Loffeld A, Marsden J R
Skin Oncology Service, University Hospital Birmingham NHS Trust, Birmingham B29 6JD, UK.
Br J Dermatol. 2005 Jun;152(6):1206-10. doi: 10.1111/j.1365-2133.2005.06574.x.
Metastases to the breast from extramammary cancers are rare; melanoma is one of the malignancies that can metastasize to the breast.
To examine the records of a series of patients with a previous diagnosis of melanoma and a metastasis to the breast, and review the published literature of this condition.
We report details of eight female patients with breast metastases from melanoma seen over a 36-month period from 2001. All patients were female aged 28-84 years (median 58). The breast lump was investigated by core-cut biopsy or fine needle aspiration, with or without a mammogram.
The time between diagnosis of the primary melanoma and the occurrence of a breast metastasis ranged from 13 to 180 months (median 62). In three patients the breast lump was the first sign of recurrence of melanoma. In three patients melanoma had previously relapsed in regional lymph nodes and in two patients it had already relapsed as locoregional and distant subcutaneous metastases before metastasizing to the breast. In two patients presenting via the breast clinic, the lump was subsequently confirmed on excision to be melanoma in an intramammary lymph node. In seven patients, a lumpectomy was performed after histological confirmation; one of these also had a level 1-3 axillary dissection. The eighth patient deteriorated clinically before further surgery was possible. Six patients developed further metastases within 1-5 months of breast lump detection. In one case a second 9 mm breast lump in the deeper tissue of the same breast was detected on a computed tomography scan and has been removed using stereotactic surgery. Four patients have died.
Presentation is usually with a palpable mass without skin changes. Investigation must include histology or cytology to confirm the diagnosis. Management of melanoma metastasis to the breast is discussed; in this series it was surgical unless there were many metastases.
乳腺外癌症转移至乳腺较为罕见；黑色素瘤是可转移至乳腺的恶性肿瘤之一。
检查一系列先前诊断为黑色素瘤且发生乳腺转移的患者记录，并回顾有关该病症的已发表文献。
我们报告了2001年起36个月内见到的8例黑色素瘤乳腺转移女性患者的详细情况。所有患者均为女性，年龄28 - 84岁（中位数58岁）。通过粗针活检或细针穿刺对乳腺肿块进行检查，有或没有进行乳房X线摄影。
原发性黑色素瘤诊断与乳腺转移发生之间的时间间隔为13至180个月（中位数62个月）。3例患者中乳腺肿块是黑色素瘤复发的首个迹象。3例患者黑色素瘤先前已在区域淋巴结复发，2例患者在转移至乳腺之前已作为局部和远处皮下转移复发。2例通过乳腺门诊就诊的患者，肿块在切除后经证实为乳腺内淋巴结的黑色素瘤。7例患者在组织学确诊后进行了肿块切除术；其中1例还进行了1 - 3级腋窝清扫。第8例患者在进一步手术可行之前临床病情恶化。6例患者在乳腺肿块检测后1 - 5个月内出现了进一步转移。1例患者在计算机断层扫描中在同一乳腺深层组织发现了第二个9毫米的乳腺肿块，并已通过立体定向手术切除。4例患者已死亡。
通常表现为可触及的肿块，无皮肤改变。检查必须包括组织学或细胞学以确诊。讨论了黑色素瘤转移至乳腺的治疗；在本系列中，除非有许多转移灶，否则采用手术治疗。
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