Acral Junctional Nevus Versus Acral Lentiginous Melanoma In Situ A Differential Diagnosis That Should Be Based on Clinicopathologic Correlation
Acral Junctional Nevus Versus Acral Lentiginous Melanoma In Situ A Differential Diagnosis That Should Be Based on Clinicopathologic Correlation
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DOI：
10.1043/2010-0323-rar.1
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发表时间：
2011-07-01
影响因子：
4.6
通讯作者：
Chian, Cesar
中科院分区：
文献类型：
--
作者：
Bravo Puccio, Francisco;Chian, Cesar
研究背景：肢端雀斑样黑色素瘤是除白人以外的少数族裔中最常见的黑色素瘤临床表现，在北美和欧洲也有相当数量的黑色素瘤发生。尽管有明确的临床图像，但在部分活检中看到的组织学结果可能太过微妙，欺骗了处理这种情况的病理学家。目的：使病理学家了解肢端雀斑黑色素瘤早期(包括原位阶段)的组织学结果，将这些发现与在肢端交界部痣中所见的组织学结果进行比较，并强调它们的异同。这篇综述还将强调诊断肢端雀斑样黑色素瘤时需要考虑的重要临床和皮肤镜检查结果。资料来源：已发表的流行病学文章综述；临床、皮肤镜和组织病理学结果；肢端雀斑样黑色素瘤的分子生物学以及作者在处理此类病例时的个人经验。结论：肢端雀斑样黑色素瘤是一种临床病理实体，具有明确的临床特征：直径大于0.7毫米；边界不清，暗色，扁平，肢端边界不规则；沿着真皮-表皮交界处存在主要单细胞黑素细胞增殖。再加上一些额外的标准，这些发现应该足以让病理学家做出诊断并建议完全切除。临床医生和病理医生之间流畅的沟通将有助于正确的诊断。(ARCH Pathol Lab Med.2011；135：847-852)
Context.-Acral lentiginous melanoma is the most prevalent clinical presentation of melanoma in ethnic groups other than whites and also occurs in significant numbers in North America and Europe. Despite a clear-cut clinical picture, histologic findings seen in partial biopsies may be too subtle and deceive pathologists dealing with such cases.Objectives.-To make pathologists aware of the histologic findings during early phases of acral lentiginous melanoma (including the in situ phase), to compare those findings with what is seen in acral junctional nevus, and to highlight their similarities and differences. This review will also emphasize the important clinical and dermatoscopic findings to be considered when diagnosing acral lentiginous melanoma.Data Sources.-Review of published articles on the epidemiology; the clinical, dermatoscopic, and histopathologic findings; and the molecular biology of acral lentiginous melanoma as well as the personal experience of the authors when dealing with such cases.Conclusions.-Acral lentiginous melanoma is a clinicopathologic entity with a clear-cut clinical picture: a diameter larger than 0.7 mm; ill-defined, darkly pigmented, flat lesion with irregular borders on acral locations; and the presence of mostly single-cell proliferations of melanocytes along the dermo-epidermal junction. Along with a few additional criteria, these findings should be sufficient to allow the pathologist to make the diagnosis and to recommend complete excision. Fluent communication between clinician and pathologist will facilitate a correct diagnosis. (Arch Pathol Lab Med. 2011;135:847-852)