先天性小痣在恶性黑素瘤发生中的地位

目前对先天性小痣(CSN)易恶变与否及是否应予预防性切除尚未获共识。本研究应用显微分光光度计DNA定量、N-ras p21蛋白检测、超微结构观察及临床资料分析,对CSN在恶性黑素瘤(MM)发生中的地位进行探讨。结果显示:后天性痣(AN)、CSN、先天性巨痣(CGN)及MM的DNA含量依次递增,各组间有显著差异(P<0.05)。N-ras基因产物p21蛋白检测:26/48例MM阳性,4/13例CGN阳性,2/13例CSN阳性,15例AN全部阴性。电镜下3例CSN、1例CGN皮内痣中找到异常黑素小体。54例MM 6例来源于CSN(11.11％)。结果提示CSN较AN易于恶变,主张作预防性切除,为以往把CGN看作MM“癌前病变”的认识找到了实验依据。     

恶性黑素瘤治疗进展

恶性黑素瘤(malignant melanoma)是来源于黑色素细胞的恶性肿瘤,是一类起源于神经嵴的黑色素细胞恶性肿瘤.发病率为全身恶性肿瘤的1%～2%,其恶性程度高,预后差,大多数患者在10年内死亡.早期诊断及正确处理对预后有重要意义,美国疾病控制中心最新公布的来自监测、流行病学及最终结果注册资料表明,近10年来,黑素瘤发病率持续上升,且各种厚度的黑素瘤发病均有增加.其中厚度不足1 mm的黑素瘤增加了22%,1～3 mm厚度增加了26%,3 mm或3 mm以上的增加了31%.浅表性黑素瘤患者的5年存活率接近100%,而肿瘤厚度＞3 mm的患者5年存活率不足60%,皮肤病医师应引起足够的重视[1].本文结合近年来有关文献对恶性黑素瘤的治疗进展综述如下.     

KBA.62在黑色素瘤诊断中的作用

KBA.62是一种研究相对较少的抗黑色素瘤相关抗原单克隆抗体.KBA.62还是诊断结缔组织增生性黑色素瘤有用抗体.未来需要灵敏性和特异性更高的抗黑色素瘤相关抗原抗体.     

恶性黑色素瘤人端粒酶RNA原位杂交研究及意义

应用原位杂交法检测恶性色素瘤,黑色素痣和正常皮肤中的ｈＴＲ表达。结果显示：（１）恶性黑色素瘤,黑色素细胞痣和正常皮肤ｈＴＲ阳性表达率分别为８６．３％,６．２５％和１６．７％;恶性黑色素瘤的ｈＴＲ阳性表率显著高于黑色素细胞痣和正常皮夫的阳性表达率。（２）转移性黑色素瘤的ｈＴＲ阳表达强度显著强于原发性恶性黑色素瘤。提示ｈＴＲ能间接地反映端粒酶的活性,ｈＴＲ可作为恶性黑色瘤的诊预测的新标志物。     

皮肤恶性黑素瘤的免疫组化研究

目的 探讨Ｓ－１００蛋白和ＨＭＢ４５单克隆抗体在恶性黑素瘤诊断中的价值。方法 以痣、乳腺癌、卵巢癌作为对照病例,对５８例恶性黑素瘤进行ＳＰ免疫组化染色。结果 ５８例恶性黑素瘤中ＨＭＢ４５阳性５６例（９６．６％）,对照组有３例阳性;Ｓ－１００蛋白染色有５５例阳性（９４．８％）,对照组中,痣细胞痣１００％阳性,乳腺癌、卵巢癌中偶见阳性病例。结论 Ｓ－１００蛋白和ＨＭＢ４５单克隆抗体对恶性黑素瘤的诊断敏     

恶性黑色素瘤82例临床分析

从1972年2月至1987年4月,收治恶性黑色素瘤(恶黑)82例,49例原发于皮肤,其中24例系黑痣恶变.早期诊断、早期治疗预后好.原发于脑组织及外生殖器预后差.属肿瘤完整切除(完整切、扩大切及加预防清扫)之间的预后没有大的区别,但没有完整切除或仅仅作活检者只有一例生存5年.用DTIC为主的化疗方案5年生存率达77.7%,而以环磷酰胺、噻哌和博莱霉素为主5年生存率为11.1%,两者有极显著性差异.化疗与BCG(皮肤利打)结合治疗5年生存率为70%,仅用化疗是31.4%,两者之间有明显差异.     

