Læknablaðið - 15.10.1985, Side 58

280
L.ÆKNABLAÐIÐ
nokkuð á við það sem yfirleitt er talið (12, 19).
Á það skal þó bent, að meðalaldur sjúklinga
nteð freknunrein var mun hærri en hjá
sjúklingum með aðrar tegundir sortuæxla.
Það sem helst hefur verið talið hafa áhrif á
horfur sjúklinga með sortuæxli, er annars
vegar Clark’s dýpt (20) og hins vegar Bre-
slow’s þykkt (21) í mm, en hvort tveggja hefur
verið gagnrýnt töluvert á undanförnum árum
(22, 23). Clark’s dýpt tekur ekki nægilegt tillit
til þykktar hvers æxlis í mm, meðan Breslow’s
þykkt tekur ekki nægilegt tillit til þess, að
húðin er misþykk. Nýlega birtist grein (22),
þar sem stungið er upp á annarri viðmiðun:
DT/TT, þar sem mælt er hlutfall húðþykktar
(DT) og æxlisþykktar (TT) og sýnt fram á, aö
það ætti að gefa betri vísbendingu um horfur.
j heild var 5 ára lifun sjúklinga með
sortuæxli i húð og meinvörp án finnanlegs
frumæxlis 53°/o, en ef meinvörpin eru undan-
skilin 56°/o. í sortuæxlum í augum var 5 ára
lifun 51,2% (1), en í slímhúðarsortuæxlum
aöeins 29%.
Ekki virðist vera um aö ræða aukningu á
augn- eða slímhúðarsortuæxlum svipað og í
húð.
Slímhúðarsortuæxlin voru fremur fá á
þessu 30 ára tímabili eða 25, en það er mjög
misjafnt eftir rannsókum hversu hátt hlutfall
þau eru af sortuæxlum í heild (25, 26). Hér á
landi voru þau 10%. Vegna tilfellafæðar
æxlanna í slímhúöum er 5 ára lifun ekki mjög
áreiðanleg, en það kemur ekki á óvart að hún
er mun iægri en hjá húðæxlunum, þar senr þau
gefa siðar einkenni.
SUMMARY
In the period 1955-84, 255 malignant melanomas were
diagnosed in lceland. The male/female ratio was 1:1.77.
Melanomas in the skin were 181, in the eyes 39, mucous
mémbranes 25 and 10 malignant melanomas with
unknown primari site.
As in many other countries, there has been an increase
in incidence of skin melanomas in lceland. For men the
increase has been from 0.5/100.000 a year for the period
1955-64 to 3.6/100.000a year for the period 1975-84. For
women the incidence has increased from 1.6/100.000 a
year for the period 1955-64 to 6.4/100.000 a year for the
period 1975-84.
The reasons for this inerease are not clear, but it is well
known that the Icelandic people have travelled much
more to the southern countries during the last 10 to 20
years, than they did bel'ore, and the use of solaria has
inereased enormously over the last few years. In support
of the theory that malignant melanoma of the skin is
related to increased exposure to ultraviolet light, is the
definately incrteased incidence of malignant melanoma
arising in lentigo meligna (Hutchinson’s melanotic
freckle) in Iceland. This type of melanoma has bcen
connected with sunlight exposure by many authors.
HEIMILDIR
1) Gislason 1, Magnusson B, Tulinius H. Melanoma of
the uvea in leeland 1955-1979. Læknablaðiö 1984;
70: 335-42.
2) McGovern VJ, Milim MC, Bailly C et al. The
classification of malignant melanoma and its histo-
logic reporting. Cancer 1973; 32: 1446-57.
3) Lennish WM, Heenan P.l, Holman CD.I, Armstrong
BK. Survival l'rom preinvasive and invasive malig-
nant melanoma in Western Australia. Cancer 1983;
52: 580-5.
4) McGovern VJ. The nature ol' melanoma. A critieal
review. .1 Cutan Pathol 1982; 9: 61-81.
5) Mackie RM. The pathogenesis of cutaneous malig-
nant melanoma. Br Med J 1983; 286: 1568-9.
6) Elwood JM, Gallagher RP, Hill GB, Spinelli JJ,
Pearson JCG, Threlfall W. Pigmentation and skin
reaetion to sun as risk factors for cutaneous
ntelanoma: Western Canada melanoma study. Br
Med J 1984; 288: 99-102.
7 Magnus K. Incidence of malignant melanoma of the
skin in the five Nordic Countries: Significance of
solar radiation. Int .1 Cancer 1977; 20: 477-85.
8) Dobson AJ, Leeder SR. Mortality from malignant
ntelanoma in Australia: Effects due to counlry of
birlh. Int J Epidemiol 1982; 11: 207-11.
9) l.ewis MG. Malignant melanoma in Uganda. Br .1
Cancer 1967; 21: 483-95.
10) Green A, Siskind V. Geographic distribution of
cutaneous ntelanoma in Queensland. Med J Aust
1983; 1: 407-10.
11) Ehsood JM, Hislop TG. Solar radiation in the
etiology of cutaneous malignant melanoma in
caueasians. Natl Cancer Inst Monogr 1982; 62: 167-
71.
12) Kopf AW, Bart RS, Rodriquez-Sains RS. Malignant
melanoma: A review. J Dermatol Surg Oneol 1977;
3: 41-125.
13) HerseyP, HasicE, Edwards A, BredleyM, HaranG,
McCarthy WH. Immunologic effects of solarium
exposure. Laneet 1983; 1: 545-8.
14) Lee RA, Sober AJ, Cook N, Marvell R, Fitzpatrick
TB. Sun exposure habits in patients with cutaneous
melanoma: A case study. .1 Dermatol Surg Oncol
1983; 9: 981-6.
15) Lee JA, Merrill JM. Sunlight and the etiology of
malignant melanoma: asynthesis. Med J Austr 1970;
2: 846-1.
16) Mackie RM, Aitchison TC. Severe sunburn and
subsequent risk of primary cutaneous malignant
melanoma in Scotland. Br J Cancer 1982; 46: 9055-
60.
17) Hinds MW. Nonsölar factor in the etiology og
malianant melanoma. Natl Cancer Inst Monogr
1982'; 62: 173-8.
18) Shavv HM, McGovern VJ, Milton GW, Farago GA,
McCarthy WH. Histologic features of tumors and
the female superiority in survival from malignant
melanoma. Cancer 1980; 45: 1604-8.