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Updated: Jan 22, 2026

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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
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2ミリ未満の皮膚原発性メラノーマに対する2センチ対4センチ外科切除マージン:多センターランダム化試験の長期追跡
Deborah Utjés1, Jonas Malmstedt2, Jüri Teras3
1Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
Lancet (London, England)
|July 9, 2019
まとめ
厚皮性メラノーマの患者にとって2cmの切除限界は安全であり,ほぼ20年後に4cmの生存限界と比較して差異はありません. これらの発見は,局所メラノーマの臨床実践におけるより狭い範囲の使用を支持する.
科学分野:
- 腫瘍学
- 皮膚科
- 手術腫瘍学
背景:
- 厚さ (> 2 mm) の局所性皮膚メラノーマの最適の切除限界は不明である.
- 以前の報告では,6. 7年の追跡期間で2cmと4cmの生存差は示されなかった.
研究 の 目的:
- 狭い (2cm) と広い (4cm) の切除範囲で治療された厚皮メラノーマ患者の生存結果に関する拡張した追跡データを提示する.
- 2cmの切除枠の長期的な安全性と有効性を評価する.
主な方法:
- 濃厚な局所皮膚メラノーマの患者936人を対象とした多中心のランダム化比較試験です.
- 患者は2cmまたは4cmの切除範囲でランダムに分けられました.
- 延長フォローアップでは,全生存率とメラノーマ特有の生存率を治療意図に基づいて分析した.
主要な成果:
- 追跡期間中位は19. 6年,死亡者数は621人 (2cm群で304人,4cm群で317人) であったが,全生存率の有意な差は認められなかった (HR 0. 98, p=0. 75).
- 397例の死亡はメラノーマに関連しており,2cm (192例) と4cm (205例) のグループには有意な差異はなかった (HR 0. 95, p=0. 61).
結論:
- 厚い局所性皮膚黒色腫の患者にとって,2cmの切除幅は安全で効果的な選択肢です.
- これらの発見は,このような患者に2cmの切除枠を使用する現在の臨床慣行を支持します.
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