巴西南部地区皮肤黑色素瘤患者的流行病学概况</T.itle> <link href="//www.newsama.com/static/themes/hindawi/base.css" rel="stylesheet"> <link href="https://static-01.hindawi.com/next_assets/B3mMnZy7okrdcmfy00DUF/static/lib/basictable.css" rel="stylesheet" media="none" class="next-head"> <link rel="stylesheet" href="https://static-01.hindawi.com/next_assets/B3mMnZy7okrdcmfy00DUF/static/lib/owl.carousel.min.css" media="none" class="next-head"> <link rel="stylesheet" href="https://static-01.hindawi.com/next_assets/B3mMnZy7okrdcmfy00DUF/static/lib/owl.theme.default.min.css" media="none" class="next-head"> <link rel="stylesheet" type="text/css" href="https://cdn.bibblio.org/rcm/4.18/bib-related-content.min.css" media="none" class="next-head"> <link rel="stylesheet" type="text/css" href="https://cdn.bibblio.org/rcm/4.18/bib-related-content.min.css" media="none" class="next-head"> <link rel="stylesheet" href="https://static-01.hindawi.com/next_assets/B3mMnZy7okrdcmfy00DUF/_next/static/css/common.d0e3caef.chunk.css"> 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href="//www.newsama.com/journals/jsc/" aria-label="Journal of Skin Cancer">皮肤癌杂志</a>/<a class="sc-htpNat bUhGXt link sc-eitiEO jXeALb breadCrumb" href="//www.newsama.com/journals/jsc/contents/year/2012/" aria-label="2012">2012年</a>/<span class="sc-bhlBdH UVThf">文章</span> </div> <div class="threeColumn__ThreeColumnWrapper-sc-1bf4078-0 dDyxFF threeColumnWrapper"> <div class="threeColumn__LeftWrapper-sc-1bf4078-1 fkVFlF leftWrapper"> <button type="button" class="sc-eKZiaR dzZrgS section__button " id="sectionButton"><span class="sc-htoDjs diutvq icon__dots dots__detector icon-colored _3n-7Ho7DlfjMlZbrRr9Q4a icon-themeable" title="" font-size="22"></span>文章部分</button> <div class="sc-bEjcJn jLUVhb static_contents__section_links links__hidden "> <div id="leftSectionMenu" class="sc-cbkKFq prcY sc-bGbJRg dVCLgr left_section_menu"> <p>在本页</p> <span class="sc-likbZx bBmZJZ grey" property="background-color" color="#D8D8D8"><a class="sc-htpNat bUhGXt link sc-ePZHVD ewHMLz" href="#abstract" 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article_type">临床研究|开放获取</p> <div class="sc-RcBXQ ztvYg article_citation"> 体积 2012年 <span class="sc-fZwumE cUsFHx">|</span>文章的ID 917346 <span class="sc-fZwumE cUsFHx">|</span> <a class="sc-htpNat bUhGXt link sc-fQejPQ duuwge" href="https://doi.org/10.1155/2012/917346" aria-label="Doi-link">https://doi.org/10.1155/2012/917346</a> </div> <div class="sc-LKuAh lcOiDF article_full_citation"> <div class="sc-hzNEM gsmOCv isHide"> <p>马塞洛·莫雷诺，里卡多·路德维希·施密特，玛丽亚·加布里埃拉·朗，凡妮莎·盖诺， ＂<span class="adjust-article-svg-size">巴西南部地区皮肤黑色素瘤患者的流行病学概况</span>"，<i>皮肤癌杂志</i>， 卷。2012年， 文章的ID917346， 8   页面， 2012年． https://doi.org/10.1155/2012/917346</p> </div> <button class="sc-hSdWYo etauus sc-iBEsjs kPshFw" color="">显示引用</button> </div> <h1 class="sc-iRbamj jZOxOO sc-iSDuPN bDJBEi article_title adjust-article-svg-size heading-title">巴西南部地区皮肤黑色素瘤患者的流行病学概况</h1> </div> <div class="sc-jrIrqw eHMFfo article_authors"> <hr class="sc-cEvuZC XkrFe hr__author"> <span class=""><b>Marcelo Moreno.</b><a class="sc-htpNat bUhGXt link" href="mailto:" aria-label="Mail Option"><span class="sc-htoDjs kNoiZu sc-hjRWVT irNWJI icon-colored _2zt-1j0LmaF8UjTQAM413G icon-themeable" title="" font-size="16"></span></a>，<sup>1</sup></span> <span class="">Ricardo Ludwig Schmitt.，<sup>1</sup></span> <span class="">Maria Gabriela Lang.，<sup>1</sup> 和</span> <span class="">凡妮莎Gheno<sup>1</sup></span> <div class="sc-fHxwqH dMuGGA isHide"> <p><sup>1</sup><span>UniversidadeComunitáriaDaRegiãodeChapecó-Unochapecó，Avenida SenadoratílioFontana，591-e。Efapi，Caixa邮政1141 89809-000，Chapecó，SC，巴西</span></p> </div> <button class="sc-hSdWYo etauus sc-iQtOjA kfDwZY" color="">展示更多</button> </div> <div class="articleContent__EditorWrapper-sc-2yl9jy-3 evMkvU"> <div class="articleContent__TextWrapper-sc-2yl9jy-8 fYrLtk"> <b>学术编辑器:</b>穆罕默德Kashani-Sabet</div> <div class="articleContent__PublicationTimeLineWrapper-sc-2yl9jy-4 fjviok"> <div class="articleContent__PublcationCol-sc-2yl9jy-5 hgKieC notPublished"> <span class="articleContent__PublicationField-sc-2yl9jy-6 cIribm">收到了</span> <span class="articleContent__PublicationValue-sc-2yl9jy-7 khHUcu">2011年9月21日</span> </div> <div class="articleContent__PublcationCol-sc-2yl9jy-5 hgKieC notPublished"> <span class="articleContent__PublicationField-sc-2yl9jy-6 cIribm">修改后的</span> <span class="articleContent__PublicationValue-sc-2yl9jy-7 khHUcu">2011年12月20日</span> </div> <div class="articleContent__PublcationCol-sc-2yl9jy-5 hgKieC notPublished"> <span class="articleContent__PublicationField-sc-2yl9jy-6 cIribm">接受</span> <span class="articleContent__PublicationValue-sc-2yl9jy-7 khHUcu">2011年12月29日</span> </div> <div class="articleContent__PublcationCol-sc-2yl9jy-5 hgKieC isPublished"> <span class="articleContent__PublicationField-sc-2yl9jy-6 cIribm">发表</span> <span class="articleContent__PublicationValue-sc-2yl9jy-7 khHUcu">2012年3月27日</span> </div> </div> </div> <article class="sc-jtRlXQ hkyIvx article_body "> <div> <div class="xml-content"> <h4 class="header" id="abstract">抽象的</h4> <p>恶性皮肤癌中75%的死亡是由皮肤黑素瘤造成的。