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NEJM：弥漫性黑变病和黑色素瘤-病例报道

2019-03-21 xing.T 网络

弥漫性黑变病黑色素瘤转移
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弥漫性黑变病和黑色素瘤是转移性黑素瘤的罕见并发症，并且与预后非常差有关。确切的机制尚不清楚，但认为涉及黑素瘤细胞的细胞溶解，导致大量黑色素和黑色素前体释放到循环血液中。

患者为一名47岁的妇女，因皮肤、指甲和口腔粘膜弥漫性逐渐变色（如图A所示）和尿液变黑（如图B所示）4周而皮肤科门诊就诊。



在就诊前8年，她在右肩部病变活检后证实了黑色素瘤的诊断。那时，黑色素瘤采用广泛的手术切除治疗; 前哨淋巴结活检呈阴性。在就诊前6个月，患者被诊断为转移性黑色素瘤，在脑、肺、肝和椎骨中发现了转移。因为黑色素瘤是BRAF V600E阳性，所以患者用达拉菲尼和曲美替尼治疗以及对椎骨病变进行放射治疗。

弥漫性黑变病和黑色素瘤是转移性黑素瘤的罕见并发症，并且与预后非常差有关。确切的机制尚不清楚，但认为涉及黑素瘤细胞的细胞溶解，导致大量黑色素和黑色素前体释放到循环血液中。

该患者尽管进行了治疗，疾病仍在进展，患者在就诊后2周死亡。

原始出处：

Simonetta Piana,et al.Diffuse Melanosis and Melanuria.N Engl J Med 2019;https://www.nejm.org/doi/full/10.1056/NEJMicm1810151

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    2019-04-07 sunylz

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