Division of Dermatology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Department of Pathology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada.
Department of Pathology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada.
J Am Acad Dermatol. 2011 Aug;65(2):357-363. doi: 10.1016/j.jaad.2010.07.031. Epub 2011 May 6.
Childhood malignant melanomas frequently present as nodular melanomas with Spitzoid features. Spitz nevus and Spitzoid melanoma overlap clinically and histopathologically and there have been many attempts to differentiate between them. Spitz nevi differ from melanomas by their immunohistochemical pattern of expression of cell cycle and apoptosis regulators such as the p16 protein.
The aim of this study was to evaluate in a childhood population the expression of p16 in nodular malignant melanoma of Spitzoid type, Spitz nevi, and a control group of benign compound melanocytic nevi.
We performed immunohistochemical studies for expression of p16 in 6 Spitzoid malignant melanomas, 18 Spitz nevi, and 12 compound melanocytic nevi in children younger than 18 years. Statistical analysis was used to compare p16 expression, mitotic count/mm(2), and Ki-67 index of childhood nodular malignant melanomas and Spitz nevi.
All the childhood melanoma cases were associated with loss of p16 without any correlation with their Breslow thickness whereas all the Spitz nevi and benign melanocytic nevi had strong positive nuclear and cytoplasmic expression of p16 staining. We found a statistically significant difference in p16 expression, mitotic counts, and Ki-67 index when comparing the Spitzoid melanomas with the Spitz nevi.
This study is limited by the small number of malignant melanomas, which are known to be rare in childhood.
p16 Expression in childhood nodular Spitzoid malignant melanomas and Spitz nevi, in conjunction with clinical and histopathological evaluation, may be a useful tool in differentiating between these two entities.
儿童期恶性黑色素瘤常表现为结节性黑色素瘤，具有 Spitz 样特征。Spitz 痣和 Spitz 样黑色素瘤在临床上和组织病理学上有重叠，因此有很多尝试对它们进行区分。Spitz 痣与黑色素瘤不同，其细胞周期和凋亡调节因子如 p16 蛋白的免疫组织化学表达模式不同。
本研究旨在评估儿童人群中 Spitz 样型结节性恶性黑色素瘤、Spitz 痣和良性复合性黑色素细胞痣中 p16 的表达。
我们对 6 例儿童 Spitz 样恶性黑色素瘤、18 例 Spitz 痣和 12 例复合性黑色素细胞痣进行了 p16 免疫组织化学研究，这些儿童的年龄均小于 18 岁。采用统计学方法比较儿童结节性恶性黑色素瘤和 Spitz 痣的 p16 表达、有丝分裂计数/mm(2)和 Ki-67 指数。
所有儿童黑色素瘤病例均与 p16 缺失相关，与 Breslow 厚度无任何相关性，而所有 Spitz 痣和良性黑色素细胞痣均有强烈的核和细胞质 p16 染色阳性表达。我们发现 Spitz 样黑色素瘤与 Spitz 痣之间的 p16 表达、有丝分裂计数和 Ki-67 指数有统计学显著差异。
本研究受到儿童恶性黑色素瘤数量较少的限制，已知恶性黑色素瘤在儿童中较为罕见。
结合临床和组织病理学评估，儿童结节性 Spitz 样恶性黑色素瘤和 Spitz 痣中 p16 的表达可能是区分这两种实体的有用工具。
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