Repertinger Susan, Wang Jeff, Adickes Edward, Sarma Deba P
Department of Pathology, Creighton University Medical Center, Omaha, NE 68131, USA.
Cases J. 2008 Oct 23;1(1):263. doi: 10.1186/1757-1626-1-263.
Seborrheic keratosis is a very common benign skin tumor in man. Melanoma is rare but is the most dreaded of all malignant skin tumors. A melanoma arising in a seborrheic keratosis is distinctly rare. We are reporting such a case occurring in an 86-year-old man.
An-86-year-old male with a history of multiple actinic keratoses and seborrheic keratoses of the head and trunk presented with a mid-back skin lesion. The lesion was poorly circumscribed, flat, and gray, with a pink-tan, well-circumscribed scaly nodule within it. The biopsied lesion was composed of the usual features of hyperkeratotic seborrheic keratosis, but with focal atypical melanocytic proliferation with nesting along the dermal-epidermal junction. We interpreted this lesion as a melanoma in-situ arising within a seborrheic keratosis.
It is not uncommon for many physicians to remove a typical seborrheic keratosis without a confirmatory microscopic confirmation. We urge that all such lesions be examined by the pathologist to avoid missing another concomitant malignant lesion such as melanoma which needs adequate resection and close follow-up.
脂溢性角化病是人类非常常见的一种良性皮肤肿瘤。黑色素瘤虽然罕见，但却是所有恶性皮肤肿瘤中最可怕的。起源于脂溢性角化病的黑色素瘤极为罕见。我们在此报告一例发生在一名86岁男性身上的此类病例。
一名86岁男性，有头部和躯干多处光化性角化病及脂溢性角化病病史，背部中部出现皮肤病变。该病变边界不清，扁平，呈灰色，内部有一个粉褐色、边界清晰的鳞屑结节。活检病变具有角化过度性脂溢性角化病的常见特征，但有局灶性非典型黑素细胞增殖，并沿真皮 - 表皮交界处呈巢状分布。我们将此病变解释为起源于脂溢性角化病的原位黑色素瘤。
许多医生在未进行显微镜确诊的情况下切除典型的脂溢性角化病并不罕见。我们敦促所有此类病变都应由病理学家进行检查，以避免漏诊其他伴随的恶性病变，如需要充分切除和密切随访的黑色素瘤。
