Umeda M, Shimada K
Department of Maxillofacial Surgery, Kobe University School of Medicine, Japan.
Br J Oral Maxillofac Surg. 1994 Feb;32(1):39-47. doi: 10.1016/0266-4356(94)90172-4.
In contrast to Caucasians, the Japanese population has a relatively high incidence of malignant melanoma in the oral cavity, but its classification and treatment has not been established up to now. We present here the detailed clinical and histological features of 14 cases of oral melanoma. In 13 of the 14 patients, the lesions exhibited three phases: a nodular phase consisting of spindle-shaped or epithelioid tumor cells in the submucosa, a pigmented plaque phase consisting of preinvasive tumor cell nests in the lower epithelial layers, and a macular phase consisting of proliferation of dendritic melanocytes without apparent atypia or simple hyperpigmentation in the basal cell layer. The macroscopic and microscopic findings of 13 melanomas corresponded to those of acral lentiginous melanoma of the skin, while the one lesion showing no radial growth phase was classified as nodular melanoma. We devised a new treatment plan for oral melanoma in 1980, which includes surgical excision via an intraoral approach, therapeutic neck dissection, and adjuvant immunochemotherapy. Out of 11 patients treated in this manner, nine had a good outcome without major cosmetic and functional morbidity. This suggests that the prognosis of oral melanoma is not so poor as reported previously if adequate therapy is provided.
与白种人相比，日本人群口腔恶性黑色素瘤的发病率相对较高，但目前其分类和治疗方法尚未确立。在此，我们展示14例口腔黑色素瘤的详细临床和组织学特征。在14例患者中的13例中，病变呈现三个阶段：黏膜下层由梭形或上皮样肿瘤细胞组成的结节期，上皮下层由侵袭前肿瘤细胞巢组成的色素沉着斑块期，以及基底细胞层由树突状黑素细胞增殖但无明显异型性或单纯色素沉着过度组成的斑片期。13例黑色素瘤的宏观和微观表现与皮肤肢端雀斑样痣性黑色素瘤一致，而1例无放射状生长期的病变被归类为结节性黑色素瘤。我们在1980年设计了一种新的口腔黑色素瘤治疗方案，包括经口内途径手术切除、治疗性颈部清扫和辅助免疫化疗。以这种方式治疗的11例患者中，9例预后良好，无严重的美容和功能损害。这表明，如果提供充分的治疗，口腔黑色素瘤的预后并不像之前报道的那么差。
