Anstey A, McKee P, Jones E W
St John's Dermatology Centre, St Thomas' Hospital, London, U.K.
Br J Dermatol. 1993 Oct;129(4):359-71. doi: 10.1111/j.1365-2133.1993.tb03159.x.
Sixteen cases of malignant melanoma which showed prominent desmoplastic and/or neurotropic features occurring throughout the tumour were compiled from the St John's Dermatology Centre histopathological archives. A further nine melanomas in which both conventional and desmoplastic melanoma were present concomitantly were also studied (three tumours with 66% desmoplastic change, two with 50%, and four with less than 50%). There were 14 males and 11 females, with a mean age of 64 years (range 39-86). The mean interval between presentation and diagnosis was 8 months. Eighteen of the 25 tumours were located on the head and neck, three were on the trunk, one was on the upper limb and three were on the lower limb. Histological review revealed 21 of 25 tumours with overlying atypical lentiginous hyperplasia, lentigo maligna melanoma, or superficial spreading malignant melanoma. Neurotropism was present in nine tumours, with the changes confined to local recurrences in two instances; neuroid differentiation was present in four tumours, and neural and perineural tumour spread was present in four tumours. The depth of invasion exceeded 6 mm in seven tumours, and was 2-6 mm in 16, and less than 2 mm in two. Eighteen of the 25 tumours were incompletely excised at the time of the first excision. Lymphoid aggregates were present in 16 tumours, but in most cases were limited to a few lymphoid foci. Melanin was identified in the dermal component of only five tumours, but not in areas showing typical histological features of desmoplastic malignant melanoma. Treatment was by surgical excision in all cases, and was preceded by radiotherapy in one case. Details of follow-up were obtained in all cases, and the duration ranged from 9 months to 10 years (mean, 3 years 11 months). Eleven patients had died; nine from melanoma and two from other causes. One patient was alive, with deep, inoperable local recurrence. Thirteen patients were alive and clinically free from tumour, including two patients in whom there had been local recurrence. A lower rate of neurotropism was present in the nine patients with partial desmoplastic change compared with those with desmoplasic change throughout the tumour, and represented the only significant difference between the two groups of patients.
从圣约翰皮肤病中心的组织病理学档案中收集了16例在整个肿瘤中表现出显著促纤维增生和/或亲神经性特征的恶性黑色素瘤病例。还研究了另外9例同时存在传统型和促纤维增生型黑色素瘤的病例（3例肿瘤促纤维增生性改变占66%，2例占50%，4例占比小于50%）。患者共14名男性和11名女性，平均年龄64岁（范围39 - 86岁）。从出现症状到确诊的平均间隔时间为8个月。25例肿瘤中，18例位于头颈部，3例位于躯干，1例位于上肢，3例位于下肢。组织学检查显示，25例肿瘤中有21例伴有上皮异型性雀斑样增生、恶性雀斑样黑色素瘤或浅表扩散性恶性黑色素瘤。9例肿瘤存在亲神经性，其中2例的改变局限于局部复发；4例肿瘤存在神经样分化，4例肿瘤存在神经和神经周围肿瘤扩散。7例肿瘤的浸润深度超过6mm，16例为2 - 6mm，2例小于2mm。25例肿瘤中有18例在首次切除时切除不完全。16例肿瘤中存在淋巴样聚集，但在大多数情况下仅限于少数淋巴样病灶。仅5例肿瘤的真皮成分中发现黑色素，但在显示促纤维增生性恶性黑色素瘤典型组织学特征的区域未发现。所有病例均采用手术切除治疗，1例术前接受了放疗。所有病例均获得随访详情，随访时间从9个月至10年不等（平均3年11个月）。11例患者死亡；9例死于黑色素瘤，2例死于其他原因。1例患者存活，但有深部、无法手术切除的局部复发。13例患者存活且临床上无肿瘤，其中包括2例曾有局部复发的患者。与肿瘤全程存在促纤维增生性改变的患者相比，9例有部分促纤维增生性改变的患者亲神经性发生率较低，这是两组患者之间唯一的显著差异。
