RESUMO
INTRODUCTION: In patients with primary cutaneous melanoma, there is generally a delay between excisional biopsy of the primary tumour and sentinel-node biopsy. The objective of this study is to analyse the prognostic implications of this delay. PATIENTS AND METHOD: This was an observational, retrospective, cohort study in four tertiary referral hospitals. A total of 1963 patients were included. The factor of interest was the interval between the date of the excisional biopsy of the primary melanoma and the date of the sentinel-node biopsy (delay time) in the prognosis. The primary outcome was melanoma-specific survival and disease-free survival. RESULTS: A delay time of 40 days or less (hazard ratio (HR), 1.7; confidence interval (CI), 1.2-2.5) increased Breslow thickness (Breslow ⩾ 2 mm, HR, > 3.7; CI, 1.4-10.7), ulceration (HR, 1.6; CI, 1.1-2.3), sentinel-node metastasis (HR, 2.9; CI, 1.9-4.2), and primary melanoma localised in the head or neck were independently associated with worse melanoma-specific survival (all P < 0.03). The stratified analysis showed that the effect of delay time was at the expense of the patients with a negative sentinel-node biopsy and without regression. CONCLUSION: Early sentinel-node biopsy is associated with worse survival in patients with cutaneous melanoma.
Assuntos
Linfonodos/patologia , Melanoma/secundário , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/patologia , Listas de Espera , Adulto , Idoso , Intervalo Livre de Doença , Feminino , França , História Antiga , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , Melanoma/mortalidade , Melanoma/terapia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/terapia , Espanha , Centros de Atenção Terciária , Fatores de Tempo , Resultado do TratamentoRESUMO
A high growth rate in melanomas has been associated with a more aggressive phenotype and worse survival. The aim of this study was to define the dermoscopic characteristics associated with this type of cutaneous melanoma. We carried out a retrospective study of 132 cutaneous melanomas, analyzing certain clinical characteristics and the most important dermoscopic variables related to the melanomas. Fast-growing melanomas were considered to be those with a growth rate of more than 0.5 mm per month. Fast-growing melanomas more often lacked an atypical network, were symmetrical, presented ulceration, and were hypopigmented. The dermoscopic vascular pattern often showed atypical irregular vessels and milky-red areas. The association of these two is a specific characteristic. Fast-growing melanomas have a characteristic phenotype and dermoscopy can be useful for their identification.
Assuntos
Melanoma/patologia , Neoplasias Cutâneas/patologia , Pele/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dermoscopia , Feminino , Humanos , Hipopigmentação/etiologia , Masculino , Melanoma/irrigação sanguínea , Melanoma/fisiopatologia , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/etiologia , Estudos Retrospectivos , Pele/irrigação sanguínea , Neoplasias Cutâneas/irrigação sanguínea , Neoplasias Cutâneas/fisiopatologia , Úlcera Cutânea/etiologia , Espanha , Melanoma Maligno CutâneoRESUMO
OBJECTIVE: To determine whether growth rate (GR) of cutaneous melanoma predicts the histological sentinel lymph node (SLN) positivity. DESIGN: Retrospective cohort study. SETTING: Two tertiary melanoma referral centers. PATIENTS: A total of 698 patients with invasive primary cutaneous melanoma in whom the SLN was identified between January 1, 2000, and June 30, 2010. MAIN OUTCOME MEASURE: Based on previous studies, a surrogate measure for GR in primary invasive melanoma was calculated as the ratio of Breslow thickness to time to melanoma development. RESULTS: The SLN was positive in 20.2% of patients. Multivariate logistic regression analysis revealed that GR, Breslow thickness, and the presence of microscopic satellitosis were independently associated with SLN positivity. The probability of SLN positivity was 8.2% for slow-growth melanomas (<0.10 mm/mo) compared with 19.8% for intermediate-growth melanomas (0.10-0.50 mm/mo) and 37.7% for fast-growth melanomas (>0.50 mm/mo). Growth rate was not an independent predictive factor for survival. CONCLUSION: Growth rate of primary cutaneous melanoma, together with Breslow thickness and the presence of microscopic satellitosis, predicts the histological SLN positivity.