巴西南部地区，特别是圣卡塔琳娜西部地区的CM发病率可能比估计的要高。在本研究中，研究了圣卡塔琳娜西部地区CM患者的临床和流行病学概况。一项横断面研究对2002年1月至2009年12月圣卡塔琳娜州西部78个县诊断为CM的患者进行了研究。采用巴西黑色素瘤组采用的方案收集数据，并对503例患者进行评估。该地区的结核分枝杆菌发病率和流行率远远高于该国其他地区。这一事实很可能是由于人口的表型特征，以及该地区由于地处巴西南部而紫外线辐射发生率高，大洋洲各国的情况也是如此。</p> <span class="end-abs"></span> <h4 id="introduction">1.介绍</h4> <p>在皮肤癌中，皮肤黑素瘤（cm）是最小的。但是，它提出了更高的死亡率，主要是由于其通过不同组织侵入和传播的能力[<a href="#B1">1</a>］．然而，如果在早期发现，它有很高的治愈率[<a href="#B2">2</a>］．</p> <p>CM主要发生在白人种群中[<a href="#B1">1</a>］．CM发病率在北欧、北美和澳大利亚特别高，而在非洲、亚洲、拉丁美洲和南欧的土著人口中较低[<a href="#B3">3.</a>］．在新西兰和澳大利亚，2002年，全球分析显示，每100 000名居民的37.7例和29.4例中的男性发病率为37.7例[<a href="#B4">4</a>］．</p> <p>澳大利亚昆士兰州被认为是世界上黑色素瘤发病率最高的地区:2002年每10万人中有51人患黑色素瘤[<a href="#B5">5</a>］．据报道，2003年在新西兰陶兰加地区，每10万居民中就有70人患此病，甚至高于澳大利亚的统计数字[<a href="#B6">6</a>］．一种解释是CM的发病率也与该地区的纬度密切相关，在太阳辐射高的地区发病率更高[<a href="#B5">5</a>，<a href="#B7">7</a>］．</p> <p>在巴西，与黑色素瘤发病率相关的研究仍然很少。据巴西国家癌症研究所(INCA)估计，2012年全国发病率很低:男性3170例，女性3060例。估计死亡率最高的是南部地区。然而，由于人口特征和地理位置，巴西南部的CM发病率可能高于估计[<a href="#B8">8</a>］．地理位置优越地，澳大利亚和新西兰（昆士兰州-26°至29°S）和巴西南部（西方Santa Catarina-26°至26°S）处于类似的纬度[<a href="#B9">9</a>，<a href="#B10">10</a>］．</p> <p>在巴西，强制通报癌症病例尚未在全国实现，仅在该国的30%发生。因此，存在大量的子记录是可能的[<a href="#B8">8</a>］．</p> <p>本研究旨在描绘巴西圣卡塔琳州西部患者的患者的流行病学概况。</p> <h4 id="materials-and-methods">2.材料和方法</h4> <p>2002年至2009年期间进行了横截面研究，2009年纵向研究。由巴西圣卡塔琳娜伦盖普阁伦理研究委员会审查和批准了该研究。从区域癌症通知服务中收集数据，并从癌症治疗的转诊服务的病程中收集，用As参考巴西黑色素瘤组的修改方案[<a href="#B11">11</a>］．通过电话联系病人、家庭、医生和保健服务机构来填写不完整的数据。所有有关圣卡塔琳娜西部地区的记录(图)<a href="//www.newsama.com/journals/jsc/2012/917346/fig1/" target="_blank">2</a>在本研究中包含初始诊断CM，并排除了那些具有眼黑素瘤，粘膜黑素瘤和内粘膜瘤的人。从巴西政府（Datasus）的医疗保健数据库中提取人口统计数据[<a href="#B12">12</a>］．采用SPSS软件进行统计学分析<i>统计数据</i>版本19.0。为了比较连续变量，学生的<i>T.</i>- 最低使用，而Chi-Square和Fisher的测试用于标称变量。</p> <h4 id="results">结果</h4> <h5 id="sec3.1">3．1.圣卡塔琳娜西部地区CM流行病学调查</h5> <p>在8年的时间里，登记了503例病例，但有6例由于缺乏数据而被排除在研究之外。该地区每年的CM病例数从2002年的50例至2008年的89例不等，导致发病率分别为每10万居民7.4和12.2例。该地区8年期间的CM患病率为每10万居民71.5例，2009年发病率为每10万居民9.3例(见表)<a href="//www.newsama.com/journals/jsc/2012/917346/tab1/" target="_blank">1</a>）.</p> <div class="floats-partial-section partial-other-wrapper" data-section="tab1"> <div class="floats-partial-content fig-content-tab1"> <table class="table-group" id="tab1"> <tbody> <tr> <td> <table class="table"> <tbody> <tr> <td class="thead-hr" colspan="4"> <hr></td> </tr> <tr class="thead"> <td align="left">年</T.d> <td align="center">CM病例数</T.d> <td align="center">西部地区人口*</T.d> <td align="center">cm的发病率（案例/ 100.000名居民）</T.d> </tr> <tr> <td class="thead-hr" colspan="4"> <hr></td> </tr> <tr> <td align="left">2002年</T.d> <td align="center">50.</T.d> <td align="center">678 428.</T.d> <td align="center">7．4</T.d> </tr> <tr> <td align="left">2003年</T.d> <td align="center">55.</T.d> <td align="center">680 118</T.d> <td align="center">8．1</T.d> </tr> <tr> <td align="left">2004年</T.d> <td align="center">51.</T.d> <td align="center">681 796.</T.d> <td align="center">7．5</T.d> </tr> <tr> <td align="left">2005年</T.d> <td align="center">60.</T.d> <td align="center">685 586.</T.d> <td align="center">8、7</T.d> </tr> <tr> <td align="left">2006年</T.d> <td align="center">64.</T.d> <td align="center">687 586</T.d> <td align="center">9.3</T.d> </tr> <tr> <td align="left">2007年</T.d> <td align="center">60.</T.d> <td align="center">689 568.</T.d> <td align="center">8、7</T.d> </tr> <tr> <td align="left">2008年</T.d> <td align="center">89.</T.d> <td align="center">727 014</T.d> <td align="center">12.2</T.d> </tr> <tr> <td align="left">2009年</T.d> <td align="center">68.</T.d> <td align="center">731 679.</T.d> <td align="center">9.3</T.d> </tr> <tr class="table-tr"> <td colspan="4"> <hr class="tbody-hr"></td> </tr> </tbody> </table></td> </tr> <tr class="table-fn"> <td>*基于巴西地理与统计研究所（2002-2009）的数据计算。<br></td> </tr> </tbody> </table> </div> <div class="floats-partial-footer"> <div class="floats-partial-caption"> <span class="caption-text">表1</span> <a aria-label="full view" class="caption-partial-url" href="//www.newsama.com/journals/jsc/2012/917346/tab1/" title="" target="_blank"></a> </div> <div class="floats-partial-caption-text"> 巴西圣卡塔丽娜西部每年患者和皮肤黑素瘤发生率（<i>n</i>= 497）。</div> </div> </div> <p>患者来自78个不同的县。大多数最初来自Chapecó（26.2％），然后是SãoMiguel做oeste（5.2％）。该县在此期间具有最高的CM患病率为Sãojoão，每100 000名居民305.6例。2009年CM最大发病率的县是Nova Itaberaba，每10万人71.1例。</p> <p>如图所示<a href="//www.newsama.com/journals/jsc/2012/917346/fig2/" target="_blank">1</a>，在50岁以上的个体中发现了更高的厘米，在80岁或以上的人中被发现最高。然而，这个年龄组代表了该地区患者的少数。