15例甲下色素痣临床及组织病理学分析

目的:探讨甲下色素痣的临床及组织病理学特点.方法:回顾分析西京医院全军皮肤病研究所2003-2009年诊断的15例甲下色素痣患者的临床及组织病理学特点.结果:15例患者年龄均<25岁,其中男6例.女9例.发生于指甲14例,发生于趾甲1例,各指(趾)间病甲分布无明显差异.12例表现为界限清楚,颜色均一的甲黑线,3例表现为全甲黑变.有1例患者为复发性甲色素痣.组织病理资料显示14例患者表现为交界痣,1例为混合痣,未发现单纯皮内痣患者.甲色素痣表现为以甲母质为中心的黑素细胞增生,细胞呈单个分布或聚集成巢,多位于近基底层部位.混合痣真皮内可见少量界限清楚的细胞巢.色素痣细胞形态均一,细胞核小,无典型核分裂象,树状突不明显,多产生较细腻的色素颗粒.结论:甲下色素痣是发生在甲母质及甲板部位的良性色素痣,多见于儿童和青少年,临床以颜色均一、界限清楚的甲黑线或弥漫性黑甲为主要表现.其组织病理特征多为交界痣.     

甲下黑素瘤1例

患者女,43岁.因右手拇指甲下黑色沉积物2年余,切削后伤口不愈伴黑色沉积物扩散10个月于2009年8月19日来我科门诊就诊.2007年4月,患者发现右手拇指甲下有黑色线样沉积物,2008年10月在当地按"灰指甲"进行治疗,给予指甲修剪,后伤口不愈合,指甲不生长,黑色沉积物逐渐向周围扩散.     

恶性雀斑样黑素瘤6例临床及组织病理学分析

目的:分析恶性雀斑样黑素瘤的临床和组织病理特点.方法:回顾性分析6例恶性雀斑样黑索瘤患者的临床和组织病理资料.结果:4例患者在老年期发病,其中1例患者有两处皮损,另2例患者在中青年期发病.所有皮损临床上均表现为面部直径较大的边界不规则、颜色不均的黑色斑片,有1例出现溃疡.皮损组织病理学检查:1例为浸润性黑素瘤,其余皮损均为原位黑素瘤.原位黑素瘤表现为表皮内不典型黑素细胞增生,细胞分布不均,有明显异形性,充分进展的皮损可形成小细胞巢.2例发病年龄较早的患者无明显胶原嗜碱性变,其余的组织病理学特征与发生在老年的恶性雀斑样痣无明显差异.免疫组化结果示所有皮损肿瘤细胞S-100蛋白和Melan-A均为阳性.结论:恶性雀斑样黑素瘤是一种老年人多发的多见于面部的黑素瘤,但也可见于中青年患者.其组织病理可表现为原位黑素瘤或浸润性黑素瘤.     

痣样黑素瘤三例临床及组织病理学分析

【摘要】 目的 探讨痣样黑素瘤的临床和组织病理学特征。方法 回顾性分析2000—2020年西京皮肤医院诊断的3例痣样黑素瘤患者的临床和组织病理资料。结果 3例痣样黑素瘤患者中,女2例,男1例,皮损初始表现为黑斑、丘疹。2例在手术切除后皮疹复发增大成斑块或新发结节样皮损。组织病理学检查：表皮及真皮内上皮样黑素细胞增生,细胞有异型性,部分细胞核深染。免疫组化结果显示,皮损内瘤细胞Melan-A、S100表达阳性;HMB45在真皮瘤细胞内弥漫阳性,局部阴性;Ki67增殖指数升高,细胞周期蛋白D1表达活跃。结论 痣样黑素瘤易误诊为色素痣或脂溢性角化病;对于组织学诊断为色素痣,但临床出现复发或者转移的患者,需高度警惕痣样黑素瘤的可能。     

右手拇指甲床和甲周肿胀及黑褐色斑——甲下梭形细胞恶性黑素瘤

诊断:甲下梭形细胞恶性黑素瘤. 皮损组织病理:表皮破溃,大量炎性细胞浸润,真皮层大量梭形细胞,部分呈巢状,细胞异形性明显,可见病理性核分裂象(图1B).免疫组化染色结果:S-100蛋白(+),HMB-45(+)(图1C),P53(+),Ki-67 20%(+),CD34(-),CK(-).     

