Müller Cornelia S L, Hinterberger Louisa, Vogt Thomas, Pföhler Claudia
Dermatology Department, Saarland University, Homburg/Saar, Germany.
BMJ Case Rep. 2011 Jun 29;2011:bcr1220103643. doi: 10.1136/bcr.12.2010.3643.
An 84-year-old woman presented with ulcerated scalp lesions that had been mistreated as acute haemorrhagic eczema for several months. Examination showed confluent purple-blue-grey macules, papules and nodules covering a great portion of the parietofrontotemporal scalp with focal areas of ulceration. Dermatopathologic examination of two 5 mm punch biopsies confirmed an invasive malignant melanoma (Breslow thickness of 5 mm, clark level V). In addition, lymphangiosis melanomatosa, intravascular tumour growth and a diffuse infiltration of the subcutaneous tissue were seen. Possible treatment options (eg, surgery, irradiation, intralesional treatment) were discussed with the patient, but declined. It is important that clinicians are aware that melanomas may be large and biopsies are mandatory to avoid delayed diagnosis. Thus, a dermatologist has a pre-eminent position in diagnostic procedure.
一名84岁女性因头皮溃疡性病变就诊，该病变被误诊为急性出血性湿疹数月。检查发现融合性紫蓝色至灰色斑疹、丘疹和结节，覆盖顶额颞部头皮的大部分区域，并有局部溃疡。对两处5毫米钻孔活检组织进行的皮肤病理检查确诊为侵袭性恶性黑色素瘤（Breslow厚度为5毫米，Clark分级为V级）。此外，可见黑色素瘤淋巴管炎、血管内肿瘤生长以及皮下组织弥漫性浸润。与患者讨论了可能的治疗方案（如手术、放疗、皮损内治疗），但患者拒绝。临床医生应意识到黑色素瘤可能体积较大，必须进行活检以避免延误诊断，这一点很重要。因此，皮肤科医生在诊断过程中具有首要地位。
