Malignant Melanoma with Melanosis

Ultrastructural and histological investigations were performed on a case of generalized melanosis associated with superficial spreading melanoma. The hyperpigmentation of the general body surface, mucous membranes and nail beds was associated with deposition of melanin in macro-phages in the dermis, together with some hyperactivity of epidermal melanocytes. Melanin granules were observed lying free in the stroma, suggesting pigment incontinence and phagocytosis by macrophages. Giant melanosomes were noted in melanocytes, keratinocytes and melanophages in the hyperpigmented skin. No evidence was found to suggest dissemination of individual malignant cells throughout the skin. Subcutaneous nodules of malignant melanoma were, however, present, as well as metastases to the iris, liver and to other organs.     

Cutaneous Malignant Melanoma Associated with Papillary Thyroid Cancer

As the survival from cutaneous malignant melanoma and its clinical concerns have been steadily increasing, the possibility has been raised of an increased risk of second primary cancers in the patients with malignant melanoma. Especially, recent studies have identified an association between cutaneous malignant melanoma and thyroid carcinoma. We here report on a case of cutaneous malignant melanoma that developed in a 61-year-old female patient who had hypothyroidism caused by papillary thyroid carcinoma. We suggest that the individuals who have cutaneous malignant melanoma may be predisposed to other primary cancers and especially thyroid carcinoma. Continuous monitoring of the thyroid function in melanoma patients is required because hypothyroidism can worsen due to malignant melanoma and this is probably associated with thyroid carcinoma.     

Acute Kidney Injury in a Patient with Melanuria, Diffuse Melanosis, and Metastatic Malignant Melanoma

Diffuse melanosis with melanuria is a rare complication of metastatic malignant melanoma that is associated with a very poor prognosis. Acute kidney injury secondary to melanuria has not been reported previously. We describe a patient with malignant melanoma, diffuse melanosis, and melanuria who developed acute kidney injury that was clinically indicated by an increase in urinary excreted metabolites in the serum. Histopathologic examination of kidney tissue revealed damage to tubules associated with disseminated intra-tubular melanin deposits. Diffuse melanosis with melanuria may lead to morphologic and functional kidney changes and warrants careful monitoring of kidney function in affected malignant melanoma patients.     

Dural Melanoma Associated with Ocular Melanosis and Multiple Blue Nevi

BACKGROUND: Primary meningeal melanomas of the central nervous system (CNS) are a rare malignant process with the majority originating from the leptomeninges. Primary dural melanomas have been reported to occur in isolation or in conjunction with Nevus of Ota. The association of primary dural melanoma with multiple cutaneous blue nevi has not been reported previously. OBJECTIVE: To describe a case of a 41-year-old Asian woman patient with a primary dural melanoma that arose in association with ocular melanosis and multiple cutaneous blue nevi. The patient is alive almost more than 8 years after subtotal and subsequent total resection of her primary tumor. Primary dural melanomas, Nevus of Ota, and blue nevi are discussed in relation to their coexistence and potential for intracranial melanoma. CONCLUSION: CNS melanoma is regarded as an extremely aggressive disease with poor prognosis. This case and previous reports of dural melanomas occurring in isolation or with Nevus of Ota have demonstrated relatively prolonged survival after surgical intervention. We conclude that dural melanomas are less aggressive tumors requiring surgical extirpation only.     

皮肤转移性黑素瘤1例

患者男,53岁。左大腿肿块伴瘙痒2月余。结合病史、皮损特点、实验室检查、皮损组织病理学改变、免疫组化检查结果,确诊为皮肤转移性黑素瘤。     

c-kit蛋白在恶性黑素瘤中的表达

目的　探讨c kit蛋白在人恶性黑素瘤中的表达及临床意义 ,分析它和临床病理参数的关系。方法　采用免疫组化S P法检测 44例原发性皮肤恶性黑素瘤、9例转移性恶性黑素瘤及 2 0例良性痣中c kit蛋白的表达。结果　3 4例原发性皮肤恶性黑素瘤、4例转移性恶性黑素瘤、5例良性痣表达c kit蛋白 ,阳性率分别为 77.3 %、44 .4%、2 5 .0 % ,前者的阳性表达率显著高于后两者 (P均 <0 .0 5 ) ;原发性皮肤恶性黑素瘤中浅表扩散性恶性黑素瘤 (SSM )的c kit蛋白阳性表达率显著高于其它类型 (P均 <0 .0 1) ;c kit蛋白的表达与年龄 性别 发病部位 是否淋巴结转移等临床病理因素均无关 (P均 >0 .0 5 )。结论　c kit蛋白的表达可能与人恶性黑素瘤的发生发展有关 ,其有望成为治疗黑素瘤的有效靶向分子之一     

