Guerry D, Synnestvedt M, Elder D E, Schultz D
Department of Medicine, University of Pennsylvania, Philadelphia 19104.
J Invest Dermatol. 1993 Mar;100(3):342S-345S. doi: 10.1111/1523-1747.ep12470248.
Primary melanoma generally evolves through three clinically and morphologically discernable tumor progression steps. Transformed melanocytes first proliferate above the epidermal basement membrane, then invade the papillary dermis (the in situ and invasive radial growth phases of melanoma), and subsequently develop the capacity to grow as a tumor (the vertical growth phase). Here, we address three aspects of the invasive radial growth phase that provide the rationale for viewing it as the critical lesion for melanoma detection and therapy. We determined the fraction of melanomas having this growth phase, tested its hypothesized incapacity to metastasize, and estimated its longevity. The high prevalence of this step in tumor progression was demonstrated in a data base of 624 patients, where at least 87% of melanomas exhibited a radial growth phase. The benignity of this lesion was evinced by the perfect metastasis-free survival of 161 patients treated for pure radial growth-phase melanomas and followed for a median of 13.7 years. Its indolence was evident in an analysis of the ages of 234 patients with superficial spreading melanomas without or with vertical growth phase: The cases with lesions having only radial growth phase were 4.3 years younger than those additionally having vertical growth phase (p < 0.05). These features of the invasive radial growth phase of primary melanoma, first described by Wallace H. Clark, make it a pivotal lesion in the evolutionary biology of melanocytic neoplasia and confirm its central place in public health programs to control melanoma mortality.
原发性黑色素瘤通常通过三个临床和形态学上可辨别的肿瘤进展阶段演变。转化的黑素细胞首先在表皮基底膜上方增殖，然后侵入乳头真皮（黑色素瘤的原位和侵袭性放射状生长阶段），随后发展为具有肿瘤生长的能力（垂直生长阶段）。在此，我们探讨侵袭性放射状生长阶段的三个方面，这些方面为将其视为黑色素瘤检测和治疗的关键病变提供了理论依据。我们确定了具有此生长阶段的黑色素瘤的比例，测试了其假设的无转移能力，并估计了其持续时间。在一个包含624名患者的数据库中证实了这一肿瘤进展步骤的高发生率，其中至少87%的黑色素瘤表现出放射状生长阶段。161例接受单纯放射状生长阶段黑色素瘤治疗且中位随访13.7年的患者无转移生存，证明了该病变的良性。在对234例有无垂直生长阶段的浅表扩散性黑色素瘤患者的年龄分析中，其惰性显而易见：仅具有放射状生长阶段病变的患者比另外具有垂直生长阶段的患者年轻4.3岁（p<0.05）。原发性黑色素瘤侵袭性放射状生长阶段的这些特征最早由华莱士·H·克拉克描述，使其成为黑素细胞肿瘤进化生物学中的关键病变，并证实了其在控制黑色素瘤死亡率的公共卫生项目中的核心地位。
