Aplicación de diferentes hallazgos histológicos como indicadores de pronóstico en el Melanoma de estadio clínico I
Palabras clave:
Melanoma Maligno, Nivel de Clark, indice de Breslow, Promedio mitótico, Índice pronósticoResumen
Con el fin de evaluar la importancia en nuestro medio de cuatro marcadores histológicos, como indicadores del pronóstico en el melanoma maligno estadío clínico 1, se realizó un trabajo descriptivo con 36 pacientes diagnosticados en el servicio de Dermatología de la Universidad de Antioquia, entre enero de 1976 y diciembre de 1989, en los cuales fue posible determinar la supervivencia 5 años después del diagnóstico. Los factores estudiados en los cortes histológicos pertenecientes a estos 36 pacientes fueron: el nivel de invasión de Clark, el índice de Breslow, el número de mitosis por milímetro cuadrado y el índice pronóstico; además, cada uno de ellos fue correlacionado con la supervivencia de los pacientes. Nuestros hallazgos permiten concluir que el número de mitosis (que influye en el índice pronóstico) y el nivel de invasión de Clark son más importantes que el índice de Breslow como factores predictivos. La importancia de estos resultados radica en que estos hallazgos pueden ser estudiados en los cortes histológicos de rutina con el microscopio de luz, sin necesidad de aditamentos especiales.
Biografía del autor/a
Juan Guillermo Hoyos Gaviria, Universidad de Antioquia
Residente III Dermatología, Universidad de Antioquia-Hospital Universitario San Vicente de Paul, Medellín, Colombia.
María Clemencia Gómez Molina, Universidad de Antioquia
Residente III Dermatología, Universidad de Antioquia-Hospital Universitario San Vicente de Paul, Medellín.
Susana Restrepo Gutiérrez, Hospital Pablo Tobón Uribe
Patóloga. Hospital "Pablo Tobón Uribe", Medellín.
Referencias bibliográficas
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2. Diagnosis and treatrnent of early melanoma. NIH Consens Dev Conf Con ens Starment 1992; 10:1-25.
3. Rige! DS. Epidemiology and prognostic factors in malignant melanoma. Ann Plast Su,g 1992; 28:7-10.
https://doi.org/10.1097/00000637-199201000-00003
4. Cbanda JJ. Diagnó tico clínico y factores pronósticos en melanoma cutáneo maligno primario. Clin Med NA 1986; 1 :39-55.
5. Schomoeckel C, Braun-Falco O. Prognostic lndex in malignant c melanoma. Ar h. Dermatol 1978; 114:87 1-873.
https://doi.org/10.1001/archderm.114.6.871
6. Rige! DS, Friedman RJ, Kopf AW, Silverman, M.K. Factors influencing survival in melanoma. Dermatol Clin 1992; 9: 631- 642.
https://doi.org/10.1016/S0733-8635(18)30367-X
7. Bakh CM, Soong SJ, Murad TM, lngalls AL, Maddox WA. Multifactorial analysis of melanoma Il. Prognostic factors in patients with stage 1 (localized) melanoma. Surge,y 1979; 862:343-351.
8. Clark WH, Elder DE, Guerry D, Braitman LE, Truck BC, et al. Model predicting sw-vival in stage I melanoma based on tumor progression. J Na1h Cancer /ns/ 1989; 81: 1893-1904.
https://doi.org/10.1093/jnci/81.24.1893
9. Day CL, Mihm MC, Lew RA, Kopf AW, Sober AJ, Fitzpatrick TB. Cutaneous malignant melanoma: Prognostic guideLines for physicians and patients. CA 1982; 32: 133-122.
https://doi.org/10.3322/canjclin.32.2.113
10. Kopf A, Gross D, Rogers G, Rige! D, Hellman U, Levenstein M, et al. Prognostic Jndex for malignant melanoma. Cancer 1987; 59: 1236- 1241.
https://doi.org/10.1002/1097-0142(19870315)59:6<1236::AID-CNCR2820590634>3.0.CO;2-I
11. Balch CM, Milton GW, (eds). Cutaneus Melanoma Clinical Management and Treatrnent, Results Worldwide. 1985, Lippincott, Philadelphia.
