上顎牙齦惡性黑色素瘤－病例報告

Malignant Melanoma of Maxillary Gingiva-A Case Report

呂明怡(Ming-Yi Lu) ； 彭芷瑜(Chih-Yu Peng) ； 黃裕峰(Yu-Feng Huang) ； 郭智(Chih Kuo) ； 黃淑卿(Shu-Ching Huang) ； 吳伯璋(Buor-Chang Wu)

《臺灣口腔顎面外科學會雜誌》 20卷4期 (2009/12) Pp. 288-299

https://doi.org/10.7104/TJOMS.200912.0288

摘要

口腔惡性黑色素瘤發生率約佔全身惡性黑色素瘤的0.2~8%，好發部位爲硬腭及上顎牙齦，治療一般以手術切除爲主，預後不佳，五年存活率約爲15%。本病例爲一女性因左上顎第二、第三大臼齒區腫痛至診所就診，拔除患齒後觀察了一個月，症狀並沒有改善而轉診至本科。臨床按查發現左上顎後牙區有一紅腫塊伴有色素沉積，於當天進行切片檢查，病理報告爲惡性周邊神經鞘細胞瘤，隨後安排患者接受廣泛性切除手術。不幸於術後第四個月例行追蹤時發現左頸淋巴腫大，進一步檢查高度懷疑有淋巴轉移，隨後進行左頸淋巴廓清手術，病理報告爲惡性黑色素瘤，病理科醫師合併檢視口腔原發腫瘤之切片後亦推翻之前診斷。患者術後接受輔助性放射線治療，目前持續於門診追蹤。因病例之特殊性，故在此提出，並回顧相關文獻。

關鍵字

口腔惡性黑色素瘤

並列摘要

Oral malignant melanoma is a very rare tumor, representing 0.2% to 8% of all melanomas. The most frequently affected oral sites are palate and maxillary gingiva. Surgical excision is usually the treatment of choice but the prognosis is poor, with a 5-year survival rate of approximately 15%.
This artic1e reported a female who went to local dental c1inic for swelling and pain over left maxillary first and second molar. The teeth were extracted and she was followed for one month. However, the symptoms and signs persisted. Oral examination revealed an erythematous lesion over left posterior maxillary buccal gingiva with a brown spot. The biopsy was performed and the histopathologic report revealed a malignant schwannoma. Operation was performed with wide excision of the tumor. Unfortunately, a swelling over left submandibular region was noted at 4-month postoperatively routine follow-up. Lymph node metastasis was highly suspected after further examination and left supraomohyoid neck dissection was performed. The histopathologic report revealed the lesion as malignant melanoma. The pathologist reviewed the intraoral primary lesion and revised the report. After operation, the patient received adjuvant radiotherapy and kept regular follow-up. Because of its rarity, the diagnosis and treatment of this disease were discussed and the literature was reviewed.

並列關鍵字

oral malignant melanoma