女性尿道恶性黑色素瘤：附三例报告

报告原发性女性尿道恶性尿道恶性黑色素瘤３例，结合文献复习对其发病情况、临床过程、诊断，治疗及预后进行讨论。     

手指甲下恶性黑色素瘤八例报告

为提高临床对手指甲下恶性黑色素瘤的认识，对我科１９８２～１９９２年收治的８例手指甲床恶性黑色素瘤进行分析。肿瘤发生部位；拇指甲床６例，食指甲床１例，食指末端皮肤１例。大部分病人未能早期诊治，症状出现至确诊时间平均７年２个月。主要采用诚指术及转移淋巴结清扫术，并辅以免疫治疗、化疗及放疗。８例中无病存活３例，带病存活２例，死亡３例。中位存活时间４年８个月，平均无病存活时间２年８个月。本组结果提示早期确诊非常重要，凡可疑病变均应做病理检查，一旦确诊即行手指截除术。术后免疫治疗有一定效果，免疫治疗应持续１～２年，以后间断巩固治疗。转移病灶对放疗、化疗不敏感。术后应严密随访．积极治疗转移病灶。     

Intestinal melanoma: A broad spectrum of clinical presentation

INTRODUCTIONSmall intestine melanomas are rare and the most of them are metastases from primary cutaneous neoplasms.PRESENTATION OF CASEBelow, we report two cases of small intestine metastatic melanoma with very different clinical presentation.DISCUSSIONStill now, primary versus metastatic origin is often unclear. Small bowel melanoma is often asymptomatic. However, clinical picture can be various; it may occurs with non specific symptoms and signs of gastro-intetstinal involvement, like chronic abdominal pain, occult or gross bleeding and weight loss, or with an emergency picture due to intestinal intussusception, obstruction or, rarely, perforation.CONCLUSIONSmall bowel melanoma is rare and the diagnosis done late. Imaging techniques are recommended in order to obtain early diagnosis of gastrointestinal metastases.     

女性尿道原发性恶性黑色素瘤1例并文献复习

目的 结合文献资料复习,提高女性原发性尿道恶性黑色素瘤的诊疗水平.方法 回顾性分析1例女性原发性尿道恶性黑色素瘤患者临床资料.结果 病例行尿道癌根治术+回肠膀胱术,术后病理证实为尿道恶性黑色素瘤,浸及尿道全层及阴道浆膜面,阴道黏膜及肌层未见癌,膀胱、双侧附件、子宫体、宫颈未见癌,双侧盆腔淋巴结未见转移癌.已随访1年,...     

肛管直肠恶性黑色素瘤

为了探讨肛管直肠恶性黑色素瘤的疗效，对１９６０～１９９６年收治的２７例肛管直肠恶性黑色素瘤（ＡＲＭＭ）进行了临床分析，其中１６例行经腹会阴联合根治术（Ｍｉｌｅ＇ｓ术），６例行局部切除术，５例行剖腹探查术。２２例获随访，随访时间为１～１２年。结果表明：中位生存时间Ｍｉｌｅ＇ｓ术组２１．５月、局部切除术组１３．５月、剖腹探查术组７．０月。Ｍｉｌｅ＇ｓ术效果优于局部切除术。提示：对ＡＲＭＭ应行Ｍｉｌｅ＇ｓ术，并对伴有腹股沟淋巴结转移或可疑者行腹股沟淋巴结清扫     

膀胱原发性恶性黑色素瘤1例并文献复习

目的 观察原发性恶性黑色素瘤的病理形态、免疫组化和电镜特征,进一步探讨其组织起源和鉴别诊断,指导临床诊治.方法 用组织病理学、免疫组化、透射电镜方法进行观察,并结合国外文献资料进行探讨.结果 肿瘤位于膀胱黏膜下,瘤细胞呈巢状或弥漫排列,具有一定异型性,部分为透亮型,部分为小细胞型,靠近边缘的肿瘤细胞呈梭形伴黑色素沉着....     

