From L
Women's College Hospital, Toronto, Ontario, Canada.
Adv Dermatol. 1987;2:97-106.
Reviews of the literature support the view that melanomas arise in LCHN as well as other types of nevi and normal skin. The cases reported in the literature show a pediatric predominance. It is impossible to develop predictable figures by combining incidences of nevi with historical data from case reports. A long-term registry and follow-up are needed. In the meantime, each case should be treated individually, keeping in mind that especially in LCHN, it may be impossible to remove all melanocytes both in skin and in the CNS. Associated neuromelanosis may be present. Whether or not surgery is done, the patient must be carefully followed. Large nevi may be observed and changes that are noted should be biopsied early. Even with biopsy, the diagnosis may be unclear because some changes may be pseudomalignancies rather than true malignancies. Parents of infants should be informed of all possibilities and the complications of surgery adequately outlined. The adult with a LCHN should be informed that there is some risk. (It has been our experience that most adults prefer cosmetic revision of small areas and elect observation rather than excision.) As new techniques such as tissue expanders and more refined investigations to delineate extent of the nevus are found, it may be possible to adequately ablate more lesions in the future if a prospective study shows a convincing incidence of melanoma.
文献综述支持黑色素瘤起源于先天性巨型痣（LCHN）以及其他类型痣和正常皮肤的观点。文献报道的病例以儿童为主。将痣的发病率与病例报告的历史数据相结合来得出可预测的数据是不可能的。需要长期的登记和随访。与此同时，每个病例都应单独处理，要记住，特别是在先天性巨型痣中，可能无法清除皮肤和中枢神经系统中的所有黑素细胞。可能存在相关的神经黑色素沉着。无论是否进行手术，都必须对患者进行仔细随访。对于大型痣，可以进行观察，发现的变化应尽早进行活检。即使进行了活检，诊断也可能不明确，因为有些变化可能是假性恶性而非真正的恶性病变。应告知婴儿父母所有可能性，并充分说明手术的并发症。应告知患有先天性巨型痣的成年人存在一定风险。（根据我们的经验，大多数成年人更喜欢对小面积进行美容修复并选择观察而非切除。）随着组织扩张器等新技术以及用于确定痣范围的更精细检查方法的出现，如果前瞻性研究显示黑色素瘤的发病率令人信服，未来可能有能力充分切除更多病变。
