耳黑色素瘤的预后因素和外科治疗策略  

Melanoma of the ear: Prognostic factors and surgical strategies

作　　者：Jahn V. Breuninger H. Garbe C. Moehrle M. 刘艳 

机构地区：[1]Department of Dermatology, University of Tuebingen Clinics, Eberhard-Karls-Universitt, Liebermeisterstr. 25, D-72076 Tuebingen, Germany

出　　处：《世界核心医学期刊文摘（皮肤病学分册）》2006年第6期28-29,共2页Digest of the World Core Medical JOurnals:Dermatology

摘　　要：Background: The ear’s specific anatomical and lymphatic characteristics impose special requirements on the treatment of melanoma of the ear. Objectives: The aim of this prospective study was to define prognostic factors for melanoma of the ear and to evaluate surgical strategies for excision margins, histological evaluation and sentinel lymph node biopsy (SLNB) in order to achieve better cosmetic and functional results. Patients and methods: One-hundred and sixty-one patients with stage I/II melanoma of the external ear were treated in the Department of Dermatology, University of Tuebingen, from March 1976 to March 2004 (median follow-up 62 months). Malignant melanoma of the external ear represented 3%of the stage I/II cutaneous melanomas and 20%of the stage I/II head and neck melanomas recorded in the Melanoma Registry of the Department of Dermatology at the University of Tuebingen. Twenty of 42 lentigo maligna melanomas (LMM) underwent conventional histological evaluation, 22 underwent complete three-dimensional histology of excision margins (3D histology) in a paraffin-technique, i.e. micrographic surgery. SLNB was performed in 28 patients with melanomas thicker than 1.0 mm. Clinical, histological and surgical risk factors were evaluated by univariate and multivariate analysis. Results: The median thickness of the tumours in the present study was 1.08 mm (mean 1.51 mm; range 0.18-8.50 mm), and the median excision margins were 11.0 mm (mean 12.61 mm; range 2.0-31.0 mm). The 3-year disease-specific survival rate was 98%, and the 3-year recurrence-free survival rate was 83%. Tumour thickness and invasion level were the only risk factors significant for disease-specific survival. Tumour thickness, location of the tumour and extent of excision margins were independently significant risk factors for recurrence free survival. LMMs removed surgically with accompanying 3D histology were thicker than those examined by conventional histology (median 0.93 mm vs. 0.83 mm). The use of surgery with 3D histology, i.e. microBackground： The ear＇s specific anatomical and lymphatic characteristics impose special requirements on the treatment of melanoma of the ear. Objectives： The aim of this prospective study was to define prognostic factors for melanoma of the ear and to evaluate surgical strategies for excision margins, histological evaluation and sentinel lymph node biopsy （SLNB） in order to achieve better cosmetic and functional results. Patients and methods： One-hundred and sixty-one patients with stage Ⅰ/Ⅱ melanoma of the external ear were treated in the Department of Dermatology, University of Tuebingen, from March 1976 to March 2004 （median follow-up 62 months）. Malignant melanoma of the external ear represented 3% of the stage Ⅰ/Ⅱ cutaneous melanomas and 20% of the stage Ⅰ/Ⅱ head and neck melanomas recorded in the Melanoma Registry of the Department of Dermatology at the University of Tuebingen. Twenty of 42 lentigo maligna melanomas （LMM） underwent conventional histological evaluation, 22 underwent complete three-dimensional histology of excision margins （3D histology） in a paraffin-technique, i.e. micrographic surgery. SLNB was performed in 28 patients with melanomas thicker than 1.0 mm. Clinical, histological and surgical risk factors were evaluated by univariate and multivariate analysis. Results： The median thickness of the tumours in the present study was 1.08 mm （mean 1.51 mm; range 0. 18- 8.50 mm）, and the median excision margins were 11.0 mm （mean 12.61 mm; range 2.0 - 31.0 mm）. The 3-year disease-specific survival rate was 98%, and the 3-year recurrence-free survival rate was 83%. Tumour thickness and invasion level were the only risk factors significant for disease-specific survival. Tumour thickness, location of the tumour and extent of excision margins were independently significant risk factors for recurrence free survival. LMMs removed surgically with accompanying 3D histology were thicker than those examined by conventional histology （median 0. 93 mm vs. 0. 83 mm

关 键 词：皮肤黑色素瘤 显微外科 治疗策略 预后因素 耳部 组织病理检查 恶性黑色素瘤 手术危险因素 组织学检查 阳性患者 

分 类 号：R739.5[医药卫生—肿瘤] R739.41[医药卫生—临床医学]