A novel surgical margin (1 cm) might be from benefit for patients with dysplastic nevi,thin melanomas,and melanoma in situ: Analysis based on clinical cases

Malignant melanoma is an oncologic disease, whose current management among others includes surgical and immunological therapy. According to the current recommendations of the American Joint Committee on Cancer, the surgical excision of the primary tumor should be performed in two operative sessions, which has several consequences. The following paper will present and discuss six cases of pigmented lesions and the advantages of the one‐step melanoma surgery in their management.     

皮肤镜表现为红色均质模式的Spitz痣一例

19岁女性患者,右乳下缘红棕色斑块10余年,逐渐增大。皮肤镜检查:中央均质暗红色区域,可见白色晶状体结构,周边对称分布网状色素沉着和色素条纹向四周呈放射状排列。皮损组织病理示:表皮和真皮可见大量梭形细胞和上皮样黑素细胞组成的瘤细胞巢,具有典型收缩间隙,周围炎性细胞浸润。诊断:Spitz痣。     

A dual concept of nevogenesis:Theoretical considerations based on dermoscopic features of melanocytic nevi

The dermoscopic features of melanocytic nevi in children are clearly different from those in adults. While nevi in children show almost exclusively globular patterns, those in adults usually exhibit reticular patterns. These remarkable differences could be explained by a dual concept of nevogenesis, based on current clinico‐epidemiologic, dermoscopic, histopathologic and genetic data.     

Spitz样肿瘤320例临床及组织病理分析

【摘要】 目的 总结Spitz样肿瘤的临床及组织病理特征。方法 回顾2005年1月至2020年1月西京皮肤医院确诊的320例Spitz样肿瘤患者的临床及病理资料。结果 320例患者中,男141例,女179例,年龄0 ~ 65（12.5 ± 11.7）岁,病程1个月至30年;其中,Spitz痣307例,不典型Spitz肿瘤（AST）8例,Spitz痣样黑素瘤（SM）5例。皮损多为单发,可见于头面部、躯干和四肢,边界均清楚。307例Spitz痣皮损以黑色（132例,43.0%）和红色（108例,35.1%）为主,多数色素均匀（262例,85.3%）且表面平滑（272例,88.6%）。Spitz痣存在特殊临床亚型,11例 （3.6%）发生在斑痣上,11例 （3.6%）呈簇发性,6例（2.0%）播散性,7例（2.3%）结节性,1例（0.3%）为瘢痕疙瘩样。Spitz痣特征性病理表现包括表皮内痣细胞呈Paget样扩散（123例,40.1%）,真表皮交界处出现Kamino小体（74例,24.1%）,痣细胞呈水平带状（177例,57.8%）及楔形分布（118例,38.4%）,痣细胞巢周围出现裂隙（177例,57.8%）,可见生理性核分裂象（117例,38.1%）,核染色质均细腻。根据特殊组织病理表现,Spitz痣又分为色素性上皮样Spitz痣（9例,2.9%）、结缔组织增生性Spitz痣（13例,4.2%）、血管瘤样Spitz痣（8例,2.6%）、疣状Spitz痣（12例,3.9%）、黏液样Spitz痣（10例,3.3%）、晕痣样Spitz痣（4例,1.3%） 等。4例AST皮损为黑色,7例色素均匀,3例皮损表面粗糙;特征病理表现包括细胞均有轻度至中度的异型性,均可见核分裂象（7例为2 ~ 6个/mm2）,5例核染色质粗糙。3例SM皮损呈红色,4例色素不均匀,3例表面粗糙;特征病理表现包括黑素细胞呈Paget样扩散（3例）,瘤细胞呈无极性浸润性生长且均未见成熟现象,均有明显异型性,并可见病理性核分裂象（3例, > 6个/mm2）,核染色质均粗糙且核膜明显着色。结论 Spitz样肿瘤的临床及组织病理表现具有特征性,Spitz痣的临床及病理亚型繁多,AST同时具有Spitz痣和黑素瘤的临床及组织学特征。     

结缔组织增生性色素痣四例临床病理分析

目的 探讨结缔组织增生性色素痣的病理学特点及鉴别诊断.方法 对4例皮肤结缔组织增生性色素痣的临床表现、组织学表现、免疫组化及荧光原位杂交(FISH)特点进行分析.结果 4例结缔组织增生性色素痣中,男2例,女2例,年龄19 ～ 30岁,平均26.5岁;皮损位于四肢3例,外阴1例.组织学特点:均为皮内痣,病变左右对称,痣细胞呈上皮样和(或)梭形,聚集成团或单个散在分布于增生的纤维组织之间,均未见淋巴细胞聚集、坏死或溃疡.免疫组化显示,3例痣细胞为S100和Melan A阳性,2例为P16阳性;Ki-67阳性指数均小于5％;2例间质细胞为凝血因子FⅫ和CD34阴性.荧光原位杂交(FISH)显示结缔组织增生性色素痣在6p25(RREB1)、6q23 (MYB)、6p11.1-q11.1(Cep6)及11q13(CCND1)4个基因位点均无拷贝数异常.结论 结缔组织增生性色素痣是一种组织学独特的良性黑素细胞痣,ki-67 、S100、Melan A、凝血因子FⅩⅢ等免疫组化染色和黑素瘤FISH检测有助于其与皮肤纤维组织细胞瘤和黑素瘤鉴别.     

Vulvar and breast Paget’s disease with synchronous underlying cancer: a unique association

Background  We report a unique case of Paget’s disease of vulva and breast. Sequentially the patient had invasive ductal carcinoma of the breast, 5 years later was diagnosed with vulvar Paget’s with underlying adenocarcinoma and after another 2 years was diagnosed with Paget’s disease of the breast. Case  A 58-year-old woman with invasive ductal cancer of the left breast was treated with lumpectomy, lymph node dissection, radiation therapy and tamoxifen. Five years later and after complaints of longstanding vulvar pruritus, the patient was diagnosed with vulvar Paget’s disease and treated with simple vulvectomy, which revealed a concurrent underlying adenocarcinoma. Subsequently there was recurrence of vulvar malignancy and wide local excision was performed. Seven years after the initial diagnosis of the breast cancer, a biopsy of a left areolar red, ulcerated lesion revealed Paget’s disease of the breast. Conclusion  Physicians need to be cognizant of the rare occurrence of mammary and extramammary Paget’s disease with underlying malignancies in both locations. A thorough physical examination including biopsy is essential for early detection and appropriate management.     

Use of negative pressure wound therapy after infection and flap dehiscence in radical vulvectomy: A case report

IntroductionVulvar cancer has a lower incidence in high income countries, but is rising, in part, due to the high life expectancy in these societies. Radical vulvectomy is still the standard treatment in initial stages. Wound dehiscence contitututes one of the most common postoperative complications.Presentation of caseA 76 year old patient with a squamous cell carcinoma of the vulva, FIGO staged, IIIb is presented. Radical vulvectomy and bilateral inguinal lymph node dissection with lotus petal flaps reconstruction are performed as the first treatment. Wound infection and dehiscence of lotus petal flaps was seen postoperatively. Initial management consisted in antibiotics administration and removing necrotic tissue from surgical wound. After this initial treatment, negative wound pressure therapy was applied for 37 days with good results.DiscussionWound dehiscence in radical vulvectomy remains the most frequent complication in the treatment of vulvar cancer. The treatment of this complications is still challenging for most gynecologic oncologist surgeons.ConclusionThe utilization of the negative wound pressure therapy could contribute to reduce hospitalization and the direct and indirect costs of these complications.