- 期刊
Cervical Lymph Node Metastasis from Melanoma of an Unknown Primary Site - Case Report
原發部位不明的惡性黑色素瘤併頸部淋巴轉移－病例報告
摘要
原發位置不明的惡性黑色素瘤，約佔惡性黑色素瘤的3－8%，這些病人中約64%會有淋巴轉移，包括頸部淋巴、腮腺淋巴、腹股溝及腋下淋巴。根據文獻報告指出，這種現象是由於患者本身的免疫系統，消弭了原發部位的病灶，以致於這些轉移性的惡性黑色素瘤找不到原發部位的病灶，且預後比確定原發位置的惡性黑色素瘤甚至來得佳。治療的原則仍以廣泛性的外科切除為主，術後的放射治療或輔助性的化學治療，對預後而言，並沒有統計上的差異。病例報告為一71歲女性，1996年2月住入本院。病人主訴在左側頸部有腫塊半年之久，臨床上觸診發現在耳後、頸部中段和頸後三角，各有4 × 3、2 × 2、3 × 3 cm的腫塊，不痛且無任何不適感。電腦斷層與細胞學檢查皆支持為一軟組織腫瘤，經左頸根治性廓清術後，病理報告是轉移性惡性黑色素瘤。接下來為病人安排一連串的內視鏡檢查，並從頭皮到腳底，為病人做1次徹底的身體檢，皆無發現原發的病灶。此後，病人在門診追蹤3年至今，從臨床上和影像檢查方面，皆無復發之跡象。
並列摘要
Cancer can occasionally manifest initially as nodal metastases without any known primary site. Metastatic melanoma with an unknown primary site is a relatively unusual clinical entity with a reported incidence of between 1 and 15%. Regional lymph node metastasis accounts for up to 64% of metastatic melanoma. We report a 71-year-old woman who presented with metastatic melanoma of the retroauricular, middle jugular and posterior triangle lymph nodes with an unknown primary site. Radical neck dissection was performed. A retrospective search for a primary melanoma disclosed a pigmented lesion over her scalp. However, pathology of the resected lesion was negative for malignancy. The patient remained well without recurrent disease after 3 years of follow-up. Diagnosis of metastatic melanoma of the cervical lymph nodes with an unknown primary site should only be made after a careful search for primary melanoma in the cutaneous and mucosal surfaces of the head and neck. Neck dissection is the treatment of choice, and survival is not significantly different from patients with known primary sites.
延伸閱讀
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