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Objective:To analyze clinical manifestations, pathological features and prognosis of patients with stage Ⅰ cutaneous melanoma.Methods:Clinical data were collected from 163 patients with stage Ⅰ cutaneous melanoma in Department of Dermatology, Xijing Hospital from January 2010 to January 2020, and clinical manifestations, pathological features, treatment methods and prognosis were retrospectively analyzed.Results:Among the 163 patients with stage Ⅰ cutaneous melanoma, 56 (34.36%) were males, and 107 (65.64%) were females, with a median age of 53 years at the clinic visit. Primary skin lesions were most frequently located on the extremities in 104 cases (63.80%) , of which 39 presented with lesions on the finger or toe nails and 65 with lesions on the other parts of the extremities; skin lesions were located at sun-exposed sites such as the head and face in 29 (17.79%) cases, and at non-sun-exposed sites such as the trunk and extremities except the hands and feet in 30 (18.40%) . Of the 163 patients, 56 (34.36%) were pathologically diagnosed with stage ⅠA cutaneous melanoma, and 107 (65.64%) with stage ⅠB cutaneous melanoma. According to a pathological staging system, 104 (63.80%) patients suffered from acral lentiginous melanoma, 23 (14.11%) superficial spreading melanoma, 15 (9.20%) nodular melanoma, 14 (8.59%) malignant lentigo-maligna melanoma, and 7 (4.29%) other rare or difficult-to-determine types. All the 163 patients received surgical treatment at least once, of whom 15 underwent finger or toe amputation, 94 extended resections, and 54 unextended resections; 35 received secondary surgeries, of whom 33 underwent extended resections and 2 finger amputation. Seven patients developed postoperative lymph node and/or distant organ metastases, 2 of whom died after distant organ metastases. The 5-year survival rate of the 163 patients was 98.00%.Conclusion:Stage Ⅰ cutaneous melanoma commonly has favorable prognosis, and 7 patients developed postoperative lymph node and/or distant organ metastases in this study, suggesting that long-term follow-up of patients with acral melanoma and early intervention of those with metastatic melanoma should be strengthened.
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Objective:To investigate clinical and histopathological features of Meyerson nevus.Methods:Clinical and histopathological data were collected from 6 patients with confirmed Meyerson nevi in Department of Dermatology, the Fourth Military Medical University from January 2015 to January 2019, and retrospectively analyzed.Results:Among the 6 patients, 3 were males and 3 were females, with a median age of 10.5 years (range, 7 months to 28 years). Skin lesions were located on the extremities of 3 cases, as well as on the trunk of 3 cases. Meyerson nevi arose from congenital pigmented nevi in 4 cases, as well as from acquired pigmented nevi in 2 cases. The duration of pigmented nevi varied from 7 months to 18 years. Four patients felt itching in the past 2 months, and 2 had no concomitant symptoms such as itching. Central pigmented nevi manifested as papules in 5 cases and a plaque in 1 case, which were brown or black in color, with regular shapes, uniform pigmentation and clear borders. Pigmented nevi were surrounded by a halo of erythema in 6 cases, and skin lesions were covered with scales or crusts in 4 cases. Histopathological examination of Meyerson nevi revealed characteristics of both pigmented nevus and eczema. Histopathologically, pigmented nevi manifested as junctional nevi or compound nevi, and eczema manifested as serous exudation, irregular epidermal hyperplasia, spongiosis and perivascular infiltration of lymphocytes in the superficial dermis.Conclusions:Meyerson nevus is rare, and mostly occurs on the trunk and extremities. When itching occurs or erythema appears around the pigmented nevus, the diagnosis of Meyerson nevus should be considered.
