Savoia P, Quaglino P, Verrone A, Bernengo M G
First Dermatologic Clinic, University of Turin, Torino, Italy.
Melanoma Res. 1998 Aug;8(4):361-6. doi: 10.1097/00008390-199808000-00010.
Development of multiple primary melanomas is a rare but well recognized disease, with an estimated incidence ranging from 1.75% to 8.5% in several series. The clinical, histological and epidemiological characteristics of 49 patients, identified from 2470 with histologically confirmed melanoma, are described in this study. Thirty-five of these patients had two primary melanomas, 11 had three melanomas and three had four, five and six melanomas, respectively. Diagnosis was concurrent in 22 patients (45%); in the remaining cases the median time interval between the first and second melanoma was 22.6 months and the longest interval was 21.5 years. The mean Breslow's thickness decreased significantly (P < 0.001) from the first melanoma to the second and third lesion. The multiple melanoma patients had a higher percentage of subjects over 70 years of age or with lentigo maligna melanoma than single melanoma patients. The mean follow-up time was 12 years (range 4 23 years). The 5-year survival rate from first melanoma excision (83%) does not differ from that of patients with a single melanoma. In conclusion, the presence of multiple primary melanomas does not appear to be a negative prognostic factor; our data show the importance of close follow-up in melanoma patients in order to detect not only metastases, but also subsequent primaries in their earliest phases.
多原发性黑色素瘤是一种罕见但已得到充分认识的疾病，在多个系列研究中，其估计发病率在1.75%至8.5%之间。本研究描述了从2470例经组织学确诊的黑色素瘤患者中识别出的49例患者的临床、组织学和流行病学特征。这些患者中，35例有两个原发性黑色素瘤，11例有三个黑色素瘤，3例分别有四个、五个和六个黑色素瘤。22例患者（45%）为同时诊断；在其余病例中，第一和第二个黑色素瘤之间的中位时间间隔为22.6个月，最长间隔为21.5年。从第一个黑色素瘤到第二个和第三个病灶，平均Breslow厚度显著降低（P < 0.001）。与单发黑色素瘤患者相比，多原发性黑色素瘤患者中70岁以上或患有恶性雀斑样痣黑色素瘤的比例更高。平均随访时间为12年（范围4至23年）。首次黑色素瘤切除后的5年生存率（83%）与单发黑色素瘤患者的生存率无差异。总之，多原发性黑色素瘤的存在似乎不是一个负面的预后因素；我们的数据表明，对黑色素瘤患者进行密切随访很重要，以便不仅能检测到转移，还能在最早阶段发现后续的原发性肿瘤。
