Prasad Manju L, Busam Klaus J, Patel Snehal G, Hoshaw-Woodard Stacy, Shah Jatin P, Huvos Andrew G
Department of Pathology, Ohio State University Medical Center, Columbus 43210,
Arch Pathol Lab Med. 2003 Aug;127(8):997-1002. doi: 10.5858/2003-127-997-CDIMMA.
Primary mucosal melanomas are rare tumors. We compare melanomas arising in 2 histologically different mucosa, the stratified oral squamous mucosa and pseudostratified sinonasal respiratory mucosa, to investigate the clinicopathologic influence of native mucosal histology on the tumor.
Clinicopathologic features of 36 melanomas arising in the squamous mucosa of the oral cavity were compared with 59 melanomas arising in the sinonasal respiratory mucosa.
The median age of patients was 61 and 63 years for oral and sinonasal melanomas, respectively, with the squamous and respiratory mucosa covering the maxilla being most frequently involved (68.7% and 66%, respectively). The former had a remarkable male predilection (28 men, 8 women), while the latter affected both sexes equally (29 men, 30 women). The oral melanomas were more likely to be detected in the early in situ or microinvasive stage (4 cases vs none, P =.008) and were more frequently amelanotic (14 vs 12, P =.049) than sinonasal melanomas. The sinonasal melanomas were frequently thicker (median thickness, 9 vs 2.6 mm), polypoid (29 vs none), ulcerated (57 vs 20), and necrotic (57 vs 14) than oral melanoma (P <.001). Pseudopapillary architecture was more frequent in sinonasal melanomas (16 tumors vs none, P <.001), and desmoplastic melanomas were more frequent in the oral mucosa (6 vs 1, P =.005). Sinonasal melanoma showed vascular and deep tissue invasion more frequently than oral melanoma; however, no significant difference in disease-specific survival was noted (median survival, 2.8 years vs 3.0 years; 5-year survival, 37% vs 35%, respectively).
Sinonasal melanomas demonstrated aggressive morphologic features significantly more frequently than oral melanomas; however, prognosis remained similar in both groups.
原发性黏膜黑色素瘤是罕见肿瘤。我们比较发生于两种组织学不同黏膜（复层口腔鳞状黏膜和假复层鼻窦呼吸黏膜）的黑色素瘤，以研究天然黏膜组织学对肿瘤的临床病理影响。
将36例发生于口腔鳞状黏膜的黑色素瘤的临床病理特征与59例发生于鼻窦呼吸黏膜的黑色素瘤进行比较。
口腔和鼻窦黑色素瘤患者的中位年龄分别为61岁和63岁，上颌部的鳞状黏膜和呼吸黏膜受累最为常见（分别为68.7%和66%）。前者男性明显居多（28例男性，8例女性），而后者男女受累相当（29例男性，30例女性）。口腔黑色素瘤更易在早期原位或微侵袭阶段被发现（4例对0例，P = 0.008），且比鼻窦黑色素瘤更常为无色素性（14例对12例，P = 0.049）。鼻窦黑色素瘤比口腔黑色素瘤更常表现为厚度更大（中位厚度，9对2.6 mm）、息肉样（29例对0例）、溃疡形成（57例对20例）和坏死（57例对14例）（P < 0.001）。假乳头结构在鼻窦黑色素瘤中更常见（16例肿瘤对0例；P < 0.001），促纤维增生性黑色素瘤在口腔黏膜中更常见（6例对1例，P = 0.005）。鼻窦黑色素瘤比口腔黑色素瘤更常表现血管和深部组织侵犯；然而，疾病特异性生存率无显著差异（中位生存时间，2.8年对3.0年；5年生存率分别为37%对35%）。
鼻窦黑色素瘤比口腔黑色素瘤更常表现侵袭性形态学特征；然而，两组预后相似。
