早期甲黑素瘤115例手术治疗方案和预后回顾分析

Surgical treatment strategies and outcomes of early-stage nail apparatus melanoma:a retrospective analysis of 115 cases

目的探讨早期甲黑素瘤的手术治疗方案和预后。方法回顾并分析第四军医大学西京皮肤医院2011年7月至2019年12月收集的115例早期甲黑素瘤的手术治疗方案及预后。结果115例早期甲黑素瘤患者按改良的ABCDEF标准并根据如甲板改变、溃疡、结节等临床表现评估后,73例按原位甲黑素瘤扩大切除,22例按Ⅰ、Ⅱ期甲黑素瘤扩大切除,20例按Ⅰ、Ⅱ期甲黑素瘤且有浸润风险方案扩大切除。随访6个月至9年,所有患者均未出现原发灶复发;101例患者淋巴结B超检查未见异常;2例截指患者出现转移,其中1例死亡;失访12例。结论依据患者甲黑素瘤临床表现选择手术扩大切除方案治疗早期甲黑素瘤,可以在确保充分治疗的基础上,最大程度保留肢端正常功能,且不会出现原发灶复发。

Objective To explore surgical treatment strategies and prognosis of early-stage nail apparatus melanoma.Methods A total of 115 patients with early-stage nail apparatus melanoma receiving surgical treatment were collected from Department of Dermatology,Xijing Hospital,the Fourth Military Medical University from July 2011 to December 2019,and surgical treatment strategies and outcomes were analyzed retrospectively.Results According to the modified ABCDEF criteria and clinical manifestations(such as deformation of the nail plate,ulcers,nodules),73 patients with early-stage nail apparatus melanoma received extended surgical resection based on the resection principles of melanoma in situ,22 based on the resection principles of stage I and II melanoma,20 based on the resection principles of stage I and II melanoma with invasion risks.During the follow-up period of 6 months to 9 years,there was no recurrence of the primary tumors in any patients;no abnormalities were observed by the ultrasound examination of lymph nodes in 101 patients;metastases occurred in 2 patients receiving finger amputation,1 of whom died;12 patients were lost to follow-up.Conclusion To select extended surgical resection strategies for early-stage nail apparatus melanoma based on clinical manifestations,can ensure adequate treatment and preserve the normal function of the extremities to the greatest extent without recurrence of the primary tumors.