足底部恶性黑色素瘤的临床特征与治疗

目的探讨足底皮肤恶性黑色素瘤的临床特征及治疗效果。方法回顾性分析我院1998-2010年共收治的61例足底皮肤恶性黑色素瘤患者临床资料,主要采用手术、全身化疗及免疫治疗。根据分期不同,所有患者分别采用截趾术、病变切除+植皮术、病变切除+皮瓣转位,其中32例行同侧腹股沟淋巴结清扫术。用Kaplan-Meier法统计生存率,肿瘤溃疡、厚度、淋巴结转移等预后因素用Kaplan-Meier和Log-rank 方法进行分析。结果53例足底皮肤恶性黑色素瘤患者获得随访,其中8例2年后失访。随访时间为1~10年,平均4.5年。1年生存率为77.0%(47/61),3年生存率为58.5%(31/53),5年生存率为26.4%(14/53)。术后功能恢复,没有复发。27例患者死于远处转移,12例出现淋巴结转移。结论足底皮肤恶性黑色素瘤转移率高,易远处转移。患者预后与肿瘤溃疡、厚度、淋巴结转移等因素有关。足底皮肤恶性黑色素瘤,治疗应以手术、化疗、免疫等综合方法为主。     

原发性外阴、阴道恶性黑色素瘤14例临床分析

目的:探讨原发性外阴及阴道恶性黑色素瘤(恶黑)的临床诊治特点及影响预后的因素.方法:对我院1990年～2004年间收治的9例外阴恶性黑色素瘤及5例阴道恶性黑色素瘤的临床资料进行回顾性分析.结果:本组病例平均年龄55岁,发生于60岁以上者占42.9%(6/14).14例中手术治疗12例,其他治疗2例.术后发现9例外阴恶性黑色素瘤患者腹股沟淋巴结转移6例,盆腔淋巴结转移2例;阴道恶性黑色素瘤患者盆腔淋巴结转移2例.随访4例中复发1例(Ⅲ期),转移1例(Ⅲ期),其病灶直径均大于2cm.1例Ⅳb期患者出现右下肢浮肿.另有1例Ⅰ期患者术后7个月未见异常.结论:外阴及阴道恶性黑色素瘤预后不良.治疗原则应采用以手术为主的综合治疗,其预后与有无黑色素沉着,组织病理类型,生长方式,肿瘤厚度(Breslow),侵入皮肤层次(Clark),淋巴结转移情况及脉管内瘤栓等因素有关.     

前哨淋巴结活检在外阴恶性黑色素瘤治疗中的初步研究

目的:初步探讨前哨淋巴结(SLN)在外阴恶性黑色素瘤治疗中的临床应用可行性.方法:3例外阴恶性黑色素瘤患者接受根治性外阴切除术+双腹股沟淋巴结清扫术,术前在肿瘤周围皮下粘膜注射1%亚甲蓝溶液1.5ml.术中先行SLN活检术(SLNB),根据染料指示在腹股沟术野内对淋巴结组织进行精细解剖,分离出蓝染的淋巴结为SLN.SLN与清扫术中的非前哨淋巴结(NSLN)分别送检,通过HE染色常规病理检查时病理结果进行比较.结果:3例患者均有SLN检出,分别为1、5、3枚.清扫手术切除NSLN分别为19、32、16枚.3例中1例出现淋巴结转移,为1枚SLN转移;其余2例无淋巴结转移发生.没有假阴性情况出现,无与本研究相关的损伤及副反应发生.结论:SLNB应用于外阴恶性黑色素瘤具有可行性.     

