Department of Pathology, Weill Medical College of Cornell University, 1300 York Ave, F-309, New York, NY 10021, USA.
J Am Acad Dermatol. 2010 Mar;62(3):469-79. doi: 10.1016/j.jaad.2009.06.042.
The borderline melanocytic tumor (BMT) is a morphologically and biologically indeterminate melanocytic proliferation manifesting worrisome architectural features and cytologic atypia exceeding that encountered in melanocytic nevi yet insufficient to warrant designation as melanoma. The criteria that define the BMT are not well defined nor is the concept widely recognized.
The purpose of this study is to provide a practical framework for the approach to the dermal BMT.
Thirty-two patients with BMTs extending into the reticular dermis and at a depth of 0.75 mm or more underwent local excision and sentinel lymph node biopsy between 2000 and 2006. Four categories of BMT were recognized: (1) nevoid BMT (BNM); (2) the atypical Spitz tumor (AST); (3) pigmented epithelioid melanocytoma (PEM); and (4) BMT arising in a deep penetrating nevus (B-DPN).
Four patients were in the BNM category (male/female ratio [M:F] = 1:3; mean age = 27 years, range = 15-36), 14 in the AST category (M:F = 7:7; mean age = 20.9, range = 3-58), 7 in the PEM category (M:F = 4:3; mean age = 23.5, range = 3-39), and 7 in the B-DPN category (M:F = 5:2; mean age = 22.3, range = 14-36). The percentages of patients with positive sentinel nodes in each category were 25% (1/4), 35% (5/14), 14% (1/7), and 57% (4/7), respectively. The average time of follow-up was approximately 4.2 years. One patient, a 36-year-old man, died of disease, while the others are alive and well. In the one death attributable to widespread metastatic disease, the lesion was initially interpreted as a deep penetrating nevus; however, retrospective review revealed features compatible with a B-DPN; the review was prompted by a recurrence that was morphologically compatible with a Clark level V malignant melanoma, reflecting clinical and morphologic progression.
The mean follow-up was less than 5 years. Molecular studies to further explore the biologic commonality with melanoma were not performed.
The dermal variant of BMT is a tumor of younger adults and children that can be associated with lymph node disease and a potential for morphologic and biologic progression when inadequately treated.
交界性黑素细胞肿瘤（BMT）是一种形态学和生物学上不确定的黑素细胞增生，表现出令人担忧的结构特征和细胞学异型性，超过了黑素细胞痣的程度，但不足以诊断为黑色素瘤。定义 BMT 的标准尚未明确，其概念也未得到广泛认可。
本研究旨在为真皮 BMT 的处理提供一个实用的框架。
2000 年至 2006 年间，32 例 BMT 延伸至网状真皮，深度为 0.75mm 或以上的患者接受了局部切除和前哨淋巴结活检。识别出 4 种 BMT 类型：（1）痣样 BMT（BNM）；（2）非典型 Spitz 肿瘤（AST）；（3）色素性上皮样黑素细胞瘤（PEM）；和（4）起源于深部穿透性痣的 BMT（B-DPN）。
4 例患者为 BNM 型（男/女比例[M/F] = 1:3；平均年龄 27 岁，范围 15-36 岁），14 例为 AST 型（M/F = 7:7；平均年龄 20.9 岁，范围 3-58 岁），7 例为 PEM 型（M/F = 4:3；平均年龄 23.5 岁，范围 3-39 岁），7 例为 B-DPN 型（M/F = 5:2；平均年龄 22.3 岁，范围 14-36 岁）。每个类别的患者中，前哨淋巴结阳性的百分比分别为 25%（1/4）、35%（5/14）、14%（1/7）和 57%（4/7）。平均随访时间约为 4.2 年。1 例 36 岁男性患者死于疾病，其余患者均存活且状况良好。在 1 例归因于广泛转移性疾病的死亡病例中，最初的病变被解释为深部穿透性痣；然而，回顾性复习显示出与 B-DPN 相容的特征；进行回顾性复习是因为形态学上与 Clark 水平 V 恶性黑色素瘤相匹配的复发病变，反映了临床和形态学的进展。
平均随访时间不足 5 年。未进行进一步探索与黑色素瘤生物学共性的分子研究。
真皮 BMT 是一种发生于年轻人和儿童的肿瘤，可能与淋巴结疾病相关，在治疗不充分时具有形态和生物学进展的潜在风险。
