Billings K R, Wang M B, Sercarz J A, Fu Y S
Division of Head and Neck Surgery, University of California, Los Angeles School of Medicine, USA.
Otolaryngol Head Neck Surg. 1995 Jun;112(6):700-6. doi: 10.1016/S0194-59989570179-6.
Metastatic mucosal melanoma is extremely rare. Only 0.6% to 9.3% of patients with cutaneous malignant melanoma will have metastases to the mucosa of the upper aerodigestive tract. The records of all patients with mucosal melanoma of the head and neck at the University of California, Los Angeles Medical Center during the past 30 years were reviewed. Patients with primary tumors were separated form those with metastatic involvement from a cutaneous primary site. These two groups were compared for differences in clinical symptoms, histopathologic findings, treatment, and survival characteristics. Frequent sites of metastatic involvement included the base of tongue and nasal cavity. These arose from a variety of cutaneous sites including the trunk and extremities and, in most instances, did not arise until 2 to 7 years after the initial cutaneous lesion. Most of those with metastases to the head and neck mucosa had disseminated disease. The histopathologic distinction between the two groups is described with photomicrographs. Junctional activity in the overlying or adjacent mucosa distinguishes primary mucosal melanoma from metastatic disease, in which the overlying mucosa is usually intact. This difference is useful in determining workup and treatment options. Aggressive surgical resection is suggested in treatment of primary melanomas, whereas surgery is at best palliative in those with metastatic disease.
转移性黏膜黑色素瘤极为罕见。仅有0.6%至9.3%的皮肤恶性黑色素瘤患者会发生上呼吸消化道黏膜转移。回顾了加利福尼亚大学洛杉矶分校医学中心过去30年里所有头颈部黏膜黑色素瘤患者的记录。将原发性肿瘤患者与皮肤原发性部位发生转移累及的患者区分开来。比较了这两组患者在临床症状、组织病理学发现、治疗及生存特征方面的差异。转移累及的常见部位包括舌根和鼻腔。这些转移灶源自包括躯干和四肢在内的各种皮肤部位，且在大多数情况下，直到最初皮肤病变出现2至7年后才会发生转移。大多数发生头颈部黏膜转移的患者已有播散性疾病。用显微照片描述了两组之间的组织病理学差异。覆盖或相邻黏膜中的交界活性可将原发性黏膜黑色素瘤与转移性疾病区分开来，转移性疾病中覆盖的黏膜通常是完整的。这种差异有助于确定检查方法和治疗方案。原发性黑色素瘤的治疗建议采用积极的手术切除，而对于转移性疾病患者，手术充其量只是姑息性的。