外阴阴道恶性黑色素瘤20例临床分析

目的:研究原发女性外阴阴道恶性黑色素瘤的临床特点、治疗和预后.方法:系统回顾本院自1976年6月-2006年3月收治的20例原发性女性外阴阴道恶性黑色素瘤的临床资料.结果:本组病例平均年龄48.5岁,绝经后妇女占55%.20例病例中手术治疗19例,1例仅行腹壁下动脉化疗.术后发现8例外阴恶性黑色素瘤患者腹股沟淋巴结转移2例,12例阴道恶性黑色素瘤中,腹股沟淋巴结转移2例,盆腔淋巴结转移2例.外阴恶性黑色素瘤的5年生存率为25%,平均生存期为40.7个月,阴道恶性黑色素瘤的5年生存率为16.7%,平均生存期为19.7个月.结论:女性外阴阴道恶性黑色素瘤是一类恶性程度高,预后差的肿瘤,手术是治疗的主要手段,临床分期,肿瘤部位,病灶大小,淋巴结转移及治疗方法是影响预后的因素;局部复发和早期转移是预后差的主要原因.     

足底部恶性黑色素瘤切除术后两种修复方法临床疗效观察

目的：比较足底部皮肤恶性黑色素瘤切除术后两种修复方法的疗效。方法：回顾性分析2006年7月~2014年2月我院收治31例足底部皮肤恶性黑色素瘤患者临床病理资料,其中男14例,女17例。临床分期：I期2例,Ⅱ期9例,Ⅲ期20例。手术均行距肿瘤边缘2cm的广泛切除＋腹股沟淋巴结清扫术；足底肿瘤切除术后缺损以两种方式修复,A组（11例）：直接从同侧腹股沟切口取全厚皮片修复或皮瓣修复＋取同侧腹股沟全厚皮片修复供皮瓣区。 B组（20例）：直接取同侧大腿中厚皮片植皮修复或皮瓣修复＋取同侧大腿中厚皮片修复供皮瓣区；比较两组患者的手术时间、术中出血量、术中淋巴结清扫数目、住院时间、住院费用、腹股沟伤口并发症及足底局部复发情况等方面的差异。结果：术后足底缺损区植皮或皮瓣完全成活,肿瘤均无局部复发。两种方法在住院时间、住院费用及腹股沟伤口术后并发症方面差异有统计学意义（p0．05）。结论：与从同侧大腿取中厚皮片修复相比,从腹股沟切口直接取全厚皮片修复减少手术伤口,并发症少,住院时间短,住院费用低,是一种较理想的修复方法。     

预防性淋巴结清扫在恶性黑色素瘤治疗中的价值

目的 探讨预防性区域淋巴结清扫在恶性黑色素瘤治疗中的价值。方法 56例WHO临床分期Ⅰ期即区域淋巴结不能扪及的肢体恶性黑色素瘤随机分为清扫组和对照组,清扫组30例施行预防性区域淋巴结清扫,而对照组26例不进行预防性区域淋巴结清扫,两组均以至少2cm的边界对原发灶做广泛切除和术后应用相同方案的辅助治疗。用Kaplan Meier法统计清扫组和对照组的生存率,以Log rank检验比较两组的生存曲线。结果 全部病例获得11月～84月随访,中位随访期43.5月,清扫组和对照组5年生存率分别为64.79%和33.68%,清扫组生存率较对照组高,生存曲线Log Rank检验比较（P=0.0414）显示两组间差异有统计学意义。结论 预防性区域淋巴结清扫有助于提高WHO分期Ⅰ期的恶性黑色素瘤病例的生存率。     

手足黑色素瘤的外科治疗及其预后

目的探讨手足黑色素瘤的手术方式及影响预后的因素.方法回顾分析经手术治疗的患者99例,对可能影响预后的因素进行分析并进行统计学处理.结果足底发病率多于手掌,指甲多于趾甲.总5年生存率33.3%,肿瘤厚度2～4 mm者5年生存率为64.5%,＞4 mm为18.1%(P＜0.001).肿瘤有溃疡者5年生存率为27.3%,而无溃疡为36.3%,但无统计学差异.肿瘤局部切除与截肢术患者5年生存率相似,行预防性区域淋巴结清扫术与未清扫淋巴结患者5年生存率相似.结论影响患者预后的主要因素是肿瘤厚度,应强调早期治疗.手术应根据病变部位,在保证切缘无癌残留的基础上保持患肢功能,选择局部扩大切除或远端肢体截除术;对淋巴结有转移者选择治疗性淋巴结清扫术.     

