악성 흑색종의 임상 및 병리조직학적 고찰

장경애(Kyoung Ae Jang),최지호(Jee Ho Choi),성경제(Kyung Jeh Sung),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh),김종혁(Chong Hyeok Kim) 대한피부과학회 2000 大韓皮膚科學會誌 Vol.38 No.11

Background:Cutaneous malignant melanoma represents a tumor arising within the melanocytic systems of the skin. Once considered an uncommon cancer, melanoma is now rising in incidence at a rate faster than any other cancer. Objective:The purpose of this study was to investigate the clinico-pathological characteristics of malignant melanoma. Methods:A total of 61 patients with malignant melanoma were enrolled in this retrospective study. We classified malignant melanoma as follows; ALMM, acral lentigious malignant melanoma, NMM, nodular malignant melanoma, SSMM, superficial spreading malignant melanoma, MM, mucosal melanoma, LMM, lentigo maligna melanoma. We used the staging system of American Joint Committee on Cancer to evaluate the clinical status in our subjects. The hospital charts and histopathological slides of patients with malignant melanoma diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. Immunohistochemical study was performed for S-100 and HMB-45 in 10 cases and for Ki-67 in 5 cases. Results:1. The male to female ratio was 1.3. The mean age at diagnosis was 52.6 years. ALMM was the most common type(52.5%) in this study. ALMM and NMM developed in elderly persons, while SSMM developed in younger persons. Malignant melanomas arising from pre-existing mole were 10 cases(16.4%). 2. In forty two cases(68.9%), malignant lesions were limited to skin, but 19 cases(31.1%) were disseminated to lymph nodes, skin or internal organ at the initial examination. Sole and heel were the favored sites in ALMM. Lower extremities and back were the favored sites in NMM and SSMM. Four patients were initially presented with metastatic symptoms such as dyspnea, abdominal mass, headache, or axillary mass, and cutaneous malignant melanoma eventually were diagnosed as their origin.3. Histopathologically, 6 cases were categorized into amelanotic type and 1 case was into desmoplastic type.4. More than a half cases developed metastases to other organs. Common metastatic sites were lymph nodes, lung, brain, skin, liver, bone, and bladder in decreasing order of frequency. 5. The five-year survival rate was 100% in stage IA, IB, and IIA but 0% in stage IV. Face, chest and lower extremities showed worse prognosis. Men had worse prognosis than women. NMM revealed the lowest 5-year survival rate(30%). Conclusion:Among the prognostic factors such as locations, clinical types, ages, and gender, the stages at the initial presentation was the most important predictable value in our study. Therefore, the early recognition of malignant melanoma is the key to possible cure.(Korean J Dermatol 2000;38(11):1435~1443)

악성흑색종에 대한 14년간의 임상적 고찰

박동하,박명철,배남석,이일재,서승조 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.3

Purpose: Recently, the incidence of malignant melanoma has been steadily increasing. Malignant melanoma is already known to have poorer prognosis than other primary skin cancers. Despite the poor prognosis, it is relatively less known to the public so that a number of patients visit hospital carrying advanced stage tumor. Yet, extensive study about malignant melanoma is currently insufficient, and specific guidelines and statistical figures in Korea are almost inexistent. Therefore, authors reviewed patients with malignant melanoma who have visited our hospital for last 14 years. Methods: Between January 1994 and January 2008, 62 patients were diagnosed with malignant melanoma at our hospital. A retrospective study was performed with data from patients' charts and biopsy results. Annual incidence, mean age of onset, gender, tumor location, tumor thickness, pathologic ulceration, clinicopathologic subtype, and clinical AJCC stage were evaluated. Analysis of factors associated with survival were performed using the Cox proportional hazard model. Kaplan - Meier method was used to generate survival curves. Results: Clinicopathologic features of 62 patients (32 male, 30 female) with average age of 57 years were evaluated. Most lesions were found in lower limb, and the most common subtype was acral lentiginous melanoma. We could also find that age, tumor thickness, and clinical stage were the only significant prognostic factors. Conclusion: Clinicopathologic features of malignant melanoma were analyzed in this study, but the result is not ready to be generalized because the number of cases is too small. Further study must be performed to report clinical guidelines for prognosis and treatment for malignant melanoma patients in Korea.

