Kruijff Schelto, Vink Robert, Klaase Joost
Medical Spectrum Twente, Enschede, The Netherlands.
Rare Tumors. 2011 Jul 11;3(3):e28. doi: 10.4081/rt.2011.e28.
We report a case of a giant melanoma on the back with a very extreme Breslow thickness. On physical examination a large odorous and ulcerating tumour was seen adjacent to two large crusted lesions, probably in transit metastases. In the right and left axilla enlarged lymph nodes were palpated. The patient underwent salvage surgery consisting of a complete wide excision of the tumors on the back as well as axillary lymph node dissection on both sides. Histopathology showed a malignant melanoma with a Breslow thickness of 48 mm. Four of fifteen nodes in the right axilla and one of nine nodes in the left axilla, were positive for metastatic disease. Also various in transit and subcutaneous metastases were found in the wide excision specimen. The interest of our observation relies in the rarity of a melanoma with such an extreme Breslow thickness and the difficulty in performing adequate palliative therapy that offers quality of life by means of tumor control.
我们报告一例背部巨大黑色素瘤病例，其Breslow厚度非常大。体格检查发现一个大的、有异味且溃疡的肿瘤，毗邻两个大的结痂病变，可能为移行转移灶。在左右腋窝可触及肿大淋巴结。患者接受了挽救性手术，包括背部肿瘤的完整广泛切除以及双侧腋窝淋巴结清扫。组织病理学显示为恶性黑色素瘤，Breslow厚度为48mm。右腋窝15个淋巴结中有4个、左腋窝9个淋巴结中有1个有转移病灶。在广泛切除标本中还发现了各种移行和皮下转移灶。我们此次观察的意义在于，如此极端Breslow厚度的黑色素瘤十分罕见，且难以实施通过控制肿瘤来提高生活质量的充分姑息治疗。