不同时期淋巴结清扫术对阴茎癌预后的影响

目的 回顾性分析295例阴茎癌的临床资料,比较阴茎癌不同时期行双侧腹股沟淋巴结清扫对预后的影响,探讨阴茎癌有效合理的手术治疗方法。方法 回顾性调查随访哈尔滨医科大学附属第三医院和解放军第二一一医院的295例阴茎癌患者,收集年龄、职业、病理、Jackson分期、淋巴结转移等可能影响其生存情况的因素。按照一期是否行双侧腹股沟淋巴结清扫术将患者分为两组,采用Log-rank检验、Cox回归等统计方法分别比较淋巴结有转移情况和无转移情况下两组患者的生存预后。结果 295例患者均获得随访。一期手术患者212人,二期手术患者83人。无淋巴结转移情况下,一期组5年生存率为96.12%;二期组为80.00%,有淋巴转移情况下,一期组5年生存率为91.30%,二期组为50.80%,不同淋巴结转移情况下一期组生存率均高于二期组(χ²=37.406,P＜0.001;χ²=53.427,P＜0.001)。经Cox回归分析,不同时期行淋巴结清扫术、年龄、化疗药物对预后的影响显著。结论 阴茎部分切除术或阴茎全切除术同时行双侧腹股沟淋巴结清扫术是治疗阴茎癌十分合理和有效的方法,根治术同期行腹股沟淋巴结转移生存率与二期行双侧腹股沟淋巴结清扫术有显著差异。     

皮肤恶性黑素瘤的外科治疗

目的:探讨皮肤恶性黑素瘤的外科治疗方式.方法:回顾性分析2007年10月—2011年12月共93例皮肤恶性黑素瘤患者的临床资料、外科手术方式和预后.按照美国癌症联合委员会(American Joint Committee on Cancer,AJCC)外科分期标准: ⅠA期1例, Ⅰ B期2例,Ⅱ A期8例,Ⅱ B期9例,Ⅱ C期20例,Ⅲ A期18例,Ⅲ B期17例,Ⅲ C期16例,Ⅳ期2例;外科手术方式:广泛切除术26例,广泛切除术十游离植皮或转移皮瓣重建术7例,截指(趾)8例,髂腹股沟淋巴结清扫术32例,腋窝淋巴结清扫术3例,广泛切除术十一期髂腹股沟淋巴结清扫术15例,广泛切除术十一期腋窝淋巴结清扫术2例;术后辅助化疗53例,干扰素或白细胞介素治疗78例.对77例患者进行了随访,平均随访时间为20 (2～50)个月.结果:Ⅰ期3例患者均存活;Ⅱ期获随访的28例患者中,8例于术后12个月时出现腹股沟淋巴结转移,2例于术后18个月时出现骨转移,6例于术后36个月时出现皮内转移;Ⅲ期获随访的44例患者中,11例于随访期间死于肺转移,5例死于肝转移;Ⅳ期2例患者中,1例于术后12个月时因肺转移而死亡,1例于术后11个月时因肝转移而死亡.随访期间,77例患者中的43例患者为无进展生存.结论:早期发现以及早期手术治疗皮肤恶性黑素瘤可以获得较好的疾病控制率,规范化的区域淋巴结清扫术是控制疾病进展的重要手段,术后辅助治疗可使生存获益.     