12. Crotty KA, McCarthy SW, Palmer AA, Thompson JF, Gianoutsos MP. MaLignant melanoma in childhood: A clinicpathologic study of 13 cases and comparison with Spitz nevi. World J Surg 1992; 16:179-185.
https://doi.org/10.1007/BF02071518
13. Slingluff CL, Seigler HF. Malignant melanoma and pregnancy. Ann Plcm Surg 1992; 28: 95-99.
https://doi.org/10.1097/00000637-199201000-00024
14. Stankard C, Cruse CW, Cox C, Wells KE, King J, Reinrgen DS. The concept of lymph node dissections in patients with malignant melanoma. Ann Plast Surg 1992; 28:33-38.
https://doi.org/10.1097/00000637-199201000-00011
15. Balch CM, WiLkerson JA, Murad TM, Soong SJ, lngalls AL, Maddox WA. The prognostic significance of ulceration of cutaneus melanoma. Cancer 1980; 45:3012-3017.
https://doi.org/10.1002/1097-0142(19800615)45:12<3012::AID-CNCR2820451223>3.0.CO;2-O
16. Clark WH, From L, Bemandino, EH, Mihm MC. The histogenesis and biologic behavior of primary malignant melanoma of the skin. Cancer Res l 969; 29:705-727.
17. Breslow A. Thickness cross- sectional arcas and depth of invasion in the prognosis of cutaneus melanoma. Ann Swg 1970; 172: 902-908.
https://doi.org/10.1097/00000658-197011000-00017
18. Elder DE, Murphy GF. Malignant tumors (melanoma and related lesions): Prognostic models for common melanomas. En: Atlas ofTumor Pathology. Melm10cytic rumors of the skin. Third series. Anned Forces lnstitute of Pathology 1991; 154-165.
19. Roman SG, Han MC, Gupta TKD. Histologic prognostic lndicators in cutaneus malignant melanoma. Seminars in Oncology 1980; 15: 558-565.
20. Larsen TE, Little JH, OreU SR, et al. lnternational Pathologists congruence survey on cuantitation of Malignant Melanoma. Pathologyl980; 12: 245-253.
https://doi.org/10.3109/00313028009060079
21. Johnson TM, Smith II J W, elson BR, et al. Current therapy for cutaneous melanoma. J Am Acad Dermmol 1995; 32:
https://doi.org/10.1016/0190-9622(95)91443-9
689- 707.
22. Green MS, Ackennan BA. Thickness is not an accurate gauge of prognosis of primary cutaneous melanoma. Am J Dermalopathol 1993; 15: 461- 473.
https://doi.org/10.1097/00000372-199310000-00009
23. Naruns P, Nizze J, Cochran A, et al. Recurrence potential of thin Primary Melanomas. Cancer 1986; 57 545-548.
https://doi.org/10.1002/1097-0142(19860201)57:3<545::AID-CNCR2820570323>3.0.CO;2-K
24. Sl.inguffC, Vollner R, Reintgen D, et al. Lethal "thin" Malignan! Melanoma: identifying patients at risk. Ann Surg 1988; 208: 150-161.
https://doi.org/10.1097/00000658-198808000-00004
25. Blessing K, Melaren K, McLean A, et al. Thin Malignan! Melanomas (less than 0.5 mm) with metastasis: A histological study and survival analysis. Histopathology l 990; 17:389-395.
https://doi.org/10.1111/j.1365-2559.1990.tb00757.x
26. Evans J, McCann B. A new Protocol for the Treatment of stage cutaneous MaLignant Melm1oma: lnterim Results of the ftrst 806 patients treated. Br. J. Plast Surg, 1990; 43: 426-430.
https://doi.org/10.1016/0007-1226(90)90007-M
27. Kuehn - Petzoldt C, Wiebelt H, Berger H. Prognostic groups of patients with Srage I Melanoma. Arch Dermarol 1983; 119: 816-819.
