Shen Xu-xia, Kong Yun-yi, Dai Bo, Cai Xu, Wang Li-wei, Kong Jin-cheng
Department of Pathology, Shanghai Cancer Center, Fudan University and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
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Zhonghua Bing Li Xue Za Zhi. 2013 Oct;42(10):675-8.
To study the clinicopathologic features and differential diagnosis of cutaneous regressing/regressed melanoma.
Histopathologic evaluation and immunohistochemical study by EnVision method were performed in 8 cases of cutaneous regressing/regressed melanoma. The clinical presentation, treatment and follow-up data were analyzed.
The age of the patients ranged from 40 to 69 years (mean 58 years). The male-to-female ratio was 3: 1. Tumors were located on the back (4 cases), sole of the foot (2 cases), ventral aspect of the toes (1 case), and the forearm (1 case). Clinically, 6 patients presented with progressive black mole of the skin, followed by subsequent focal hypopigmentation, even scarring. Two patients presented with multiple foci of dark-brown pigmentation. Microscopically, 3 cases were completely regressed malignant melanoma. Tumoral melanosis was found in 1 of 3 cases. The other 5 cases were melanoma with severe regression. The extent of regression ranged from 75% to 90%. The Breslow depth of the tumors ranged from 0.5 to 1.0 mm. Immunohistochemically, both metastatic and primary tumor cells were diffusely positive for S-100, HMB45 and Melan A, while melanophages were positive for CD68. Follow-up data were available in 8 patients, ranging from 8 to 27 months. Five patients were alive with no evidence of disease, 1 patient was alive with stable disease and 2 patients died of metastatic melanoma.
Correlation between clinical presentation and pathologic features is important for diagnosis of cutaneous regressing/regressed melanoma. Thin melanoma with extensive regression ( ≥ 75%) should not been regarded as low metastatic risk and wide excision combined with sentinel lymph node biopsy is recommended.
研究皮肤消退型/消退后黑色素瘤的临床病理特征及鉴别诊断。
对8例皮肤消退型/消退后黑色素瘤进行组织病理学评估及采用EnVision法进行免疫组化研究。分析临床表现、治疗及随访数据。
患者年龄40至69岁（平均58岁）。男女比例为3:1。肿瘤位于背部（4例）、足底（2例）、趾腹（1例）和前臂（1例）。临床上，6例患者表现为皮肤进行性黑痣，随后出现局灶性色素减退，甚至瘢痕形成。2例患者表现为多个深褐色色素沉着灶。显微镜下，3例为完全消退的恶性黑色素瘤。3例中有1例发现肿瘤性黑变病。另外5例为重度消退的黑色素瘤。消退程度为75%至90%。肿瘤的Breslow厚度为0.5至1.0mm。免疫组化方面，转移瘤细胞和原发瘤细胞S-100、HMB45和Melan A均弥漫性阳性，而巨噬细胞CD68阳性。8例患者有随访数据，随访时间8至27个月。5例患者存活且无疾病证据，1例患者存活且病情稳定，2例患者死于转移性黑色素瘤。
临床表现与病理特征之间的相关性对皮肤消退型/消退后黑色素瘤的诊断很重要。广泛消退（≥75%）的薄黑色素瘤不应被视为低转移风险，建议行广泛切除联合前哨淋巴结活检。
