纵行黑甲常见临床分型及组织病理学分析

Common clinical typing and histopathological analysis of longitudinal melanonychia

目的探讨皮肤科常见纵行黑甲的临床分型及组织病理表现。方法总结新疆医科大学第一附属医院皮肤科自2018年1月-12月纵行黑甲24例患者的临床及组织病理学资料。结果甲色素痣10例,其中交界痣6例、复合痣4例、甲下出血8例、甲黑素瘤6例。甲色素痣病理表现为以甲母痣为中心的黑素细胞增生,交界性色素痣痣细胞较一致,无非典型性或核分裂象;复合痣的真皮内痣细胞巢大多见于甲下皮。甲下出血镜下可见少量含铁血黄素,病理无特殊性。甲下原位黑素瘤表现为甲母质或甲床部位单个黑素细胞增生,核染色质深,细胞树突明显,黑素细胞位置较高(基底层以上)。结论纵行黑甲是发生于甲母质及甲板的肿瘤,部分甲色素痣需警惕及定期随访,甲下出血无需特殊处理,可自愈。甲恶性黑素瘤临床表现为颜色不均匀,影响整个甲板或甲床,病理可见异型细胞,恶性程度高,转移早,病死率高,预后差,目前尚无有效的治疗方案,需早期活检明确诊断,积极治疗。

Objective To investigate the clinical classification and histopathologic manifestations of the common longitudinal melanonychia in dermatology.Methods The clinical and histopathological data of 24 patients with vertical hejia in the Department of Dermatology of the First Affiliated Hospital of Xinjiang Medical University from January to December 2018 were summarized.Results There were 10 cases of nail pigment nevus,including 6 cases of border nevus,4 cases of compound nevus,8 cases of subnail hemorrhage and 6 cases of nail melanoma.The pathological manifestations of nail pigment nevus were melanocyte hyperplasia centered on nail mother nevus,and the nevus cells of borderline nail pigment nevus were consistent,but there was no typical or mitotic pattern.The nests of intradermal nevus cells of compound nevus were mostly found in the subnail skin.A small amount of hemosiderin was observed under the subnail hemorrhage microscope,and there was no special pathology.Subnail in situ melanoma is characterized by hyperplasia of single melanocytes in the nail parent material or nail bed,deep nuclear chromatin,obvious dendritic cells,and high melanocytes(above the basal layer).Conclusion The vertical black nail is a tumor occurring in the parent material and deck of nail.Some nail pigment nevus need to be vigilant and follow up regularly.Subnail hemorrhage can heal itself without special treatment.The clinical manifestations of malignant melanoma a are uneven color,affecting the whole deck or nail bed,and the pathologic manifestations are characterized by atypia,high degree of malignancy,early metastasis,high mortality,and poor prognosis.Currently,there is no effective treatment plan,so early biopsy is needed for clear diagnosis and active treatment.