1
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Colombino M, Casula M, Paliogiannis P, Manca A, Sini MC, Pisano M, Santeufemia DA, Cossu A, Palmieri G. Heterogeneous pathogenesis of melanoma: BRAF mutations and beyond. Crit Rev Oncol Hematol 2024; 201:104435. [PMID: 38977143 DOI: 10.1016/j.critrevonc.2024.104435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/22/2024] [Accepted: 06/29/2024] [Indexed: 07/10/2024] Open
Abstract
Melanoma pathogenesis, conventionally perceived as a linear accumulation of molecular changes, discloses substantial heterogeneity driven by non-linear biological processes, including the direct transformation of melanocyte stem cells. This heterogeneity manifests in diverse biological phenotypes and developmental states, influencing variable responses to treatments. Unveiling the aberrant mechanisms steering melanoma initiation, progression, and metastasis is imperative. Beyond mutations in oncogenic and tumor suppressor genes, the involvement of distinct molecular pathways assumes a pivotal role in melanoma pathogenesis. Ultraviolet (UV) radiations, a principal factor in melanoma etiology, categorizes melanomas based on cumulative sun damage (CSD). The genomic landscape of lesions correlates with UV exposure, impacting mutational load and spectrum of mutations. The World Health Organization's 2018 classification underscores the interplay between sun exposure and genomic characteristics, distinguishing melanomas associated with CSD from those unrelated to CSD. The classification elucidates molecular features such as tumor mutational burden and copy number alterations associated with different melanoma subtypes. The significance of the mutated BRAF gene and its pathway, notably BRAFV600 variants, in melanoma is paramount. BRAF mutations, prevalent across diverse cancer types, present therapeutic avenues, with clinical trials validating the efficacy of targeted therapies and immunotherapy. Additional driver mutations in oncogenes further characterize specific melanoma pathways, impacting tumor behavior. While histopathological examination remains pivotal, challenges persist in molecularly classifying melanocytic tumors. In this review, we went through all molecular characterization that aid in discriminating common and ambiguous lesions. Integration of highly sensitive molecular diagnostic tests into the diagnostic workflow becomes indispensable, particularly in instances where histology alone fails to achieve a conclusive diagnosis. A diagnostic algorithm based on different molecular features inferred by the various studies is here proposed.
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Affiliation(s)
- Maria Colombino
- Unit of Cancer Genetics, Institute of Genetic Biomedical Research (IRGB), National Research Council (CNR), Sassari, Italy.
| | - Milena Casula
- Unit of Cancer Genetics, Institute of Genetic Biomedical Research (IRGB), National Research Council (CNR), Sassari, Italy
| | | | - Antonella Manca
- Unit of Cancer Genetics, Institute of Genetic Biomedical Research (IRGB), National Research Council (CNR), Sassari, Italy
| | - Maria Cristina Sini
- Unit of Cancer Genetics, Institute of Genetic Biomedical Research (IRGB), National Research Council (CNR), Sassari, Italy
| | - Marina Pisano
- Unit of Cancer Genetics, Institute of Genetic Biomedical Research (IRGB), National Research Council (CNR), Sassari, Italy
| | | | - Antonio Cossu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Giuseppe Palmieri
- Unit of Cancer Genetics, Institute of Genetic Biomedical Research (IRGB), National Research Council (CNR), Sassari, Italy; Immuno-Oncology & Targeted Cancer Biotherapies, University of Sassari, Sassari, Italy
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2
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Delsupehe L, Steelandt T, Lemahieu J, Volders PJ, Geerdens E, Berden S, Daniels A, Froyen G, Maes B. Novel gene fusion discovery in Spitz tumours and its relevance in diagnostics. Virchows Arch 2024; 485:269-279. [PMID: 37731064 DOI: 10.1007/s00428-023-03649-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
In addition to morphologic analysis, molecular diagnostic work up of Spitz tumours is often of great value for their accurate diagnosis/classification. Nowadays, next-generation sequencing (NGS) is the predominant screening method in molecular diagnostics. Up to 80% of these melanocytic neoplasms comprise gene fusions as genetic anomalies for which the driver codes for a protein harbouring a kinase domain. However, because of the variety of fusion partners the use of PCR-based targeted enrichment NGS methods is not recommended. We describe a series of four Spitz tumour samples in which distinct gene fusions were detected by hybridisation-based capture NGS (TPM3::ALK, LIMA1::ROS1, LRRFIP2::ROS1 and MYO5A::RET). Two of these fusions are not previously described. All 4 fusions were confirmed by reverse transcription-PCR. These findings demonstrate the need for molecular analysis that can detect unknown fusions in Spitz neoplasms for optimal diagnosis.
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Affiliation(s)
- Louis Delsupehe
- Laboratory for Molecular Diagnostics, Department of Clinical Biology, Jessa Hospital, Hasselt, Belgium
- Department Jessa & Science, LCRC (-MHU), Hasselt, Belgium
- Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | - Thomas Steelandt
- Laboratory of Pathological Anatomy, Jessa Hospital, Hasselt, Belgium
| | - Julie Lemahieu
- Laboratory for Dermatopathology, Dermpat, Ghent, Belgium
| | - Pieter-Jan Volders
- Laboratory for Molecular Diagnostics, Department of Clinical Biology, Jessa Hospital, Hasselt, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Ellen Geerdens
- Laboratory for Molecular Diagnostics, Department of Clinical Biology, Jessa Hospital, Hasselt, Belgium
| | - Severine Berden
- Laboratory for Molecular Diagnostics, Department of Clinical Biology, Jessa Hospital, Hasselt, Belgium
| | - Annick Daniels
- Laboratory for Molecular Diagnostics, Department of Clinical Biology, Jessa Hospital, Hasselt, Belgium
| | - Guy Froyen
- Laboratory for Molecular Diagnostics, Department of Clinical Biology, Jessa Hospital, Hasselt, Belgium
- Department Jessa & Science, LCRC (-MHU), Hasselt, Belgium
- Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | - Brigitte Maes
- Laboratory for Molecular Diagnostics, Department of Clinical Biology, Jessa Hospital, Hasselt, Belgium.
- Department Jessa & Science, LCRC (-MHU), Hasselt, Belgium.
- Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium.
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3
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Cho WC, Prieto VG, Yang RK. Spitz Melanoma With SLC20A1::ALK Fusion: A Novel Fusion Previously Undescribed in Spitz Melanocytic Neoplasm. Am J Dermatopathol 2024:00000372-990000000-00377. [PMID: 38941542 DOI: 10.1097/dad.0000000000002778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
ABSTRACT Spitz melanocytic neoplasms exhibit frequent chromosomal rearrangements leading to recurring gene fusions, such as ALK fusions. TPM3 and DCTN1 emerge as the predominant fusion partners of ALK, although less common partners such as NPM1, TPR, CLIP1, GTF3C2, MLPH, EEF2, MYO5A, and KANK1 have also been documented. Although ALK fusions are primarily associated with Spitz nevi or atypical Spitz tumors, instances of Spitz melanoma with ALK fusions documented in the English literature are exceedingly rare. Here, we present a case of Spitz melanoma harboring SLC20A1::ALK fusion, highlighting a novel fusion transcript not previously reported in Spitz melanocytic neoplasms, including Spitz melanomas. In addition, the tumor exhibits multiple aberrant chromosomal alterations characteristic of melanoma, along with a somatic mutation in GRM3.
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Affiliation(s)
- Woo Cheal Cho
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
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4
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Slack JC, Church AJ. Molecular Alterations in Pediatric Solid Tumors. Clin Lab Med 2024; 44:277-304. [PMID: 38821645 DOI: 10.1016/j.cll.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Pediatric tumors can be divided into hematologic malignancies, central nervous system tumors, and extracranial solid tumors of bone, soft tissue, or other organ systems. Molecular alterations that impact diagnosis, prognosis, treatment, and familial cancer risk have been described in many pediatric solid tumors. In addition to providing a concise summary of clinically relevant molecular alterations in extracranial pediatric solid tumors, this review discusses conventional and next-generation sequencing-based molecular techniques, relevant tumor predisposition syndromes, and the increasing integration of molecular data into the practice of diagnostic pathology for children with solid tumors.
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Affiliation(s)
- Jonathan C Slack
- Pathology & Laboratory Medicine Institute (Robert J. Tomsich), Cleveland Clinic, Cleveland, OH, USA
| | - Alanna J Church
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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5
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Salah HT, Yang RK, Roy-Chowdhuri S, Ross MI, Aung PP, Rothrock AT, Torres-Cabala CA, Curry JL, Prieto VG, Nagarajan P, Cho WC. Spitz melanocytic neoplasms with MLPH::ALK fusions: Report of two cases with previously unreported features and literature review. J Cutan Pathol 2024; 51:407-414. [PMID: 38444194 DOI: 10.1111/cup.14605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/08/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024]
Abstract
ALK-fused Spitz melanocytic neoplasms are a distinct subgroup of melanocytic lesions exhibiting unique histopathologic characteristics. These lesions often manifest as exophytic or polypoid tumors, characterized by fusiform-to-epithelioid melanocytes arranged in a nested, fascicular, or plexiform growth pattern. Several fusion partners of the ALK gene have been identified in spitzoid melanocytic neoplasms, with TPM3 and DCTN1 being the most prevalent. Less common fusion partners include NPM1, TPR, CLIP1, GTF3C2, EEF2, MYO5A, KANK1, and EHBP1. The MLPH gene, which encodes melanophilin (MLPH), playing a crucial role in regulating skin pigmentation by acting as a linker between RAB27A and myosin Va during melanosome transport, has also recently been recognized as a rare fusion partner of ALK in Spitz melanocytic neoplasms. Currently, there exists a sparse documentation within English literature, illustrating a limited number of cases featuring MLPH::ALK fusion in Spitz melanocytic neoplasms. In this report, we present two additional cases, including a previously unreported instance of Spitz melanoma, contributing to the expanding knowledge on ALK-fused Spitz melanocytic neoplasms. In addition, we provide a comprehensive review of the clinical, histopathologic, and molecular features observed in documented cases with this novel fusion.
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Affiliation(s)
- Haneen T Salah
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Richard K Yang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Merrick I Ross
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aimi T Rothrock
- Department of Pathology, Albany Medical Center, Albany, New York, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Woo Cheal Cho
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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6
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Homer NA, Rieger KE. Melanocytoma of the eyelid: Case report and introduction of new nomenclature. Am J Ophthalmol Case Rep 2024; 34:102059. [PMID: 38690089 PMCID: PMC11059469 DOI: 10.1016/j.ajoc.2024.102059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/17/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Abstract
Purpose The term melanocytoma was recently proposed for intermediate-stage melanocytic lesions with specific histopathologic and molecular genetic features. Prior studies have demonstrated a heightened potential for these intermediate lesions to spread to regional lymph nodes, with decreased likelihood for distant spread, when compared to melanomas. Observations Herein we present a case of a 28-year-old male who presented with a recurrent right lower eyelid margin combined cutaneous and palpebral conjunctival pigmented lesion, ultimately classified as a melanocytoma, to highlight this new nomenclature, characteristic histopathologic and genetic findings, and prognostic implications. Conclusions Ophthalmologists should be aware of this new cutaneous histopathologic classification system and apply to the periorbital region to improve melanocytic lesion management and surveillance.
