Lentigo Maligna and Lentigo Maligna Melanoma in Young Adults

BACKGROUND: We observed two young women with skin types II to III according to Fitzpatrick's classification who developed pigmented macules in the face that were histologically diagnosed as lentigo maligna melanomas. OBJECTIVE: The objective of this study was to examine lentigo maligna melanoma in young adults. METHODS: According to private photographs of one of those patients a precursor lesion was clinically apparent as early as in her 26th year. Ten years later, the diagnosis of a lentigo maligna melanoma was made. The other patient was diagnosed with lentigo maligna at the age of 37. After excision, a relapse occurred in her 39th year. At this time histopathology revealed an early invasive lentigo maligna melanoma. RESULTS: These case reports demonstrate that the diagnosis of both lentigo maligna and lentigo maligna melanoma cannot be dismissed because of young age or well-tanning skin types. CONCLUSION: We conclude that owing to changes in social behavior and sporting activities with high short-term ultraviolet exposures, one must be aware of the possibility of an unusual early onset of lentigo maligna and lentigo maligna melanoma already in the third and fourth decade of life. Furthermore, our observations support the effectiveness of dermatoscopy in diagnosing ambiguous pigmented skin lesions in sun-exposed skin.     

Amelanotic Lentigo Maligna Melanoma: A Unique Case Presentation

Amelanotic melanomas comprise only 2% of melanomas and are commonly a difficult clinical diagnosis, due to the lack of melanin pigment typically found in melanomas. Even rarer is the amelanotic lentigo maligna, which may have an unusual clinical presentation, such as erythema, pruritus, or edema. Biopsy is the key to diagnosis. Multiple therapies for amelanotic lentigo malignas have been tried, but excision, with margin control (Mohs micrographic surgery-frozen or paraffin sections), remains the treatment of choice.     

Mohs Micrographic Surgery for Lentigo Maligna and Lentigo Maligna Melanoma using Mel-5 Immunostaining: University of Minnesota Experience

BACKGROUND: Mohs micrographic surgery (MMS) continues to become a more common and accepted treatment for lentigo maligna (LM) and lentigo maligna melanoma (LMM). The primary difficulty encountered lies in the accurate identification of atypical single melanocytes to determine tumor-free margins. Numerous methods have been used to better visualize single melanocytes, with varying results. We present our experience using Mel-5 immunostaining in MMS of LM and LMM. METHODS: Two hundred patients with primary or recurrent LM or LMM were treated using MMS from 1999 to 2003 at the University of Minnesota. The initial clinical margins were determined by Wood's light examination, and an initial debulk specimen was taken and sent for formalin fixation and later reviewed by a dermatopathologist. The first Mohs layer was then taken, and staining with hemotoxylin and eosin as well as Mel-5 immunostaining was performed. All patients were followed up to evaluate for recurrence, with a mean follow-up time of 38.4 months. RESULTS: Of the 200 patients treated, only one recurrence was noted. This patient had been treated with excision followed by radiation before MMS. Use of Mel-5 immunostaining added approximately 40 minutes to each stage. Use of the Autostainer Immunostaining System (DAKO, Carpenterina, CA, USA) shortened the added time to 20 minutes. CONCLUSIONS: MMS with Mel-5 immunostaining yielded excellent results in the treatment of LM and LMM, with only one recurrence noted in 200 patients. When an automated immunostainer was used, minimal time was added to each Mohs stage.     

Treatment of Lentigo Maligna with Imiquimod before Staged Excision

BACKGROUND Imiquimod 5% cream has demonstrated effectiveness in the treatment of lentigo maligna (LM) in several small studies. None of the studies to date have included posttreatment surgical removal to confirm negative histologic margins.
OBJECTIVE The aim of this retrospective analysis was to assess the efficacy of topical imiquimod in LM by circumferentially examining vertically oriented sections from a geometrically designed "picture frame" margin as well as bread-loafed sections of the central portion after staged excisions of imiquimod-treated lesions of LM.
METHODS Forty patients with biopsy-confirmed LM were treated five times a week for 3 months with 5% imiquimod cream before staged excision. Tazarotene 0.1% gel was added when no clinical signs of erythema developed with imiquimod alone after 1 month (10 patients). After the course of topical therapy, patients were assessed for clinical and complete histologic clearance after staged excision.
RESULTS A total of 33 of 40 patients had a complete clinical response as determined by the absence of remaining clinical lesion on physical examination. Upon histologic review, 30 of 40 patients had no evidence of LM whereas 10 of 40 harbored residual disease. One patient was found to have histologic evidence of invasion after completing the topical protocol. After a mean follow-up of 18 months (range, 12–34 months) and after complete surgical excision of the treatment site, none of the imiquimod-treated patients had evidence of recurrence.
CONCLUSIONS Imiquimod appears to be an effective adjunctive treatment for LM but does not qualify as a replacement therapy for surgery.     