头颈部皮肤与粘膜恶性黑色素瘤的临床探讨

目的 :探讨头颈部皮肤恶性黑色素瘤和粘膜恶性黑色素瘤的转移规律及疗效 ,及头颈部粘膜恶性黑色素瘤套用皮肤恶性黑色素瘤临床分期是否合理。方法 :采用回顾性多因素回归分析 ,将 5 5例头颈部恶性黑色素瘤分成皮肤恶性黑色素瘤组 31例 ,黏膜恶性黑色素瘤 2 4例 ,分析转移规律及预后因素。结果 :皮肤恶性黑色素瘤和粘膜恶性黑色素瘤原发灶复发率、淋巴结转移率、血行转移率分别为 4 8 38%、4 5 16 %、2 1 81%和 37 5 0 %、4 1 6 7%、33 33% ;多因素回归分析两组原发灶复发率、淋巴结转移率、血行转移率有显著性差异 (P <0 0 5 ) ,临床分期、原发灶首次手术方式、起源影响复发率和转移率 (P<0 0 5 )。皮肤恶性黑色素瘤组和粘膜恶性黑色素瘤组 1、3、5年生存率分别为 81 15 %、6 6 2 0 %、4 5 0 7%和 81 95 %、4 9 72 %、39 77% ;多因素回归分析两组间生存率无显著性差异 (P >0 0 5 ) ,临床分期、原发灶首次手术方式、血行转移影响头颈部恶性黑色素瘤生存率 (P <0 0 5 )。分组后行多因素回归分析 ,皮肤恶性黑色素瘤组临床分期与生存率有显著性差异 (P<0 0 1) ,黏膜恶性黑色素瘤组临床分期与生存率无显著性差异 (P >0 0 5 )。结论 :①皮肤恶性黑色素瘤原发灶复发率、淋巴结转移率高 ,粘膜恶性黑色     

Outcome of sentinel lymph node biopsy and prognostic implications of regression in thin malignant melanoma

Thin melanomas with partial or complete regression may provide clues about antitumor immunity, but their management remains controversial. We have characterized the management and clinical outcomes of regressed thin (<1 mm) T1a melanomas and hypothesized that regression increases the risk of regional metastases when compared with nonregressed thin melanomas. A prospectively collected clinical database was reviewed, and T1a melanomas with regression were identified. Histology, surgical approach, outcome, and survival were evaluated. The primary outcome measures were sentinel node positivity, subsequent lymph node metastasis, and survival. A total of 75 patients with T1a or in-situ melanomas were grouped into three subsets. Group 1: 35 underwent a sentinel node biopsy (SNBx), none of which were positive. No patients developed nodal recurrence. The 5-year survival of this group was 93%, with a median follow-up of 52 months. Group 2: 31 were followed up without SNBx; two developed regional nodal disease (6.5%), neither of whom died of subsequent distant disease. The 5-year survival was 89%, with a median follow-up of 38 months. There was no significant difference in the survival between groups 1 and 2. Group 3: nine patients presented with metastatic disease concurrent with a regressed thin melanoma. These patients had a median survival of 2.3 years and a 4-year survival estimate of 22%. Regression should not be used as an indication for SNBx in T1a melanomas; we recommend that such patients be managed with wide local excision and a long-term clinical follow-up. The poor prognosis of thin regressed primary melanoma with simultaneous metastatic disease may indicate the existence of immune escape phenotypes supporting melanoma progression.     

Ultrathin primary is a marker for worse prognosis in lymph node–positive cutaneous melanoma

BACKGROUND:

Lymph lymph node metastasis from melanoma ≤0.50 mm (ultrathin) is an infrequent event. However, because many newly diagnosed melanomas are ultrathin, a significant proportion of patients who present with lymph node disease have an ultrathin melanoma. The authors hypothesized that ultrathin melanomas that present with lymph node metastasis represent biologically aggressive lesions with a worse prognosis.

METHODS:

The Surveillance, Epidemiology, and End Results registry data were queried to identify patients with cutaneous melanoma who presented with lymph node metastasis diagnosed between 1998 and 2008. Hazard ratios (HRs) from Cox proportional hazards regression models were used to compare disease‐specific survival (DSS) between various tumor depths.