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Affiliation(s)
| | - Kerri E. Rieger
- Departments of Dermatology and Pathology, Stanford University, Palo Alto, CA, USA
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7
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Gerami P, Chen A, Sharma N, Patel P, Hagstrom M, Kancherla P, Geraminejad T, Olivares S, Biswas A, Bosenberg M, Busam KJ, de La Fouchardière A, Duncan LM, Elder DE, Ko J, Landman G, Lazar AJ, Lowe L, Massi D, Mihic-Probst D, Parker DC, Scolyer RA, Shea CR, Zembowicz A, Yun SJ, Blokx WAM, Barnhill RL. BRAF Mutated and Morphologically Spitzoid Tumors, a Subgroup of Melanocytic Neoplasms Difficult to Distinguish From True Spitz Neoplasms. Am J Surg Pathol 2024; 48:538-545. [PMID: 38525831 DOI: 10.1097/pas.0000000000002194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Drivers of Spitz neoplasms include activating point mutations in HRAS and Spitz-associated genomic fusions. It has become evident that some BRAF -mutated melanocytic neoplasms can morphologically mimic Spitz tumors (STs). These have been termed BRAF mutated and morphologically spitzoid (BAMS). In this study, 17 experts from the International Melanoma Pathology Study Group assessed 54 cases which included 40 BAMS and 14 true STs. The participants reviewed the cases blinded to the genomic data and selected among several diagnostic options, including BAMS, ST, melanoma, and other. A total of 38% of all diagnostic selections in the BAMS cases were for BAMS, whereas 32% were for ST. In 22 of the BAMS cases, the favored diagnosis was BAMS, whereas in 17 of the BAMS cases, the favored diagnosis was ST. Among the 20 cases in the total group of 54 with the highest number of votes for ST, half were BAMS. Of BAMS, 75% had a number of votes for ST that was within the SD of votes for ST seen among true ST cases. There was poor interobserver agreement for the precise diagnosis of the BAMS (kappa = 0.16) but good agreement that these cases were not melanoma (kappa = 0.7). BAMS nevi/tumors can closely mimic Spitz neoplasms. Expert melanoma pathologists in this study favored a diagnosis of ST in nearly half of the BAMS cases. There are BAMS cases that even experts cannot morphologically distinguish from true Spitz neoplasms.
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Affiliation(s)
- Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Alice Chen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Natasha Sharma
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Pragi Patel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Michael Hagstrom
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Pranav Kancherla
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Tara Geraminejad
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Asok Biswas
- Department of Pathology, Western General Hospital, Edinburgh, UK
| | | | - Klaus J Busam
- Department of Pathology, Dermatopathology Service, Memorial Sloan Kettering Cancer Center, New York City, NY
| | | | - Lyn M Duncan
- Department of Dermatopathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Division of Anatomic Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jennifer Ko
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH
| | - Gilles Landman
- Department of Pathology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alexander J Lazar
- Department of Pathology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Lori Lowe
- Department of Dermatology and Pathology, University of Michigan Medical School, Ann Arbor, MI
| | - Daniela Massi
- Department of Health Sciences, Section of Anatomic Pathology, University of Florence, Florence, Italy
| | - Daniela Mihic-Probst
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Douglas C Parker
- Departments of Pathology and Dermatology, Emory University School of Medicine, Atlanta, GA
| | - Richard A Scolyer
- Department of Tissue Pathology, Royal Prince Alfred Hospital, and NSW Health Pathology, North Sydney, NSW, Australia
- Department of Dermatopathology, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute Australia, North Sydney, NSW, Australia
| | - Christopher R Shea
- Department of Medicine, Section of Dermatology, University of Chicago, Chicago, IL
| | - Artur Zembowicz
- Department of Anatomic and Clinical Pathology, Tufts Medical School, Boston, MA
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Willeke A M Blokx
- Department of Pathology, Division Laboratories, Pharmacy and Biomedical Genetics University Medical Center Utrecht, The Netherlands
| | - Raymond L Barnhill
- Department of Translational Research, Curie Institute, Paris Sciences & Letters University, and UFR of Medicine, University of Paris Cité, Paris, France
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8
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Patel P, Hagstrom M, Sharma N, Chen A, Dhillon S, Fumero-Velázquez M, Olivares S, Gerami P. Clinical, Morphologic, and Molecular Features of MAP3K8 Rearranged Spitz Neoplasms: A Retrospective Study Documenting That Bonafide Spitz Melanomas Are Rare. Am J Surg Pathol 2024; 48:437-446. [PMID: 38233731 DOI: 10.1097/pas.0000000000002179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Previous studies regarding the clinical behavior of Spitz neoplasms lack genomic characterization. We aim to assess our hypothesis that most MAP3K8 Spitz neoplasms are indolent despite MAP3K8 being the single most common driver of Spitz melanoma. Further, we aim to identify genomic features associated with aggressive behavior and to better characterize the morphology of these cases. We analyzed the outcomes of MAP3K8 Spitz neoplasms. We also performed a meta-analysis of the outcomes of MAP3K8 Spitz from the literature. Morphologic features were compared with other variants of Spitz using a Student t test and χ 2 test. Two of 35 cases resulted in local recurrence and one of these cases had local regional metastasis; all other cases had no evidence of recurrence (mean follow-up time: 33 mo). MAP3K8 Spitz only rarely results in aggressive behavior. Metastatic cases have genomic mutations associated with tumor progression. Morphologically, MAP3K8 Spitz neoplasms frequently showed nodular silhouette, large cell size, epithelioid morphology, and severe nuclear atypia resulting in more frequent diagnosis as Spitz melanoma. Most MAP3K8 Spitz neoplasms have excellent prognoses, apart from rare cases harboring additional genomic abnormalities associated with tumor progression.
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Affiliation(s)
- Pragi Patel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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9
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Phillips GS, Mengden-Koon S, Dhossche J, LeBoit PE, Goldstein AM, Lee I, Raffeld M, Papanicolau-Sengos A, Sargen MR, Chung J. Atypical Spitz tumor with SQSTM1::NTRK2 fusion: Report of a case with unique spindled cell features. J Cutan Pathol 2024; 51:198-204. [PMID: 38031352 DOI: 10.1111/cup.14565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/28/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
A host of signature genetic alterations have been demonstrated in Spitz neoplasms, most notably fusions of kinase genes (including BRAF, ALK, ROS1, NTRK1, NTRK3, RET, MET, MAP3K8) or variants in HRAS. While there are multiple reports of rearrangements involving NTRK1 and NTRK3 in Spitz tumors, there are very few reports of NTRK2-rearranged Spitz nevi in the literature. This report presents an NTRK2-rearranged atypical Spitz tumor with spindled cell features. The patient was a 6-year-old female with a growing pigmented papule on the back. Histopathological evaluation revealed an asymmetric, biphasic, compound proliferation of melanocytes featuring an epithelioid cell population arranged as variably sized nests and single cells along the basal layer with extension down adnexa, as well as a population of spindled melanocytes with desmoplastic features and loss of Melan-A expression in the dermis. There was partial loss of p16 expression in the epidermal component and diffuse loss in the dermal component. Immunohistochemistry for PRAME, ALK, NTRK1, HRAS Q61R, p53, and BRAF V600E were negative. A SQSTM1::NTRK2 fusion was identified by RNA sequencing. No TERT promoter hotspot variants were detected. This case report expands the known histopathologic spectrum of genetic alterations in Spitz neoplasms.
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Affiliation(s)
- Gregory S Phillips
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Julie Dhossche
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Philip E LeBoit
- Dermatopathology and Oral Pathology Service, Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Alisa M Goldstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Ina Lee
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark Raffeld
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Antonios Papanicolau-Sengos
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael R Sargen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Jina Chung
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
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10
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Daruish M, Ambrogio F, Colagrande A, Marzullo A, Alaggio R, Trilli I, Ingravallo G, Cazzato G. Kinase Fusions in Spitz Melanocytic Tumors: The Past, the Present, and the Future. Dermatopathology (Basel) 2024; 11:112-123. [PMID: 38390852 PMCID: PMC10885070 DOI: 10.3390/dermatopathology11010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
In recent years, particular interest has developed in molecular biology applied to the field of dermatopathology, with a focus on nevi of the Spitz spectrum. From 2014 onwards, an increasing number of papers have been published to classify, stratify, and correctly frame molecular alterations, including kinase fusions. In this paper, we try to synthesize the knowledge gained in this area so far. In December 2023, we searched Medline and Scopus for case reports and case series, narrative and systematic reviews, meta-analyses, observational studies-either longitudinal or historical, case series, and case reports published in English in the last 15 years using the keywords spitzoid neoplasms, kinase fusions, ALK, ROS1, NTRK (1-2-3), MET, RET, MAP3K8, and RAF1. ALK-rearranged Spitz tumors and ROS-1-rearranged tumors are among the most studied and characterized entities in the literature, in an attempt (although not always successful) to correlate histopathological features with the probable molecular driver alteration. NTRK-, RET-, and MET-rearranged Spitz tumors present another studied and characterized entity, with several rearrangements described but as of yet incomplete information about their prognostic significance. Furthermore, although rarer, rearrangements of serine-threonine kinases such as BRAF, RAF1, and MAP3K8 have also been described, but more cases with more detailed information about possible histopathological alterations, mechanisms of etiopathogenesis, and also prognosis are needed. The knowledge of molecular drivers is of great interest in the field of melanocytic diagnostics, and it is important to consider that in addition to immunohistochemistry, molecular techniques such as FISH, PCR, and/or NGS are essential to confirm and classify the different patterns of mutation. Future studies with large case series and molecular sequencing techniques are needed to allow for a more complete and comprehensive understanding of the role of fusion kinases in the spitzoid tumor family.
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Affiliation(s)
- Maged Daruish
- Dorset County Hospital NHS Foundation Trust, Dorchester DT1 2JY, UK
| | - Francesca Ambrogio
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Anna Colagrande
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Andrea Marzullo
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Rita Alaggio
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Irma Trilli
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Giuseppe Ingravallo
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gerardo Cazzato
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", 70124 Bari, Italy
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11
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Schoelinck J, Pissaloux D, Mouthon M, Vergara R, de la Fouchardière A. [Clinical, histological and genetic correlations in melanocytic tumours with chromosomal rearrangements]. Ann Pathol 2024:S0242-6498(24)00031-2. [PMID: 38320889 DOI: 10.1016/j.annpat.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/08/2024]
Abstract
In some tumoral subtypes chromosomal translocations lead to an oncogenic chimeric protein acting as a tumorigenesis driver event. The main fusion model combines the promoter swapping of an inactivated tumor suppressor gene and a functional kinase that evades its regulatory system. The range of described fusions keeps growing in the 2023 WHO classification of melanocytic tumours. It is not limited to the group of Spitz tumours as previously but now extends to blue tumours and dermal tumours with a melanocytic phenotype. Molecular pathology helps detect these anomalies using clinical and morphological features. This analysis is essential as this strongly conditions the adapted local treatment of such tumours who are often overtreated.
