melanoma
Introduction
Introduction to melanoma Melanmoa (melanmoa), also known as malignant melanoma, is a highly malignant tumor that produces melanin. It is mostly found in adults over 30 years old. It occurs in the skin and is seen around the bottom of the foot and the vulva and anus. It can be It is malignant, but it usually comes from the abomination of the border. Deepening of the pigment of the sable, increased volume, accelerated growth or ulceration, inflammation and bleeding are often symbols of malignant transformation. This tumor can also occur in mucous membranes and internal organs. The melanoma has a diverse tissue structure, and the tumor cells can be arranged in a nest, a cord, or an acinar. Tumor cells can be polygonal or fusiform, with large nuclei, often with large eosinophilic nucleoli, and melanin particles in the cytoplasm. There are also melanomas with no melanin particles in the cytoplasm, called melanoma-free melanoma, but the dopa reaction can be positive. Under electron microscopy, it can be seen that the cytoplasm contains a few typical melanomasomes or premelanosomes, which is helpful for diagnosis. The prognosis of melanoma is mostly poor, and lymphatic and hematogenous metastasis may occur in the advanced stage. Therefore, early diagnosis and timely treatment of this tumor is very important. Melanoma is extremely malignant in clinical practice. Most melanomas occur on the basis of pigmented lesions, and a small number of pigment cells that occur in normal skin or mucous membranes. basic knowledge The proportion of illness: 0.001% - 0.005% Susceptible people: more common in adults over 30 years old Mode of infection: non-infectious Complications: skin cancer
Cause
Melanoma etiology
The specific reasons are unknown, and most believe that it is related to endocrine factors. In the case of traumatic stimulation, sun exposure has the effect of promoting melanoma.
Prevention
Melanoma prevention
Try to avoid sun exposure. The use of sun screen is an important primary prevention measure, especially for those at high risk, to strengthen education for the general public and professionals, to improve early morning, early detection, early diagnosis, early treatment, and more important .
1. For pigmented sputum that occurs in the easily rubbed parts, biopsy should be taken. For example, children with large edema at the waist, often subject to friction and squeezing of the belt, should be removed as soon as possible. If it is difficult to remove all at once, it is not malignant. Before the middle part of the big edulis, the main part should be removed as much as possible, and the two sides should be sutured on both sides. After the surrounding skin is loosened, the rest will be removed until all the black sputum is removed to prevent malignant transformation. The specimens must be sent for pathological examination. If there is malignant transformation, all should be removed and skin grafting should be performed.
2. It is not advisable to stimulate the black scorpion with corrosive drugs or thorough freezing. It can be dangerous to repeat it several times without freezing. Because black mites are often malignant due to traumatic stimulation, it is reported that someone is frozen once. If it is not complete and malignant, about 30% to 50% of malignant melanoma is related to external stimuli. If it is necessary for cosmetic treatment, it should be removed once and for all. It is safe and reliable, and the combination of freezing and resection is completed. Do not remove the resection, the excised specimen should be sent for pathological examination.
3. Colorless information
(1) The color of the color is increased, and the pigment is deep or light.
(2) The color enamel spreads radially to the periphery.
(3) There is no pain or discomfort in the color, and there is a small amount of exudate on the surface.
(4) The lymph nodes in the color sputum area are swollen, and blue and black are faintly visible.
(5) The patient dissolves blue and black urine.
Complication
Melanoma complications Complications skin cancer
Metastasis can occur in the early stage, and the metastatic sites are mostly seen in the lungs, brain, and late metastasis of lymph nodes and other parts.
Symptom
Melanoma Symptoms Common Symptoms Nodular lymph nodes, blue, blue-gray or... Invasive growth of the dermis, subcutaneous nodules, freckles, nails and nail beds... Pigmented skin lesions edema
Clinical manifestation
Melanoma occurs in middle-aged and elderly people, males are more common than females, and tend to have lower limbs, followed by trunk, head and neck and upper limbs. Symptoms are mainly melanoma nodules that grow up rapidly, and melanin can occur in normal skin at the beginning. Sudden, or pigmentation, pigmentation, blackening, followed by lesions continue to expand, increased hardness, accompanied by itching pain, melanoma lesions are bulging, plaque and nodular, and some are sick Or cauliflower-like, subcutaneous nodules or masses when subcutaneous tissue is grown, and stellate dark spots or small nodules appear in the spread around. Common manifestations are regional lymph node metastasis of melanoma, and even regional lymphadenopathy. In the late stage of the visit, the blood flow is transferred to the lungs, liver, bones, and brain organs.
Clinical classification
(1) superficial spreading type is the most common, accounting for about 70%, occurring in the age of 50, women are more common in the limbs, males occur in the trunk, the degree of malignancy between freckles and nodules, early performance Brownish yellow, brown, blue or black, most of which may be rose red or pink, with jagged edges and skin texture disappearing. The radiation growth period lasts for 1 to 12 years, and lymph node metastasis does not occur during this period. 5%.
(2) Freckles account for 10% to 15%, which is the lowest degree of malignancy in the fourth type. It occurs in the exposed parts of the head, neck and back of the hand. It is more common in 60-70 years old, more common in women, and clinically manifested as Larger, flat or slightly higher-skinned brown-yellow or brown lesions. When radiation growth is accompanied by vertical growth, localized focal bulges, the color is still brownish yellow, and the lymph node metastasis rate is about 25%.
