皮肤黑素瘤70例临床与病理特征分析

Cutaneous Malignant Melanoma:Clinicopathological Analysis of 70 Cases

目的探讨皮肤黑素瘤的临床和病理特点。方法回顾分析1983—2010年本院病理诊断为皮肤黑素瘤患者的临床资料，重新阅片，再次进行确认诊断和病理分型，对病理诊断不明确者行免疫组化检查，并进行统计学分析。结果皮肤黑素瘤高峰发病年龄为51～60岁，肢端、非肢端部位黑素瘤各占70．00％和30．00％．肢端雀斑样黑素瘤最多，占67．14％，其次为恶性雀斑样痣型黑素瘤（11-43％）和浅表扩散型黑素瘤（10．00％），本研究中结节型仅有3例（4．29％），非暴露与暴露部位在原发损害、原位和侵袭的分布上差异有统计学意义（P=0．045，0．013）。甲下黑素瘤手部明显多于足部（P=0．000）。结论国内黑素瘤发病可能有年轻化趋势；外伤在肢端部位黑素瘤发生中作用有待进一步证实；临床的ABCD标准敏感性较高，可推广使用和作为患者自检的方法。

Objective To investigate the clinical and pathological features of cutaneous melanoma. Methods Clini- cal data of cutaneous melanoma confirmed pathologically from 1983 to 2010 in Peking University First Hos- pital were retrospectively analyzed by statistical methods. The cases which were pathologically diagnosed in- decisively were confirmed by immunohistochemical stain. Results The peak age of onset were the fifth decade of life. Acral and non-acral malignant accounted for 70.00% and 30.00% respectively. The most common pathological subtype was acral lentiginous melanoma（ALM）which accounted 67.14%, following by lentigo maligna melanoma （ LMM ） and superficial spreading melanoma （ SSM ） which accounted 11.43% and 10.00% respectively. The subtype of nodular melanoma（NM）was only 3 cases. There were statistical signifi- cances between exposed and unexposed location with regard to the primary lesions, and the distribution of in- vasive or situ （P = 0.045,0.013）. Subungual melanomas have a predilection for fingers （P = 0.000）. Con- clusion The age of onset of melanoma may have been dropping in chinese people; The relationship between trauma and occurrence of melanoma of acral sites should be confirmed further; The clinical ABCD criteria, which has high sensitivity, can be extended and become the patient self-test method.