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鼻腔鼻竇黏膜惡性黑色素瘤之病例報告
Sinonasal Mucosal Malignant Melanoma-A Case Report
摘要
惡性黑色素瘤根據發生的位置可分為皮膚性及黏膜性，雖然鼻腔黏膜惡性黑色素瘤是最常發生的頭頸部黏膜黑色素瘤，但仍是罕見，只佔全部惡性黑色素瘤0.3－2%，佔頭頸部黑色素瘤4%。本院2008年10月經歷一名69歲男性，主訴鼻流血持續1個月、鼻涕倒流及右眼瞼腫脹，經病理報告及免疫組織化學報告診斷為鼻腔鼻竇惡性黑色素瘤，電腦斷層掃描、核磁共振影像及正子斷層造影顯示腫瘤已侵犯至顱底，且有骨轉移，病人接受廣泛手術切除病灶，術後採免疫治療，治療1次後病人因高燒未再持續治療，於隔年2月過世。鼻腔黏膜惡性黑色素瘤因無特殊症狀且腫瘤位置隱密，容易延誤診斷，以致預後不佳，所以當發現鼻流血、鼻塞及鼻內有黑色病變時，應接受鼻內視鏡、病理及電腦斷層掃描檢查，以期早期發現，予以治療，減少局部復發或遠端轉移，以提高存活率。
並列摘要
Malignant melanoma can be classified according to the site of the lesion into cutaneous and mucosa. Although nasal cavity mucosal malignant melanoma is the most common head and neck mucosal melanoma, it is still rare and accounting for only 0.3- 2.0% of all malignant melanoma, and 4% of all head and neck melanoma. We report a case of a 69 year-old man presented to our hospital in October, 2008 with complaints of epistaxis for 1 month, nasal obstruction and swelling of the right eyelid. Biopsy was taken/ performed and the subsequent pathology reports and immunohistochemistry studies confirmed the diagnosis of sinonasal malignant melanoma. Computer tomography, magnetic resonance imaging and PET computer tomography were performed and the tumor was shown to have extended to skull base and metastasized to the bone marrow cavity (with bone metastasis). The patient received wide excision of the tumor followed by postoperative immunotherapy. However after 1 course of immunotherapy, the patient did not continue with the treatment due to high fever. He died in February the following year. Diagnosis of nasal cavity malignant melanoma is often delayed due to its non-specific presentations and its insidious tumor location, resulting in poor prognosis. Hence, physicians should raise their awareness when encountering patients presented with epistaxis, nasal obstruction and black nasal lesions, nasal endoscopy, pathology examination and computed tomography scan can be arranged to avoid delayed diagnosis. Early detection and appropriate treatment would reduce the local recurrence or distant metastases and ultimately improve the overall prognosis.
延伸閱讀
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