Department of Pathology, University of Virginia, Charlottesville, 22908 VA, USA; Department of Pathology, The University of Texas MD Anderson Cancer Center, 77030 Houston, TX, USA.
Department of Pathology, The University of Texas MD Anderson Cancer Center, 77030 Houston, TX, USA.
Hum Pathol. 2019 Feb;84:270-274. doi: 10.1016/j.humpath.2018.10.010. Epub 2018 Oct 22.
Melanomas, like nonmelanoma skin cancers, are known to be causally related to sun exposure. It is therefore not surprising to see benign nevi and melanomas in a background of solar damage, which at times may complicate their distinction. Because of their long-standing nature, nevi often occur before the development of solar elastosis and as such are intimately associated with the solar elastosis. In contrast, visible solar elastosis often occurs before the development of melanoma, in which case the band of solar elastosis is displaced downward from the overlying invasive melanoma and/or its host response. We describe 4 cases in which invasive melanoma cells were intimately admixed with actinically damaged elastin fibers in the absence of a prominent host response. In each case, melanoma cells were admixed with prominent solar elastosis and lacked a significant host response, suggesting that they were either histiocytes or an associated melanocytic nevus. Recognition of this potential pitfall may be helpful in the diagnosis of primary/in-transit/satellite/metastatic melanoma as well as when evaluating marginal status and determining Breslow thickness.
黑素瘤与非黑素瘤皮肤癌一样，已知与阳光暴露有因果关系。因此，在阳光损伤的背景下看到良性痣和黑素瘤并不奇怪，有时这可能会使它们的区别变得复杂。由于痣的长期存在，它们通常在太阳弹性纤维变性之前出现，因此与太阳弹性纤维变性密切相关。相比之下，可见的太阳弹性纤维变性通常在黑素瘤发生之前发生，在这种情况下，太阳弹性纤维变性带从覆盖的侵袭性黑素瘤及其宿主反应向下移位。我们描述了 4 例侵袭性黑素瘤细胞与光化性损伤的弹性纤维密切混合的病例，而没有明显的宿主反应。在每种情况下，黑素瘤细胞与明显的太阳弹性纤维变性混合，缺乏明显的宿主反应，提示它们是组织细胞或相关的黑素细胞痣。认识到这一潜在的陷阱可能有助于诊断原发性/转移/卫星/转移性黑素瘤，以及评估边缘状态和确定 Breslow 厚度。
