牙龈无色素恶性黑色素瘤1例报道并文献复习

目的：分析牙龈无色素恶性黑色素瘤的临床及病理特点，提高该病在口腔黏膜发病的认识、减少误诊、漏诊。方法：报道1例牙龈原发性无色素恶性黑色素瘤患者的临床资料，对其进行组织学观察及免疫组化标记。结果：镜下瘤组织呈小结节状，可见梭形细胞区及大部分为小圆形细胞弥漫分布区，并见有腺泡样结构，组织形态多样化。免疫组化标记瘤细胞表达HMB45、S-100、Vimentin、CK，而LCA、CD20、CD79ct、Act、Myg、EMA均为阴性。结果：口腔黏膜原发恶性黑色素瘤是一种少见的恶性黑色素瘤，尤其是无色素恶性黑色素瘤更是罕见，其临床表现无特异性，具有易复发、易转移、预后差的特点，病理表现形态复杂多样，临床与病理均要与口腔低分化癌、淋巴瘤、软组织肉瘤等鉴别，预后不良。     

病人源性头颈部黏膜恶性黑色素瘤细胞模型的构建及鉴定

目的：构建及鉴定头颈部黏膜恶性黑色素瘤（mucosal melanoma of head and neck, HNMM）病人源性肿瘤细胞（patient derived tumor cell, PDC）模型。方法：通过肿瘤组织块原代培养、分离肿瘤细胞,利用免疫荧光染色鉴定分离的肿瘤细胞;以PDC皮下成瘤,通过组织切片染色和免疫组织化学染色对比病人原发灶和PDC成瘤组织的细胞学形态。结果：头颈黏膜恶性黑色素瘤患者移植瘤组织块分离出的细胞细胞膜和细胞质HMB-45和Melan-A免疫荧光染色呈阳性。PDC可以在裸鼠皮下成瘤,成瘤组织与患者组织细胞形态一致。结论：头颈部黏膜恶性黑色素瘤构建的PDC模型能够反映患者的组织学特征,PDC模型能够为头颈部黏膜恶性黑色素瘤的研究提供可靠的模型。     

口腔黏膜恶性黑色素瘤与鳞癌之间颈淋巴结转移差异性比较

目的：比较口腔黏膜恶性黑色素瘤与鳞癌之间颈淋巴结转移异同点.方法：收集2000年1月～2011年12月口腔黏膜恶性黑色素瘤及鳞状细胞癌颈部Ⅰ-Ⅲ区淋巴结转移患者的回顾性资料;x2检验比较口腔鳞癌患者与口腔黏膜恶性黑色素瘤患者之间Ⅳ-Ⅴ区转移率差别.结果：口腔黏膜恶性黑色素瘤Ⅰ-Ⅲ区转移患者31例（35侧）,其中Ⅰ-Ⅲ/Ⅳ-Ⅴ区转移4侧,转移率11.42％（4/35）;口腔鳞癌Ⅰ-Ⅲ区转移患者170例（175侧）,其中Ⅰ-Ⅲ/Ⅳ-Ⅴ区转移12侧,转移率6.86％（12/175）,x2检验结果显示两者间Ⅳ-Ⅴ区转移无统计学差异（P =0.352＞0.05）.结论：口腔黏膜恶性黑色素瘤临床上比较少见,其颈部淋巴结转移主要发生在Ⅰ-Ⅲ区;口腔黏膜恶性黑色素瘤Ⅳ-Ⅴ区转移率与口腔鳞癌相类似.     

头颈部黏膜恶性黑色素瘤的临床分期

恶性黑色素瘤属于易复发和高转移率的恶性肿瘤。与头颈部鳞状细胞癌具有统一独立的肿瘤淋巴结转移(TNM)分期不同,头颈部黏膜恶性黑色素瘤的临床分期一直沿用皮肤恶性黑色素瘤的TNM分期。但头颈部黏膜在组织学结构上与皮肤有着显著的差异,所以头颈黏膜恶性黑色素瘤应该具有一套独立的分期体系,以利于临床上进行诊治和判断预后。下面就口腔、鼻腔和副鼻窦黏膜恶性黑色素瘤分期的研究进展作一综述。     

卡介苗辅助治疗口腔颌面部恶性黑色素瘤初步报道

恶性黑色素瘤是恶性程度较高，治疗效果较差的一种肿瘤，该瘤细胞具有抗原性，与免疫有关，卡介苗(BCG)能提高机体免疫机制及抗癌能力，作者应用冷冻加手术治疗口腔颌面部恶性黑色素瘤42例，其中11例加用BCG免疫治疗。结果：加BCG组的中位生存时间为4年，3、5、7年的生存率分别为90%、72%、32%，8年以上为18%．而未用BCG组的中位生存时间为2年，3、5、7年生存率分别为55％、24%、12%，8年以上为3%，二组比较，BCG组生存时间明显延长，初步提示，BCG辅助治疗恶性黑色素瘤能减少复发或转移，延长病人的生存时间。     

