恶性黑素瘤38例临床分析

目的探讨皮肤恶性黑素瘤流行病学特点。方法分析38例患者的临床资料。结果73.7%的皮肤恶性黑素瘤发生于肢端;47.4%原发部位曾有先天性痣。近年来面、颈部皮肤恶性黑素瘤比例增加,足部减少;就诊病人多为Clark中后期,生存率低。结论肢端是皮肤恶性黑素瘤最常见的发病部位,大多原有先天性痣,外伤是发病重要诱因。近年来皮肤恶性黑素瘤人数增加,且预后极差。     

皮肤黑素瘤70例临床与病理特征分析

目的探讨皮肤黑素瘤的临床和病理特点。方法回顾分析1983-2010年本院病理诊断为皮肤黑素瘤患者的临床资料,重新阅片,再次进行确认诊断和病理分型,对病理诊断不明确者行免疫组化检查,并进行统计学分析。结果皮肤黑素瘤高峰发病年龄为51~60岁,肢端、非肢端部位黑素瘤各占70.00%和30.00%,肢端雀斑样黑素瘤最多,占67.14%,其次为恶性雀斑样痣型黑素瘤(11.43%)和浅表扩散型黑素瘤(10.00%),本研究中结节型仅有3例(4.29%),非暴露与暴露部位在原发损害、原位和侵袭的分布上差异有统计学意义(P=0.045,0.013)。甲下黑素瘤手部明显多于足部(P=0.000)。结论国内黑素瘤发病可能有年轻化趋势;外伤在肢端部位黑素瘤发生中作用有待进一步证实;临床的ABCD标准敏感性较高,可推广使用和作为患者自检的方法。     

西安、重庆两所医院20年皮肤恶性素瘤回顾

目的了解西安及重庆两所医院20年来皮肤恶性黑素瘤的临床、病理特点及发病趋势：比较两地差异；探讨皮肤恶性黑素瘤发病诱因。方法收集1981年1月1日至2000年12月31日新确诊的305例患者的临床资料，并对185例具备完整病理资料者进行分析。结果63．3％的皮肤恶性黑素瘤发生于肢端；依据临床病史，15．8％原发部位曾有先天性小痣；20世纪80、90年代皮肤恶性黑素瘤分别占同期病理活检数比例为0．053％、0．094％，该比例的年增长率为3．9％；20年来面、颈部皮肤恶性黑素瘤比例逐渐增加，足部减少。结论肢端是皮肤恶性黑素瘤最常见的发病部位．20年来上述两所医院皮肤恶性黑素瘤占活检数的比例有增加的趋势。     

西安、重庆两所医院20年皮肤恶性黑素瘤回顾

目的 了解西安及重庆两所医院20年来皮肤恶性黑素瘤的临床、病理特点及发病趋势;比较两地差异;探讨皮肤恶性黑素瘤发病诱因。方法 收集1981年1月1日至2000年12月31日新确诊的305例患者的临床资料,并对185例具备完整病理资料者进行分析。结果 63.3%的皮肤恶性黑素瘤发生于肢端;依据临床病史,15.8%原发部位曾有先天性小痣;20世纪80、90年代皮肤恶性黑素瘤分别占同期病理活检数比例为0.053%、0.094%,该比例的年增长率为3.9%;20年来面、颈部皮肤恶性黑素瘤比例逐渐增加,足部减少。结论 肢端是皮肤恶性黑素瘤最常见的发病部位,20年来上述两所医院皮肤恶性黑素瘤占活检数的比例有增加的趋势。     

5例少见恶性黑素瘤的临床和组织病理分析

一些特殊类型的黑素瘤因临床和组织病理表现不典型,很容易误诊。该文报道5例少见恶性黑素瘤患者的临床和组织病理特点。其中无色素性黑素瘤2例,肢端黑素瘤局部转移、皮赘状先天性色痣恶变、结缔组织增生性和向神经性黑素瘤各1例。     