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。     

A Malignant Melanoma Associated with a Blue Nevus of the Lip

Blue nevi are characterized by a collection of pigment-producing melanocytes in the dermis. These lesions clinically present as well demarcated cerulean-blue or bluish black colored papules or plaques that usually measure less than 1 cm in diameter. They are typically found on the dorsal surface of the hands and feet or in the head and neck region; however, they are rarely found in the oral cavity. These lesions are usually benign and stable over time. However, malignant melanomas developing in or associated with a blue nevus (which is also called malignant blue nevus) have been only rarely reported. A malignant blue nevus might develop in a common blue or cellular blue nevus, a giant congenital nevus or in a nevus of Ota, or it may be malignant from the start. Malignant blue nevi most commonly are found on the scalp. A malignant blue nevus of the lip has not been previously reported in the medical literature. We report here on a patient with a malignant melanoma associated with a blue nevus of the lip. The malignant melanoma was presumed to have developed from a blue nevus that was present on the upper lip of a 50-year-old male.     

全身转移性黑素瘤1例

患者女,60岁。头面、躯干、四肢大小不等黑红色结节,无痛痒3年,半年内泛发全身。皮肤科情况:头面、躯干、四肢见大小不等高粱粒至黄豆大小结节,呈皮色、暗红色及黑色。左膝关节上方见一直径约2cm×2cm大小肿块,其上见4～5个大小不等皮色至黑色结节,部分结节表面结痂。皮损组织病理示:真皮内弥漫性肿瘤样细胞浸润,此肿瘤样细胞核大、核仁明显,部分肿瘤样细胞呈巢状排列,肿瘤组织内见坏死。免疫组织化学染色显示肿瘤细胞LCA(-),CK20(-),S100蛋白及HMB45弥漫强阳性,Vimentin弥漫阳性。诊断:黑素瘤。     

Completely Regressed Primary Cutaneous Malignant Melanoma with Nodal and/or Visceral Metastases

Partial regression of primary cutaneous malignant melanoma is not uncommon, and may predict a higher likelihood of metastasis and decreased survival. Complete histologic regression of a primary cutaneous melanoma is a rarer occurrence of uncertain significance, with only 30 cases reported in the literature. Herein, we detail five additional cases of complete histologic regression of a primary cutaneous melanoma, which were discovered upon presentation with metastatic disease. A pigmented lesion, or its remnant, coupled with historical information was strongly suggestive of cutaneous malignant melanoma. However, histologic examination of the lesions in toto using multiple levels, and in some cases immunohistochemical stains, failed to reveal residual melanoma. Our cases are typified by the presence of metastasis of malignant melanoma to regional lymph nodes, with the absence other suspicious lesions or other malignancies. Through these instructive cases, the concept of completely regressed primary cutaneous melanoma is reviewed and the literature critically appraised. When considering a diagnosis of completely regressed primary cutaneous melanoma, it is important that the cases be well‐documented and biopsy‐proven. All patients with a diagnosis of metastatic melanoma with an occult primary lesion require a thorough and complete skin examination and consideration of completely regressed cutaneous melanoma within the differential.     

