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.
Objective To compare the cl inical effectiveness of the medial plantar flap, the retrograde posterior tibial vascular flap, and the reverse sural neurocutaneous flap in repairing defect caused by resection of cutaneous mal ignant melanoma (CMM) in the heel region. Methods The cl inical data were retrospectively analysed from 24 patients with defect who had CMM in the heel region and were treated by radical excision and flap repairing between March 2007 and March 2010. Defects were repaired with the reverse sural neurocutaneous flaps of 8 cm × 7 cm-14 cm × 12 cm at size in 12 patients (groupA), with the medial plantar flaps of 6 cm × 5 cm-8 cm × 7 cm at size in 7 patients (group B), and with the retrograde posterior tibial vascular flaps of 9 cm × 7 cm-15 cm × 13 cm at size in 5 patients (group C). There was no significant difference in gender, age, duration of illness, cl inical stage, and size of CMM among 3 groups (Pgt; 0.05). The donor site was sutured directly or by free skin graft. Results No significant difference was found in the operation time and the intraoperative blood loss among 3 groups (P gt; 0.05). All skin flaps or grafts survived and wounds healed by first intention. The patients were followed up 1-3 years. The flaps had normal texture and color with no ulcer in 3 groups. At 1 year after operation, the sensory recovery rates of the flaps were 0, 100%, and 20% in groups A, B, and C, respectively, showing significant difference among 3 groups (P=0.001). The patients had normal appearance of heel and pain-free walking [10 (83%) in group A, 6 (86%) in group B, and 4 (80%) in group C] of heel region, showing no significant difference among 3 groups (χ2=40.000, P=0.135). Heel pain existed in weightbearing walking of 3 groups, and there were significant differences in visule analogue scale (VAS) score (Plt; 0.05). There was no significant difference in range of motion of ankle joint among 3 groups (P gt; 0.05). Except 1 patiant of relapse in group A at 1 month after operation, no relapse was observed in the other patients during follow-up. Conclusion The medial plantar flap, the retrograde posterior tibial vascular flap, and the reverse sural neurocutaneous flap can achieve the good cl inical effectiveness in treating heel defect caused by the resection of CMM. And the medial plantar flap is the first choice in small skin defect of heel area.
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.
Objective To investigate the cl inical features of mal ignant melanoma (MM) in the central nervous system (CNS) and to improve the diagnosis and treatment of this disease. Methods Seven MM-in-CNS patients’ records between September 1996 and April 2007 were analyzed retrospectively, including 6 males and 1 female aged 18-74 years. The 5 cases were located in the supra-tentorial area, 1 in the spinal cord and 1 in the whole brain. CT or MRI scan was appl ied. The lesion was in the right frontal area in 4 cases, in the right temporal are in 1 case, in the left temporal area in 1 case, in the left apex area in 1 case and in the cervical spinal cord of C5-7 in 1 case. Six patients underwent neurosurgical operation and1 patient received the Gamma Knife therapy. The pathological examination revealed that 2 cases were metastatic MM and 5 were primary. Results One patient with primary MM received no follow-up, and the rest 6 patients were followed up for 2 weeks to 2 years with the time of median 8 months. One patient with metastatic MM died 2 months after operation, 1 patient to with metastatic MM died 2 weeks after Gamma-Knife treatment, 1 patient with metastatic MM with primary MM died 2 years after operation, and 3 patients with primary MM were still al ive and self-independent 6, 10 and 24 months after operation, respecti vely. Conclusion Since MM-in-CNS is short of specificity in cl inical symptoms and signs, its diagnosis mainly rel ies on the pathological examination and is assisted by MRI. The combined therapy giving priority to operation is recommended.
Objective To observe the effects of operation with large-dose of RoferonA for cutaneous malignant melanoma. Methods From January 1998 to December 2005, thirtythree patients with cutaneous malignant melanoma were treated. There were 20 males and 13 females, aging 17-79 years. The disease course was 2 months to 7 years. In 33 patients, nine patients identified as clinical-stage Ⅰ received singly enlargedresection to the primary lesion and performed split-thickness skin graft dermoplasty or adjacent skin flap repair; twenty-three patients identified as clinicalstage Ⅱ received enlargedresection to the primarylesion and performed proximal lymphaden scavenge as well as received split-thickness skin graft dermoplasty; and one patient identified as clinical-stage Ⅲ received palliative resection to the primary lesion. All patients received large dose of Roferon-A after operation. Results There are no recidivation in the 9 patients of clinicalstage Ⅰ. There are 1 recidivation and 1 quit in all the 23 patientsof clinicalstage Ⅱ. One patient of clinicalstage Ⅲ died after 18 months of operation. Conclusion The operation combined with large-dose of RoferonA after operation was a more effective way to treat cutaneous malignant melanoma.