组织学,电镜及免疫组化技术确诊口腔粘膜恶性黑色素瘤的…

总结了１５例口腔粘膜原发性恶性黑色素瘤，对比研究了Ｆｏｎｔａｎａ染色、电镜观察和免疫组化方法检查在确诊恶性黑色素瘤方面的诊断价值。结果发现，１５例口腔粘膜原发性恶性黑色素瘤中，４例为无色素型黑色素瘤，这４例中Ｆｏｎｔａｎａ染色２例阳性。电镜观察的３例无色素型黑色素瘤，均未发现典型黑色素小体存在。１５例黑色素瘤的抗单克隆抗体染色全部阳性。本研究显示，对Ｆｏｎｔａｎａ染色阴性，可疑为恶性黑色瘤的病例，     

组织学、电镜及免疫组化技术确诊口腔粘膜恶性黑色素瘤的对比研究

总结了１５例口腔粘膜原发性恶性黑色素瘤，对比研究了Ｆｏｎｔａｎａ染色、电镜观察和免疫组化方法检查在确诊恶性黑色素瘤方面的诊断价值。结果发现，１５例口腔粘膜原发性恶性黑色素瘤中，４例为无色素型黑色素瘤，这４例中Ｆｏｎｔａｎａ染色２例阳性。电镜观察的３例无色素型黑色素瘤，均未发现典型黑色素小体存在。１５例黑色素瘤的抗单克隆抗体染色全部阳性。本研究显示，对Ｆｏｎｔａｎａ染色阴性，可疑为恶性黑色瘤的病例，应做免疫组化染色，进一步确诊。     

粘膜恶性黑色素瘤

人们认识呼吸道、消化道和泌尿生殖道的原发性粘膜恶性黑色素瘤有100多年。因其很少见。故只有散在报告。由于缺乏广泛的研究,因此很少了解它的生物学性质和自然病史。一般认为,粘膜恶性黑色素瘤的侵袭性远较皮肤恶性黑色素瘤为大,且治疗更少成功。虽然对粘膜恶性黑色素瘤细胞的起源仍有争论,但现已完全证实,在呼吸道、消化道及泌尿生殖道的粘膜中有黑色素细胞存在。这些黑色素细胞,从它们的胚胎神经嵴     

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提要：口腔黏膜原发恶性黑色素瘤是一种少见的恶性肿瘤,具有易复发、易转移、预后较差的特点。由于病例数稀少,临床及随访资料匮乏,并且缺少通行的黏膜恶性黑色素瘤分期分级标准。因此,对口腔黏膜原发恶性黑色素瘤还缺乏全面深入的认识。本文通过回顾相关文献,从流行病学、临床、病理、诊断和鉴别诊断以及分类等方面来概述口腔黏膜原发恶性黑色素瘤的特点。     

16例恶性黑色素瘤治疗报道

１６例恶性黑色素瘤治疗报道宋欣，郭建平，魏奉才，宋代辉，聂旭光，贲呈瑞恶性黑色素瘤来源于黑色素细胞，该肿瘤恶性程度高，转移早、预后差。现将我们１９６２年１月～１９９３年１月所遇到的１６例”恶黑”患者，分别采用不同模式治疗。现报道如下：１临床资料性别与...     

Elemental sulphur and alkali elutable melanin detected in oral melanosis and malignant melanoma by energy-filtering transmission electron microscopy

BACKGROUND: The morphology and contents of melanosomes are important features for differentiating melanocyte-derived melanotic lesions such as melanosis and malignant melanoma. METHODS: In this study, we attempted to elucidate the structure of melanin and sulphur content in oral melanosis and malignant melanomas by ultrastructural analysis. RESULTS: In oral melanosis, the essential pathological findings were overproduction of eumelanin and discharge of melanin into keratinocytes. In malignant melanoma in situ, pleomorphic and ellipsoid abnormal melanosomes with an increase in sulphur content and alkali elution rate were detected. In invasive malignant melanoma, the irregular ellipsoid and spheroid melanosomes existing either as discrete bodies or compound melanosomes with furtherly increased sulphur content and alkali elution were detected. CONCLUSIONS: Our findings suggest that abnormal melanosome morphology and high sulphur content are predictive markers for assessment of early or precancerous melanotic lesions and malignant melanoma.     

