Skip to main content
SpringerLink
Log in

Regression beim Melanom

Definition, Ätiopathogenese, Morphologie und Differenzialdiagnose

Regression in malignant melanoma

Definition, etiopathogenesis, morphology and differential diagnosis

  • Schwerpunkt: Melanozytäre Tumoren
  • Published:
Der Pathologe Aims and scope Submit manuscript

Zusammenfassung

Das maligne Melanom ist eine der Neoplasien mit häufiger Tendenz zur Regression. Klinisch ändert sich abhängig vom Ausmaß der Regression die Farbe. Das Melanom weist neben den braunen nun auch weiße, graue und blaue Farbtöne auf. Histopathologisch ist die Regression initial durch ein dichtes lymphozytenreiches Infiltrat gekennzeichnet. Im Verlauf und in der komplett ausgebildeten Regression stehen die Fibrose und/oder Melanose im Vordergrund. Große Abschnitte des Melanoms sind bei diesem Prozess untergegangen. Die ausgedehnte komplette Regression wird von einigen Autoren wie folgt beschrieben: „Fibroplasie der Dermis ohne Nachweis von epidermalen oder dermalen Melanomzellen. Einzelzellproliferate (lentiginös) von atypischen Melanozyten entlang der dermoepidermalen Junktionszone möglich.“ Bei konsequenter Anwendung dieser Definition dürfte eine ausgedehnte Regression von >50% eines dünnen Melanoms (<1,0 mm) mit einem erhöhten Metastasierungsrisiko einhergehen.

Abstract

Malignant melanoma is a neoplasm that more often tends to undergo regression. Clinically, variation in color is perhaps the most important hallmark of primary cutaneous melanoma. The change in color to white, off-white, blue-white and gray-white is a sign of (spontaneous) regression in malignant melanoma. Histopathologically the process starts with a dense lichenoid infiltrate of lymphocytes, and ends with fibrosis and/or melanosis within a thickened papillary dermis. The dense infiltrate of lymphocytes permeates the thin melanoma and destroys the atypical melanocytes in the epidermis and the papillary dermis. A key concern is how to define regression in a reproducible way. Using the following definition, a statistically significant risk of metastases can be demonstrated in thin melanomas (<1.0 mm) with extensive regression (>50%): “fibroplasia with an absence of epidermal and dermal involvement by melanoma cells, but allowing for (lentiginous) single-cell proliferation of atypical melanocytes along the dermo-epidermal junction”.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Ackerman AB, Cerroni L, Kerl H (eds) (1994) Pitfalls in Histologic Diagnosis of Malignant Melanoma. Lea & Febiger, Philadelphia

  2. Ackerman AB, Mones JM (2001) Halo phenomenon. In: Ackerman AB, Mones JM (eds) Ackerman’s resolving quandaries in dermatology, pathology and dermatopathology. Vol. 2, Ardor Scribendi, New York, pp 196–199

  3. Ackerman AB, Su WPD (1979) The histology of cutaneous malignant melanoma. In: Kopf AW, Bart RS, Rodriguez-Saint RS, Ackerman AB (eds) Malignant melanoma. Masson, New York, pp 25–147

  4. Akiyama M, Inamoto K, Nakamura N (1997) Malignant melanoma and squamous cell carcinoma forming one tumour in a burn scar. Dermatology 194: 157–161

    Article  PubMed  CAS  Google Scholar 

  5. Bailly Ch, Mompart J-P (2004) Mélanome régressif. Bull Div Française AIP 40: 51–62

    Google Scholar 

  6. Balch CM, Buzaid AC, Soong SJ et al. (2001) Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 19: 3635–3648

    PubMed  CAS  Google Scholar 

  7. Barnhill RL, Busam KJ (1995) Regression. In: Barnhill RL, Busam KJ (eds) Pathology of melanocytic nevi and malignant melanoma. Butterworth-Heinemann, Boston, pp 237–242, 273–274

