恶性黑素瘤伴有白癜风样色素减退斑

Malignant melanoma with vitiligo-like depigmentation:a case report

报告1例恶性黑素瘤伴有白癜风样色素减退斑。患者男,58岁。双手、足色素脱色斑1年余,右足跟肿块伴疼痛6个月。皮肤科检查:两足底及足内侧见境界清楚的大块色素减退斑,双手指末节侧缘见淡白色色素减退斑,边缘模糊不清,Wood灯下色素脱色斑区呈亮白色荧光。右足跟有一3 cm×2.5 cm×1 cm半圆形暗红色肿块,表面糜烂、渗出。皮损组织病理检查示表皮下瘤细胞呈片、块状分布,细胞核大小不一,深染,异形明显,局部向肌组织内浸润。免疫组化染色示S-100蛋白(+)、HMB45E(+)、波形蛋白(+)、Ki-67(+)>50%。诊断为恶性黑素瘤伴有白癜风样色素减退斑。

A case of malignant melanoma with vitiligo-like depigmentation is reported. A 58-year-old man presented vitili- go-like depigmentation on his hands and feet for 1 year, and a painful mass on the right heel for 6 months. Physical exami- nation revealed large piece of depigmented patch with sharp margin on the plantar region and medial side of the feet. Light white depigmented macules were seen on the lateral side skin of distal end of the fingers of both hands with blurred mar- gins. The affected skin revealed brilliant white light under Wood＇s lamp examination. A semi-globular dark red mass of about 3 cm x 2.5 cm x 1 cm in size on the right heel was observed with erosive and exudative surface. Histopathologic exami- nation demonstrated that the subepidermal tumor cells were in patchy distribution, and the muscle tissue focally infiltrated. A closer view revealed that the tumor was composed of atypical cells with hyperchromatic and pleomorphic nuclei of various sizes. The tumor ceils stained positive for S-100, HMB-45 and vimentin with a Ki-67（＋） 〉50%, definite diagnosis of ma- lignant melanoma with vitiligo-like depigmentation was made.