Prognostic evaluation of intracranial metastasis in malignant melanoma

Background: Malignant melanoma (MM) is often reported as the third most common cause of intracranial metastasis (IM) after carcinoma of the breast and lung. Most patients with advanced MM will have widespread extracranial disease, but the majority will die from intracerebral spread. Methods: A retrospective review of 117 patients with documented IM from MM over the past 25 years was undertaken. Various factors (including age, race, sex distribution, primary lesions with Clark's level, Breslow's thickness, primary sites and staging at initial presentation, diagnosis of IM and its various treatment methods, survival data, and autopsy findings) were analyzed. Prognostic indicators were clarified from this analysis as a predictor of central nervous system (CNS) metastasis. An ideal treatment plan was also analyzed in order to predict a better survival. Results: Fifty-eight percent of patients were male; 42% were female. Seventy-one percent of the primary lesions were of Clark's level IV and V, with mean Breslow's thickness of 3.5 mm. Median time interval between the initial diagnosis and development of IM was 3.5 years. Complete surgical resection of the intracranial lesion in the brain resulted in the longest mean survival of 10.3 months, whereas mean survival for the group with no treatment was only 3 weeks. Patients with primary lesions of the head and neck had the lowest mean survival of 3.3 months, whereas those whose primary sites were unknown had the longest mean survival of 7.5 months. One- and 2-year survival were 9% and 3%, respectively. All but one of the 30 patients at autopsy were found to have visceral metastasis, namely of the lung, liver, and bone. Conclusion: An aggressive search for metastasis should be undertaken in patients at high risk of developing CNS metastasis, e.g., male, head and neck primary, Clark's level IV and V, Breslow's thickness of >3 mm, and presence of visceral metastases, mainly lung. A complete surgical resection should be attempted whenever possible, with adjunctive use of whole-brain irradiation, along with systemic chemotherapy for further control of recurrence and to prolong survival.Presented at the 46th Annual Cancer Symposium of the Society of Surgical Oncology, Los Angeles, March 18–21, 1993.     

bcl-2硫代反义寡核苷酸抑制人恶性黑色素瘤A375细胞bcl-2mRNA及蛋白的表达

目的 观察bcl-2硫代反义寡核苷酸（ASODN）对人恶性黑色素瘤A375细胞bcl-2mRNA及蛋白表达的影响。方法 对ASODN进行硫代修饰、脂质体转染人黑色素瘤A375细胞。实验分反义ASODN组、正义SODN组和对照组，采用逆转录聚合酶链反应（RT—PCR）和免疫组织化学检测bcl-2mRNA及蛋白水平。结果 免疫组织化学检测显示，反义组Bcl-2蛋白表达水平显著低于对照组和正义组（分别为53．14±4．26、138．22±8．45和141．08±7．83，P〈0．01）；RT—PCR结果示，反义组bcl-2mRNA水平明显低于对照组和正义组（分别为0．38±0．1l、0．964-0．13和O．97±0．14，P〈0．01）。结论 bcl-2硫代反义寡核苷酸能下调人黑色素瘤A375细胞bcl-2mRNA基因水平，阻断蛋白表达。     

足跟部恶性黑色素瘤的切除与修复重建

目的 探讨足跟部恶性黑色素瘤的手术切除和修复重建的原则。方法2001年5月～2003年12月收治8例恶性黑色素瘤，其中男5例，女3例。年龄28～56岁。病变均位于足跟部，病理检查均证实为恶性黑色素瘤；Hreslow分级：Ⅰ级2例，Ⅱ级5例，Ⅲ级1例。手术行局部广泛切除，根据足跟部软组织缺损大小，分别选用足外侧皮瓣、足底内侧皮瓣及腓肠神经营养血管逆行皮瓣移位修复，并于术前、术后应用干扰素治疗。结果术后8例皮瓣全部成活，随访1年6个月～4年，患者均健在，肿瘤未见复发。在功能及感觉恢复方面，足底内侧皮瓣与足外侧皮瓣最佳，腓肠神经营养血管逆行皮瓣恢复良好。结论足跟部恶性黑色素瘤应行局部广泛切除术，在切缘阴性的基础上进行修复重建，根据创面大小分别采用足外侧皮瓣、足底内侧皮瓣及腓肠神经营养血管逆行皮瓣移位修复，临床疗效满意。     

颅内原发性黑色素瘤的诊断及治疗

目的 探讨颅内原发性黑色素瘤的诊治方法。方法 分析１９６８年以来收治的６例颅内原发性黑色素瘤的临床表现、诊治方法和疗效。结果 临床表现无特异性,ＣＴ及ＭＲＩ均难以明确诊断。肿瘤全切除１例。在碚切除３酌,部分切除１例,活检１例。诊断颅内原发性恶性黑色素瘤３例,脑膜黑色素瘤３例。随访５例,３例恶性黑色瘤患者死亡,２例脑膜黑色素瘤３例,随访５例,３例恶性黑色素瘤鹗２死亡,２例脑膜黑色素瘤１例长期卧床,１     

直肠肛管恶性黑色素瘤的临床特征分析

目的了解原发性直肠肛管恶性黑色素瘤的临床特点。方法回顾性分析9例原发性直肠肛管恶性黑色素瘤的临床资料,并复习文献。结果直肠肛管恶性黑色素瘤以女性多见,平均发病年龄56岁,病程5.8个月;首发症状以血便为最常见,其次为肛门肿物突出。94.7%的直肠肛管恶性黑色素瘤在距离肛缘5.0cm范围内;肿瘤最大径(3.3±2.1)cm;其中54.5%可活动;有19.1%的肿瘤表面光滑;6.6%的肿瘤质地软;14.0%同期发现转移,肝转移最常见,腹股沟淋巴结转移其次;的病例出现误诊,超过者被误诊为良性疾病;手术治疗中以Miles术为主,经肛门局部切除术其次。结论直肠肛管恶性黑色素瘤极易误诊。手术治疗为主。     

