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Primary Oral Malignant Melanoma-A Clinicopathological Study of 6 Cases

原發性口腔惡性黑色素瘤-6例之臨床病理研究

摘要


原發性口腔惡性黑色素瘤是一種罕見的疾病,佔所有惡性黑色素瘤不到百分之一。在此篇研究裡,我們分析了六位從1988至2003年在台大醫院牙科部診斷及/或治療之惡性黑色素瘤患者,其中有四位是女性,兩位是男性,平均年齡為64歲。在這六位病人中,有四位腫瘤發生於硬腭,一位同時發生於硬腭與上顎牙齦,一位發生於下顎牙齦。腫瘤最大徑從1.5公分至8公分,平均為4公分。口腔惡性黑色素瘤常見的臨床症狀為黑色腫瘤伴隨潰瘍、疼痛或流血。五位牙齒狀況有記載之患者中,四位有假牙或牙橋於腫瘤附近或壓在腫瘤上“在診斷初期,有三位病人是處於臨床分期第一期(局部疾病),其它三位病人則處於第二期(伴隨局部林巴結轉移)。在治療方面,兩位接受手術切除合併或未合併改良式廣泛性頸部廓清術,這兩位患者分別存活了25及14個月;兩位接受化學治療合併或未合併放射線治療的患者分別存活了54及48個月;其餘的兩位未接受任何治療的患者,則分別存活了8個月及2個月。我們所得到的結論是,口腔惡性黑色素瘤好發於50至70歲患者,好發位置是在硬腭及上顎牙齦。常見的臨床徵候為帶有黑色素的腫瘤。我們六位病人的平均存活時間為25個月,給予某些種類的治療的確可延長這些患者的生命。

並列摘要


Oral malignant melanomas (OMMs) are a rare entity, comprising less than 1% of all malignant melanomas. Six patients with an OMM diagnosed and/or treated in our institute during the period from 1988 to 2003 were analyzed in this study. There were 4 female and 2 male patients. The mean age of the 6 patients at the time of diagnosis was 64 years. Of the 6 OMMs, 4 occurred on the hard palate, 1 on both the hard palate and maxillary gingiva, and 1 on the mandibular gingiva. The greatest dimension of the lesions ranged from 1.5 to 8cm with a mean of 4cm. The more-common clinical symptoms and signs were black-pigmented tumors with ulceration, pain, or bleeding. Of the 5 patients whose dental status was available, 4 had either a denture or a bridge near or impinging on the tumor. At the time of initial presentation, 3 patients were in clinical stage Ⅰ (localized disease), and the other 3 were in clinical stage Ⅱ (OMM with regional lymph node metastasis). Two patients who received surgical excision of the primary OMM with or without modified radical neck dissection survived for 25 and 14 months, respectively; 2 patients who were treated by chemotherapy with or without radiotherapy survived 54 and 48 months, respectively; and the remaining 2 patients who received no treatment survived 8 and 2 months, respectively. We concluded that OMMs occur more often in the sixth and seventh decades. The more-common affected sites are the hard palate and maxillary gingiva. The more-frequent clinical presentation is a pigmented mass. The mean survival of our 6 OMM patients was 25 months. Certain treatments do prolong the life of OMM patients.

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