鼻腔鼻窦恶性黑色素瘤11例临床分析

目的 探讨鼻腔鼻窦恶性黑色素瘤患者的临床特点、诊断及治疗方法。方法 回顾分析本科2000年1月～2011年11月收治的11例鼻腔鼻窦恶性黑色素瘤患者的临床资料。结果 11例中男7例,女4例, 46～82岁,平均65.7岁。采用手术+放疗治疗7例,手术+化疗2例,单纯手术1例,单纯放疗1例。术后1、2、3年生存率分别为81.82%、36.37%、9.09%。免疫组化对恶性黑色素瘤的诊断有重要价值。结论 鼻腔鼻窦恶性黑色素瘤临床少见、发展快、易复发、预后差。早期诊断和合理治疗是提高疗效的关键。     

鼻腔鼻窦恶性黑色素瘤17例临床分析

目的探讨鼻腔鼻窦恶性黑色素瘤的诊断和治疗,提高本病的诊疗水平。方法回顾性分析1980年3月-2011年6月收治的17例鼻腔鼻窦恶性黑色素瘤的临床资料,分析其临床病理特点、诊断、治疗及预后。结果患者的主要症状为单侧鼻塞,涕中带血,头痛;病灶位于鼻腔外侧壁和鼻中隔。17例患者中1例放弃治疗,2例行单纯放疗,14例行手术治疗,3、5年生存率分别为36．4％和22．2％。患者死亡原因为局部复发和远处转移。结论鼻腔鼻窦恶性黑色素瘤恶性程度高,易复发和转移,预后差,临床上尽早确诊。广泛彻底手术切除肿瘤,并辅以放疗、化疗、免疫治疗等综合治疗,是提高本病生存率的关键。     

鼻腔鼻窦恶性黑色素瘤24例报告

目的：探讨鼻腔鼻窦恶性黑色素瘤的病理、临床特点及治疗方法。方法：鼻腔鼻窦恶性黑色素瘤24例中，鼻侧切开鼻腔鼻窦肿瘤切除术18例，颈外动脉结扎上颌骨大部分切除术2例，上颌窦根治术径路鼻腔鼻窦肿瘤切除术2例，颅面联合径路前颅底鼻腔鼻窦肿瘤切除术2例，同期行颈淋巴清扫术4例；单纯手术14例，手术加术后放疗8例，手术加放疗和化疗2例，其中1例加免疫治疗（IL-2和IFN）。结果：24例患者中随访22例，失访2例，3年生存率为54．5％（12／22），5年生存率为31．8％（7／22）。结论：鼻腔鼻窦恶性黑色素瘤恶性程度高，易复发，早期诊断、根治性手术切除能提高本病生存率。     

鼻腔鼻窦恶性黑色素瘤19例分析

目的：提高对原发于鼻腔，鼻窦恶性黑色素瘤的诊疗水平。方法：对本院1992－2000年收住的19例鼻腔，鼻窦原发恶性黑色素瘤的临床表现，诊断，治疗方法和随访结果进行分析。结果：该病病理与临床易与鼻息肉，鼻腔癌，血管癌相混淆，彻底的手术切除及良好的局部控制与生存时间有关，放疗，化疗与免疫治疗的疗效有待进一步验证。结论：鼻腔，鼻窦原发恶性黑色素瘤为临床难治疾病之一，预后较差，早期诊断及彻底手术切除是提高疗效的首选措施。     

鼻腔鼻窦恶性黑色素瘤19例分析

目的 :提高对原发于鼻腔、鼻窦恶性黑色素瘤的诊疗水平。方法 :对本院 1992～ 2 0 0 0年收住的 19例鼻腔、鼻窦原发恶性黑色素瘤的临床表现、诊断、治疗方法和随访结果进行分析。结果 :该病病理与临床易与鼻息肉、鼻腔癌、血管瘤相混淆 ,彻底的手术切除及良好的局部控制与生存时间有关 ,放疗、化疗与免疫治疗的疗效有待进一步验证。结论 :鼻腔、鼻窦原发恶性黑色素瘤为临床难治疾病之一 ,预后较差 ,早期诊断及彻底手术切除是提高疗效的首选措施。     

鼻内镜下切除鼻腔鼻窦黏膜源性恶性黑色素瘤

目的探讨鼻腔鼻窦黏膜源性恶性黑色素瘤的临床特点及治疗方法。方法分析3例鼻腔鼻窦黏膜源性恶性黑色素瘤的临床特点,总结鼻内镜下手术加放疗的临床疗效。结果3例患者均在鼻内镜下一次性完全切除肿瘤,术后放疗,随访11—19个月肿瘤元复发。结论对鼻腔鼻窦黏膜源性恶性黑色素瘤,如未发现远处转移,可通过鼻内镜下行肿瘤切除术,术后辅以放射治疗能达到临床治愈的目的。     