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。     

女阴黑素瘤5例临床及组织病理学特点

目的:了解女阴黑素瘤临床和组织病理特点.方法:回顾性分析5例女阴黑素瘤的临床和组织病理资料.结果:5例女阴黑素瘤均发生于成年女性,临床上表现为外阴部位直径较大的斑片,边界不规则,可出现结节或溃疡性损害.5例患者中有4例为浸润性黑素瘤,另外1例为原位黑素瘤.结论:女阴黑素瘤确诊时多处于浸润阶段,具有高度侵袭性.     

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。     

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。     

Early malignant melanoma manifested as longitudinal melanonychia: subungual melanoma may arise from suprabasal melanocytes

A 51-year-old woman developed longitudinal melanonychia of 3 months' duration on the right index fingernail. A biopsy specimen revealed that atypical melanocytes were distributed in the lower third of the matrix epithelium but were few in number at the basal layer. The involved nail matrix was resected because of continual growth of the lesion after the biopsy. It has been proven in normal nail matrices that melanocytes are distributed not only in the basal layer but also in the lower half of the epithelium. It is therefore understandable that malignant melanoma of the nail matrix can arise from melanocytes situated in the squamous epithelium above the basal layer. The present case is a good example in which malignant melanoma of the nail matrix may arise from the intraepithelial region where melanocytes normally reside.     

Two cases of subungual melanoma in situ

Melanonychia, which is characterized by brown or black pigmentation within the nail plate, includes heterogeneous conditions such as pigmented nevus, subungual melanoma and lentigo. We treated two cases of subungual melanoma in situ. One case was a 58‐year‐old woman who suffered from a malignant melanoma in situ of the left third fingernail, who had also suffered from melanonychia of the fingers for more than 30 years. She had a past history of carcinoma of the uterine cervix. The other patient was a 42‐year‐old man, who suffered from a malignant melanoma in situ of the right fifth fingernail. He had a past history of carcinoma of the stomach for which he had undergone surgery 2 years earlier. Both cases were accompanied by Hutchinson's sign on the fingertip skin, and the presence of this sign led to the correct diagnosis of subungual melanoma in situ. Judging from previously reported cases, it is unlikely that patients with malignant melanoma have an increased risk of carcinoma of the uterine cervix or of the stomach.     

A case of nodular subungual melanoma without Hutchinson's nail sign

An early and accurate diagnosis is critical for the optimal management of subungual melanoma; the absence of Hutchinson's nail sign makes an accurate diagnosis extremely difficult. Previous publications show that most subungual melanomas have Hutchinson's nail sign. In this report, we present a rare case of a subungual melanoma without Hutchinson's nail sign and discuss the importance of cautious evaluations of Hutchinson's nail sign by dermoscopy.     

Proximal nail plate destruction in subungual melanoma could be a possible predictor of invasiveness thicker than 1.25 mm

Various patterns of nail plate destruction are common features in subungual melanoma (SUM), but there has been no reports regarding their clinical significance according to the pattern of nail plate destruction in terms of tumor thickness. We tried to find a relationship between dermal invasion of SUM and proximal nail plate destruction (PNPD). Clinical information of patients with SUM was reviewed retrospectively from seven dermatology training hospitals in Korea. The PNPD was defined as a visible loss of full thickness of nail plate touching the eponychium at the most proximal part of it. We evaluated whether there are correlations between patients' age, sex, location of SUM, Breslow thickness (BT) and the presence of PNPD. Among 93 patients with SUM, 36 (38.7%) showed PNPD. Sex and BT showed significant correlations with the presence of PNPD in univariate analysis (P < 0.05). BT, age and sex showed significant correlations with the presence of PNPD in multivariate analysis (P < 0.05). Among them, BT showed the strongest correlation with the presence of PNPD (area under the curve, 0.722) and the cut‐off value was 1.25 mm. In conclusion, we suggest that PNPD in SUM could be a possible predictor of invasiveness of more than 1.25 mm BT.     

