早期诊断黑素瘤的无创方法

黑素瘤作为一种高度恶性的皮肤肿瘤,经早期诊断和治疗能够获得较高的存活率.目前黑素瘤的诊断无疑仍依赖于组织病理学方法,然而活检或手术切除是病理学诊断的必要条件.黑素细胞性皮肤病中,良性病变占绝大多数,如能通过其他方法早期鉴别,则可减少不必要的组织创伤.皮肤自我检查、皮肤镜、远程皮肤镜、激光共聚焦显微镜等无创方法均可用于鉴别良、恶性黑素性皮肤病,缩短以往诊断黑素瘤所需要的时间、简化其繁琐的过程.概述几种主要的无创方法早期诊断黑素瘤.     

皮肤镜在色素性皮损临床处理中的应用

近年来 ,恶性黑素瘤发病率逐年上升。由于对转移的恶性黑素瘤缺乏有效的治疗方法 ,目前最好的治疗仍是早期诊断和积极手术切除原发肿瘤。临床诊断恶性黑素瘤主要依靠ABCDE准则 (即不对称性 ,边缘不规则 ,多色素性 ,直径 >5mm和皮损形态的演变 )。但存在两个主要问题 ,①此诊断准则敏感性仅为 6 5 %～ 80 % ,因它未考虑到小恶性黑素瘤(直径 <5mm)的可能 ;②许多良性黑素细胞痣临床表现与恶性黑素瘤相似 ,该准则可能导致许多不必要的手术切除。皮肤镜 (dermoscopy)是一项非侵袭性、简便、便宜的诊断技术 ,使肉眼看不见的形态学特征得以可见 …     

早期甲黑素瘤115例手术治疗方案和预后回顾分析

【摘要】 目的 探讨早期甲黑素瘤的手术治疗方案和预后。方法 回顾并分析第四军医大学西京皮肤医院2011年7月至2019年12月收集的115例早期甲黑素瘤的手术治疗方案及预后。结果 115例早期甲黑素瘤患者按改良的ABCDEF标准并根据如甲板改变、溃疡、结节等临床表现评估后，73例按原位甲黑素瘤扩大切除，22例按Ⅰ、Ⅱ期甲黑素瘤扩大切除，20例按Ⅰ、Ⅱ期甲黑素瘤且有浸润风险方案扩大切除。随访6个月至9年，所有患者均未出现原发灶复发； 101例患者淋巴结B超检查未见异常；2例截指患者出现转移，其中1例死亡；失访12例。结论 依据患者甲黑素瘤临床表现选择手术扩大切除方案治疗早期甲黑素瘤，可以在确保充分治疗的基础上，最大程度保留肢端正常功能，且不会出现原发灶复发。     

黑素瘤伴肝转移致免疫疗法疗效下降现象及其对策研究进展

恶性黑素瘤是一种临床常见的高度侵袭性肿瘤,致死率高、预后不良.早期的黑素瘤主要通过手术切除治疗,而晚期的黑素瘤目前更推荐使用靶向药物或免疫疗法治疗.晚期黑素瘤常伴发多种脏器转移,肝脏是其中常见脏器之一.大量临床研究及观察发现,不同于其它的脏器转移,黑素瘤患者发生肝转移时,免疫疗法的疗效显著下降.本文就这一有趣的临床现象...     

黑素瘤发病机制相关蛋白的研究进展

黑素瘤是高死亡率的皮肤肿瘤,鉴定出与黑素瘤发病及进展相关的蛋白质有助于阐明黑素瘤的发病机制,临床上应早期诊断以提高疗效.近年来,比较蛋白组学、蛋白质表达谱等多种蛋白质组学研究方法应用于黑素瘤发病机制的研究,有助于明确相关细胞信号通路蛋白的功能,阐明肿瘤耐药机制、发现可能的肿瘤标记物以利于早期诊断、判断疗效和预后.     

