Potter Alison J, Ferguson Peter M, Lo Serigne N, Ahmed Tasnia, Rawson Robert V, Thompson John F, Long Georgina V, Scolyer Richard A
Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.
Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.
J Cutan Pathol. 2024 Oct 2. doi: 10.1111/cup.14727.
Tumoral melanosis (TM) is a histological term to describe a nodular aggregation of macrophages containing melanin pigment (melanophages) that is devoid of viable melanocytes. It is most often identified in skin, where it may be appreciated clinically as a pigmented lesion; however, it can also be found in other organs such as lymph nodes. The presence of TM is usually thought to signify the presence of a regressed melanoma or other pigmented tumor. Until recently, it was a relatively uncommon finding; however, with the use of effective systemic therapies against melanoma, its occurrence in histological specimens is more frequent.
We identified and reviewed all histopathological diagnoses of TM at any organ site reported at a single institution from 2006 to 2018. TM cases were paired with non-TM cases of cutaneous melanoma through propensity score matching at a 1:2 ratio, and their survival outcomes were compared. The clinical outcomes examined included recurrence-free survival (RFS), distant disease-free survival (DDFS), melanoma-specific survival (MSS), and overall survival (OS).
TM was reported in 79 patients. Their median age was 65 years (range 22-88), with a 2:1 male predominance (51 out of 79, 65%). The most common organ involved was the skin (67%), with a third of all cases localized to a lower limb (36%). TM had a strong association with the presence of melanoma (91%) and regression at other sites of melanoma (54%), suggesting that it is part of a systemic immune response against melanoma. Most patients with TM either previously or subsequently developed histologically confirmed melanoma in the same anatomical region as the TM (89%). Thirty-five TM patients were matched with 70 non-TM cases. Patients with melanoma who developed TM without prior regional or systemic therapy showed improved MSS (p = 0.03), whereas no statistically significant differences were observed in terms of RFS, DDFS, and OS.
TM usually occurs in the context of a previous or subsequent cutaneous melanoma and is associated with improved MSS. It is important that TM is recognized by pathologists and documented in pathology reports.
肿瘤性黑素沉着症（TM）是一个组织学术语，用于描述含有黑色素的巨噬细胞（噬黑素细胞）的结节状聚集，其中不存在存活的黑素细胞。它最常出现在皮肤中，临床上可能表现为色素沉着病变；然而，它也可出现在其他器官，如淋巴结。TM的存在通常被认为意味着存在消退的黑色素瘤或其他色素性肿瘤。直到最近，它还是一个相对不常见的发现；然而，随着针对黑色素瘤的有效全身治疗方法的应用，其在组织学标本中的出现更为频繁。
我们确定并回顾了2006年至2018年在单一机构报告的任何器官部位TM的所有组织病理学诊断。通过倾向评分匹配，以1:2的比例将TM病例与皮肤黑色素瘤的非TM病例配对，并比较它们的生存结果。所检查的临床结果包括无复发生存期（RFS）、无远处疾病生存期（DDFS）、黑色素瘤特异性生存期（MSS）和总生存期（OS）。
报告了79例TM患者。他们的中位年龄为65岁（范围22 - 88岁），男性占主导，男女比例为2:1（79例中有51例，占65%）。最常受累的器官是皮肤（67%），所有病例中有三分之一局限于下肢（36%）。TM与黑色素瘤的存在（91%）以及黑色素瘤其他部位的消退（54%）密切相关，表明它是针对黑色素瘤的全身免疫反应的一部分。大多数TM患者之前或之后在与TM相同的解剖区域发生了组织学确诊的黑色素瘤（89%）。35例TM患者与70例非TM病例进行了匹配。在没有先前区域或全身治疗的情况下发生TM的黑色素瘤患者的MSS有所改善（p = 0.03），而在RFS、DDFS和OS方面未观察到统计学上的显著差异。
TM通常发生在先前或随后的皮肤黑色素瘤背景下，并与MSS改善相关。病理学家认识到TM并在病理报告中记录很重要。
