Ackerman A B, Sood R, Koenig M
Dermatopathology Unit, New York University Medical Center, New York.
Mod Pathol. 1991 Mar;4(2):253-63.
This essay places the concept of "primary acquired melanosis" of the conjunctiva in historical perspective and shows that it and its analogs, namely, lentigo-melanosis (Hutchinson), melanotic freckle (Hutchinson), melanose circonscrite precancereuse (Dubrueilh), melanotische precancerose (Miescher), lentigo maligna (Clark), precancerous melanosis (Reese), benign, precancerous, and cancerous melanosis (Zimmerman), atypical melanocytic hyperplasia (Silver et al.), and benign acquired melanosis (Zimmerman), are synonyms for melanoma in situ. The issue is not merely semantic or philosophical; it is urgently practical. If a clinician takes literally the meaning of a lesion designated "benign melanosis" and considers it to be benign, rather than the malignant melanoma that it actually is, a patient who bears that flat pigmented lesion may one day die of metastasis from an elevated sequella of it. The same is true of "primary acquired melanosis," which is not simply a condition of blackening by melanin, but a flat melanoma that, if not removed completely, may give rise one day to metastases that cause death. To avoid such misconstructions, we advocate naming melanomas in all organs "melanoma" and those that are confined to epithelial structures "melanoma in situ." Euphemisms like lentigo maligna and primary acquired melanosis are evasions of the diagnosis of melanoma, and use of them may be harmful. For that reason, they should be eschewed.
本文从历史角度阐述了结膜“原发性后天性黑变病”的概念，并表明它及其类似病变，即雀斑样黑素沉着病（哈钦森）、黑素性雀斑（哈钦森）、局限性癌前黑素沉着病（迪布勒伊）、黑素性癌前病变（米舍尔）、恶性雀斑（克拉克）、癌前黑变病（里斯）、良性、癌前和癌性黑变病（齐默尔曼）、非典型黑素细胞增生（西尔弗等人）以及良性后天性黑变病（齐默尔曼），都是原位黑素瘤的同义词。这一问题不仅是语义或哲学层面的；它具有迫切的现实意义。如果临床医生从字面上理解被称为“良性黑变病”的病变含义，并认为它是良性的，而不是实际上的恶性黑素瘤，那么患有这种扁平色素沉着病变的患者可能有一天会死于由其隆起后遗症引发的转移。“原发性后天性黑变病”也是如此，它并非仅仅是黑色素沉着变黑的一种情况，而是一种扁平黑素瘤，如果不完全切除，可能有一天会引发导致死亡的转移。为避免此类误解，我们主张将所有器官的黑素瘤命名为“黑素瘤”，将局限于上皮结构的黑素瘤命名为“原位黑素瘤”。诸如恶性雀斑和原发性后天性黑变病之类的委婉说法是对黑素瘤诊断的回避，使用它们可能有害。因此，应避免使用。