230例手术治疗的口腔黏膜恶性黑色素瘤患者预后的多因素分析

目的：探讨影响口腔黏膜恶性黑色素瘤患者生存率的因素.方法：单纯手术治疗的口腔黏膜恶性黑色素瘤患者230例,男141例,女89例.TNM分期：Ⅰ期,34例;Ⅱ期,87例;Ⅲ期,109例.采用Cox比例风险模型进行预后因素筛选,Kaplan-Meier法进行影响因素及生存率的分析.Log rank法比较不同生存分布的差异.结果：肿瘤厚度、淋巴结转移、肿瘤有无溃破及原发部位是影响生存率的相对独立因素,其P值与RR值依次分别为：P＜0.001、1.868,P＜0.001、1.685,P＜0.001、1.411,P=0.008、0.747.各因素不同水平间统计学差异明显.资料未显示年龄（P=0.136）、性别（P=0.721）及所用手术方法（P=0.944）对生存率有显著影响.结论：影响口腔黏膜恶性黑色素瘤的预后因素与皮肤部位发病者类似.各因素间无明显相互作用.单纯手术治疗并非最佳治疗措施.     

Primary gingival malignant melanoma. Report of 3 cases

BACKGROUND: Malignant melanoma is rare in the oral cavity and accounts for less than 1% of all melanomas. Nevertheless, the disease can be fatal, and early diagnosis and treatment may improve prognosis dramatically. The purpose of this paper is to report 3 new cases of primary malignant melanoma of the oral cavity arising in the gingiva, and to review the literature regarding intraoral melanoma. METHODS: Three cases are presented. One case was in the right mandibular molar area; the second in the right maxillary canine-premolar area; and the third in the left mandibular canine-premolar region. All patients were treated surgically, with postoperative radiotherapy. RESULTS: The first patient lived for 2 years and the second for 3 years before distant metastases were diagnosed from which they subsequently died. The third patient was lost from follow-up after 18 months. CONCLUSION: Primary oral malignant melanoma is a deadly disease. Early suspicion of this disease will allow prompt treatment and increase the prognosis for these patients.     

Malignant melanoma of the oral cavity: a review of literature.

Oral malignant melanoma is a rare aggressive neoplasm of the middle age. This malignancy commonly affects male subjects and is more frequently seen at the level of the hard palate and gingiva. At present, the clinicopathological classification of oral melanoma is not yet clearly outlined; consequently, the skin form is often taken as a reference. In many cases (up to 30%), the diagnosis of melanoma is made on lesions, which have evolved from the pre-existing pigmented lesions. The poor prognosis of oral melanomas requires that pigmented lesions of undetermined origin be routinely biopsied. The surgical approach, combined with the chemotherapeutic one, is the first choice treatment. The purpose of this study is to review literature that has been published about malignant melanoma of the oral cavity. MATERIALS AND METHODS: Thirty-eight published articles and 8 textbooks related to oral malignant melanoma and been published in the last two decades are reviewed. CONCLUSION: The review of literature in the field of malignant melanoma of the oral cavity show that this malignancy might be different from cutaneous malignant melanomas, and new criteria for diagnosis and therapy should be considered for this disease. Physicians and dentists who treat problems of the oral cavity should be aware of the need for early diagnosis of oral melanomas and performing biopsies of doubtful pigmented lesions.     

Primary malignant melanoma of the oral mucosa.

PURPOSE: To present our experience on the epidemiology, clinical features, management, and survival of patients with oral malignant melanoma. PATIENTS AND METHODS: Records of patients with a histologic diagnosis of primary oral mucosal malignant melanoma seen over a 23-year period were retrospectively reviewed. RESULTS: There were 6 females and 2 males, ranging in age from 18 to 60 years; 4 cases in the maxilla, 2 in the mandible, 1 on the lower lip, and 1 on the buccal mucosa. Local recurrences developed in 2 patients who eventually died with clinical metastatic cervical nodal disease. Follow-up ranged from 6 months to 16 years 3 months. Surgery was the only treatment available. CONCLUSION: Primary oral mucosal melanoma is rare, with a 3 to 1 female to male ratio and an average age of 41.7 years at presentation. It is most common in the maxilla and has poor prognosis despite apparent adequate local surgical control.     

