甲下黑色素瘤误诊原因分析

目的 分析甲下黑色素瘤的误诊原因,探索其早期诊断依据.方法 总结8例甲下黑色素瘤患者的临床特征,分析误诊原因.结果 8例中误诊为其他指甲疾病并对应治疗(抗感染及抗真菌)6例(其中4例曾行拔甲,1例反复激光冷冻),误诊为血管瘤1例.7例于我院行跨关节截指术,病理均证实为甲下黑色素瘤.结论 临床表现多样、无黑色素性黑色素瘤的存在、局部活组织取材病理检查不充分以及病变初期的病理诊断困难,是导致甲下黑色素瘤误诊的常见原因.提高临床医生对该病的认知度和敏感度有助于早期诊治.

Analysis of misdiagnosis of subungual melanoma

Objective To analyze the factors responsible for misdiagnosis or delayed diagnosis of subungual melanoma(SM)in order to improve diagnostic accuracy in the early phase. Methods clinical characteristics of 8 cases with established diagnosis of subungual melanoma were reviewed and the factors that led to misdiagnosis were analyzed.Results Six of the 8 cases were misdiagnosed as other nail diseases and treated accordingly(anti-infection and antifungal therapy).Four of these cases underwent nail removal and one had repeated laser ablation.One case was diagnosed as hemangioma.Eventually seven cases underwent proximal amputation in our hospital where pathology confirmed the diagnosis of SM. Conclusion Various clinical presentations,existence of amelanotic melanoma,insuglcient pathological evidence from biopsy and dittlculty in pathological diagnosis during the initial phase are the common causes of SM misdiagnosis.Raising cliniciam' awareness of the idsease will be helpful to its early diagnosis and management.