頭頸部領域における悪性黒色腫—当科における過去16年間の臨床的検討

Malignant Melanoma in Head and Neck:A Clinical Analysis of 16-years' Experience

　緒言

　悪性黒色腫は皮膚または粘膜内のメラノサイトから発生する予後不良の疾患であり，とくに頭頸部領域に発生する悪性黒色腫は粘膜原発のものがほとんどであることから，他領域の皮膚原発のものに比較して一層その予後は悲観的である。

　本腫瘍は頭頸部領域のなかでもとくに鼻腔および口腔に好発するため，初診時には比較的局所に限局した初期のものでもその解剖学的理由ゆえに広範切除が不可能な症例も多く，化学療法，免疫療法あるいは低pheynylalanine-tyrosine食などに依存せざるをえない症例も多い。頭頸部上皮性腫瘍の最近の治療成績の向上に比較しても，悪性黒色腫の治療成績は一向に改善せず，われわれ頭頸部外科医にとって相変わらず悩みの種である。

Malignant melanomas in mucosa of the head and neck region of 19 patients were treated in our institute in 16 years consisted of 7 in the nasal cavity, 4 in the oral cavity, 2 in the pharynx and 6 in the other areas.

Fifteen patients received extirpation or extensive resection with unilateral neck dissection. Chemo-therapy and immunotherapy were administered in 14 cases.

The 3-years survival rate in 16 cases which were followed up was 50%, and the 3-year survival rate in 14 cases was 35.7%. The prognosis of melanoma of mucosa is poor comparing with those of skin. This unfavorable prognosis was derived from the high probability of recurrence and metastasis. Eight in our 19 cases developed distant metastasis after the first treatments. If the case with malig-nant melanoma in the region of head and neck was operable, we had to remove the tumor exten-sively with combination of chemotherapy and immunotherapy.