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沙利度胺联合三苯氧胺治疗Ⅳb期牙龈恶性黑色素瘤一例

Atypical malignant melanoma of the chest wall skin and breast: A case report

Malignant melanoma is a kind of highly malignant tumor, which mainly occurs in the skin, mucous membrane, and rarely in the breast. Here we reported a case of malignant melanoma in the chest wall skin with mammary metastasis. A sizable pigment spot on the skin of the thoracic region was found at the patient’s birth, existing for 50 years with quite atypical clinical manifestation. A nodule at 12 o’clock of the left breast was found by ultrasound four months ago, who was mistaken for a fibroadenoma. As a result, the patient received a minimally invasive excision of the breast lesion, after which the pathological report suggested malignant melanoma. By sharing this case, we aimed to discuss the diagnosis and treatment of this kind of atypical malignant melanoma in detail and provide some clinical experience.

EXPERIMENTAL STUDIES ON INHIBITION OF MALIGNANT MELANOMA GROWTH BY GENE TRANSFER OF ADENOVIRUS-MEDIATED AV ERSE VASCULAR ENDOTHELIAL GROWTH FACTOR165

Objective To investigate the effect of Adenovirus-mediated averse vascular endothelial growth factor165（Ad-aVEGF165）on the growth of human melanoma cells(A375) in vivo and in vitro.Methods In vitro,the 100 multiplicity of infection of Aadenovirus-mediated green fluorescent protein（Ad-GFP）and Ad-aVEGF165 were transfected into human endothelium cell of vessel 304（ECV 304） and A 375. ECV 304 cells were divided into 3 groups: A 375 group, AdGFP group and AdaVEGF 165group. A375cells were also divided into 3 groups:1640 group, Ad-GFP group and AdaVEGF165 group. Their effects were analyzed by proliferation assay, cell cycle, and VEGF expression. In vivo,A375cells were injected into the axilla of the nude mouse. When the tumor formed, they were transplanted into another 15 mice. After treatment, the tumor was excised for naked eye observation, HE observation and microvascular density(MVD) counting. Results The cell supernatant fluid of A 375 group and AdGFP group could stimulate ECV304 cell growth，butthat of AdaVEGF165 group could inhibit the growth of ECV304 cell.All the A375cells in 3 groups had the proliferation trend, showing no statistically significant difference（Pgt;0.05）. ECV 304 cell proliferation index(PI) in Ad-aVEGF165group reduced（Plt;0.05）. There was no statistically significant difference（Pgt;0.05） in the PI of A 375 cell. The A 375cell integral optical densities were 234.41±13.8 in 1640 group， 222.73±3.67 in AdGFP group and 180.84±6.34 in Ad-aVEGF165group. The tumor volume in Ad-aVEGF165 group was smaller than that in Ad-GFP group and PBS group at 2 weeks after operation, the trend became much obvious with the time delay. AdaVEGF165 brought to much tissue necrosis under HE stain. The MVD of PBS group, Ad-GFP group and Ad-aVEGF165group were 65 10/view,52±11/view and 30±6/view, respectively. Conclusion In Vitro, Ad-VEGF 165gene could inhibited ECV304 cells’ growth by weakening VEGF expression of A 375cells. In vivo, Ad-aVEGF 165could inhibit the growth of human melanoma from blockinmicrovascular.

右肺原发恶性黑色素瘤一例

RESECTION OF MALIGNANT MELANOMA ON HEEL AND RECONSTRUCTION OF DEFECT

Objective To study the surgical resection and reconstruction methods of mal ignant melanoma on the heel. Methods Between July 2007 and June 2009, 15 cases of mal ignant melanoma on the heel were treated. There were 9 males and 6 females, aged from 32 to 71 years with a mean age of 47.2 years. Of them, 13 patients were initially treated, and 2 patients received repair after local excision. Tumor thickness was from 0.6 mm to 7.2 mm, and the size of the lesion was from 1.3 cm × 0.5 cm to 5.0 cm × 3.5 cm. According to the American Joint Committee on Cancer (AJCC) stage system, there were 1 case of IA, 2 cases of IB, 3 cases of IIA, 5 cases of IIB, 1 case of IIC, and 3 cases of III. Wide excision was performed in all cases. Defects were repaired by medial pedal skin flap (5 cases), lateral pedal skin flap (2 cases), and retrograde skin flap suppl ied by sural nutrition blood vessels (8 cases), and the flap size ranged from 7 cm × 5 cm to 12 cm × 8 cm. Inguinal lymph node dissection was performed in 3 patients. Wounds of donor site were repaired by skin graft. Results One case had marginal necrosis of lateral pedal skin flap and 2 cases had local necrosis of medial pedal skin flap on the skin graft; the other flaps and skin grafts survived and incisions healed by first intention. All patients were followed up from 12 to 36 months (mean, 21 months). Considering the recovery of the function and sense, the best result was acquired in the lateral pedal skin flap, followed by the medial pedal skin flap, and the poor result in the retrograde skin flap suppl ied by sural nutrition blood vessel. No patient had local recurrence at follow-up. Five patients had inguinal lymph node metastasis, and 1 patient died of lung metastasis. Conclusion Wide resection can provide satisfactory local control for mal ignant melanoma on the heel. Local flap can cover the wound safely, but the retrograde skin flap suppl ied by sural nutrition blood vessel has poor sensory recovery.

