Hitzer S, Bialasiewicz A A, Richard G
Augenklinik mit Poliklinik, Universitäts-Krankenhauses Eppendorf, Hamburg.
Klin Monbl Augenheilkd. 1998 Oct;213(4):230-7. doi: 10.1055/s-2008-1034978.
Benign and malignant melanocytic lesions of the conjunctiva are difficult to differentiate histologically. At present in the ophthalmologic literature there is not known a high specific and simply applicable histological feature (tumor marker) of differentiation to identify melanocytic lesions of the conjunctiva.
In this study 55 nevi, 15 primary acquired melanoses (stage Ia) and 54 melanomas of the conjunctiva were examined retrospectively immunhistochemically by antibodies vs. S-100 protein, and the melanoma-associated antigens HMB-45 and NKI/C3 using the labelled avidin-biotin method. 45 patients (25 female, 20 male) with malignant melanomas of the conjunctiva have been followed up clinically.
S-100, HMB-45 and NKI/C3 are highly significant markers to identify malignant melanomas of the conjunctiva (sensitivity: S-100: 96.4%, HMB-45: 96.3%, NKI/C3: 98.1%), whereas markers in acquired melanoses (sensitivity: 93.3%, 78.6% and 92.9%), and nevi (sensitivity: 92.9% 40.7%, 98.2%) are not. Positive tumor markers do not correlate with local recurrences or metastasis. The localization of malignant melanomas and the lymphocytic infiltration are not prognostically significant. The only significant risk factor (p = 0.0485) predicting the development of recurrence or metastasis is tumor thickness > 1.5 mm.
The tumor markers S-100, HMB-45 and NKI/C3 cannot differentiate reliably between benign and malignant melanocytic lesions of the conjunctiva, and positive tumor markers do not correlate with local recurrences or metastasis. The only significant risk factor (p = 0.0485) predicting the development of metastasis is tumor thickness (> 1.5 mm).
结膜的良性和恶性黑素细胞病变在组织学上难以区分。目前在眼科文献中，尚不存在一种高特异性且易于应用的组织学特征（肿瘤标志物）来鉴别结膜黑素细胞病变。
本研究采用标记抗生物素蛋白-生物素法，对55例结膜痣、15例原发性后天性黑素沉着病（Ia期）和54例结膜黑色素瘤进行了S-100蛋白、黑素瘤相关抗原HMB-45和NKI/C3抗体的回顾性免疫组织化学检查。对45例结膜恶性黑色素瘤患者（25例女性，20例男性）进行了临床随访。
S-100、HMB-45和NKI/C3是鉴别结膜恶性黑色素瘤的高度显著标志物（敏感性：S-100：96.4%，HMB-45：96.3%，NKI/C3：98.1%），而后天性黑素沉着病中的标志物（敏感性：93.3%、78.6%和92.9%）以及痣中的标志物（敏感性：92.9%、40.7%、98.2%）则不然。阳性肿瘤标志物与局部复发或转移无关。恶性黑色素瘤的部位和淋巴细胞浸润在预后方面无显著意义。预测复发或转移发生的唯一显著危险因素（p = 0.0485）是肿瘤厚度>1.5 mm。
肿瘤标志物S-100、HMB-45和NKI/C3不能可靠地区分结膜良性和恶性黑素细胞病变，阳性肿瘤标志物与局部复发或转移无关。预测转移发生的唯一显著危险因素（p = 0.0485）是肿瘤厚度（>1.5 mm）。