复发性鼻腔及鼻窦恶性黑色素瘤的治疗

目的 探讨鼻腔及鼻窦恶性黑色素瘤复发的原因和治疗方法.方法 回顾性分析1993～2003年我科收治的11例复发性鼻腔及鼻窦恶性黑色素瘤患者的临床资料.结果 临床误诊或误治引起的复发患者4例,病理明确手术治疗后复发7例,其中5例为单纯手术后复发,2例为手术加术后放疗后复发.11例复发病例中,局部复发局限于鼻腔及鼻窦7例;局部复发侵犯眼眶、颅底、软腭及硬腭1例;局部复发侵犯腮腺和皮肤1例;面部、眼眶及颅底广泛侵犯者1例;颈部淋巴结转移复发1例.首次复发时间最短为治疗后10个月.所有病例再次手术治疗后的累积生存率为:1年生存率72.7%,2年生存率18.2%,3年生存率9.1%.结论 减少误诊,选择适当的治疗方法是提高复发性鼻腔及鼻窦恶性黑色素瘤治愈的主要手段.     

48例鼻腔鼻窦肉瘤的临床分析

目的：探讨鼻腔鼻窦肉瘤的临床表现、诊断、治疗及预后，以提高对鼻腔鼻窦肉瘤的诊疗水平。方法：回顾性分析48例鼻腔鼻窦肉瘤患者的临床资料。结果：鼻腔鼻窦纤维肉瘤4例，恶性纤维性组织细胞瘤3例，脂肪肉瘤4例，平滑肌肉瘤5例，横纹肌肉瘤5例，骨肉瘤2例，软骨肉瘤3例，恶性黑色素瘤4例，非霍奇金淋巴瘤4例，浆细胞肉瘤1例，恶性神经鞘膜瘤5例，嗅神经母细胞瘤5例，血管肉瘤3例，综合治疗后随访，1，3，5年生存率分别为62．5％，46．7％，35．7％。结论：鼻腔鼻窦肉瘤不易明确诊断，结合免疫组织化学有助于诊断，对肿瘤易复发及全身转移者，综合治疗可提高生存率。     

单侧鼻腔鼻窦良恶性病变并发鼻息肉25例临床分析

目的分析单侧鼻腔鼻窦良恶性病变并发鼻息肉的临床特征、诊断及治疗方法。方法回顾分析25例单侧鼻腔鼻窦良恶性病变并发鼻息肉患者的临床资料。结果25例中，霉菌性鼻窦炎9例．出血坏死性息肉4例．内翻性乳头状瘤8例，血管瘤2例．鳞状细胞癌2例。15例行鼻内镜手术．4例行上颁窦根治结合鼻内镜手术．5例行鼻侧切开术．1例行上颁骨部分切除术。术前误诊4例，术后2例复发再次手术治疗。结论单侧鼻腔息肉患者．要警防是否合并其它鼻腔鼻窦病变。鼻内镜、CT检查和活检有助于术前明确诊断，以彻底清除病变为治疗原则。     

鼻腔鼻窦粘膜恶性黑色素瘤的治疗选择和生存

鼻腔鼻窦粘膜恶性黑色素瘤较少见，其发病率占全身恶性黑色素瘤的1％以下，占鼻腔鼻窦肿瘤的4％以下，不管选择何种治疗方法，其预后均较差，文献报告5年生存率为6．5％～34％。作者早期的治疗经验提示手术加放疗可能会增加生存期，但未得到大组病例长期随访的统计学分析证实。为此，作者对1963年至1996年期间治疗的鼻腔鼻窦恶性黑色素瘤72例中资料完整的58例进行回顾性分析，旨在确定选择手术加放疗是否比单纯根治性手术对生存期有所增加。58例中男性30例，女性28例，年龄39岁～90岁，平均年龄64岁。生存分析用Kaplan－Meter法。临床表现…     

外耳恶性黑瘤14例报告

目的：提高对外耳恶性黑瘤的诊治水平。方法：回顾分析１４例外耳恶性黑瘤的临床资料,所有患者均行手术切除。结果：１３例获随访,其中７例无瘤生存,６例死亡,５年生存率为５０．０％．结论：本病进展快,预后差,临床上应及早诊断与治疗,广泛彻底地切除肿瘤;对复发者,应行肿瘤再切除加放射治疗。     

Cutaneous malignant melanoma in the area of the head and neck with intermediate tumor thickness: does primary site have prognostic relevance?