</p> <div class="floats-partial-section partial-carousel-wrapper" data-section="fig2"> <div class="floats-partial-content fig-content-fig2"> <div class="partial-carousel--single-image"> <img alt="" name="917346.fig.002" src="https://static-01.hindawi.com/articles/jsc/volume-2012/917346/figures/917346.fig.002.jpg"> <br> <strong></strong> </div> </div> <div class="floats-partial-footer"> <div class="floats-partial-caption"> <span class="caption-text">图1</span> <a aria-label="full view" class="caption-partial-url" href="//www.newsama.com/journals/jsc/2012/917346/fig2/" title="" target="_blank"></a> </div> <div class="floats-partial-caption-text"> <table> 从2002年到2009年的性别，巴西西部地区皮肤黑素瘤的累积频率分布，从2002年到2009年（XY MEN和XY妇女）。</T.able> </div> </div> </div> <div class="floats-partial-section partial-carousel-wrapper" data-section="fig1"> <div class="floats-partial-content fig-content-fig1"> <div class="partial-carousel--single-image"> <img alt="" name="917346.fig.001" src="https://static-01.hindawi.com/articles/jsc/volume-2012/917346/figures/917346.fig.001.jpg"> <br> <strong></strong> </div> </div> <div class="floats-partial-footer"> <div class="floats-partial-caption"> <span class="caption-text">图2</span> <a aria-label="full view" class="caption-partial-url" href="//www.newsama.com/journals/jsc/2012/917346/fig1/" title="" target="_blank"></a> </div> <div class="floats-partial-caption-text"> <table> 巴西圣卡塔琳娜州西部地区来自巴西地理与统计研究所，2010年。</T.able> </div> </div> </div> <div class="floats-partial-section partial-carousel-wrapper" data-section="fig3"> <div class="floats-partial-content fig-content-fig3"> <div class="partial-carousel--single-image"> <img alt="" name="917346.fig.003" src="https://static-01.hindawi.com/articles/jsc/volume-2012/917346/figures/917346.fig.003.jpg"> <br> <strong></strong> </div> </div> <div class="floats-partial-footer"> <div class="floats-partial-caption"> <span class="caption-text">图3</span> <a aria-label="full view" class="caption-partial-url" href="//www.newsama.com/journals/jsc/2012/917346/fig3/" title="" target="_blank"></a> </div> <div class="floats-partial-caption-text"> <svg height="11.1" id="M1" style="vertical-align:-0.17555pt" version="1.1" viewbox="0 0 50.724998 11.1" width="50.724998" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.1)"> <g transform="translate(72,-63.12)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> </T.span> <tspan style="font-size: 12.50px; " x="9.6773224" y="0"> ＝</T.span> <tspan style="font-size: 12.50px; " x="21.71771" y="0"> 2</T.span> <tspan style="font-size: 12.50px; " x="27.969212" y="0"> 0</T.span> <tspan style="font-size: 12.50px; " x="34.220711" y="0"> 5</T.span> </text> </g> </g> </svg> <table> 2002 - 2009年巴西圣卡塔琳娜西部地区男性皮肤黑素瘤病变的解剖部位(）.*淋巴结淋巴结的患者和第一次呈现的未知初级皮肤部位。</T.able> </div> </div> </div> <div class="floats-partial-section partial-carousel-wrapper" data-section="fig4"> <div class="floats-partial-content fig-content-fig4"> <div class="partial-carousel--single-image"> <img alt="" name="917346.fig.004" src="https://static-01.hindawi.com/articles/jsc/volume-2012/917346/figures/917346.fig.004.jpg"> <br> <strong></strong> </div> </div> <div class="floats-partial-footer"> <div class="floats-partial-caption"> <span class="caption-text">图4</span> <a aria-label="full view" class="caption-partial-url" href="//www.newsama.com/journals/jsc/2012/917346/fig4/" title="" target="_blank"></a> </div> <div class="floats-partial-caption-text"> <svg height="11.0375" id="M2" style="vertical-align:-0.27588pt" version="1.1" viewbox="0 0 50.724998 11.0375" width="50.724998" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.0375)"> <g transform="translate(72,-63.17)"> <text transform="matrix(1,0,0,-1,-71.95,63.5)"> <tspan style="font-size: 12.50px; " x="0" y="0"> </T.span> <tspan style="font-size: 12.50px; " x="9.6773224" y="0"> ＝</T.span> <tspan style="font-size: 12.50px; " x="21.71771" y="0"> 2</T.span> <tspan style="font-size: 12.50px; " x="27.969212" y="0"> 9</T.span> <tspan style="font-size: 12.50px; " x="34.220711" y="0"> 2</T.span> </text> </g> </g> </svg> <table> 2002 - 2009年巴西圣卡塔琳娜西部地区女性皮肤黑素瘤病变的解剖部位(）.*首次出现淋巴结转移和原发皮肤部位不明的CM患者。</T.able> </div> </div> </div> <h5 id="sec3.2">3.2。患者的临床特征</h5> <p>患者平均年龄50.6岁(SD = 15.4岁)，年龄14 ~ 90岁。以20 ~ 50岁经济活动年龄组为主，占50.7%。</p> <p>我们发现疾病比男性（292例）（292例）更普遍（205例）（<svg height="11.0625" id="M3" style="vertical-align:-0.30096pt;width:56.150002px;" version="1.1" viewbox="0 0 56.150002 11.0625" width="56.150002" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.0625)"> <g transform="translate(72,-63.15)"> <text transform="matrix(1,0,0,-1,-71.95,63.5)"> <tspan style="font-size: 12.50px; " x="0" y="0"> </T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> <</T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> 0</T.span> <tspan style="font-size: 12.50px; " x="29.182001" y="0"> ．</T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 0</T.span> <tspan style="font-size: 12.50px; " x="38.559254" y="0"> 1</T.span> </text> </g> </g> </svg>）.2009年的发病率为每10万名妇女10.21及每10万名男子8.5，而在8年期间的发病率则为每10万名妇女84.2及每10万名男子58.8。