外科手术治疗皮肤黑素瘤的进展

皮肤恶性黑素瘤是由皮肤黑素细胞系统所发生的一种恶性肿瘤 ,约占恶性肿瘤的 1 %～ 3%。在过去数 1 0年中 ,其发病率有明显增高趋势。文中综述了恶性黑素瘤的临床分期、外科手术治疗、淋巴处理、刮除术和电干燥术及冷冻治疗等。早期诊断和外科手术切除为治疗原发性恶性黑素瘤的理想疗法     

黑素瘤与DNA甲基化研究进展

黑素瘤作为一种侵袭性强的皮肤恶性肿瘤,在发病率和死亡率方面都在上升,目前仍缺乏较为有效的治疗手段.近年来,随着人们对黑素瘤认识的逐渐深入,黑素瘤的表观遗传学修饰特别是在DNA甲基化方面的研究也受到广泛关注.DNA甲基化在肿瘤细胞中的改变相对较常见,包括黑素瘤细胞.因此,DNA甲基化相关基因可以作为黑素瘤早期筛查、诊断、预后、治疗分期以及治疗后监测的生物标记.     

关于色素性损害的诊断方法

发育不良痣综合征和恶性黑素瘤的早期诊断和鉴别诊断是临床和组织病理学方面经常遇到的重要问题。黑素瘤若早期诊断并早期切除预后较好。发育不良痣综合征和肢端雀斑样原位黑素瘤在损害不典型时难以鉴别,而且临床和组织病理学上均无绝对诊断标准。关于上述问题以往曾提出了大量的探讨方法,包括强白炽光照射下的临床检查法、荧光法、体表显微镜技术、表面发光技术等。虽然,这几项技术有效地提高了诊断水平,但由于价格昂贵,设备笨重,因此临床应用有限。临床需要快速、简便、无损伤,而价格低廉的技术以诊断这类损害。一种新技术,透明膜和(或)液体态膜覆盖皮损,现已应用于临床,它可以改善临床观察时光线的影响,不但排除了观察者眼睛与皮损面折射与反射的影响,也去除了由于人体皮肤内血液所造成的对皮色的影响。Pierard 等沿用了丙烯酸氰皮肤表面剥脱技术研究黑素细胞损害,这种方法提供了一个非常浅表的组织标本,并与常规组织病理的切面垂直,可在95%以上黑素瘤的此种切片中角质层内发现异形黑素细胞,具有高度的特异性,而此类情况在常规组织病理切片中看不到或被忽略。角质层中异形黑素细胞对恶性黑素瘤具有诊断价值,而黑素细胞的良性损害则无此改变。作者认为上述检查所取得的资料仍需进行一定     

免疫疗法治疗恶性黑素瘤的研究进展

恶性黑素瘤(以下简称黑素瘤)是一种好发于皮肤的高度恶性肿瘤,发病率呈不断上升趋势,其发病与免疫有关。该病的治疗以手术切除为主,辅以化疗及放疗等,但是对于非原位黑素瘤,常不能控制其发展。免疫疗法是近年为人们所重视的治疗黑素瘤的辅助手段,部分已经在临床上应用,并取得初步的效果。它在控制黑素瘤转移,延缓复发,以及提高患者生存率方面具有积极作用。     

Bmi-1在皮肤黑素瘤中的表达及其与Nestin的相关性分析

目的探讨干细胞更新因子Bmi-1、干细胞表面标志物巢蛋白Nestin在皮肤黑素瘤中表达的临床与病理意义。方法收集武汉市妇女儿童医疗保健中心、荆州市中心医院2010-2015年40例经手术切除经组织病理加免疫组化诊断为黑素瘤的石蜡包埋切片为研究对象(实验组),选择40例组织病理诊断为良性色素痣标本作为阴性对照(对照组)。SP免疫组化法分别检测实验组与对照组Bmi-1、Nestin的表达与患者性别、年龄、发病部位、肿块大小、病理分级、临床分期等因素是否具有差异;并对Bmi-1及Nestin行相关性统计分析。结果黑素瘤组中Bmi-1、Nestin高表达,且Bmi-1、Nestin的高表达与肿瘤大小、病理分级、临床分期密切相关;Bmi-1与Nestin的表达呈正相关。结论 Bmi-1和Nestin在肿瘤的发生、发展中可能存在相关性,可能是一个新的皮肤黑素瘤辅助诊断组织学标记。     

Surgical approaches to malignant melanoma. Practical guidelines

Practical guidelines for the surgical approach to malignant melanoma are discussed in detail. Topics include diagnosis and proper biopsy technique; the appropriate preoperative metastatic workup; width of excision margins; treatment of the regional lymph nodes including cutaneous lymphoscintigraphy, intraoperative lymphatic mapping, and sentinel lymphadenectomy; postoperative follow-up schedules; management of local recurrence including surgical resection, isolated limb perfusion, intralesional therapy, adjuvant immunotherapy; management of special clinical situations including subungal melanoma, plantar melanoma, melanoma on the face, melanoma in pregnancy, and the treatment of lesions of uncertain diagnosis.     