Significance of aberrant melanosomes in the diagnosis of malignant melanoma

In order to clarify the significance of the aberrant melanosomes in thediagnosis of malignant melanoma,17 cases of malignant melanoma were studied with elec-tron microscopy,and 30 cases of nevus were studied likewise for comparison.Aberrantmelanosomes were present in 12 cases of pigmented and 2 cases of amelanotic malignantmelanoma.They were also found in 4 cases of congenital nevus.The findings suggest thatthe presence of aberrant melanosomes is of significance for the diagnosis of malignantmelanoma but this has been overemphasized.It is believed that the diagnosis of malignantmelanoma depends upon a comprehensive judgement of all the ultrastructural findings un-der electron microscopy.     

Diagnosis of malignant melanoma by general practitioners and hospital specialists

The aim of this study was to audit all malignant melanomas confirmed histologically in the Scarborough Health District over six years, prompted by the continuing rise in incidence rate nationally and relatively high number of malignant melanomas excised by general practitioners (GPs) in this area. A total of 157 malignant melanomas were diagnosed (60% from females and 40% from males) over the six years; primary excisions being carried out by GPs (37%) and hospital specialists (63%). The clinical diagnosis of malignant melanoma was made in 9% of GP cases and 35% of the hospital specialist cases. However another 45.5% of GP cases, and 38% of hospital specialist cases were regarded as suspicious pigmented lesions clinically. The histological diagnosis was of superficial spreading malignant melanoma in 72% of the GP and 69% of the hospital specialist cases. Most of the GP melanomas were excised with a lateral margin of 2 mm or less (71%); around half of the hospital excisions had a margin of over 2 mm (49%). Most melanomas were 2 mm or less in depth (Breslow depth) in both the GP (81%) and hospital specialist (75%) series. Over the six year period (1993-98) the incidence of malignant melanomas has continued to rise, but Breslow depth at diagnosis has not changed significantly. It is therefore important to continue with early recognition of this condition by GPs in the first instance, reduction in its incidence being the long term goal. During five years of the study there were only 67 lesions thought clinically to be malignant melanoma (26 GP and 41 hospital specialist cases), but which proved to be benign histologically.     

警惕色素痣——黑素瘤的危险信号

2010年7月29日出版的《临床医师肿瘤杂志》（CA Cancer J Clin）杂志刊载了一篇关于黑素瘤的研究综述．题为“黑素瘤诊断方法的革新：ABCDs诊断法确立后的25年”。我们对该论文进行研读后,就文中恶性黑素瘤的发生与色素痣密切相关,部分皮肤恶性肿瘤起源于色素痣,先天性痣可以转化为黑素瘤,色素痣的恶变是黑素瘤发生的一个重要因素。因此．我们应该重视黑素瘤和色素痣之间的关系,在临床工作中做到早发现、早诊断,以便及时的治疗等方面提出自己的见解,得到编辑的认可。我们撰写的Letter于2010年8月30日发表在《CA Cancer J Clin》杂志上。     

p53和Survivin在交界痣中的表达

目的研究交界痣的免疫表型特征,并初步探讨交界痣与恶性黑素瘤在免疫表型方面的可能差异性。方法采用免疫组化S-P法检测p53和Survivin在47例交界痣、13例皮内痣、16例恶性黑素瘤中的表达状况。结果p53在交界痣、皮内痣、恶性黑素瘤中表达的阳性率分别为78.72%、30.77%、81.25%;Survivin在交界痣、皮内痣、恶性黑素瘤中的表达阳性率分别为80.85%、23.08%、87.50%。p53和Survivin在交界痣中高表达且具有正相关性,在交界痣与恶性黑素瘤中表达一致。结论p53和Survivin的表达异常在交界痣易恶变为恶性黑素瘤的发生机制中可能发挥重要作用。     

