JAMA Dermat:分期切除与永久切除对控制头和颈部黑色素瘤的功效

2017-01-22 MedSci MedSci原创

长期光损伤皮肤(特别是头部和颈部的黑色素瘤)的临床边缘定义尚不明确且其具有不可预测的隐匿延伸。分期切除技术已经描述了如何治疗这些具有挑战性的黑素瘤。近期,一项发表在JAMA Dermat杂志上的研究使用分期切除与综合苏木精 - 曙红染色永久性部分边缘控制调查局部复发率和清除终点的边缘。研究者们选取1997年10月8日至2006年12月31日进行观察性队列研究,中位随访时间为9.3年,研究了医疗中心

长期光损伤皮肤(特别是头部和颈部的黑色素瘤)的临床边缘定义尚不明确且其具有不可预测的隐匿延伸。分期切除技术已经描述了如何治疗这些具有挑战性的黑素瘤。

近期,一项发表在JAMA Dermat杂志上的研究使用分期切除与综合苏木精 - 曙红染色永久性部分边缘控制评估局部复发率和清除终点的边缘。

研究者们选取1997年10月8日至2006年12月31日进行观察性队列研究,中位随访时间为9.3年,研究了医疗中心806名头颈部黑色素瘤患者。

干预措施为分期切除术与综合性苏木精 - 曙红染色的永久性切片边缘控制。

主要结果为:局部复发率和边缘至清除终点。

此项研究结果显示说:共有806名患者(276名女性[34.2%];805名白人[99.9%]),在第一阶段切除手术时的中位年龄为65岁(范围,20-94岁)。估计局部复发率为:5年为1.4%,7.5年为1.8%,10年为2.2%。对于临床病变大小每增加50mm2,局部复发率增加9%(风险比,1.09;95%CI,1.02-1.15;P = 0.02)。


从病变到原位黑色素瘤清除的平均(SD)边缘为9.3(5.1)mm,而侵袭性黑色素瘤为13.7(5.9)mm。对于原位黑素瘤,232次切除(41.1%)为5mm或更小者以及420次切除中为10mm或以下者(74.5%)的边缘清楚。对于侵袭性黑色素瘤,8次切除(3.0%)为5mm或更小者以及141次切除(52.2%)为10mm或以下者的边缘清晰。

此项研究得出结论:当黑色素瘤的边缘难以评估,传统技术的复发率高时,分期切除与综合永久性部分边缘控制在长期阳光损伤所致头部和颈部皮肤黑色素瘤中有较好的复发率。

原始出处:
Moyer JS, Rudy S, Boonstra PS, Kraft C, Chinn SB, Baker SR, Schwartz JL, Bichakjian CK, Fullen D, Durham AB, Lowe L, Johnson TM.Efficacy of Staged Excision With Permanent Section Margin Control for Cutaneous Head and Neck Melanoma.JAMA Dermatol. 2016 Dec 21.