39例皮肤黑素瘤临床病理分析

目的探索皮肤黑素瘤的临床和组织病理特点。方法回顾性分析(2008~2015)年昆明医科大学第一附属医院皮肤科确诊的39例皮肤恶性黑素瘤临床特点及组织病理学特点,并进行Clark(1969)分级。结果 39例皮肤恶性黑色素瘤中男性患者15例(38.5%),女性24例(61.5%);发病年龄在(17~84)岁之间,平均年龄(58.5±12.5)岁;发病部位肢端31例(79.5%),面部6例(15.3%),背部及左膝关节各1例(2.6%);出现溃疡者17例(43.6%),无溃疡者22例(56.4%);临床与病理诊断符合病例数31例,占统计病例79.5%;免疫组化染色结果示S-100(+)27例(69.23%),HMB-45(+)28例(71.79%),Melanin-A(27)例(69.23%),Ki-67(+)24例(61.54%)。结论皮肤黑素瘤发病年龄以中老年为主,肢端部位好发,斑疹侵袭深度为II级及以下,斑块、结节及溃疡侵袭深度为III级及以上。     

少见病理类型的恶性黑素瘤

恶性黑素瘤是一种高度恶性的肿瘤,多发生于皮肤。根据恶性黑素瘤的临床及病理特点,通常将恶性黑素瘤分为原位恶性黑素瘤(malignant melanoma insitu)和侵袭性恶性黑素瘤(invasive malignant melanoma)。原位恶性黑素瘤又分3型,分别为恶性雀斑样痣(lentigo maligna)、浅表扩散性原位恶性黑素瘤(superficial spreading malignant melanoma)及肢端原位恶性黑素瘤(acral melanoma in situ)。     

以反复感染为主要表现的肢端恶性黑素瘤1例

正恶性黑素瘤是皮肤科较常见的一种高度恶性肿瘤,以快速进展及容易转移而著称。本病一般根据典型的临床表现,结合组织病理和免疫组化即可确诊,但一些特殊类型的恶性黑素瘤因临床和组织病理表现不典型,很容易误诊。我科近期收治1例因反复甲下感染被误诊及误治的肢端恶性黑素瘤患者,现报告如下。     

Ⅰ期皮肤黑素瘤163例临床病理特征及预后分析

目的:分析Ⅰ期皮肤黑素瘤患者的临床特点、病理特征及预后情况。方法:收集西京皮肤医院2010年1月至2020年1月收治的163例Ⅰ期皮肤黑素瘤患者资料,回顾性分析临床特点、病理特征、治疗方法及预后。结果:163例Ⅰ期皮肤黑素瘤患者就诊中位年龄53岁,男56例（34.36%）,女107例（65.64%）。原发皮损位于肢端1...     

骨桥蛋白在恶性黑素瘤中的表达

目的探讨骨桥蛋白在人恶性黑素瘤中的表达及意义,分析其与临床病理参数的关系。方法采用免疫组化SP法检测23例原发性恶性黑素瘤、17例转移性恶性黑素瘤及20例色素痣中骨桥蛋白的表达。结果骨桥蛋白在原发性恶性黑素瘤、转移性恶性黑素瘤、色素痣中的阳性表达率分别为91.3%,82.4%,15.0%,前两者阳性表达率明显高于后者,差异均有显著性意义(P均<0.05);骨桥蛋白的表达与年龄、性别、发病部位、是否淋巴结转移等病理因素均无关系(P均>0.05)。结论骨桥蛋白的表达可能与人恶性黑素瘤的侵袭行为的形成有关。     

Acral lentiginous melanoma simulating "clear cell sarcoma of tendon and aponeuroses"

Clear cell sarcoma was closely mimicked in metastatic tumor deposits from two patients with acral lentiginous malignant melanoma. A subcutaneous deposit composed of glycogen-laden spindle cells dominated the presenting clinical picture in one patient. In the other, primary acral melanoma resembled a histiocytic tumor and metastatic tumor simulated clear cell sarcoma. The cases illustrate the pleomorphism that may be encountered in malignant melanoma.     