최근 6년간 경험한 악성 흑색종의 임상병리조직학적 유형 분석

최수종,배용찬,문재술,남수봉,오창근,곽희숙,김창원 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.5

Purpose: Malignant melanoma is a fatal tumor arising in the melanocytic systems of the skin. The incidence of malignant melanoma, formerly considered a rare tumor in Korea, is observed to increase. The aim of this study is to analyze the clinical and histopathological pattern of malignant melanoma in one institute.Methods: Thirty patients with ages ranging from 33 to 80 years, diagnosed as malignant melanoma at our skin tumor department, were enrolled in a retrospective study over a 6 year period(2000. 9-2006. 7). The analyzed data included age, sex, location, duration before diagnosis, clinical type, level of invasion, and stage.Results: The cases were identified and analyzed by clinical and histopathologic study. The male to female ratio was 1:1.7. Lower extremities(especially, feet) were favored sites. The majority of cases were acral lentiginous melanoma(40%), followed by nodular melanoma (36.7%), superficial spreading melanoma(20%) in this study. Clark level IV was predominant in histopathologic study. There was merely narrow gap among each stage by AJCC.Conclusion: The clinicopathological characteristic of melanoma in our patients is quite different with that in the West. In this retrospective study, primary lesions of the foot were predominant with melanoma, and a high percentage of these were classified pathologically as acral lentiginous melanomas. Patients had a more advanced stage of disease at first presentation and a more deeply invasive primary lesion than Western patients. These suggest that malignant melanoma has a worse prognosis in our patients than in the West. So, further organized prospective studies are needed to approach the prudent and accurate diagnosis and management of melanoma in Korea.

구강 악성 흑색종에서 PCNA 발현에 관한 면역조직화학적 연구

황경균,남윤우,이재일,이종호,심광섭,김명진 大韓顎顔面成形再建外科學會 2002 Maxillofacial Plastic Reconstructive Surgery Vol.24 No.6

Malignant melanoma arising from the mucosa of head and neck region was rare and showed poor prognosis. Some of malignant melanoma were transformed from benign melanotic lesion. Malignant melanoma had high cellular proliferation and rapid growth. The percentage of PCNA-positive cell (labeling index) is high in many malignant tumor. So we compared the pattern of PCNA expression in the melanotic lesion. We performed the immunohistochemical study in malignant melanoma(19 cases), benign melanotic macule(24 cases) and normal mucosa(20 cases) were diagnosed in Seoul National University Dental Hospital between 1980 and 2000. Positive PCNA staining was found mainly in malignant melanoma. The mean PCNA expression in malignant melanoma, melanotic macule, normal tissue were 29.2%, 1.4%, 0%, respectively. Significant differences in PCNA expression were noted between malignant melanoma and melanotic macule(p<0.01), normal mucosa(p<0.01). These result suggested that the PCNA expression seems to be used as a diagnostic indicator for malignancy in malignant melanoma and melanotic lesion.

하지에 발생한 악성흑색종의 예후

김지예,이원재,유대현,나동균,탁관철 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.4

Purpose: Malignant melanoma is recognized as the most serious skin cancer. We examined anatomical distribution and 5-year survival rate of each stage of malignant melanoma on lower leg. Methods: We retrospectively analyzed the medical records of 91 patients(46 males and 45 females) with malignant melanoma on lower leg from 1985 to 2008. Age, sex, anatomical distribution and 5-year survival rates of each stage of malignant melanoma on lower leg were investigated. Also, 5-year survival rates of each stage and invasion depth of malignant melanoma on heel pad were investigated. Results: On lower leg, most frequently 32 cases (35.1%) occurred on heel pad, 27 cases(29.7%) occurred on dorsum of foot, 18 cases(19.8%) in toe, and 14 cases(15.4%) on others in lower leg. We used the excision margin as 3-5cm. After wide excision, in stage III, IV, the patients underwent the immunologic / chemo-therapy. The incidences of each stage were 22 cases(24.2%) in stage I, 47(51.6%) in II, 17(18.7%) in III and 5(5.5%) in IV. The 5-year survival rates of each stage were 85%, 53.2%, 47.1% and 40%. On heel pad, the incidences of each stage were 5 cases(15.6%) in stage I, 19 cases(59.4%) in II, 7 cases(21.9%) in III and 1 case(3.1%) in IV. The 5-year survival rates of each stage were 80%, 63.2%, 42.9% and 100%, respectively. On heel pad, incidence of local recurrence was 2 and 5-year survival rate of this case was 100%. And systemic recurrence was 9 and 5-year survival rate of this case was 55.6%. Conclusion: The 5-year survival rate of malignant melanoma on heel pad was higher than previous study. To maintain the weight-bearing function of foot, we recommend the active reconstructive surgery for heel pad reconstruction after wide excision of heel pad malignant melanoma.

