皮肤恶性肿瘤的治疗:我们应依赖临床诊断至何种程度?

作     者：Brown S.J Lawrence C.M 李政霄 

作者机构：Department of Dermatology Royal Victoria Infirmary Newcastle-uponTyne United Kingdom [Dr. 

出 版 物：《世界核心医学期刊文摘（皮肤病学分册）》 (Digest of the World Core Medical JOurnals:Dermatology)

年 卷 期：2006年第2卷第9期

页      面：34-34页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：皮肤恶性肿瘤 临床诊断 治疗 Merkel细胞癌 恶性皮肤肿瘤 皮肤科医师 医师工作量 恶性黑素瘤 

摘      要：Background: Cutaneous malignancy forms a major part of the dermatologist’ s workload. Clinical diagnosis is an important factor in facilitating the urgent excision of squamous cell carcinomas (SCC) and malignant melanomas. Objectives: To identify the numbers and types of malignant skin tumours managed in an NHS teaching hospital and to assess the diagnostic accuracy. Methods: Data were collected on every histologically proven malignant skin lesion over a 6-month period. Results: One thousand one hundred and ninety-five malignant skin tumours were identified: 78% were basal cell carcinomas, 14% were SCC, 6% were malignant melanomas and the remaining 2% included Merkel cell tumours, malignant adnexal tumours and lentigo maligna. Eighty-one per cent of the tumours were managed by dermatologists. The correct clinical diagnosis had been made by the secondary care clinician in 84% of cases but an incorrect clinical diagnosis was given in 32% of SCC. Of the 1195 tumours, 916 (77% ) had a primary excision and 92% (843 of 916) of these were completely excised. Conclusions: The majority of skin malignancies (968 of 1195, 81% ) were managed by dermatologists. Where primary excision was attempted, this was complete in 91% (767 of 916) of cases. The correct clinical diagnosis was made in 84% of all tumours, but 32% of SCC were not correctly diagnosed prior to surgery.