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。

Clinical analysis of cervical lymph node matastasis in malignant melanoma

Objective To analyze the features of cervical lymph node metastasis of primary malignant melanoma derived from oral mucosa and to explore its diagnosis and treatment plan.Methods The clinical and pathological data of 88 patients with primary malignant melanoma hospitalized from 2001 to 2006 were retrospectively studied.The characteristic,location and metastatic pattern of the lesion were analyzed.Results All the patients were treated with comprehensive therapy including cryosurgery and neck dissection.The commonly affected sites of malignant melanoma were palate and maxillary gingival mucosa.The cervical metastasis sites were mostly located at submandibular and upper jugular groups(78.9%),followed by submentum and middle jugular groups.Lower jugular group(3 cases) and the opposite side(4 cases) were also discovered.Incomplete treatment of primary focus,long history and repeated relapse were the main reasons for contralateral cervical metastasis.Conclusion The primary oral mucosal malignant melanoma was easily metastasized to cervical lymph nodes,and the most common metastatic sites were submandibular and upper jugular group.The study also suggests that the cryosurgery and neck dissection were the effective methods for the treatment of malignant melanoma derived from oral mucosa and the supraomohyoid neck dissection(SOND) was recommended.