| Background and ObjectiveMalignant Melanoma(MM)is a highly malignant tumor derived from neural crest melanocytes,mostly occurring in the skin,digestive tract,uveal,pia mater,genitalia and nasal cavity.Cutaneous Malignant Melanoma(CMM)is the most common type.In recent years,the incidence of CMM is on the rise year by year,Each year,?200,000 cases of CMM are reported globally and?20,000 are reported in China.While CMM accounts for 3?5%of all skin cancer,it causes an extremely high fatality rate,accounting for 75%of skin-cancer-related deaths.The incidence of CMM is lower in China compared with Western countries,but the survival is shorter in Chinese people.The prognosis of patients with MM is poor and the 5-year survival is reported to be<20%,suggesting that the incidence and prognosis of CMM may be different among different races.CMM is characterized by high malignancy,high invasiveness,easy metastasis and poor prognosis.Little is known about the differences in epidemiology,pathogenesis,clinical manifestations and treatment among different ethnic groups,partly due to the insufficient understanding of CMM among Chinese people.S-100,HMB45 and Melan-A and other markers can be positive expression in CMM,which has important value in diagnosis of CMM.S-100 is the most sensitive immunohistochemical marker of melanocytes,and is considered to be the gold standard for IHC differentiation of melanocyte tumors.HMB45 can recognize pre-melanosomal globulin gP100,react with atypical melanocytes and melanose-specific intracytoplasmic antigen,and is highly specific to CMM.Melan-A is highly specific to melanocytes and is mainly used for the diagnosis and differentiation of CMM and tumors with melanocyte differentiation.The purpose of this study was to investigate the epidemiological,clinical and pathological features of primary cutaneous malignant melanoma and to analyze the relevant factors affecting prognosis,using immunohistochemical SP method to investigate the expression of S-100,HMB45 and Melan-A in CMM and its significance,so as to provide a certain basis for clinical diagnosis and treatment.MethodsFrom January 2013 to December 2019,pathology and clinical data of 132 patients with CMM in the Department of Plastic Surgery of the First Affiliated Hospital of Zhengzhou University were reviewed,and the clinical features,pathogenesis,diagnostic and therapeutic methods,patients' survival and tumor recurrence were analyzed retrospectively.The same case with the same type of malignant tumor was treated as a single case.Tumor classification of case data is based on WHO 2002 international classification of cancer diseases.The clinical and pathological data of 132 cases were collected,including gender,age,course of disease,affected side,anatomical site,pathological stage,and its etiology,clinical and pathological characteristics,diagnosis and treatment and prognosis were analyzed.Among them,the anatomical position is divided into 4 groups:head and neck(including face),trunk(chest wall,abdominal wall,groin,upper back,lower back,buttocks),upper limbs(upper arm,fore arm,elbow,hand),lower limbs(thigh,calf,knee,foot).The data of 132 patients were complete.Four cases of old patients with severe organic diseases such as hypertension,heart disease were taken the local tissue biopsy,the rest of all were under the treatment of surgical removal of the lesions,some patients received adjuvant treatment after operation.All the surgical specimens were made into tissue sections.HE staining and immunohistochemical SP method were used to observe the microscopic characteristics of tumor cells and the expression of S-100,HMB45and Melan-A in CMM was studied.All analyses were performed using Stata software,version 21.0(StataCorp LP,College Station,Texas,USA).The measurement data was represented by(?s),and the counting data was represented by case number(n)or percentage(%),?2 test was used for paired comparison.The statistical significance was set at p<0.05.ResultsThe results of this study were as follows:1.Age distribution:The age of initial diagnosis of most patients was over 60 years old,with a total of 68 cases(51.5%).2.Anatomical site:65 cases(49.24%)of lower limbs;30 cases of upper limb(22.73%);Head and neck were 14 cases(10.61%);In 23 patients(17.42%),the feet were the most common site of primary CMM,accounting for 37.88%of 50 cases.3.The relationship between gender and lesion location and the affected side:males tended to occur on the right side and the head and neck,while females tended to occur on the left side and lower limbs(p<0.05).4.pTNM stage:22 cases(16.67%)were melanoma in situ,and the pTNM stage from ? to ? involved 19 cases(14.39%),51 cases(38.64%),36 cases(27.27%)and 4 cases(3.03%).5.Follow-up and prognosis:As of February 15,2020,108 patients were successfully followed up,of which twenty-two patients with MIS survived.No recurrence or metastasis was found in nineteen patients of stage ? after regular review.Among the forty-one patients of stage ?,seven cases had regional recurrence,two cases had distant metastasis.No recurrence was found in twenty-two patients of stage ? after regular review.Four patients of stage V died within thirteen months.6.Cellular morphology of CMM:Epithelioid cell,spindle cell,neviod cell or both of them could be observed under the microscope.The most common type in this group was epithelial cell(n=59,44.70%).7.Histological type:it was mainly divided into acral lentiginous melanoma,nodular melanoma,superficial spreading melanoma and lentigo malignant melanoma.In this group,the arcal type was the most common(n=58,43.94%).8.Immunohistochemistry:S-100 was mainly expressed in the cytoplasm and nucleus of melanocytes,with a positive rate of 100%(54/54),HMB45 mainly expressed in cytoplasm,with a positive rate of 92.59%(50/54),and melan-A mainly expressed in cytoplasm,with a positive rate of 81.48%(44/54).There was a statistical significance in positive rate between the latter two(p<0.05).Conclusions1.The numer of patients with CMM admitted in our hospital from January 2013 to December 2019 showed an upward trend.2.The age of onset of CMM peaks at 60?69 years,and the incidence of men is higher than that of women.3.The diagnosis of CMM is mainly based on pathological diagnosis.The most common histological type in the rigion is mainly acral letiginous melanoma,which is most common in the feet.4.Surgery remains the primary treatment modality for CMM,and the Surgical margins should be selected according to the anatomical site,tumor thickness,lymph node metastasis,and clinical pathological stage.Tumor thickness,invasion depth,ulcers,tumor infiltrating lymphocytes,and lymph node conditions are important prognostic factors.5.The sensitivity and specificity of S-100,HMB45 and Melan-A to CMM were different,and the combined detection of multiple indicators can improve the diagnostic rate. |
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