Photo courtesy of vision china
Inexplicable lymphadenopathy is actually malignant melanoma metastasis.
54-year-old Ms. Feng (pseudonym) has always been in good health. A month ago, she found a tumor on her left neck, which she thought would subside. However, after more than a month, not only did it show no signs of weakening, but it gradually increased. Ms. Feng went to the local hospital for tumor resection and biopsy. Postoperative pathological examination showed that it was "metastatic malignant tumor of left cervical lymph nodes" Ms. Feng was immediately transferred to a hospital in Hangzhou for further treatment.
Imaging examination showed that Ms. Feng had swollen lymph nodes on both sides of her neck and behind her ears, and no related organ tumors were found. So, where is the primary focus of this metastatic malignant tumor? Is this malignant tumor cancer? Is it sarcoma? Or lymphoma? At this time, the clinical evidence is difficult to solve, and surgery "turns to pathology".
After understanding the detailed medical history, the pathologist immediately carefully observed Ms. Feng's pathological biopsy tissue section under the microscope. Microscopic examination showed that the left neck mass was a lymph node with completely destroyed tissue structure, and the tumor cells were abnormal and distributed in solid sheets, which replaced the normal tissue structure of lymph nodes. At high magnification, a small amount of brown pigment particles were deposited in the cytoplasm of some tumor cells. It is the pigment particles under these microscopes that have aroused the high vigilance of pathologists-this metastatic tumor is likely to come from malignant melanoma and needs further immunohistochemical examination to be diagnosed.
Soon after, the family sent a piece of pathological tissue wax to Ms. Feng. Immunohistochemical examination showed that HMB45 and MelanA, the specific markers of malignant melanoma, were strongly positive in tumor tissues, while other specific markers related to cancer, sarcoma and lymphoma were negative. Finally, the pathological diagnosis was final-Ms. Feng's neck mass was metastatic malignant melanoma of lymph nodes.
The mole may have become malignant when it is obviously enlarged.
According to the guidance of pathological diagnosis results, medical staff were able to ask for consultation: Ms. Feng had a flat small mole from her left atrial appendage. After 20 18, she felt that the mole was obviously enlarged and occasionally accompanied by itching. At the same time, considering the influence on appearance, I went to have a laser Dot mole in May 20 19 (the treatment institution is unknown), and there was no discomfort after that. I didn't go to the hospital until I found an obvious swollen nodule on my neck a month ago.
Physical examination showed that Ms. Feng could see multiple raised moles and obvious irregular patchy moles inside and outside the left atrial appendage, both of which were about 1cm in size, and swollen lymph nodes could be touched on both sides of the neck and behind the left ear. According to the clinical features and pathological examination results, Ms. Feng was finally diagnosed as multiple malignant melanoma in the ear with multiple lymph node metastases all over the body, which belongs to the middle and late clinical stage. Ms. Feng immediately transferred to the Oncology Department of the First Hospital of the City for comprehensive radiotherapy and chemotherapy.
The doctors and nurses who handled it also lamented that when Ms. Feng first found that the ear mole was obviously increased, it was probably that the mole had changed. If Ms. Feng had gone to a special medical institution to have a complete nevus excision operation, then she was sent to the pathology department to check the nature of the nevus after operation, instead of having a laser Dot mole in a hurry, then the terrible consequences of rapid recurrence of multiple foci with multiple lymph node metastasis in a short time might not have happened.
Improper treatment such as laser may induce malignant transformation of pigmented nevus.
As for laser Dot mole, I believe everyone is familiar with it, but few people know its principle. It uses the huge energy emitted by laser to instantly act on the pigment tissue, so that the pigment is crushed and decomposed, swallowed by macrophages and excreted with lymphatic circulation, thus achieving the purpose of removing pigment. But this is generally only applicable to ordinary moles whose body surface is very small and flat. For larger moles and stains, Dot mole should not be used, because there is no specimen sent for pathological biopsy after Dot mole, which will miss the diagnosis and delay some suspicious or malignant lesions.
Ms. Feng just thought that the obvious increase of "moles" would affect the appearance, so she rashly made laser Dot mole, which directly led to the rapid development of tumor nevus cells into multiple malignant melanoma recurrence in the ear and multiple lymph node metastasis in the whole body after laser stimulation. As we all know, improper treatment may induce malignant transformation and rapid growth of pigmented nevus, such as knife cutting, rope twisting, salt curing, laser and freezing.
Malignant melanoma of skin is a kind of skin tumor, which originated from melanocytes in normal skin. Although its incidence rate only accounts for about 5% of all skin malignant tumors, its harm can not be ignored, and its mortality rate is definitely the first among skin tumors.
In recent years, malignant melanoma has doubled in China, with about 20,000 new cases every year. Melanoma has become one of the diseases that seriously endanger the health of our people. Because the lesions of patients in China are often hidden and people don't know enough, the early detection rate of melanoma patients in China is low, and it is easy to be misdiagnosed and mistreated in clinic. Many patients are in the middle and late stage when they see a doctor, and the 5-year survival rate is only about 40%. Therefore, it is very important to correctly distinguish skin malignant melanoma from common nevus.
Zhang said that most people will have pigmented nevus, and most of them are benign common nevus. However, if you have many moles, you may need to pay more attention to the shape and changes of some moles, especially for a few high-risk groups. If the original mole changes suddenly recently, such as sudden enlargement, asymmetry, unclear boundary, variegated color and diameter exceeding 5mm, you need to be vigilant, see a doctor in time, and ask a specialist to distinguish between benign and malignant.