BACKGROUND: Tumor thickness and infiltration of malignant melanoma are the main prognostic factors for recurrence and survival. The sentinel lymph node biopsy may provide a step toward a more individual staging and therapy. It was the aim of this study to investigate the prognostic influence of the primary localization of head and neck melanoma subdivided into scalp, ear, neck, and face. To form a basis for routine sentinel lymph node biopsy in case of intermediate tumor thickness metastatic pattern of the different primary sites were analysed. METHOD: Survival rates depending on primary tumor site of 51 patients with cutaneous malignant melanoma of the head and neck were analysed. Metastatic pattern were evaluated with the help of clinical, intraoperative, pathohistologic data. RESULTS: Scalp and ear melanoma were found to be higher risk lesions with a 5-year survival rate of 28% and 59% respectively. Melanoma of the neck and face had a 5-year survival rate of 75% and 78% respectively. In two cases of ear melanoma lymph node metastases could be demonstrated in unusual sites by skipping the first draining basin. In three cases bilateral metastases could be shown histologically as opposed to clinical prediction. CONCLUSIONS: Localization of cutaneous malignant melanoma of the head and neck is a prognostic factor for survival. Because of the discordancy between clinical prediction and lymphatic drainage pattern sentinel lymph node biopsy improves accuracy of diagnostic and therapeutic procedures.     

CPA melanoma: diagnosis and management.

OBJECTIVE: Melanoma rarely invades the cerebellopontine angle (CPA) and can evade accurate diagnosis, which may alter management decisions. Diagnosis may be facilitated via careful history, magnetic resonance imaging (MRI) findings, and cerebrospinal fluid (CSF) analysis. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Thirteen internal auditory canal/CPA lesions in eight patients who presented with CPA syndrome and who had a pathological diagnosis consistent with malignant melanoma. There were four bilateral and four unilateral lesions. Six of eight patients had a history of melanoma. One was apparently primary CPA lesion, whereas all others were metastatic. INTERVENTION(S): T1- and T2-weighted precontrast and postcontrast gadolinium-enhanced MRI were obtained, including fat suppression and fluid-attenuated inversion recovery sequence images in two patients; lumbar puncture with CSF centrifugation and cytological analysis confirmed the diagnosis in two patients. Translabyrinthine craniotomy was performed for tumor extirpation in five patients. MAIN OUTCOME MEASURE(S): Symptoms at presentation, MRI findings, presence of malignant cells in CSF, tumor progression, intraoperative findings, response to treatment, time interval from initial diagnosis of melanoma elsewhere, and survival. RESULTS: Seven of eight patients had history and/or MRI findings suggestive of malignancy in the internal auditory canal and/or CPA, and diagnosis was confirmed via CSF analysis in two patients. In one patient, diagnosis was made at surgery. CONCLUSION: Internal auditory canal melanoma portends a grim prognosis, can occur up to 17 years after initial melanoma diagnosis/treatment, and can be detected with appropriate MRI sequences, especially enhanced fluid-attenuated inversion recovery images. In disseminated cases, diagnosis can be confirmed with lumbar puncture demonstrating malignant cells. Management includes tumor resection when melanoma seems to be solitary and malignant cells are not present in CSF. Intrathecal chemotherapy and radiation are recommended for dissemination, although the survival rate is still poor.     

Juvenile malignant melanoma of the head and neck

Malignant melanoma of the head and neck is a potentially lethal disease and considered rare among juveniles. Treatment patterns have historically been dictated by experience with adults, however a paucity of data is available to determine the natural history and treatment guidelines for juveniles and children with malignant melanoma. Therefore a retrospective computer-aided analysis of patients less than 20 years of age having malignant melanoma were obtained from the records of 4,843 patients with malignant melanoma recorded from 1972 through 1986. Eighty-seven patients were identified from this group with 17 patients having primary malignant melanomas confined to the head and neck. Parameters evaluated were age at diagnosis, sex, type of melanoma, Clark Level, Breslow depth of invasion, pathologic classification, site of primary, nodal status at diagnosis, surgical treatment, recurrence rate and site of recurrence, and follow-up status. Two of 17 patients had stage II disease and were treated with wide local excision and therapeutic radical neck dissection. Fifteen of 17 patients initially presented with stage I disease were treated with wide local excision. Two of these patients underwent elective radical neck dissection both of which proved to have positive occult nodal disease. Both are alive without evidence of disease 2 1/2 to 7 years later. Of the 13 patients who were initially treated with only wide local excision, nine patients developed local (3), regional (3), or systemic (3) disease within 3 months to 9 years from the date of diagnosis. Seven of the nine died of their disease 5 months to 20 years later. When juvenile patients with melanomas of the head and neck are compared to a comparable age group of patients with melanomas at other primary body sites, the head and neck group had a significantly higher frequency of death. Compared to the adult head and neck population, juvenile patients had identical actuarial survival time, but shorter disease-free intervals, even though the adult population had a higher percent of poor prognostic indices (presence of ulceration and thickness of lesions). Failure to control local and regional disease coupled with the overall poor survival rate, indicates that malignant melanoma occurs in the young as a biologically active tumor and suggests an aggressive approach for better control of local and regional disease and, hopefully, survival.     

