Spontaneous regression of melanoma-letting us reaffirm the significance of immunotherapy.
Spontaneous regression of melanoma-letting us reaffirm the significance of immunotherapy.
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黑色素瘤的自发消退——让我们再次肯定了免疫治疗的意义。
DOI：
10.1093/jjco/hyx035
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发表时间：
2017
期刊：
影响因子：
2.4
通讯作者：
Sato S.
中科院分区：
文献类型：
--
作者：
Miyagawa T;Kadono T;Yamada D;Sato S.
一名 27 岁男性被转诊至我们科室评估左上臂色素病变。体格检查显示病变长5毫米，由棕黑色斑驳区和浅棕色区组成（图1A）。考虑到颜色不均匀的发现，我们怀疑这种病变是黑色素瘤。进行手术切除并病理检查证实为黑色素瘤。与棕黑色区域相比，浅棕色区域显示明显的炎性细胞浸润和真皮噬黑素细胞的广泛沉积，提示肿瘤消退（图1B和C）。随访5年未见复发。自发消退被定义为：（i）恶性肿瘤的诊断；（ii）缺乏治疗操作；（iii）消退的临床证据和（iv）消退病变的组织学检查。就黑色素瘤而言，消退的临床证据包括病变内色素沉着的丧失、周围色素沉着不足的区域和疤痕形成的证据，并且这些不一定需要随着时间的推移进行观察。消退的病理特征包括炎症细胞浸润和真皮噬黑素细胞广泛沉积。我们可以看到，在图1C中，由于淋巴细胞攻击表皮中的黑色素细胞，表皮中的黑色素落入真皮，导致颜色消退，表皮中黑色素细胞的数量较图1B有所减少。据报道，黑色素瘤的部分消退率为7-35%；然而，很少有关于临床和病理结果之间比较的报道。尽管尚不清楚是否
A 27-year-old man was referred to our department for the evaluation of a pigmented lesion on the left upper arm. Physical examination revealed that the lesion was 5mm long and comprised a mottled brown-black and a pale brown area (Fig. 1 A). Considering the finding of color unevenness, we suspected this lesion of melanoma. Surgical excision was performed and pathological examination confirmed melanoma. Compared with the brown-black area, the pale brown area showed marked inflammatory cell infiltrate and extensive deposition of dermal melanophages, suggesting regression of the tumor (Fig. 1 B and C). No recurrence was found at 5-year follow-up. Spontaneous regression has been defined as:(i) diagnosis of malignancy;(ii) lack of therapeutic manipulation;(iii) clinical evidence of regression and (iv) histological examination of regressed lesions. In the case of melanoma, clinical evidence of regression includes loss of pigmentation within the lesion, an area of surrounding hypopigmentation and evidence of scarring, and these do not necessarily need the observation with the passage of time. Pathological features of regression include inflammatory cell infiltrate and extensive deposition of dermal melanophages. We can see that in Fig. 1 C, as a result of lymphocytes’ attack to melanoma cells in the epidermis, melanins in the epidermis fall to the dermis leading to the regression of color and the number of melanoma cells in the epidermis decreases compared with Fig. 1 B. The rate of partial regression of melanoma was reported to be 7–35%; however, there has been few reports of comparison between clinical and pathological findings. Although it remains unclear whether the