Fortin P T, Freiberg A A, Rees R, Sondak V K, Johnson T M
University of Michigan Medical Center, Ann Arbor, USA.
J Bone Joint Surg Am. 1995 Sep;77(9):1396-403. doi: 10.2106/00004623-199509000-00016.
The records of sixty patients who had a malignant melanoma of the foot or ankle were reviewed retrospectively to determine the clinical features, prognostic factors, and distinguishing characteristics. Fifty-seven patients were white and three were black. There were forty-two women and eighteen men (a female-to-male ratio of 2.3 to 1). The mean age at the time of presentation was fifty-seven years (range, twenty-two to eighty-three years). The most common site of involvement was the plantar aspect of the foot. The mean duration of follow-up was forty-five months (range, three to 144 months). Kaplan-Meier life-table analysis revealed an over-all five-year survival rate of 63 per cent and an over-all ten-year survival rate of 51 per cent. The mean duration of survival for the patients who had a plantar or subungual lesion was significantly shorter than that for the patients who had a lesion at another site on the dorsal aspect of the foot or on the ankle (forty-seven compared with seventy-two months) (p = 0.02). The mean depth of the lesion, according to the criteria of Breslow, was 3.03 millimeters, and the mean level, according to the classification of Clark et al., was IV. According to the classification of the American Joint Commission on Cancer, forty-three patients had stage-I or II (local) disease, thirteen had stage-III disease (nodal or in-transit disease, defined as cutaneous or subcutaneous metastases more than two centimeters from the primary tumor but not beyond the regional lymph nodes), and four had stage-IV disease (distant visceral metastases) at the time of presentation. Lesions at plantar and subungual sites were also associated with a higher prevalence of clinical misdiagnosis compared with lesions on the dorsal aspect of the foot or on the ankle (p = 0.02). The misdiagnoses included a benign nevus (one patient), a paronychia (one patient), a pyogenic granuloma (two patients), a plantar wart (three patients), a ganglion cyst (one patient), a blister (two patients), and a traumatic lesion (five patients).(ABSTRACT TRUNCATED AT 250 WORDS)
对60例足部或踝部恶性黑色素瘤患者的记录进行回顾性分析，以确定其临床特征、预后因素和鉴别特征。57例患者为白人，3例为黑人。有42名女性和18名男性（女性与男性比例为2.3比1）。就诊时的平均年龄为57岁（范围为22至83岁）。最常见的受累部位是足底。平均随访时间为45个月（范围为3至144个月）。Kaplan-Meier生存表分析显示，总体五年生存率为63%，总体十年生存率为51%。足底或甲下病变患者的平均生存时间明显短于足部背侧或踝部其他部位病变的患者（47个月与72个月相比）（p = 0.02）。根据Breslow标准，病变的平均深度为3.03毫米，根据Clark等人的分类，平均水平为IV级。根据美国癌症联合委员会的分类，43例患者在就诊时有I期或II期（局部）疾病，13例有III期疾病（淋巴结或转移灶疾病，定义为距原发肿瘤超过2厘米但未超出区域淋巴结的皮肤或皮下转移），4例有IV期疾病（远处内脏转移）。与足部背侧或踝部病变相比，足底和甲下部位的病变临床误诊率也更高（p = 0.02）。误诊包括良性痣（1例）、甲沟炎（1例）、化脓性肉芽肿（2例）、跖疣（3例）、腱鞘囊肿（1例）、水疱（2例）和创伤性病变（5例）。（摘要截断于250字）