Dermoscopic clues in the diagnosis of amelanotic and hypomelanotic malignant melanoma

The clinical identification of amelanotic malignant melanoma (AMM) and hypomelanotic malignant melanoma (HMM) becomes difficult due to the lack of pigmentation and to the diverse clinical presentations. Dermoscopy is very useful in these cases, increasing the level of suspicion of malignancy. We report 4 cases of amelanotic malignant melanoma and hypomelanotic malignant melanoma with characteristic dermoscopic findings. Dermoscopy under polarized light demonstrates vascular polymorphism, globules and milky-red areas, in addition to chrysalis and multiple blue-gray dots.     

Congenital acral melanocytic nevi clinically simulating acral lentiginous melanoma

Three cases of congenital acral melanocytic nevi with unusual clinical characteristics are reported. In all of the cases the surface changes and their growth were clinically suggestive of acral lentiginous melanoma, but biopsies revealed their benign nature. This exceptional presentation of congenital acral melanocytic nevi merits recognition by physicians and underscores the need for histologic diagnosis prior to definitive surgery in any cases suspected of being malignant melanoma.     

Early acral melanoma in situ: correlation between the parallel ridge pattern on dermoscopy and microscopic features

In non-white populations, acral skin is the most prevalent site of malignant melanoma. Early melanomas of this anatomic site are often misdiagnosed as melanocytic nevi, which are not uncommon on acral skin. In fact, clinical and/or histopathological features of melanocytic nevi occasionally mimic those of early acral melanoma and vice versa, and thus differentiation of early acral melanoma from melanocytic nevus is sometimes very difficult for clinicians as well as for histopathologists. Our dermoscopic investigation has revealed that the parallel ridge pattern, a band-like pigmentation on the ridges of the skin markings, is highly specific to malignant melanoma in situ on acral volar skin. In the present study, we reviewed 22 acral melanocytic lesions that showed the parallel ridge pattern on dermoscopy but had very subtle clinical and/or histopathological presentations. We diagnosed 20 of them as early melanoma in situ by careful histopathological examination, which revealed histopathological features very similar to those seen in macular portions of overt acral melanoma, but fundamentally different from features found in melanocytic nevi on acral skin. In correspondence with their dermoscopic pattern, in these early lesions of acral melanomas, proliferation of solitary arranged melanocytes was mainly detected in the crista profunda intermedia, the epidermal rete ridge underlying the ridge of the skin marking. The two remaining lesions were diagnosed as possible cases of acquired melanocytic nevus because of the formation of well-demarcated nests of melanocytes in the epidermal rete ridges. We propose that a finding of preferential proliferation of solitary arranged melanocytes in the crista profunda intermedia is an important clue for the histopathological diagnosis of early phases of acral melanoma.     

Benign acral lesions showing parallel ridge pattern on dermoscopy

One of the recent advances in dermoscopy is the significance of parallel ridge pattern (PRP), which has 99% specificity in detecting both melanoma in situ and advanced melanoma on the acral volar skin. This review features exceptionally benign acral lesions showing PRP on dermoscopy. These benign lesions can be distinguished from malignant melanoma, because of the typical clinical history and associated symptoms. However, it is sometimes difficult for dermatologists to exclude malignant melanoma and a subsequent skin biopsy should be strongly recommended. These benign lesions include pigmentation due to a dye such as para-phenylenediamine, acral pigmented macules associated with Peutz-Jeghers syndrome, anti-cancer drug-induced hyperpigmentation on the volar skin, acral subcorneal hemorrhage and pigmented warts.     

