Malignant melanoma of the upper extremities
Malignant melanoma of the upper extremities
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上肢恶性黑色素瘤
DOI：
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发表时间：
1981
影响因子：
2.5
通讯作者：
I. Ariel
中科院分区：
文献类型：
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作者：
I. Ariel
1939年至1967年（含），在纽约市的帕克医疗集团有487例上肢恶性黑色素瘤患者接受治疗，在这里接受治疗的恶性黑色素瘤总数中占第四位（14.7%），超过躯干（34%）、头颈部（23%）和下肢（20%）的恶性黑色素瘤。342例确定性患者的10年生存率为63%。死于黑色素瘤的患者中有14%在第5年和第10年之间死亡，这表明需要报告10年的生存期。两性的存活率相同（男性61%，女性64%）。大多数患者患有浸润性黑色素瘤（Clark 4级和5级），生存率为62%。10例浅表扩散性黑色素瘤（Clark 2级和3级）和青少年黑色素瘤患者的10年生存率为100%。预后最差的是6名无色素性黑色素瘤患者，10名患者中只有2名存活10年或更长时间。选择性腋窝淋巴结清扫术的问题仍然难以捉摸。在106例临床I期患者中，55例进行了选择性腋窝淋巴结清扫，26例患者有转移的显微镜证据。他们的10年生存率为65%，略高于16例未进行选择性腋窝淋巴结清扫的患者，其中6例后来出现转移证据，接受了治疗性淋巴结清扫，10年生存率为56%。根治性截肢术有时能极大地缓解症状，并能延长生命。
There were 487 patients treated for malignant melanoma of the upper extremities at the Pack Medical Group in New York City between 1939 and 1967 inclusive, fourth in frequency (14.7%) of total malignant melanomas treated here, being exceeded by malignant melanoma of the trunk (34%), head and neck (23%), and the lower extremities (20%). A 10‐year survival rate of 342 determinate patients was 63%. Fourteen percent of the patients who died of melanoma died between the fifth and tenth years, indicating the need to report survival at the 10‐year span. Survival was equal for the sexes (61% male and 64% female). The majority of the patients had infiltrating melanomas (Clark's Level 4 and 5) with a survival rate of 62%. Ten patients with superficial spreading melanomas (Clark's Level 2 and 3) and juvenile melanomas enjoyed a 100% 10‐year survival. The worst prognosis was for six patients with amelanotic melanoma in that only two of ten survived ten years or longer. The question of elective axillary dissection remains elusive. In 106 patients classified as clinical Stage I, elective axillary dissection was performed in 55 instances, and 26 patients had microscopic evidence of metastases. Their 10‐year survival rate was 65%, slightly higher than 16 patients in whom no elective axillary dissection was performed, among whom six later developed evidence of metastases, underwent therapeutic node dissections, and had a 10‐year survival of 56%. Radical amputation is occasionally indicated with great palliation and often prolongation of life.