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Affiliation(s)
- Jeremy Schoelinck
- Service de biopathologie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, Lyon, France.
| | - Daniel Pissaloux
- Service de biopathologie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, Lyon, France
| | - Maxime Mouthon
- Service de biopathologie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, Lyon, France
| | - Rémi Vergara
- Service de biopathologie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, Lyon, France
| | - Arnaud de la Fouchardière
- Service de biopathologie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, Lyon, France; Équipe labellisée Ligue contre le cancer, Inserm 1052, CNRS 5286, centre Léon-Bérard, Cancer Research Center of Lyon, université de Lyon, université Claude-Bernard Lyon 1, Lyon, France
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12
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Chatzopoulos K, Syrnioti A, Linos K. Spitz Melanocytic Tumors: A Fascinating 75-Year Journey. Genes (Basel) 2024; 15:195. [PMID: 38397186 PMCID: PMC10887813 DOI: 10.3390/genes15020195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024] Open
Abstract
Over the last 75 years, our understanding of Spitz lesions has undergone substantial evolution. Initially considered a specific type of melanoma, the perception has shifted towards recognizing Spitz lesions as a spectrum comprising Spitz nevi, Spitz melanocytomas, and Spitz melanomas. Spitz lesions are known for posing a significant diagnostic challenge regarding the distinction between benign neoplasms displaying atypical traits and melanomas. A comprehensive understanding of their molecular basis and genomic aberrations has significantly improved precision in classifying and diagnosing these challenging lesions. The primary aim of this review is to encapsulate the current understanding of the molecular pathogenesis and distinct clinicopathologic characteristics defining this intriguing set of tumors.
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Affiliation(s)
- Kyriakos Chatzopoulos
- Department of Pathology, Aristotle University, 54636 Thessaloniki, Greece; (K.C.); (A.S.)
| | - Antonia Syrnioti
- Department of Pathology, Aristotle University, 54636 Thessaloniki, Greece; (K.C.); (A.S.)
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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13
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González-Muñoz JF, Sánchez-Sendra B, Monteagudo C. Diagnostic Algorithm to Subclassify Atypical Spitzoid Tumors in Low and High Risk According to Their Methylation Status. Int J Mol Sci 2023; 25:318. [PMID: 38203489 PMCID: PMC10779069 DOI: 10.3390/ijms25010318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Current diagnostic algorithms are insufficient for the optimal clinical and therapeutic management of cutaneous spitzoid tumors, particularly atypical spitzoid tumors (AST). Therefore, it is crucial to identify new markers that allow for reliable and reproducible diagnostic assessment and can also be used as a predictive tool to anticipate the individual malignant potential of each patient, leading to tailored individual therapy. Using Reduced Representation Bisulfite Sequencing (RRBS), we studied genome-wide methylation profiles of a series of Spitz nevi (SN), spitzoid melanoma (SM), and AST. We established a diagnostic algorithm based on the methylation status of seven cg sites located in TETK4P2 (Tektin 4 Pseudogene 2), MYO1D (Myosin ID), and PMF1-BGLAP (PMF1-BGLAP Readthrough), which allows the distinction between SN and SM but is also capable of subclassifying AST according to their similarity to the methylation levels of Spitz nevi or spitzoid melanoma. Thus, our epigenetic algorithm can predict the risk level of AST and predict its potential clinical outcomes.
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Affiliation(s)
| | - Beatriz Sánchez-Sendra
- Skin Cancer Research Group, Biomedical Research Institute INCLIVA, 46010 Valencia, Spain (B.S.-S.)
| | - Carlos Monteagudo
- Skin Cancer Research Group, Biomedical Research Institute INCLIVA, 46010 Valencia, Spain (B.S.-S.)
- Department of Pathology, University of Valencia, 46010 Valencia, Spain
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14
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Urso C. Spitz Tumors and Melanoma in the Genomic Age: A Retrospective Look at Ackerman's Conundrum. Cancers (Basel) 2023; 15:5834. [PMID: 38136379 PMCID: PMC10741987 DOI: 10.3390/cancers15245834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
After 25 years, "Ackerman's conundrum", namely, the distinction of benign from malignant Spitz neoplasms, remains challenging. Genomic studies have shown that most Spitz tumors harbor tyrosine and serine/threonine kinase fusions, including ALK, ROS1, NTRK1, NTRK2, NTRK3, BRAF and MAP3K8, or some mutations, such as HRAS and MAP3K8. These chromosomal abnormalities act as drivers, initiating the oncogenetic process and conferring basic bio-morphological features. Most Spitz tumors show no additional genomic alterations or few ones; others harbor a variable number of mutations, capable of conferring characteristics related to clinical behavior, including CDKN2A deletion and TERT-p mutation. Since the accumulation of mutations is gradual and progressive, tumors appear to form a bio-morphologic spectrum, in which they show a progressive increase of clinical risk and histological atypia. In this context, a binary classification Spitz nevus-melanoma appears as no longer adequate, not corresponding to the real genomic substrate of lesions. A ternary classification Spitz nevus-Spitz melanocytoma-Spitz melanoma is more adherent to the real neoplastic pathway, but some cases with intermediate ambiguous features remain difficult to diagnose. A prognostic stratification of Spitz tumors, based on the morphologic and genomic characteristics, as a complement to the diagnosis, may contribute to better treatment plans for patients.
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Affiliation(s)
- Carmelo Urso
- Dermatopathology Study Center of Florence, I-50129 Florence, Italy
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15
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Mosquera-Zamudio A, Launet L, Del Amor R, Moscardó A, Colomer A, Naranjo V, Monteagudo C. A Spitzoid Tumor dataset with clinical metadata and Whole Slide Images for Deep Learning models. Sci Data 2023; 10:704. [PMID: 37845235 PMCID: PMC10579378 DOI: 10.1038/s41597-023-02585-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/22/2023] [Indexed: 10/18/2023] Open
Abstract
Spitzoid tumors (ST) are a group of melanocytic tumors of high diagnostic complexity. Since 1948, when Sophie Spitz first described them, the diagnostic uncertainty remains until now, especially in the intermediate category known as Spitz tumor of unknown malignant potential (STUMP) or atypical Spitz tumor. Studies developing deep learning (DL) models to diagnose melanocytic tumors using whole slide imaging (WSI) are scarce, and few used ST for analysis, excluding STUMP. To address this gap, we introduce SOPHIE: the first ST dataset with WSIs, including labels as benign, malignant, and atypical tumors, along with the clinical information of each patient. Additionally, we explain two DL models implemented as validation examples using this database.
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Affiliation(s)
- Andrés Mosquera-Zamudio
- Pathology Department Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain.
- INCLIVA, Instituto de Investigación Sanitaria, Valencia, Spain.
| | - Laëtitia Launet
- Instituto Universitario de Investigación en Tecnología Centrada en el Ser Humano, HUMAN-tech Universitat Politècnica de València, Valencia, Spain
| | - Rocío Del Amor
- Instituto Universitario de Investigación en Tecnología Centrada en el Ser Humano, HUMAN-tech Universitat Politècnica de València, Valencia, Spain
| | - Anaïs Moscardó
- Pathology Department Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Adrián Colomer
- Instituto Universitario de Investigación en Tecnología Centrada en el Ser Humano, HUMAN-tech Universitat Politècnica de València, Valencia, Spain
- valgrAI: Valencian Graduate School and Research Network of Artificial Intelligence, Valencia, Spain
| | - Valery Naranjo
- Instituto Universitario de Investigación en Tecnología Centrada en el Ser Humano, HUMAN-tech Universitat Politècnica de València, Valencia, Spain
- valgrAI: Valencian Graduate School and Research Network of Artificial Intelligence, Valencia, Spain
| | - Carlos Monteagudo
- Pathology Department Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain.
- INCLIVA, Instituto de Investigación Sanitaria, Valencia, Spain.
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16
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Fumero-Velázquez M, Hagstrom M, Dhillon S, Olivares S, Jennings LJ, Dittman D, Sukhanova M, Arva NC, Goldstein SD, Theos A, Pavlidakey P, Carr Z, Gerami P. Agminated presentation of fusion-driven melanocytic neoplasms. J Cutan Pathol 2023; 50:913-921. [PMID: 37407520 DOI: 10.1111/cup.14482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The conventionally understood pathogenesis of agminated Spitz nevi includes a mosaic HRAS mutation followed by copy number gains in 11p. However, we have recently observed agminated presentations of fusion-driven melanocytic neoplasms. METHODS We retrieved cases from our database of benign fusion-induced melanocytic neoplasms with an agminated presentation. Both the primary lesion and the secondary lesion were sequenced. TERT-promoter mutational testing and the melanoma fluorescence in situ hybridization assay were also performed. RESULTS Three cases were included. Two had a PRKCA fusion (partners ATP2B4 and MPZL1) and one had a ZCCHC8::ROS1 fusion. None of the cases met morphologic or molecular criteria for malignancy. There was no evidence of tumor progression in secondary lesions. The same fusion was identified in the primary and secondary lesions. None of the patients developed evidence of nodal or systemic metastasis. CONCLUSIONS We present accumulating evidence that fusion-driven melanocytic neoplasms can present with an agminated presentation. The differential diagnosis of an agminated presentation versus a locally recurrent or potentially locally metastatic tumor is critical, and accurate diagnosis has significant prognostic and therapeutic consequences for the patient. As with HRAS mutations, fusion-driven melanocytic tumors may have an agminated presentation.
