Steele Lloyd, Yeoh Chit Cheng
Imperial College Healthcare NHS Trust, London, UK.
Acute Medicine, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
BMJ Case Rep. 2019 Feb 25;12(2):e228114. doi: 10.1136/bcr-2018-228114.
A 46-year-old man presented with a 4-week history of bruising with subcutaneous nodules and weight loss. He also had a 2-week history of progressive back and hip pain. He had been diagnosed with stage Ib cutaneous melanoma 30 months previously, which had been fully excised. A sentinel lymph node biopsy was negative. On examination, there were five skin lesions at different stages. Each had spontaneously appeared as a bruise with a central subcutaneous nodule, and the bruising then faded to leave a persistent subcutaneous nodule. Excision of one of the nodules demonstrated a 4.5 mm diameter partly necrotic melanoma deposit in the dermis. CT scan of the head, chest, abdomen and pelvis showed widespread metastases. This rare presentation of cutaneous malignant melanoma metastases has been termed 'sentinel bruising'. There are fewer than 10 cases reported in the literature.
一名46岁男性，有4周的瘀斑伴皮下结节及体重减轻病史。他还有2周的进行性背部和髋部疼痛病史。30个月前他被诊断为Ib期皮肤黑色素瘤，已完全切除。前哨淋巴结活检为阴性。检查发现有5个处于不同阶段的皮肤病变。每个病变最初均自发出现为带有中央皮下结节的瘀斑，随后瘀斑消退，留下持续存在的皮下结节。切除其中一个结节显示真皮内有一个直径4.5毫米的部分坏死黑色素瘤沉积物。头部、胸部、腹部和骨盆的CT扫描显示广泛转移。皮肤恶性黑色素瘤转移的这种罕见表现被称为“前哨瘀斑”。文献报道的病例少于10例。
