하지에 발생한 악성흑색종의 예후

Abstract

Purpose: Malignant melanoma is recognized as the most serious skin cancer. We examined anatomical distribution and 5-year survival rate of each stage of malignant melanoma on lower leg.

Methods: We retrospectively analyzed the medical records of 91 patients(46 males and 45 females) with malignant melanoma on lower leg from 1985 to 2008. Age, sex, anatomical distribution and 5-year survival rates of each stage of malignant melanoma on lower leg were investigated. Also, 5-year survival rates of each stage and invasion depth of malignant melanoma on heel pad were investigated. Received January 25, 2009 Revised March 6, 2009 Accepted April 27, 2009 Address Correspondence: Won Jai Lee, M.D., Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea. Tel: 02) 228-2210/Fax: 02) 393-6947/E-mail: pswjlee@yuhs.ac

Results: On lower leg, most frequently 32 cases (35.1%) occurred on heel pad, 27 cases(29.7%) occurred on dorsum of foot, 18 cases(19.8%) in toe, and 14 cases(15.4%) on others in lower leg. We used the excision margin as 3-5cm. After wide excision, in stage III, IV, the patients underwent the immunologic / chemo-therapy. The incidences of each stage were 22 cases(24.2%) in stage I, 47(51.6%) in II, 17(18.7%) in III and 5(5.5%) in IV. The 5-year survival rates of each stage were 85%, 53.2%, 47.1% and 40%. On heel pad, the incidences of each stage were 5 cases(15.6%) in stage I, 19 cases(59.4%) in II, 7 cases(21.9%) in III and 1 case(3.1%) in IV. The 5-year survival rates of each stage were 80%, 63.2%, 42.9% and 100%, respectively. On heel pad, incidence of local recurrence was 2 and 5-year survival rate of this case was 100%. And systemic recurrence was 9 and 5-year survival rate of this case was 55.6%.

Conclusion: The 5-year survival rate of malignant melanoma on heel pad was higher than previous study. To maintain the weight-bearing function of foot, we recommend the active reconstructive surgery for heel pad reconstruction after wide excision of heel pad malignant melanoma.