Hoss D M, Grant-Kels J M
Dermatol Clin. 1986 Jan;4(1):29-44.
Malignant melanoma is diagnosed yearly in approximately 300 persons under age 20 in the United States. Relatively recent advances in dermatology include the recognition of lesions felt to be potential precursors of malignant melanoma. Small congenital melanocytic nevi, present in 1 per cent of all newborn infants, may have a small but definite potential for developing malignant melanoma. Furthermore, despite inconclusive data, many leading dermatologists now advocate removal of these small congenital lesions. Giant congenital melanocytic nevi, with their strong predilection for undergoing malignant change, are removed surgically at an early age, often in multistaged procedures. Dermabrasion, once felt to have a role in the treatment of giant congenital nevi, does not remove the malignant potential of these lesions. The dysplastic nevus syndrome, recognized in 1976, identifies individuals at increased risk for developing melanoma. Adolescents who have the dysplastic nevus syndrome or who are members of families with the syndrome require close medical supervision and patient education. The benign Spitz nevus, with its histologic similarity to malignant melanoma, continues to challenge the dermatopathologist and clinician. These lesions--the Spitz nevus, dysplastic nevus, congenital melanocytic nevus, and malignant melanoma--must all be actively considered when regarding the many other benign melanocytic lesions found in infancy, childhood, and adolescence.
在美国，每年约有300名20岁以下的人被诊断出患有恶性黑色素瘤。皮肤病学领域相对较新的进展包括认识到一些被认为是恶性黑色素瘤潜在前驱病变的皮损。小先天性黑素细胞痣在所有新生儿中的发生率为1%，可能有较小但明确的发展为恶性黑色素瘤的可能性。此外，尽管数据尚无定论，但许多顶尖皮肤科医生现在主张切除这些小的先天性病变。巨大先天性黑素细胞痣极易发生恶变，通常在早期通过多阶段手术切除。皮肤磨削术曾被认为在巨大先天性黑素细胞痣的治疗中起作用，但并不能消除这些病变的恶变潜能。1976年被确认的发育异常痣综合征，确定了发生黑色素瘤风险增加的个体。患有发育异常痣综合征或其家族成员的青少年需要密切的医学监测和患者教育。良性斯皮茨痣在组织学上与恶性黑色素瘤相似，继续给皮肤病理学家和临床医生带来挑战。在考虑婴儿期、儿童期和青少年期发现的许多其他良性黑素细胞病变时，必须积极考虑这些病变——斯皮茨痣、发育异常痣、先天性黑素细胞痣和恶性黑色素瘤。