阴茎恶性黑色素瘤诊治分析

目的 探讨阴茎恶性黑色素瘤的诊断和治疗方法。方法 回顾性分析4例阴茎恶性黑色素瘤患者的临床病理学特征、诊治过程及预后情况。结果 4例患者经病理学检查确诊为阴茎恶性黑色素瘤;临床分期Ⅰ期1例（T1N0M0）,Ⅲ期3例（T3N2M0、T3N2M0和T4N3M0各1例）;4例患者均接受手术治疗,3例阴茎部分切除加双侧腹股沟淋巴结清扫术,1例阴茎全切加双侧腹股沟淋巴结清扫术;术后随访6～60个月,1例临床分期I期患者术后随访60个月肿瘤无复发;2例临床分期Ⅲ期患者术后2年内死亡。结论 前期痣的长期存在可能是阴茎恶性黑色素瘤发生的危险因素,早期发现和及时手术对改善阴茎恶性黑色素瘤患者的预后至关重要。     

阴茎恶性黑色素瘤诊治分析

目的探讨阴茎恶性黑色素瘤的诊断和治疗方法。方法回顾性分析4例阴茎恶性黑色素瘤患者的临床病理学特征、诊治过程及预后情况。结果 4例患者经病理学检查确诊为阴茎恶性黑色素瘤;临床分期Ⅰ期1例（T1N0M0）,Ⅲ期3例（T3N2M0、T3N2M0和T4N3M0各1例）;4例患者均接受手术治疗,3例阴茎部分切除加双侧腹股沟淋巴结清扫术,1例阴茎全切加双侧腹股沟淋巴结清扫术;术后随访6～60个月,1例临床分期I期患者术后随访60个月肿瘤无复发;2例临床分期Ⅲ期患者术后2年内死亡。结论前期痣的长期存在可能是阴茎恶性黑色素瘤发生的危险因素,早期发现和及时手术对改善阴茎恶性黑色素瘤患者的预后至关重要。     

恶性黑色素瘤人端粒酶RNA原位杂交研究及意义

应用原位杂交法检测恶性黑色素瘤,黑色素细胞痣和正常皮肤中的ｈＴＲ表达。结果显示：①恶性黑色素瘤,黑色素细胞痣和正常皮肤的ｈＴＲ阳性表达率分别为８６３％,６２５％和１６７％;恶性黑色素瘤的ｈＴＲ阳性表达率显著高于黑色素细胞痣和正常皮肤的阳性表达率（Ｐ＜０．０１）。②转移性恶性黑色素瘤的ｈＴＲ阳性表达强度显著强于原发性恶性黑色素瘤者（Ｐ＜０．０５）。提示ｈＴＲ能间接地反映端粒酶的活性。ｈＴＲ可作为恶性黑色素瘤的诊断和转移预测的新标志物。     

Intraoral malignant melanoma

Primary oral mucosal melanoma is a rare aggressive neoplasm and accounts for only 0.2-8% of all reported melanomas. It is a malignant neoplasm of melanocytes that may arise from a benign melanocytic lesion or de novo from melanocytes within normal skin or mucosa. It is considered to be the most deadly and biologically unpredictable of all human neoplasms, having the worst prognosis. In this article, we report a case of oral melanoma in a 52-year-old female patient with a chief complaint of black discolouration of the maxillary gingiva and palate.     

Giant congenital cerebriform pigmented nevus of scalp: case report

Giant pigmented nevus is a kind of congenital malformation that derived from ectodermal neural crest cells. In this article, we report a case of giant gyrus-like pigmented nevus of the scalp.