Costa Sergio Renato Pais, Horta Sergio Henrique Couto, Henriques Alexandre Cruz
Faculdade de Medicina do ABC, General Surgery Service, Teaching Hospital, Santo André, São Paulo, Brazil.
Sao Paulo Med J. 2008 Jul;126(4):232-5. doi: 10.1590/s1516-31802008000400009.
Regional lymph node involvement in patients with malignant melanomas has been associated with poor prognosis. In-transit metastases also lead to poor long-term survival. Whereas for nodal disease only regional lymphadenectomy offers adequate locoregional control, for in-transit metastasis both local excision and isolated limb perfusion with chemotherapy plus tumor necrosis factor-alpha can be used for disease control. In cases of tumors located in the distal region of the legs, the lymphatic dissemination most commonly observed is to the inguinal chain. Consequently, therapeutic inguinal lymphadenectomy or even selective lymphadenectomy (sentinel lymph node biopsy) have been recommended. On the other hand, involvement of the popliteal chain is very rare. When this occurs, popliteal lymphadenectomy should be indicated. Local excision may be the logical approach for a few small in-transit metastases because of the low morbidity in this procedure, when compared with isolated limb perfusion.
A case of melanoma of the heel with popliteal chain involvement and in-transit metastases is presented. This was treated by means of regional lymphadenectomy plus in-transit metastases excision, with a good postoperative course.
恶性黑色素瘤患者出现区域淋巴结受累与预后不良相关。皮下转移也会导致长期生存率低下。对于淋巴结疾病，仅区域淋巴结清扫术可提供充分的局部区域控制，而对于皮下转移，局部切除以及化疗加肿瘤坏死因子-α的隔离肢体灌注均可用于疾病控制。在位于腿部远端区域的肿瘤病例中，最常观察到的淋巴扩散是至腹股沟链。因此，推荐进行治疗性腹股沟淋巴结清扫术甚至选择性淋巴结清扫术（前哨淋巴结活检）。另一方面，腘窝链受累非常罕见。当出现这种情况时，应进行腘窝淋巴结清扫术。由于与隔离肢体灌注相比，该手术的发病率较低，对于一些小的皮下转移，局部切除可能是合理的方法。
本文报告了1例足跟黑色素瘤伴腘窝链受累及皮下转移的病例。该病例通过区域淋巴结清扫术加皮下转移灶切除术进行治疗，术后病程良好。
