Zusammenfassung
Melanozyten sind Pigment-bildende Zellen, die sich ganz überwiegend im Stratum basale der Epidermis finden. Hier ist jede 5. – 10. Zelle ein Melanozyt, der bei UV-Anregung über dendritische Fortsätze Melanin-Pigment an die umliegenden Keratinozyten abgibt. Weiterhin finden sich Melanozyten in der Uvea, im Innenohr, in den Meningen und den Schleimhäuten, wo auch Melanome entstehen können. Das Gesamtvolumen des melanozytären Systems beträgt ca. 2cm3 (ein Stück Würfelzucker). Gutartige melanozytäre Nävi und bösartige Melanome stellen Neubildungen dar, die von den Melanozyten ausgehen. Im Vergleich zum Volumen des melanozytären Systems sind sie sehr häufig. Kongenitale melanozytäre Nävi sind entweder bei Geburt vorhanden oder manifestieren sich tardiv überwiegend im ersten Lebensjahrzehnt. Erworbene melanozytäre Nävi entwickeln sich neu vor allem in den ersten zwei Lebensjahrzehnten. Das dermatologische Spektrum melanozytärer Nävi ist variantenreich und in diesem Kapitel werden mehr als 30 Subtypen melanozytärer Nävi dargestellt. Unter ihnen befinden sich die Melanomsimulatoren, deren Abgrenzung zum bsartigen Melanom eine der größten Anforderungen der Dermatopathologie darstellt. Zu diesen gehören Spitz-Nävi und Varianten, dysplastische Nävi, Rezidiv-Nävi, akrale und genitale Nävi, Halo-Nävi, atypische blaue Nävi, „deep penetrating“, Nävi, kombinierte Nävi, Nävi bei Neugeborenen und „ancient-Nðvi“. Melanome können sich ab dem 14. Lebensjahr mit einem medianen Alter von 55 – 60 Jahren entwickeln, in seltenen Ausnahmen auch bereits in der Kindheit. Sie werden zu den bösartigsten Malignomen gezählt, weil sich Metastasierung bereits von kleinem Tumorvolumen aus entwickeln kann. Mehr als 20 Varianten des Melanoms werden in diesem Kapitel beschrieben. Am häufigsten sind das superfiziell spreitende Melanom, gefolgt vom nodulären Melanom, dem Lentigo maligna-Melanom, dem akral-lentiginösen Melanom und dem desmoplastischen Melanom. Während diese klassischen und häufigen Melanom-Subtypen recht sicher diagnostiziert werden können, ist die Abgrenzung seltener Subtypen von melanozytären Nävi sehr schwierig. Zu diesen schwer einzuordnenden Subtypen gehören das spitzoide Melanom, das nävoide Melanom und das genestete Melanom. Insbesondere für das spitzoide Melanom kann die Anwendung molekular-genetischer Verfahren wie der komparativen genomischen Hybridisierung die diagnostische Einordnung verbessern.
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Garbe, C., Kerl, H., Cerroni, L. (2015). Melanozytäre Nävi und Melanom. In: Cerroni, L., Garbe, C., Metze, D., Kutzner, H., Kerl, H. (eds) Histopathologie der Haut. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44367-5_30-1
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