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Objective:To investigate clinical and histopathological features of congenital melanocytic nevi (CMN) complicated by proliferative nodules (PN) .Methods:Ten patients with clinically and pathologically confirmed CMN complicated by PN were collected from Department of Dermatology, the Fourth Military Medical University from 2015 to 2019, and their clinical and pathological data were analyzed retrospectively.Results:The 10 patients were aged from 2 to 45 years, with an average age of 15 years. Nine patients developed PN in infancy, and 1 in adulthood. The skin lesions were located on the extremities in 4 cases, on the head and face in 3 cases, and on the trunk in 2 cases, and the trunk and extremities were both involved in 1 case. Skin lesions clinically manifested as 1 or more nodules arising in black patches or plaques. Six patients presented with multiple PN, 4 with solitary PN, with the diameter of a single nodule being 0.2-1.5 cm, and only 1 case presented with ulcers. Histopathological examination showed mature melanocytes in the PN, with few mitotic figures, no obvious cytological atypia, and no necrosis. Immunohistochemical study showed that nevus cells diffusely expressed Melan-A, but did not express or partially expressed HMB45, and the Ki67 proliferation index was below 5%.Conclusion:CMN complicated by PN can occur on the extremities, head, face, and trunk, clinically manifesting as solitary or multiple nodules on pre-existing CMN; histopathologically, mature melanocytes can be observed in PN, immunohistochemical staining for HMB45 and Ki67 can facilitate the diagnosis, and its prognosis needs long-term follow-up.
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Objective:To analyze clinical and histopathological characteristics of infantile congenital melanocytic nevi (ICMN) .Methods:Clinical and pathological data were collected from 126 infants with confirmedly diagnosed congenital melanocytic nevi in Department of Dermatology, Xijing Hospital from January 2015 to January 2020, and were retrospectively analyzed. Chi-square test was used for comparisons of enumeration data.Results:Among the 126 patients with ICMN, 68 were males and 58 were females; 109 (86.5%) presented with skin lesions at birth; 73 (57.9%) were 2 - 3 years old at the first clinic visit. The skin lesions occurred on the head and face (76 cases, 60.3%) , trunk (24 cases, 19.1%) or extremities (26 cases, 20.6%) . There were 36 (28.6%) patients with small congenital nevi, 68 (54.0%) with M1-type medium-sized nevi, 13 (10.3%) with M2-type medium-sized nevi and 9 (7.1%) with giant nevi. Of 126 cases of ICMN, 121 (96.0%) had solitary lesions, 5 (4.0%) had multiple lesions, 44 (34.9%) had nevi with coarse hairs, 15 (11.9%) had nevi complicated by papules or hyperplastic nodules, and 6 (4.8%) had satellite lesions. Pathological subtypes included compound nevus (120 cases, 95.2%) , intradermal nevus (4 cases, 3.2%) , and junctional nevus (2 cases, 1.6%) . Under the microscope, the depth of the skin lesions was < 1 mm in 38 (30.1%) cases, 1 - 2 mm in 61 (48.4%) and > 2 mm in 25 (19.8%) , and 45 (35.7%) cases showed nevus cells infiltrating the subcutaneous fat layer or deeper tissues. Among the 126 ICMN lesions, common pathological features included nevus tissue maturation (100%, 2 cases of junctional nevi were excluded) , pigment granules in the stratum corneum (53 cases, 42.1%) , disordered/asymmetric distribution of nevus cells (80 cases, 63.5%) , scattered epidermal nevus cells (91 cases, 72.2%) , pagetoid spread of epidermal nevus cells (67 cases, 53.2%) , melanophages in the dermis (71 cases, 56.4%) , and nevus cells distributed along hair follicles/sebaceous glands (82 cases, 65.1%) . Special pathological features included nevus cells embedded in the vascular/lymphatic vessels (42 cases, 33.3%) , nevus cell lysis (45 cases, 35.7%) , fibromatous changes (25 cases, 19.8%) , involvement of the arrector pilli muscles (31 cases, 24.6%) , and mast cell infiltration (30 cases, 23.8%) . Pathological patterns of ICMN with different clinical features: the incidences of infiltration depth > 2 mm, pigment granules and columnar pigment granules in the stratum corneum were significantly higher in the giant nevi than in the small and medium-sized nevi ( χ2 = 7.93, 10.76, 5.89 respectively, all P < 0.05) ; the incidences of infiltration depth > 2 mm, epidermal spongiosis with scattered nevus cells, nevus cell nests distributed along the hair follicles/sebaceous glands, fibromatous changes and mast cell infiltration were significantly higher in the skin lesions with coarse hairs than in those without ( χ2 = 28.29, 8.11, 6.22, 7.92, 8.19 respectively, all P < 0.01) ; the incidences of pagetoid spread of epidermal nevus cells and atypical nevus cells were significantly higher in the skin lesions with papules/hyperplastic nodules than in those without papules/hyperplastic nodules ( χ2 = 4.92, 6.30 respectively, both P < 0.05) . Conclusions:The clinical and histopathological characteristics of ICMN are unique, and atypical nevus cells are common in ICMN. The diagnosis and treatment of ICMN need to be based on the combination of clinical and pathological characteristics.