女性平均年龄为50.8岁(SD = 15.6)，男性平均年龄为50.4岁(SD = 15.2)<a href="//www.newsama.com/journals/jsc/2012/917346/fig2/" target="_blank">1</a>）.</p> <p>共有445例(92.7%)患者为I型和II型皮肤。浅色头发237人(52.5%)，浅色眼睛247人(54.8%)(绿色或蓝色)。评估的其他特征是童年时的蚤史，166例为阳性。327例被认为职业性日晒过高。38名患者在儿童时期有晒伤史，73名在成年时期有晒伤史。共有167人在童年和成年时期都有晒伤史;164例无晒伤史。与黑色素瘤相关的先天性痣84例为阳性。143例患者出现多发性痣。在这些人中，只有51人有超过50个痣。 The presence of atypical nevi detected by histopathological examination occurred in 43 cases.</p> <p>男士在头部，颈部和躯干区域（58.9％）和肢体上的女性（59.8％）（图3，4和表格）上显示了厘米的主要突出<a href="//www.newsama.com/journals/jsc/2012/917346/tab2/" target="_blank">2</a>）.</p> <div class="floats-partial-section partial-other-wrapper" data-section="tab2"> <div class="floats-partial-content fig-content-tab2"> <table class="table-group" id="tab2"> <tbody> <tr> <td> <table class="table"> <tbody> <tr> <td class="thead-hr" colspan="4"> <hr></td> </tr> <tr class="thead"> <td align="left">特征（<i>n</i>）</T.d> <td align="center">男人</T.d> <td align="center">女性</T.d> <td align="center"><i>P</i></td> </tr> <tr> <td class="thead-hr" colspan="4"> <hr></td> </tr> <tr> <td align="left">年龄（497）</T.d> <td align="center"><span style="width: 88.112503px;"> <svg height="12.2375" id="M4" style="vertical-align:-1.09097pt" version="1.1" viewbox="0 0 88.112503 12.2375" width="88.112503" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,12.2375)"> <g transform="translate(72,-62.21)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 5</T.span> <tspan style="font-size: 12.50px; " x="6.2515001" y="0"> 0</T.span> <tspan style="font-size: 12.50px; " x="12.503" y="0"> ．</T.span> <tspan style="font-size: 12.50px; " x="15.62875" y="0"> 4</T.span> <tspan style="font-size: 12.50px; " x="21.880251" y="0"> 5</T.span> <tspan style="font-size: 12.50px; " x="30.907415" y="0"> ±</T.span> <tspan style="font-size: 12.50px; " x="42.247639" y="0"> 1</T.span> <tspan style="font-size: 12.50px; " x="48.499138" y="0"> 5</T.span> <tspan style="font-size: 12.50px; " x="54.750637" y="0"> ．</T.span> <tspan style="font-size: 12.50px; " x="57.876389" y="0"> 2</T.span> <tspan style="font-size: 12.50px; " x="64.127884" y="0"> 0</T.span> </text> </g> </g> </svg></span></td> <td align="center"><span style="width: 88.112503px;"> <svg height="12.2375" id="M5" style="vertical-align:-1.09097pt" version="1.1" viewbox="0 0 88.112503 12.2375" width="88.112503" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,12.2375)"> <g transform="translate(72,-62.21)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 5</T.span> <tspan style="font-size: 12.50px; " x="6.2515001" y="0"> 0</T.span> <tspan style="font-size: 12.50px; " x="12.503" y="0"> ．</T.span> <tspan style="font-size: 12.50px; " x="15.62875" y="0"> 8</T.span> <tspan style="font-size: 12.50px; " x="21.880251" y="0"> 1</T.span> <tspan style="font-size: 12.50px; " x="30.907415" y="0"> ±</T.span> <tspan style="font-size: 12.50px; " x="42.247639" y="0"> 1</T.span> <tspan style="font-size: 12.50px; " x="48.499138" y="0"> 5</T.span> <tspan style="font-size: 12.50px; " x="54.750637" y="0"> ．</T.span> <tspan style="font-size: 12.50px; " x="57.876389" y="0"> 5</T.span> <tspan style="font-size: 12.50px; " x="64.127884" y="0"> 7</T.span> </text> </g> </g> </svg></span></td> <td align="center">0.045 * *</T.d> </tr> <tr> <td align="left">网站（489）</T.d> <td align="center"></td> <td align="center"></td> <td align="center">< 0.001 *<svg height="0.125" id="M6" style="vertical-align:-0.0pt" version="1.1" viewbox="0 0 5.3375001 0.125" width="5.3375001" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,0.125)"> <g transform="translate(72,-71.9)"></g> </g> </svg></td> </tr> <tr> <td align="left">头部和颈部</T.d> <td align="center">36 (17.82)</T.d> <td align="center">55（19.16）</T.d> <td align="center"></td> </tr> <tr> <td align="left">躯干</T.d> <td align="center">73（36.14）</T.d> <td align="center">55（19.16）</T.d> <td align="center"></td> </tr> <tr> <td align="left">成员</T.d> <td align="center">76 (37.62)</T.d> <td align="center">164 (57.14)</T.d> <td align="center"></td> </tr> <tr> <td align="left">未知的</T.d> <td align="center">17 (8.42)</T.d> <td align="center">13（4.54）</T.d> <td align="center"></td> </tr> <tr> <td align="left">组织学类型(445)</T.d> <td align="center"></td> <td align="center"></td> <td align="center">0.04 *</T.d> </tr> <tr> <td align="left">舰导弹</T.d> <td align="center">104（59.10）</T.d> <td align="center">183（68.03）</T.d> <td align="center"></td> </tr> <tr> <td align="left">纳米</T.d> <td align="center">42（23.86）</T.d> <td align="center">48 (17.84)</T.d> <td align="center"></td> </tr> <tr> <td align="left">lmm.</T.d> <td align="center">13 (7.39)</T.d> <td align="center">20 (7.43)</T.d> <td align="center"></td> </tr> <tr> <td align="left">mal</T.d> <td align="center">8（4.54）</T.d> <td align="center">9 (3.35)</T.d> <td align="center"></td> </tr> <tr> <td align="left">其他</T.d> <td align="center">9 (5.11)</T.d> <td align="center">9 (3.35)</T.d> <td align="center"></td> </tr> <tr> <td align="left">肿瘤厚度（mm）（462）</T.d> <td align="center"></td> <td align="center"></td> <td align="center">< 0.01 *</T.d> </tr> <tr> <td align="left">≤1毫米</T.d> <td align="center">73（39.46）</T.d> <td align="center">135（48.74）</T.d> <td align="center"></td> </tr> <tr> <td align="left">1.01-2.0.