Johnson T L, Kumar N B, White C D, Morley G W
Int J Gynecol Pathol. 1986;5(2):110-8.
We studied 19 cases of vulvar melanoma to determine significant clinical and histologic prognostic predictors. The average follow-up time was 32 months. Fourteen patients died of melanoma, four patients are alive with no evidence of melanoma, and one patient is alive with residual melanoma. All disease-free survivors had clinical stage I disease and a maximum tumor thickness of 1.3 mm. The average mitotic count in this group was 5.5 per 10 high power fields (HPF) and 50% of the tumors were superficial spreading melanomas. All survivors were treated by radical vulvectomy with bilateral inguinal lymph node dissection. Of the nonsurvivors, four (28.5%) were clinical stage I, five (36%) were clinical stage II, four (28.5%) were clinical stage III, and one (7%) was clinical stage IV. The average tumor thickness for nonsurvivors was 9.5 mm (range 2.6-18 mm) and the average mitotic count was 13.3/10 HPF. Only three (21%) tumors from nonsurvivors were superficial spreading melanomas; the majority were nodular melanomas. The statistically significant prognostic predictors were clinical stage of disease and tumor thickness. Tumor type (i.e., superficial spreading, nodular, or acral lentiginous) correlated with tumor thickness and was indirectly related to prognosis. The mitotic count was also a useful prognostic feature.
我们研究了19例外阴黑色素瘤患者，以确定重要的临床和组织学预后预测指标。平均随访时间为32个月。14例患者死于黑色素瘤，4例患者存活且无黑色素瘤证据，1例患者存活但有残留黑色素瘤。所有无病生存者均为临床I期疾病，最大肿瘤厚度为1.3mm。该组的平均有丝分裂计数为每10个高倍视野（HPF）5.5个，50%的肿瘤为浅表扩散型黑色素瘤。所有生存者均接受了根治性外阴切除术及双侧腹股沟淋巴结清扫术。在非生存者中，4例（28.5%）为临床I期，5例（36%）为临床II期，4例（28.5%）为临床III期，1例（7%）为临床IV期。非生存者的平均肿瘤厚度为9.5mm（范围2.6 - 18mm），平均有丝分裂计数为13.3/10 HPF。非生存者中只有3例（21%）肿瘤为浅表扩散型黑色素瘤；大多数为结节型黑色素瘤。具有统计学意义的预后预测指标为疾病的临床分期和肿瘤厚度。肿瘤类型（即浅表扩散型、结节型或肢端雀斑样痣型）与肿瘤厚度相关，且与预后间接相关。有丝分裂计数也是一个有用的预后特征。
