O'Rourke M G, Altmann C R
Mater Misericordiae Adult Public Hospital, Brisbane, Queensland, Australia.
Ann Surg. 1993 Jan;217(1):2-5. doi: 10.1097/00000658-199301000-00002.
Through retrospective analysis of patient records for 187 patients with melanoma seen between 1975 and 1989, the aim of this study was to determine whether outcome varied according to degrees of surgical intervention in the primary treatment of stage I disease for thin, intermediate, and thick lesions. There were no significant differences in recurrence rate associated with an excision margin of 15 mm or less compared with wider excision margins; with initial excision compared with wider re-excision after excision biopsy; or for primary closure as compared with closure with a graft. There was, however, a significant difference in wound complication rate between wounds closed primarily (6%) and those closed by grafting (31%) (p < 0.01). The authors advocate the more conservative excision margin of 1.00 cm to 1.50 cm in the treatment of stage I melanoma with primary closure of the wound where possible.
通过回顾性分析1975年至1989年间收治的187例黑色素瘤患者的病历，本研究旨在确定在I期疾病的初级治疗中，对于薄、中等厚度和厚病变，手术干预程度不同时，预后是否存在差异。与更宽的切缘相比，切缘为15毫米或更小的复发率无显著差异；与切除活检后更宽的再次切除相比，初次切除时复发率无显著差异；与植皮闭合相比，一期闭合时复发率无显著差异。然而，一期闭合伤口（6%）和植皮闭合伤口（31%）的伤口并发症发生率存在显著差异（p<0.01）。作者主张在治疗I期黑色素瘤时，采用1.00厘米至1.50厘米更保守的切缘，并尽可能一期闭合伤口。
