Primary Malignant Mucosal Melanoma-In the Oral Cavity

原發口腔黏膜黑色素瘤

張凱成(Kai-Cheng Chang) ； 李麗玉(Li-Yu Lee) ； 吳若萱(Jo-Hsuan Wu) ； 廖俊達(Chun-Ta Liao) ； 陳一豪(I-How Chen) ； 康仲然(Chung-Jan Kang) ； 黃祥富(Shiang-Fu Huang)

《台灣耳鼻喉頭頸外科雜誌》 47卷4期 (2012/12) Pp. 304-311

https://doi.org/10.6286/2012.47.4.304

摘要

背景：原發性口腔黏膜黑色素瘤（OMM）是在頭部和頸部黏膜罕見的惡性腫瘤。在早期皮膚黑色素瘤的預後相對較好，相比之下，儘管實施積極的治療，口腔黑色素瘤的預後仍舊不佳。方法和材料：我們回顧分析在1982年至2012年間林口長庚紀念醫院16例原發性口腔黏膜黑色素瘤。結果：病患男性略多於女性（男：女=1.67：1），患者的平均年齡為63歲（範圍：31至91歲）。原發性口腔黏膜黑色素瘤的最常見的部位是在硬顎（7/16，43.75%）和牙齦（6/16，37.5%）。腫瘤分期主要分佈為第III期4名（25%），第Iva期11人（68.75%）和第IVc期1名（6.25%）。接受廣泛性手術切除腫瘤及頸部淋巴廓清手術的患者中，8/9（88.9%）被發現有頸部淋巴結轉移。在臨床及影像診斷無頸部淋巴結轉移的患者，7名中6名（85.7%）被發現有隱匿性頸部淋巴結轉移。最常見的淋巴結轉移是在II區（6/9, 66.7%）。在後續追蹤中，9/16（56.3%）發現遠處轉移。原發性口腔黏膜黑色素瘤的死亡主因為遠處轉移。此研究中原發性口腔黏膜黑色素瘤5年總存活率為31.3%。結論：於原發性口腔黏膜黑色素瘤中可發現頸部淋巴轉移機率較高，病患治療後遠端轉移情形亦高於局部復發。原發性口腔黏膜黑色素瘤即使於手術及輔助治療後存活率仍舊不佳。

關鍵字

口腔黏膜 ； 黑色素瘤 ； 預後因子

並列摘要

BACKGROUND: Primary oral mucosal melanomas (OMM) of the head and neck are rare. In contrast to the relatively good prognosis of early skin melanoma, and despite the implementation of aggressive treatment, the prognosis of oral melanoma is extremely poor.METHODS AND MATERIALS: We retrospectively analyzed 16 patients with primary melanomas of the oral cavity between 1986 and 2012 in Chang Gung Memorial Hospital, Linkou.RESULTS: A slight male predominance was found (M : F = 1.67 : 1), and the mean age of the patients was 63 years (range: 31 to 91 years). The most common sites of OMM were in the hard palate (7/16, 43.8%) and alveolar ridge (6/16, 37.5%). The stage distribution was 4 (25.0%) in stage III, 11 (68.8%) in stage IVa and 1 in stage IVc (6.3%). In 9 patients who received radical surgery with neck dissection, 8 patients (88.9%) had lymph node metastasis. In 7 patients who were clinically negative for neck lymph node metastasis, 6 patients (85.7%) were found to have occult neck metastasis. The most common metastatic lymph nodes for therapeutic neck dissections were in level II (6/9, 66.7%). Distant metastasis was found in 9/16 (56.3%) of the cases during follow-up. The main cause of death from OMM was distant metastasis. The 5-year overall survival rate of primary OMM was 31.3% in our patients..CONCLUSIONS: We found a high incidence of neck lymph node metastasis in OMM. The development of distant metastasis after treatment was more frequent than local failure. The prognosis of OMM was poor even after radical surgery and adjuvant treatment.

並列關鍵字

oral mucosa ； melanoma ； prognostic factor