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Affiliation(s)
- Mónica Fumero-Velázquez
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael Hagstrom
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Soneet Dhillon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lawrence J Jennings
- Division of Molecular Pathology, Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - David Dittman
- Division of Molecular Pathology, Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Madina Sukhanova
- Division of Molecular Pathology, Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nicoleta C Arva
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Seth D Goldstein
- Department of Surgery, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy Theos
- Department of Dermatology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter Pavlidakey
- Department of Dermatology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Zachary Carr
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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17
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Leupold D. [Fluorescence detection to diagnose melanoma : An alternative objective method for dermatohistology]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:725-729. [PMID: 37351600 DOI: 10.1007/s00105-023-05182-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Dermatohistological assessment is the gold standard in the diagnosis of melanoma. As a subjective method, this depends, among other things, on the expertise of the examiner. AIM A new objective method of investigation-dermatohistofluoroscopy-aims to improve the diagnostic reliability of melanoma diagnosis. MATERIALS AND METHODS The ultra-weak spectrally resolved fluorescence of melanin of pigment-bearing skin cells is a reliable indicator of the malignancy of the tissue to be diagnosed. Using a special laser spectroscopic method, this fluorescence can be measured on histological specimen (and also on tissue in vivo and on excidate). RESULTS AND DISCUSSION Melanocytes from normally pigmented skin, nevomelanocytes from benign and dysplastic nevi, and melanoma cells each show characteristic, different fluorescence spectra. If these cell types are shown spatially resolved in different colors on the preparation to be diagnosed, they give the histologist an objective basis for the diagnosis, even in difficult cases, e.g., the so-called stumbling blocks of melanoma diagnosis such as Spitzoid tumors. Currently, the method can only be used for Fitzpatrick skin types 1 and 2. In addition, a separate second measurement signal at 400 nm can be used to identify tumor breakthrough through the basement membrane. This signal is collagen bound, so it also appears in amelanotic melanomas, to which the method is otherwise inherently inapplicable.
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Affiliation(s)
- Dieter Leupold
- vormals LTB Lasertechnik Berlin GmbH, Am Studio 2c, 12489, Berlin, Deutschland.
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18
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Miller EM, Linos K, Bacchi CE, Gru AA, Raghavan SS. Histopathologic and molecular characterization of BAP-1-inactivated melanoma. J Cutan Pathol 2023; 50:349-357. [PMID: 36285428 DOI: 10.1111/cup.14346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 10/07/2022] [Accepted: 10/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND BRCA1-associated protein 1 (BAP-1) is a deubiquitylase that functions as a tumor suppressor, regulating multiple cellular processes including cell cycle control, differentiation, cell death, and DNA repair. BAP-1-inactivated melanocytic tumors (BIMTs) have recently been described and are characterized by epithelioid cytomorphology, are often clonal in appearance, and typically do not recur or show malignant transformation on follow-up. AIM To describe the histopathologic and molecular characterization of five cases of BAP-1-inactivated cutaneous malignant melanomas. METHODS The archives at two separate institutions were retrospectively searched for tumors classified as melanoma with loss of BAP-1 via immunohistochemistry. Five cases were identified. These cases were classified as malignant melanoma based on cytomorphology, immunohistochemistry, and ancillary molecular testing. The clinical demographics were recorded, along with the histomorphologic features of each case. Genomic analysis for all cases was performed via OncoScan. RESULTS The five reviewed cases consisted of two females and three males ranging from 67 to 74 years in age. Molecular characterization of each case was performed using OncoScan. Microarray assay showed that there was a complete deletion of 3p in all cases, BRAF V600E mutation in two cases, NRAS missense variant in one case, and loss of 9p in three cases. All cases showed malignant copy number alterations. CONCLUSIONS Herein we describe five cases of BAP-1-inactivated melanomas confirmed by histomorphology and immunohistochemistry, all of which show malignant copy number profiles including loss of 3p. In addition, we provide a case of a likely BIMT showing progression to BAP-1-inactivated melanoma on a 16-year follow-up.
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Affiliation(s)
- Elisabeth M Miller
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Konstantinos Linos
- Department Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
- NH and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | - Alejandro A Gru
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Shyam S Raghavan
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
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19
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Andea AA. Molecular testing in melanoma for the surgical pathologist. Pathology 2023; 55:245-257. [PMID: 36653236 DOI: 10.1016/j.pathol.2022.12.343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
The diagnostic work-up of melanocytic tumours has undergone significant changes in the last years following the exponential growth of molecular assays. For the practising pathologist it is often difficult to sort through the multitude of different tests that are currently available for clinical use. The molecular tests used in melanocytic pathology can be broadly divided into four categories: (1) tests that predict response to systemic therapy in melanoma; (2) tests that predict prognosis in melanoma; (3) tests useful in determining the type or class of melanocytic tumour; and (4) tests useful in the differential diagnosis of naevus versus melanoma (primarily used as an aid in the diagnosis of histologically ambiguous melanocytic lesions). This review will present an updated synopsis of major molecular ancillary tests used in clinical practice.
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Affiliation(s)
- Aleodor A Andea
- Departments of Pathology and Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
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20
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Hagstrom M, Fumero-Velázquez M, Dhillon S, Olivares S, Gerami P. An update on genomic aberrations in Spitz naevi and tumours. Pathology 2023; 55:196-205. [PMID: 36631338 DOI: 10.1016/j.pathol.2022.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
Spitz neoplasms continue to be a diagnostic challenge for dermatopathologists and are defined by distinctive morphological and genetic features. With the recent advancements in genomic sequencing, the classification, diagnosis, and prognostication of these tumours have greatly improved. Several subtypes of Spitz neoplasms have been identified based on their specific genomic aberrations, which often correlate with distinctive morphologies and biological behaviour. These genetic driver events can be classified into four major groups, including: (1) mutations [HRAS mutations (with or without 11p amplification) and 6q23 deletions]; (2) tyrosine kinase fusions (ROS1, ALK, NTRK1-3, MET and RET); (3) serine/threonine kinase fusions and mutations (BRAF, MAP3K8, and MAP2K1); and (4) other rare genomic aberrations. These driver genomic events are hypothesised to enable the initial proliferation of melanocytes and are often accompanied by additional genomic aberrations that affect biological behaviour. The discovery of theses genomic fusions has allowed for a more objective definition of a Spitz neoplasm. Further studies have shown that the majority of morphologically Spitzoid appearing melanocytic neoplasms with aggressive behaviour are in fact BRAF or NRAS mutated tumours mimicking Spitz. Truly malignant fusion driven Spitz neoplasms may occur but are relatively uncommon, and biomarkers such as homozygous 9p21 (CDKN2A) deletions or TERT-p mutations can have some prognostic value in such cases. In this review, we discuss the importance and various methods of identifying Spitz associated genomic fusions to help provide more definitive classification. We also discuss characteristic features of the various fusion subtypes as well as prognostic biomarkers.
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Affiliation(s)
- Michael Hagstrom
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mónica Fumero-Velázquez
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Soneet Dhillon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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21
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Modern Concepts in Melanocytic Tumors. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:402-412. [PMID: 36649787 DOI: 10.1016/j.ad.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/29/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023] Open
Abstract
The advent of molecular pathology has fueled unprecedented advances in the diagnosis and understanding of melanocytic tumors. These advances, however, have also generated concepts that may be difficult to grasp for clinical practitioners, who are not always conversant with the array of genetic techniques employed in the laboratory. These same practitioners, however, are being increasingly called on to provide treatments that are often based on the latest molecular findings for melanocytic tumors. We review the most recent concepts in the pathway classification of melanocytic tumors, including intermediate lesions known as melanocytomas. We examine the genetic and molecular techniques used to study these tumors, look at where they overlap, and discuss their limitations and some of the most difficult-to-interpret results.
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22
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Deep Learning for Skin Melanocytic Tumors in Whole-Slide Images: A Systematic Review. Cancers (Basel) 2022; 15:cancers15010042. [PMID: 36612037 PMCID: PMC9817526 DOI: 10.3390/cancers15010042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
The rise of Artificial Intelligence (AI) has shown promising performance as a support tool in clinical pathology workflows. In addition to the well-known interobserver variability between dermatopathologists, melanomas present a significant challenge in their histological interpretation. This study aims to analyze all previously published studies on whole-slide images of melanocytic tumors that rely on deep learning techniques for automatic image analysis. Embase, Pubmed, Web of Science, and Virtual Health Library were used to search for relevant studies for the systematic review, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Articles from 2015 to July 2022 were included, with an emphasis placed on the used artificial intelligence methods. Twenty-eight studies that fulfilled the inclusion criteria were grouped into four groups based on their clinical objectives, including pathologists versus deep learning models (n = 10), diagnostic prediction (n = 7); prognosis (n = 5), and histological features (n = 6). These were then analyzed to draw conclusions on the general parameters and conditions of AI in pathology, as well as the necessary factors for better performance in real scenarios.
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23
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Rousi EK, Kallionpää RA, Kallionpää RE, Juteau SM, Talve LAI, Hernberg MM, Vihinen PP, Kähäri VM, Koskivuo IO. Increased incidence of melanoma in children and adolescents in Finland in 1990-2014: nationwide re-evaluation of histopathological characteristics. Ann Med 2022; 54:244-252. [PMID: 35037531 PMCID: PMC8765276 DOI: 10.1080/07853890.2022.2026001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Changes in the incidence of melanoma in children and adolescents have been reported in Europe and in the USA in the recent decades. AIMS The aim of this study was to examine the incidence of paediatric and adolescent melanomas in Finland in 1990-2014, and the associated clinical and histopathological characteristics to reveal temporal trends, such as changes in diagnostic sensitivity of Spitzoid melanomas. METHODS Information on 122 patients diagnosed with cutaneous melanoma at 0-19 years of age in Finland in 1990-2014 were retrieved from the Finnish Cancer Registry. 73 primary melanoma archival samples were re-evaluated by two dermatopathologists to allow comparability over time. RESULTS A 5.6% annual increase was observed in the incidence of melanoma among children and adolescents during the study period. Fifty-six tumours were confirmed as malignant melanomas in the re-evaluation. After correction for tumour misclassification in the Cancer Registry, the age-adjusted annual incidence was estimated to have increased from 1.4/1 000 000 in 1990-1994 to 5.8/1 000 000 in 2010-2014. The change in incidence was most prominent among adolescents and in Spitzoid melanoma subtype. Melanomas diagnosed 1990-2002 and 2003-2014 did not differ in terms of their clinicopathological characteristics or prognosis (hazard ratio for melanoma-related death 1.53, 95% CI 0.30 to 7.88). Spitzoid melanomas were diagnosed at a younger age, were of higher stage and had higher Clark level than other melanomas, yet the hazard ratio for death was 0.52 (95% CI 0.10 to 2.58) for Spitzoid versus other melanomas. CONCLUSIONS The incidence of cutaneous melanoma has clearly increased among the young in Finland, especially among adolescents. No evidence for overdiagnosis of Spitzoid melanomas as the underlying cause of the increased incidence was observed.Key messageA nationwide retrospective re-evaluation of the cutaneous melanomas recorded in the Finnish Cancer Registry among patients aged 0-19 years in Finland in 1990-2014 revealed an approximately 4-fold increase in the incidence. The increase in the incidence was most prominent among adolescents and in the Spitzoid melanoma subtype. Our results contrast those reported in other countries, where the incidence of melanoma among adolescents has declined.
