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目的:探讨皮肤恶性黑素瘤的外科治疗方式。方法:回顾性分析2007年10月—2011年12月共93例皮肤恶性黑素瘤患者的临床资料、外科手术方式和预后。按照美国癌症联合委员会(American Joint Committee on Cancer,AJCC)外科分期标准:ⅠA期1例,ⅠB期2例,ⅡA期8例,ⅡB期9例,ⅡC期20例,ⅢA期18例,ⅢB期17例,ⅢC期16例,Ⅳ期2例;外科手术方式:广泛切除术26例,广泛切除术+游离植皮或转移皮瓣重建术7例,截指(趾)8例,髂腹股沟淋巴结清扫术32例,腋窝淋巴结清扫术3例,广泛切除术+一期髂腹股沟淋巴结清扫术15例,广泛切除术+一期腋窝淋巴结清扫术2例;术后辅助化疗53例,干扰素或白细胞介素治疗78例。对77例患者进行了随访,平均随访时间为20(2～50)个月。结果:Ⅰ期3例患者均存活;Ⅱ期获随访的28例患者中,8例于术后12个月时出现腹股沟淋巴结转移,2例于术后18个月时出现骨转移,6例于术后36个月时出现皮内转移;Ⅲ期获随访的44例患者中,11例于随访期间死于肺转移,5例死于肝转移;Ⅳ期2例患者中,1例于术后12个月时因肺转移而死亡,1例于术后11个月时因肝转移而死亡。随访期间,77例患者中的43例患者为无进展生存。结论:早期发现以及早期手术治疗皮肤恶性黑素瘤可以获得较好的疾病控制率,规范化的区域淋巴结清扫术是控制疾病进展的重要手段,术后辅助治疗可使生存获益。
Objective: To investigate the surgical treatment of malignant melanoma of the skin. Methods: Retrospective analysis of clinical data, surgical methods and prognosis of 93 patients with malignant melanoma of the skin from October 2007 to December 2011. According to the American Joint Committee on Cancer (AJCC) surgical staging criteria: IA phase 1 case, IB stage 2 cases, IIA stage 8 cases, IIB stage 9 cases, IIC stage 20 cases, IIIA stage 18 cases, IIIB stage 17 cases, 16 cases of IIIC stage, 2 cases of IV stage; surgical methods: extensive resection in 26 cases, extensive resection + free skin graft or metastasis flap reconstruction in 7 cases, 8 fingers (toe), sputum inguinal lymph node dissection Thirty-two patients were treated with axillary lymph node dissection in 3 cases, extensive resection + first stage iliac inguinal lymph node dissection in 15 cases, extensive resection + first stage axillary lymph node dissection in 2 cases, postoperative adjuvant chemotherapy in 53 cases, interferon or interleukin Treatment of 78 cases. 77 patients were followed up for an average of 20 (2 to 50) months. Results: All 3 patients in stage I survived; of the 28 patients who were followed up in stage II, 8 had inguinal lymph node metastasis at 12 months postoperatively, 2 cases had bone metastasis at 18 months postoperatively, and 6 cases had Intradermal migration occurred 36 months after surgery; of the 44 patients who were followed up in stage III, 11 died of lung metastasis during follow-up and 5 died of hepatic metastasis; of the 2 patients in stage IV, 1 was postoperative He died of lung metastasis at 12 months and 1 patient died of hepatic metastasis at 11 months after surgery. During follow-up, 43 of the 77 patients were progression-free. Conclusion: Early detection and early surgical treatment of malignant melanoma of the skin can obtain better disease control rates. Standardized regional lymph node dissection is an important means of controlling disease progression. Postoperative adjuvant therapy can benefit survival.