Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, Australia; Melanoma Institute of Australia, The University of Sydney, North Sydney, Australia; Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, Australia; Melanoma Institute of Australia, The University of Sydney, North Sydney, Australia; Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Pathology. 2018 Jan;50(1):16-23. doi: 10.1016/j.pathol.2017.09.002. Epub 2017 Nov 10.
A stepwise progression from melanocytic precursors to cutaneous melanoma is a well-established model, based on decades of careful observation and morphological analysis. The steps identified are benign melanocytic naevus, dysplastic naevus, 'radial growth phase' melanoma (including melanoma in situ) and 'vertical growth phase' melanoma (also termed tumourigenic melanoma). Recent genomic data have refined the understanding of the steps of melanoma development and their relationship to one another. These data support the existence of dysplastic naevi as distinct lesions; suggest the importance of clonal dynamics in the precursor steps of melanoma; and confirm the carcinogenic role of ultraviolet radiation throughout early melanoma development and progression. In this review, the steps of melanoma development and progression are summarised and discussed in the context of recent genomic studies. This new understanding of melanoma pathogenesis that has been facilitated through careful correlation of morphological and molecular features will allow the identification and development of robust biomarkers to assist in more accurate diagnosis and prognostication of melanocytic tumours.
从黑素细胞前体到皮肤黑色素瘤的逐步进展是一个经过充分验证的模型，其建立基于数十年的仔细观察和形态学分析。已确定的步骤包括良性黑素细胞痣、发育不良痣、“放射状生长阶段”黑色素瘤（包括原位黑色素瘤）和“垂直生长阶段”黑色素瘤（也称为致瘤性黑色素瘤）。最近的基因组数据细化了对黑色素瘤发展步骤及其相互关系的理解。这些数据支持将发育不良痣作为独立病变的存在；提示克隆动力学在黑色素瘤前体步骤中的重要性；并确认紫外线辐射在整个早期黑色素瘤发展和进展过程中的致癌作用。在这篇综述中，根据最近的基因组研究，总结和讨论了黑色素瘤的发展和进展步骤。通过仔细关联形态学和分子特征，对黑色素瘤发病机制的这种新认识将有助于识别和开发稳健的生物标志物，以协助更准确地诊断和预测黑素细胞肿瘤。