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Affiliation(s)
- Emma K Rousi
- Department of Plastic and General Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Roope A Kallionpää
- Institute of Biomedicine, University of Turku, University of Turku, Turku, Finland
| | - Roosa E Kallionpää
- Auria Biobank, Turku University Hospital and University of Turku, Turku, Finland
| | - Susanna M Juteau
- Central Laboratory of Pathology, Helsinki University Hospital, Helsinki, Finland
| | - Lauri A I Talve
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Micaela M Hernberg
- Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Pia P Vihinen
- Tyks Cancer Centre and FICAN West, University of Turku and Turku University Hospital, Turku, Finland
| | - Veli-Matti Kähäri
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland.,FICAN West Cancer Centre Laboratory, University of Turku and Turku University Hospital, Turku, Finland
| | - Ilkka O Koskivuo
- Department of Plastic and General Surgery, Turku University Hospital and University of Turku, Turku, Finland
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24
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Moran JMT, Le LP, Nardi V, Golas J, Farahani AA, Signorelli S, Onozato ML, Foreman RK, Duncan LM, Lawrence DP, Lennerz JK, Dias-Santagata D, Hoang MP. Identification of fusions with potential clinical significance in melanoma. Mod Pathol 2022; 35:1837-1847. [PMID: 35871080 DOI: 10.1038/s41379-022-01138-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 12/24/2022]
Abstract
Though uncommon in melanoma, gene fusions may have therapeutic implications. Next generation sequencing-based clinical assays, designed to detect relevant gene fusions, mutations, and copy number changes, were performed on 750 melanomas (375 primary and 375 metastases) at our institution from 2014-2021. These included 599 (80%) cutaneous, 38 (5%) acral, 11 (1.5%) anorectal, 23 (3%) sinonasal, 27 (3.6%) eye (uveal/ conjunctiva), 11 (1.5%) genital (vulva/penile), and 41 (5.5%) melanomas of unknown primary. Sixteen fusions (2%) were detected in samples from 16 patients: 12/599 (2%) cutaneous, 2/38 (5%) acral, 1/9 (11%) vulva, 1/23(4.3%) sinonasal; and 12/16 (75%) fusions were potentially targetable. We identified two novel rearrangements: NAGS::MAST2 and NOTCH1::GNB1; and two fusions that have been reported in other malignancies but not in melanoma: CANT1::ETV4 (prostate cancer) and CCDC6::RET (thyroid cancer). Additional fusions, previously reported in melanoma, included: EML4::ALK, MLPH::ALK, AGAP3::BRAF, AGK::BRAF, CDH3::BRAF, CCT8::BRAF, DIP2B::BRAF, EFNB1::RAF1, LRCH3::RAF1, MAP4::RAF1, RUFY1::RAF1, and ADCY2::TERT. Fusion positive melanomas harbored recurrent alterations in TERT and CDKN2A, among others. Gene fusions were exceedingly rare (0.2%) in BRAF/RAS/NF1-mutant tumors and were detected in 5.6% of triple wild-type melanomas. Interestingly, gene rearrangements were significantly enriched within the subset of triple wild-type melanomas that harbor TERT promoter mutations (18% versus 2%, p < 0.0001). Thirteen (81%) patients were treated with immunotherapy for metastatic disease or in the adjuvant setting. Six of 12 (50%) patients with potentially actionable fusions progressed on immunotherapy, and 3/6 (50%) were treated with targeted agents (ALK and MEK inhibitors), 2 off-label and 1 as part of a clinical trial. One patient with an AGAP3::BRAF fusion positive melanoma experienced a 30-month long response to trametinib. We show that, detecting fusions, especially in triple wild-type melanomas with TERT promoter mutations, may have a clinically significant impact in patients with advanced disease who have failed front-line immunotherapy.
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Affiliation(s)
- Jakob M T Moran
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Long P Le
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Josephine Golas
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander A Farahani
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sylvia Signorelli
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maristela L Onozato
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ruth K Foreman
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lyn M Duncan
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Donald P Lawrence
- Division of Medical Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Jochen K Lennerz
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dora Dias-Santagata
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Mai P Hoang
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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25
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Liu C, Zhao Z, Lv H, Yu J, Zhang P. Microneedles-mediated drug delivery system for the diagnosis and treatment of melanoma. Colloids Surf B Biointerfaces 2022; 219:112818. [PMID: 36084509 DOI: 10.1016/j.colsurfb.2022.112818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/16/2022] [Accepted: 08/29/2022] [Indexed: 11/26/2022]
Abstract
As an emerging novel drug delivery system, microneedles (MNs) have a wide range of applications in the medical field. They can overcome the physiological barriers of the skin, penetrate the outermost skin of the human body, and form hundreds of reversible microchannels to enhance the penetration of drugs and deliver drugs to the diseased sites. So they have great applications in the diagnosis and treatment of melanoma. Melanoma is a kind of malignant tumor, the survival rate of patients with metastases is extremely low. The traditional methods of surgery and drug treatment for melanoma are often accompanied by large adverse reactions in the whole body, and the drug concentration is low. The use of MNs for transdermal administration can increase the drug concentration, reduce adverse reactions in the treatment process, and have good therapeutic effect on melanoma. This paper introduced various types of MNs and their preparation methods, summarized the diagnosis and various treatment options for melanoma with MNs, focused on the treatment of melanoma with dissolved MNs, and made prospect of MNs-mediated transdermal drug delivery in the treatment of melanoma.
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Affiliation(s)
- Cheng Liu
- Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, China
| | - Zhining Zhao
- Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, China
| | - Hongqian Lv
- Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, China
| | - Jia Yu
- Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, China.
| | - Peng Zhang
- Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, China.
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26
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Zaremba A, Jansen P, Murali R, Mayakonda A, Riedel A, Philip M, Rose C, Schaller J, Müller H, Kutzner H, Möller I, Stadtler N, Kretz J, Sucker A, Bankfalvi A, Livingstone E, Zimmer L, Horn S, Paschen A, Plass C, Schadendorf D, Hadaschik E, Lutsik P, Griewank K. Genetic and methylation profiles distinguish benign, malignant and spitzoid melanocytic tumors. Int J Cancer 2022; 151:1542-1554. [PMID: 35737508 PMCID: PMC9474633 DOI: 10.1002/ijc.34187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 11/07/2022]
Abstract
Accurate classification of melanocytic tumors is important for prognostic evaluation, treatment and follow-up protocols of patients. The majority of melanocytic proliferations can be classified solely based on clinical and pathological criteria, however in select cases a definitive diagnostic assessment remains challenging and additional diagnostic biomarkers would be advantageous. We analyzed melanomas, nevi, Spitz nevi and atypical spitzoid tumors using parallel sequencing (exons of 611 genes and 507 gene translocation analysis) and methylation arrays (850k Illumina EPIC). By combining detailed genetic and epigenetic analysis with reference-based and reference-free DNA methylome deconvolution we compared Spitz nevi to nevi and melanoma and assessed the potential for these methods in classifying challenging spitzoid tumors. Results were correlated with clinical and histologic features. Spitz nevi were found to cluster independently of nevi and melanoma and demonstrated a different mutation profile. Multiple copy number alterations and TERT promoter mutations were identified only in melanomas. Genome-wide methylation in Spitz nevi was comparable to benign nevi while the Leukocytes UnMethylation for Purity (LUMP) algorithm in Spitz nevi was comparable to melanoma. Histologically difficult to classify Spitz tumor cases were assessed which, based on methylation arrays, clustered between Spitz nevi and melanoma and in terms of genetic profile or copy number variations demonstrated worrisome features suggesting a malignant neoplasm. Comprehensive sequencing and methylation analysis verify Spitz nevi as an independent melanocytic entity distinct from both nevi and melanoma. Combined genetic and methylation assays can offer additional insights in diagnosing difficult to classify Spitzoid tumors.
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Affiliation(s)
- Anne Zaremba
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Philipp Jansen
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Rajmohan Murali
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Anand Mayakonda
- Division of Cancer Epigenomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Helmholtz International Graduate School for Cancer Research, Heidelberg, Germany
- Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Anna Riedel
- Division of Cancer Epigenomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Helmholtz International Graduate School for Cancer Research, Heidelberg, Germany
- Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Manuel Philip
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | | | | | | | - Heinz Kutzner
- Dermatopathologie Friedrichshafen, Medical faculty of the University Leipzig, Leipzig, Germany
| | - Inga Möller
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Nadine Stadtler
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Julia Kretz
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Antje Sucker
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Agnes Bankfalvi
- Department of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Susanne Horn
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany, and German Cancer Consortium (DKTK), Heidelberg, Germany
- Rudolf-Schönheimer-Institute of Biochemistry, Medical faculty of the University Leipzig, Leipzig, Germany
| | - Annette Paschen
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Christoph Plass
- Division of Cancer Epigenomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Eva Hadaschik
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Pavlo Lutsik
- Division of Cancer Epigenomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Klaus Griewank
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany, and German Cancer Consortium (DKTK), Heidelberg, Germany
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27
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Clark HE, Huang YYM, Vance GH, Alomari AK. Fatal melanoma with a novel MYO5A-BRAF fusion and small associated conventional nevus: A case report and review of literature. J Cutan Pathol 2022; 49:808-812. [PMID: 35596628 PMCID: PMC9545590 DOI: 10.1111/cup.14263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 12/01/2022]
Abstract
Kinase fusions play an important role in the pathogenesis of Spitz neoplasms and occasionally non-Spitz neoplasms. We report a case of a 19-year-old woman with a growing nodule on the scalp, morphologically consistent with a diagnosis of melanoma with epithelioid features arising in association with small nevus. This tumor aggressively metastasized and failed to respond to immunotherapy. Next-generation sequencing of a metastatic focus revealed an MYO5A-BRAF kinase fusion with a low mutational burden and fluorescence in situ hybridization (FISH) of the primary melanoma showed similar results. FISH testing of the associated nevus failed because of technical reasons. MYO5A has rarely been reported as the fusion partner with BRAF-rearranged melanocytic tumors. Moreover, this case raises speculations and contributes to the growing literature on the pathogenesis, nomenclature, and tumorigenic pathways in kinase-fusion melanomas. The patient succumbed to disease, which is in concordance with some literature suggesting aggressive behavior of BRAF fusion melanomas with TERT promoter mutations.
