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。     

面部色素痣的诊断与处理

本文通过对面部常见的痣细胞痣、表皮黑素细胞损害和真皮黑素细胞损害的临床表现、鉴别诊断和处理进行介绍,以期对这类疾病能作出正确诊断和治疗。     

结缔组织增生性Spitz痣和色素性梭形细胞痣临床及组织病理学特征

目的:分析结缔组织增生性Spitz痣和色索性梭形细胞痣的临床及组织病理学特点.方法:回顾性分析确诊的8例结缔组织增生性Spitz痣和9例色素性梭形细胞痣患者的临床和组织病理学特征.结果:结缔组织增生性Spitz痣表现为梭形或上皮样痣细胞增生并伴有显著的胶原硬化和均质化,色素性梭形细胞痣表现为真、表皮交界处梭形细胞增生并伴有纤细的色素颗粒沉积.结论:结缔组织增生性Spitz痣和色素性梭形细胞痣是Spitz痣中较少见的特殊类型.其中色素性梭形细胞痣需要与黑素瘤相鉴别.     

雀斑样痣共聚焦激光扫描显微镜图像特征分析北大核心CSCD

目的通过在体共聚焦激光扫描显微镜（CLSM）采集雀斑样痣的图像,研究其影像学特征。方法30例临床诊断为日光性雀斑样痣、10例单纯性雀斑样痣患者,用CLSM观察皮损及皮损周边正常皮肤,并与组织病理学表现相比较。结果CLSM下所有雀斑样痣的主要表现在真表皮交界处,表现为表皮突延长,数目增多且基底层色素显著增加,形成几种不同的图像特征如形状不规则的真皮乳头环扩大,周围环绕折光度较高的细胞等。真皮浅层可见少许噬黑素细胞及淋巴细胞浸润。讨论雀斑样痣的CLSM图像与常规组织病理表现相符合。     

恶性雀斑样痣和恶性雀斑样黑素瘤的分阶段治疗（附10年临床观察结果）

恶性雀斑样痣于1892年首次被Hutchinson描述为长期慢性晒伤后非典型黑素细胞在真皮表皮交界部的过度增生。由于其临床特征不典型,常常影响皮肤科及整形科医师及时诊治。恶性雀斑样黑素瘤由恶性雀斑样痣发展而来,其发病率与年龄、性别、地理、阳光暴晒有关。     

非典型阴茎雀斑样痣1例

患者男,23岁。阴茎龟头黑褐色斑片5年余。皮损组织病理检查示:表皮基底层黑素和黑素细胞增生,部分区域呈连续性分布,个别黑素细胞向表皮上部扩散,可见黑素细胞异型改变,真皮浅层多数淋巴细胞、噬色素细胞浸润。免疫组织化学(SP法)示:S-100(2+)、HMB-45(3+)、Melan-A(3+)、Ki-67:10%细胞阳性。诊断:非典型阴茎雀斑样痣。     

唇部蓝痣1例报道

患者女,37岁,发现唇部灰蓝色丘疹8年。组织病理示：表皮轻度增生,表皮突稍延长,真皮浅中层可见大量树枝样、长梭形黑素细胞弥漫分布,并见致密色素颗粒及噬黑素细胞,局灶胶原纤维增生。诊断为：（唇部）普通蓝痣（BN）。术后6个月随访未复发。     

女阴部痣细胞痣组织学特征

作者通过活检观察85例(13～73岁)妇女外阴、阴道和会阴部的色素性皮损.其中59例痣细胞痣,16例雀斑样痣,4例黑素瘤和6例其它皮损.并将痣细胞痣与20～60岁,4个年龄组妇女躯干部所取200个痣进行对照比较,共同观察的组织学特征有:(1)雀斑样痣性黑素细胞增生;(2)黑素细胞异形性;(3)结构异形性:交界性黑素细胞巢的大小、形态、位置或与相邻细胞巢融合;(4)真皮痣细胞成熟和(或)神经样变;(5)真皮乳头板层状及(或)同心圆状嗜酸性纤维增生;(6)     

发育不良痣综合征1例报道

发育不良痣综合征(dysplastic nevus syndrome,DNS)根据临床特征又名家族性非典型性多发性痣―黑素瘤综合征、B-K痣综合征、Clark痣等.根据组织病理学特征又名"Paget"样黑素细胞增多症、非典型黑素细胞增生症、表皮内黑素细胞瘤等.因本病可以转变为恶黑,故对其应有足够的认识.近年来国内外有关发育不良痣综合征报道很少,笔者见到1例典型发育不良痣综合征,现报道如下:     

普通蓝痣伴卫星灶

报告1例普通蓝痣伴卫星灶。患者女，26岁。右臀部蓝黑色结节20年，斑疹2周。皮肤科检查：右臀部见一直径约18 mm蓝黑色结节，边界清楚，边缘见一直径约3 mm蓝黑色斑疹。取结节性皮损组织病理检查：表皮轻度增生；真皮全层及皮下脂肪可见大量树枝样、长梭形黑素细胞弥漫分布，并见致密色素颗粒及噬黑素细胞，局灶胶原纤维增生。斑疹处组织病理：真皮中层可见局灶性树枝样、长梭形黑素细胞，并见致密色素颗粒及噬黑素细胞。诊断：普通蓝痣伴卫星灶。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.