  8. Barr RJ (2004) The many faces of completely regressed malignant melanoma. In: LeBoit PE (eds) Pathology: Malignant melanoma and melanocytic neoplasms. Hanley & Belfus, Inc., Philadelphia, pp 359–370

  9. Bastian BC (2003) Hypothesis: A role for telomere crisis in spontaneous regression of melanoma. Arch Dermatol 139: 667–668

    Article  PubMed  Google Scholar 

  10. Bastian BC, LeBoit PE, Pinkel D (2001) Genomic approaches to skin cancer diagnosis. Arch Dermatol 137: 1507–1511

    PubMed  CAS  Google Scholar 

  11. Blessing K, McLaren KM (1992) Histological regression in primary cutaneous melanoma: recognition, prevalence and significance. Histopathology 20: 315–322

    Article  PubMed  CAS  Google Scholar 

  12. Bodey B (2002) Spontaneous regression of neoplasms: new possibilities for immunotherapy. Expert Opin Biol Ther 2: 49–476

    Google Scholar 

  13. Bowen GM, Chang AE, Lowe L et al. (2000) Solitary melanoma confined to the dermal and / or subcutaneous tissue. Arch Dermatol 136: 1397–1399

    Article  PubMed  CAS  Google Scholar 

  14. Breslow A (1970) Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg 172: 902–908

    Article  PubMed  CAS  Google Scholar 

  15. Breslow A (1977) Problems in the measurement of tumor thickness and level invasion in cutaneous melanoma. Hum Pathol 8: 1–2

    Article  PubMed  CAS  Google Scholar 

  16. Brownstein MH, Helwig EB (1972) Patterns of cutaneous metastasis. Arch Dermatol 105: 862–868

    Article  PubMed  CAS  Google Scholar 

  17. Bulkley GB, Cohen MH, Banks PM et al. (1975) Long-term spontaneous regression of malignant melanoma with visceral metastases. Cancer 36: 485–494

    Article  PubMed  CAS  Google Scholar 

  18. Carcelain G, Rouas-Freiss N, Zorn E et al. (1997) In situ T-cell response in a primary regressive melanoma and subsequent metastases: a comparative analysis. Int J Cancer 17: 241–247

    Article  Google Scholar 

  19. Carlson JA, Mu XC, Slominski A et al. (2002) Melanocytic proliferations associated with lichen sclerosus. Arch Dermatol 138: 77–87

    Article  PubMed  Google Scholar 

  20. Cooper PH, Harold J, Wanebo J, Hagar W (1985) Regression in thin malignant melanoma. Arch Dermatol 121: 1127–1131

    Article  PubMed  CAS  Google Scholar 

  21. Das Gupta T, Bowden L, Berg JW (1963) Malignant melanoma of unknown primary origin. Surg Gynecol Obstet 117: 341–345

    Google Scholar 

  22. Everson TC, Cole WH (1966) Spontaneous regression of cancer. WB Saunders, Philadelphia, pp 1–1187

  23. Flax SH, Skelton HG, Smith KJ, Lupton GP (1998) Nodular melanosis due to epithelial neoplasms. Am J Dermatopathol 20: 118–122

    Article  PubMed  CAS  Google Scholar 

  24. Fontaine D, Parkhill W, Greer W, Walsh N (2003) Partial regression of primary cutaneous melanoma. Is there an association with sub-clinical sentinel lymph node metastasis? Am J Dermatopathol 25: 371–376

    Article  PubMed  Google Scholar 

  25. Fritsch P, Zelger B, Sepp N (2003) Tumoren der Haut. In: Fritsch P (Hrsg) Dermatologie, Venerologie. 2. Aufl. Springer, Berlin Heidelberg New York, S 585–697