https://doi.org/10.1001/archderm.1983.01650340026014
28. Heenan P, English D, Darcy C, et al. Survival among patients with stage 1 Cutaneous Malignant Melanoma Diagnosed in Wetem Australia in I 875/1976 and I 980/198 l. Cancer l 99 I; 68: 2079-2087.
https://doi.org/10.1002/1097-0142(19911101)68:9<2079::AID-CNCR2820680940>3.0.CO;2-7
29. Vilmer C, Bailly C, Doussal VL, et al. Thin melm1omas with unusual aggressive behavior: A report of nine cases. J Am Acad Dermatol 1996; 34: 439-445.
https://doi.org/10.1016/S0190-9622(96)90436-3
30. Me. Govern VJ, Shaw HM, Milton GW, et al. Prognostic sign.ificance of the histopathologic fearures of malignant melanoma. Histopathologic 1979; 3:385-393.
https://doi.org/10.1111/j.1365-2559.1979.tb03020.x
31. Eldh J, Boeryd B, Peterson LE. Prognostic factors in cutaneous malignant melanoma in stage l. Scand J PI Reconst Surg 1978; 12:243-355.
https://doi.org/10.3109/02844317809013000
32. Day CL, Sober AJ, Kopf AW, et al. A prognostic model for clinical stage I melm1oma of the lower extremety: Location on foot as independent risk factor for recurrent disease. Surgery 1981; 89: 599-603.
33. Day CL, Mihm MC, Lew RA, et al. Prognostic factors for patients with clinical stage I melanoma of intemnediate thickness ( 1.51-3.99 mm): A conceptual model for tumor growth and metastasis. Ann Surg l 982; 195: 35-42.
34. Van der Esch EP, CascinelJ N, Preda F, et al. Stage 1 melanoma of the skin: Evaluation of prognosis according to histologic characteristics. Cancer 1983; 48: 1688-1673.
35. Schoeckel C, Bockelbrink A, Bockerbrink H, et al. Low and high risk melanoma J: Evaluation of clinical and histologic prognosticators in 585 cases. Eur J Cancer Clin Oncol 1983; 19: 227-235.
https://doi.org/10.1016/0277-5379(83)90421-2
36. Fidler IJ, Kripke Ml. Metastasis results from preexisting variant cells within a malignant rumor. Science 1983; 26: 893- 895.
https://doi.org/10.1126/science.887927
37. owel PC. The clona] evolution of tumor ceU populations. Science. l 976: 194: 23-28.
https://doi.org/10.1126/science.959840
38. Poste G, Fidler IJ. The pathogenesis of the cancer metastasis. Narure 1980; 283: 139-149.
https://doi.org/10.1038/283139a0
2. Diagnosis and treatrnent of early melanoma. NIH Consens Dev Conf Con ens Starment 1992; 10:1-25.
3. Rige! DS. Epidemiology and prognostic factors in malignant melanoma. Ann Plast Su,g 1992; 28:7-10.
https://doi.org/10.1097/00000637-199201000-00003
4. Cbanda JJ. Diagnó tico clínico y factores pronósticos en melanoma cutáneo maligno primario. Clin Med NA 1986; 1 :39-55.
5. Schomoeckel C, Braun-Falco O. Prognostic lndex in malignant c melanoma. Ar h. Dermatol 1978; 114:87 1-873.
https://doi.org/10.1001/archderm.114.6.871
6. Rige! DS, Friedman RJ, Kopf AW, Silverman, M.K. Factors influencing survival in melanoma. Dermatol Clin 1992; 9: 631- 642.
https://doi.org/10.1016/S0733-8635(18)30367-X
7. Bakh CM, Soong SJ, Murad TM, lngalls AL, Maddox WA. Multifactorial analysis of melanoma Il. Prognostic factors in patients with stage 1 (localized) melanoma. Surge,y 1979; 862:343-351.