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Affiliation(s)
| | - Yuan Yu Michael Huang
- Department of DermatologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Gail H. Vance
- Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolisIndianaUSA,Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Ahmed K. Alomari
- Department of DermatologyIndiana University School of MedicineIndianapolisIndianaUSA,Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolisIndianaUSA
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28
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Waqar S, George S, Jean-Baptiste W, Yusuf Ali A, Inyang B, Koshy FS, George K, Poudel P, Chalasani R, Goonathilake MR, Mohammed L. Recognizing Histopathological Simulators of Melanoma to Avoid Misdiagnosis. Cureus 2022; 14:e26127. [PMID: 35875272 PMCID: PMC9299949 DOI: 10.7759/cureus.26127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/20/2022] [Indexed: 11/05/2022] Open
Abstract
Melanocytic lesions have a wide morphological spectrum, ranging from benign nevi to malignant melanoma. In contrast to a diagnosis of a benign nevus, a diagnosis of melanoma could mean intensive treatment, lifetime monitoring, and a worse prognosis. Therefore, melanocytic tumors are notoriously challenging and associated with a high risk of litigation in surgical pathology. After describing the basic features of nevi and melanoma, this article describes the detailed clinical and histological features of those lesions that share many similar features with melanoma. The entities included are Spitz nevi and atypical Spitz tumors (AST), Reed nevus, dysplastic nevus, cellular blue nevus (CBN), deep penetrating nevus, combined nevus, recurrent nevus, irritated nevus, congenital pattern nevus, acral nevus, and nevi of special sites. Knowledge of these imitators can help pathologists distinguish between benign and malignant cases and avoid misdiagnosis.
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29
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Cheng TW, Ahern MC, Giubellino A. The Spectrum of Spitz Melanocytic Lesions: From Morphologic Diagnosis to Molecular Classification. Front Oncol 2022; 12:889223. [PMID: 35747831 PMCID: PMC9209745 DOI: 10.3389/fonc.2022.889223] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
Spitz tumors represent a distinct subtype of melanocytic lesions with characteristic histopathologic features, some of which are overlapping with melanoma. More common in the pediatric and younger population, they can be clinically suspected by recognizing specific patterns on dermatoscopic examination, and several subtypes have been described. We now classify these lesions into benign Spitz nevi, intermediate lesions identified as “atypical Spitz tumors” (or Spitz melanocytoma) and malignant Spitz melanoma. More recently a large body of work has uncovered the molecular underpinning of Spitz tumors, including mutations in the HRAS gene and several gene fusions involving several protein kinases. Here we present an overarching view of our current knowledge and understanding of Spitz tumors, detailing clinical, histopathological and molecular features characteristic of these lesions.
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Affiliation(s)
- Tiffany W. Cheng
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Madeline C. Ahern
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Alessio Giubellino
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
- *Correspondence: Alessio Giubellino,
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30
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Ricci C, Dika E, Ambrosi F, Lambertini M, Veronesi G, Barbara C. Cutaneous Melanomas: A Single Center Experience on the Usage of Immunohistochemistry Applied for the Diagnosis. Int J Mol Sci 2022; 23:5911. [PMID: 35682589 PMCID: PMC9180684 DOI: 10.3390/ijms23115911] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 12/12/2022] Open
Abstract
Cutaneous melanoma (cM) is the deadliest of all primary skin cancers. Its prognosis is strongly influenced by the stage at diagnosis, with early stages having a good prognosis and being potentially treatable with surgery alone; advanced stages display a much worse prognosis, with a high rate of recurrence and metastasis. For this reason, the accurate and early diagnosis of cM is crucial-misdiagnosis may have extremely dangerous consequences for the patient and drastically reduce their chances of survival. Although the histological exam remains the "gold standard" for the diagnosis of cM, a continuously increasing number of immunohistochemical markers that could help in diagnosis, prognostic characterization, and appropriate therapeutical choices are identified every day, with some of them becoming part of routine practice. This review aims to discuss and summarize all the data related to the immunohistochemical analyses that are potentially useful for the diagnosis of cM, thus rendering it easier to appropriately applicate to routine practice. We will discuss these topics, as well as the role of these molecules in the biology of cM and potential impact on diagnosis and treatment, integrating the literature data with the experience of our surgical pathology department.
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Affiliation(s)
- Costantino Ricci
- Pathology Unit, Ospedale Maggiore, 40139 Bologna, Italy; (C.R.); (F.A.)
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40139 Bologna, Italy;
| | - Emi Dika
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40139 Bologna, Italy;
| | - Francesca Ambrosi
- Pathology Unit, Ospedale Maggiore, 40139 Bologna, Italy; (C.R.); (F.A.)
| | - Martina Lambertini
- Dermatology Unit, IRCCS Policlinico Sant’Orsola-Malpighi, University of Bologna, 40139 Bologna, Italy; (M.L.); (G.V.)
| | - Giulia Veronesi
- Dermatology Unit, IRCCS Policlinico Sant’Orsola-Malpighi, University of Bologna, 40139 Bologna, Italy; (M.L.); (G.V.)
| | - Corti Barbara
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40139 Bologna, Italy
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31
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Santandrea G, Valli R, Zanetti E, Ragazzi M, Pampena R, Longo C, Lai M, Piana S, Cesinaro AM. Comparative Analysis of PRAME Expression in 127 Acral and Nail Melanocytic Lesions. Am J Surg Pathol 2022; 46:579-590. [PMID: 35275883 DOI: 10.1097/pas.0000000000001878] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRAME (PReferentially expressed Antigen in MElanoma), a cancer testis antigen expressed in low levels in gonadal, endometrial, and adrenal gland tissues, has been recently considered a valuable tool in the differential diagnosis between benign and malignant melanocytic lesions. The aim of the current study is to perform PRAME immunostaining on a large series of benign and malignant acral lesions to evaluate the reproducibility of data reported in the literature and to validate PRAME as an affordable tool in the differential diagnosis between benign and malignant acral melanocytic tumors. Immunohistochemical analysis for PRAME was performed in 127 benign and malignant acral and nail melanocytic lesions. To better correlate PRAME expression with the nature (benign vs. malignant) of the lesions, we categorized PRAME tumor cells percentage positivity and intensity in a cumulative score obtained by adding the quartile of positive tumor cells (0, 1+, 2+, 3+, 4+) to PRAME expression intensity in tumor cells (0, 1+, 2+, 3+). Adopting an arbitrary PRAME expression score of < 5 versus ≥5 resulted in a correct identification of 82.5% of benign and 87.1% of malignant lesions. PRAME immunohistochemistry demonstrated good sensitivity and specificity in the diagnosis of acral melanocytic lesions, however, in line with the previous literature, we identified a subset of challenging cases such as acral Spitz nevi, in situ melanomas, and small, thin, invasive melanomas in which PRAME did not correlate with morphologic features. This suggests that PRAME can be a valid tool to be incorporated in a diagnostic clinicopathologic algorithm, subject to morphologic characteristics.
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Affiliation(s)
| | | | | | | | - Riccardo Pampena
- Skin Cancer Center, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia
| | - Caterina Longo
- Skin Cancer Center, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia
- Department of Dermatology, University of Modena and Reggio Emilia
| | - Michela Lai
- Skin Cancer Center, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia
- Department of Dermatology, University of Modena and Reggio Emilia
| | | | - Anna M Cesinaro
- Department of Pathological Anatomy, Modena University Hospital, Modena, Italy
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32
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Church AJ, Moustafa D, Pinches RS, Hawryluk EB, Schmidt BAR. Genomic comparison of malignant melanoma and atypical Spitz tumor in the pediatric population. Pediatr Dermatol 2022; 39:409-419. [PMID: 35194848 DOI: 10.1111/pde.14935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES The diagnostic distinction between atypical Spitz tumor (AST) and malignant melanoma (MM) in pediatric tumors is challenging. Molecular tests are increasingly used to characterize these neoplasms; however, limited studies are available in pediatric patients. This study aimed to provide a genomic comparison of pediatric MM and AST in the context of comprehensive clinical annotation. METHODS Pediatric patients diagnosed with MM (n=11) and AST (n=12) were compared to a cohort of 693 adult melanoma patients. DNA next-generation sequencing assessed kinase gene fusions, tumor mutational burden, sequence variants, copy number alterations, structural variants, microsatellite instability, and mutational signatures. RESULTS Seven AST cases and eight MM cases were successfully sequenced. Kinase gene fusions were identified in both the MM and AST cohorts (NTRK1, ROS1, and MET). MM cases had TERT, BRAF, and CDKN2A alterations, which were not identified in the AST cohort. Tumor mutational burden (TMB) analysis showed pediatric ASTs had an average of 2.82 mutations/Mb, pediatric MM had an average of 5.7 mutations/Mb, and adult MM cases averaged 18.8 mut/Mb. One pediatric MM case had an elevated TMB of 15 mutations/Mb and a UV mutational signature. CONCLUSIONS These data expand our understanding of pediatric malignant melanoma. The differences between the molecular signatures for AST and MM are not statistically significant, and histopathology remains the gold standard for the diagnosis of pediatric AST and MM at this time. With more data, molecular studies may provide additional support for diagnosis and targeted therapeutics.
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Affiliation(s)
- Alanna J Church
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Danna Moustafa
- Harvard Medical School, Boston, Massachusetts, USA
- Dermatology Section, Department of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert Seth Pinches
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Elena B Hawryluk
- Harvard Medical School, Boston, Massachusetts, USA
- Dermatology Section, Department of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Birgitta A R Schmidt
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
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33
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Dal Pozzo CA, Cappellesso R. The Morpho-Molecular Landscape of Spitz Neoplasms. Int J Mol Sci 2022; 23:ijms23084211. [PMID: 35457030 PMCID: PMC9030540 DOI: 10.3390/ijms23084211] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 12/14/2022] Open
Abstract
Spitz neoplasms are a heterogeneous group of melanocytic proliferations with a great variability in the histological characteristics and in the biological behavior. Thanks to recent discoveries, the morpho-molecular landscape of Spitz lineage is becoming clearer, with the identification of subtypes with recurrent features thus providing the basis for a more solid and precise tumor classification. Indeed, specific mutually exclusive driver molecular events, namely HRAS or MAP2K1 mutations, copy number gains of 11p, and fusions involving ALK, ROS, NTRK1, NTRK2, NTRK3, MET, RET, MAP3K8, and BRAF genes, correlate with distinctive histological features. The accumulation of further molecular aberrations, instead, promotes the increasing malignant transformation of Spitz neoplasms. Thus, the detection of a driver genetic alteration can be achieved using the appropriate diagnostic tests chosen according to the histological characteristics of the lesion. This allows the recognition of subtypes with aggressive behavior requiring further molecular investigations. This review provides an update on the morpho-molecular correlations in Spitz neoplasms.
