Hudson D A, Krige J E
Department of Plastic Surgery, University of Cape Town, South Africa.
J R Coll Surg Edinb. 1995 Apr;40(2):93-6.
Local recurrence and survival were evaluated in 19 patients with melanoma of the scalp after conservative local treatment using a standard protocol of 3 cm excision margins and split skin grafting. Sixteen men and three women had a mean age of 46 years. 12 presented with stage I disease, one with stage II, five with stage III, and one with stage IV disease. Nodular melanoma was present in 16 patients. 17 patients had either Clark level IV or V lesions and mean Breslow depth was 3.4 mm (range 0.9-25). Local recurrence occurred in only one patient who had an excision biopsy performed. Six of 12 patients with stage I disease developed regional adenopathy and only 2 are alive after therapeutic block dissection. All patients with stage III and stage IV disease have died. Excision using 3 cm margin is adequate to control local disease. Scalp melanoma is a specific anatomical subsite associated with a high incidence of regional disease and has a poor prognosis. This high risk group of patients may benefit from elective lymph node dissection.
采用3厘米切缘和分层皮片移植的标准方案对19例头皮黑色素瘤患者进行保守局部治疗后，评估局部复发情况和生存率。其中16例男性和3例女性，平均年龄46岁。12例为I期疾病，1例为II期，5例为III期，1例为IV期疾病。16例患者为结节性黑色素瘤。17例患者有Clark IV级或V级病变，平均Breslow深度为3.4毫米（范围0.9 - 25）。仅1例接受切除活检的患者出现局部复发。12例I期疾病患者中有6例发生区域淋巴结病，经治疗性淋巴结清扫术后仅2例存活。所有III期和IV期疾病患者均已死亡。采用3厘米切缘切除足以控制局部疾病。头皮黑色素瘤是一个特定的解剖亚部位，与区域疾病的高发病率相关，预后较差。这类高风险患者可能从选择性淋巴结清扫术中获益。