  26. Gromet MA, Epstein WL, Blois MS (1978) The regressing thin malignant melanoma. Cancer 42: 2282–2292

    Article  PubMed  CAS  Google Scholar 

  27. Guitart J, Lowe L, Piepkorn M et al. (2002) Histological characteristics of metastasizing thin melanomas. Arch Dermatol 138: 603–608

    Article  PubMed  Google Scholar 

  28. Hammond WG, Benfield JR, Tesluk H et al. (1995) Tumor progression by lung cancer growing in hosts of different immunocompetence. Cancer 8: 130–138

    Google Scholar 

  29. Harvell JD, Meehan SA, LeBoit PE (1997) Spitz’s nevi with halo reaction: a histopathologic study of 17 cases. J Cutan Pathol 24: 611–619

    Article  PubMed  CAS  Google Scholar 

  30. Hussein MR (2005) Tumor-infiltrating lymphocytes and melanoma tumorigenesis: an insight. Br J Dermatol 153: 18–21

    Article  PubMed  CAS  Google Scholar 

  31. Kang S, Barnhill RL, Mihm MC Jr, Sober AJ (1993) Histologic regression in malignant melanoma: an interobserver concordance study. J Cutan Pathol 20: 126–129

    Article  PubMed  CAS  Google Scholar 

  32. Kelly JW, Sagebiel RW, Blois MS (1985) Regression in malignant melanoma. A histologic feature without independent prognostic significance. Cancer 56: 2287–2291

    Article  PubMed  CAS  Google Scholar 

  33. Kerl H, Soyer HP, Cerroni L et al. (1998) Ancient melanocytic nevus. Semin Diagn Pathol 15: 210–215

    PubMed  CAS  Google Scholar 

  34. Kornberg R, Ackerman AB (1975) Pseudomelanoma. Arch Dermatol 111: 1588–1590

    Article  PubMed  CAS  Google Scholar 

  35. LeBoit PE (1998) Dermatitis involving the dermoepidermal junction. In: Maize JC (ed) Cutaneous pathology. Churchill Livingstone, Philadelphia, pp 87–145

  36. LeBoit PE (2000) Puzzling follicular germinative proliferations. Am J Dermatopathol 22: 87–88

    Article  PubMed  CAS  Google Scholar 

  37. LeBoit PE (2002) Melanosis and its meanings. Am J Dermatopathol 24 369–372

    Google Scholar 

  38. Linderman RB, Melton ME (1985) Metastasis of a thin regressing malignant melanoma. Ann Plast Surg 15: 247–251

    Article  PubMed  CAS  Google Scholar 

  39. Massi G, LeBoit PE (2004) Regressing and regressed melanoma. In: Massi G, LeBoit PE (eds) Histological diagnosis of nevi and melanoma. Springer, Steinkopff Darmstadt, pp 617–630

  40. McGovern VJ, Shaw HM, Milton GW (1983) Prognosis in patients with thin malignant melanoma: influence of regression. Histopathology 7: 673–680

    Article  PubMed  CAS  Google Scholar 

  41. McGovern VJ (1983) Spontaneous Regression of Malignant Melanoma In: McGovern VJ (ed) Melanoma histological diagnosis and prognosis, biopsy interpretation series. Raven Press, New York, pp 138–147

  42. Menasce LP, Shanks JH, Howarth VS, Banerjee SS (2005) Regressed cutaneous malignant melanoma mimicking lymphoma: a potential diagnostic pitfall. Int J Surg Pathol 13: 281–284

    Article  PubMed  CAS  Google Scholar 

  43. Menzies SW, McCarthy WH (1997) Complete regression of primary cutaneous malignant melanoma. Arch Surg 132: 553–556

    PubMed  CAS  Google Scholar 

  44. Mooi WJ, Krausz T (eds) (1992) Biopsy Pathology of melanocytic disorders. Chapman and Hall Medical, London, pp 1–433

  45. Murray C, D’Intino Y, MacCormick R et al. (1999) Melanosis in association with metastatic malignant melanoma: report of a case and an unifying concept of pathogenesis. Am J Dermatopathol 21: 28–30

