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- Title
Malignant melanoma on the sole showing prominent neural differentiation and perineural infiltration.
- Authors
Hayashi, Koichi; Okubo, Sachiko; Watanabe, Tomomi; Yamazaki, Yoriko; Horiuchi, Nobuyuki; Saida, Toshiaki
- Abstract
A 56-year-old Japanese woman presented with a 15 × 6 mm, ill-demarcated, irregularly bordered, brownish macule on the distal portion of her left sole (Fig. 1a). She had first noticed the macule 3 years earlier. The color was variegated from tan to grayish blue, and no nodules or induration were detected within the lesion. A biopsy revealed malignant melanoma with neural differentiation showing prominent infiltration around vessels and peripheral nerves. There was no lymphadenopathy in the left inguinal area and whole body examinations with echography and computed tomography scan showed no evidence of metastases. She underwent a wide local excision with amputation of the fourth and fifth toes and dissection of the inguinal lymph nodes. The patient received adjuvant chemobiotherapy using dacarbazine, nimustine hydrochloride, and vincristine sulfate, together with local injection of interferon β around the operation scar. No signs of recurrence have been detected for 6 years since the operation. The biopsy specimen revealed asymmetric, poorly circumscribed growth of neoplastic cells in the epidermis and the dermis (Fig. 1b). In the lower epidermis, oval or polygonal melanocytes with atypical and large nuclei were arranged as solitary units and in nests of variable sizes (Fig. 2a). In the superficial dermis, diffuse infiltration of atypical spindle cells was observed (Fig. 2b), some being continuous with the atypical melanocytes in the epidermis. In the mid to deeper dermis, the spindle cells were detected mostly in perivascular and perineural patterns (Fig. 3). There was slight perivascular lymphocytic infiltration and no desmoplasia was detected. The spindle-shaped cells in the dermis were wavy in shape and resembled Schwann cells. A few melanin granules were found in some areas in the dermis. Immunohistochemically, both the atypical melanocytes in the epidermis and the spindle cells in the dermis were positive for S-100 protein, but negative for HMB-45....
- Subjects
MELANOMA; NEUROENDOCRINE tumors
- Publication
International Journal of Dermatology, 2002, Vol 41, Issue 4, p247
- ISSN
0011-9059
- Publication type
Article
- DOI
10.1046/j.1365-4362.2002.01470.x