头颈部恶性黑色素瘤28例的治疗及预后因素

目的：探讨影响恶性黑色素瘤的治疗及其预后因素。方法：本院头颈外科1984年-1994年10年间诊断28例恶性黑色素瘤，治疗方法分广泛切除，广泛切除加预防性颈清扫术，广泛切除加治疗性颈清扫术3组，并作回顾性分析。结果：28例患者外院局部切除23例，残留率34.8%。原发灶切除范围分≤2cm组及＞2cm组，五年生存率分别为58%及40%。上述3组的五年生存率分别为80%、80%及39%。结论：原发灶的处理要规范，切除范围2cm以内。对颈淋巴结未及肿大的患者可暂不行颈淋巴结清扫术。颈洒巴结阳性患者可依原发灶的部位不同施行不同方式的颈清扫术，并强调颈清扫术中皮片分离应在颈阔肌浅面进行，以减少术后复发。

Treatment and prognostic predictor of 28 cases with malignant melanoma of the head and neck

Purpose：To determine the treatments and prognostic predictors of malignant melanoma of the head and neck. Methods：Surgical treatment and outcome was analyzed for 28 patients with malignant melanoma of the head and neck at department of the head and neck of our hospital (1984-1994). Results：23 patients underwent local excised as the first treatment, and local recurrence was demonstrated in 8 (34.8%). Margin of resection of primary melanoma was divided into narrow excision (≤2 cm) and wide excision (＞2 cm), and 5-year survival was 58% and 40%(P＜0.01). According to surgical methods, 5-year survival of WE, WE/END and WE/TLND were 80%, 80% and 39%. Conclusions：An excision with 2 cm margin is safe procedure for primary tumor of malignant melanoma of the head and neck. Neck dissection may not be practiced until neck lymph node is positive. Neck dissections differ from the positions of the primary tumors, and the flaps must be raised preferably superficial to the platysma.