恶性黑色素瘤2例报告并文献复习

发布时间：2018-03-27 19:34

本文选题：恶性黑色素瘤　切入点：临床表现　出处：《山东大学》2015年硕士论文

【摘要】：目的分析恶性黑色素瘤的病因、临床表现、诊断及治疗,提高对恶性黑色素瘤的认识,强调早期发现、早期治疗对改善恶性黑色素瘤预后的重要性。方法回顾性分析2例恶性黑色素瘤患者的临床资料,结合综述国内外文献报道,对恶性黑色素瘤的病因、临床表现、诊断标准、鉴别诊断及治疗进行讨论。结果病例1.男性,73岁,左胫前黑色结节1年,渐生长,近2月破溃。左胫前一处约1.5*1.5cm大小黑色结节,表面破溃,无渗出。表面及边缘色素分布欠均匀,质偏硬,有轻压痛,周围皮肤红肿。病理报告：左胫前恶性黑色素瘤。诊断：皮肤结节性恶性黑色素瘤。治疗：局部恶性黑色素瘤扩大切除术,胭窝,腹股沟淋巴结清扫术,术后给予DP方案(达卡巴嗪+恩度)化疗3个周期,随访1年无复发。病例2.女性,26岁,左乳房色素痣增大1年。患者自幼左乳房内侧米粒大黑褐色斑片,随年龄增长缓慢生长。近1年皮疹面积迅速扩大,渐高出皮面,颜色加深,表面色素不均匀,无破溃、渗出,无触痛及皮下硬结。病理诊断：恶性黑色素瘤。诊断：浅表扩散性恶性黑色素瘤。治疗：局部皮损扩大切除术及区域淋巴结清扫术。术后行联合化疗(氮烯咪胺、长春新碱)并干扰素免疫支持疗法。随访半年无复发。结论皮肤恶性黑色素瘤是黑色素细胞的恶性肿瘤,在世界范围内的发病率呈逐年升高趋势,年增长率在4%-6%。本病多发于中老年人,但亦可见于青年人及儿童。临床表现主要为较快速生长的黑素皮损,可呈斑块,结节,蕈状或菜花状。边缘参差不齐,呈锯齿状,表面不光滑,部分糜烂、溃疡,局部发痒,灼痛或压痛感。恶性黑色素瘤的确诊依靠病理学诊断。恶性黑色素瘤的治疗采用以个体化治疗为主,基础治疗和辅助治疗为辅的综合治疗。早期手术切除是首选治疗方法,手术方式根据病变分期选择。恶性黑色素瘤对化疗药物相对不敏感,但对中晚期患者应于以放化疗、免疫治疗等辅助治疗。目前恶性黑色素瘤尚无有效的治疗方法,因此做好预防措施尤为重要,特别是对高危人群,实现早发现,早诊断,早治疗。再此基础上,积极探索针对恶性黑色素瘤的早期、敏感、特异的诊断指标,寻找有效的治疗方法,最终为预防该病,延长患者的生存时间和提高生活质量提供新的途径。
[Abstract]:Objective to analyze the etiology, clinical manifestation, diagnosis and treatment of malignant melanoma, to improve the understanding of malignant melanoma and to emphasize its early detection. Methods the clinical data of 2 patients with malignant melanoma were retrospectively analyzed, and the etiology, clinical manifestations and diagnostic criteria of malignant melanoma were reviewed. The differential diagnosis and treatment were discussed. Results 1.The male was 73 years old. The black tubercle of left anterior tibia grew gradually for 1 year and broke in the last two months. The size of 1.5*1.5cm was about the size of black tubercle in the left tibia and the surface was ruptured. No exudation. Uneven distribution of surface and edge pigments, hard quality, slight tenderness, Peripheral skin redness. Pathological report: left anterior tibial malignant melanoma. Diagnosis: cutaneous nodular malignant melanoma. Treatment: extended excision of local malignant melanoma, popliteal and inguinal lymph node dissection, After operation, DP regimen was given for 3 cycles, followed up for 1 year without recurrence. Case 2. The female was 26 years old, the left breast pigmented nevus was enlarged for 1 year. The rash area expanded rapidly in the past one year, gradually higher than the leather, the color deepened, the surface pigment was uneven, no breakup, exudation, No tenderness and subcutaneous sclerosis. Pathological diagnosis: malignant melanoma. Diagnosis: superficial diffuse malignant melanoma. Treatment: extended excision of local lesions and regional lymph node dissection. There was no recurrence after half a year follow-up. Conclusion malignant melanoma of skin is a malignant tumor of melanocytes, and the incidence of melanoma in the world is increasing year by year. The annual growth rate is between 4% and 6%. The disease is more common in middle and old people, but also in young people and children. The clinical manifestations are mainly rapid growth melanin lesions, which can be plaques, nodules, mushrooms or cauliflower. The edges are uneven and serrated. Surface is not smooth, partial erosion, ulcer, local itching, burning or tenderness. Diagnosis of malignant melanoma depends on pathological diagnosis. Early surgical resection is the first choice of treatment according to the pathological stages. Malignant melanoma is relatively insensitive to chemotherapeutic drugs, but should be treated with radiotherapy and chemotherapy. Immunotherapy and other adjuvant treatments. At present, there is no effective treatment for malignant melanoma, so it is particularly important to do a good job of preventive measures, especially for high-risk groups, to realize early detection, early diagnosis, and early treatment. On this basis, To actively explore the early, sensitive and specific diagnostic indicators of malignant melanoma, to find effective treatment for the prevention of the disease, prolong the survival time of patients and improve the quality of life to provide a new way.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R739.5

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