原发皮肤＂消退性＂恶性黑色素瘤的临床病理特征  

Cutaneous regressing/regressed malignant melanoma： a clinicopathologic analysis of 8 cases

作　　者：沈旭霞[1] 孔蕴毅[1] 戴波 蔡旭[1] 王丽薇[1] 孔今城[3] 

机构地区：[1]复旦大学上海医学院肿瘤学系复旦大学附属肿瘤医院病理科,200032 [2]泌尿外科 [3]复旦大学临床病理诊断中心

出　　处：《中华病理学杂志》2013年第10期675-678,共4页Chinese Journal of Pathology

基　　金：上海市自然科学基金（12ZR1406600）;国家临床重点专科建设项目

摘　　要：目的探讨原发皮肤“消退性”恶性黑色素瘤的临床病理特点、预后和鉴别诊断。方法收集2009至2012年间原发皮肤“消退性”恶性黑色素瘤8例，总结临床病理、治疗和随访资料。常规HE染色和免疫组织化学EnVision法染色行组织病理形态学观察。结果患者年龄40～69岁（平均58岁），男女比3：1，发生部位分别为背部4例，足底2例，足趾腹面I例，上臂1例。临床上，6例初始表现为逐渐增大的皮肤黑斑，随后出现局部区域皮损颜色变浅并扩大，最终可呈瘢痕样。2例表现为散在簇状分布多灶黑点黑斑。组织学上，完全消退型3例，其中1例表现为肿瘤样黑变病。广泛消退型5例，消退比例达75％～90％，大部分区域示完全消退期图像，局部区域呈消退进行期改变，Breslow厚度0．5～1．0mm。免疫组织化学标记显示淋巴结内转移灶和广泛消退型原发灶内残留的少量黑色素瘤细胞均弥漫强阳性表达S-100蛋白、HMIM5和MelanA。吞噬黑色素的组织细胞CD68阳性。8例均获得随访，随访时间8—27个月（中位时间13个月），5例无瘤生存；3例发生远处转移，其中1例带瘤生存，2例死亡。结论消退性恶性黑色素瘤是一种好发于中老年人罕见的特殊类型的黑色素瘤，诊断时应综合临床病史和病理学改变。消退≥75％是T1期（Breslow厚度≤1mm）恶性黑色素瘤预后的一个不利因素，建议行病灶局部广泛切除术同时予以前哨淋巴结活检。Objective To study the clinicopathologic features and differential diagnosis of cutaneous regressing/regressed melanoma. Methods Histopathologic evaluation and immunohistochemical study by EnVision method were performed in 8 cases of cutaneous regressing/regressed melanoma. The clinical presentation, treatment and follow-up data were analyzed. Results The age of the patients ranged from 40 to 69 years （mean 58 years）. The male-to-female ratio was 3： l. Tumors were located on the back （4 cases） , sole of the foot （ 2 cases ）, ventral aspect of the toes （ 1 case ）, and the forearm （ 1 case ）. Clinically, 6 patients presented with progressive black mole of the skin, followed by subsequent focal hypopigmentation, even scarfing. Two patients presented with multiple loci of dark-brown pigmentation. Microscopically, 3 cases were completely regressed malignant melanoma. Tumoral melanosis was found in 1 of 3 cases. The other 5 cases were melanoma with severe regression. The extent of regression ranged from 75% to 90%. The Breslow depth of the tumors ranged from 0. 5 to 1.0 mm. Immunohistochemieally, both metastatic and primary tumor cells were diffusely positive for S-100, HMB45 and Melan A, while melanophages were positive for CD68. Follow-up data were available in 8 patients, ranging from 8 to 27 months. Five patients were alive with no evidence of disease, 1 patient was alive with stable disease and 2 patients died of metastatic melanoma. Conclusions Correlation between clinical presentation and pathologic features is important for diagnosis of cutaneous regressing/regressed melanoma. Thin melanoma with extensive regression （ 〉 75% ） should not been regarded as low metastatic risk and wide excision combined with sentinel lymph node biopsy is recommended.

关 键 词：恶性黑色素瘤 皮肤 消退 预后 

分 类 号：R739.5[医药卫生—肿瘤]