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Regression beim Melanom

Definition, Ätiopathogenese, Morphologie und Differenzialdiagnose

Regression in malignant melanoma

Definition, etiopathogenesis, morphology and differential diagnosis

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”.

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

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Schlüsselwörter

  • Regression
  • Malignes Melanom
  • Fibrose
  • Melanose
  • Metastase

Keywords

  • Regression
  • Malignant melanoma
  • Fibrosis
  • Melanosis
  • Metastasis