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Improved overall survival of melanoma of the head and neck treated with Mohs micrographic surgery versus wide local excision.

Mohs显微摄影手术与广泛局部切除治疗头颈部黑色素瘤的总生存率提高。

  • 影响因子:2.93
  • DOI:10.1016/j.jaad.2019.08.059
  • 作者列表:"Hanson J","Demer A","Liszewski W","Foman N","Maher I
  • 发表时间:2020-01-01
Abstract

BACKGROUND:Optimal surgical management for melanoma of the head and neck remains controversial. OBJECTIVE:Assess outcomes for melanomas of the head and neck treated with Mohs micrographic surgery (MMS) versus wide local excision (WLE) from the National Cancer Database. METHODS:Head and neck melanoma data from the National Cancer Database from years 2004-2015 were analyzed. RESULTS:In total, 50,397 cases of head and neck melanoma were reviewed; 3510 (7%) were treated with MMS and 46,887 (93%) with WLE. After controlling for potential confounding variables, patients treated with MMS were more likely than patients treated with WLE to survive after 5 years (hazard ratio [HR] 1.181, 95% confidence interval [CI] 1.083-1.288; P < .001). Factors associated with a statistically significant survival disadvantage included male sex (HR 1.287, 95% CI 1.242-1.357; P = 0), tumor ulceration (HR 1.687, 95% CI 1.616-1.760; P = 0), and positive surgical margins (HR 1.395, 95% CI 1.306-1.490; P = 0). Patient survival was inversely proportional to tumor Breslow depth. LIMITATIONS:Database study, limited number of MMS treated melanomas. CONCLUSION:MMS is a valid treatment option for melanoma of the head and neck; National Cancer Database data suggests that MMS might confer a survival benefit over WLE.

摘要

背景: 头颈部黑色素瘤的最佳手术治疗仍存在争议。 目的: 评估来自国家癌症数据库的Mohs显微外科手术 (MMS) 与广泛局部切除术 (WLE) 治疗头颈部黑色素瘤的结局。 方法: 对来自 2004-2015 年国家癌症数据库的头颈部黑色素瘤数据进行分析。 结果: 共回顾了 50,397 例头颈部黑色素瘤,3510 例 (7%) 采用MMS治疗,46,887 例 (93%) 采用WLE治疗。在控制了潜在的混杂变量后,MMS治疗的患者比WLE治疗的患者在 5 年后更有可能存活 (风险比 [HR] 1.181,95% 置信区间 [CI] 1.083-1.288; P <.001)。与统计学显著生存劣势相关的因素包括男性 (HR 1.287,95% CI 1.242-1.357; P = 0),肿瘤溃疡 (HR 1.687,95% CI 1.616-1.760; P = 0) 和阳性手术切缘 (HR 1.395,95% CI 1.306-1.490; P = 0)。患者生存期与肿瘤Breslow深度成反比。 局限性: 数据库研究,MMS治疗的黑色素瘤数量有限。 结论: MMS是头颈部黑色素瘤的有效治疗选择; 国家癌症数据库数据表明,MMS可能比WLE带来生存获益。

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影响因子:2.93
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DOI:10.1016/j.jaad.2019.04.067
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METHODS:BACKGROUND:Human papillomavirus (HPV) infections are associated with common dermatologic and nondermatologic diseases. Although HPV vaccines are well established as preventive measures for genital warts and cervical neoplasia, their use as therapeutic agents deserves greater attention. OBJECTIVE:To evaluate the use of HPV vaccine(s) as a treatment modality for cutaneous and/or mucosal disease. METHODS:A primary literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in January 2019 by using the PubMed and Cochrane databases. RESULTS:A total of 63 articles with 4439 patients were included. The majority of patients with cutaneous warts, recurrent respiratory papillomatosis, and squamous and basal cell carcinomas were successfully treated with HPV vaccination. Preliminary data on patients with pre-existing anogenital warts, cervical intraepithelial neoplasia, anal intraepithelial neoplasia, and vulvar intraepithelial neoplasia is promising. LIMITATIONS:This review was limited by the lack of controls, patients' previous HPV vaccination status, and publication bias. CONCLUSION:The commercially available three-dose, quadrivalent HPV vaccine is a potential therapeutic option for the treatment of cutaneous warts, recurrent respiratory papillomatosis, and squamous and basal cell carcinomas. Noncommercially available HPV vaccines demonstrate therapeutic response for treating anogenital warts, cervical intraepithelial neoplasia, anal intraepithelial neoplasia, and vulvar intraepithelial neoplasia. The vaccine's efficacy as an adjunct therapy for HPV-associated cutaneous and/or mucosal disease warrants further exploration.

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皮肤肿瘤方向

皮肤肿瘤是发生在皮肤的细胞增生性疾病,是一种常见病。发生于皮内或皮下组织的新生物,种类很多,临床上分良性肿瘤和恶性肿瘤。恶性肿瘤可以不断增殖,引起转移,威胁生命,称为皮肤癌。

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