Malignant melanoma

【Overview】

Malignant melanoma (Malignant melanoma referred to as evil, black) is derived from melanocytes to malignant tumors, mostly occurs in the skin, the incidence of skin cancer accounts for the third.

【Diagnosis】

All suspected the black color of the damage, as well as expansion of the original nevus deepened, redness, bleeding, ulceration should be removed to do the whole pathological examination. When the damage may lead to disseminated, it should not result in an early biopsy to prevent the transfer. The best conditions to do quick frozen biopsy, once diagnosed should be a wide range
Resection.

The disease is sometimes required and pigmented basal cell carcinoma, nevus benign juvenile melanoma (Spitz nevus), seborrheic keratosis, squamous cell carcinoma, pyogenic granuloma and other identification. When necessary, immunohistochemical staining, such as S-100 protein, HM-45, etc. to be confirmed.

【Treatment measures】

Without the transfer of early nodules or plaques damage should be surgical resection, removal of the scope of normal tissues, including skin rash around the 1 ~ 3cm, if the means (toe) evil, black, cut-off means the surgery is necessary. Has affirmed the involvement of the lymph nodes should be removed, but the preventive lymph node dissection is still controversial. From the limb arterial infusion of anti-mitotic drug treatment of limb melanoma, there is a certain effect. Widespread occurrence of hematogenous metastasis is required to adopt a microphone amine as a nitrogen-based combination chemotherapy and radiotherapy.

【Etiology】

Is not entirely clear. Sunlight exposure is a risk factor, particularly in Caucasian skin, excessive exposure to sunlight after contracting this disease easily. Local incentives are also common causes of trauma. In addition, with the nevus malignant transformation related to a statistical report about 10%. Other possible causes related to genetic, immune response in patients with low and viral infections.

Pathological changes 【】

The typical pathological features of malignant melanoma in the dermis epidermis at the junction of non-atypical hyperplasia of melanocytes, and the tumor cells invaded the epidermis and dermis. Biphasic differentiation of tumor cells, epithelial cell and spindle cell type. Nucleus was significantly shaped nature of the nuclear-shaped weird. Also be found in single-core, dual-core or multi-core, common mitotic figures.

Evil black histopathological patterns are different due to different type.

1. Lentigo malignant melanoma, skin atrophy, basal layer have more atypical melanocytes to the dermis under the invasion of the tumor cells or cell interstitial macrophages in a considerable number of pigment cells containing melanin.

2. Superficial spreading melanoma skin sudden downward irregular hyperplasia, dermal epidermal junction and dermis seen in the atypical nevus cells in nests, in addition to epithelial cell type with spindle cell type melanocytes, the skin and sometimes the upper part of also be found in a small number of paget-like melanocytes. Dermal inflammatory cell infiltration.

3. Nodular melanoma, atypical melanocytes in the vertical downward dermal proliferation of intrusive, rather than violations of the epidermis. Epithelial cell type of melanoma cells often arranged in alveolar; spindle cell type is similar to fibroblasts, and sometimes arranged as bundles.

4. Acral lentigo melanoma skin thickening, a large number of pigment-containing non-typical nests of melanocytes located in the lower epidermis, common spindle melanocytes. The upper epidermis is also seen paget kind of melanocytes, dermal papilla can be seen macrophage pigment cells.

No black-pigmented malignant melanoma cell morphology with black evil characteristics, HE staining no obvious melanin, using dopa (Dopa) test may be positive, silver staining shows a small amount of melanin.

The organization of the evil black confirmed diagnosis apart from, sub-type, we must also observe the extent of its invasion of the tumor cells invaded deeper the prognosis worse. Usually Clork depth and Breslow thickness of the two main parameters to represent.

(1) Clork grade Ⅰ: tumor cells confined to the epidermis; Ⅱ grade: invasive dermal papilla; Ⅲ grade: full of dermal papilla; Ⅳ Class: invasive dermal reticular layer; Ⅴ grade: invasive subcutaneous fat layer. From grade Ⅰ to Ⅴ grade followed by 5-year survival rate of 99%, 95%, 90%, 65% and 25%.

(2) Breslow measurement method is to use eyepiece micrometer measurement of tumor thickness. Tumor thickness and 5-year survival in patients with the relationship as follows: thickness of less than 0.85mm for 98%; 0.8 ~ 1.69mm for 90%; 1.7 ~ 3.59mm, 70%; greater than 3.6mm is 45%.

Clinical manifestations 【】

1. Lentigo malignant melanoma (Lentigo maligna melanoma) is from lentigo malignant evolved, usually in malignant lentigo years later, expanding rash appears blue-black nodules and ulcers, more common in the elderly face.

2. Superficial spreading melanoma (Superficial spreading melanoma) more common in Caucasians. Rash of red, white or blue irregular pigmentation spots, edges irregular, uneven surface can touch a small bulge nodules.

3. Nodular melanoma (nodular melanoma) skin rashes can occur in any part of, the rapid development began shall be brown, blue or black subcutaneous nodules, can have ulcers and bleeding, characteristic of the performance of a satellite-like damage or There pigment overflow phenomenon. Early prone to lymph node metastasis and hematogenous spread.

4. Acral lentigo melanoma (Acrallentiginous melanoma) incidence rate of approximately 5% of all melanoma, but more common in black people and yellow people. The report also more common in this type of domestic. Began to slow and spread of irregular pigmentation spots, color and diverse like malignant lentigo. Eventually develop into a rash, nodules and ulcers, mostly in the palms and soles, especially plantar. Means (toe) A and A is also surrounded by easy to under involved.

In addition to these types of things, visible after dark pigmented malignant melanoma (Amelanotic malignant melanoma).