RESULTS:

In total, 6134 patients with lymph node‐positive melanoma were identified and stratified according to tumor depth, including 588 (10%) with a tumor depth ≤0.50 mm, 519 (8%) with a tumor depth from 0.51 to 1.00 mm, 1669 (27%) with a tumor depth from 1.01 to 2.00 mm, 1871 (31%) with a tumor depth from 2.01 to 4.00 mm, and 1487 (24%) with a tumor depth >4.00 mm; and the respective 5‐year DSS rates were 63%, 76%, 75%, 60%, and 43%. Multivariable analysis confirmed a similar trend in HRs for DSS: The HR was 1.00 for a tumor depth ≤0.50 mm (reference category) and 0.64 (P < .001), 0.65 (P < .001), 0.95 (P = .57), and 1.42 (P < .001) for tumor depths of 0.51 to 1.00 mm, 1.01 to 2.00 mm, 2.01 to 4.00 mm, and >4.00 mm, respectively. This association of tumor depth with DSS persisted for N1 and N2 disease but not for N3 disease.

CONCLUSIONS:

Ultrathin melanoma (≤0.50 mm) was identified as a marker of poor prognosis in the setting of lymph node metastasis. These results may improve recommendations for adjuvant therapy, surveillance protocols, and risk stratification for clinical trials. Cancer 2013. © 2013 American Cancer Society.     

两种治疗足跟与足跖部皮肤恶性黑色素瘤手术的远期疗效评价

 目的　探讨手术治疗足跟与足跖部部皮肤恶性黑色素瘤的适宜方式。方法　对 1 994年以来收治的 1 2例足跟与足跖部皮肤恶性黑色素瘤患者在病灶彻底切除后 ,7例患者采用岛状皮瓣转移修复创面 ,5例患者采用全厚皮片移植修复创面。对其临床资料与随访结果进行回顾性总结和分析。结果　皮瓣修复组获得随访的 6例患者均存活 ,术区外形和功能恢复良好 ,局部无复发 ;皮片修复组 4例患者获得随访 ,其中 2例死亡 ,1例局部复发 ,1例发生全身转移 ,另外 2例存活 ,术区外形和功能尚满意。结论　在一定的广度和深度彻底切除足跟与足跖部皮肤恶性黑色素瘤是取得良好疗效的关键 ,其中切除深度更重要。     

Gastric cancer with extragastric lymph node metastasis: multivariate prognostic study

Background. Although many authors have investigated the prognostic factors of gastric cancer, there are few comprehensive studies on the prognosis of patients with extensive lymph node metastasis. The aim of this study was to clarify the prognostic factors of gastric cancer with extragastric lymph node metastasis, using multivariate analysis. Methods. The study population consisted of 121 patients who had undergone radical gastrectomy and extended lymph node dissection (D2, D3) for gastric cancer with extragastric lymph node metastasis. We examined 18 clinicopathologic factors, including the type of gastrectomy, tumor size, depth of wall invasion, status of lymph node metastasis, and stage of disease. Survival rates were analyzed by the Kaplan-Meier and Mantel-Cox methods, and multivariate analysis was done using the Cox proportional hazards model. Results. The overall 5-year survival rate was 32%, and the 5-year survival rate after curative gastrectomy was 37%. Overall survival rate was associated with the type of gastrectomy, stage of disease, operative curability, tumor size, depth of wall invasion, and anatomical distribution of positive nodes, whereas the survival rate after curative gastrectomy was correlated with the type of gastrectomy, stage of disease, tumor size, gross type, and depth of wall invasion. Independent prognostic factors were operative curability and depth of wall invasion, and survival after curative gastrectomy was influenced only by the depth of wall invasion (mucosa and submucosa [T1], muscularis and subserosa [T2] vs serosa [T3]). Conclusion. In patients with gastric cancer with extragastric lymph node metastasis, independent prognostic factors after gastrectomy were operative curability and depth of wall invasion. Long-term survival can be achieved when the patients have no serosal invasion (T1, T2) and are treated by curative gastrectomy. Received: August 7, 2000 / Accepted: December 19, 2000     