Clinical and dermoscopic features of nail unit melanoma in an Australian nail clinic cohort

Nail unit melanoma carries diagnostic challenges conferring with its poor prognosis. This audit aims to characterise both clinical and dermoscopic features of nail unit malignant lesions and compare them with biopsied benign lesions. It focuses on informing future practice by aiding in the stratification and recognition of malignant diagnostic patterns in the Australian context.     

Dermoscopy of desmoplastic melanoma: report of six cases

Background  Desmoplastic melanoma (DM) is a rare variant of cutaneous melanoma. Its diagnosis is often delayed by an unusual clinical presentation. The dermoscopic features of DM have not yet been described.
Objective  To define the dermoscopic features of DM.
Patients and methods  A single-institution register-based retrospective study of six cases of histology-proven desmoplastic melanoma for which dermoscopy data were available. The criteria we studied included: network, dots and globules, streaks, regression features, ulceration, number of colours, blue/white veil, and vascular pattern.
Results  Only three cases exhibited one classical feature for a melanocytic lesion; other cases were recognized on the basis of the presence of figures of regression (all six), i.e. white scar-like areas and 'peppering' (three of six), multiple (> 4) colours (five of six), and of melanoma-related vascular patterns (five) such as linear-irregular vessels (four) and milky-red areas (two).
Discussion  We believe that dermoscopy could help in the accurate diagnosis of this rare neoplasm. In the absence of a pigmented network, attention should be given to the identification of features of regression and to melanoma-associated vascular patterns.     

The rare occurrence of three subungual melanomas in one patient

Subungual melanoma commonly presents with solitary longitudinal melanonychia. Herein, we report the case of a patient with subungual melanoma who developed involvement of three digits by three independent primary melanomas. A 98-year-old male patient presented with a two-year history of longitudinal melanonychia on three different fingernails. Histopathologically, all three lesions were proved to be melanoma. To our knowledge, this is the first reported case in which three subungual melanomas developed in one patient. Our case indicates that that not all examples of multiple longitudinal melanonychia represent benign lesions.     

Subungual melanoma: Histological examination of 50 cases from early stage to bone invasion

Subungual melanoma is a rare form of malignant melanoma. It is extremely difficult to differentiate it histologically from benign melanonychia striata or melanocytic nevus, especially in the early stage. We divided 50 cases of subungual melanoma into four groups according to clinical progress, and examined their histological findings in each respective stage. In the early stage (19 cases), atypical melanocytes were polygonal showing slight nuclear atypia with no mitoses at all. In six out of 19 cases (31.6%), the atypical melanocytes proliferated more in the hyponychium than in the nail matrix, and only very few in the nail bed. Periungual pigmentation (Hutchinson's sign) appeared from the early stage in almost all cases. With stage progression (middle stage, 13 cases; progressive stage, 13 cases; and bone invasive stage, five cases) the number of atypical melanocytes and their degree of nuclear atypia increased, and the ascent of atypical melanocytes and pagetoid spread became conspicuous. Mitoses became apparent only from the progressive stage. From these observations, we would like to propose three new pathological clues of early stage subungual melanoma: (i) “skip lesion”, proliferation of the tumor cells are more prominent in the hyponychium than in the nail bed or nail matrix; (ii) histological confirmation of Hutchinson's sign; and (iii) epithelial thickening and/or compact arrangement of the elongated basal cells.