Cutaneous malignant melanoma of the head and neck with intermediate tumor thickness: the role of elective lymph node dissection for clinical stage I

BACKGROUND: At present a tendency towards a more limited surgery in the treatment of clinical stage I and II melanoma exists. The controversy of elective lymph node dissections (ELND) in stage-I-melanoma with intermediate tumor thickness continues to be discussed. The sentinel lymph node biopsy may provide improved staging accuracy. METHODS: It was the aim of this study to examine whether extent of surgical treatment particularly the ELND in case of intermediate tumor thickness has prognostic significance. Metastatic pattern of these malignant melanoma were analyzed to form a basic for routine sentinel lymph node biopsy. RESULTS: No prognostic difference could be shown in clinical stage I melanoma with intermediate tumor thickness between "local excision" (no lymph node dissection) or "wait and see" (delayed lymph node dissection because of clinical suspicion) respectively and "local excision with elective neck dissection". The 5-year survival was 67 %, 67 % and 69 %. It ran to 53 % in case of therapeutical lymph node dissection as primary therapy. Occult nodal metastases occur in 15 % and "skip"-metastases in 6 %. CONCLUSIONS: No therapeutic value for ELND in clinical stage I malignant melanoma of the head and neck with intermediate tumor thickness could be shown. The low incidence of occult nodal metastases and "skip"-metastases represents the basic for sentinel lymph node biopsy.     

鼻中隔恶性肿瘤的手术径路探讨

目的:探讨鼻中隔恶性肿瘤的手术径路。方法:16例中,鼻侧切开术8例、鼻内镜下手术5例、面中部揭翻术2例、经腭入路1例。并对其病理学特征、手术径路及预后进行回顾性分析。结果:16例中,鼻中隔鳞状细胞癌7例、腺样囊性癌4例、恶性黑色素瘤3例、腺癌1例、黏液表皮样癌1例。术后随访1~10年,其中失访1例,死亡2例,带瘤生存3例,无瘤生存10例。病死率为12.5%,带瘤生存率为18.8%,无瘤生存率为62.5%。结论:鼻中隔恶性肿瘤手术径路应根据病变范围、患者年龄采取不同的术式。如病变局限于鼻中隔前下部或后部,则鼻内镜下切除;如病变涉及鼻中隔全部或累及鼻腔其他部位,则以鼻侧切开为宜;若患者年龄较小,则以面中部揭翻或经腭入路为宜。     

Management of malignant melanoma of the head and neck using dynamic lymphoscintigraphy and gamma probe-guided sentinel lymph node biopsy

BACKGROUND: The sentinel lymph node (SLN) biopsy is revolutionizing the surgical management of primary malignant melanoma. It allows accurate nodal staging, and targets patients who may benefit from regional lymphadenectomy and systemic therapy; however, its use in the management of head and neck melanoma has not been widely accepted. METHODS: A retrospective review of patients treated for clinical stages I and II malignant melanoma of the head and neck with dynamic lymphoscintigraphy and gamma probe-guided SLN biopsy. RESULTS: Fifty-eight patients (47 male and 11 female) were identified. Primary melanoma sites included the scalp (21), ear (8), face (13), neck (15), and eyelid (1). Primary tumor staging was T2 (11), T3 (24), and T4 (23). Dynamic lymphoscintigraphy visualized SLNs in 57 patients (98.3%). In 43 cases (75%) a single draining nodal basin was identified, and in 14 cases there were multiple draining nodal basins. Sentinel lymph nodes were successfully identified in 72 (96%) of 75 nodal basins. Positive SLNs were identified in 10 patients (17.5%). Sentinal lymph node positivity by tumor staging was T3, 16.7% and T4, 27.3%. Completion lymphadenectomy revealed residual disease in 3 patients (30%). Relapse occurred in 10 (21.3%) of the 47 patients with negative SLN biopsy results and 7 (70%) of those with positive results. CONCLUSIONS: Gamma probe-guided SLN localization in the head and neck region was successful in 96% of draining nodal basins. It can target regional lymphadenectomy in patients who may benefit from regional nodal dissection.