A micromorphometry-based concept for routine classification of sentinel lymph node metastases and its clinical relevance for patients with melanoma

BACKGROUND: The sentinel lymph nodes (SLNs) as the primary targets for lymphatic metastases can be removed selectively by gamma probe-guided sentinel lymph nodectomy (SLNE) in nearly all patients with cutaneous melanoma. Correspondingly high standards in terms of specificity, sensitivity, and microstaging are required for the evaluation of SLNs. METHODS: Since 1995, the authors have performed SLNE in 389 lymph node regions (LNRs) on 342 patients with melanoma. The harvested 636 SLNs and a further 1394 nonsentinel lymph nodes (non-SLNs) were evaluated by standardized, semiserial section histology, including immunohistochemistry. For each LNR, this technique permitted routine S classification using two simple morphometric parameters: the number of tumor-involved, 1-mm slices of the SLNs (n) and the centripetal depth of metastatic cell invasion (d). S1 was defined by 1 < or = n < or = 2 and d < or = 1 mm, equivalent to localized peripheral tumor cell deposits; S2 was defined by n > 2 and d < or = 1 mm, indicating more extended peripheral metastases; S3 was defined by d > 1 mm in SNLs with deeper metastatic infiltration; and S0 meant no detectable tumor cells (n = 0). RESULTS: The authors diagnosed 325 SLNs as S0, 24 SLNs as S1, 22 SLNs as S2, and 18 SLNs as S3. The occurrence of at least one melanoma-positive non-SLN subsequent regional completion lymph node dissection (RCLND) significantly increased from 0 of 12 in S1 SLNs to 2 of 13 in S2 SLNs and 9 of 15 in S3 SLNs (P = 0.001; chi-square test). Like the T classification of the primary melanoma, the S classification proved to be a highly significant predictor for distant metastasis (P < 0.001). It turned out to be an independent factor of influence on distant metastasis and survival in multivariate Cox analyses, which included tumor thickness, primary tumor site, patient gender, and patient age as covariates. CONCLUSIONS: The data presented recommend the S-staging concept as a promising option to fill a gap between the T and conventional N component of the pTNM classification. If its predictive capacity can be confirmed in multicenter studies, then the S classification may become the decisive criterion for or against RCLND, and a combined T plus S staging system will help to improve prognostically relevant stratification of melanoma patients in adjuvant therapy trials.     

Conditional survival of malignant melanoma in The Netherlands: 1994–2008

BackgroundCutaneous malignant melanoma causes the majority of skin cancer related deaths and features increasing incidence and mortality rates in the Netherlands. Conditional survival analysis is performed on patients who survived the preceding year(s).MethodsPatients with invasive melanoma, as recorded in the population-based Netherlands Cancer Registry, were included. To assess prognosis of melanoma survivors according to gender and Breslow thickness, conditional five-year relative survival was calculated for lymph node negative melanoma patients and conditional one-year relative survival was analysed for melanoma patients with and without nodal involvement.FindingsBetween 1994 and 2008, 40,050 patients developed a melanoma (stage I–III, of whom 6% with nodal involvement). Six to 8 years after diagnosis, survival of patients with a 1–2 mm (T2) thick melanoma equalised the general population. Conditional five-year relative survival for patients with >4 mm thick (T4) melanomas increased from about 60% at diagnosis to 90% at 7 years after diagnosis. Largest improvements were found in patients with thick melanomas and female patients with nodal involvement.InterpretationThe prognosis for melanoma survivors improved with each additional year of survival after diagnosis, except for patients with a ⩽1 mm thick melanoma, who never had any excess mortality during follow-up. Conditional survival of melanoma was better amongst females, amongst those with lower Breslow thickness and nodal stage.     

