Zusammenfassung
Wir berichten über einen 30-jährigen Patienten, der vier
Monate nach Strahlentherapie von mediastinalen Lymphomen bei Morbus Hodgkin
(Stadium IV b) und vorausgegangener BACOPP-D (Bleomycin, Doxyrubicin,
Cyclophosphamid, Vincristin, Procarbazin, Prednisolon und
Dacarbazin)-Polychemotherapie im Bestrahlungsfeld ein malignes Melanom (Stadium
I a) entwickelte. Daneben fanden sich Vitiligo-Herde und ein
Halo-Nävus am sonstigen Integument. Der mögliche Zusammenhang
zwischen der Entstehung eines malignen Melanoms und einer Strahlentherapie wird
anhand der aktuellen Literatur diskutiert. Die regelmäßige Kontrolle
des Bestrahlungsfeldes auf auffällige Hautveränderungen wird
empfohlen.
Abstract
We report on a 30-years old male caucasian patient who developed a
malignant melanoma (stage I a) in the radiotherapy field within four months
after radiotherapy because of mediastinal lymphomas of Hodgkin's disease
(stage IV b) and additional BACOPP-D (bleomycin, doxorubicin, cyclophosphamide,
vincristine, procarbazine, prednisolone and dacarbazine) polychemotherapy in
sequence. Beside of this, vitiligo lesions and a Sutton's nevus were
present in other areas of the body. A possible causal connection between
developement of melanoma and radiotherapy is discussed in the light of recent
literature. The regular examination of radiation fields for skin changes is
recommended.
Literatur
1
Bartal A H, Cohen Y, Robinson E.
Malignant melanoma arising at tattoo sites used
for radiotherapy field marking.
Btit J Radiol.
1980;
53
913-914
2
Chudecki B.
Radiation cancer of the thoracic oesophagus.
Br J Radiol.
1972;
45
303-304
3
Conley J.
Irradiation as an etiologic factor in the
development of melanoma.
Arch Otolaryng.
1970;
92
627-631
4
Corpron C A, Black C T, Ross M I. et al .
Melanoma as a second malignant
neoplasm after childhood cancer.
Am J Surg.
1996;
172
459-462
5
Dolan R, Vaughan C, Fuleihan N.
Metachronous cancer: prognostic factors including
prior irradiation.
Otolaryngol Head Neck Surg.
1998;
119
619-623
6
Dutrillaux B.
Radiation-induced cancers.
Cancer Radiother.
1998;
2
541-548
7
Inbar M, Matzkin H, Rozin R R. et al .
Malignant melanoma developing in a
radiation field.
Brit J Radiol.
1988;
61
519-520
8
van Leeuwen F E, Klokman W J, Hagenbeek A.
Second cancer risk following Hodgkin"s
disease: 20-year follow-up study.
J Clin Oncol.
1994;
12
312-315
9
Licata A G, Wilson L D, Braverman I M.
Malignant melanoma and other second cutaneous
malignancies in cutaneous T-cell lymphoma.
Arch Dematol.
1995;
131
432-435
10
Kalemeris G C, Rosenfeld L, Gray G F. et al .
Malignant melanoma of the tongue
following low-dose radiation.
Arch Pathol Lab Med.
1985;
109
290-291
11
Miracco C, Materno M, De Santi M M.
Unusual second malignacies following radiation
therapy: subcutaneous pleomorphic rhabdomyosarcoma and cutaneous melanoma. Two
case reports.
J Cutan Pathol.
2000;
27
419-422
12
Nelson D F, Cooper S, Weston M G. et al .
Second malignant neoplasms in patients
treated for HodgkinŽs disease with radiotherapy or radiotherapy and
chemotherapy.
Cancer.
1981;
48
2386-2393
13
Préaux J, Noury-Duperrat G, Belaïch S.
Épithélioma baso-cellulaire et
mélanome malin apparus sur radiodermite.
Ann Dermatol Venereol.
1986;
113
1011-1013
14
Ron E.
Ionizing radiation and cancer risk: evidence from
epidemiology.
Radiat Res.
1998;
150
30-41
15
Schallreuther K U, Levenig C, Berger J.
Vitiligo and cutaneous melanoma. A case
study.
Dermatologica.
1991;
183
230-245
16
Trefzer U, Voit C, Milling A. et al .
Malignant melanoma arising in a
radiotherapy field: report of two cases and review of the literature.
Dermatology.
2003;
206
265-268
17
Waxler B.
Malignant melanoma in patient who received
neutron beam therapy.
Lancet.
1984;
i
904-905
18
Zschunke E.
Ionizing radiation – a cause of malignant
melanoma?.
Dermatol Monatsschr.
1989;
176
69-75
Prof. Dr. med. habil. Lutz Kowalzick
Klinik für Hautkrankheiten und Allergologie HELIOS
Vogtland-Klinikum Plauen GmbH
Postfach 100153 08505 Plauen