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：

足溃疡; 黑色素瘤; 误诊

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目的　探讨表现为足溃疡的恶性黑色素瘤临床特点。方法　回顾性分析2002年1月－2010年12月收治的46例表现为足溃疡的恶性黑色素瘤患者。结果　46例均病理组织活检确诊，男29例，女17例，平均年龄57岁。溃疡形成前多表现为包块、黑素斑、痣、水泡、灰指甲、鸡眼、疣等；溃疡形成后表现为外伤不愈或反复复发、溃疡中央或边缘破溃、不规则、表面凹凸不平、颗粒状或呈瘢痕状态、焦痂、菜花样新生物等；溃疡好发部位为足底、足跟、足趾；3例患者无色素沉着；确诊前溃疡存在时间为（10.74 ± 10.94）个月，38例患者（82.6%）在确诊前误诊，中位误诊时间为6个月（2.75～48个月），分别被误诊为黑色素斑、痣、慢性溃疡、黑色包块等。确诊时18例存在远处转移；35例进行手术治疗，3例采用单纯化学治疗，8例放弃治疗。结论　恶性黑色素瘤早期表现不典型，常被误诊，由于其高度侵袭性，对表现不典型的足溃疡应提高警惕，尽早行病理组织学检查，以减少其误诊。

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. 　叶明福, 张哉根, 王亚丽,等. 恶性黑色素瘤组织学变异性与鉴别诊断[J]. 临床与实验病理学杂志, 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. 　高伟, 冉兴无. 误诊为糖尿病足溃疡的黑色素瘤临床特点[J]. 西部医学, 2011, 23(7): 1233-1235.
12. 　李曙光, 黎莉. 93例转移性恶性黑色素瘤预后分析[J]. 中国肿瘤临床, 2004, 31(8): 446-448.
13. 　江华, 张文俊, 林子豪, 等. 足部恶性黑色素瘤21例临床分析[J]. 中国美容整形外科杂志, 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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