Glass L F, Guffey J M, Schroer K R, Reintgen D
Department of Internal Medicine, H. Lee Moffitt Cancer Center and Research Institute, James A. Haley Veterans' Hospital, University of South Florida College of Medicine, Tampa 33612.
Semin Surg Oncol. 1993 May-Jun;9(3):202-7.
Overall, the prognosis for thin lesions of melanoma (less than 0.76 mm) is excellent. However, a number of melanoma patients with seemingly innocuous lesions have been reported to develop recurrences. For this reason, we examined histologic sections taken from eight cases of Clark level II melanoma that unexpectedly recurred, and compared their histopathologic features with an equal number of nonrecurrent lesions in whom reliable clinical follow-up data were available. Prognostic variables including Breslow thickness, mitotic rate, ulceration, the presence or absence of regression, a vertical growth phase component, and an associated banal nevus were evaluated in a double blind manner. When attempts were made to predict outcome based on one or more prognostic variables, the only correlation of statistical significance was the Breslow thickness (P = 0.04). A Breslow thickness greater than 0.4 mm was associated with a significantly shorter disease free interval than a thickness below 0.4 mm. There was no significant correlation between predicted outcome based on the histologic features examined and the eventual outcome based on history of recurrence (P = 0.36). These data indicate that although prognostic models that predict outcome in melanoma are generally reliable, there is a sizable population of patients with thin melanomas that do worse than would be expected.
总体而言，黑色素瘤薄病灶（小于0.76毫米）的预后极佳。然而，据报道，一些看似无害病灶的黑色素瘤患者会出现复发。因此，我们检查了8例意外复发的Clark II级黑色素瘤的组织切片，并将其组织病理学特征与同等数量的有可靠临床随访数据的未复发病灶进行了比较。以双盲方式评估了包括Breslow厚度、有丝分裂率、溃疡、有无消退、垂直生长期成分以及相关的普通痣等预后变量。当试图根据一个或多个预后变量预测结果时，唯一具有统计学意义的相关性是Breslow厚度（P = 0.04）。Breslow厚度大于0.4毫米与无病间期明显短于厚度低于0.4毫米相关。基于所检查的组织学特征预测的结果与基于复发史的最终结果之间没有显著相关性（P = 0.36）。这些数据表明，尽管预测黑色素瘤预后的模型通常是可靠的，但仍有相当一部分薄黑色素瘤患者的病情比预期的更差。
