黑色素瘤

什么是脱肿瘤性黑色素瘤？

了解这种罕见的快速发展形式的黑色素瘤可能会导致早期检测。

经过安德里亚黎明·克拉克（Andrea Dawn Clark） Health Writer

2022年9月6日

医学评论者

亚伦·法伯格（Aaron S. Farberg），医学博士

GetTyimages/Marina Demeshko

2022年9月6日

医学评论者

亚伦·法伯格（Aaron S. Farberg），医学博士

In 2015, ESPN体育新闻记者霍莉·罗（Holly Rowe）注意到，她以前去除痣的胸部疤痕越来越大。“我去了我的皮肤科医生，说我很想去除这件事，疤痕还没有愈合，我们能把它切掉吗？”她后来在广播节目中召回。皮肤科医生进行活检后，“他给我回电，说那是癌症。”在购物之旅中间，罗（Rowe）难以置信。

结果表明她被诊断出罕见的皮肤癌称为去肿瘤性黑色素瘤(DM). While DM accounts forless than 4% of melanomas，它可以积极移动，扩散到淋巴结和器官。“它往往发生在慢性阳光受损的皮肤的地区，”位于宾夕法尼亚州普鲁士国王的董事会认证皮肤科医生Erum Ilyas说，Schweiger Dermotology Group。就罗（Rowe）而言，该点位于她的锁骨下方，这是阳光暴露的一个相当容易的目标。

知道脱肿瘤性黑色素瘤的症状

Like allmelanomas, desmoplastic melanoma is atype of skin cancer that impacts melanocytes- 制成黑色素或皮肤色素的细胞。

发现DM的棘手是它不遵循典型的ABCDE特征of most melanomas. “Desmoplastic melanoma can be challenging to recognize because it often presents without pigment and can appear nonspecific, even potentially appearing pink or skin-toned,” says Dr. Ilyas. “It can be mistaken for a scar, or a noncancerous growth under the skin. The skin is typically thickened and can be flat or raised.”

DM肿瘤的混合物，纤维组织和胶原蛋白，可以模仿皮肤上的许多常见良性生长，通常可以被忽略。他说：“如果在皮肤癌筛查期间未被注意到，这使它有更多的时间成长和进步。”由于诊断经常会延迟，DM可以变得侵入性，引起刺痛或痛苦因为它倾向于周围形成nerve fibers。

那你怎么能积极主动呢？当每月进行皮肤的自我检查时，请密切关注皮肤，通常会暴露于阳光（面，头皮，脖子，手臂和腿部），并在寻找任何斑块，颠簸或结块中，并带有疤痕 -喜欢纹理。并与皮肤科医生一起进行年度皮肤癌筛查，以便他们可以使用一种称为A皮肤镜。

是什么引起去肿瘤性黑色素瘤？

Ilyas博士说：“人们认为，DM的主要原因是慢性，DNA损害，紫外线暴露。”（慢性阳光暴露等于每天几乎每天在户外时间长时间的户外活动，与间歇性暴露相对, which is more like being a weekend warrior with your outside time.)

Indeed, the areas of the body where DM appears most are those which are more likely to be exposed to sunlight. The top three DM sites include the head and neck, which accounts for 53% of cases; arms, legs, hands, and feet, accounting for 26% of cases; and the torso, accounting for 20% of cases.

While anyone can develop desmoplastic melanoma, “there are certain groups more prone to getting DM, such as older patients with fairer skin who are often in settings that produce UV skin damage,” adds Dr. Ilyas. Men are also受DM影响的可能性两倍作为妇女的原因，原因还不完全清楚。

如何诊断出脱肿瘤性黑色素瘤？

When it comes to diagnosing DM, the dermatoscope is one of the best front-line defenses. A dermatologist can place this hand-held imaging device directly on a person’s skin during an examination, taking advantage of light and magnification to help see the area in greater detail.

Eldik博士说：“提供商可以使用多个线索使用其皮肤镜，这些线索可以指示DM，例如乳状区域，线性液体式船只和白色疤痕状的无结构区域，” Eldik博士说。从那里，您的皮肤科医生可以消除任何可疑生长，并将其发送到实验室进行测试。他说：“确认诊断是在对病变进行活检后在光学显微镜下进行的。”“ DM具有非常有特征的组织学[又名结构模式，使病理学家能够做出诊断。”

DM有两个亚型 - PURE DM和混合DM，这些亚型被发现存在于活检的皮肤组织中的浸润性肿瘤细胞的百分比。“这种分类是在光学显微镜下进行的，” Eldik博士说。“这种区别如此重要的原因是，与混合DM的患者相比，纯DM患者的淋巴结受累频率较低，癌症的侵略性较低。”

Treatment for Desmoplastic Melanoma

通常，DM治疗将涉及手术以去除癌症，根据纪念斯隆·克特林癌症中心的说法（MSKCC）在纽约市。

一旦形成，脱粒性黑色素瘤就会具有很高的复发率，因此您的医生可能希望您参加常规的后续筛查。一小型研究在里士满的弗吉尼亚联邦医学中心，在43个月的随访时间内复发率为32％。

In the case that DM has spread, or metastasized, to other areas of the body including the lymph nodes or organs, MSKCC notes that “immunotherapy, targeted therapy, chemotherapy, radiation, surgery, or a combination of therapies may be used to shrink the tumor.”

最近的研究表明，DM患者对称为免疫疗法药物的反应特别好免疫检查点抑制剂, which work by enlisting the help of one’s own immune system to shrink the cancer. “This is a novel type of chemotherapy that has proven to be very effective in treating DM specifically,” says Dr. Eldik. Encouragingly, a多中心分析发现70％的DM患者具有完整或部分反应。

“This is significant because many of these patients had metastases, which means the cancer traveled to other parts of the body like the lung. This is usually thought of as late stage and difficult to treat,” he explains. “Their responses were durable, meaning sustained over time with lower rates of relapse.” That’s welcome news to anyone who is facing an advanced DM diagnosis or who has a loved one they aresupporting through metastatic melanoma。

Indeed, Rowe herself found success after being treated with immune checkpoint inhibitors: The cancerous tumors, which had spread to her lungs, gradually shrunk and she happily reported that “I haven’t gotten any new ones” inan interviewwithThe Salt Lake Tribune。自从Rowe的黑色素瘤恐慌以来，她成为健康皮肤护理的声音拥护者，警告她早些时候的日光浴和晒黑床的行为。讲话今天的癌症，she said, “We need to be shouting from the rooftops that these habits are literally killing us.”

Meet Our Writer

安德里亚黎明·克拉克（Andrea Dawn Clark）

安德里亚黎明·克拉克（Andrea Dawn Clark）is the Editorial Director at John Jay College, City University of New York (CUNY). With over 20 years of professional publishing experience, she’s worked at numerous consumer magazines as an Executive Editormore

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