피부 악성 흑색종의 임상 및 병리조직학적 소견

박경덕 ( Kyung Duck Park ),이석종 ( Seok Jong Lee ),이원주 ( Weon Ju Lee ),김도원 ( Do Won Kim ),정호윤 ( Ho Yun Chung ),조병채 ( Byung Chae Cho ) 대한피부과학회 2007 대한피부과학회지 Vol.45 No.2

Background: Malignant melanoma is the leading cause of death among skin cancers in western countries. The incidence of melanoma has been steadily increasing over the last 20 years, and age and sex distribution, anatomic location, clinicopathologic subtypes, and prognostic factors of malignant melanoma are also well known. However, various clinicopathologic aspects such as incidence, clinicopathologic subtypes and tumor behaviors are quite different in Asian and black skin. Objective: The purpose of this study was to investigate the clinicopathologic behavior and statistics of malignant melanoma patients of Kyungpook National University Hospital, and to evaluate prognostic predictors. Methods: Of the 97 out of 103 patients diagnosed with malignant melanoma at the Department of Dermatology of Kyungpook National University Hospital over a 14 year period (l992~2006), we analyzed mean age of onset, gender, tumor location, duration, tumor number, color, tumor thickness, Clark`s level, pathologic ulceration, tumor-infiltration lymphocytes, clinicopathologic subtype, and clinical AJCC stage. Univariate analysis and multivariate analyses for survival, according to clinical and histologic tumor settings, were performed by means of the Cox proportional hazard model. Survival curves were plotted by the Kaplan-Meier method. Results: Ninety-seven melanomas were identified and analyzed by both clinical behavior and pathology. Of these, 44 were male and 53 were female patients and the mean age was 59.7 years. Most of the tumors were located on the hands and feet. Thin melanoma was the most common tumor and histologic ulcerations were observed in 37 out of 81 patients who were available for evaluation. For tumor-infiltrating lymphocytes (TIL), 22 out of 76 patients were confirmed with TIL in the pathologic review. Acral lentiginous melanoma was the most common type, followed by nodular melanoma, superficial spreading melanoma, and lentigo maligna melanoma. Univariate analysis for overall survival of melanoma revealed that thickness of tumor, the presence of ulceration, the presence of tumor-infiltrating lymphocytes, clinicopathological subtype, and clinical stage have a tendency for a poorer prognosis. Multivariate analysis demonstrated that advanced stages (III and IV) and tumor thickness were the independent risk factors for poor prognosis. Conclusion: Few similar large studies have been conducted to assess the prognostic factors of melanoma in Korea. Therefore, further prospective studies are needed to assess the biological behavior of malignant melanoma, of which the incidence has been steadily increasing in Korea. (Korean J Dermatol 2007;45(2):149~158)

Spinal Cord Malignant Melanoma with Leptomeningeal Metastasis: A Case Report

최대한,박찬우,김우경,이상구 대한척추신경외과학회 2009 Neurospine Vol.6 No.4

The authors report a rare case of spinal malignant melanoma with leptomeningeal metastasis. A 35‐year‐old female had suffered from motor weakness and paresthesia in the lower extremities for 1 month. Thoracic magnetic resonance imaging (MRI) revealed intradural mass at T8 and T9 level. Total laminectomy T6 to T9 and grossly total removal of the intradural mass were performed. Histopathological investigation confirmed the malignant melanoma. Seven days after operation the patient complained of headache, dizziness, and pain on neck and left upper extremity, so brain and cervical MRI were checked. MRI showed multifocal parenchymal lesions which were compatible with the leptomeningeal metastasis of the malignant melanoma. The prognosis of malignant melanoma with leptomeningeal metastasis is very poor. The clinical, radiologic, and pathologic features are reviewed. The authors report a rare case of spinal malignant melanoma with leptomeningeal metastasis. A 35‐year‐old female had suffered from motor weakness and paresthesia in the lower extremities for 1 month. Thoracic magnetic resonance imaging (MRI) revealed intradural mass at T8 and T9 level. Total laminectomy T6 to T9 and grossly total removal of the intradural mass were performed. Histopathological investigation confirmed the malignant melanoma. Seven days after operation the patient complained of headache, dizziness, and pain on neck and left upper extremity, so brain and cervical MRI were checked. MRI showed multifocal parenchymal lesions which were compatible with the leptomeningeal metastasis of the malignant melanoma. The prognosis of malignant melanoma with leptomeningeal metastasis is very poor. The clinical, radiologic, and pathologic features are reviewed.

