目的:探讨原发甲下恶性黑色素瘤的临床病理特征.方法:回顾性分析 2013 年 1 月至2022 年 06 月山东第一医科大学附属皮肤病医院病理科 28 例甲下恶性黑色素瘤的临床病理资料.结果:28 例甲下恶性黑色素瘤中,男 12 例、女 16 例,平均年龄 50 岁,好发于拇指,临床表现为甲黑线、甲破坏等,黑线宽度均>3 mm,哈钦森征阳性 9 例;组织学类型主要为肢端雀斑样痣型,细胞组成主要为上皮样细胞,免疫组化SOX10 比S100 表达阳性率高;28 例中随访 16 例,7 例扩大切除,8 例局部截肢治疗,1 例化疗后死亡.12 例失访.结论:甲下恶性黑色素瘤有不同于其他部位恶性黑色素瘤的临床病理学特点,临床与病理均易误诊.对于年龄大于 50 岁,临床表现为甲黑线,宽度>3 mm,哈钦森阳性的患者均应警惕甲下恶性黑色素瘤,应及时做病理检查.
Objective:To explore the clinicopathologic features of primary subungual malignant melanoma.Methods:The clinicopathologic and prognostic information of 28 cases of subnail malignant melanoma in our hospital from January 2013 to June 2022 were analyzed respectively.Results:Of 28 cases,12 were male and 16 were female,the average age was 50 years old,and the lesions most occurred on the thumb,with clinical manifestations such as black line of the nail,nail destruction,etc.The width of the black line was greater than 3 mm,and 9 cases were positive for Hutchinson.The histological type was mainly of the limb freckle-like ne-vus type,and the cellular composition was mainly of epithelioid cells.The positivity rate of immunohistochem-istry was higher in the expression of SOX10 than that of S100.Sixteen cases were followed up,including 7 ca-ses were treated with extended resection,eight with local amputation,and one died after chemotherapy,and 12 cases were lost to follow up.Conclusion:Subungual malignant melanoma has different clinicopathologic characteristics from malignant melanoma in other parts of the body,and is easy to be misdiagnosed both clini-cally and pathologically.For patients who are older than 50 years old,with clinical manifestations of black nail lines,width>3mm,and Hutchinson's positivity should be alerted to subnail malignant melanoma,and patho-logical examination should be done in time.