Lentiginous melanoma: a histologic pattern of melanoma to be distinguished from lentiginous nevus
Lentiginous melanoma: a histologic pattern of melanoma to be distinguished from lentiginous nevus
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DOI：
10.1038/modpathol.3800454
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发表时间：
2005-10-01
期刊：
影响因子：
7.5
通讯作者：
Mihm, MC
中科院分区：
文献类型：
--
作者：
King, R;Page, RN;Mihm, MC
老年患者的非典型雀斑样黑色素细胞增殖仍然是一个诊断难题，其病变被分类为发育不良痣、非典型交界痣、原位黑色素瘤（早期或进展中）和癌前黑变病。我们目前的色素性病变从16例（7男9女），除一例，所有年龄超过50岁。解剖部位包括躯干（7例）、头颈部（6例）和上肢（3例）。临床诊断多种多样，包括恶性雀斑样痣、非典型痣、色素性基底细胞癌、脂溢性角化病和雀斑样痣。最初的活检模仿雀斑样痣或发育不良痣，其特征是黑素细胞在真皮表皮交界处的雀斑样增生，既有单细胞，也有融合生长区域的小巢，延伸到活检边缘。在苏木精和伊红染色的切片中，网状表皮得以维持，黑素细胞的pagetoid扩散并不明显。皮肤纤维化不明显，黑素细胞增殖表现为细胞学异常。随后的再次切除显示在先前活检部位两侧的广泛区域上发生类似的非典型黑素细胞增殖。在完整切除的标本中更容易识别黑色素瘤的诊断。Mitf和Mart- 1的免疫组织化学染色突出了基底层黑素细胞增殖的程度以及黑素细胞扩散的pagetoid病灶。熟悉这种早期黑色素瘤的模式有助于对老年人活检中的雀斑样黑色素细胞增殖进行正确的分类。
Atypical lentiginous melanocytic proliferations in elderly patients continue to pose a diagnostic dilemma with lesions variably categorized as dysplastic nevus, atypical junctional nevus, melanoma in situ ( early or evolving) and premalignant melanosis. We present pigmented lesions from 16 patients ( seven male and nine female) and with the exception of one case, all were older than 50 years of age. The anatomical sites included trunk ( 7), head and neck ( 6) and upper extremity ( 3). The clinical diagnosis was variable and included lentigo maligna, atypical nevus, pigmented basal cell carcinoma, seborrheic keratosis and lentigo. The initial biopsies mimicked lentiginous nevus or dysplastic nevus and were characterized by a lentiginous proliferation of melanocytes at the dermoepidermal junction both as single cells and as small nests with areas of confluent growth, extending to the edges of the biopsy. The retiform epidermis was maintained and pagetoid spread of melanocytes was not prominent in hematoxylin- and eosin- stained sections. Dermal fibrosis was variably present and the melanocytic proliferation demonstrated cytological atypia. The subsequent re- excisions demonstrated similar atypical melanocytic proliferation occurring over a broad area flanking the prior biopsy sites. The diagnosis of melanoma was more easily recognized in the complete excision specimens. Immunohistochemical stains for Mitf and Mart- 1 highlighted the extent of the basalar melanocytic proliferation as well as foci of pagetoid spread by melanocytes. Familiarity with this pattern of early melanoma should facilitate proper classification of lentiginous melanocytic proliferations in biopsies from older adults.