Skender-Kalnenas T M, English D R, Heenan P J
Department of Dermatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia.
J Am Acad Dermatol. 1995 Dec;33(6):1000-7. doi: 10.1016/0190-9622(95)90294-5.
The role of benign melanocytic lesions as precursors and not only as risk markers for the development of cutaneous melanoma is controversial.
The purpose of the study was to assess the frequency of the histologic association of benign melanocytic lesions with cutaneous melanoma of a maximum thickness of 1.00 mm. The possibility that the spatial association of benign lesions with melanoma may be coincidental was also investigated.
The study subjects representing 289 cases of cutaneous melanoma of maximum thickness 1.00 mm (or less) were examined histologically for the presence of an associated benign melanocytic lesion(s), including lentiginous melanocytic proliferation; junctional, compound, or intradermal nevus; dysplastic nevus; and congenital nevus contiguous with or adjacent to the melanoma. The effects of age, tumor thickness, level of invasion, histologic type, and anatomic site on the association of benign melanocytic lesions with melanoma were assessed. In the control subjects 40 basal cell carcinomas and 38 compound nevi (not dysplastic) randomly chosen and matched for age (+/- 1 year) and site (head/neck, trunk, upper and lower limbs) with a melanoma case were examined to assess the proportion of these cases associated with benign lesions compared with the matched melanoma cases.
A nevus was associated with melanoma in 51% of cases (n = 147). Of these, 82 (56%) were dysplastic nevi, 61 (41%) were common acquired nevi, and 4 (3%) were congenital nevi. Lentiginous melanocytic proliferation was present in the epidermis adjacent to 219 melanomas (75%) and in 44% of these cases (n = 97) a coexisting nevus was also present.
The results of this study lend further support to the concept of common acquired nevi and dysplastic nevi as precursors of cutaneous melanoma. In addition, lesions diagnosed clinically as simple lentigo and solar lentigo may be important as potential precursors of melanoma, particularly in the elderly.
良性黑素细胞性病变作为皮肤黑素瘤发生的前体而非仅仅是风险标志物的作用存在争议。
本研究的目的是评估最大厚度为1.00 mm的皮肤黑素瘤与良性黑素细胞性病变的组织学关联频率。还研究了良性病变与黑素瘤的空间关联可能是巧合的可能性。
对代表289例最大厚度为1.00 mm（或更小）的皮肤黑素瘤的研究对象进行组织学检查，以确定是否存在相关的良性黑素细胞性病变，包括雀斑样黑素细胞增生；交界痣、混合痣或皮内痣；发育异常痣；以及与黑素瘤相邻或毗连的先天性痣。评估年龄、肿瘤厚度、浸润水平、组织学类型和解剖部位对良性黑素细胞性病变与黑素瘤关联的影响。在对照组中，随机选择40例基底细胞癌和38例复合痣（非发育异常），并与黑素瘤病例在年龄（±1岁）和部位（头颈部、躯干、上肢和下肢）上进行匹配，以评估这些病例与良性病变相关的比例，并与匹配的黑素瘤病例进行比较。
51%的病例（n = 147）中痣与黑素瘤相关。其中，82例（56%）为发育异常痣，61例（41%）为普通获得性痣，4例（3%）为先天性痣。219例黑素瘤（75%）相邻的表皮中存在雀斑样黑素细胞增生，其中44%的病例（n = 97）也存在共存的痣。
本研究结果进一步支持普通获得性痣和发育异常痣作为皮肤黑素瘤前体的概念。此外，临床上诊断为单纯雀斑和日光性雀斑的病变可能作为黑素瘤的潜在前体很重要，尤其是在老年人中。