A case of malignant melanoma associated with the history of trauma

( Yu Jin Jeon ),( Hyun Yi Lee ),( Dae Young Oh ),( Young Min Cho ),( Kyung Eun Jung ),( Dae Won Koo ),( Joong Sun Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Risk factors of cutaneous melanoma include history of sunburns and/or heavy sun exposure, blue or green eyes, blonde or red hair, fair complexion, over 100 typical nevi, any atypical nevi, prior personal or family history of melanoma, or p16 mutation. Here, we present a unique case of malignant melanoma which occurred associated with the history of trauma. A 63-year-old woman presented with a painful brownish oozing plaque involving left sole of 2-month in duration. She had keratotic brownish plaque on left sole for 5 years ago, and she treated with cryotherapy as a viral wart for 6 months. She has not been to the hospital for two months in recent, and the lesion suddenly got worse. She had a history of hypertension, diabetes, dyslipidemia, and no familial history of melanoma. Histopathologic examination of the lesion on the sole revealed asymmetrical and poorly circumscribed lesions with nests of melanocytes that had marked cytological atypia, which was supportive for malignant melanoma. She was transferred to other hospital for further evaluation. The association between trauma and melanoma has been a controversial issue. In this case, the patient had viral wart at first and got cryotherapy repeatedly. We think that such stimuli may have acted as a kind of trauma. We report this case of malignant melanoma associated with the history of trauma because it is interesting and meaningful for educational purposes.

Malignant melanoma in the back with involving sentinel lymph nodes on ipsilateral axillary area

( Jae Yeong Jeong ),( Haneul Oh ),( Sook In Ryu ),( Bo Young Kim ),( Il-hwan Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

In malignant melanoma, sentinel lymph node(LN) site is an important factor because it shows where the LN metastasis occurs. However, patterns of lymphatic drainage from trunk are highly variable because both axillary and inguinal LN could be affected. A 36-year-old male patient visited our dermatology clinic with 1x1 cm blackish nodule on Right lower back found at 5 years prior to visit. He had no underlying disease or trauma history. Under the impression of malignant melanoma, skin punch biopsy was done on the lesion. In histopathological review, it was consistent with malignant melanoma and invasion depth was 1.84mm. Immunohistochemistrically, tumor cells were positive for S-100, Melan-A, HMB45, p53, confirming the diagnosis of malignant melanoma. Because location of lesion, lymphoscintigraphy was done and showed axillary LN involvement. Wide excision and SLNB was done. 2 of 4 LNs involvement was confirmed and additional axillary LN dissection was done, none of 16 LNs was involved. The patient had no tumor recurrence for 3 months after surgery. We herein reported malignant melanoma in the back with axillary lymph node metastasis. Lymphatic drainage of right lower back is unexpected because distance between lesion and inguinal area is shorter than axillary area. This case indicated malignant melanoma on posterior trunk could spread into axillary LN and lymphoscintigraphy should be considered to clarify its unexpected lymphatic drainage.

복강내 전이된 난소의 악성 흑색종

기경도 ( Kyung Do Ki ),하창욱 ( Chang Wook Ha ),서상기 ( Sang Gi Seo ),허주엽 ( Chu Yeop Huh ),양문호 ( Moon Ho Yang ),이주희 ( Ju Hie Lee ),박지선 ( Ji Seon Park ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.7

Malignant melanoma is a neoplasm of the skin and mucous membrane which very rarely occurs in the ovary. Malignant melanomas occurring in the ovary must be differentiated from primary and metastatic malignant melanoma. Primary malignant melanoma of the ovary is extremely rare and is thought to originate from a cystic teratoma. Malignant melanoma of ovary without evidence of residual teratoma must be considered metastatic even in the absence of a previously cutaneous or mucocutaneous lesion. Opinions about its histogenesis, diagnostic criteria and elective treatment are controversial because of rare manifestations, and the prognosis remains poor in spite of the variety of therapeutic measures. After thoroughly surveying the specific literature, we report case of malignant melanoma with multiple metastases located in the stomach, the omentum and both ovaries with unknown site of primary origin.