Malignant melanoma
April 10th, 2008 Guage
[outline]
The malignant melanoma (Malignant melanoma is called wickedly black) to stem from the melanocyte cell’s malignant tumor, occurs in the skin, its morbidity occupies the skin malignant tumor third.
[diagnosis]
All suspicion’s black harm as well as the original nevus expansion color deepen, blush, the hemorrhage, broken kui should the entire excision make the organization pathology inspection. When harms has the possibility causes to spread, should not take the biopsy by against to create the early shift. Has the condition should better to make the freezing fast slice inspection, once diagnoses should be widespread
Excision.
Sometimes this sickness must with the pigment basal-cell carcinoma, the nevus benign childhood melanin lump (the Spitz mole), distinctions and so on steatorrhea keratonosis, scale cancer, suppurative granuloma. When necessity makes the immunity group like S-100 protein, HM-45 and so on to further determine.
[remedial measure]
Should the surgery excise to the early shift’s tubercle or the spot piece harm, excises including skin rash peripheral scope Normal tissue 1~3cm, if refers to (foot) wickedly black, the finger amputation is necessary. Has definitely exhausted oneself the lymph node should excise, but the preventive lymph node excision still had the dispute. Pours into the anti-mitosis pharmacological treatment body melanoma from the body artery also to have certain curative effect. Has a blood line of widespread shift to use take the armor nitrogen onamot amine as the foundation union chemotherapy and the radiotherapy.
[etiology]
Not very clear. The sunlight illumination is a dangerous factor, especially caucasian skin sunlight excessive radiation later easily this sickness. The partial flesh wound stimulation is also the common reason. In addition, but also becomes malignant with the nevus related, some people count approximately compose 10%. Other possible related reasons to have the heredity, the patient immune response are low and virus infection and so on.
[pathology change]
The malignant melanoma’s typical pathology characteristic is in the dermis epidermis intersection point not atypical melanocyte cell proliferation, and lump cell infringement epidermis and dermis. The lump cell assumes the double-phase differentiation, the epithelial cell and the spindle-shaped cell. The cell nucleus assumes the remarkable heteromorphism, the nuclear shape is strange. Also obvious single nucleus, binuclear or polynuclear, common nuclear fission elephant.
The wicked black organization pathology shape is different because of the different type.
1. the malignant freckle type mole melanoma epidermis withers, the stratum basale has the many atypical melanocyte cells, and makes a sneak attack the dermis downward, in the lump cell or the intercellular substance bites the chromatophore to include quite many melanocytes.
2. shallow table diffusibility melanoma epidermis suddenly downward anomalous proliferation, in dermis epidermis intersection point and dermis obviously atypical mole cell nest, except epithelial cell and spindle-shaped cell’s melanocyte extracellular, sometimes on epidermis also obviously minority paget type melanocyte cell. The dermis inflammatory cell infiltration is obvious.
3. nodular melanoma atypical melanocyte cell vertical downward proliferation invasion dermis, but not to epidermis infringement. Epithelial cell’s melanophore Chang Paicheng acinus shape; The spindle-shaped cell similarly becomes the ciliary cell, sometimes does ties the shape arrangement.
4. extremity freckle type mole melanoma epidermis accumulation, including massive pigment atypical melanocyte cell nest located at epidermis lower part, common spindle-shaped melanocyte cell. On the epidermis also obviously the paget type’s melanocyte cell, the papillae of true skin obviously bites the chromatophore.
Does not have the melanocyte malignant melanoma’s cellular form structure to have the wicked black characteristic, HE dyes not obvious melanocyte, (Dopa) experiments with multi-Pakistan may assume the positive reaction, the silver dyes may demonstrate the few melanocytes.
To the wicked black histology diagnosis besides the diagnosis, divides, but should also observe its attack degree, lump cell infringement is deeper, then the prognosis is worse. Usually uses the Clork depth and the Breslow thickness two main parameters expressed.
(1) Clork graduation ⅠLevel: Lump cell limited to epidermis in;ⅡLevel: Invasion papillae of true skin;ⅢLevel: Fills the papillae of true skin;ⅣLevel: Invasion dermis reticular layer;ⅤLevel: Invades the subcutaneous fat level. FromⅠLevelⅤA level 5 year survival percentage is in turn 99%,95%,90%,65% and 25%.
(2) the Breslow measuring method is surveys the tumor thickness with the ocular micrometer. Tumor thickness and the patient 5 year survival percentage’s relations are: Thickness is smaller than 0.85mm is 98%; 0.8~1.69mm is 90%; 1.7~3.59mm is 70%; Is bigger than 3.6mm is 45%.
[clinical manifestation]
1. the malignant freckle type mole melanoma (Lentigo maligna melanoma) is comes from the malignant freckle type mole development, usually malignant freckle type mole many years later, the skin rash expands, presents the blue black tubercle and ulcer, sees in the senior citizen face.
2. the shallow table diffusibility melanoma (Superficial spreading melanoma) sees by the caucasian. The skin rash for red, the white or the blue color anomalous pigment spot, the edge is anomalous, the surface is uneven, may touch slightly sticks out the tubercle.
3. the nodular melanoma (nodular melanoma) the skin rash may present any spot, the development is rapid, starts namely for brown red, the blue color or the black hypodermic tubercle, may have ulcer and the hemorrhage, the characteristic value performance is the health astroid harm or has the pigment to overflow the phenomenon. The early time easy to have the lymph node shift and the blood line spreads.
4. the extremity freckle type mole melanoma (Acrallentiginous melanoma) the disease incidence rate approximately composes all melanomas 5%, but sees in the melanoderm and the person of Asian descent. The domestic report also much sees by this. Starts for the anomalous pigment spot which spreads slowly, the color to resemble the malignant freckle type mole diversely. The final skin rash develops the tubercle and ulcer, the majority occurs in the palm is specially . Refers to (foot) under the armor also easy to exhaust oneself with the armor around.
Besides above type also obvious darkness natural disposition malignant melanoma (Amelanotic malignant melanoma).
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Entry Filed under: Skin cancer
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