甲下黑色素瘤的临床特点与治疗结果  

Clinical features and treatment outcomes of subungual melanoma

作　　者：尹佳丽[1] 田文[2] 李淳[2] 张友乐[2] 侯春梅[2] 易传军[2] 薛云皓[2] 杨勇[2] 

机构地区：[1]唐山市第二医院手外科,063000 [2]北京积水潭医院手外科

出　　处：《中华手外科杂志》2011年第4期205-207,共3页Chinese Journal of Hand Surgery

摘　　要：目的总结甲下黑色素瘤的临床特点和治疗结果。方法回顾性分析1994年1月至2010年7月由北京积水潭医院收治，并经病理检查证实为甲下黑色素瘤的31例患者的临床资料，其中21例行病变指（趾）超关节截指（趾）术；4例行序列截指（趾）术；6例行局部／扩大切除术。其中5例淋巴转移患者同时行局部淋巴结清扫，并辅以全身化学治疗和免疫治疗。结果31例中18例获得随访，随访年限3～16年。4例行序列截指（趾）术后随访均未复发；8例行超关节截指（趾）中2例复发；6例行局部病灶切除或扩大切除术中5例复发。侵袭性甲下黑色素瘤患者1年生存率为88．9％（8／9），3年生存率为66．7％（6／9），5年生存率为33．3％（3／9）。结论甲下黑色素瘤是一种恶性程度很高的肿瘤，具有非特异性的临床表现，治疗应以手术为主，辅以化疗、免疫等综合治疗。Objective To review and summarize the clinical features and treatment outcomes of subungnal melanoma. Methods The clinical data of 31 cases of subungual melanoma with pathological confirmation that were admitted and treated from January 1994 to July 2010 in Jishuitan Hospital were retrospectively analyzed. Amputation of the involved fingers （toes） at the level proximal to the adjacent joint was done in 21 patients. Complete amputation of the digits （toes） was carried out in 4 cases. Other 6 cases had wide/extended local excision. There were 5 patients who had regional lymph node metastasis that underwent lymph node excision along with chemotherapy and immunotherapy. Results Eighteen patients had long-term follow-up ranging from 3 to 16 years. No recurrence was found in the 4 cases that underwent complete amputation of the involved digits （toes）. Melanoma recurred in 2 of the 8 eases treated with amputation at the level proximal to the adjacent joint. Five out of the 6 cases undergoing wide/extended local excision recurred. The 1-year, 3- year and 5-year survival rates of invasive melanoma were 88.9% （8/9）, 66.7 % （6/9） and 33.3 % （3/9）, respectively. Conclusion Subungnal melanoma is a highly malignant tumor with non-specific clinical manifestations. Surgical resection is the major treatment, which should he supplemented with chemotherapy and immunothempy.

关 键 词：黑色素瘤 指(趾)甲 外科手术 治疗结果 

分 类 号：R739.5[医药卫生—肿瘤]