Bouffard D, Barnhill R L, Mihm M C, Sober A J
Dermatopathology Division, Massachusetts General Hospital, Boston.
Dermatology. 1994;189(2):162-6. doi: 10.1159/000246823.
We report a case of primary cutaneous melanoma with the incidental finding of a lung metastasis 27 years following the original diagnosis. The case is exceptional in that it is a late metastasis of a melanoma that arose in association with a halo giant congenital nevus. The original tumor was a large dermal/subcutaneous nodule composed of very well-differentiated cells reminiscent of type B nevomelanocytes. The metastasis displayed similar histology. This case emphasizes the unpredictable behavior of malignant melanoma. In cases with 'unusual' histology such as this one, the usual prognostic parameters are less helpful in predicting survival. Melanoma should be included in the differential diagnosis of an undiagnosed lesion suspicious for metastasis even if the primary was removed in the remote past.
我们报告一例原发性皮肤黑色素瘤病例，在最初诊断27年后偶然发现肺转移。该病例不同寻常之处在于，它是与晕痣型巨大先天性痣相关的黑色素瘤的晚期转移。原发肿瘤是一个大的真皮/皮下结节，由分化良好的细胞组成，类似于B型痣黑素细胞。转移灶显示出相似的组织学特征。该病例强调了恶性黑色素瘤行为的不可预测性。在具有如此“不寻常”组织学特征的病例中，通常的预后参数在预测生存方面帮助较小。即使原发灶在很久以前就已切除，对于可疑转移的未确诊病变进行鉴别诊断时也应考虑黑色素瘤。