8. Clark WH, Elder DE, Guerry D, Braitman LE, Truck BC, et al. Model predicting sw-vival in stage I melanoma based on tumor progression. J Na1h Cancer /ns/ 1989; 81: 1893-1904.
https://doi.org/10.1093/jnci/81.24.1893
9. Day CL, Mihm MC, Lew RA, Kopf AW, Sober AJ, Fitzpatrick TB. Cutaneous malignant melanoma: Prognostic guideLines for physicians and patients. CA 1982; 32: 133-122.
https://doi.org/10.3322/canjclin.32.2.113
10. Kopf A, Gross D, Rogers G, Rige! D, Hellman U, Levenstein M, et al. Prognostic Jndex for malignant melanoma. Cancer 1987; 59: 1236- 1241.
https://doi.org/10.1002/1097-0142(19870315)59:6<1236::AID-CNCR2820590634>3.0.CO;2-I
11. Balch CM, Milton GW, (eds). Cutaneus Melanoma Clinical Management and Treatrnent, Results Worldwide. 1985, Lippincott, Philadelphia.
12. Crotty KA, McCarthy SW, Palmer AA, Thompson JF, Gianoutsos MP. MaLignant melanoma in childhood: A clinicpathologic study of 13 cases and comparison with Spitz nevi. World J Surg 1992; 16:179-185.
https://doi.org/10.1007/BF02071518
13. Slingluff CL, Seigler HF. Malignant melanoma and pregnancy. Ann Plcm Surg 1992; 28: 95-99.
https://doi.org/10.1097/00000637-199201000-00024
14. Stankard C, Cruse CW, Cox C, Wells KE, King J, Reinrgen DS. The concept of lymph node dissections in patients with malignant melanoma. Ann Plast Surg 1992; 28:33-38.
https://doi.org/10.1097/00000637-199201000-00011
15. Balch CM, WiLkerson JA, Murad TM, Soong SJ, lngalls AL, Maddox WA. The prognostic significance of ulceration of cutaneus melanoma. Cancer 1980; 45:3012-3017.
https://doi.org/10.1002/1097-0142(19800615)45:12<3012::AID-CNCR2820451223>3.0.CO;2-O
16. Clark WH, From L, Bemandino, EH, Mihm MC. The histogenesis and biologic behavior of primary malignant melanoma of the skin. Cancer Res l 969; 29:705-727.
17. Breslow A. Thickness cross- sectional arcas and depth of invasion in the prognosis of cutaneus melanoma. Ann Swg 1970; 172: 902-908.
https://doi.org/10.1097/00000658-197011000-00017
18. Elder DE, Murphy GF. Malignant tumors (melanoma and related lesions): Prognostic models for common melanomas. En: Atlas ofTumor Pathology. Melm10cytic rumors of the skin. Third series. Anned Forces lnstitute of Pathology 1991; 154-165.
19. Roman SG, Han MC, Gupta TKD. Histologic prognostic lndicators in cutaneus malignant melanoma. Seminars in Oncology 1980; 15: 558-565.
20. Larsen TE, Little JH, OreU SR, et al. lnternational Pathologists congruence survey on cuantitation of Malignant Melanoma. Pathologyl980; 12: 245-253.
https://doi.org/10.3109/00313028009060079
21. Johnson TM, Smith II J W, elson BR, et al. Current therapy for cutaneous melanoma. J Am Acad Dermmol 1995; 32:
https://doi.org/10.1016/0190-9622(95)91443-9
689- 707.
22. Green MS, Ackennan BA. Thickness is not an accurate gauge of prognosis of primary cutaneous melanoma. Am J Dermalopathol 1993; 15: 461- 473.
https://doi.org/10.1097/00000372-199310000-00009
23. Naruns P, Nizze J, Cochran A, et al. Recurrence potential of thin Primary Melanomas. Cancer 1986; 57 545-548.
https://doi.org/10.1002/1097-0142(19860201)57:3<545::AID-CNCR2820570323>3.0.CO;2-K
24. Sl.inguffC, Vollner R, Reintgen D, et al. Lethal "thin" Malignan! Melanoma: identifying patients at risk. Ann Surg 1988; 208: 150-161.
