22例甲下黑素瘤临床及组织病理学分析

Clinical and histopathological characters of 22 cases of subungual melanoma

目的:探讨甲下黑素瘤的临床及组织病理学特点。方法:回顾分析西京医院皮肤科2003—2009年间诊断的22例甲下黑素瘤患者临床及组织病理学特点。结果:全部患者均为成人,其中男9例,女13例。发生于拇指9例,示指5例,发生于第一趾4例,发生于其他指(趾)4例。16例出现甲周皮肤颜色变黑,10例表现为甲板毁损或溃疡、结节性损害,6例为单纯甲黑线或黑甲。组织病理资料分析结果表明10例为原位黑素瘤,12例为浸润性黑素瘤。结论:甲下黑素瘤好发于成年人,尤其是中老年患者,拇指、示指以及第一趾是其好发部位。早期甲下黑素瘤表现为皮损较宽、颜色不均的甲黑线或弥漫性黑甲,晚期甲下黑素瘤累及甲周皮肤,或形成结节溃疡性损害。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,黑素细胞位置较高(基底层以上),核染色质深,细胞树突明显,合成颗粒较粗大的黑素。甲下浸润性黑素瘤累及真皮内,呈浸润性生长,细胞异形性明显。

Objective： To analyze the clinical and histological characters of subungual melanoma. Methods： Retrospective analysis of 22 cases of subungual melanoma was made at the Department of Dermatology, Xijing Hospital from 2003 to 2009. Results： The clinical data showed all patients were adult （9 males, 13 females）. Nine lesions were located on thumbs, 5 on index fingers, 4 on the first toes and 4 distributed on other fingers or toes. Sixteen cases showed darkening of skin around nail, 10 damage of nail plate, nodules or ulceration, 6 cases presented as melanonychia. Histological data showed 10 cases were melanoma in situ and 12 invasive melanoma. Conclusion： Subungual melanoma always appears in adults, especially in the senile. Thumbs, index fingers and the first toes were the most predilection sites. Its early stage always presented as broad melanonychia with uneven color. Its late stage always involves skin around the nail, or forms nodules or ulceration. Subungual melanoma in situ showed proliferations of single cells distributed at very high level in matrix or nail bed. The neoplasm cells always show dense chromatin, prominent dendrites and contained coarse pigment. Subungal invasive melanoma involves dermis and shows infiltrative growth pattern, maturation of melanoeytes is not existed and cellular polymorphism is prominent.