耳鼻颌面部恶性黑色素瘤(附11例分析)

目的：探讨发生于耳鼻颌面部恶性黑色素瘤(恶黑)的诊疗方法。方法：对1986～2001年收治的11例恶黑患的临床资料进行临床病理分析。结果：男性6例、女性5例，年龄6个月～83岁；原发部位：牙龈粘膜2例，外耳道l例，耳廓2例，鼻腔筛蝶窦l例，鼻中隔l例，中耳l例，下睑腮腺l例，上唇2例；手术切除9例，术后化疗2例，术后放疗3例，未治疗2例。0．5～10年随访，死亡6例，生存期6个月～3年；健在5例，生存期1．0—15年。结论：恶黑在皮肤粘膜交界处的色素层或粘膜黑色素斑的基础上发生，肿块多呈黑褐色且常伴溃疡，诊断较易，而对于不含黑色素的恶黑容易误漏诊，须待病理确诊。瘤细胞内含大量黑色素颗粒为其病理特点，免疫组化显示VIM—HMB45和S-100蛋白及Vs38阳性反应均有助于不含色素的恶黑的确诊。本病恶性度极高，可采用手术、放化疗或免疫治疗，但预后差。

Malignant Melanoma of the Head and Neck -Report of 11 cases

Objective:To find the diagnosis and treatment methods of the malignant melanoma in head and neck. Methods: 11 patients with malignant melanoma of the head and neek were analyzed from 1986 to 2001. Results: Male 6 eases, Female 5 eases, A-mong 11 cases, primary position of 4 eases were in oral cavity and gum muscoal, 3 in external ear, 2 in nasal cavity and sinuses, 1 in middle ear, 2 in lower eyelid and partoid. Nine patients were treated with surgery, radiotherapy and chemotherapy. Follow-up from 0. 5 - 15 years. Result showed that six patients had died of recurrence or distant metastasis of tumor, which survival time was 0. 5 - 3 years. Five patients still were alive, which survival time was 1-15 years. Conclusion:The differential diagnosis of these tumors with nasal cavity and sinus carcinoma, nasal polyp and angionoma was noted. The pathological characteristics of malignant melanoma showed a typical fore-melanin body in different tumor cells. It's a great role in the diagnosis of the malignant melanoma without mela-nine ( amelanotic melanoma). Extensive excision of primary tumor should be an important factor for prognosis of patients with malignant melanoma.