Abstract：
Knowledge about lentigo maligna (melanoma) (LM/LMM) and its associated prognostic clinicopathological characteristics are limited compared to that of non-LM/LMM subtypes. The current study aimed to determine the clinical relevance of the LM/LMM subtype and its influence on recurrence and survival outcomes.
All consecutive cases of primary cutaneous head and neck LM/LMM treated by wide local excision over a ten-year period were retrospectively reviewed and compared to non-LM/LMM. Clinical outcome and prognostic factors were assessed by cumulative incidence and competing risk analyses.
A total of 345 patients were identified. Specific clinicopathological characteristics such as lower median Breslow thickness (1.6 mm versus 2.1 mm; P = 0.013), association with diagnostic sampling errors (17.3% versus 5.2%; P = 0.01), and increased risk of local recurrences due to incomplete resection (18.7% versus 2.3%; P < 0.001), were significantly associated with LM/LMM. Guideline adherence was similar between the two study groups. The positive nodal status at baseline for LMM was low compared to non-LM/LMM (4.2% vs 17.9%; P = 0.037). The LMM subtype, facial localization, and reduced surgical margins (i.e., guideline non-adherence) were not shown to be independent prognostic factors for disease-free, melanoma-specific, or overall survival after correction for competing risks such as patient age and Breslow thickness.
The LMM subtype was not shown to be prognostically different from non-LM/LMM when corrected for other variables of influence such as patient age and Breslow thickness. Reduced resection margins did not seem to affect disease-free, and melanoma-specific survival and warrant LM/LMM-specific guidelines. Further research is needed to evaluate the value of SLNB in LMM patients.
All consecutive cases of primary cutaneous head and neck LM/LMM treated by wide local excision over a ten-year period were retrospectively reviewed and compared to non-LM/LMM. Clinical outcome and prognostic factors were assessed by cumulative incidence and competing risk analyses.
A total of 345 patients were identified. Specific clinicopathological characteristics such as lower median Breslow thickness (1.6 mm versus 2.1 mm; P = 0.013), association with diagnostic sampling errors (17.3% versus 5.2%; P = 0.01), and increased risk of local recurrences due to incomplete resection (18.7% versus 2.3%; P < 0.001), were significantly associated with LM/LMM. Guideline adherence was similar between the two study groups. The positive nodal status at baseline for LMM was low compared to non-LM/LMM (4.2% vs 17.9%; P = 0.037). The LMM subtype, facial localization, and reduced surgical margins (i.e., guideline non-adherence) were not shown to be independent prognostic factors for disease-free, melanoma-specific, or overall survival after correction for competing risks such as patient age and Breslow thickness.
The LMM subtype was not shown to be prognostically different from non-LM/LMM when corrected for other variables of influence such as patient age and Breslow thickness. Reduced resection margins did not seem to affect disease-free, and melanoma-specific survival and warrant LM/LMM-specific guidelines. Further research is needed to evaluate the value of SLNB in LMM patients.
摘要：
背景：与非-LM/LMM亚型相比，关于恶性黑色素瘤（LM/LMM）及其相关预后临床病理特征的知识有限。本研究旨在确定LM/LMM亚型的临床相关性及其对复发和生存结果的影响。
方法：回顾性分析了经过十年的广泛局部切除术治疗的所有原发性皮肤头颈部LM/LMM的连续病例，并与非LM/LMM进行了比较。通过累积发生率和竞争风险分析评估临床结果和预后因素。
结果：共确定了345例患者。特定的临床病理特征，如较低的中位Breslow厚度（1.6mm对2.1mm；P=0.013），与诊断抽样误差的相关性(17.3%对5.2%；P=0.01)，由于不完全切除而导致局部复发的风险增加（18.7％对2.3％；P<0.001），与LM/LMM显著相关。两个研究组之间的指南依从性相似。与非LM/LMM相比，LMM的基线阳性淋巴结状态较低（4.2％vs17.9％；P=0.037）。LMM子类型,面部定位，并减少手术切缘(即，指南不依从性）未显示为无病的独立预后因素，黑色素瘤特异性，或纠正竞争风险后的总体生存率，如患者年龄和Breslow厚度。
结论：当校正其他影响变量如患者年龄和Breslow厚度时，未显示LMM亚型与非LM/LMM的预后差异。切缘减少似乎并不影响无病，和黑色素瘤特异性生存率，并保证LM/LMM特异性指南。需要进一步的研究来评估SLNB在LMM患者中的价值。
方法：回顾性分析了经过十年的广泛局部切除术治疗的所有原发性皮肤头颈部LM/LMM的连续病例，并与非LM/LMM进行了比较。通过累积发生率和竞争风险分析评估临床结果和预后因素。
结果：共确定了345例患者。特定的临床病理特征，如较低的中位Breslow厚度（1.6mm对2.1mm；P=0.013），与诊断抽样误差的相关性(17.3%对5.2%；P=0.01)，由于不完全切除而导致局部复发的风险增加（18.7％对2.3％；P<0.001），与LM/LMM显著相关。两个研究组之间的指南依从性相似。与非LM/LMM相比，LMM的基线阳性淋巴结状态较低（4.2％vs17.9％；P=0.037）。LMM子类型,面部定位，并减少手术切缘(即，指南不依从性）未显示为无病的独立预后因素，黑色素瘤特异性，或纠正竞争风险后的总体生存率，如患者年龄和Breslow厚度。
结论：当校正其他影响变量如患者年龄和Breslow厚度时，未显示LMM亚型与非LM/LMM的预后差异。切缘减少似乎并不影响无病，和黑色素瘤特异性生存率，并保证LM/LMM特异性指南。需要进一步的研究来评估SLNB在LMM患者中的价值。
