| ObjectiveThe aim of this study was to investigate the morbidity and the change of cutaneous carcinoma in the Institute of Dermatology, Chinese Academy of Medical Sciences by analysis of the clinical data and pathological results of patients with cutaneous carcinoma received in our institute; and further provide the evidences of safety surgical margin choice by studying the relationship between the surgical margin performed and recurrence and metastasis of cutaneous carcinoma.MethodsA total 1261 patients diagnozed with cutaneous carcinoma were enrolled from Feb.1995-Dec.20’15.The clinical data and pathological results of patients were retrospectively analyzed. The statistical analysis was performed using the SPSS software (Version 19.0), including the t test, Chi-squared test, Spearman rank correlation analysis and analysis of variance. P<0.05 was considered to be of statistical significance.ResultsAmong the 1261 patients,530 were males, accounting to 54.4%, and 445 were females (45.6%).The average age was (62.5 ± 13.6) years old, and the major population aged in 40-80 years old (85.2%). EMPD had the highest percentage in male patients, followed by squamose cell cancer (SCC). The masculine patient averge age is bigger than the female. In the skin malignant tumor case, basal-cell carcinoma and squamose cell cancer were the top two types, both accounting for 68.2%.For BCC, the most affected site was head and face (90.0%), nose and zygomatic cheek was given priority to 65.7%. For SCC, the most affected site was head and face (52.4%) and vagina (18.0%), zygomatic cheek and scalp were the most common sites in the head face (71.8%). For SCC, the significant variances were existed between genders for the lesions in genital sites, between below and above 50 years old. The constituent ratio of sex was different in genital sites. In BCC patients who received operation, the difference of the rates of positive margins between surgical margin of 0.3cm group and 0.5cm group was significant (P＜O.05), but no difference between 0.5cm and 1.0 cm patients. The difference of the margins positive rate between 0.5cm and 1.0 cm of surgical margin in SCC patients was significant (P＜O.05), but no difference between 1.0 cm and over 1.5 cm. The significance were existed between 1 cm and 2 cm surgical margin in EMPD patients.Fifty-fivepatients with BCC and 16 cases of SCC received Mohs surgery, weren’t reported to recur.Among 98 EMPD patients with follow-up (5.3-3.7 years),51 patients were lost and 21 cases recurred with the recurrence rate of 21.4%.A total of 179 patients of CMM received Regional lymph node biopsy, and 13 cases were positive with positive rate of 41.9%. For 103 cases with follow-up,19 died with mortality rate of 18.4%, of which 13 cases died of malignant melanoma metastasis and 6 cases died of other causes, and the 5-year survival rate was 88.4%. Among patients with Regional lymph node biopsy of 25 cases,9 patients were found lymph nodes metastasis, and 6 died, the 5-year survival rate was 44.4%.Among the patients with malignant melanoma followed up,66 cases (64.1%) reported to have ulceration, and 12 cases died because of the disease; for 37 cases (35.9%) without ulceration, only 1 case died because of the disease. Significantly statistical differences was reported on the mortality between the patients with and without ulceration (x2= 3.8, P< 0.05).Conclusions1. The male and female proportion had significance differences in various cancers and the former is a larger group, the average age for visiting hospital was (62.5 ± 13.6) years old, and the average age of males was (62.6 ± 13.3) compared female patients’(62.4±14.1) years old.2. BCC and SCC case were in the majority. The relationship between SCC and UVR is not as closely as BCC. Except for the exposed site, SCC often occurs in the perineum. There were more patients above 50 years old with lesions in absolute exposure sites, more patients below 50 years old with lesions in perineum lesions. No positive relationship between CMM and UVR was reported, most of the CMM occurred in acromegaly, especially pelma.3. Mohs surgery is the gold standard for treatment of BCC and SCC. For the patients who were unsuitable for Mohs surgery, surgical margin of 0.5cm is recommended for BCC, and 1.0cm for SCC. The safe surgical margin of EMPD is 2 cm, and 2 cm for CMM.4. Regional lymph node biopsy in the CMM is important for judging of stage and prognosis. The patients with ulceration on lesion had a poor prognosis. |
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