综合治疗足底皮肤恶性黑色素瘤

 目的 探讨足底皮肤恶性黑色素瘤的手术疗效. 方法 回顾性分析我院1998～2004年共收治的31例足底皮肤恶性黑色素瘤患者,均有病理学证实,采取手术、Ⅰ期腹股沟淋巴结清扫术为主的综合方式治疗足底皮肤恶性黑色素瘤.用Kaplan-Meier法统计生存率,用Log-rank检验模型对患者肿瘤大小、厚度、手术切除范围等影响因素进行分析. 结果 31例足底皮肤恶性黑色素瘤患者至今生存22例,5年生存率为70%（22/31,P＝0.0366）,无局部复发,Ⅰ期行腹股沟淋巴结清扫术28例,9例出现腹股沟淋巴结转移,4例出现全身多处转移,死亡9例.T〈1.5mm,1.5mm〈T〈2.5mm,2.5mm〈T〈4.0mm,T〉4.0mm,5年生存率分别是66.7%,63.64%,30%,0%. 结论 足底皮肤恶性黑色素瘤恶性程度高,易远处转移.综合方式治疗可降低转移率,使大部分患者的生存期得到延长.

Comprehensive Treatment of Melanoma on Foot

Objective 　To study the clinical operative treatment of cutaneous malignant melanoma on foot .Methods 　Since 1998 to 2004 , 31 patient s with melanoma on foot were treated in our department by comprehensive treatment , individual operation , and first stage radical groin dissection . Their clinical materials and follow up results were ret rospectively analyzed. Results 　22 patients were survived. The appearance and function of foot recovered well , the recurrence didn’t appear in operative sites. The 5-year overall survival rates of 31 patient s were 70 %(22/ 31) . T < 1. 5mm ,1. 5mm < T < 2. 5mm , 2. 5mm < T < 4. 0mm ,T > 4. 0mm were 66. 7 % ,63. 64 % ,30 % , 0 % respectively. Among them , nine patient s died f romsystemic metastasis , regional groin lymph node metastasis appeared in nine patients , the other patients survived. Factors that might be related to survival , including tumor size , excising depth and range , were analyzed by Kaplan-Meier and Log-rank method. Conclusion 　Patient s with melanoma on foot had high distant metastasis rate. Distant metastasis is an important factor that affects the survival rate. It might be a key to reach satisfactory curative effect to thoroughly individual excise melanoma on foot in a certain range and depth.