Frequency of Trauma,Physical Stress,and Occupation in Acral Melanoma: Analysis of 313 Acral Melanoma Patients in Korea

BackgroundTraumatic events are thought to be a cause of acral melanoma. However, little is known about the role of mechanical trauma or physical stress in the development of acral melanoma.ObjectiveIn our study, we evaluated the frequency of trauma, physical stress, and occupation in patients with acral melanoma and aimed to identify any pathological correlates of these factors.MethodsWe conducted a retrospective study of 313 acral melanoma patients from Chonnam National University Hospital. We mapped melanoma-developed anatomical sites of acral areas and assessed patients'' history of trauma, physical stress, and occupation.ResultsAmong the 313 acral melanoma patients, many reported a traumatic event (84 of 313; 26.8%) or physical stress (91 of 313; 29.1%) before the melanoma developed. The most common anatomical sites in these patients were on the borders of the foot (136 of 313; 43.5%). Trauma was more commonly associated with the fingernails and toenails than other sites. The frequency of each type of physical stress depended on the site of the lesion. Farmer and fisherman were the most common occupations (130 of 313; 41.5%) of the acral melanoma patients.ConclusionOur results demonstrate that traumatic events, physical stress, and certain occupations are common in acral melanomas. Further studies are needed to establish whether these are risk factors for acral melanomas.     

Comparison of Melanoma Subtypes among Korean Patients by Morphologic Features and Ultraviolet Exposure

Background

Genetic alterations have been identified in melanomas according to different levels of sun exposure. Whereas the conventional morphology-based classification provides a clue for tumor growth and prognosis, the new classification by genetic alterations offers a basis for targeted therapy.

Objective

The purpose of this study is to demonstrate the biological behavior of melanoma subtypes and compare the two classifications in the Korean population.

Methods

A retrospective chart review was performed on patients found to have malignant melanoma in Severance Hospital from 2005 to 2012. Age, sex, location of the tumor, histologic subtype, tumor depth, ulceration, lymph node invasion, visceral organ metastasis, and overall survival were evaluated.

Results

Of the 206 cases, the most common type was acral melanoma (n=94, 45.6%), followed by nonchronic sun damage-induced melanoma (n=43, 20.9%), and mucosal melanoma (n=40, 19.4%). Twenty-one patients (10.2%) had the chronic sun-damaged type, whereas eight patients (3.9%) had tumors of unknown primary origin. Lentigo maligna melanoma was newly classified as the chronic sun-damaged type, and acral lentiginous melanoma as the acral type. More than half of the superficial spreading melanomas were newly grouped as nonchronic sun-damaged melanomas, whereas nodular melanoma was rather evenly distributed.

Conclusion

The distribution of melanomas was largely similar in both the morphology-based and sun exposure-based classifications, and in both classifications, mucosal melanoma had the worst 5-year survival owing to its tumor thickness and advanced stage at the time of diagnosis.     

Acral lentiginous malignant melanoma

Whether acral lentiginous malignant melanoma (ALM) has to be regarded as an independent entity of malignant melanoma is still controversial. But sure, there are some clinical and histological characteristics regarding melanoma of acral location which support a separate consideration of this disease. Our paper will discuss the peculiarities of ALM.     

Trauma and melanoma formation: a true association?

BACKGROUND: Little is known about the role of mechanical trauma in the pathogenesis of malignant melanoma. In individual patients, traumatic events have been discussed as a causative factor for the induction of melanoma and diagnosis of melanoma following trauma may raise medico-legal questions. OBJECTIVES: To evaluate the relationship between traumatic single or recurrent events and melanoma characteristics. METHODS: Retrospective questionnaire in 369 melanoma patients. RESULTS: A large number of patients (337 of 369; 91.3%) denied an association between a possible traumatic event and melanoma formation. Thirty-two of 369 patients (8.7%) considered an association of trauma and melanoma formation likely. Of these 32 patients, 22 patients (13 men, nine women) reported a single event, and 10 patients (four men, six women) a persisting irritation. An irritation of a pre-existing melanocytic naevus was reported by two patients with histologically confirmed melanoma on acquired or congenital naevus. CONCLUSIONS: As most of the patients who mentioned a trauma in this study suffered from acral melanoma, or melanoma located on the extremities, a history of trauma should be expected more frequently at these body sites. A review of epidemiological, clinical and scientific research indicates that there seems to be no evidence for single or persistent traumatic events as a causative factor for melanoma formation.