Smithers B M, McLeod G R, Little J H
Princess Alexandra Hospital, Queensland Melanoma Project, Brisbane, Australia.
Aust N Z J Surg. 1990 Dec;60(12):967-72. doi: 10.1111/j.1445-2197.1990.tb07515.x.
An analysis of the clinicopathological features of 45 cases of desmoplastic, neural transforming and neurotropic melanoma assessed by a single pathologist are reported. The age range of 27 males and 18 females was 17-88 years. Twenty primary lesions (44%) were on the head and neck and fourteen (31%) were on the trunk. Thirty lesions (67%) were amelanotic. The initial clinical diagnosis was incorrect for 16 patients. Mean thickness was 4.5 mm. Recurrence occurred in 17 patients (38%). Local recurrence has occurred in 12 patients. This was related to a primary where: pathological diagnosis was incorrect; excision was less than 1 cm; the site was on the head and neck; Clarke level was V; and Breslow thickness was greater than 4 mm. Four patients had cranial nerve neuropathies due to recurrent neurotropic melanoma. Four patients are alive with inoperable disease and five have died from disseminated melanoma. These tumours can be difficult to recognize clinically and pathologically, with poor results if not adequately treated primarily. Therefore, the need for surgeons to be aware of this tumour and its clinicopathological features is important. Close follow-up is essential.
本文报告了由一位病理学家评估的45例促纤维增生性、神经转化性和嗜神经性黑色素瘤的临床病理特征分析。27例男性和18例女性的年龄范围为17至88岁。20例原发性病变（44%）位于头颈部，14例（31%）位于躯干。30例病变（67%）为无色素性。16例患者的初始临床诊断有误。平均厚度为4.5毫米。17例患者（38%）出现复发。12例患者出现局部复发。这与以下原发性情况有关：病理诊断有误；切除范围小于1厘米；病变部位位于头颈部；克拉克分级为V级； Breslow厚度大于4毫米。4例患者因复发性嗜神经性黑色素瘤出现颅神经病变。4例患者患有无法手术的疾病仍存活，5例患者死于播散性黑色素瘤。这些肿瘤在临床和病理上可能难以识别，如果初始治疗不充分，预后较差。因此，外科医生了解这种肿瘤及其临床病理特征很重要。密切随访至关重要。