Age as a prognostic factor in the malignant melanoma population

Background: The incidence of malignant melanoma is increasing faster than any other cancer, and the state of Florida has one of the highest incidence of melanoma in the United States. This increased incidence is thought to be due to the intense sunlight exposure and ultraviolet radiation exposure in the elderly population. With the increased emphasis on issues of aging, it is appropriate to study the role of age as a prognostic factor for malignant melanoma in the Florida population. Methods: A retrospective, computer-aided search identified 442 consecutively registered patients with malignant melanoma at the Cutaneous Oncology Program. All patients had stage 1 or 2 disease (cutaneous disease only) at diagnosis. Prognostic variables analyzed included the most powerful factors for stage 1 and 2 melanoma, tumor thickness, ulceration, and Clark level of invasion. Other prognostic variables included in the analysis were the clinical variables of sex and primary site (axial vs. extremity). The population was divided into patients 65 and >65 years of age. Results: Significant disease-free survival differences were encountered in the older population, with only 55% of the elderly population being disease free at 5 years compared with 65% for the younger population (p=0.0073). However, a greater percentage of patients with melanoma who were >65 years of age had ulcerated lesions (17.5% vs. 12.9%) and a greater percentage of thick lesions at diagnosis (67.2% vs. 62.7%). Both of these prognostic factors would bias the older population with a poorer survival. A stepwise regression analysis of the entire population was performed, treating age as a continuous variable. Surprisingly, increasing age along with tumor thickness were the only significant predictors for disease-free survival. After inclusion of these two prognostic variables, none of the other prognostic factors, including Clark level, ulceration, sex, and primary site, added to the prognostic model. Conclusions: From this analysis, it is apparent that geriatric patients with melanoma have a worse prognosis than a younger control population, even after the correction for the more commonly cited prognostic factors. This information should be used in mathematical modeling to identify high-risk populations who are candidates for perhaps more aggressive primary or adjuvant therapies.Presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993.     

In vitro and in vivo effects of photodynamic therapy on murine malignant melanoma

Background: The role of photodynamic therapy (PDT) in the treatment of malignant melanoma is not well defined, nor is it known whether the dark melanoma cells absorb the light used in PDT. Methods: In vitro studies: 2×10⁵ B16 murine melanoma cells were incubated with aluminum phthalocyanine (AlpcS₄, 2.5 mg/kg) and were then subjected to photoradiation (50, 100 or 200 J/cm²). Viability was then assessed.In vivo studies: Histology: C57/B1 mice received 2×10⁵ B16 cells subcutaneously and were randomized into study (PDT) and three control groups. AlpcS₄ 2.5 mg/kg was injected intraperitoneally and the mice were exposed to light (100 J/cm²). After 24 hours they were sacrificed and underwent autopsies. Survival: 40 mice were randomized into PDT (40 J/cm²) and control groups and were monitored for 50 days. Tumor growth: 40 mice were randomized into one control and three treatment groups (PDT on day 3, 6, or 12 after injection with B16 cells), and were monitored for 50 days. Temperature: Tumor temperatures before and at the end of PDT were recorded. Results: In vitro studies: PDT caused a decrease in cell viability to 15.5±0.7%, 11.5±2.1%, and 1.5±0.7% (at 50, 100, and 200 J/cm², respectively;P<.001). A significant reduction in thymidine incorporation was noted at all energy levels.In vivo studies: Histology: PDT caused massive tumor necrosis. Survival: PDT prolonged the survival of mice (41±13.4 days) compared to controls (15.8±3.8 days,P<.001). Tumor growth: 31 days after injection with B16 cells, the tumor size was 2.6±0.3 cm in the control group and 1.6±0.2, 0.9±0.3, and 1.0±0.4 cm in the PDT groups (days 3, 6 and 12, respectively;P<.01). Temperature: PDT increased skin temperature to 42.8°C±1.3°C, 45.3°C±3.5°C, and 51.7°C±2.7°C at 40, 60, and 100 J/cm², respectively (P<.01). Conclusions: Photodynamic therapy was found to have significant effects in experimental melanoma in mice. The role of PDT in human melanoma remains to be studied.Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, Illinois, March 20–23, 1997.     

Does endogenous immune response determine the outcome of surgical therapy for metastatic melanoma?

