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中等大小先天性黑素细胞痣在孕期疑似进展为黑色素瘤：对患者而言最佳方案是什么？

Medium Sized Congenital Melanocytic Nevus with Suspected Progression to Melanoma during Pregnancy: What's the Best for the Patient?

作者信息

Tchernev Georgi, Dzhelyatova Gabriela Atanasova, Wollina Uwe, Lozev Ilia, Lotti Torello

机构信息

Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria.

"Onkoderma"- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria.

出版信息

Open Access Maced J Med Sci. 2018 Jan 13;6(1):143-145. doi: 10.3889/oamjms.2018.016. eCollection 2018 Jan 25.

DOI:10.3889/oamjms.2018.016
PMID:29484013
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5816287/
Abstract

BACKGROUND

Congenital melanocytic nevi (CMN) are pigmented skin lesions usually present at birth. Rare varieties can develop and become clinically very large. Although they are benign nevomelanocytic neoplasms, all CMN may be precursors of the melanoma, regardless of their size. Individual risk of malignant transformation of melanocyte is determined by simultaneous action of exogenous and endogenous factors. The major exogenous risk factor is ultraviolet radiation. Leading roles among the endogenous factors are attributed to skin phenotype, gene mutation, sex hormones and their significance.

CASE REPORT

We present a case of a 27 - year - old pregnant female patient with a congenital melanocytic nevus, which increased significantly in size, during her pregnancy. Estrogen levels increase during pregnancy and clinical evidence has suggested that melanocytes are estrogen - responsive. Nevi in a pregnant patient would exhibit increased expression of estrogen receptor β (ERβ) and thus enhanced the potential to respond to altered estrogen levels.

CONCLUSION

All pigmented skin lesions should be carefully observed during pregnancy by a dermatologist due to the increased risk of malignant transformation, associated with the endocrine dependence. All lesions with visible changes should be removed surgically with appropriative anaesthesia.

摘要

背景

先天性黑素细胞痣（CMN）是通常在出生时就存在的色素沉着性皮肤病变。罕见类型可发展并在临床上变得非常大。尽管它们是良性痣黑素细胞肿瘤，但所有CMN都可能是黑色素瘤的前体，无论其大小如何。黑素细胞恶性转化的个体风险由外源性和内源性因素的共同作用决定。主要的外源性风险因素是紫外线辐射。内源性因素中起主要作用的是皮肤表型、基因突变、性激素及其意义。

病例报告

我们报告一例27岁的怀孕女性患者，其先天性黑素细胞痣在怀孕期间大小显著增加。怀孕期间雌激素水平升高，临床证据表明黑素细胞对雌激素有反应。怀孕患者的痣会表现出雌激素受体β（ERβ）表达增加，从而增强了对雌激素水平变化的反应潜力。

结论

由于与内分泌依赖性相关的恶性转化风险增加，皮肤科医生在怀孕期间应仔细观察所有色素沉着性皮肤病变。所有有可见变化的病变都应在适当麻醉下进行手术切除。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b28c/5816287/6ee900e8f512/OAMJMS-6-143-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b28c/5816287/6ee900e8f512/OAMJMS-6-143-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b28c/5816287/6ee900e8f512/OAMJMS-6-143-g001.jpg

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Medium-sized congenital melanocytic nevus of the forehead, glabella and temple – surgical treatment and long-term follow-up.额部、眉间和颞部中型先天性黑素细胞痣的手术治疗及长期随访。
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