Robinson J K
Department of Dermatology, Northwestern University Medical School, Chicago, IL 60611.
J Am Acad Dermatol. 1994 Jul;31(1):79-85. doi: 10.1016/s0190-9622(94)70140-7.
Lentigo maligna is an in situ malignant melanoma for which the treatment of choice is surgical excision. The current recommendation is local resection with a 0.5 to 1.0 cm margin of normal skin. Because many lesions occur on the face, the narrowest possible margin reduces the amount of scarring. Controversy surrounds the use of Mohs micrographic surgery to preserve normal skin and resect the lentigo maligna.
The purposes of this prospective study were to determine the narrowest possible margin of resection of lentigo maligna and the accuracy of frozen and fixed histologic specimens from those margins. In addition, the benefit of adjunctive immunoperoxidase staining with antibodies to S-100 protein and HMB-45 monoclonal antibody was examined retrospectively.
A Wood's light was used to delineate the clinical margin in 16 cases of lentigo maligna that were resected with serial excisions 0.3, 0.6, 1.0, and 1.3 cm from the clinical border of the tumor. Frozen sections were confirmed by fixed histopathologic specimens. Subsequently these tissue blocks were examined with antibodies to S-100 protein and HMB-45 monoclonal antibodies. Patients were observed 5 to 9 years.
One of the 16 patients had a recurrence 8 years after surgery. Although lesions with a diameter less than 2.0 cm had narrower margins of resection, the majority of lesions were resected with a margin of 0.6 to 1.0 cm. Lesions larger than 3.0 cm in diameter required a margin of resection greater than 1.0 cm. The antibody to S-100 protein was neither sensitive nor specific enough to assist with identification of the process. HMB-45 monoclonal antibody was sensitive and assisted in the identification of atypical melanocytes.
The modifications of Mohs micrographic surgery including the use of fixed histopathologic specimens and the use of HMB-45 monoclonal antibody to help delineate atypical melanocytes offer the possibility of narrower margins of resection for lentigo maligna.
恶性雀斑样痣是一种原位恶性黑色素瘤，其首选治疗方法是手术切除。目前的建议是进行局部切除，切除范围包括距正常皮肤边缘0.5至1.0厘米。由于许多病变发生在面部，尽可能窄的切缘可减少瘢痕形成量。关于使用莫氏显微外科手术来保留正常皮肤并切除恶性雀斑样痣存在争议。
这项前瞻性研究的目的是确定恶性雀斑样痣的最窄切除边缘以及这些边缘的冷冻和固定组织学标本的准确性。此外，回顾性研究了用抗S-100蛋白抗体和HMB-45单克隆抗体进行辅助免疫过氧化物酶染色的益处。
使用伍德灯在16例恶性雀斑样痣病例中勾勒临床边缘，这些病例通过从肿瘤临床边界起0.3、0.6、1.0和1.3厘米的连续切除进行切除。冷冻切片由固定的组织病理学标本确认。随后，用抗S-100蛋白抗体和HMB-45单克隆抗体检查这些组织块。对患者进行了5至9年的观察。
16例患者中有1例在术后8年复发。尽管直径小于2.0厘米的病变切除边缘较窄，但大多数病变的切除边缘为0.6至1.0厘米。直径大于3.0厘米的病变需要大于1.0厘米的切除边缘。抗S-100蛋白抗体在辅助识别该病变过程方面既不敏感也不特异。HMB-45单克隆抗体敏感，有助于识别非典型黑素细胞。
莫氏显微外科手术的改良，包括使用固定的组织病理学标本和使用HMB-45单克隆抗体来帮助勾勒非典型黑素细胞，为恶性雀斑样痣提供了更窄切除边缘的可能性。
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