Background Although the presence of tumor cells in the blood of patients with metastatic melanoma suggests widely disseminated disease many of these patients enjoy prolonged survival or cure after surgical resection. Our previous study of adjuvant vaccine therapy after complete resection of metastatic melanoma revealed a strong correlation between postoperative survival and elevated antibody titers to a 90-kDa tumor-associated antigen (TA90) expressed by melanoma cells of the vaccine. We hypothesized a similar correlation between postoperative survival and endogenous anti-TA90 antibody titers induced by the patient’s melanoma in the absence of postoperative adjuvant immunotherapy. Methods From 1970 to 1996, 64 patients underwent complete resection of distant melanoma metastases and did not receive postoperative adjuvant immunotherapy. Serum collected within 4 months after surgery was tested in a coded and blinded fashion for anti-TA90 IgG and IgM by enzyme-linked immunosorbent assay, and for total IgG and IgM (controls) by radial immunodiffusion. Results Median follow-up for the study population was 19 months (range, 3–147 months). There was no significant correlation between anti-TA90 IgG titer and total IgG level (P=.4785), or between anti-TA90 IgM and total IgM (P=.0989). Univariate analysis showed that postoperative anti-TA90 IgM titer as a continuous variable was significantly associated with overall survival (OS); i.e, the higher the anti-TA90 IgM titer, the longer the OS. Using an established cutoff titer of 800, median OS was 42 months for patients with high anti-TA90 IgM titer (n=28) vs. 9 months for patients with low titers (n=36) (P=.0001). There was no significant correlation between total IgG/IgM and survival (P=.4107 and .4044, respectively). Multivariate, analysis identified anti-TA90 IgM as the most significant independent variable influencing OS after complete resection of distant melanoma metastases (P-.0001). Conclusions We conclude that the endogenous immune response to metastatic melanoma determines the outcome after surgical therapy. Enhancement of this specific immune response may prolong the survival of patients with distant melanoma metastases. Presented at the 52nd Annual Meeting of the Society of Surgical Oncology, Orlando, Florida, March 4–7, 1999.     

Sentinel lymph node biopsy in children and adolescents with malignant melanoma

Background/purpose

Sentinel lymph node biopsy (SLNB) provides valuable staging information for adult patients presenting with clinically localized cutaneous melanoma. There are little data pertaining to the use of SLNB in the pediatric melanoma population. The objective of this study is to investigate the use of SLNB in the pediatric population, focusing on its diagnostic and therapeutic implications.

Methods

Retrospective identification was made of patients 18 years or younger who underwent sentinel lymph node biopsy for clinically localized melanoma at Indiana University Medical Center between 1994 and 2001. Patient demographics, primary tumor thickness, location of primary tumor, presence of tumor ulceration, number of lymph nodes removed, pathology of examined nodes, and number of lymph nodes involved with tumor were recorded. Disease status and dates of last clinical contact were determined.

Results

Twelve patients, 18 years or younger, were identified. Mean age of the study population was 14.1 years (range, 4 to 18). Mean tumor thickness was 1.65 mm (range, 0.36 to 4.7 mm). Three patients (25%) had positive sentinel lymph node biopsies. All 3 patients underwent completion lymph node dissection (CLND). One patient had micrometastatic disease detected on CLND; he had recurrence 6.1 months later and died 7.5 months after his SLND/CLND. At a median follow-up of 11.7 months, the remaining 11 patients had not experienced recurrence. There were no complications related to the SLNB procedure.

Conclusions

The minimally invasive surgical approach and limited complications associated with SLNB make this procedure a useful aid in assisting the physician in making therapeutic decisions in the pediatric melanoma patient.     

Routine restaging PET/CT and detection of initial recurrence in sentinel lymph node positive stage III melanoma

Background

Follow-up of patients with sentinel lymph node–positive stage III melanoma uses history, physical exam, and cross-sectional imaging. The aim of this study was to evaluate positron emission tomographic (PET)/computed tomographic (CT) scans in the detection of recurrence.

Methods

From 2003 to 2009, a single-institution prospective database of all cutaneous melanoma patients was used to identify sentinel lymph node–positive stage III patients with disease-free survival >1 year and 1 restaging PET/CT scan.

Results

Thirty-eight patients were identified, with a median follow-up period of 27.5 months. Seven (18%) developed recurrence (median time to recurrence, 25 months). Recurrences were detected as follows: 3 by patients, 1 by physician, 1 by PET/CT scan and lactate dehydrogenase, 1 by PET/CT scan, and 1 by brain magnetic resonance imaging. One hundred eight follow-up PET/CT scans were performed. Two of 38 patients had asymptomatic metastases detected by routine restaging PET/CT scan, and there were 9 scans with false-positive results.

Conclusions

With short follow-up, the utility of routine PET/CT scans in identifying unsuspected recurrence in patients with sentinel lymph node–positive stage III melanoma appears minimal.