晚期恶性黑色素瘤的新药治疗进展

恶性黑色素瘤是起源于神经嵴黑色素细胞的高度恶性肿瘤。近10年来，恶性黑色素瘤发病率日益增加。世界卫生组织报道全球每年新发皮肤恶性黑色素瘤大约13.2万例，而我国每年新发病例已超过1万例。恶性黑色素瘤易于远处转移和扩散，而晚期患者的治疗手段有限，预后极差。近年来，恶性黑色素瘤相关的研究进展迅速，已经发现遗传和免疫因素与恶性黑色素瘤的发生、发展密切相关，这为恶性黑色素瘤的靶向和免疫治疗奠定了基础。不断的新药临床研究取得了重要临床成果。该文就此进行了综述。

The Advances of Diagnosis and Treatment of Malignant Anorectal Melanoma

ObjectiveTo study the advance of malignant anorectal melanoma. MethodsThe literature in recent years about risk factors,clinical characteristic,early diagnosis,treatment and the prognosis of the anorectal melanoma were reviewed.ResultsMalignant anorectal melanoma was very rare.The history of pigment naevus,human immunodeficiency virus infection and sunlight exposure might be the risk factors.Clinic characteristics were rectal bleeding,anorectal mass and changing in bowel habits.Early diagnosis mainly depended on performing routine examination on patients between the ages of 45-80 years.The staining for polycolnal CEA in anorectal melanoma has a role on diagnostic pathology.The treatment is controversial and the combined treatments of chemotherapy with radiation therapy and immunotherapy which were based on surgery (abdominoperineal resection or wide local excision) are introduced.Conclusion Early diagnosis of malignant anorectal melanoma is difficult and the prognosis is poor.It is necessary to pay more attention to this disease and the most successful therapeutic approaches need to be developed.

改良带蒂（足母）展肌肌皮瓣修复足跟部皮肤恶性黑色素瘤术后缺损

目的 总结采用改良带蒂（足母）展肌肌皮瓣移位修复足跟部皮肤恶性黑色素瘤扩大切除后软组织缺损的疗效。方法 2008年2月－2011年6月，收治5例足跟部皮肤恶性黑色素瘤患者。男2例，女3例；年龄35～69岁，平均49岁。病程2～10年。足跟原发肿瘤范围为3 cm × 2 cm～5 cm × 4 cm，3例伴破溃。4例肿瘤扩大切除后缺损范围为6 cm × 6 cm～8 cm × 6 cm，1例因伴卫星灶缺损达13 cm × 12 cm；采用大小为6 cm × 6 cm～11 cm × 9 cm改良带蒂（足母）展肌肌皮瓣移位修复缺损，不足部分取中厚皮片修复。供区采用腹股沟中厚皮片修复。 结果术后肌皮瓣及供受区植皮均成活，创面Ⅰ期愈合。2例腹股沟切口发生淋巴漏，经换药和清创术后愈合。5例均获随访，随访时间12～24个月。足跟部皮肤无破裂和磨损，外形丰满、弹性良好，肌皮瓣痛、温觉和耐磨性能良好。足踝伸屈功能正常，恢复负重功能，无肿瘤生长。足部切取肌皮瓣处凹陷明显，第1、2、3趾底感觉减退、麻木。 结论改良带蒂（足母）展肌肌皮瓣修复足跟部皮肤恶性黑色素瘤切除后缺损可获得丰满、耐磨和弹性好的外观。

Inhibitory Effect of Hydroxyapatite Particles with Different Size on Malignant Melanoma A375 Cells: A Preliminary Study

To explore the inhibitory effect of hydroxyapatite (HA) particles with different sizes on malignant melanoma A375 cells in vitro, we synthesized 4 short rod-like HA particles using TIPS. Their mean diameters were 998.0 nm (HA1), 511.0 nm (HA2), 244.0 nm (HA3), and 71.6 nm (HA4), respectively. Malignant melanoma A375 cells were co-cultured with HA particles in vitro. Results showed that HA particles smaller than 511.0 nm in mean diameter could always inhibit proliferation of A375 cells, and nanometer-HA particles (HA4) had the strongest inhibitory effect on A375 cell proliferation and the strongest inducing effect on apoptosis. HA particles were distributed in plasma of A375 cells. The ultrastructure changes of A375 cells were found most significant in nanometer-HA particles (HA4) group. We conclude that particle size is a very important influencing factor on anti-tumor effects of HA and that nanometer-HA particle has the strongest inhibitory effect on tumor cell proliferation.

恶性黑色素瘤综合治疗的护理体会

目的　探讨恶性黑色素瘤手术结合大剂量重组干扰素α-2a治疗的护理措施,总结最佳护理方法。 方法　回顾性总结2001年1月－2011年12月138例恶性黑色素瘤手术结合大剂量重组干扰素α-2a治疗的护理措施，包括心理护理以及营养支持，伤口的观察、疼痛护理、并发症的观察与处理方法。 结果　经过密切观察及精心护理，136例患者伤口顺利愈合。 结论　术前进行心理疏导，术后密切的伤口观察，对重组干扰素α-2a使用不良反应的观察和护理等能加快患者的康复。