熱傷瘢痕上に生じた Desmoplastic melanoma の1例

概要

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A 50-year-old man developed a rapidly growing tumor in old burn scar on the left heel which had been ulcerated for recent 5 years. A firm, immovable subcutaneous nodule was palpable in the left femoral area. Below-knee amputation of the left leg and radical groin dissection were performed. Six courses of CYVA-DIC chemotherapy were also given. Two years after the operation, a lymph node metastasis around external iliac artery developed. After the radical dissection, another chemotherapy including CBDCA, DTIC, ACNU and tamoxifen was introduced. Histological examination revealed the bulk of the primary tumor was composed of atypical, amelanotic, spindle cells with fibrous tissues. Small nests of epithelioid cells were also present. Neural invasion was observed in the deep dermis. Neuroid structures composed of atypical cells in fibrous stroma were present in the section of the inguinal subcutaneous tissue. The metastatic lesion to the lymph node adjacent to left external iliac artery showed similar changes to the primary skin tumor, with more marked fibrosis. The tumor cells were strongly positive for S-100 and NSE. In the primary tumor and metastatic lesion to the lymph node, the tumor cells were positive for alpha-1 antichymotrypsin and lysozyme as well.
日本皮膚悪性腫瘍学会の論文