Betti R, Inselvini E, Vergani R, Crosti C
Clinica Dermatologica IV, Università degli Studi di Milano, Ospedale San Paolo, Milan, Italy.
J Dermatol. 2000 Sep;27(9):583-90. doi: 10.1111/j.1346-8138.2000.tb02233.x.
Melanocytic nevi, both congenital and acquired, are considered to be precursors of melanomas. Data about the malignant potential of these nevi are conflicting, particularly with reference to the nevus of the smallest size. Patients with preexisting melanocytic nevi (both congenital and acquired) have risks of developing melanoma that differ from those of subjects without them. The purpose of this study was to verify the presence of melanoma in preexisting nevi both congenital (congenital nevus associated melanoma) (CNAM) and acquired (ANAM). In particular, we investigated melanomas associated with small congenital nevi (SCN). A cohort of 190 patients with primary melanomas was studied. Congenital nevi were called "small" (SCN) when their diameters were less than 1.5 cm. Epiluminescence microscopy (ELM) was performed to further improve the clinical diagnosis and to observe the more subtle changes in the preexisting nevi. Forty of the 190 cases of melanoma were associated with preexisting nevi; of these, 15 had congenital features with a CNAM largest diameter of 1.5 cm. These 15 cases were melanomas of the superficial type with a mean tumor thickness lower than that of ANAM (0.33 vs 1.50). There were no differences between the locations of CNAM and other melanomas. Male patients were significantly more affected. ELM microscopy permitted us to detect the early malignant changes in nevi and thus to improve our diagnosis. A high percentage of small congenital nevi were found to be associated with melanomas. They may be considered as melanomas precursors. Because of their large number and frequency, prophylactic removal of all SCN is not feasible. However, they should be removed as soon as possible when clinical or ELM changes are observed.
先天性和后天性黑素细胞痣都被认为是黑色素瘤的前体。关于这些痣的恶性潜能的数据存在矛盾，特别是对于最小尺寸的痣。患有先天性和后天性黑素细胞痣的患者发生黑色素瘤的风险与没有这些痣的受试者不同。本研究的目的是验证先天性（先天性痣相关黑色素瘤）（CNAM）和后天性（后天性痣相关黑色素瘤）（ANAM）中存在的黑色素瘤。特别是，我们研究了与小先天性痣（SCN）相关的黑色素瘤。对190例原发性黑色素瘤患者进行了队列研究。当先天性痣的直径小于1.5 cm时，称为“小”（SCN）。进行表皮透光显微镜检查（ELM）以进一步改善临床诊断并观察现有痣中更细微的变化。190例黑色素瘤病例中有40例与现有痣相关；其中15例具有先天性特征，CNAM最大直径为1.5 cm。这15例为浅表型黑色素瘤，平均肿瘤厚度低于ANAM（0.33对1.50）。CNAM和其他黑色素瘤的位置没有差异。男性患者受影响明显更多。ELM显微镜使我们能够检测痣中的早期恶性变化，从而改善我们的诊断。发现高比例的小先天性痣与黑色素瘤相关。它们可被视为黑色素瘤前体。由于它们的数量众多和出现频率高，预防性切除所有SCN是不可行的。然而，当观察到临床或ELM变化时，应尽快将其切除。