肛管直肠恶性黑色素瘤的诊治进展

目的：探讨肛管直肠恶性黑色素瘤的诊治进展，方法：复习相关文献并对本病病因，临床特点，早期诊断，治疗及预后作一综述报告。结果：肛管直肠恶性黑色素瘤是一种发病率很低的恶性肿瘤，发病原因可能与良性黑痔史，HIV感染，太阳光照射有关，主要症有便血，局部肿块，大便习惯改变等，早期诊断主要依赖对45－80岁的高危发病人群进行常规直肠检查，CEA多克隆抗体标记阳性在病理诊断中有一定帮助，治疗方法现存在争议，多主张在手术治疗（腹会阴联合切除或局部广泛切除）的基础上辅以化疗，放疗或免疫治疗。结论：肛管直肠恶性黑色素瘤早期诊断困难，预后差，应提高警惕，最佳治疗方法还有待进一步探讨。     

Pathology Review Significantly Affects Diagnosis and Treatment of Melanoma Patients: An Analysis of 5011 Patients Treated at a Melanoma Treatment Center

Background

Pathologists sometimes disagree on the diagnosis of melanoma or its histopathologic staging, which may have implications for treatment and follow-up. For this reason, melanoma patients referred to Melanoma Institute Australia (MIA) for further treatment routinely have their pathology slides reviewed by MIA pathologists. This study sought to determine whether diagnosis, staging, and treatment of melanoma patients changed significantly after central pathology review.

Methods

A total of 5,011 pairs of non-MIA and MIA pathology reports on the same primary melanoma specimen were reviewed. Differences in diagnosis, American Joint Committee on Cancer (AJCC) T classification, and treatment recommendations based on the non-MIA and MIA pathology reports were determined.

Results

A melanoma diagnosis changed in 5.1 % of cases after review. Where both pathologists agreed on a diagnosis of melanoma, AJCC T classification changed in 22.1 % after review. After MIA review, planned surgical excision margins changed in 11.2 % of cases, and a recommendation for sentinel lymph node biopsy (SLNB) changed in 8.6 %. Non-MIA reports less frequently contained criteria to define AJCC T classification (86.6 vs. 97.6 %), select appropriate surgical excision margins (95.2 vs. 99.6 %) and make a recommendation for SLNB (94.5 vs. 99.4 %), (each p < 0.001). On multivariate analysis, partial biopsies were independently associated with more frequent changes in AJCC T classification (p < 0.001), planned surgical excision margins (p < 0.001), and SLNB recommendations (p < 0.001) on the basis of MIA pathology review.

Conclusions

Diagnosis, AJCC T classification, and treatment recommendations often change after pathology review by specialist melanoma pathologists. We recommend pathology review be considered for all patients attending specialist melanoma treatment centers.     

腹腔间隔室综合征的诊治现状

腹腔间隔室综合征 (ａｂｄｏｍｉｎａｌｃｏｍｐａｒｔｍｅｎｔｓｙｎｄｒｏｍｅ,ＡＣＳ)是一个近百年来未引起重视的问题。 1 9世纪末至 2 0世纪初 ,Ｍａｒｅｙ、Ｈｅｉｎｒｉｃｉｏｓ和Ｗｅｎｄｔ等发现 ,腹内压升高到 2 7～ 46ｃｍＨ2 Ｏ时可导致动物呼吸功能不全、心血管功能紊乱和肾功能不全 ,甚至死亡。随着基础医学和临床研究的进展 ,已证实腹内压升高对多器官系统功能有影响。Ｋｒｏｎ等[1 ] 在 80年代首次使用ＡＣＳ一词来描述腹主动脉瘤手术后腹内高压 (ｉｎｔｒａ ａｂｄｏｍｉｎａｌｈｙｐｅｒｔｅｎｓｉｏｎ,ＩＡＨ)所致的病理…