King Roy, Hayzen Brett A, Page Robert N, Googe Paul B, Zeagler Deborah, Mihm Martin C
Knoxville Dermatopathology Laboratory, Department of Pathology, University of Tennessee, Graduate School of Medicine, Knoxville, TN 37919, USA.
Mod Pathol. 2009 May;22(5):611-7. doi: 10.1038/modpathol.2009.22. Epub 2009 Mar 6.
Recurrent nevus phenomenon and regression in melanoma may have overlapping histologic features. The clinical findings and histologic changes in 357 cases of recurrent nevus phenomenon were compared with 34 cases of melanoma with regression. Regression was defined as (1) Early: dense lymphoid infiltrates replacing nests of melanocytes, (2) Intermediate: absence/ loss of tumor with replacement by mix of lymphocytes and melanophages and early fibrosis, and (3) Late: tumor absence with extensive fibrosis and telangiectasia, melanophages and epidermal effacement. Four broad histologic patterns of recurrent nevus were identified and classified into type 1: junctional melanocytic hyperplasia with effacement of the retiform epidermis and associated dermal scar, type 2: compound melanocytic proliferation with effacement of the retiform epidermis and associated dermal scar, type 3: junctional melanocytic hyperplasia with retention of the retiform epidermis, and type 4: compound melanocytic hyperplasia with retention of the retiform epidermis and scar. Melanomas with early and intermediate regression were recognizable due to the presence of residual melanoma. Melanomas with late regression had overlapping features of type 1 and 2 recurrent nevi. Type 3 recurrent nevi resembled primary melanoma with scar/fibrosis. Histologically, the vast majority of recurrent nevi are readily identifiable; however, partial biopsies or cases without prior knowledge of the original biopsy may lead to misdiagnosis. This is especially true in recurrent nevus and regression in malignant melanoma, where these two lesions share overlapping histologic features. Correlation with the clinical findings and prior biopsy will avoid these pitfalls.
黑色素瘤中的复发性痣现象和消退可能具有重叠的组织学特征。将357例复发性痣现象的临床发现和组织学变化与34例伴有消退的黑色素瘤进行了比较。消退被定义为：（1）早期：密集的淋巴细胞浸润取代黑素细胞巢；（2）中期：肿瘤缺失/消失，被淋巴细胞和噬黑素细胞混合以及早期纤维化取代；（3）晚期：肿瘤缺失伴广泛纤维化和毛细血管扩张、噬黑素细胞以及表皮消失。识别出复发性痣的四种主要组织学模式并将其分类为：1型：交界性黑素细胞增生伴网状表皮消失及相关真皮瘢痕；2型：复合性黑素细胞增生伴网状表皮消失及相关真皮瘢痕；3型：交界性黑素细胞增生伴网状表皮保留；4型：复合性黑素细胞增生伴网状表皮保留及瘢痕。伴有早期和中期消退的黑色素瘤由于存在残余黑色素瘤而可识别。伴有晚期消退的黑色素瘤具有1型和2型复发性痣的重叠特征。3型复发性痣类似于伴有瘢痕/纤维化的原发性黑色素瘤。组织学上，绝大多数复发性痣很容易识别；然而，部分活检或对原始活检不知情的病例可能会导致误诊。在恶性黑色素瘤的复发性痣和消退中尤其如此，这两种病变具有重叠的组织学特征。与临床发现和先前活检结果相关联将避免这些陷阱。