https://doi.org/10.1097/00000658-198808000-00004
25. Blessing K, Melaren K, McLean A, et al. Thin Malignan! Melanomas (less than 0.5 mm) with metastasis: A histological study and survival analysis. Histopathology l 990; 17:389-395.
https://doi.org/10.1111/j.1365-2559.1990.tb00757.x
26. Evans J, McCann B. A new Protocol for the Treatment of stage cutaneous MaLignant Melm1oma: lnterim Results of the ftrst 806 patients treated. Br. J. Plast Surg, 1990; 43: 426-430.
https://doi.org/10.1016/0007-1226(90)90007-M
27. Kuehn - Petzoldt C, Wiebelt H, Berger H. Prognostic groups of patients with Srage I Melanoma. Arch Dermarol 1983; 119: 816-819.
https://doi.org/10.1001/archderm.1983.01650340026014
28. Heenan P, English D, Darcy C, et al. Survival among patients with stage 1 Cutaneous Malignant Melanoma Diagnosed in Wetem Australia in I 875/1976 and I 980/198 l. Cancer l 99 I; 68: 2079-2087.
https://doi.org/10.1002/1097-0142(19911101)68:9<2079::AID-CNCR2820680940>3.0.CO;2-7
29. Vilmer C, Bailly C, Doussal VL, et al. Thin melm1omas with unusual aggressive behavior: A report of nine cases. J Am Acad Dermatol 1996; 34: 439-445.
https://doi.org/10.1016/S0190-9622(96)90436-3
30. Me. Govern VJ, Shaw HM, Milton GW, et al. Prognostic sign.ificance of the histopathologic fearures of malignant melanoma. Histopathologic 1979; 3:385-393.
https://doi.org/10.1111/j.1365-2559.1979.tb03020.x
31. Eldh J, Boeryd B, Peterson LE. Prognostic factors in cutaneous malignant melanoma in stage l. Scand J PI Reconst Surg 1978; 12:243-355.
https://doi.org/10.3109/02844317809013000
32. Day CL, Sober AJ, Kopf AW, et al. A prognostic model for clinical stage I melm1oma of the lower extremety: Location on foot as independent risk factor for recurrent disease. Surgery 1981; 89: 599-603.
33. Day CL, Mihm MC, Lew RA, et al. Prognostic factors for patients with clinical stage I melanoma of intemnediate thickness ( 1.51-3.99 mm): A conceptual model for tumor growth and metastasis. Ann Surg l 982; 195: 35-42.
34. Van der Esch EP, CascinelJ N, Preda F, et al. Stage 1 melanoma of the skin: Evaluation of prognosis according to histologic characteristics. Cancer 1983; 48: 1688-1673.
35. Schoeckel C, Bockelbrink A, Bockerbrink H, et al. Low and high risk melanoma J: Evaluation of clinical and histologic prognosticators in 585 cases. Eur J Cancer Clin Oncol 1983; 19: 227-235.
https://doi.org/10.1016/0277-5379(83)90421-2
36. Fidler IJ, Kripke Ml. Metastasis results from preexisting variant cells within a malignant rumor. Science 1983; 26: 893- 895.
https://doi.org/10.1126/science.887927
37. owel PC. The clona] evolution of tumor ceU populations. Science. l 976: 194: 23-28.
https://doi.org/10.1126/science.959840
38. Poste G, Fidler IJ. The pathogenesis of the cancer metastasis. Narure 1980; 283: 139-149.
https://doi.org/10.1038/283139a0
Cómo citar
1.
Hoyos Gaviria JG, Gómez Molina MC, Restrepo Gutiérrez S. Aplicación de diferentes hallazgos histológicos como indicadores de pronóstico en el Melanoma de estadio clínico I. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 1 de noviembre de 1999 [citado 19 de abril de 2024];7(3):197-204. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/785
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1999-11-01
Cómo citar
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Hoyos Gaviria JG, Gómez Molina MC, Restrepo Gutiérrez S. Aplicación de diferentes hallazgos histológicos como indicadores de pronóstico en el Melanoma de estadio clínico I. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 1 de noviembre de 1999 [citado 19 de abril de 2024];7(3):197-204. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/785
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