Clinical Analysis of Malignant Melanoma Presenting as Foot Ulcer_West China Medical Journal

Authors：

CHEN Dawei , GAO Wei , KANG Xin , WANG Chun , CEN Shiqiang ,  RAN Xingwu

Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

RAN Xingwu, Email: wdc104@163.com

Keywords：

足潰瘍; 黑色素瘤; 誤診

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目的　探討表現為足潰瘍的惡性黑色素瘤臨床特點。方法　回顧性分析2002年1月－2010年12月收治的46例表現為足潰瘍的惡性黑色素瘤患者。結果　46例均病理組織活檢確診，男29例，女17例，平均年齡57歲。潰瘍形成前多表現為包塊、黑素斑、痣、水泡、灰指甲、雞眼、疣等；潰瘍形成后表現為外傷不愈或反復復發、潰瘍中央或邊緣破潰、不規則、表面凹凸不平、顆粒狀或呈瘢痕狀態、焦痂、菜花樣新生物等；潰瘍好發部位為足底、足跟、足趾；3例患者無色素沉著；確診前潰瘍存在時間為（10.74 ± 10.94）個月，38例患者（82.6%）在確診前誤診，中位誤診時間為6個月（2.75～48個月），分別被誤診為黑色素斑、痣、慢性潰瘍、黑色包塊等。確診時18例存在遠處轉移；35例進行手術治療，3例采用單純化學治療，8例放棄治療。結論　惡性黑色素瘤早期表現不典型，常被誤診，由于其高度侵襲性，對表現不典型的足潰瘍應提高警惕，盡早行病理組織學檢查，以減少其誤診。

Citation： CHEN Dawei,GAO Wei,KANG Xin,WANG Chun,CEN Shiqiang,RAN Xingwu. Clinical Analysis of Malignant Melanoma Presenting as Foot Ulcer. West China Medical Journal, 2012, 27(5): 701-703. doi: Copy

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1. 　Schade VL, Roukis TS, Homann JF, et al. “The malignant wart”: a review of primary nodular melanoma of the foot and report of two cases[J]. J Foot Ankle Surg, 2010, 49(3): 263-273.
2. 　Bristow IR, Acland K. Acral lentiginous melanoma of the foot and ankle: a case series and review of the literature[J]. J Foot Ankle Res, 2008, 1(1): 11.
3. 　Dwyer PK, Mackie RM, Watt DC, et al. Plantar malignant melanoma in a white Caucasian population[J]. Br J Dermatol, 1993, 128(2): 115-120.
4. 　Fortin PT , Freiberg AA, Rees R, et al. Malignant melanoma of the foot and ankle[J]. J Bone Joint Surg Am, 1995, 77(9): 1396-1403.
5. 　Metzger S, Ellwanger U, Stroebel W, et al. Extent and consequences of physician delay in the diagnosis of acral melanoma[J]. Melanoma Res, 1998, 8(2): 181-186.
6. 　葉明福, 張哉根, 王亞麗,等. 惡性黑色素瘤組織學變異性與鑒別診斷[J]. 臨床與實驗病理學雜志, 2004, 20(5): 588-591.
7. 　Moulik PK, Mtonga R, Gill GV. Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology[J]. Diabetes Care, 2003, 26(2):491-494.
8. 　Lens MB, Dawes M. Global perspectives of contemporary epidemiological trends of cutaneous malignant melanoma[J]. Br J Dermatol, 2004, 150(2):179-185.
9. 　Albreski D, Sloan SB. Melanoma of the feet: misdiagnosed and misunderstood[J]. Clin Dermatol, 2009, 27(6): 556-563.
10. 　Gualandri L, Betti R, Crosti C, et al. Clinical features of 36 cases of amelanotic melanomas and considerations about the relationship between histologic subtypes and diagnostic delay[J]. J Eur Acad Dermatol Venereol, 2009, 23(3): 283-287.
11. 　高偉, 冉興無. 誤診為糖尿病足潰瘍的黑色素瘤臨床特點[J]. 西部醫學, 2011, 23(7): 1233-1235.
12. 　李曙光, 黎莉. 93例轉移性惡性黑色素瘤預后分析[J]. 中國腫瘤臨床, 2004, 31(8): 446-448.
13. 　江華, 張文俊, 林子豪, 等. 足部惡性黑色素瘤21例臨床分析[J]. 中國美容整形外科雜志, 2008, 19(6) : 439-441.
14. 　Torres T, Rosmaninho A, Caetano M, et al. Malignant melanoma misdiagnosed as a diabetic foot ulcer[J]. Diabet Med, 2010, 27(11): 1302-1303.

West China Medical Journal

Clinical Analysis of Malignant Melanoma Presenting as Foot Ulcer

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