Malignant melanocytic tumor of eyelid
Introduction
Introduction to orbital malignant melanoma tumors Eyelid malignant melanoma accounts for 5.4% of orbital malignant lesions, which is 1% of all orbital tumors. The incidence is slightly lower than that of the head and neck area. Malignant melanoma is rare in children. Occasionally, most young people are 60 to 70 years old (span between 18 and 80 years old), and women are slightly more than men. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: Lymphopathy
Cause
Orbital malignant melanocyte tumor etiology
(1) Causes of the disease
The occurrence of tumors is related to many factors. The etiology of this disease is not very clear. The risk factors for melanoma are congenital or abnormal development, black spot, etc., as well as excessive sunlight, family history, age and ethnicity. Wait.
(two) pathogenesis
Skin malignant melanoma is caused by the biotransformation of melanocytes in the epidermis derived from neural crest. The melanoma of the primary eyelid is clinically characterized, histopathological findings, biological behavior and prognosis, and other parts of the skin melanoma. Basically, the occurrence of tumors stems from the malignant transformation of normal melanocytes in the body, leading to changes in their biological behavior, forming autonomously growing new organisms, which are related to the changes in intracellular genetic material caused by tumorigenic factors.
Prevention
Orbital malignant melanocyte tumor prevention
There is no effective preventive means, and the exposed parts of the skin are pigmented with ultraviolet rays. Adjust daily life and workload, and regularly carry out activities and exercise to avoid fatigue.
Complication
Orbital malignant melanocyte tumor complications Complications
Tumors can spread locally to the eyelids, conjunctiva and other parts, and can also spread to distant organs through lymph or blood flow, and complications of different clinical manifestations appear.
Symptom
Orbital malignant melanocyte tumor symptoms common symptoms nodular crusting ulcer
Skin melanoma is currently considered to be classified into 4 types:
1. lentigo malignant melanoma (lent igo lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent lent Blocks, unclear borders, varying degrees of pigmentation, lesions have a long-term in-situ development stage, where the pigment can spread around, up to 6 to 7 cm in diameter (horizontal growth phase), and can last for many years, The disease can continue to grow, but it can also spontaneously resolve, accompanied by changes in pigmentation. Histopathologically, there is atypical polymorphic melanocyte diffuse hyperplasia in the basal cell layer of the epidermis, extending to the outer sheath of the hair sebum structure. When the dermis invades (vertical growth phase), the lesion bulges to form a dark brown to black nodule, which is composed of bundled spindle cells.
2. Superficial spreading melanoma is different from small malignant melanoma, which occurs mainly in middle-aged people (mean age 50-60 years) with small lesions (average diameter 2.5 cm). The typical change is disseminated pigment plaques with different colors and unclear borders, but can be touched. The areas where spontaneous regression can be seen are gray-white or blue-gray pigment loss areas. Under the microscope, the epidermal components are composed of atypical melanocytes, single or Nested in a nested manner, the size and shape of the tumor cells in the invading phase vary, and may be epithelial, fusiform, sputum-like or mixed.
3. Nodular melanoma (nodular melanoma) is common in middle-aged people aged 40 to 50 years old. The ratio of male to female is 2:1. The small pedicled nodules with blue-black or non-pigmentation can rapidly develop to 1 to 3 cm, often accompanied by ulcers and hemorrhage. Histopathology, the cells lose their normal polarity and invade the epithelium above them. If only the epithelium is invaded, it is superficial spreading melanoma. If the dermis is also invaded, It is a nodular melanoma, the tumor cells are atypical, the nuclear to cytoplasmic ratio is increased, there may be mitotic figures and large abnormal cells, and lymphocytes infiltration under them are often seen.
4. The occurrence of various types of malignant melanoma from sputum melanoma is associated with pre-existing sputum, especially those that are completely in the epidermis, about 50% of superficial spreading melanoma and 20% nodular Melanoma occurs with sputum, and the conversion of pigmented nevus to malignant melanoma can have the following manifestations: 1 color change, especially red, white and blue, and sudden darkening; 2 size change; 3 surface feature changes, such as Scarring, exudation, bleeding or ulceration; 4 texture changes, especially soft or brittle; 5 symptoms change, such as pain, itching or tenderness; 6 shape changes, such as the original flat lesions rapidly uplift; 7 weeks of skin changes, such as Red, swollen or satellite lesions.
Examine
Examination of malignant melanoma tumors of the eyelid
Histopathological changes: The tumor cells of malignant melanoma of the skin resemble benign sputum cells, but the atypia are obvious, and there are several tumor cells:
1 dendritic cells, larger than normal melanocytes, with fewer branches.
2 large epithelioid cells can appear in many tumors, with large cell bodies and clear outlines. Occasionally, the membranes are connected to each other to form a conformation, cytoplasm is lightly stained, silky or punctate, nuclear round or oval, staining The material is coarse or fine granular, and the nucleolus is obvious. The cytoplasm has yellow-brown fine or coarse pigment particles.
3 small sputum-like cells, larger than benign sputum cells, cytoplasm is not as rich as large epithelial cells, and the difference between benign sputum cells is that the nucleus is larger, the number is larger, the chromatin is more dispersed, and the mitotic image is visible.
4 spindle cells, nuclear ellipse, longer, randomly arranged, the pigments vary.
5 strange cells, mononuclear, binuclear (nuclear bean-like) or multi-nuclear huge strange cells, cytoplasm without pigment, can be stained with Fontana, some cytoplasm can show pigment particles, electron microscopy can be seen in the cytoplasm with black bodies .
A malignant melanoma derived from sputum, a serial section of malignant melanoma specimens, found that about 50% of superficial diffuse malignant melanoma, the bottom of the lesion has sputum cells, 20% nodular melanoma with sputum cells, Benign sputum: The size and shape of cell nests in the epidermal dermal junction are more consistent, with regular separation, cell nests are closely arranged, each cell is more consistent, no atypical, no mitotic division, sputum cells are mature, shallow The layer cells are larger, the deeper the cells, the smaller the cells, the no inflammatory reaction, the malignant sputum: the cell nests at the junction are different in size, often larger, and merge with each other, the cells are loose, can expand horizontally, and the cells are dispersed. The whole layer of the epidermis, individual cells are larger, the nucleus is atypia, and mitotic figures are seen, often accompanied by inflammatory reactions.
B-ultrasonography, CT and other imaging examinations can detect signs of metastasis of other organs of malignant melanoma.
Diagnosis
Diagnosis and differentiation of orbital malignant melanoma tumors
According to the clinical process and performance, the diagnosis of malignant melanoma can be basically determined, and histopathological examination is needed for the diagnosis.
Non-pigmented malignant melanoma is easily confused with other malignant tumors, such as adenocarcinoma, squamous cell carcinoma, etc., should be noted for identification, the main means of identification is histopathological examination.