Vaccines for melanoma

Melanoma vaccines are now an accepted but still experimental treatment for patients who have been rendered clinically free of disease by surgical resection but are at high risk of recurrence and in selected patients with advanced but still limited disease. In general, there seems to be a correlation between the ability of melanoma vaccines to stimulate antimelanoma cellular or antibody immune responses and improved clinical outcome. Accordingly, a number of strategies are now being pursued to improve the clinical effectiveness of this first generation of vaccines by improving their ability to stimulate antimelanoma immunity. To establish the true effectiveness of vaccines in the treatment of malignant melanoma, several large, prospectively randomized phase III studies are currently being conducted.     

Childhood melanoma

Pediatric melanoma is rare but increasing in incidence. Because early diagnosis and treatment improves prognosis, clinicians need to include it as a possible diagnosis when evaluating a pigmented lesion in a pediatric patient. Some risk factors for melanoma include xeroderma pigmentosum, giant congenital melanocytic nevi, dysplastic nevus syndrome, atypical nevi, many acquired melanocytic nevi, family history of melanoma, and immunosuppression. Definitive treatment is with surgical excision. Adjuvant therapies such as chemotherapy, immunotherapy, and radiation therapy can be used in advanced cases.     

Malignes Melanom der Uvula und des weichen Gaumens

Malignant melanoma of the uvula and soft palate is very rare. We describe a case demonstrating the typical aggressive behavior of mucosal melanoma in contrast to cutaneous melanoma. Regional lymph node and distant metastases often develop rapidly in this type of melanoma. Despite aggressive surgical approaches, other treatment options are often limited and usually palliative. Therefore, early diagnosis is critical in patients with mucosal melanoma.     

Oral mucosal melanoma of the mandibular gingiva: a case report

Oral mucosal melanoma is rare and is reported to be more aggressive than cutaneous melanoma. The incidence of oral mucosal melanoma peaks at 41 to 60 years of age and the male to female ratio is 2 to 1. Preferred sites in the oral mucosa include the hard palate and maxillary alveolar crests. Risk factors have not been clearly identified, but melanotic pigmentation is present in one-third of patients prior to the diagnosis of melanoma. We report an unusual case of oral mucosal melanoma of the mandibular gingiva with the main characteristics of an in situ lesion and areas of superficial invasion in a 45-year-old woman. The patient was treated with surgical resection of the lesion and a 54-month follow-up shows no evidence of recurrence. Oral mucosal melanomas are aggressive neoplasms that may arise from prior pigmented lesions in the oral mucosa. Classification of these tumors is not well-established and the main prognostic factor appears to be lymph node compromise. The main treatment modality is surgical resection.     

Prolonged survival in metastatic malignant melanoma associated with vitiligo

A metastatic malignant melanoma presenting with axillary lymphadenopathy and without a detectable primary lesion is described in a 66-year-old woman. Extensive vitiligo developed 6 years after this diagnosis. There has been no recurrence of melanoma for 10 years following surgical resection of the lymph nodes. The significance of vitiligo and an elusive primary lesion to the favourable prognosis in metastatic malignant melanoma is discussed.     

Melanoma in Children and Adolescents

Abstract: Melanoma is a life-threatening and rare malignancy in childhood and adolescence. Because it is so uncommon, melanoma may not be recognized readily or considered seriously in a differential diagnosis, resulting in delays in definitive treatment. We review melanoma occurring in 13 patients under 20 years of age who presented to a single tertiary care children's hospital. Five patients had nonmetastatic primary cutaneous melanoma, with Breslow thickness measurement ranging from 0.84 to 7.8 mm. Three patients had metastatic primary cutaneous melanoma, three had metastatic melanoma arising in a congenital giant nevus, and two had primary leptomeningeal melanoma. All of the patients were given definitive surgical treatment; some received adjunctive radiation therapy and chemotherapy. Overall 5-year survival rate was 40.0% for all cutaneous melanomas, which included 100% for clinical stage I disease, and 0% for clinical stage II and III disease. Both patients with primary leptomeningeal melanoma died an average of 6 months following diagnosis. Nonmetastatic primary cutaneous melanoma is a survivable disease if detected early and treated by surgical excision; metastatic and leptomeningeal disease were uniformly fatal. Types of melanoma, risk factors for melanoma, and the role of the dermatologist in primary prevention and detection are discussed.