Ng Yvonne Y R, Tan Grace H C, Quek Richard H H, Farid Mohamad B H R, Soo Khee Chee, Teo Melissa C C
Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.
Division of Medical Oncology, National Cancer Centre Singapore, Singapore.
ANZ J Surg. 2018 Nov;88(11):1145-1150. doi: 10.1111/ans.14373. Epub 2018 Feb 1.
Primary mucosal melanomas (MM) are rare neoplasms arising from melanocytes in mucosal membranes. Delayed diagnosis and aggressive disease biology contribute to a poorer prognosis. The clinical patterns of MMs treated in a large tertiary centre, and the differences between MMs in the head and neck versus other anatomical sites are described.
A retrospective review of 43 patients diagnosed with MM in the head and neck, urogenital, esophageal and anorectal sites from 1993 to 2015 was conducted.
Distribution of head and neck, urogenital and gastrointestinal MM were 42, 30 and 28% respectively. Disease extent was local in 44%, regional in 40% and distal in 12% at diagnosis. Head and neck MMs were more likely to be diagnosed at an earlier stage as compared to other sites (P = 0.04). Surgery was performed with curative intent in 72%, while 2% had palliative surgery for symptom control. Of the remaining patients who did not undergo surgery, four had palliative chemotherapy and/or radiotherapy. Median disease-free survival was 13 months (1-179 months). There was a significantly longer time to locoregional recurrence in head and neck MM (16 months) compared to other sites (11 months) (P = 0.03). The 2-year overall survival was also significantly higher in head and neck MM (P = 0.003).
MM of the head and neck is diagnosed at an earlier stage and associated with a longer time to locoregional recurrence. Surgical resection is the mainstay of treatment and may offer long-term survival benefit in selected patients.
原发性黏膜黑色素瘤（MM）是起源于黏膜膜中黑素细胞的罕见肿瘤。诊断延迟和侵袭性疾病生物学特性导致预后较差。本文描述了在一家大型三级中心接受治疗的MM的临床模式，以及头颈部MM与其他解剖部位MM之间的差异。
对1993年至2015年期间在头颈部、泌尿生殖系统、食管和肛门直肠部位诊断为MM的43例患者进行回顾性研究。
头颈部、泌尿生殖系统和胃肠道MM的分布分别为42%、30%和28%。诊断时疾病范围为局部的占44%，区域的占40%，远处的占12%。与其他部位相比，头颈部MM更有可能在早期被诊断出来（P = 0.04）。72%的患者进行了根治性手术，而2%的患者进行了姑息性手术以控制症状。其余未接受手术的患者中，有4例接受了姑息性化疗和/或放疗。无病生存期的中位数为13个月（1 - 179个月）。与其他部位（11个月）相比，头颈部MM的局部区域复发时间明显更长（16个月）（P = 0.03）。头颈部MM的2年总生存率也明显更高（P = 0.003）。
头颈部MM在早期被诊断出来，且局部区域复发时间较长。手术切除是主要的治疗方法，可能为部分患者带来长期生存益处。
