【摘要】 目的探讨大同市恶性黑素瘤的临床及组织病理特点,以提高本地区临床诊断水平。方法选取2008年7月～2018年6月间就诊于大同市某三甲医院恶性黑素瘤患者43例,回顾性分析患者的临床表现、组织病理特点,选用SPSS18.0统计软件进行分析。结果 43例恶性黑素瘤患者中男17例,女26例,男女性别比为1:1.53,平均年龄60.53岁,发病年龄高峰段51～80岁28例(65.12%);肢端多见25例(58.14%);病因不明23例(53.49%);发生淋巴转移的20例(46.51%)。病灶体积最小0.6 cm×0.4 cm×0.2 cm,最大8.0 cm×3.5 cm×1.5 cm;肿瘤Breslow厚度≤1 cm患者19例(44.19%),>4 cm患者14例(32.56%);Clark分级处于Ⅰ级、Ⅱ级,28例(65.12%),无溃疡多为Ⅰ级、Ⅱ级,有溃疡多为Ⅲ级以上;有26例进一步行免疫组化确诊,HMB45(+)例数19例(73.08%),S-100(+)例数21例(80.77%)。参照AJCC临床分期简化分成早期23例,晚期20例,早晚期的临床特点比较,发病部位和淋巴转移比较,差异有统计学意义(P<0.05)。结论恶性黑素瘤病因多数不明,以老年人多见,肢端为最常见的发病部位,病理特征具有多样性特点,免疫组化检测有助于诊断。黏膜型恶性黑素瘤发病更隐匿,多数发病即为临床晚期,易发生转移。更多还原

【Abstract】 Objective To investigate the clinical and histopathological features of malignant melanoma in Datong City,in order to improve the clinical diagnosis level in this area. Methods From July 2008 to June 2018, 43 patients with malignant melanoma who were diagnosed in a Grade III hospital in Datong City were selected. Patients’ clinical manifestations and histopathological features were retrospectively analyzed. SPSS18.0 statistical software was selected for analysis. Results Among the 43 patients with malignant melanoma, 17 were male and 26 were female. The male-female ratio was 1∶1.53, the average age was 60.53 years, and 28 cases were in the onset peak age of 51-80 years old(65.12%);there were 25 cases(58.14%) mostly seen in extremities, 23 cases(53.49%) with unknown etiology, and 20 cases(46.51%)with lymphatic metastasis. The lesion volume was 0.6 cm×0.4 cm×0.2 cm as the minimum, and 8.0 cm×3.5 cm×1.5 cm as the maximum; there were 19 patients(44.19%) with tumor Breslow thickness ≤1 cm and 14 patients(32.56%) with>4 cm thickness; There were 28 cases with Clark grade in grade Ⅰ and grade Ⅱ(65.12%). Those with no ulcers were mostly in grade Ⅰ and grade Ⅱ, and those with ulcers were mostly in grade Ⅲ or above; there were 26 cases who were confirmed diagnosis by further immunohistochemical testing, with 19 cases(73.08%) of HMB45(+) and 21 cases(80.77%)of S-100(+). According to the simplified AJCC clinical staging, 23 cases were in the early stage and 20 cases in the late stage. The clinical features of early and late stage were compared, and the differences in pathogenic sites and lymphatic metastasis were statistically significant(P <0.05). Conclusion The cause of malignant melanoma is mostly unknown, and it is more common in the elderly. The extremity is the mostly seen pathogenic site. Pathological features are characterized by diversity,and immunohistochemical testing is helpful for diagnosis. The incidence of mucosal malignant melanoma is more concealed. Most of the onset is at the advanced clinical stage and prone to metastasis.更多还原