Clinical Pathological Characteristics And Prognostic Factors Of Cutaneous Malignant Melanoma

Background and ObjectivesCutaneous malignant melanoma?CMM?,is a malignant tumor highly that derived from epidermal basal melanoma cells,which is invasive growth with the characteristics of a high relapse rate and metastasis,so the prognosis is poor.Genetic factors and the external environment are the main causes of the disease,the most importantexogenous pathogenic factor is ultraviolet radiation.Malignant melanoma?MM?mainly invades the skin and mucous membranes,which comprises 1%³%of all human tumors,the incidence of melanoma is rising.Although the incidence rate is relatively lo-low in china,but the growth is fast relatively,about 20 thousand new cases each year,which is one of the common diseases in plastic surgery.We investigate the clinical characteristic and analysis of prognostic factors,which will provide reference for exploring the characteristics of cutaneous malignant melanoma in this region,to provide a certain reference value for the diagnosis and treatment of cutaneous malignant melanoma.MethodsWe collected clinical data of 128 cases with cutaneous cutaneous malignant melanoma that can followed-up from January 2005 to December 2014 in our department.All patients were diagnosed by histologically and were undergo surgical,using TNM clinical staging.The database include age,gender,clinical staging,tumor size,lymph node metastasis situation,treatment modality,Clark stage,primary site,primary tumor ulceration,histological type,physicalstatus score.All patients were followed for overall,and we annlyzed the prognostic factors.All statistical analyzes were performed by SPSS19.0 software package to P<0.05 is considered significant differences.Qualitative data were compared using X² test,life table method was used to draw survival curve.Univariate survival analysis using log-rank from Kaplan-Meier method,multivariate analysis of prognostic risk using COX regression model.ResultsThere were 66 female and 62 male from 128 cases of cutaneous malignant melanoma patients,which had a average age of 62.1 years old.The TNM stage from stage I to IV involed 17cases?13.28%?,25 cases?19.53%?,45cases?35.16%?,41cases?32.03%?.Lymph node metastasis were 78 cases,and Without lymph node metastasis were 50 cases?39.06%?.Patients with Mean diameter?2cm were 52cases?40.62%?,with mean diameter>2cm were 76 cases?59.37%?.The 78 cases of cutaneous malignant melanoma patients,primary site located on the acral sites were89 cases?69.53%?,on the arms and legs were 17 cases?13.28%?,on the trunks were12 cases?9.37%?,on the head and neck were 10 cases?7.81%?.73 cases?57.03%?presented ulceration,and without ulceration were 55 cases?42.96%?.KPS score??80points?accunted for 75.78%.Simple operation group were 44 cases?39.63%?,and surgery and adjuvant therapy group were 67 cases?60.63%?.The proportion of histological types in 128 cases ALM 86 cases?67.18%?,SSM 12 cases?9.37%?,NM20 cases?15.62%?,LMM 10 cases?7.81%?.According to Clark classification,I+II grade were 45 cases?35.15%?,III grade were 37 cases?28.90%?,IV grade were 34cases?26.56%?,V grade were 12 cases?9.37%?.Patents with ki-67<30%were 54Cases?42.18%?,and ki-67?30%were 74 cases?57.81%?.The median survival of all patents was 32.2 months,and 1 years,and 2 years survival rates were 87.5%,57%,respectively.Univariate analysis showed that age,clinical staging,tumor size,lymph node metastasis situation,treatment modality,Clark classification,primary site,primary tumor ulceration,histological type,physicalstatus score,Positive rate of Ki-67 were associated with prognosis.COX regression analysis showed that physicalstatus score,primary tumor ulceration,Clark classification,clinical staging were independent prognostic cutaneous malignant melanoma risk factors.Conclusions1.The number of patients with cutaneous malignant melanoma in our department 10 years rising steadily.2.In this study,the high age is 55 to 65 years.Age,primary tumor size had no significant effect on the prognosis of patients.postoperative adjuvant therapy can improve the total survival time of patients.3.In this study,acral site is the most common primary site,ALM is the most common type of pathology,tumor ulceration is common for cutaneous malignant melanoma.4.In this study,The prognosis is poor for cutaneous malignant melanoma.Clinical staging,lymph node metastasis situation,treatment modality,Clark classification,primary site,primary tumor ulceration,histological type,physicalstatus score,Positive rate of Ki-67 were associated with prognosis.COX regression analysis showed that local lymph node metastasis,primary tumor ulceration,Clark classification,clinical staging were independent prognostic cutaneous malignant melanoma risk factors.