Evaluation of Multiple Tissue Levels Frequently Upstages Patients With Clinically Localized Thin Primary Cutaneous Melanoma.

IF 1.6 4区 医学 Q3 DERMATOLOGY
Louise A Jackett, James P Gullifer, Richard A Scolyer
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Abstract

Background: Breslow thickness (BT), ulceration, and microsatellitosis are critical prognostic parameters for cutaneous melanoma staging. These parameters can vary depending on the number of tissue levels examined from individual paraffin blocks. We sought to evaluate all prognostic histopathologic parameters in melanoma for their variations between levels, taken at regular intervals, in a single study.

Methods: We analyzed 40 consecutive cases of primary cutaneous (nonacral) melanoma through five hematoxylin and eosin sections, taken at 100 μm intervals, for staging and prognostic parameters.

Results: Examination of additional levels resulted in (a) an increase in BT in 47.5% (19 out of 40) of cases and (b) detection of ulceration in a further 5% (2/40). This resulted in upstaging for 20% (8 out of 40) of patients (15% because of BT, 2.5% because of ulceration, and 2.5% because of BT and ulceration). The upstaging effect was incremental, with approximately 5% of patients upstaged with each additional 100 μm interval (up to 400 μm). Incipient ulceration and epidermal consumption were infrequent (10% of cases); however, when present, ulceration was subsequently observed in half of cases. We encountered no cases where microsatellitosis was detected at deeper levels.

Conclusion: The performance of additional tissue levels is a simple and inexpensive procedure that can improve the accuracy of staging for patients with thin (pT1) primary cutaneous melanomas. It may be pertinent for pathologists to consider additional levels for thin melanomas when a BT measurement is close to a staging threshold (e.g., within 0.1-0.3 mm for pT1a vs. pT1b, or pT1b vs. pT2a), or when incipient ulceration is encountered.

对多个组织水平进行评估可提高临床局部薄型原发性皮肤黑色素瘤患者的预后。
背景:布氏厚度(BT)、溃疡和微粒化是皮肤黑色素瘤分期的关键预后参数。这些参数会因检查各个石蜡块组织层面的数量而不同。我们试图在一项研究中评估黑色素瘤的所有预后组织病理学参数,以确定它们在不同层次、不同时间段的变化情况:方法:我们对 40 例连续的原发性皮肤(非口腔)黑色素瘤病例进行了分析,通过 5 个苏木精和伊红切片,以 100 μm 的间隔进行分期和预后参数检查:结果:对其他层面的检查结果是:(a) 47.5%的病例(40 例中有 19 例)BT 增高;(b) 另外 5%的病例(40 例中有 2 例)发现溃疡。这导致 20% 的患者(40 例中有 8 例)分期提前(15% 因为 BT,2.5% 因为溃疡,2.5% 因为 BT 和溃疡)。上行分期的效果是递增的,每增加 100 μm 的间隔(最多 400 μm),约有 5% 的患者上行分期。初期溃疡和表皮消耗并不常见(10% 的病例);但是,如果出现溃疡,半数病例随后会被观察到。我们没有在更深的层次发现微星状菌:结论:增加组织层次是一种简单而廉价的方法,可以提高薄型(pT1)原发性皮肤黑色素瘤患者分期的准确性。当BT测量值接近分期阈值时(如pT1a与pT1b或pT1b与pT2a的分期阈值在0.1-0.3毫米范围内),或遇到初起溃疡时,病理学家可能需要考虑对薄黑色素瘤进行额外分期。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.20
自引率
5.90%
发文量
174
审稿时长
3-8 weeks
期刊介绍: Journal of Cutaneous Pathology publishes manuscripts broadly relevant to diseases of the skin and mucosae, with the aims of advancing scientific knowledge regarding dermatopathology and enhancing the communication between clinical practitioners and research scientists. Original scientific manuscripts on diagnostic and experimental cutaneous pathology are especially desirable. Timely, pertinent review articles also will be given high priority. Manuscripts based on light, fluorescence, and electron microscopy, histochemistry, immunology, molecular biology, and genetics, as well as allied sciences, are all welcome, provided their principal focus is on cutaneous pathology. Publication time will be kept as short as possible, ensuring that articles will be quickly available to all interested in this speciality.
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