Objective To investigate the effect of Adenovirus-mediated averse vascular endothelial growth factor165（Ad-aVEGF165）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, AdGFP group and AdaVEGF 165group. A375cells were also divided into 3 groups:1640 group, Ad-GFP group and AdaVEGF165 group. Their effects were analyzed by proliferation assay, cell cycle, and VEGF expression. In vivo,A375cells 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 microvascular density(MVD) counting. Results The cell supernatant fluid of A 375 group and AdGFP group could stimulate ECV304 cell growth，butthat of AdaVEGF165 group could inhibit the growth of ECV304 cell.All the A375cells in 3 groups had the proliferation trend, showing no statistically significant difference（Pgt;0.05）. ECV 304 cell proliferation index(PI) in Ad-aVEGF165group 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-aVEGF165group. 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. AdaVEGF165 brought to much tissue necrosis under HE stain. The MVD of PBS group, Ad-GFP group and Ad-aVEGF165group were 65 10/view,52±11/view and 30±6/view, respectively. Conclusion In Vitro, Ad-VEGF 165gene could inhibited ECV304 cells’ growth by weakening VEGF expression of A 375cells. In vivo, Ad-aVEGF 165could inhibit the growth of human melanoma from blockinmicrovascular.
Objective To investigate the surgical resection and reparation of heel with malignant melanoma. Methods Eight patients with malignant melanoma were treated from May 2001 to December 2003. The patients included 5 males and 3 females, and their ages ranged from 28 to 56 years. All lesions were located in theheel and were proved by pathological examination. According to Breslow classification, there were 2 cases of Grade Ⅰ, 5 cases of Grade Ⅱ, and 1 case of GradeⅢ. Local extensive resection was performed in all cases. Lateral pedal skin flap, plantar medial artery island skin flap, and retrograde skin flap supplied bysural nutrition blood vessel were respectively applied in the reparation according to the size of heel soft tissue defect. The treatment with interferon was delivered before and after the operation. Results The surgical reparation was successful in all 8 cases. The postoperative follow-up was conducted from 18 monthsto 4 years. All patients remained alive and no tumor recurrence was observed. Considering the recovery of the function and sense, the best result was acquired with plantar medial artery island skin flap and lateral pedal skin flap, good with retrograde skin flap supplied by sural nutrition blood vessel. Conclusion Local extensive resection is essential for the heel with malignant melanoma. Reparative reconstruction should be made on negative operative margin. Satisfactory clinical outcome is achieved by using lateral pedal skin flap, plantar medial artery island skin flap, and retrograde skin flap supplied by sural nutrition blood vessel.
Objective To observe the macular morphological changes of choroidal melanoma with coherence tomography (OCT) after plaque radiotherapy (PRT). Methods A total of 48 patients (48 eyes) with choroidal melanoma who underwent125I PRT were enrolled in this study. All the patients were examined documenting OCT to get the image of macula. The macula of all the patients was not involved. The median visual acuity was 0.4plusmn;0.2, which ranged from 0.02 to 1.0. There were 18 eyes (37.5%) with retinal detachment, 12 eyes (25.0%) with retinal pigment epithelium (RPE) changes, seven eyes (14.6%) with macular edema, epimacular membrane, detachment combined with edema, exudation and RPE changes, 11 eyes (22.9%) with normal macular structure. The median follow-up time was (10.4plusmn;5.9) months, which ranged from one to 24 months. The tumor control situation and visual acuity were observed in follow-up period. The same equipment and methods of OCT were used to return visit in follow-up period. The macular morphological changes at the final visit and its relationship with PRT and visual acuity were contrastively analyzed. Results All the patients had good control of tumor. The vision acuity improved in two eyes (4.2%), unchanged in 10 eyes (20.8%), and decreased in 36 eyes (75.0%). The differences of the visual acuity was statistically significant between before and after treatment (Z=-3.778,P＜0.05). There were 13 eyes (27.1%) with retinal detachment; nine eyes (18.8%) with RPE changes; 17 eyes (35.4%) with macular edema, detachment combined with edema, exudation and RPE changes; six eyes (12.5%) with proliferation, atrophy, detachment combined with edema, exudation and epimacular membrane;three eyes (6.3%) with normal macular structure. There were 15 patients (31.3%) with two or more abnormal macular morphology after PRT. Conclusions Retinal detachment, RPE changes, macular edema and exudation are common abnormal macular morphology after PRT. The incidence rate of abnormal macular morphology is increased. There are 31.3% patients with two or more abnormal macular morphology.