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Affiliation(s)
- Carlo Alberto Dal Pozzo
- Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy;
| | - Rocco Cappellesso
- Pathological Anatomy Unit, University Hospital of Padua, 35121 Padua, Italy
- Correspondence: ; Tel.: +39-049-8217962
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34
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Melanoma in prepuberal children: Diagnostic and therapeutic challenges. An Pediatr (Barc) 2022; 96:352-357. [DOI: 10.1016/j.anpede.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
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35
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Evangelou Z, Linos K. Nevus, melanoma or something else? Mesenchymal neoplasms with melanocytic differentiation. J Cutan Pathol 2022; 49:747-759. [PMID: 35338512 DOI: 10.1111/cup.14232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 03/13/2022] [Accepted: 03/20/2022] [Indexed: 11/30/2022]
Abstract
The overwhelming majority of cutaneous neoplasms with melanocytic differentiation are nevi, melanomas and more rarely melanocytomas. Nevertheless, there is also a group of mesenchymal neoplasms with genuine melanocytic differentiation which can create diagnostic difficulties with significant repercussions. These can rarely present as primary or metastatic cutaneous lesions. Theones that are relevant to a dermatopathologist include malignant melanotic nerve sheath tumor, perivascular epithelioid cell neoplasm and clear cell sarcoma. This work will provide a thorough review of clinical presentation, morphologic and immunohistochemical features as well as molecular pathogenesis of these tumors. We hope to familiarize the general dermatopathology readership with a group of neoplasms of mesenchymal lineage exhibiting melanocytic differentiation and ultimately avoid diagnostic misadventures. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zoi Evangelou
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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36
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Gassenmaier M, Soltanpour N, Held L, Metzler G, Yazdi AS, Brecht IB, Schneider DT, Stadler R, Garbe C, Bauer J. Diagnostic and prognostic classification of atypical spitzoid tumours based on histology and genomic aberrations: A prospective cohort study with long-term follow-up. Eur J Cancer 2022; 163:200-210. [PMID: 35104769 DOI: 10.1016/j.ejca.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/21/2021] [Accepted: 12/13/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Histological classification of atypical spitzoid tumours (ASTs) is unreliable, and categorisation of these lesions into benign and malignant is poorly reproducible. Here, we classified ASTs based on histology and chromosomal aberrations and explored the prognostic significance of genomic aberrations in a prospective cohort with a long-term follow-up. PATIENTS AND METHODS Histologically equivocal ASTs from 76 patients were analysed by array comparative genomic hybridisation (aCGH). Tumours were histologically assessed by a panel of dermatopathologist before and after aCGH and classified as benign, ambiguous or malignant. Chromosomal aberrations were correlated with an outcome. RESULTS Chromosomal aberrations were detected in 45 (59%) of 76 ASTs (median age: 16 years, range: 0-74; median follow-up: 90 months, range: 13-153). The initial histological diagnosis was changed upon presentation of aCGH results in 36 of 76 cases (47%). The final diagnostic interpretation classified 61% of the lesions as benign, 18% as ambiguous and 21% as malignant. Positive sentinel lymph node biopsies (6+/29) occurred at similar rates in all diagnostic groups (P = 0.83) and were not associated with an unfavourable outcome. Two patients had local recurrences, but none of the patients developed metastasis beyond the sentinel lymph node. CONCLUSIONS All ASTs had an excellent prognosis, even in cases with worrisome morphology and chromosomal aberrations. With no distant metastasis or death in long-term follow-up of 76 patients, no correlation between chromosomal aberrations and prognosis was possible. However, it seems likely that in larger cohorts, metastases would arise in cases with complex aberrations and these patients should undergo clinical follow-up.
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Affiliation(s)
| | - Narges Soltanpour
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Laura Held
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany; MVZ Dermatopathologie Friedrichshafen/Bodensee PartG, Friedrichshafen, Germany
| | - Gisela Metzler
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany; Zentrum für Dermatohistologie und Oralpathologie Tübingen/Würzburg, Tübingen, Germany
| | - Amir S Yazdi
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany; Department of Dermatology and Allergology, University Hospital RWTH Aachen, Aachen, Germany
| | - Ines B Brecht
- Pediatric Hematology and Oncology, Children's Hospital, Eberhard Karls University, Tübingen, Germany
| | | | - Rudolf Stadler
- Department of Dermatology, Venereology, Allergology and Phlebology, Johannes Wesling Medical Center, University Hospital of Ruhr-University Bochum, Minden, Germany
| | - Claus Garbe
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany; Dermatologie in Stuttgart, Stuttgart, Germany
| | - Jürgen Bauer
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany; Dermatologie in Stuttgart, Stuttgart, Germany
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Kestel S, Uyar Göçün FP, Öğüt B, Erdem Ö. Metastatic melanoma: clinicopathologic features and overall survival comparison. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2022. [DOI: 10.15570/actaapa.2022.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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38
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Yeh I, Busam KJ. Spitz melanocytic tumours – a review. Histopathology 2021; 80:122-134. [DOI: 10.1111/his.14583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Iwei Yeh
- Department of Dermatology and Pathology University of California San Francisco CAUSA
| | - Klaus J Busam
- Department of Pathology Memorial Sloan Kettering Cancer Center New York NY USA
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39
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Andea AA. Molecular testing for melanocytic tumors: a practical update. Histopathology 2021; 80:150-165. [DOI: 10.1111/his.14570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Aleodor A Andea
- Departments of Pathology and Dermatology Michigan Medicine University of Michigan Ann Arbor MI USA
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40
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Impact of Next-generation Sequencing on Interobserver Agreement and Diagnosis of Spitzoid Neoplasms. Am J Surg Pathol 2021; 45:1597-1605. [PMID: 34757982 DOI: 10.1097/pas.0000000000001753] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Atypical Spitzoid melanocytic tumors are diagnostically challenging. Many studies have suggested various genomic markers to improve classification and prognostication. We aimed to assess whether next-generation sequencing studies using the Tempus xO assay assessing mutations in 1711 cancer-related genes and performing whole transcriptome mRNA sequencing for structural alterations could improve diagnostic agreement and accuracy in assessing neoplasms with Spitzoid histologic features. Twenty expert pathologists were asked to review 70 consultation level cases with Spitzoid features, once with limited clinical information and again with additional genomic information. There was an improvement in overall agreement with additional genomic information. Most significantly, there was increase in agreement of the diagnosis of conventional melanoma from moderate (κ=0.470, SE=0.0105) to substantial (κ=0.645, SE=0.0143) as measured by an average Cohen κ. Clinical follow-up was available in all 70 cases which substantiated that the improved agreement was clinically significant. Among 3 patients with distant metastatic disease, there was a highly significant increase in diagnostic recognition of the cases as conventional melanoma with genomics (P<0.005). In one case, none of 20 pathologists recognized a tumor with BRAF and TERT promoter mutations associated with fatal outcome as a conventional melanoma when only limited clinical information was provided, whereas 60% of pathologists correctly diagnosed this case when genomic information was also available. There was also a significant improvement in agreement of which lesions should be classified in the Spitz category/WHO Pathway from an average Cohen κ of 0.360 (SE=0.00921) to 0.607 (SE=0.0232) with genomics.
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41
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NTRK Gene Fusion Detection in Atypical Spitz Tumors. Int J Mol Sci 2021; 22:ijms222212332. [PMID: 34830218 PMCID: PMC8619835 DOI: 10.3390/ijms222212332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/04/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Atypical Spitz tumors (AST) deviate from stereotypical Spitz nevi for one or more atypical features and are now regarded as an intermediate category of melanocytic tumors with uncertain malignant potential. Activating NTRK1/NTRK3 fusions elicit oncogenic events in Spitz lesions and are targetable with kinase inhibitors. However, their prevalence among ASTs and the optimal approach for their detection is yet to be determined. A series of 180 ASTs were screened with pan-TRK immunohistochemistry and the presence of NTRK fusions was confirmed using FISH, two different RNA-based NGS panels for solid tumors, and a specific real time RT-PCR panel. Overall, 26 ASTs showed pan-TRK immunostaining. NTRK1 fusions were detected in 15 of these cases showing cytoplasmic immunoreaction, whereas NTRK3 was detected in one case showing nuclear immunoreaction. Molecular tests resulted all positive in only two ASTs (included the NTRK3 translocated), RNA-based NGS and real time RT-PCR were both positive in three cases, and FISH and real time RT-PCR in another two cases. In seven ASTs NTRK1 fusions were detected only by FISH and in two cases only by real time RT-PCR. The frequency of NTRK fusions in ASTs is 9%, with a clear prevalence of NTRK1 compared to NTRK3 alterations. Pan-TRK immunohistochemistry is an excellent screening test. Confirmation of NTRK fusions may require the use of different molecular techniques.
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Del Amor R, Launet L, Colomer A, Moscardó A, Mosquera-Zamudio A, Monteagudo C, Naranjo V. An attention-based weakly supervised framework for spitzoid melanocytic lesion diagnosis in whole slide images. Artif Intell Med 2021; 121:102197. [PMID: 34763799 DOI: 10.1016/j.artmed.2021.102197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 02/07/2023]
Abstract
Melanoma is an aggressive neoplasm responsible for the majority of deaths from skin cancer. Specifically, spitzoid melanocytic tumors are one of the most challenging melanocytic lesions due to their ambiguous morphological features. The gold standard for its diagnosis and prognosis is the analysis of skin biopsies. In this process, dermatopathologists visualize skin histology slides under a microscope, in a highly time-consuming and subjective task. In the last years, computer-aided diagnosis (CAD) systems have emerged as a promising tool that could support pathologists in daily clinical practice. Nevertheless, no automatic CAD systems have yet been proposed for the analysis of spitzoid lesions. Regarding common melanoma, no system allows both the selection of the tumor region and the prediction of the benign or malignant form in the diagnosis. Motivated by this, we propose a novel end-to-end weakly supervised deep learning model, based on inductive transfer learning with an improved convolutional neural network (CNN) to refine the embedding features of the latent space. The framework is composed of a source model in charge of finding the tumor patch-level patterns, and a target model focuses on the specific diagnosis of a biopsy. The latter retrains the backbone of the source model through a multiple instance learning workflow to obtain the biopsy-level scoring. To evaluate the performance of the proposed methods, we performed extensive experiments on a private skin database with spitzoid lesions. Test results achieved an accuracy of 0.9231 and 0.80 for the source and the target models, respectively. In addition, the heat map findings are directly in line with the clinicians' medical decision and even highlight, in some cases, patterns of interest that were overlooked by the pathologist.
