurrence from satellite or in-transit metastases. Also, we defined guidelines for the surgical management of true local cutaneous recurrent melanoma.
We calculated the surgical margin necessary to reach a tumor-free plane using Mohs surgery in 50 patients with true local recurrent melanoma. Patient survival was determined by the Kaplan-Meier method.
Seventy-six percent of the tumors were completely excised using a margin of less than 1 cm. However, a margin of up to 2 cm was required to successfully treat all 50 patients. Thicker tumors did require significantly larger margins. The Kaplan-Meier 5-year overall and melanoma survival rates were 89% and 98%, respectively. The 5-year disease-free survival rate was 66%.
The prognosis of true local recurrent melanoma is related to tumor thickness. We recommend full-thickness excision of the entire old scar including a 2-cm margin or Mohs surgery if a narrower margin of resection is desired.
目前，真正的局部皮肤复发性恶性黑色素瘤的预后和治疗方法尚不清楚。我们将这一实体定义为具有原位成分的黑色素瘤，其复发部位与原发灶切除瘢痕相邻。虽然以前并不常见，但由于最近对薄型原发性黑色素瘤采用了更窄的切除边缘，真正的局部复发性黑色素瘤的发病率可能会上升。
我们假设真正的局部皮肤复发性黑色素瘤与卫星灶或移行转移导致的局部复发在预后上存在差异。此外，我们还制定了真正的局部皮肤复发性黑色素瘤的手术治疗指南。
我们对50例真正的局部复发性黑色素瘤患者采用莫氏手术计算达到无瘤平面所需的手术切缘。采用Kaplan-Meier法确定患者生存率。
76%的肿瘤在切缘小于1 cm的情况下被完全切除。然而，要成功治疗所有50例患者，需要高达2 cm的切缘。较厚的肿瘤确实需要明显更大的切缘。Kaplan-Meier法计算的5年总生存率和黑色素瘤生存率分别为89%和98%。5年无病生存率为66%。
真正的局部复发性黑色素瘤的预后与肿瘤厚度有关。如果希望采用更窄的切除边缘，我们建议完整切除整个旧瘢痕，包括2 cm的切缘，或采用莫氏手术。