</T.d> <td align="center">29 (15.67)</T.d> <td align="center">54（19.49）</T.d> <td align="center"></td> </tr> <tr> <td align="left">2.01 - -4.0</T.d> <td align="center">28日(15.14)</T.d> <td align="center">49（17.69）</T.d> <td align="center"></td> </tr> <tr> <td align="left">> 4.0</T.d> <td align="center">55（29.73）</T.d> <td align="center">39 (14.08)</T.d> <td align="center"></td> </tr> <tr> <td align="left">克拉克(420)</T.d> <td align="center"></td> <td align="center"></td> <td align="center">< 0.01 *</T.d> </tr> <tr> <td align="left">我</T.d> <td align="center">26（15.76）</T.d> <td align="center">29（11.37）</T.d> <td align="center"></td> </tr> <tr> <td align="left">II</T.d> <td align="center">16（9.70）</T.d> <td align="center">42 (16.47)</T.d> <td align="center"></td> </tr> <tr> <td align="left">III</T.d> <td align="center">33（20）</T.d> <td align="center">78 (30.59)</T.d> <td align="center"></td> </tr> <tr> <td align="left">IV.</T.d> <td align="center">72 (43.64)</T.d> <td align="center">100 (39.22)</T.d> <td align="center"></td> </tr> <tr> <td align="left">V</T.d> <td align="center">18（10.90）</T.d> <td align="center">6（2.35）</T.d> <td align="center"></td> </tr> <tr> <td align="left">存在溃疡（418）</T.d> <td align="center"></td> <td align="center"></td> <td align="center">0.013 *</T.d> </tr> <tr> <td align="left">是的</T.d> <td align="center">67（41.61）</T.d> <td align="center">78 (30.35)</T.d> <td align="center"></td> </tr> <tr> <td align="left">没有</T.d> <td align="center">94（58.39）</T.d> <td align="center">179（69.65）</T.d> <td align="center"></td> </tr> <tr> <td align="left">回归的存在（399）</T.d> <td align="center"></td> <td align="center"></td> <td align="center">0.254 *</T.d> </tr> <tr> <td align="left">是的</T.d> <td align="center">37（24.02）</T.d> <td align="center">49 (20.00)</T.d> <td align="center"></td> </tr> <tr> <td align="left">没有</T.d> <td align="center">117（75.98）</T.d> <td align="center">196 (80.00)</T.d> <td align="center"></td> </tr> <tr> <td align="left">有丝分裂指数（显微性/ mm<sup>2</sup>）（401）</T.d> <td align="center"></td> <td align="center"></td> <td align="center">0.045 *</T.d> </tr> <tr> <td align="left">0</T.d> <td align="center">27（17.65）</T.d> <td align="center">49（19.76）</T.d> <td align="center"></td> </tr> <tr> <td align="left">≥1</T.d> <td align="center">126（82.35）</T.d> <td align="center">199（80.24）</T.d> <td align="center"></td> </tr> <tr> <td align="left">SLN积极(225)</T.d> <td align="center"></td> <td align="center"></td> <td align="center">0.600 *</T.d> </tr> <tr> <td align="left">是的</T.d> <td align="center">21日(24.70)</T.d> <td align="center">16（11.42）</T.d> <td align="center"></td> </tr> <tr> <td align="left">没有</T.d> <td align="center">64（72.30）</T.d> <td align="center">124 (88.57)</T.d> <td align="center"></td> </tr> <tr> <td align="left">生长阶段（434）</T.d> <td align="center"></td> <td align="center"></td> <td align="center">0.271 *</T.d> </tr> <tr> <td align="left">径向</T.d> <td align="center">28（16.57）</T.d> <td align="center">49（18.49）</T.d> <td align="center"></td> </tr> <tr> <td align="left">垂直</T.d> <td align="center">141（83.43）</T.d> <td align="center">216（81.51）</T.d> <td align="center"></td> </tr> <tr> <td align="left">血管侵犯(400)</T.d> <td align="center"></td> <td align="center"></td> <td align="center">0.877 *</T.d> </tr> <tr> <td align="left">是的</T.d> <td align="center">16（10.19）</T.d> <td align="center">24（9.88）</T.d> <td align="center"></td> </tr> <tr> <td align="left">没有</T.d> <td align="center">141（89.81）</T.d> <td align="center">219（90.12）</T.d> <td align="center"></td> </tr> <tr> <td align="left">危险入侵（392）</T.d> <td align="center"></td> <td align="center"></td> <td align="center">0.398 *</T.d> </tr> <tr> <td align="left">是的</T.d> <td align="center">6 (3.82)</T.d> <td align="center">4（1.70）</T.d> <td align="center"></td> </tr> <tr> <td align="left">没有</T.d> <td align="center">151（96.18）</T.d> <td align="center">231（98.30）</T.d> <td align="center"></td> </tr> <tr class="table-tr"> <td colspan="4"> <hr class="tbody-hr"></td> </tr> </tbody> </table></td> </tr> <tr class="table-fn"> <td>数据显示为平均值±SD和频率（百分比）。**学生们<i>T-Test.</i><b>＊</b><i>ch</i>-Square测试。SSM，浅表蔓延的黑色素瘤;NM，结节黑色素瘤;LMM，Lentigo Maligna Melanoma;Mal，辅助毒性黑素瘤;SLN，Sentinel淋巴结。<br></td> </tr> </tbody> </table> </div> <div class="floats-partial-footer"> <div class="floats-partial-caption"> <span class="caption-text">表2.</span> <a aria-label="full view" class="caption-partial-url" href="//www.newsama.com/journals/jsc/2012/917346/tab2/" title="" target="_blank"></a> </div> <div class="floats-partial-caption-text"> 巴西圣卡塔琳娜西部地区皮肤黑色素瘤患者的临床和组织病理学特征，按性别分类</div> </div> </div> <h5 id="sec3.3">３．