Search

Resume Introduction Le but de cette etude etait d’evaluer l’evolution de l’incidence et de la mortalite du melanome (MM) en Seine-Maritime pendant une periode de 20 ans. Methodes Nous avons collige retrospectivement les comptes-rendus anatomopathologiques des cas de MM sur trois periodes espacees chacune de dix ans (1988–1989, 1998–1999, 2008–2009) aupres des laboratoires d’anatomopathologie de Seine-Maritime. Les taux d’incidence et de mortalite ont ete calcules a partir des donnees de l’Insee et de l’Inserm. Resultats En 20 ans, l’incidence du MM a augmente de 8,6 a 21,2 cas/100 000 habitants/an (+147 %, p p = 0,0003). L’incidence des MM invasifs a augmente de +110 % et celle des MM in situ de +456 %. L’incidence des MM invasifs et le taux de mortalite ont surtout augmente pendant les dix premieres annees : +62 % ( p p = 0,01), beaucoup moins les dix dernieres annees : +30 % ( p = 0,0007) et +22 % ( p = 0,22). Ce ralentissement de l’augmentation d’incidence des MM invasifs et de la mortalite qui y est liee a ete encore plus marque chez les femmes pendant les dix dernieres annees (+17 % et +9 % respectivement), tandis que ces taux ont continue d’augmenter chez les hommes (+49 % et +35 % respectivement). A l’inverse, l’incidence des MM in situ a surtout augmente ces dix dernieres annees (+257 %). Conclusion Le taux d’incidence des MM invasifs et le taux de mortalite des MM n’ont que peu augmente ces dix dernieres annees en Seine-Maritime, tandis que l’incidence des MM in situ a continue de fortement augmenter.

Resume Introduction Peu d’etudes ont evalue les complications survenues apres exerese du ganglion sentinelle chez les malades atteints de melanome. Le but de ce travail etait d’etudier les complications liees a la technique d’exerese du ganglion sentinelle chez les malades atteints de melanome. Malades et methodes Tous les malades ayant eu une exerese du ganglion sentinelle, entre mars 2000 et decembre 2002, ont ete inclus dans cette etude retrospective. Les malades ayant un ganglion envahi histologiquement et ayant eu secondairement un curage ganglionnaire ont ete exclus. La duree moyenne de suivi des malades etait de 12,6 ± 8,8 mois apres l’exerese. Les complications observees ont ete classees en complications precoces (survenant moins d’un mois apres l’intervention), ou tardives, passe ce delai. Resultats Quarante malades (17 hommes, et 23 femmes), issus d’une serie de 61 malades atteints de melanome ayant eu l’exerese de leur ganglion sentinelle, ont ete inclus. Quatorze complications ont ete observees chez dix malades (25 p. 100). Les deux complications precoces ont ete un hematome sur cicatrice et une thrombose veineuse compliquee d’embolie pulmonaire. Douze complications tardives ont ete observees : cinq lymphœdemes moderes, deux cicatrices hypertrophiques, quatre cicatrices douloureuses et une lymphorrhee. Trente-trois pour cent des complications observees interessaient le site inguinal. Discussion La morbidite de la technique d’exerese du ganglion sentinelle doit etre prise en compte dans l’evaluation de cette technique, surtout si son interet therapeutique n’etait pas montre par les etudes en cours.

The aim of this study was to assess changes in the incidence and mortality rates of malignant melanoma (MM) over a 20-year period in a region without a cancer registry.All cases of MM studied were collected retrospectively from the databases of six private and three hospital-based histopathology laboratories in the Seine-Maritime region covering three 24-month periods each 10years apart: 1988-1989, 1998-1999 and 2008-2009, The incidence and mortality rates were estimated based on data provided by French National Institute for Statistics and Economic Studies (Insee) and French National Institute of Health and Medical Research (Inserm).Over the 20-year period, the incidence of MM increased from 8.6 to 21.2/100,000inhabitants per year (+147%, P0.0001) while the mortality rate rose from 1.3 to 2.8/100,000inhabitants per year (+115%, P=0.0003). The incidence of invasive MM increased by +110%, while the incidence of MM in situ increased by +456%. The incidence and overall mortality rate of invasive MM increased particularly during the first 10-year period: +62% (P0.0001) and +77% (P=0.01) respectively, and to a much lesser extent during the last 10-year period: +30% (P=0.0007) and +22% (P=0.22) respectively. This slowdown in the incidence of invasive MM and in overall mortality rates was even more pronounced in women over the last 10years (+17 and +9%), whereas these rates continued to increase in men (+49% and +35%, respectively). In contrast, the incidence of MM in situ increased above all during this same period (+257%).This study shows that while the incidence and mortality rate of invasive MM has increased little over the last 10years in the Seine-Maritime region, the incidence of MM in situ continues to rise sharply.

Side-effects occurring after sentinel lymph node excision in malignant melanoma patients have been poorly evaluated to date. The aim of the present study was to assess the side-effects of sentinel lymph node excision in this population.All consecutive malignant melanoma patients undergoing sentinel lymph node excision between March 2000 and December 2002 were included in this retrospective study. Patients with a metastatic sentinel node subsequently undergoing lymph node dissection were excluded. Median follow-up of patients was 12.6 +/- 8.8 months. Complications were classified as "early" (i.e. occurring the month following surgery), or "late" (after this time).Forty malignant melanoma patients (17 males, 23 females) with a normal histologic examination of their sentinel lymph node were included. They belonged to a series of sixty-one melanoma patients undergoing lymph node excision. Fourteen complications were observed in ten patients. Two early complications were seen: hematoma (n=1) and deep venous thrombosis with pulmonary embolism (n=1). Twelve late complications were observed: mild lymphoedema (n=5), hypertrophic scars (n=2), painful scars (n=4), and one chronic seroma (n=1). Many complications (33%) were observed after excision in the inguinal area.The complications of sentinel lymph node excision must be considered in determining the benefit/risk ratio of this technique.