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Affiliation(s)
- Rocío Del Amor
- Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain.
| | - Laëtitia Launet
- Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain
| | - Adrián Colomer
- Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain
| | - Anaïs Moscardó
- Pathology Department, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Andrés Mosquera-Zamudio
- Pathology Department, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Carlos Monteagudo
- Pathology Department, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Valery Naranjo
- Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain
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43
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Yin SJ, Qian GY, Yang JM, Lee J, Park YD. Detection of melanogenesis- and anti-apoptosis-associated melanoma factors: Array CGH and PPI mapping integrating study. Protein Pept Lett 2021; 28:1408-1424. [PMID: 34749602 DOI: 10.2174/0929866528666211105112927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/02/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND We investigated melanogenesis- and anti-apoptosis-related melanoma factors in melanoma cells (TXM1, TXM18, A375P, and A375SM). OBJECTIVE To find melanoma associated hub factor, high-throughput screening-based techniques integrating with bioinformatics were investigated. METHODS Array CGH analysis was conducted with a commercial system. Total genomic DNAs prepared individually from each cell line with control DNA were properly labeled with Cy3-dCTP and Cy5-dCTP and hybridizations and subsequently performed data treatment by the log2 green (G; test) to red (R; reference) fluorescence ratios (G/R). Gain or loss of copy number was judged by spots with log2-transformed ratios. PPI mapping analysis of detected candidate genes based on the array CGH results was conducted using the human interactome in the STRING database. Energy minimization and a short molecular dynamics (MD) simulation using the implicit solvation model in CHARMM were performed to analyze the interacting residues between YWHAZ and YWHAB. RESULTS Three genes (BMP-4, BFGF, LEF-1) known to be involved in melanogenesis were found to lose chromosomal copy numbers, and Chr. 6q23.3 was lost in all tested cell lines. Ten hub genes (CTNNB1, PEX13, PEX14, PEX5, IFNG, EXOSC3, EXOSC1, EXOSC8, UBC, and PEX10) were predicted to be functional interaction factors in the network of the 6q23.3 locus. The apoptosis-associated genes E2F1, p50, BCL2L1, and BIRC7 gained, and FGF2 lost chromosomal copy numbers in the tested melanoma cell lines. YWHAB, which gained chromosomal copy numbers, was predicted to be the most important hub protein in melanoma cells. Molecular dynamics simulations for binding YWHAB and YWHAZ were conducted, and the complex was predicted to be energetically and structurally stable through its 3 hydrogen-bond patterns. The number of interacting residues is 27. CONCLUSION Our study compares genome-wide screening interactomics predictions for melanoma factors and offers new information for understanding melanogenesis- and anti-apoptosis-associated mechanisms in melanoma. Especially, YWHAB was newly detected as a core factor in melanoma cells.
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Affiliation(s)
- Shang-Jun Yin
- College of Biological and Environmental Sciences, Zhejiang Wanli University, Ningbo 315100. China
| | - Guo-Ying Qian
- College of Biological and Environmental Sciences, Zhejiang Wanli University, Ningbo 315100. China
| | - Jun-Mo Yang
- Department of Dermatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 135-710. Korea
| | - Jinhyuk Lee
- Genome Editing Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Gwahak-ro, Yuseong-gu, Daejeon, 34141. Korea
| | - Yong-Doo Park
- College of Biological and Environmental Sciences, Zhejiang Wanli University, Ningbo 315100. China
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44
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Abstract
The Spitz nevus is an uncommon melanocytic nevus. These lesions classically appear in childhood as a red, dome-shaped papule. They appear rarely in adults and may be pigmented. The Spitz nevus can develop suddenly and grow rapidly, reaching a 1-cm diameter in 6 months or less. There are 3 classes of spitzoid neoplasms: typical Spitz nevus, atypical Spitz nevus, and spitzoid melanoma. The diagnosis should be cautiously differentiated, especially in children. Immunohistochemistry and molecular studies have been helpful in differentiating difficult cases; however, no set of criteria has been accepted to predict biological behavior of atypical Spitz nevi.
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Affiliation(s)
- Amanda Brown
- The Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 N. Rutledge Street, Springfield, IL 62704, USA
| | - Justin D Sawyer
- The Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 N. Rutledge Street, Springfield, IL 62704, USA
| | - Michael W Neumeister
- The Institute for Plastic Surgery, Department of Surgery, Southern Illinois University, 747 N. Rutledge Street, Springfield, IL 62704 USA.
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45
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Abstract
Conventional histopathology is the primary means of melanoma diagnosis. Both architectural and cytologic features aid in discrimination of melanocytic nevi from melanoma. Communication between the clinician and pathologist regarding the history, examination, differential diagnosis, prior biopsy findings, method of sampling, and specimen orientation is critical to an accurate diagnosis. A melanoma pathology report includes multiple prognostic indicators to guide surgical and medical management. In challenging cases, immunohistochemistry and molecular diagnostics may be of benefit.
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46
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Sitenga G, Aird J, Wieland C, Moran SL, Tollefson M. An unusual pediatric case of atypical spitzoid neoplasm. Pediatr Dermatol 2021; 38:1255-1257. [PMID: 34561882 DOI: 10.1111/pde.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Spitzoid melanocytic lesions describe a spectrum of pediatric melanocytic proliferations ranging from benign Spitz nevi to malignant spitzoid melanomas typically arising within the first two decades of life. Atypical spitzoid neoplasm (ASN) is a poorly defined category within this spectrum that poses a unique diagnostic challenge due to histologic findings with insufficient atypical characteristics to make the diagnosis of melanoma. This report presents an exceptionally rare case of an ulcerative atypical spitzoid neoplasm mimicking an infantile hemangioma in a two-month-old girl treated with pulse dyed laser (PDL) and surgical excision. Our patient ultimately underwent five excisions over a 2-year period, with successful maintenance of function and dexterity of the affected fingers.
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Affiliation(s)
| | - Jenna Aird
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | | | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | - Megha Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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47
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Houlier A, Pissaloux D, Tirode F, Lopez Ramirez N, Plaschka M, Caramel J, Masse I, de la Fouchardiere A. RASGRF2 gene fusions identified in a variety of melanocytic lesions with distinct morphological features. Pigment Cell Melanoma Res 2021; 34:1074-1083. [PMID: 34310073 DOI: 10.1111/pcmr.13004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/11/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022]
Abstract
The WHO classification identifies nine classes of melanocytic proliferations according to location, UV exposure, histological, and genetic features. Only a minority of lesions remain unclassified. We describe five cases that harbored either an ERBIN-RASGRF2 or an ATP2B4-RASGRF2 in-frame fusion transcript. These lesions were collected from different studies, unified only by the lack of identifiable known mutations, with a highly variable phenotype. One case was a large abdominal congenital nevus, three were slowly growing pigmented nodules, and the last was an ulcerated nodule arising on the site of a preexisting small nevus, known since childhood. The latter was diagnosed as a 4 mm thick melanoma with loss of BAP1 expression. The four other cases were compound, melanocytic proliferations with an unusual deep pattern of small dense nests of bland melanocytes encased in a fibrous background. The RASGRF2 fusion was confirmed by a break-apart FISH technique. Array CGH performed in three cases found non-recurrent secondary copy number alterations. Follow-up was uneventful. In silico analysis identified a single RASGRF2 fusion in the TCGA pan-cancer database, whereas RASGRF2 variants were stochastically distributed in all cancer subtypes.
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Affiliation(s)
- Aurélie Houlier
- University of Lyon, Université Claude Bernard Lyon 1, CNRS UMR 5286, INSERM U1052, Cancer Research Centre of Lyon, Lyon, France.,Department of Biopathology, Centre Léon Bérard, Lyon, France
| | - Daniel Pissaloux
- University of Lyon, Université Claude Bernard Lyon 1, CNRS UMR 5286, INSERM U1052, Cancer Research Centre of Lyon, Lyon, France.,Department of Biopathology, Centre Léon Bérard, Lyon, France
| | - Franck Tirode
- University of Lyon, Université Claude Bernard Lyon 1, CNRS UMR 5286, INSERM U1052, Cancer Research Centre of Lyon, Lyon, France
| | - Noémie Lopez Ramirez
- University of Lyon, Université Claude Bernard Lyon 1, CNRS UMR 5286, INSERM U1052, Cancer Research Centre of Lyon, Lyon, France
| | - Maud Plaschka
- University of Lyon, Université Claude Bernard Lyon 1, CNRS UMR 5286, INSERM U1052, Cancer Research Centre of Lyon, Lyon, France
| | - Julie Caramel
- University of Lyon, Université Claude Bernard Lyon 1, CNRS UMR 5286, INSERM U1052, Cancer Research Centre of Lyon, Lyon, France
| | - Ingrid Masse
- University of Lyon, Université Claude Bernard Lyon 1, CNRS UMR 5286, INSERM U1052, Cancer Research Centre of Lyon, Lyon, France
| | - Arnaud de la Fouchardiere
- University of Lyon, Université Claude Bernard Lyon 1, CNRS UMR 5286, INSERM U1052, Cancer Research Centre of Lyon, Lyon, France.,Department of Biopathology, Centre Léon Bérard, Lyon, France
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48
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Bellantoni AJ, Wagner LM. Pursuing Precision: Receptor Tyrosine Kinase Inhibitors for Treatment of Pediatric Solid Tumors. Cancers (Basel) 2021; 13:3531. [PMID: 34298746 PMCID: PMC8303693 DOI: 10.3390/cancers13143531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
Receptor tyrosine kinases are critical for the growth and proliferation of many different cancers and therefore represent a potential vulnerability that can be therapeutically exploited with small molecule inhibitors. Over forty small molecule inhibitors are currently approved for the treatment of adult solid tumors. Their use has been more limited in pediatric solid tumors, although an increasing number of single-agent and combination studies are now being performed. These agents have been quite successful in certain clinical contexts, such as the treatment of pediatric tumors driven by kinase fusions or activating mutations. By contrast, only modest activity has been observed when inhibitors are used as single agents for solid tumors that do not have genetically defined alterations in the target genes. The absence of predictive biomarkers has limited the wider applicability of these drugs and much work remains to define the appropriate patient population and clinical situation in which receptor tyrosine kinase inhibitors are most beneficial. In this manuscript, we discuss these issues by highlighting past trials and identifying future strategies that may help add precision to the use of these agents for pediatric extracranial solid tumors.
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Affiliation(s)
| | - Lars M. Wagner
- Division of Pediatric Hematology/Oncology, Duke University, Durham, NC 27710, USA;
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49
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Abstract
Pediatric tumors can be divided into hematologic malignancies, central nervous system tumors, and extracranial solid tumors of bone, soft tissue, or other organ systems. Molecular alterations that impact diagnosis, prognosis, treatment, and familial cancer risk have been described in many pediatric solid tumors. In addition to providing a concise summary of clinically relevant molecular alterations in extracranial pediatric solid tumors, this review discusses conventional and next-generation sequencing-based molecular techniques, relevant tumor predisposition syndromes, and the increasing integration of molecular data into the practice of diagnostic pathology for children with solid tumors.
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Affiliation(s)
- Jonathan C Slack
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Alanna J Church
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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50
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Sondak VK, Messina JL. What's new in pediatric melanoma and Spitz tumors? Pretty much everything. Cancer 2021; 127:3720-3723. [PMID: 34228362 DOI: 10.1002/cncr.33749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/24/2021] [Indexed: 12/25/2022]
Abstract
LAY SUMMARY Pathologists sometimes have great difficulty in determining whether a mole biopsied from the skin of a child is benign or malignant. New molecular technologies have helped pathologists to identify pediatric melanomas, but there are still some atypical moles that cannot be definitively classified as benign or malignant. With further research, it is hoped that the number of these atypical tumors can be decreased and that the treatment for all children with moles and melanoma can be improved.
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Affiliation(s)
- Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Jane L Messina
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida.,Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida
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