(3) Nodular type is the most malignant type of type IV, accounting for about 12%, and occurs in about 50 years old. The ratio of male to female is 2:1, which is good for the back. The clinical color is gray with pink color. Nodules, when the lesion continues to grow, its color turns blue-black, purple-black jam-like dome-shaped or polypoid mass, vertical growth is its only growth mode, the disease progresses rapidly, generally lasts for several months to 1 year, and Early ulceration and lymph node metastasis, this type of prognosis is poor.
(4) Acromoid-like melanoma mainly occurs in the palm of the hand, under the soles of the feet and under the arm. The skin lesions in the radiation growth period are brownish yellow, brown or black, not higher than the leather surface. If irregular brown is visible under the nails The yellow or tan stripes extend from the nail bed to the proximal end. The radiation growth period lasts for about 1 year. If it is not treated in time, it enters the vertical growth phase. The lesions are nodular, the lymph node metastasis rate increases, and the prognosis is also poor.
2. Clinical stage According to the scope of the primary tumor, lymph node metastasis and imaging examination whether the distant metastasis and other results to estimate the disease period.
(1) Stage I: no regional lymph node metastasis.
(2) Stage II: accompanied by regional lymph node metastasis.
(3) Phase III: accompanied by distant metastasis.
In general, if the following changes in pigmented skin lesions often indicate the possibility of early black:
(1) Color variegated is a signal of malignant lesions. Freckles and superficial spreads are often mixed in red or white or blue in brown or black, especially blue.
(2) The edge often has a jagged change, which is caused by the spread of the tumor to the periphery or self-degeneration.
(3) The surface is not smooth, often rough and accompanied by scaly flaky desquamation, when there is bleeding, exudate, can be higher than the leather surface.
(4) The skin around the lesion may show edema or loss of original skin luster or turn white, gray.
(5) Itching, local itching, burning or tenderness.
Examine
Melanoma examination
1. Anti-human melanoma serum is indirectly immunofluorescent labeled melanin tissue, when the antiserum is diluted to 1:2, the highest positive rate can reach 89%.
2. Using the Vacca double PAP immunoenzyme labeling assay, when the antiserum dilution was 1:400, 82.14% was positive.
3. Pigmentogen examination After the melanin is excreted by the kidney, the urine is dark brown, which is called black urine. If ferric chloride, potassium dichromate or sulfuric acid is added to the urine, it can promote its oxidation, and then add sodium nitrate. The urine is purple; first add acetic acid, then add sodium hydroxide, and the urine is blue.
Diagnosis
Melanoma diagnosis
diagnosis
The diagnosis of melanoma is generally not difficult. A few atypical cases are confirmed by pathological examination. Indirect immunofluorescence labeling of melanin tissue, double PAP immunoenzyme labeling and chromogen examination are helpful for diagnosis, and "no pigment" or less pigmentation. The diagnosis of melanoma and the identification of benign sputum cell tumors and their malignant transformation are helpful.
Differential diagnosis
The disease should be distinguished from benign borderline tumors, juvenile melanin and cellular blue sputum, and should also be distinguished from basal cell carcinoma. It should also be noted with sclerosing hemangioma, senile sputum, seborrheic keratosis, Identification of old hematoma under the nail bed.
1. Benign borders are seen as benign large sputum cells, no heterosexual cells, only grow in the dermis, and the inflammatory response is not obvious.
2. Juvenile melanoma is a circular nodule with slow growth on the face of the child. Under the microscope, the cells are pleomorphic and have nuclear division. The tumor cells do not infiltrate into the epidermis, and the surface of the tumor does not form ulcers.
3. Cellular blue sputum occurs in the buttocks, cercariae, waist, light blue nodules, smooth and irregular surface, dark dendritic cells with dendrites, large prismatic cells, and clustered into cell islands When there is a mitotic phase or necrotic area, the possibility of malignant transformation should be considered.
4. Basal cell carcinoma is a malignant tumor of epithelial cells. It is infiltrated deep from the basal layer of the epidermis. The cancer nest is surrounded by a column of columnar or cuboid cells. The cancer cells are deeply stained and there is no certain arrangement. The cancer cells may contain melanin.
5. Sclerosing hemangioma epidermal hyperkeratosis, dermal papillary proliferation, dilated capillaries are often surrounded by a downwardly extending epidermal process, which looks like an intraepithelial hematoma.
6. The elderly are seen in the sputum of the elderly, the epidermis is hyperkeratotic, the granules are partially thickened or atrophied, the acanthosis is thick, the basal layer is intact, and the pigmentation is increased. The dermal papilla is proliferated and the appearance is papillary hyperplasia. .
7. Seborrheic keratosis lesions also have papillary-like hyperplasia, the lower boundary of the epidermis is clear, the keratinization is incomplete, the granules are thickened first, then thinned or even disappeared, and there may be a small amount or more in the proliferating epidermal cells. melanin.
8. There is a corresponding history of trauma under the nail bed. The microscope is dry blood cells, and there may be epithelial fibroblast proliferation.
