19例口腔黏膜恶性黑色素瘤临床分析  

Clinical analysis of 19 cases of oral mucosal malignant melanoma

作　　者：杨慧 王翔[1] 张磊[2] 王文梅[1] 段宁[1] 李若玮 张苗苗 YANG Hui;WANG Xiang;ZHANG Lei;WANG Wenmei;DUAN Ning;LI Ruowei;ZHANG Miaomiao(Department of Oral Medicine,Nanjing Stomatolog-ical Hospital,Medical School of Nanjing University,Nanjing 210008,China;Department of Oral Pathology,Nan-jing Stomatological Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属口腔医院,南京市口腔医院口腔黏膜病科,江苏南京210008 [2]南京大学医学院附属口腔医院,南京市口腔医院口腔病理科,江苏南京210008

出　　处：《口腔疾病防治》2021年第12期843-847,共5页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金项目(81870767);江苏省临床医学专项(BL2014018);江苏省青年医学人才项目(QNRC2016118)。

摘　　要：目的研究口腔黏膜恶性黑色素瘤的临床病理特征、治疗方式及预后情况,为临床提供参考。方法对19例原发性口腔黏膜恶性黑色素瘤患者的临床表现、治疗方式及随访结果进行回顾性分析。结果口腔黏膜恶性黑色素瘤患者病损表现为口腔黏膜黑色肿块,19例患者中,病损发生于牙龈者11例(58%),发生于腭部者7例(37%),发生于舌部者1例(5%);不同部位发生率差异有统计学意义(P<0.05)。8例患者有区域淋巴结转移,转移率为42%,其中4例为多个部位转移,区域淋巴结转移部位共计15个;19例患者,仅手术治疗者3例,仅冷冻治疗者4例,手术、冷冻、生物免疫联合治疗者12例。病理结果均为恶性黑色素瘤,免疫组化结果:S⁃100阳性率为95%;HMB⁃45阳性率为89%;Melan⁃A阳性率为84%。Kaplan⁃Meier生存分析表明,病损面积在5 cm^(2)以下者,患者的生存率较高。结论口腔恶性黑色素瘤临床表现为口腔黏膜黑色肿块,早期易发生转移,病损面积可能会影响疾病的预后,对于范围较大的黑色病损或肿块,要提高警惕;多采取手术治疗、冷冻治疗、生物免疫治疗等治疗手段相结合的综合治疗。Objective To investigate the clinicopathological features,treatment and prognosis of oralmucosal malig⁃nant melanoma to provide a reference for clinical practice.Methods Data from 19 patients with oralmucosal malig⁃nant melanoma were collected,and their clinical manifestations,treatment methods and follow⁃up results were retrospec⁃tively analyzed.Results Among the 19 patients,11 cases(58%)had lesions in the gingiva,7 cases(37%)had lesions in the palate,and 1 case(5%)had lesions in the tongue,the difference was statistically significant(P<0.05).Eight pa⁃tients had regional lymph node metastasis with a metastasis rate of 42%,of which 4 cases had multiple site metastasis,and the total number of regional lymph node metastasis sites was 15.Among the 19 patients,3 cases received only sur⁃gery,4 cases received cryotherapy,and 12 cases received combined surgery,cryotherapy and biological immunotherapy.Pathological examination showed malignant melanoma.The positive rates of S⁃100,HMB⁃45 and Melan⁃A were 95%,89%and 84%,respectively.Kaplan⁃Meier survival analysis showed that patients with lesions less than 5 cm^(2) had a higher survival rate(P<0.05).Conclusions Oral malignant melanomas usually present as black lesions in the oral mucosa,which are prone to metastasis in early stage.The area of lesions may affect the prognosis of the disease.Therefore,the large range of black lesions or masses should be the alert for the clinicians.Oral malignant melanoma patients are usually treated with combined treatment with surgery,cryotherapy and biological immunotherapy.

关 键 词：口腔 原发性恶性黑色素瘤 临床病理特征 淋巴结转移 生物免疫治疗 白细胞介素⁃2 冷冻治疗 手术治疗 预后 

分 类 号：R78[医药卫生—口腔医学]