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Objective@#To investigate the significance of lymphatic markers in the differential diagnosis of angiokeratoma corporis diffusum (ACD) and angioma serpiginosum (AS) .@*Methods@#Totally, 9 patients with ACD and 6 with AS were enrolled from Department of Dermatology, Xijing Hospital between 2006 and 2017, and their clinical and histopathological features were retrospectively analyzed. Skin sections from all the patients were stained for CD31, D2-40 and Prox1.@*Results@#In the 9 patients with ACD, abnormal vessels were weakly positive or negative for CD31, and positive for Prox1. Endothelial cells in abnormal vessels were locally positive for D2-40 in 4 patients with ACD, but negative for D2-40 in the other 5 patients. In the 6 patients with AS, the endothelia of hyperplastic small vessels were positive for CD31, but negative for D2-40 and Prox1.@*Conclusion@#The clinical features of a few patients with ACD are similar to those of patients with AS, and lymphatic markers have definite significance in the differential diagnosis of the two diseases.
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Objective To evaluate the efficacy of the first metatarsophalangeal joint arthrodesis versus resection arthroplasty for rheumatoid forefoot deformity.Methods Randomized controlled studies in the first metatarsophalangeal joint arthrodesis versus resection arthroplasty for rheumatoid forefoot deformity were collected in data bases like Cochrane library (Issue 3,2011),OVID (from January 1996 to June 2012),PubMed (from January 1990 to June 2012),CNKI (from January 1990 to June 2012),CBM,EMBASE (from January 1966 to June 2012) and Wanfang (from January 1990 to June 2012).Software RevMan 5.1 was used to analyze the trials included in terms of patient satisfaction,hallux area weight-bearing,AOFAS score,FFI score,HAV angle,IMA angle,operative time and complications.Results The totals of 5 RCTs were included in the study which involved 285 patients.The results of meta-analysis showed that the efficacy of the arthrodesis group was superior to that of the arthroplasty group in footwear (MD=-0.88,95％CI [-1.55,-0.22],P=0.010)and alignment (MD=-5.04,95％CI [-8.94,-1.14],P=0.01) significantly.The arthrodesis group also has an advantage of IMA and HAV angle correction (MD=1.43,95％CI [0.37,2.48],P=0.008; MD=13.27,95％CI [11.44,15.09],P＜ 0.00001).Significant difference was found between the two groups in the rate of complications.The rate of complication in the arthrodesis group was lower than that of the arthroplasty group (OR=2.32,95％CI [1.06,5.05],P=0.03).No significant difference was found between the two groups in patient satisfaction and FFI score.Conclusion Compared with resection arthroplasty,first metatarsophalangeal joint arthrodesis could be a better choice.It alleviates the pain effectively,improves the appearance and functions of the foot,and has a lower rate of postoperative complications.