足底部恶性黑色素瘤的临床特征与治疗

Clinical Features and Treatment Outcome of Malignant Melanoma on Foot

目的探讨足底皮肤恶性黑色素瘤的临床特征及治疗效果。方法回顾性分析我院1998—2010年共收治的61例足底皮肤恶性黑色素瘤患者临床资料,主要采用手术、全身化疗及免疫治疗。根据分期不同,所有患者分别采用截趾术、病变切除+植皮术、病变切除+皮瓣转位,其中32例行同侧腹股沟淋巴结清扫术。用Kaplan-Meier法统计生存率,肿瘤溃疡、厚度、淋巴结转移等预后因素用Kaplan-Meier和Log-rank方法进行分析。结果 53例足底皮肤恶性黑色素瘤患者获得随访,其中8例2年后失访。随访时间为1～10年,平均4.5年。1年生存率为77.0%(47/61),3年生存率为58.5%(31/53),5年生存率为26.4%(14/53)。术后功能恢复,没有复发。27例患者死于远处转移,12例出现淋巴结转移。结论足底皮肤恶性黑色素瘤转移率高,易远处转移。患者预后与肿瘤溃疡、厚度、淋巴结转移等因素有关。足底皮肤恶性黑色素瘤,治疗应以手术、化疗、免疫等综合方法为主。

Objective To discuss the clinical features and outcome of malignant melanoma of the skin on foot.Methods From 1998 to 2010,61 patients with melanoma on foot were retrospectively analyzed in our department.The main treatments were surgery,chemotherapy and immunotherapy.All patients undergo operation,all patients were treated by toe resection,lesion resection and skin graft,or lesions resection with flap transfer.while 32 cases had groin lymph node reaction at the same time.The survival rate was statistics.Factors that might be related to survival,included tumor depth,ulcer and lymph node metastasis.Analyzed by Kaplan-Meier and Log-rank method.Results Fifty-three patients were followed,and 8 of them were lost to follow up 2 years later.The follow up period ranged from 1 to 10 years,4.5 years on average.Survival rates in 1,3 and 5 years were 77.0%（47/61）,58.5%（31/53） and 26.4%（14/53）,respectively.The appearance and function of foot recovered well,and the local recurrence didn’t appear.Among them,27 patients died from systemic metastasis,and regional groin lymph node recurrence appeared in twelve patients.Conclusion The rate of metastasis in patients with melanoma on foot was higher.Factors related to survival,included tumor ulcer and depth,and lymph node metastasis,are analyzed by Kaplan-Meier and Log-rank method,the tumor depth may play a more important role in operation.Combination therapy included surgery,chemotherapy,and immunotherapy is the main treatment.