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.

Surgical treatment for cutaneous malignant melanoma

Objective: To investigate the efficacy of surgical treatment for cutaneous malignant melanoma. Methods: Retrospective analysis of clinical records, surgical procedures and the prognosis was performed in 93 patients who were diagnosed of cutaneous malignant melanoma and underwent surgical treatment between October 2007 and December 2011. According to American Joint Committee on Cancer (AJCC) staging system, one patient was in stage ⅠA, two patients were in stage ⅠB, eight patients were in stage ⅡA, nine patients were in stage ⅡB, twenty patients were in stage ⅡC, eighteen patients were in stage ⅢA, seventeen patients were in stage ⅢB, sixteen patients were in stage ⅢC, and two patients were in stage Ⅳ. The surgical procedures include extensive skin resection for 26 patients, extensive skin resection plus construction with skin graft or local flap for 7 patients, finger (toe) amputation for 8 patients, ilioinguinal lymph node dissection for 32 patients, axillary lymph node dissection for 3 patients, extensive skin resection plus one-stage ilioinguinal lymph node dissection for 15 patients, and extensive skin resection plus one-stage axillary lymph node dissection for 2 patients. Fifty-three patients received adjuvant chemotherapy and seventy-eight patients received interferon or interleukin treatment. Of 93 patients, 77 patients were followed-up, with an average follow-up period of 20 months (range: 2-50 months). Results: All of three stage Ⅰ patients survived; of 28 stage Ⅱ patients, 8, 2 and 6 patients had linguinal lymph node, bone or skin metastasis 12, 18 and 36 months after surgical treatment, respectively; of 44 stage Ⅲ patients, 11 patients died of lung metastasis, and 5 patients died of liver metastasis during the follow-up; of 2 stage Ⅳ patients, 1 patients died of lung metastasis 12 months after surgical treatment, and 1 patient died of liver metastasis 11 months after surgical treatment. Of the 77 patients who were followed-up, 43 patients survived with neither local recurrence nor progressive disease. Conclusion: Early diagnosis and surgical treatment of cutaneous malignant melanoma can achieve desirable disease control, and the standardized regional lymph node dissection is important in the control of tumor progression, as well as the adjuvant therapy is benefit for the survival.