Måsbäck A, Westerdahl J, Ingvar C, Olsson H, Jonsson N
Department of Pathology, University of Lund, Sweden.
Cancer. 1994 Mar 15;73(6):1625-30. doi: 10.1002/1097-0142(19940315)73:6<1625::aid-cncr2820730614>3.0.co;2-#.
There is an increase in the incidence of cutaneous malignant melanoma (CMM) among white people throughout the world. In Sweden, a fivefold increase has been recorded since 1960, but the mortality is rising at a much lower rate. Tumor thickness is the single most important prognostic factor for primary melanoma. This study aimed to clarify whether the thickness of the tumor in invasive CMM decreased during the period 1965-1985.
This population-based study identified 574 cases of CMM, both invasive and noninvasive, in the South Swedish Health Care Region in 1965, 1975, and 1985. Twenty-six cases were excluded because the collection or evaluation of the material was not possible. The remaining 548 cases were reviewed histopathologically, and a diagnosis of invasive CMM was rejected in 71 cases. Eventually, 467 cases of invasive melanoma remained in our study (70 in 1965, 124 in 1975, and 273 in 1985). The level of invasion, tumor thickness, regression, ulceration, presence of inflammatory cells, benign naevus cells, and the site of presentation were studied.
The study found neither a significant decrease of tumor thickness of invasive CMM nor changes in the level of invasion or proportion of ulcerated melanoma. A significantly higher proportion of melanoma tumors containing benign naevus cells was seen throughout the years (P < 0.05). Women had significantly fewer inflammatory cells in their tumors than did men (P < 0.01). As expected, the anatomical site of presentation showed a significant sex-related difference, with more tumors on the legs of female patients and more on the trunk of male patients (P < 0.001).
There is a divergence between the rapidly increasing incidence and the slower increase in mortality of CMM. This cannot be explained by a removal of the melanoma at a thinner thickness. Differences between the sexes according to the tumor site and the increasing rate of CMM containing benign naevus cells could implicate changes in the tumor biology. Public education in Sweden concerning ultraviolet radiation and the connection with melanoma is fairly new and might not have any influence on this time period. Additional investigation is needed to clarify this matter.
全球白人皮肤恶性黑色素瘤（CMM）的发病率呈上升趋势。在瑞典，自1960年以来已记录到五倍的增长，但死亡率上升的速度要低得多。肿瘤厚度是原发性黑色素瘤最重要的单一预后因素。本研究旨在阐明1965年至1985年期间侵袭性CMM的肿瘤厚度是否有所下降。
这项基于人群的研究确定了1965年、1975年和1985年瑞典南部医疗保健地区的574例CMM病例，包括侵袭性和非侵袭性病例。26例病例被排除，因为无法收集或评估材料。对其余548例病例进行了组织病理学复查，71例病例被排除侵袭性CMM的诊断。最终，我们的研究中保留了467例侵袭性黑色素瘤病例（1965年70例，1975年124例，1985年273例）。研究了侵袭水平、肿瘤厚度、消退、溃疡、炎症细胞的存在、良性痣细胞以及发病部位。
研究发现侵袭性CMM的肿瘤厚度既没有显著下降，侵袭水平或溃疡型黑色素瘤的比例也没有变化。多年来，含有良性痣细胞的黑色素瘤肿瘤比例显著更高（P < 0.05）。女性肿瘤中的炎症细胞明显少于男性（P < 0.01）。正如预期的那样，发病的解剖部位显示出明显的性别差异，女性患者腿部的肿瘤更多，男性患者躯干的肿瘤更多（P < 0.001）。
CMM发病率迅速上升与死亡率缓慢上升之间存在差异。这不能用在较薄厚度时切除黑色素瘤来解释。根据肿瘤部位的性别差异以及含有良性痣细胞的CMM发病率增加可能意味着肿瘤生物学的变化。瑞典关于紫外线辐射及其与黑色素瘤关系的公众教育相当新，可能对这一时期没有任何影响。需要进一步调查以澄清此事。