手术联合免疫疗法治疗皮肤恶性黑色素瘤的疗效分析

目的探讨采用手术联合免疫疗法治疗皮肤恶性黑色素瘤的临床疗效。方法1998年8月-2010年12月,对收治的34例皮肤MM患者按照无瘤技术在一定深度与广度完整切除肿瘤病灶,根据创面部位、大小、深度,遵照“宁近勿远,宁简勿繁”的原则,分别选择皮瓣或皮片修复创面;术后按照“扶正驱邪”理论,选择免疫治疗做为辅助治疗,并按期随访。结果14例采用18个皮瓣修复,皮瓣均100%成活,术区外形与功能良好;13例于术后7~132月得到随访,9例存活,4例死亡;存活者中最长1例已无瘤健康存活11年。18例皮片修复者中,7例皮片存活率为95%左右,经换药愈合;其余11例皮片成活率均为100%,术区外形与功能均良好;15例术后12~120月随访结果显示,9例存活,6例死亡。2例分别行掌指/跖趾关节离断术者,伤口一期愈合,现分别为手术后15月与24月,全身情况良好,局部无任何复发迹象。结论手术联合免疫治疗是目前治疗皮肤恶性黑色素瘤的良好方法。     

脉络膜恶性黑色素瘤立体定向放射外科治疗初探

目的　评价立体定向放射外科治疗脉络膜恶性黑色素瘤的临床价值。方法　1 6例脉络膜恶性黑色素瘤患者中,2例接受单次立体定向放射外科治疗,1 4例采用分次立体定向放射外科治疗。靶中心1～2个,准直器1 5～4 0mm ,参考剂量曲线70 %～90 %,单次治疗DT2 5Gy/次和DT35Gy/次,分次治疗总剂量DT4 2～5 5Gy/ 3～4次,共4～1 6d。结果　中位随访期6 6个月(3～1 0 0个月) ,1 6例患者全部生存。1 6例中,有1 3例随诊满5年,其5年生存率为1 0 0 %。有7例患者疗后4～1 5个月摘除眼球,其中担心肿瘤未控中断观察2例,继发性青光眼3例,角膜溃疡2例。全组有1例发现远处转移。结论　立体定向放射外科治疗脉络膜恶性黑色素瘤是安全有效的,适用于肿瘤位于后极(或位于赤道后1 / 2 )、最大径线<2 0mm、厚度<1 5mm的脉络膜恶性黑色素瘤。     

The effectiveness of complete decongestive physiotherapy for the treatment of lymphedema following groin dissection for melanoma

OBJECTIVE: Groin dissection is performed for the treatment of melanoma and other malignancies. Lymphedema rates as high as 47% have been reported. In 1996, we began using complete decongestive physiotherapy (CDP) in selected patients with lymphedema following groin dissection. Here, we review our results in a small cohort of patients. METHODS: A retrospective review of the medical records of 14 patients, treated with CDP for lymphedema secondary to groin dissection for melanoma was conducted. All patients were treated with CDP at Roswell Park Cancer Institute (RPCI), between 1996 and 2002. Of the 14 patients, 12 underwent groin dissection at RPCI. Response to therapy was measured by limb volume determinations. Patient gender, age, body mass index (BMI), type of operation, type of adjuvant therapy, time to treatment, patient compliance, lymphedema stage, and initial edema were analyzed for association with response to treatment. Incidence was estimated by a review of the operative logs. RESULTS: Fourteen patients were treated with CDP for lymphedema secondary to groin dissection for melanoma, with a median decrease in lymphedema of 60% (range: 35-145%; P = 0.0003). Increased BMI was associated with a decreased response to treatment (P = 0.02). Response to CDP was not effected by time to treatment, patient compliance, lymphedema stage, and initial edema. During this time, 39 groin dissections were done at RPCI. The incidence of lymphedema treated with CDP at RPCI was 31% (12/39; standard error 7.4%). CONCLUSIONS: With a decrease in lymphedema of 60%, CDP may provide relief for patients with lymphedema following groin dissection. Elevated BMI was associated with a decreased response to CDP.