Kelly R I, Cook M G, Mortimer P S
Department of Dermatology, St George's Hospital, London, U.K.
Br J Dermatol. 1994 Oct;131(4):562-5. doi: 10.1111/j.1365-2133.1994.tb08561.x.
A 66-year-old woman had a long-standing, scaly erythematous lesion on her left temple which histologically showed features of amelanotic lentigo maligna. It had recurred on numerous occasions over a period of 17 years, in spite of multiple attempts at curative surgery. There were also recurrences within a skin graft which, to our knowledge, has not been documented previously with lentigo maligna. In spite of the prolonged course, and extensive intraepidermal melanocytic proliferation amounting to melanoma in situ, there has been no evidence of dermal invasion. The lack of pigmentation in such lesions means that clinical definition of margins is highly inaccurate. In view of the aggressive horizontal growth phase of this lesion, with rapid recurrence following surgery, it was treated with electron beam therapy, and this has resulted in complete clinical remission. This most unusual case illustrates the potential difficulties in diagnosis and management of amelanotic lentigo maligna.
一名66岁女性左侧颞部有一长期存在的鳞屑性红斑病变，组织学显示为无色素性恶性雀斑样痣的特征。尽管多次尝试进行根治性手术，但在17年的时间里该病变多次复发。在一块皮肤移植区内也出现了复发，据我们所知，此前尚无恶性雀斑样痣出现这种情况的记录。尽管病程较长，且表皮内黑素细胞广泛增殖达到原位黑素瘤的程度，但尚无真皮浸润的证据。此类病变缺乏色素沉着意味着临床对边缘的界定极不准确。鉴于该病变具有侵袭性的水平生长期，术后复发迅速，遂采用电子束治疗，结果实现了完全临床缓解。这一极为罕见的病例说明了无色素性恶性雀斑样痣在诊断和管理方面可能存在的困难。
