Gibson L E, Goellner J R
Department of Dermatology, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1988 Aug;63(8):777-82. doi: 10.1016/s0025-6196(12)62357-x.
We studied 15 cases of amelanotic melanoma by using light microscopy (in conjunction with Fontana staining and S-100 immunostaining) and electron microscopy. In 14 of the 15 cases, metastatic melanomas were present; 11 were associated with a history of pigmented primary melanoma. The Fontana stain was positive in 4 cases and negative in 11. The S-100 stain was positive in 13 cases and negative in 2. Of the 11 cases with negative Fontana stains, 9 were positive with the S-100 immunostain and 2 were negative. Electron microscopy showed melanosomes in 13 cases. Melanosomes were seen in the two cases with negative Fontana and S-100 staining. Although all stages of melanosomes were identified, generally the majority were immature melanosomes. This study demonstrates the difficulties associated with the histologic diagnosis of amelanotic melanoma. The Fontana stain may be helpful, and the S-100 stain is generally positive. Electron microscopy provided the only evidence for melanoma in two cases and is considered the most definitive method of diagnosis of amelanotic melanomas. These tumors generally produce some pigment and thus are called amelanotic by convention, not because pigmentation is totally absent.
我们通过光学显微镜（结合Fontana染色和S-100免疫染色）及电子显微镜对15例无色素性黑色素瘤进行了研究。15例中有14例存在转移性黑色素瘤；11例有色素性原发性黑色素瘤病史。Fontana染色4例阳性，11例阴性。S-100染色13例阳性，2例阴性。在Fontana染色阴性的11例中，9例S-100免疫染色阳性，2例阴性。电子显微镜检查显示13例有黑素小体。在Fontana和S-100染色均阴性的2例中也可见黑素小体。虽然识别出了黑素小体的各个阶段，但通常大多数是未成熟的黑素小体。本研究表明无色素性黑色素瘤的组织学诊断存在困难。Fontana染色可能有帮助，S-100染色通常呈阳性。电子显微镜检查在2例中提供了黑色素瘤的唯一证据，被认为是诊断无色素性黑色素瘤最具决定性的方法。这些肿瘤通常会产生一些色素，因此按照惯例被称为无色素性，并非因为完全没有色素沉着。
