23例恶性黑色素瘤患者的临床特点及预后分析  

Clinical characteristics and prognosis analysis of 23 patients with malignant melanoma

作　　者：李玲芝 石磊[1] 朱小霞 杨枫 许素玲[1] LI Lingzhi;SHI Lei;ZHU Xiaoxia;YANG Feng;XU Suling(Department of Dermatology,the Affiliated Hospital of Medical School,Ningbo University,Zhejiang,Ningbo 315020,China)

机构地区：[1]宁波大学医学院附属医院皮肤科,浙江宁波315020

出　　处：《中国现代医生》2022年第31期39-43,共5页China Modern Doctor

基　　金：宁波市科技计划项目(202002N3190)。

摘　　要：目的分析恶性黑色素瘤患者的临床特点及预后,为临床诊疗提供参考。方法选取2020年5月至2022年1月于宁波大学医学院附属医院住院治疗的23例恶性黑色素瘤患者为研究对象,收集患者的临床表现、皮肤镜特征、病理结果、治疗及随访情况。结果23例患者中男15例,女8例;平均年龄(65.36±10.69)岁;平均体质量指数(22.29±1.10)kg/m^(2);发病时间2个月~2年,中位发病时间6个月;病变部位在肢端15例(65.22%),四肢5例(21.74%),腹部2例(8.70%),腋下1例(4.35%);黑色素瘤直径0.3~3.5cm,最大直径≤2cm 15例,>2cm 8例;TNM分期Ⅰ期3例(13.04%),Ⅱ期10例(43.48%),Ⅲ期9例(39.13%),Ⅳ期1例(4.34%)。23例患者共70处皮损,其中溃疡14处(20.00%),不规则色素球13处(18.57%),蓝白幕12处(17.14%),不典型血管11处(15.71%),不规则色素条纹9处(12.86%),多种色调9处(12.86%),粉红色无结构2处(2.86%)。病理结果显示,镜下可见大量的癌细胞,癌细胞体积大,呈圆形、椭圆、异型、梭形,边界清楚,核仁明显,胞质丰富,腺泡状或片状结构,核大深染,细胞可见色素,其中结节性黑色素瘤17例(73.91%),肢端雀斑样黑色素瘤6例(26.09%)。所有患者均接受手术治疗,术后随访6~18个月,无死亡或复发病例。结论恶性黑色素瘤起病隐匿,病理特征复杂,皮肤镜在恶性黑色素瘤诊断中具有较高价值,手术治疗具有一定的疗效。Objective To analyze the clinical characteristics and prognosis of malignant melanoma patients to provide reference for clinical diagnosis and treatment.Methods A total of 23 patients with malignant melanoma who enrolled into the Affiliated Hospital of Medical School,Ningbo University from May 2020 to January 2022 were selected as the research subjects.The clinical manifestations,dermoscopic characteristics,pathological results,treatment and follow-up of the patients were collected.Results Among the 23 patients,there were 15 males and 8 females,with average age of(65.36±10.69)years.The average body mass index was(22.29±1.10)kg/m^(2).The onset time was 2 months to 2 years,with the median of 6 months.The lesions were located in the extremities of 15 cases(65.22%),limbs of 5 cases(21.74%),abdomen of 2 cases(8.70%)and underarm of 1 case(4.35%).The diameter of melanoma was 0.3~3.5 cm,15 cases were≤2cm,and 8 cases were>2cm.There were 3 cases(13.04%)of stageⅠ,10 cases(43.48%)of stageⅡ,9 cases(39.13%)of stageⅢ,and 1 case(4.34%)of stageⅣ.There were 70 skin lesions in 23 patients,including 14(20.00%)ulcers,13(18.57%)irregular pigment globules,12(17.14%)blue and white screen,11(15.71%)atypical blood vessels,9(12.86%)irregular pigment stripes,9 cases(12.86%)multiple shades and 2 cases(2.86%)pink without structure.The pathological results showed that a large number of cancer cells were seen under the microscope.The cancer cells were large,round,oval,atypical and spindle-shaped,with clear borders,obvious nucleoli,abundant cytoplasm,acinar-like or sheet-like structures and large and deep nuclei.The cells can be seen with pigment.There were 17 cases of nodular melanoma(73.91%)and 6 cases of acral lentiginous melanoma(26.09%).All patients underwent surgical treatment and were followed up for 6 to 18 months without death or recurrence.Conclusion The onset of malignant melanoma is hidden and the pathological features are complex.Dermatoscopy has high value in the diagnosis of malignant melanoma.Surgical treatment has ce

关 键 词：恶性黑色素瘤 皮肤镜 手术 

分 类 号：R739.5[医药卫生—肿瘤]