Melanoma in a Chinese dragon tattoo 作者：Georgi Tchernev, Anastasiya Atanasova Chokoeva 期刊：The Lancet 发表时间：2015/12/23 A 42-year-old white man presented to our clinic in October, 2015, with itching in the nasolabial fold and around the eyebrows, with accompaying erythema and desquamation consistent with seborrhoeic dermatitis. We noted multiple naevi on whole body dermatological examination, as well as a multicoloured tattoo of a Chinese dragon covering almost his entire back, arms, and chest. On closer inspection he had one clinically dysplastic pigmented naevus, sited within a scale of the dragon's tail (figure). He reported having the tattoo done 1 year previously, but the naevus had been present at least 5 years earlier, and the tattoo artist had purposefully worked around the existing lesion. The patient had type II skin with blonde hair and blue eyes, and had previously worked in the French Foreign Legion during which time he had had prolonged sun exposure. He reported no medical history apart from multiple painful sunburns in childhood, took no medication, and family history for dermatological disease was negative. We did total surgical excision with 1 cm surgical margins. Histological examination confirmed the diagnosis of superficial spreading melanoma with tumour thickness 0·26 mm, and the tumour was classified as IA according to the American Joint Committee on Cancer (AJCC) staging system. Additional screening tests were within the normal range. We have given sun care education and planned follow-up in line with the AJCC recommendations for melanoma stage IA. The patient remains well with no signs of further disease.
皮肤是人体最大的器官，它有许多重要功能，包括保护身体免受感染、调节体温和体液等。皮肤状态也是我们外在形象的体现，有人注重护肤，有人热爱彩妆，也有一部分人会通过纹身让自己的皮肤更有“特点”。然而，纹身的同时，也可能存在一些潜在的皮肤健康隐患，让我们很难察觉。近期，一项发表在《柳叶刀》（The Lancet）的病例，就讲述了一位可能早已身患黑色素瘤，但因为纹身进一步掩盖病情的诊疗过程；医生切除恶性病变后，目前患者病情稳定。一起来看看这位患者的诊疗过程吧。
截图来源：The Lancet 患者男，42岁，因鼻唇沟及眉毛周围瘙痒伴红斑及脱屑就诊。皮肤检查发现，患者全身有多个痣，以及一个面积很大的龙形多色纹身。纹身几乎覆盖了患者的整个背部、手臂和胸部。仔细观察后发现，患者的背部有一个临床上发育不良的色素痣（clinically dysplastic pigmented naevus），隐藏于纹身龙尾的鳞片内（如下图A所示）。对患者的现有病灶进行手术全切，手术切缘为1厘米。组织学检查（如下图C所示）确诊为浅表扩散性黑色素瘤（superficial spreading melanoma），肿瘤厚度为0.26毫米。根据美国癌症联合委员会（AJCC）分期系统，将该肿瘤归类为IA。
▲隐藏在纹身中的恶性黑色素瘤（图片来源：参考资料[1]） 既往史和家族史
患者自述，纹身是1年前纹的，但痣至少存在了5年，纹身工作人员曾有意绕开痣（现有病灶）进行纹身。患者为II型皮肤（type II skin），金发、白色皮肤、蓝色眼睛，既往在工作期间有长时间的日晒。患者自述，儿童期间曾有多次疼痛性晒伤史；未服用任何药物，无既往家族皮肤病病史。在临床，常用Fitzpatrick量表评估患者的皮肤类型，以确定患皮肤癌的可能性。 在Fitzpatrick量表中，共包括6种不同类型的皮肤，其中I型人群的肤色最白、最易被晒伤，VI型人群的肤色最黑、从不会被晒伤。 例如，II型表示肤色较白、有红色或金色头发、且眼睛是蓝色、淡褐色或绿色的人群，这类人群虽然通常难以晒黑，但会容易被晒伤。IV型表示浅棕色皮肤，这类人容易被晒黑，但很少被晒伤。 黑素瘤是一种起源于皮肤色素生成细胞（黑色素细胞）的皮肤癌，浅表扩散性黑素瘤是最主要的类型，约占黑素瘤的70%。 黑素瘤通常始于正常皮肤，表现为新发小色素性增生物，约有1/3的黑素瘤发生在之前就有的痣痣上，肿瘤细胞通常会出现BRAF基因突变。 日光刺激可使黑素细胞产生更多的黑色素，并增加患黑素瘤的风险；皮肤白皙（在肤色较深的人中较少见）、有雀斑、有大量色素痣、免疫功能低下、遗传等因素都是黑素瘤的危险因素。 如何区分黑色素瘤和黑色素痣？详情请看：千万别大意！身上的痣出现了这些变化，很可能是黑色素瘤 根据AJCC对IA期黑色素瘤的建议，对患者进行了防晒教育和随访计划。患者目前身体状况良好，无进一步疾病体征。参考资料 [1] Georgi Tchernev, et al., December 23, 2015. Melanoma in a Chinese dragon tattoo. The Lancet. DOI:https:///10.1016/S0140-6736(15)01038-7 [2] 黑素瘤. Retrieved April 19, 2022 from https://www./home/skin-disorders/skin-cancers/melanoma [3] The Fitzpatrick Classification Scale for Skin Types. Retrieved April 19, 2022 from https://www./fitzpatrick-classification-scale-1069226
|
