Fabre B, Gigaud M, Lamant L, Boulinguez S, Viraben R
Service de Dermatologie, Hôpital La Grave, Toulouse.
Ann Dermatol Venereol. 2003 Nov;130(11):1044-6.
Neurotropic melanoma is a particular anatomopathological form corresponding to dermal proliferation of desmoplastic cells of neuroid differentiation. We report a new case of neurotropic melanoma revealed by facial neuralgia.
A 64 year-old man presented in 1996 with a lentigo maligna on the right cheek treated by complete excision. After 2 years of medical supervision, a pigmented lesion recurred leading to new surgical treatment. The histological examination of the total lesion showed intra-epidermal atypical melanocyte proliferation without dermal invasion. In 1999, right trigeminal neuralgia occurred without associated cutaneous change. Cranial MRI revealed an infiltration of the right trigeminal nerve. Endo-buccal surgery disclosed a black swelling of the trigeminal nerve. Histological examination and immunohistochemistry revealed a desmoplastic melanoma.
Neurotropic melanoma with nerve invasion by malignant cells presenting as a trigeminal neuralgia is rare. Our case report underlined the depth of the neurotropic melanoma and the initial existence of a lentigo maligna without associated "neurotropic" melanoma.
嗜神经性黑色素瘤是一种特殊的解剖病理学形式，对应于具有神经样分化的促纤维增生性细胞的真皮增殖。我们报告一例以面部神经痛为首发表现的嗜神经性黑色素瘤新病例。
一名64岁男性于1996年就诊，右颊部有一恶性雀斑样痣，经完整切除治疗。经过2年的医学观察，出现色素沉着病变，遂进行再次手术治疗。整个病变的组织学检查显示表皮内非典型黑素细胞增殖，无真皮浸润。1999年，患者出现右侧三叉神经痛，无相关皮肤改变。头颅磁共振成像显示右侧三叉神经受侵。口腔内手术发现三叉神经呈黑色肿胀。组织学检查和免疫组化显示为促纤维增生性黑色素瘤。
恶性细胞侵犯神经并表现为三叉神经痛的嗜神经性黑色素瘤较为罕见。我们的病例报告强调了嗜神经性黑色素瘤的深度以及最初存在无相关“嗜神经性”黑色素瘤的恶性雀斑样痣。
