University of Connecticut School of Medicine, Farmington, Connecticut.
Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
J Am Acad Dermatol. 2019 Sep;81(3):823-833. doi: 10.1016/j.jaad.2019.03.066. Epub 2019 Mar 28.
There are multiple, genetically distinct pathways that give rise to melanoma. Melanomas on sun-damaged skin (MSDS), including lentigo maligna and desmoplastic melanoma, have distinct genetic profiles and are uniquely linked to chronic ultraviolet exposure. In this article, we discuss the etiologies of lentigo maligna and desmoplastic melanoma, emerging diagnostic adjuncts that might be helpful for accurately identifying these lesions, and the clinical relevance of their frequent co-occurrence. We present unique and overlapping features of these entities and discuss challenges in MSDS management, including margin assessment, excision, and the potential role of nonsurgical therapy. Last, we address the role of immunotherapy in invasive disease. Understanding MSDS as distinct from melanoma arising on intermittently sun-exposed or sun-protected skin will ultimately help optimize patient outcomes.
存在多种遗传上不同的途径可导致黑色素瘤。日光损伤皮肤（MSDS）上的黑色素瘤，包括恶性雀斑样痣和硬化性黑素瘤，具有独特的遗传特征，并且与慢性紫外线暴露有独特的联系。在本文中，我们讨论了恶性雀斑样痣和硬化性黑素瘤的病因，以及可能有助于准确识别这些病变的新兴诊断辅助手段，以及它们经常同时发生的临床意义。我们介绍了这些实体的独特和重叠特征，并讨论了 MSDS 管理中的挑战，包括边缘评估、切除以及非手术治疗的潜在作用。最后，我们探讨了免疫疗法在侵袭性疾病中的作用。将 MSDS 理解为与间歇性暴露于阳光或受阳光保护的皮肤的黑色素瘤不同，最终将有助于优化患者的治疗效果。