    Article  PubMed  CAS  Google Scholar 

  46. Oberholzer MJ (2001) Die Apoptose wird durch Gene gesteuert. In: Oberholzer MJ (Hrsg) Pathologie verstehen. Molekulare Grundlagen der allgemeinen Pathologie. Thieme, Stuttgart, S 24–26

  47. Olah J, Gyulai R, Korom I et al. (2003) Tumour regression predicts higher risk of sentinel node involvement in thin cutaneous melanoma. Br J Dermatol 149: 655–680

    Article  Google Scholar 

  48. Pack GT, Miller TR (1961) Metastatic melanoma with indeterminate primary site. JAMA 176: 55–56

    PubMed  CAS  Google Scholar 

  49. Papac RJ (1998) Spontaneous regression of cancer: possible mechanisms. In Vivo 12: 571–578

    PubMed  CAS  Google Scholar 

  50. Prehn RT (1996) The paradoxical association of regression with a poor prognosis in melanoma contrasted with a good prognosis in keratoakanthoma. Cancer Res 56: 937–940

    PubMed  CAS  Google Scholar 

  51. Ramirez RD, D’Atri S, Pagani E et al. (1999) Progressive increase in telomerase activity from benign melanocytic conditions to malignant melanoma. Neoplasia 1: 42–49

    Article  PubMed  CAS  Google Scholar 

  52. Reed RJ, Ichinose H, Clark WH Jr, Mihm MC Jr (1975) Common and uncommon melanocytic nevi and borderline melanomas. Semin Oncol 2: 119–147

    PubMed  CAS  Google Scholar 

  53. Ronan SG, Eng AM, Briele HA et al. (1987) Thin malignant melanomas with regression and metastases. Arch Dermatol 123: 1326–1330

    Article  PubMed  CAS  Google Scholar 

  54. Rosenberg SA (2001) Progress in human tumour immunology and immunotherapy. Nature 411: 388–384

    Article  Google Scholar 

  55. Shaw HM, McCarthy SW, McCarthy WH et al. (1989) Thin regressing malignant melanoma: significance of concurrent regional lymph node metastases. Histopathology 15: 257–265

    PubMed  CAS  Google Scholar 

  56. Slingluff CL Jr, Vollmer RT, Reintgen DS, Seigler HF (1988) Lethal „thin“ malignant melanoma; identifying patients at risk. Ann Surg 208: 150–161

    Article  PubMed  Google Scholar 

  57. Smith JL Jr, Stehlin JS Jr (1965) Spontaneous regression of primary malignant melanomas with regional metastases. Cancer 18: 1399–1415

    Article  PubMed  Google Scholar 

  58. Sondergaard K, Hou-Jensen K (1985) Partial regression in thin primary cutaneous malignant melanomas clinical stage I: a study of 486 cases. Virchows Archiv A Pathol Anat Histopathol 408: 241–247

    Article  CAS  Google Scholar 

  59. Tefany FJ, Barnetson RS, Halliday GM et al. (1991) Immunocytological analysis of the cellular infiltrate in primary regressing and nonregressing malignant melanoma. J Invest Dermatol 97: 197–202

    Article  PubMed  CAS  Google Scholar 

  60. Zettersten E, Shaikh L, Ramirez R, Kashani-Sabet M (2003) Prognostic factors in primary cutaneous melanoma. Surg Clin North Am 83: 61–75

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Dermatopathologische Gemeinschaftspraxis, Siemensstraße 6/1, 88048, Friedrichshafen, Deutschland

    B.E. Paredes

Authors
  1. B.E. Paredes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B.E. Paredes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Paredes, B. Regression beim Melanom. Pathologe 28, 453–463 (2007). https://doi.org/10.1007/s00292-007-0937-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00292-007-0937-3

Schlüsselwörter

Keywords

Search

Navigation