３．患者的组织病理学特征</h5> <p>患者呈现的皮肤病变由专门的实验室进行组织病理学评估，该专业实验室遵循巴西黑色素瘤组（BMG）推荐的标准。关于初级病变的大小（面积为MM²），在1.04和9.090之间的变化平均为419.9（SD = 972.8）。未测量25例患者的病变，在诊断时，28例未知原主部位的转移性疾病。</p> <p>最常见的组织学类型为浅表播散型CM 287例(59.92%)，其次为结节型CM 90例(18.79%)，恶性扁豆型CM 33例(8.89%)，肢端扁豆型(ALM) 17例(3.55%)，纤维增生型(DM) 3例(0.63%)。</p> <p>当考虑到患者的性别时，观察到病理分期的差异。皮肤病变分为pTis、pT1和pT2，女性比男性更常见(<svg height="10.9125" id="M7" style="vertical-align:-0.17555pt;width:56.150002px;" version="1.1" viewbox="0 0 56.150002 10.9125" width="56.150002" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,10.9125)"> <g transform="translate(72,-63.27)"> <text transform="matrix(1,0,0,-1,-71.95,63.5)"> <tspan style="font-size: 12.50px; " x="0" y="0"> </T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> ＝</T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> 0</T.span> <tspan style="font-size: 12.50px; " x="29.182001" y="0"> ．</T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 0</T.span> <tspan style="font-size: 12.50px; " x="38.559254" y="0"> 1</T.span> </text> </g> </g> </svg>）.男性(41.6%)较女性(30.3%)更为常见(<svg height="10.9125" id="M8" style="vertical-align:-0.17555pt;width:56.150002px;" version="1.1" viewbox="0 0 56.150002 10.9125" width="56.150002" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,10.9125)"> <g transform="translate(72,-63.27)"> <text transform="matrix(1,0,0,-1,-71.95,63.5)"> <tspan style="font-size: 12.50px; " x="0" y="0"> </T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> ＝</T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> 0</T.span> <tspan style="font-size: 12.50px; " x="29.182001" y="0"> ．</T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 0</T.span> <tspan style="font-size: 12.50px; " x="38.559254" y="0"> 1</T.span> </text> </g> </g> </svg>）.</p> <p>平均有丝分裂率为每mm²3.4微分（SD = 5.04）。考虑到在40名患者中观察到患者，血管或淋巴侵袭的侵袭，10名患者中存在麻烦侵袭。Peritumoral炎症浸润出现在287个病变和222中的腹腔内。</p> <p>在接受前哨淋巴结研究的45.3%的患者中，16.4%的患者SLN阳性并接受了根治性淋巴结切除术。其中14.5%有其他淋巴结转移。除sln阳性患者外，72例因临床淋巴结受损而行根治性淋巴结切除术(见表)<a href="//www.newsama.com/journals/jsc/2012/917346/tab2/" target="_blank">2</a>）.</p> <p>在诊断时期临床分期（<svg height="11.0375" id="M9" style="vertical-align:-0.17555pt;width:50.724998px;" version="1.1" viewbox="0 0 50.724998 11.0375" width="50.724998" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.0375)"> <g transform="translate(72,-63.17)"> <text transform="matrix(1,0,0,-1,-71.95,63.4)"> <tspan style="font-size: 12.50px; " x="0" y="0"> </T.span> <tspan style="font-size: 12.50px; " x="9.6773224" y="0"> ＝</T.span> <tspan style="font-size: 12.50px; " x="21.71771" y="0"> 4</T.span> <tspan style="font-size: 12.50px; " x="27.969212" y="0"> 6</T.span> <tspan style="font-size: 12.50px; " x="34.220711" y="0"> 4</T.span> </text> </g> </g> </svg>II期102例(21.9%)，III期72例(15.5%)，IV期52例(11.2%)。</p> <h4 id="discussion">4.讨论</h4> <h5 id="sec4.1">4．1.流行病学</h5> <p>研究报告了上世纪白种人人口中厘米的发病率和死亡率急剧增加，这代表了一个重要的公共卫生问题[<a href="#B4">4</a>，<a href="#B13">13</a>- - - - - -<a href="#B15">15</a>］．发展疾病预防策略的第一步是评估问题的严重程度和受影响人群的特征[<a href="#B13">13</a>］．</p> <p>为了标准化与黑色素瘤相关的流行病学数据，BMG于2004年建立了巴西黑色素瘤登记处(Brazilian melanoma Registry)，该登记处能够对患者进行完整的临床评估并随后传播国家数据[<a href="#B11">11</a>］．</p> <p>Chapecó市是Santa Catarina西部官方注册中心，用于治疗这种恶性肿瘤。在2002年至2005年期间的Moreno（2005）期间，评估Santa Catarina西部地区的研究报告称，每100 000名居民（未公布的数据），报告平均发病率为14.5例。在这项研究中，该地区的普通率在八年内为71.5例，每100 000名居民和2009年的发病率为每100 000名居民9.3例。新伊息特拉巴镇发病率最高，每100 000名居民71.1例。这些数据表明，巴西这个地区的这种疾病的发生远远高于国家和全球水平。</p> <h5 id="sec4.2">4．2．地理位置</h5> <p>1956年，兰卡斯特提出，CM死亡率的地理分布与低纬度地区日晒增加有关，如新西兰和澳大利亚，这两个地区的CM发病率在世界上最高[<a href="#B19">16</a>，<a href="#B20">17</a>］．最近，在欧洲进行的另一项研究重申了一种假设，即越靠近赤道的地区CM发病率越高[<a href="#B21">18</a>］．</p> <p>巴西是南美洲最大的国家，也是世界上地理面积第五大的国家，位于北纬5°和南纬34°之间。由于这一特点，全国各地存在着不同的气候[<a href="#B10">10</a>］．最近的一项研究未能确定大南大里约热内卢州CM存在的季节性变化特征，但发现其发病率远高于该国其他地区，表明这主要是由于低纬度[<a href="#B22">19</a>］．Santa Catarina的状态位于平行25°和29°S之间，类似于澳大利亚和新西兰位置（10°和39°S）[<a href="#B9">9</a>，<a href="#B10">10</a>］．这可能是该地区CM发病率高的一个解释，加上人口主要由白种人组成的事实。</p> <h5 id="sec4.3">4．3．紫外线辐射与种族</h5> <p>经过50年的流行病学研究，艾德和温斯托克[<a href="#B2">2</a>]发现拉美裔、亚裔和黑人的CM发病率较低。这被归因于深色皮肤的保护作用[<a href="#B2">2</a>］．美国的一项研究评估了11个癌症登记中心10年来的数据，指出紫外线辐射是CM病因的一个关键风险因素，尤其是在I型和II型皮肤患者中[<a href="#B23">20.</a>］．西方圣达塔琳人口的风险较高，因为它是主要由高加索人殖民地殖民的区域。在这项研究中，我们发现99.6％的患者是白色的，其中，92.7％有皮肤类型和II。在38％的受试者中观察到单elides的存在，显示出差的太阳能耐受性[<a href="#B2">2</a>，<a href="#B16">21</a>］．</p> <p>太阳照射是CM的一个重要风险因素，当它在儿童时期以强烈和间歇性的方式发生时，它的破坏性甚至更大[<a href="#B1">1</a>，<a href="#B24">22</a>］．在这项工作中分析的许多患者介绍了以下风险：66.6％在高阳光暴露的地方工作，54.1％有童年晒伤的历史。</p> <p>此外，与北半球相比，南半球夏季的紫外线辐射发生率增加了7% [<a href="#B25">23</a>]南部地区呈较小的臭氧层厚度，较低的灰尘和污染物比北半球，促进了紫外线的渗透[<a href="#B25">23</a>根据美国国家空间研究所(INPE)的统计数据，圣卡塔琳娜州西部夏季紫外线的发生率在8到12之间。这种辐射水平对人类来说非常高，需要采取极端的保护措施[<a href="#B26">24</a>］．</p> <h5 id="sec4.4">4.4。性别和年龄</h5> <p>与先前的研究一致[<a href="#B27">25</a>，<a href="#B28">26</a>，我们发现女性CM的发病率较高(58.75%)。圣卡塔琳娜西部地区CM患者的平均年龄约为50岁，与1993年5月至2006年1月在São Paulo市对365名确诊CM患者进行的研究报告相似[<a href="#B14">14</a>］．