Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Dermatol Surg. 2012 Sep;38(9):1437-44. doi: 10.1111/j.1524-4725.2012.02438.x. Epub 2012 May 15.
The recognition of amelanotic cutaneous melanoma metastases (ACMM) remains a diagnostic challenge.
To describe and analyze the clinical and dermoscopic characteristics of ACMM.
Cases of ACMM were retrospectively selected from the image databases of three dermatology centers. The clinical and dermoscopic images were combined into one database for analysis.
Forty-seven ACMM were observed in 18 patients. All lesions were erythematous, symmetric, dome-shaped papules or nodules appearing an average of 17 months after the diagnosis of the primary melanoma. ACMM presented as clinical outliers or as nonspecific papules found by palpation of the skin. The predominant dermoscopic feature was the presence of vascular structures, including serpentine (45%), glomerular (30%), irregular hairpin (23%) and corkscres-like vessels (19%). A few lesions also revealed crystalline (or shiny white lines) when viewed using polarized dermoscopy.
ACMM should be considered in the differential diagnosis of new or persistent skin-colored or pink papules in patients with a previous history of invasive melanoma, especially if the lesions reveal atypical vessels under dermoscopy. The presence of crystalline structures may be another clue for the detection of some ACMM.
无色素性皮肤黑素瘤转移（ACMM）的识别仍然是一个诊断挑战。
描述和分析 ACMM 的临床和皮肤镜特征。
从三个皮肤科中心的图像数据库中回顾性选择了 ACMM 病例。将临床和皮肤镜图像合并到一个数据库中进行分析。
在 18 例患者中观察到 47 例 ACMM。所有病变均为红斑、对称、圆顶状丘疹或结节，在原发性黑素瘤诊断后平均出现 17 个月。ACMM 表现为临床异常或通过皮肤触诊发现的非特异性丘疹。主要的皮肤镜特征是存在血管结构，包括蛇行（45%）、肾小球（30%）、不规则发夹（23%）和 corkscrews 样血管（19%）。一些病变在偏振皮肤镜下也显示出结晶（或闪亮的白线）。
对于有侵袭性黑素瘤既往史的患者，新出现或持续存在肤色或粉红色丘疹时，应考虑 ACMM 的鉴别诊断，尤其是在皮肤镜下显示不典型血管的情况下。结晶结构的存在可能是检测某些 ACMM 的另一个线索。