Cutaneous Melanoma

Cutaneous melanoma is an enigmatic cancer with good survival rates with management at an early stage, i.e. thin superficial lesions localized to the primary site. However, once it becomes deeply invasive with evidence of metastasis, it is one of the most aggressive and lethal cancers. Many investigations have been done and are being conducted in the areas of prevention, (identification and removal of precursor lesions, sun avoidance and use of sun screen preparations), diagnosis (monoclonal antibodies, tumour markers) and therapy (immunotherapy, hyperthermic perfusion and randomized clinical trials. From the Royal Victoria Hospital, Montreal, Quebec, personal experiences with the use of a Levamisole/Placebo — double blind randomized clinical trial for Stage I Melanoma patients is presented. The results of another trial of combination chemoimmunotherapy utilizing BCG/DTIC and/or CCNU for Stage II patients is discussed. Experimental studies into the lymphocytic reaction of lymph nodes draining a primary melanoma site have been initiated and changes in the number of T cells and B cells in the lymph nodes have been noted, reflecting some systemic changes in the host. A prospective randomized surgical protocal on cutaneous melanoma of intermediate thickness (1 to 4 mm) is underway to determine whether a conservative local excision is sufficient and whether involved regional nodes are an indicator and not an instigator of further disease (Intergroup Melanoma Study). Hyperthermic limb perfusion as a therapeutic modality has still to be proven as a useful procedure in the management of melanoma. A clinical trial is urgently required. Increasing public and professional awareness coupled with pertinent clinical and basic research into various aspects of this disease make the future of the patient with melanoma not as black as it seems!     

Prognostic Evaluation of Cutaneous Malignant Melanoma Based on the pTNM Classification

The prognoses of 100 consecutive melanoma patients were analyzed on the basis of Breslow's thickness and Clark's levels as well as according to stage employing the 1987 UICC pTNM classification. Among patients with lesions ≦1.50 mm thick, the 10-year survival rate was 100% for both pT1 (n=13) and pT2 (n=6) disease, 73.4% for pT3a disease (n=26), 62.2% for pT3b disease (n=15), 69.3% for pT3 (n=41) disease, and 38.7% for pT4 disease (n=38). Significant differences in survival were found between the pT4 group and the pT1/pT3a or pT3 groups. The 10-year survival rate was 100% for level II (n=13) and level III (n=13) disease, 58.3% for level IV (n=46) disease, and 34.5% for level V (n=26) disease. Significant differences were found between level V and other levels. The survival rate at 10 years was 100% for stage I (n=18), 63.3% for stage II (n=24), and 52.5% for stage III (n=55). In stage IV (n=3), there was only one patient who survived for 42 months. There were significant differences in survival among all stages except I and II. The 10-year survival rate in 3 subgroups of stage III was 58.9% for pT4pN0M0 patients (n=14), 63.2% for pT,pN1M0 patients (n=31), and 20% for pT,pN2M0 patients (n=10). Significant differences were found between the pT,pN1M0 and pT,pN2M0 subgroups. These findings indicate that the survival of pT1, pT2 and stage I patients is extremely good. In contrast, the prognosis of patients with pT3, pT3b or pT4, and stage III or IV disease is significantly poor. Within stage III, the prognosis of the pT,pN2M0 subgroup is significantly poor, and the classification of pN2 patients may need to be reconsidered.     

KPNA2基因在皮肤黑素瘤中的表达及功能

目的研究KPNA2基因在皮肤黑素瘤中的生物学功能。方法基因芯片分析KPNA2在皮肤黑素瘤中的表达,Real time PCR检测KPNA2基因在皮肤黑素瘤组织及细胞中的表达水平。小干扰RNA转染A375细胞株,平板克隆、MTT法检测KPNA2基因敲低组、对照组皮肤黑素瘤细胞的增殖活性。Transwell实验计算皮肤黑素瘤细胞过膜数量,研究KPNA2与皮肤黑素瘤细胞迁移作用的关系。结果 KPNA2在皮肤黑素瘤组织中的表达显著高于癌旁皮肤组织,表达随着病理分级的恶性程度的升级而增高。高表达KPNA2组患者预后明显比KPNA2组患者差。平板克隆及MTT实验结果显示si-KPNA2组的细胞活性及增殖明显受抑制(P均<0.01),Transwell实验显示si-KPNA2组的细胞过膜数量(87.33±6.20)/视野,明显低于对照组(271.70±8.70)/视野,差异有统计学意义(P<0.01)。结论 KPNA2在皮肤黑素瘤组织表达升高,促进黑素瘤细胞的增殖和迁移,其可作为黑素瘤的潜在临床诊治靶点及预后标志物。