原发女性生殖道恶性黑色素瘤21例临床分析

Primary melanoma of the female genital tract: a report of 21 cases

目的探讨原发性女性生殖道恶性黑色素瘤的临床特点、治疗及预后。方法回顾分析本院1986年1月至2006年3月收治的原发性女性生殖道恶性黑色素瘤患者21例。其中外阴8例、阴道10例、阴道及宫颈1例、外阴及阴道1例、盆腔1例。结果患者中位年龄50（21～71）岁。临床表现主要为阴道流血、流液及发现外阴或阴道肿物。本资料阴道恶性黑色素瘤发病率高于外阴恶性黑色素瘤。按照国际妇产科联盟（FIGO）分期,期别和预后呈负相关。治疗以手术为主,手术方式由根治性切除逐渐衍变为扩大局部切除。随访：21例患者中随访率为67%（14/21）,随访时间6~96个月,死亡7例,随访期间的死亡率为50%。结论女性生殖道恶性黑色素瘤发病率低,预后差。肿瘤厚度和淋巴结转移是其主要的危险因素。应采用手术基础上的综合治疗,治疗方案个体化。

Objective： To discuss the clinical characteristics, therapy and prognosis of the primary melanoma of female genital tract. Methods： A retrospective study was undertaken of 21 patients with primary melanoma of the female genital tract treated from 1986 to 2006 in Peking Union Medical College Hospital. Eight women developed a vulvar melanoma, ten women a vaginal melanoma and one woman vulva-vaginal melanoma, while another two women had unusual primary location of the melanoma, the cervical region （n= 1） and the whole pelvic （n=1）. Results： The median age of the patients was 50. The main symptoms were vaginal bleeding or masses of vagina or vulva. The incidcnce of primary vaginal melanoma was higher than that of vulva in our hospital. FIGO stage was proved to be negatively correlated to prognosis. Surgical procedure was still the main treatment; however, traditional radical surgery has been modified to wide local excision. The follow-up rate was about 67%, and 7 patients died of the tumor, then the death rate during the follow-up period was 50%. Conclusions： The primary melanoma of female genital tract was extremely rare and had poor progno- sis. The tumor thickness and lymph node metastasis were the main risk factors. Combined treatment based on surgery should be suggested.