口腔恶性黑色素瘤中血管内皮生长因子和一氧化氮合酶的表达与癌细胞增殖的关系

目的研究口腔恶性黑色素瘤组织血管内皮生长因子(VEGF)、诱导型一氧化氮合酶(iNOS)、内皮型一氧化氮合酶(eNOS)的表达与癌细胞增殖的相关性。方法应用免疫组化方法检测11例口腔恶性黑色素瘤手术切除标本VEGF、iNOS、eNOS和增殖细胞核抗原(PCNA)的分布及表达。结果11例中7例(63.64%)瘤组织表达VEGF,6例(54.55%)表达iNOS,9例(81.82%)表达eNOS,VEGF与iNOS的表达具有相关性,而与eNOS的表达无相关性;表达VEGF的口腔恶性黑色素瘤PCNA标记指数(PLI)高于不表达VEGF者;表达iNOS的口腔恶性黑色素瘤PLI高于不表达iNOS者。表达与不表达eNOS的口腔恶性黑色素瘤PLI差异无显著性(P>0.05)。结论iNOS、PLI对口腔恶性黑色素瘤细胞增殖具有促进作用。     

Oral malignant melanoma diagnosed in an Iranian population over an 11-year period

Objective

The aim of this study was to determine the prevalence of oral malignant melanoma along with age range and site of presentation over an 11-year period in Iran.

Materials and methods

The files of Tehran Cancer Institute served as a source of material for this study. Files were systematically searched for all malignant melanomas and oral malignant melanomas during an 11-year period. Prepared slides and demographic data from the biopsy files were reviewed. Statistical analysis was performed with the use of SPSS.

Results

Of the 38,993 cases accessed during the 11-year period, 569 were identified as malignant melanomas, while 41 cases among this group had malignant oral melanomas comprising 0.1% of the total cases and 7.2% of all the malignant melanoma lesions.

Conclusion

The palate was the most common location for oral malignant melanoma. Thus, all melanocytic lesions in the palate should be viewed with caution, and biopsy is recommended to rule out melanoma.     

口腔粘膜原发恶性黑色素瘤的临床病理学研究

目的　研究口腔粘膜原发恶性黑色素瘤的临床病理特点及其与预后的关系。方法　采用回顾性分析的方法对73例口腔粘膜原发恶性黑色素瘤进行了临床病理学研究并对有随访资料的患者进行Kaplan-meier生存曲线及Log rank检验的统计学分析。结果　口腔粘膜原发恶性黑色素瘤多发于40~60岁的男性,腭部和牙龈多见。临床分期以I期最多;病理分型中结节型多见,其次是雀斑样型和表浅扩散型;按细胞形态分型以混合细胞型最为多见,其次是上皮样细胞型和梭形细胞型。有随访资料的43例患者3年生存率为19·86%,5年生存率为11·91%;淋巴结转移、浸润深度、临床分期、病理分型和治疗方法与预后有关(P<0·05)。黑斑与病理分型有关(P<0·05),黑斑多见于雀斑样型口腔粘膜原发恶性黑色素瘤,且预后较好。结论　口腔粘膜恶性黑色素瘤是一种预后差的恶性肿瘤;有无黑斑和淋巴结转移、浸润深度、临床分期、病理分型、治疗方法等与预后有关。     

口腔黏膜恶性黑色素瘤颈淋巴结转移临床分析

目的初步分析口腔黏膜原发性恶性黑色素瘤颈淋巴结转移的特点,对其诊断及治疗进行进一步探讨。方法收集2001～2006年间收治的88例恶性黑色素瘤患者的术后临床病理资料,对其发病特点、好发部位以及颈淋巴结转移的规律等进行回顾性研究。结果病例资料显示,所有患者均行综合治疗,其好发部位为腭和上颌牙龈黏膜。病理结果显示,有68例患者发生颈淋巴结转移（占77．3％）,转移的患者中颈淋巴结的部位主要在Ⅰ和Ⅱ区（占所有转移部位的78．9％）,其次为Ⅲ区,转移至Ⅳ区者只有3例;出现对侧颈淋巴结转移者4例,主要发生在原发灶冷冻不彻底、病史较长或多次复发者,转移部位也主要在Ⅰ和Ⅱ区。结论口腔黏膜原发性恶黑极易发生颈淋巴结转移,转移部位主要在Ⅰ区和Ⅱ区,初步认为原发灶冷冻和颈淋巴清扫等综合治疗是治疗恶黑的有效途径,颈清的方式宜以肩胛舌骨上清扫为主。     

Malignant melanoma of the lip spreading in a pagetoid manner into the minor salivary glands

We describe a malignant melanoma of the lower lip that upon recurrence extended in a pagetoid manner into the ducts of the oral minor salivary glands. Immunohistochemistry with antibodies to MART-1 and HMB-45 confirmed that the atypical cells in the ducts of the salivary glands were indeed melanoma cells. Pathologists involved in staging of oral melanoma are urged to look out for this previously unreported mode of spread of labial malignant melanoma.