| Objective: To explore the clinical and pathological features of patients with Cutaneous melanoma,increasing the understanding of Cutaneous melanoma,and improving the correct diagnosis rate of clinical manifestations of black skin lesions.Methods: The basic information,pathological sections and paraffin block tissue of49 patients with cutaneous melanoma were obtained by searching the pathological database of our department.The clinical and pathological characteristics of 49 patients with cutaneous melanoma were retrospectively analyzed.At the same time,the diseases easily misdiagnosed as cutaneous melanoma were screened,of which clinical and pathological characteristics were compared with that of 49 patients with cutaneous melanoma.Results: The data collected in this group included 49 patients of cutaneous melanoma,including 15 male patients(31%)and 34 female patients(69%),with ratio of males to females of 1:2.27,age ranged from 17 to 83 years old,and course of the disease ranged from half a month to 30 years.The oldest age was 83 years old and the youngest was 17 years old,with an average age of 52.18 ± 16.19 years old.The shortest course of the disease was half a month and the longest was 30 years.The main clinical manifestations of cutaneous melanoma were patches,plaques,papules,nodules,ulcers and masses.In initial clinical diagnosis,such disease was easily misdiagnosed as seborrheic keratosis,basal cell carcinoma,pigmented nevus,squamous cell carcinoma,pyogenic granuloma,Bowen's disease,angiokeratoma and so on.19 cases were correctly diagnosed clinically,with diagnostic accuracy of 39%.Histopathological examination of melanoma showed heterogenic melanoma cells distributed on epidermis and dermis with different cellmorphology and size,with observed mitosis and obvious nucleolus,mainly spindle cells and epithelioid cells.By searching the database,it was found that non-melanocytic tumors which were easily misdiagnosed as cutaneous melanoma in clinical were mainly seborrheic keratosis and basal cell carcinoma.Compared with cutaneous melanoma,seborrheic keratosis and basal cell carcinoma were predominant in middle-aged and elderly people,but both predominate on head,face and neck,while cutaneous melanoma predominantly occurs on extremities,especially on the pelma.Conclusion:Female congenital pigmented nevus during pregnancy was easy to grow and should be vigilant against canceration.Therefore,when the pigmented nevus during pregnancy suddenly developed faster and accompanied by itching and other symptoms,surgical excision and histopathological examination were recommended.Skin melanoma lesions could be manifested in a variety of ways.It was easy to be misdiagnosed in clinic.It was necessary to pay attention to differentiating them from those with black lesions,such as seborrheic keratosis,basal cell carcinoma,pigmented nevus,black heel,angiokeratoma and other diseases.The diagnosis must be combined with pathological and immunohistochemical examinations.A review of pathological sections of 49 patients showed that all malignant melanomas originating from the skin had basal layer erosion of epidermis.MM was considered in a few clinics,of which histopathological section could only be observed to the dermis,which made it difficult to accurately estimate the depth of tumor invasion,leading to the failure of effective staging of pathology.Therefore,it was suggested that if MM was considered clinically,the skin lesion should be removed completely,and if not,the deepest part of the skin lesion should be taken as far as possible.In histopathological examination,the cutaneous melanoma was difficult to be differentiated from junctional nevus and Spitz nevus,of which correct diagnosis must be combined with clinic,pathology and immunohistochemistry.Patients might be ordered to follow up regularly when necessary. |
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