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    2017-02-01 sunylz
  2. [GetPortalCommentsPageByObjectIdResponse(id=1680380, encodeId=fcf7168038079, content=<a href='/topic/show?id=9e5c86e0712' target=_blank style='color:#2F92EE;'>#色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86707, encryptionId=9e5c86e0712, topicName=色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=343027846633, createdName=sunylz, createdTime=Wed Feb 01 23:30:00 CST 2017, time=2017-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=172598, encodeId=a8611e25982e, content=较好的复发率?有才啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160530/IMG574B6FCC15A9D2891.jpg, createdBy=1fbc1611028, createdName=yangwf, createdTime=Wed Jan 25 23:56:15 CST 2017, time=2017-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=172357, encodeId=7e511e235737, content=赞一个,小编辛苦了, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Tue Jan 24 13:05:14 CST 2017, time=2017-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1558786, encodeId=58651558e8628, content=<a href='/topic/show?id=e27610332666' target=_blank style='color:#2F92EE;'>#黑色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103326, encryptionId=e27610332666, topicName=黑色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=150614999302, createdName=cqlidoudou, createdTime=Tue Jan 24 09:30:00 CST 2017, time=2017-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1564795, encodeId=63521564e95dc, content=<a href='/topic/show?id=e27610332666' target=_blank style='color:#2F92EE;'>#黑色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103326, encryptionId=e27610332666, topicName=黑色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=150614999302, createdName=cqlidoudou, createdTime=Tue Jan 24 09:30:00 CST 2017, time=2017-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589707, encodeId=b95b1589e07fd, content=<a href='/topic/show?id=124d10065220' target=_blank style='color:#2F92EE;'>#颈部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100652, encryptionId=124d10065220, topicName=颈部)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c46a17776631, createdName=木头人519, createdTime=Tue Jan 24 09:30:00 CST 2017, time=2017-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=172105, encodeId=2d801e2105a7, content=好文章,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=071c2012037, createdName=wmu姿, createdTime=Mon Jan 23 09:49:53 CST 2017, time=2017-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=172079, encodeId=551d1e207995, content=好文章,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJiaCBO9f33YY0a9cL4rhSH23PNEOVia2szWTbUl6IgFnukCuC2ptOD5mAC0Ax8qGt2pjwudkREHlmA/132, createdBy=d39e1630897, createdName=1dd8aa01m06(暂无匿称), createdTime=Mon Jan 23 07:25:13 CST 2017, time=2017-01-23, status=1, ipAttribution=)]
    2017-01-25 yangwf

    较好的复发率?有才啊

    0

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    2017-01-24 虈亣靌

    赞一个,小编辛苦了

    0

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  6. [GetPortalCommentsPageByObjectIdResponse(id=1680380, encodeId=fcf7168038079, content=<a href='/topic/show?id=9e5c86e0712' target=_blank style='color:#2F92EE;'>#色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86707, encryptionId=9e5c86e0712, topicName=色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=343027846633, createdName=sunylz, createdTime=Wed Feb 01 23:30:00 CST 2017, time=2017-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=172598, encodeId=a8611e25982e, content=较好的复发率?有才啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160530/IMG574B6FCC15A9D2891.jpg, createdBy=1fbc1611028, createdName=yangwf, createdTime=Wed Jan 25 23:56:15 CST 2017, time=2017-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=172357, encodeId=7e511e235737, content=赞一个,小编辛苦了, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Tue Jan 24 13:05:14 CST 2017, time=2017-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1558786, encodeId=58651558e8628, content=<a href='/topic/show?id=e27610332666' target=_blank style='color:#2F92EE;'>#黑色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103326, encryptionId=e27610332666, topicName=黑色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=150614999302, createdName=cqlidoudou, createdTime=Tue Jan 24 09:30:00 CST 2017, time=2017-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1564795, encodeId=63521564e95dc, content=<a href='/topic/show?id=e27610332666' target=_blank style='color:#2F92EE;'>#黑色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103326, encryptionId=e27610332666, topicName=黑色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=150614999302, createdName=cqlidoudou, createdTime=Tue Jan 24 09:30:00 CST 2017, time=2017-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589707, encodeId=b95b1589e07fd, content=<a href='/topic/show?id=124d10065220' target=_blank style='color:#2F92EE;'>#颈部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100652, encryptionId=124d10065220, topicName=颈部)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c46a17776631, createdName=木头人519, createdTime=Tue Jan 24 09:30:00 CST 2017, time=2017-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=172105, encodeId=2d801e2105a7, content=好文章,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=071c2012037, createdName=wmu姿, createdTime=Mon Jan 23 09:49:53 CST 2017, time=2017-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=172079, encodeId=551d1e207995, content=好文章,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJiaCBO9f33YY0a9cL4rhSH23PNEOVia2szWTbUl6IgFnukCuC2ptOD5mAC0Ax8qGt2pjwudkREHlmA/132, createdBy=d39e1630897, createdName=1dd8aa01m06(暂无匿称), createdTime=Mon Jan 23 07:25:13 CST 2017, time=2017-01-23, status=1, ipAttribution=)]
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    2017-01-23 wmu姿

    好文章,学习了

    0

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    2017-01-23 1dd8aa01m06(暂无匿称)

    好文章,学习了

    0

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