表现为足溃疡的恶性黑色素瘤临床分析

目的探讨表现为足溃疡的恶性黑色素瘤临床特点。方法回顾性分析2002年1月-2010年12月收治的46例表现为足溃疡的恶性黑色素瘤患者。结果 46例均病理组织活检确诊,男29例,女17例,平均年龄57岁。溃疡形成前多表现为包块、黑素斑、痣、水泡、灰指甲、鸡眼、疣等;溃疡形成后表现为外伤不愈或反复复发、溃疡中央或边缘破溃、不规则、表面凹凸不平、颗粒状或呈瘢痕状态、焦痂、菜花样新生物等;溃疡好发部位为足底、足跟、足趾;3例患者无色素沉着;确诊前溃疡存在时间为(10.74±10.94)个月,38例患者(82.6%)在确诊前误诊,中位误诊时间为6个月(2.75～48个月),分别被误诊为黑色素斑、痣、慢性溃疡、黑色包块等。确诊时18例存在远处转移;35例进行手术治疗,3例采用单纯化学治疗,8例放弃治疗。结论恶性黑色素瘤早期表现不典型,常被误诊,由于其高度侵袭性,对表现不典型的足溃疡应提高警惕,尽早行病理组织学检查,以减少其误诊。

Clinical Analysis of Malignant Melanoma Presenting as Foot Ulcer

Objective To investigate the clinical features of malignant melanoma presenting as foot ulcer.Methods The clinical data of 46 patients(17 females and 29 males with the average age of 57 years) with malignant melanoma presenting as foot ulcer diagnosed in our hospital between January 2002 and December 2010 were retrospectively analyzed. Results All of the patients were diagnosed by biopsy,and it almost presented as masses,melanotic macules,naevus,blisters, onychomycosis,clavus,wart,etc,before the formation of foot ulcer.After the formation of the ulcer,it presented as nonhealed trauma or frequently ulcerates,central or marginal ulceration,uneven or granular scar-like surface,eschar,etc.Planta,calcar pedis,and hallux were the most predilection sites of malignant melanoma.The majority of lesions were located in foot sole, heel,and the first toe.There were 3 patients without pigment.The course of ulcer was(10.74±10.94) months and 18 patients had far-distance metastasis before the diagnosis of malignant melanoma.Thirty-eighty cases were misdiagnosed as melanotic macules,naevus,chronic ulcers,etc.The median time of misdiagnosis was 6(2.75-48) months.Conclusions The clinical manifestations of malignant melanoma are not typical,which leads to the misdiagnosis.We should pay more attention to the patients with foot ulcer which should be examined by biopsy as early as possible to reduce the misdiagnosis rate.