然而，支持CM的流行率和发病率随年龄增长的研究结果，特别是在50岁以后[<a href="#B30">27</a>，我们发现50岁以上人群的患病率最高。</p> <p>性别也被认为是皮肤黑色素瘤的预后因素[<a href="#B32">28</a>］．在1956年至2005年在加拿大进行的一项研究中，根据性别，初级病变的位置存在显着变化[<a href="#B32">28</a>］．男性倾向于在轴区有肿瘤，这更有可能发展为转移性病变[<a href="#B27">25</a>，<a href="#B31">29</a>］．在我们的研究中，妇女在肢体上提出了更多病变（59.8％），而男性在头部，颈部和躯干上呈现病变（58.9％）。</p> <h5 id="sec4.5">4.5。痣</h5> <p>一些研究认为，非典型、多发黑素细胞或先天性痣的存在与CM的出现密切相关。既往CM患者出现临床不典型痣的频率为34 - 59%，此前已有报道[<a href="#B33">30.</a>］．这项研究的数据显示9.7%的患者有不典型痣，发病率比预期的低得多，这可能是由于诊断不足。</p> <p>关于CM来自先天性黑素细胞Nevi的癌症的分类和风险有很大的争议[<a href="#B34">31</a>］．在本研究中，我们无法评估先天性痣发展为CM的可能性，但我们发现18.7%的患者有先天性痣，其中，2.4%巨大，36.9%中等，60.7%小。</p> <p>一些研究表明，多发性黑素细胞痣(特别是50痣以上)与CM的发展有关[<a href="#B35">32</a>］．在本研究中，11.4%的患者痣多于50个，20.7%的患者痣少于50个，因此不可能将多发痣的存在与CM的风险联系起来。</p> <h5 id="sec4.6">4.6。组织病理学特征</h5> <p>在新西兰进行的一项与黑色素瘤厚度相关的临床和组织学因素的调查中，在1996年至2006年期间诊断的14646名患者中，48.1%的患者表现出SSM, 11.5%患有NM [<a href="#B36">33</a>］．同样，本研究中479例CM患者中最常见的类型为SSM 287例(59.9%)，其次为NM 90例(18.8%)。</p> <p>根据澳大利亚的最近进行的，该工作评估了912例患有两年时间的原发性CM患者，如Breslow所述的肿瘤厚度已被证明是最佳可重复的预后因素。相比之下，Clark的水平显示了较低的Interobserver协议。大多数患者呈现克拉克III和IV [<a href="#B39">34</a>］．这些结果与西沙卡塔琳西部发现的结果类似，其中大部分病变（40.95％）在克拉克级IV中，III水平为26.43％。</p> <h5 id="sec4.7">4.7。前哨淋巴结</h5> <p>我们发现，在圣卡塔琳娜西部地区，16.4%的患者SLN检测呈阳性。在之前的一项研究中也获得了类似的数据，该研究从1994年到2002年随访了1327例原发性中厚CM (1.2 - 3.5 mm)患者。其中764例进行了SLN检测，16%为阳性[<a href="#B42">35</a>］．</p> <p>在美国，美国癌症联合委员会推荐完全淋巴结切除术作为III期CM患者的标准治疗[<a href="#B43">36</a>］．一项研究评估了从1999年到2003年2203例SLN活检并呈SLN阳性的患者，结果显示，接受淋巴结切除术的患者中只有14%的前哨淋巴结没有阳性[<a href="#B44">37</a>］．本研究的结果与美国的数据相似，该组患者中只有14.5%的前哨淋巴结为阴性。</p> <h5 id="sec4.8">4.8。阶段</h5> <p>一些美国和欧洲的研究表明，CM的诊断主要发生在早期[<a href="#B37">38</a>- - - - - -<a href="#B46">40</a>］．从美国国家癌症数据库获得的1985年至1994年诊断的所有CM病例的分析显示，62.6%的患者在诊断时处于0期和I期[<a href="#B47">41</a>］．</p> <p>在发展中国家，CM的诊断通常发生在晚期。在巴西，几项研究表明，大约50%的患者在诊断时被划分为IV期和V期[<a href="#B49">42</a>- - - - - -<a href="#B51">44</a>］．我们的结果与国家数据不同，因为与发达国家同样，61.3％的患者阶段为0-II。</p> <h4 id="conclusions">5.结论</h4> <p>Santa Catarina西部地区发现的CM的发病率和患病率远高于该国其他地方，并高于印度提出的估计数。这一事实最有可能是由于人口的表型特征，这主要是用皮肤光学型I和II的欧洲人的后代组成。它也可以与来自该地区的个人的生命习惯相关，例如连续或间歇性的阳光照射，而不使用防晒剂导致灼伤，特别是在儿童时期。另一个假设是由于其位于巴西南部的位置，这一地区存在高紫外线辐射发病率，如大洋洲国家的含量高紫外线辐射和厘米的最高发生率。CM患者的平均年龄为50岁，但考虑到根据年龄的患病率，观察到50岁50岁后的CM率增加。厘米在女性中更常见。然而，不利的预后因素与男性更有关，以及最大数量的溃疡病变和更深度的皮肤侵袭。发生的最常见的组织学亚型是SSM，NM和LMM。大多数病变显示肿瘤厚度指数在1到2毫米之间，III和IV之间的克拉克水平和≥1/mm²的有丝分裂指数。在大多数情况下，在诊断时，该疾病是在早期（0，I或II）的早期阶段（0，I或II）。</p> <h4 id="conflict-of-interests">利益冲突</h4> <p>作者声明他们没有利益冲突，没有找到的来源。</p> <h4 id="acknowledgments">致谢</h4> <p>作者谨向Oeste病理研究所，特别是Jerso Menegassi博士和Cíntia Lopes Dias博士，Laboratório de Patologia病理诊断，Oeste地区医院和Benito Bodanese博士表示感谢，感谢他们提供了患者数据。他们也感谢Timothy Mark Brennan, Jr.对本文的指导和翻译，以及Maria Teresa Granella Lang, m.s.对本文修改的帮助。</p> </div> <div class="xml-content"> <h4 class="references" 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Andtbacka，V.G.Prieto等，“Sentinel淋巴结中的微观肿瘤负担预测了黑色素瘤患者的同步不列颠淋巴结受累”<i>临床肿瘤学杂志</i>第26卷第2期26, pp. 4296 - 4303,2008。<span class="reflinks">视图:<a href="https://doi.org/10.1200/JCO.2007.15.4179">出版商的网站</a><span class="sep">|</span><a href="https://scholar.google.com/scholar_lookup?title=Microscopic%20tumor%20burden%20in%20sentinel%20lymph%20nodes%20predicts%20synchronous%20nonsentinel%20lymph%20node%20involvement%20in%20patients%20with%20melanoma&author=J. E. Gershenwald&author=R. H. I. Andtbacka&author=V. G. Prieto et al.&publication_year=2008" target="_blank">谷歌学者</a></span></li> <li id="B37">E. Vries, F. I. Bray, J. W. W. Coebergh, D. M. Parkin，“1953-1997年欧洲恶性皮肤黑色素瘤流行病学的变化:发病率和死亡率的上升趋势，但最近西欧稳定，斯堪的纳维亚下降，”<i>国际癌症杂志</i>，第107卷，第2期1，页119-126,2003。<span class="reflinks">视图:<a href="https://doi.org/10.1002/ijc.11360">出版商的网站</a><span class="sep">|</span><a href="https://scholar.google.com/scholar_lookup?title=Changing%20epidemiology%20of%20malignant%20cutaneous%20melanoma%20in%20Europe%201953–1997:%20rising%20trends%20in%20incidence%20and%20mortality%20but%20recent%20stabilizations%20in%20western%20Europe%20and%20decreases%20in%20Scandinavia&author=E. Vries&author=F. I. Bray&author=J. W. W. Coebergh&author=&author=D. M. Parkin&publication_year=2003" target="_blank">谷歌学者</a></span></li> <li id="B45">H. I. Hall, D. R. Miller, J. D. Rogers和B. Bewerse，《美国黑色素瘤发病率和死亡率的最新进展》，<i>美国皮肤科学院学报</i>，第40卷，第5期。第1页35-42页，1999。<span class="reflinks">视图:<a href="https://doi.org/10.1016/S0190-9622(99)70562-1">出版商的网站</a><span class="sep">|</span><a href="https://scholar.google.com/scholar_lookup?title=Update%20on%20the%20incidence%20and%20mortality%20from%20melanoma%20in%20the%20United%20States&author=H. I. Hall&author=D. R. Miller&author=J. D. Rogers&author=&author=B. Bewerse&publication_year=1999" target="_blank">谷歌学者</a></span></li> <li id="B46">C. M. Balch, S. J. Soong, J. E. Gershenwald等人，“17600例黑色素瘤患者的预后因素分析:美国癌症黑色素瘤分期系统联合委员会的验证，”<i>临床肿瘤学杂志</i>，卷。19，没有。16，PP。3622-3634,2001。