Lopansri S, Mihm M C
J Cutan Pathol. 1979 Jun;6(3):180-94. doi: 10.1111/j.1600-0560.1979.tb01122.x.
We have attempted to review virtually all forms of cutaneous and mucocutaneous melanomas. Superficial spreading, lentigo maligna and nodular melanomas have been more thoroughly investigated and documented in previous studies. Lentigo maligna melanoma appears to have a longer duration and better prognosis than SSM or NM. The overall prognosis probably correlates better with the anatomic level and thickness of invasion than with type (Clark et al. 1975, Breslow 1970, 1975). It appears that certain pitfalls exist in either method of assessing prognosis, and it is recommended that both methods be applied in evaluating a malignant melanocytic lesion when feasible. With regard to in situ melanoma or Level I melanoma, it is our experience that such lesions can achieve a 100% cure rate when completely excised. Hence, we prefer to call such lesions severely atypical melanocytic hyperplasia, and thus avoid labeling these patients with a malignant diagnosis. The most difficult histologic challenge in diagnosing a lesion of malignant melanoma is the Spitz nevus. The pathologist should never be biased by the age of the patient, for a serious mistake can arise. We have seen a case of nodular melanoma in a 13-year-old girl diagnosed as Spitz nevus only to be followed by a lymph node metastasis years later. Other examples of histologic differential diagnoses of malignant melanomas include, for example, halo nevus, soft tissue sarcoma, squamous cell carcinoma with spindle cell proliferation, Paget's disease of metastatic carcinoma, (for example, from the breast). Therefore, the approach to the diagnosis of malignant melanoma necessitates an evaluation of both clinical and pathological features. Histologic study must encompass both the pattern of growth and cellular cytologic detail for successful interpretation.
我们试图对几乎所有类型的皮肤和黏膜皮肤黑色素瘤进行综述。在以往的研究中，浅表扩散型、恶性雀斑样痣型和结节型黑色素瘤已得到更深入的研究和记录。恶性雀斑样痣型黑色素瘤似乎比浅表扩散型黑色素瘤或结节型黑色素瘤病程更长，预后更好。总体预后可能与解剖学层次和浸润深度的相关性比与类型的相关性更好（克拉克等人，1975年；布雷斯洛，1970年、1975年）。似乎在评估预后的两种方法中都存在某些陷阱，建议在可行的情况下，将这两种方法都应用于评估恶性黑素细胞病变。关于原位黑色素瘤或I级黑色素瘤，根据我们的经验，此类病变完全切除后可实现100%的治愈率。因此，我们更倾向于将此类病变称为重度非典型黑素细胞增生，从而避免给这些患者贴上恶性诊断的标签。诊断恶性黑色素瘤病变时，最困难的组织学挑战是Spitz痣。病理学家绝不应受患者年龄的影响，因为这可能会导致严重错误。我们见过一例13岁女孩的结节型黑色素瘤，最初被诊断为Spitz痣，多年后出现了淋巴结转移。恶性黑色素瘤组织学鉴别诊断的其他例子包括，例如，晕痣、软组织肉瘤、伴有梭形细胞增生的鳞状细胞癌、转移性癌的佩吉特病（例如，来自乳腺）。因此，恶性黑色素瘤的诊断方法需要对临床和病理特征进行评估。为了成功解读，组织学研究必须包括生长模式和细胞细胞学细节。
