Del Mar C B, Green A C, Battistutta D
Centre for General Practice, University of Queensland Medical School, Herston, Australia.
Melanoma Res. 1997 Dec;7(6):496-9. doi: 10.1097/00008390-199712000-00008.
There is debate about the margin of normal tissue that should be included with excisions of melanocytic lesions of the skin, and about which lesions should be referred for specialist care. We describe the determinants of the margins of excised melanocytic skin lesions and of referral patterns from primary care. Copies of the pathology reports of melanocytic skin lesions excised from two cities in tropical Queensland were obtained; questionnaires about each lesion were administered to the excising doctor. Data about 3275 lesions (2914 naevi, 130 lentigos, 151 melanomas, 51 dysplastic naevi, 21 Hutchinson's melanotic freckles and eight other melanocytic lesions) were analysed. Twenty-one per cent of the treatment sessions involved the excision of more than one lesion; 5% involved three lesions or more. Most lesions were managed by one doctor. The overall mean margin of excision was 2.8 mm. It was greater for longer qualified doctors, surgeons and college-affiliated general practitioners, for lesions excised to address malignancy (3.0 mm) rather than cosmetic appearance (2.4 mm), for Hutchinson's melanotic freckles (5.9 mm) and melanomas (5.1 mm) compared with benign lesions (2.7 mm) (P < 0.001) and for older patients (2.6 mm for those < or = 15, 3.5 mm for those > 40 years) (P = 0.001). Wider excisions of skin melanocytic lesions are performed by older and more experienced doctors, on older patients, and for lesions in which malignancy is being addressed.
对于皮肤黑素细胞性病变切除时应包含的正常组织切缘范围，以及哪些病变应转诊至专科治疗，存在着争议。我们描述了切除的皮肤黑素细胞性病变切缘的决定因素以及初级保健机构的转诊模式。获取了从昆士兰热带地区两个城市切除的皮肤黑素细胞性病变的病理报告副本；向切除病变的医生发放了关于每个病变的问卷。对3275个病变（2914个痣、130个雀斑样痣、151个黑色素瘤、51个发育异常痣、21个哈钦森黑素雀斑及8个其他黑素细胞性病变）的数据进行了分析。21%的治疗过程涉及切除不止一个病变；5%涉及三个或更多病变。大多数病变由一名医生处理。总体平均切除切缘为2.8毫米。资历更长的医生、外科医生及与学院有关联的全科医生切除的切缘更大；为处理恶性病变（3.0毫米）而非出于美容目的（2.4毫米）切除的病变切缘更大；与良性病变（2.7毫米）相比，哈钦森黑素雀斑（5.9毫米）和黑色素瘤（5.1毫米）的切缘更大（P<0.001）；老年患者的切缘更大（15岁及以下者为2.6毫米，40岁以上者为3.5毫米）（P = 0.001）。年龄更大、经验更丰富的医生会对老年患者以及需要处理恶性病变的情况进行更广泛的皮肤黑素细胞性病变切除。