<span class="reflinks">视图:<a href="https://scholar.google.com/scholar_lookup?title=Prognostic%20factors%20analysis%20of%2017,600%20melanoma%20patients:%20validation%20of%20the%20American%20joint%20committee%20on%20cancer%20melanoma%20staging%20system&author=C. M. Balch&author=S. J. Soong&author=J. E. Gershenwald et al.&publication_year=2001" target="_blank">谷歌学者</a></span></li> <li id="B47">A. E. chang，L.H.Karnell和H. R.·梅克，“全国癌症数据库报告皮肤和非皮肤瘤的报告：过去十年的84,836例案件摘要，”<i>癌症</i>，第83卷，第83期8、1998年。<span class="reflinks">视图:<a href="https://scholar.google.com/scholar_lookup?title=The%20national%20cancer%20data%20base%20report%20on%20cutaneous%20and%20noncutaneous%20melanoma:%20a%20summary%20of%2084,836%20cases%20from%20the%20past%20decade&author=A. E. Chang&author=L. H. Karnell&author=&author=H. R. Menck&publication_year=1998" target="_blank">谷歌学者</a></span></li> <li id="B49">N.G.Proença，M.F.Bernardes，H. J.Muller等，“Fatores Que Computenciam Sobre oprognóstico做黑色素瘤Maligno，”<i>Anais Brasileiros de Dermatologia</i>第66期第1页，1991年。<span class="reflinks">视图:<a href="https://scholar.google.com/scholar_lookup?title=Fatores%20que%20influenciam%20sobre%20o%20prognóstico%20do%20melanoma%20maligno&author=N. G. Proença&author=M. F. Bernardes&author=H. J. Muller et al.&publication_year=1991" target="_blank">谷歌学者</a></span></li> <li id="B50">P. R.Criado，C.Vasconcellos，J.A.Siittart等人，“主要皮肤恶性黑素瘤：从1963年到1997年的医院进行回顾性学习，Do ServidorPúblicoEstadualdeSãoPaulo”<i>Revista daasciaçãomédicabrasileira</i>，卷。45，不。2，PP。157-162,1999。<span class="reflinks">视图:<a href="https://scholar.google.com/scholar_lookup?title=Primary%20cutaneous%20malignant%20melanoma:%20retrospective%20studyfrom%201963%20to%201997%20at%20Hospital%20do%20servidor%20público%20estadual%20de%20são%20Paulo&author=P. R. Criado&author=C. Vasconcellos&author=J. A. Sittart et al.&publication_year=1999" target="_blank">谷歌学者</a></span></li> <li id="B51">A. S. Gon, L. Minelli, and A. L. Guembarovski，《londrina的原发性皮肤黑色素瘤》，<i>Anais Brasileiros de Dermatologia</i>，卷。76，没有。4，pp。413-426,2001。<span class="reflinks">视图:<a href="https://scholar.google.com/scholar_lookup?title=Primary%20cutaneous%20melanoma%20in%20londrina&author=A. S. Gon&author=L. Minelli&author=&author=A. L. Guembarovski&publication_year=2001" target="_blank">谷歌学者</a></span></li> </ol> </div> <div class="xml-content"> <h4 class="copyright" id="copyright">版权</h4> <p>版权所有©2012 Marcelo Moreno等。这是分布下的开放式访问文章<a rel="license" href="http://creativecommons.org/licenses/by/3.0/">知识共享署名许可协议</a>，允许在任何媒介上不受限制地使用、传播和复制，但必须正确引用原作。</p> </div> </div> </article> </div> </div> </div> <div class="biblio__Wrapper-sc-1nou1lz-0 eyHfWh journal_article__BiblioIntegratorWidget-sc-12fk6zy-5 dbAANp article_widget biblioWrapper hide"> <hr> <h4 class="biblio__H4-sc-1nou1lz-2 kgAKHb hrTitleRef">更多相关文章</h4> <div id="biblio_widget" class="biblio__BiblioWrapper-sc-1nou1lz-1 fOXysy"></div> </div> </div> </div> <div class="threeColumn__RightWrapper-sc-1bf4078-2 jzTMLK rightWrapper" id="rightSectionMenu"> <div> <div class="journal_article__ArticleStickyTopToolbar-sc-12fk6zy-0 gbrQxi article_sticky_top_toolbar"> <div class="sc-cBdUnI hRnXob article_top_toolbar"> <a class="sc-htpNat bUhGXt link sc-jtRfpW dIjoCg sc-exkUMo 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height="24"><span class="sc-dRFtgE jrsDZP">下载其他格式</span><span class="sc-gkFcWv gWTCXQ">更多的</span></span> <span class="sc-htoDjs bMdQcY sc-gbOuXE jGPvPL icon-colored _1CwL9R82TPl2HxDleeYGDR icon-themeable" title="" font-size="11"></span> </div> <div class="sc-fnwBNb etzuBr"> <a class="sc-htpNat bUhGXt link sc-iNhVCk gWgCNb open_panel" href="//www.newsama.com/downloads/journals/jsc/2012/917346.epub" aria-label="ePub" property="background-color" color="#D8D8D8"> <div class="sc-eAKXzc WHkfb"> epub.</div><img alt="" class="sc-EHOje jOLhQl sc-bfYoXt cGuwDn" title="" role="presentation" 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height="24"><span class="sc-dRFtgE jrsDZP">订单打印副本</span><span class="sc-gkFcWv gWTCXQ">订购</span></span><span class="sc-htoDjs kNoiZu sc-gbOuXE jGPvPL right__icon icon-colored _32KP5uexH-Bgs7Kj8Gk1Tz icon-themeable" title="" font-size="16"></span></a> <div class="sc-hBbWxd kdRRST"> <div class="sc-dyGzUR cHatnS"> <div> 意见<span>1953年</span> </div> <div> 下载<span>938</span> </div> </div> <div> <div class="sc-drKuOJ kxdGAZ"> <span class="__dimensions_badge_embed__" data-doi="10.1155/2012/917346" data-style="small_circle"></span>引用</div> </div> </div> <nav class="sc-bRBYWo fXBKFa sc-hUfwpO jHPgUP" id="toolbar__iconNav"> <h3 class="sc-Rmtcm hNPrIr">分享文章</h3> <ul class="sc-hzDkRC bnbfTS"> <li class="iconBorder"><a class="sc-htpNat bUhGXt link" href="https://twitter.com/share?url=https://doi.org/10.1155/2012/917346&via=Hindawi" aria-label="Sharing on Twitter" rel="noopener noreferrer" target="_blank"><img alt="" class="sc-EHOje jOLhQl socialTwitter" title="" role="presentation" 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