A case of multiple primary malignant melanomata
1967; Elsevier BV; Volume: 20; Linguagem: Inglês
10.1016/s0007-1226(67)80074-2
ISSN1465-3087
Autores Tópico(s)Melanoma and MAPK Pathways
ResumoCUTANEOUS malignant melanomata are one of the less commonly occurring cancers, and though most large reported series have a few cases in which multiple primary lesions occur, these are relatively rare.Allen and Spitz (I953) found 3"6 per cent. of 337 cases had more than one primary tumour and Petersen et al. (I962) found 2. 3 per cent. in 220 cases.Case Report.--Anintelligent 39-year-old male patient was seen in November I96I with a lesion on the right side of his chin.He gave a history of a " mole ", present for many years, which he had cut shaving about a year previously, since when it had steadily grown and become reddish in colour.He was found to have a bright red, circumscribed, slightly raised intradermal lesion about r½ cm. in diameter, with a rough surface.This was diagnosed clinically as an infected h~emangioma.He had been a known diabetic for seven years, but had remained in good health on insulin.He had a fair complexion, with a great many small cutaneous melanotic na:vi all over his body and limbs.No count was made, but he had many more than average.(In different series averages of I4-6 and I8 were found, Pack, I959.)The majority were under I cm. in diameter and in roughly equal numbers of flat (compound) and raised (intradermal) na~vi.There was no detectable enlargement of any lymph nodes.Biopsy excision was carried out and the lesion reported as histologically a frankly malignant melanoma which had invaded the epidermis and the dermis (Figs, I and 2).In its superficial part the cells showed a semblance of alveolar grouping, and were fairly well differentiated, but their nuclei were large, and abnormal mitotic figures were common.The cells which had invaded the dermis most deeply were undifferentiated spindle cells.Invasion of lymphatic vessels had probably occurred.Many of the hair follicles had been partly destroyed.The dermis was densely infiltrated by lymphocytes.There was a mass of implanted keratin surrounded by foreign body giant cells deep in the lesion.Occasional clusters of small melanocytes, which could be benign, were present in the periphery of the lesion, but there was no certain evidence that the tumour originated from a pre-existing n~evus.In view of the morphology of the lesion a much wider excision of the area was carried out, but no residual tumour was found in the second' sections.He remained well until January I964, when he presented himself saying four " moles " on his body, all present for many years, were undergoing the same change as the one previously excised from his chin.These were found to be small reddish brown n~evi, two flat and two nodular ; one of them situated in the left iliac fossa was ulcerated and had caused some irritation and discharge.There was some brown pigmentation of the lesions but their red colour and appearance were suggestive of small hzemangiomata.There was no pigment halo, satellite formation or clinical evidence of lymph node involvement.They were excised and all four lesions were histologically melanomata showing clear evidence of malignancy.They were all situated in the superficial part of the dermis, with the exception of the ulcerated nodule, in which this aspect was impossible to assess ; they were clearly originating from active cells at the dermo-epidermal junction and invading the dermis from this site.They were all fairly well differentiated, but all contained frequent mitotic figures.The lesions varied in the depth to which they had invaded the dermis and in the density of infiltration by lymphocytes ; as was to be expected, both were greater in the ulcerated tumour.Shortly after, at follow-up, seven more lesions were found ; they appeared macroscopically the same as the four lesions excised in January I964, except that none had ulcerated.Two clinically diagnosed " moles ", one flat (compound melanotic n~evus) and one raised (intradermal melanotic n~evus) were excised at the same time as the seven melanomata ; unfortu-
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