From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer).
Arch Pathol Lab Med. 2020 Apr;144(4):500-522. doi: 10.5858/arpa.2019-0561-RA. Epub 2020 Feb 14.
CONTEXT.—: There have been major advances in the understanding of melanoma since the last revision of the World Health Organization (WHO) classification in 2006.
OBJECTIVE.—: To discuss development of the 9 distinct types of melanoma and distinguishing them by their epidemiology, clinical and histologic morphology, and genomic characteristics. Each melanoma subtype is placed at the end of an evolutionary pathway that is rooted in its respective precursor, wherever appropriate and feasible, based on currently known data. Each precursor has a variable risk of progression culminating in its fully evolved, invasive melanoma.
DATA SOURCES.—: This review is based on the "Melanocytic Tumours" section of the 4th edition of the , published in 2018.
CONCLUSIONS.—: Melanomas were divided into those etiologically related to sun exposure and those that are not, as determined by their mutational signatures, anatomic site, and epidemiology. Melanomas on the sun-exposed skin were further divided by the histopathologic degree of cumulative solar damage (CSD) of the surrounding skin, into low and high CSD, on the basis of degree of associated solar elastosis. Low-CSD melanomas include superficial spreading melanomas and high-CSD melanomas incorporate lentigo maligna and desmoplastic melanomas. The "nonsolar" category includes acral melanomas, some melanomas in congenital nevi, melanomas in blue nevi, Spitz melanomas, mucosal melanomas, and uveal melanomas. The general term is proposed to encompass "intermediate" tumors that have an increased (though still low) probability of disease progression to melanoma.
自 2006 年世界卫生组织（WHO）分类最后一次修订以来，对黑色素瘤的认识有了重大进展。
讨论 9 种不同类型黑色素瘤的发展，并通过其流行病学、临床和组织形态学以及基因组特征对其进行区分。每个黑色素瘤亚型都处于其相应前体的进化途径的末端，只要基于当前已知数据是合适且可行的，就尽可能将其放置在前体处。每个前体都有进展为完全进化的侵袭性黑色素瘤的可变风险。
本综述基于 2018 年出版的第 4 版《》中“黑素细胞肿瘤”部分。
黑色素瘤根据其病因与阳光暴露的关系以及其突变特征、解剖部位和流行病学分为两类。暴露于阳光的皮肤黑色素瘤根据周围皮肤累积的太阳损伤（CSD）的组织病理学程度进一步分为低 CSD 和高 CSD，其依据是与太阳弹性相关的程度。低 CSD 黑色素瘤包括浅表扩散性黑色素瘤，高 CSD 黑色素瘤包括恶性雀斑样痣和促结缔组织增生性黑色素瘤。“非日光性”类别包括肢端黑色素瘤、一些先天性痣中的黑色素瘤、蓝痣中的黑色素瘤、Spitz 黑色素瘤、黏膜黑色素瘤和葡萄膜黑色素瘤。“中间型”肿瘤的提出是为了包含那些具有增加（尽管仍然较低）疾病进展为黑色素瘤的概率的肿瘤。
