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Diluiso G, Pozzi M, Liso FG, Mendes VM, Hannouille J, Losco L, Bolletta A, Cigna E, Schettino M. Mind the Gap: A Questionnaire on the Distance between Diagnostic Advances and Clinical Practice in Skin Cancer Treatment. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:155. [PMID: 38256415 PMCID: PMC10819365 DOI: 10.3390/medicina60010155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Significant progress has been made in skin cancer diagnosis, with a surge in available technologies in recent years. Despite this, the practical application and integration of these technologies in dermatology and plastic surgery remain uneven. Materials and Methods: A comprehensive 20-question survey was designed and distributed using online survey administration software (Google Forms, 2018, Google, Mountain View, CA, USA) from June 2023 to September 2023. The survey aimed to assess the knowledge and utilization of dermatologic diagnostic advancements among plastic surgeons in various European countries. Results: Data were obtained from 29 plastic surgeons across nine European countries, revealing a notable gap between diagnostic technologies and their routine use in surgical practice. The gap for some technologies was both cognitive and applicative; for electrical impedance spectroscopy (EIS) and multispectral imaging, only 6.9% of the sample knew of the technologies and no surgeons in the sample used them. In the case of other technologies, such as high-frequency ultrasound (HFUS), 72.4% of the sample knew about them but only 34.5% used them, highlighting a more significant application problem. Conclusions: Spotlighting this discrepancy provides a valuable foundation for initiating collaborative efforts between units and facilitating knowledge exchange among diverse specialists. This, in turn, contributes to advancing clinical practice by integrating the innovative opportunities presented by ongoing research.
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Affiliation(s)
- Giuseppe Diluiso
- Unit of Plastic Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.D.); (M.P.)
| | - Mirco Pozzi
- Unit of Plastic Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.D.); (M.P.)
| | | | - Vanessa Marron Mendes
- Service de Chirurgie Plastique, Hôpital CHIREC (Braine L’Alleud-Waterloo, Belgium), 1420 Braine-L’Alleud, Belgium; (V.M.M.); (M.S.)
| | - Jenna Hannouille
- Hôpital Delta (Bruxelles), ULB—Université Libre de Bruxelles, 1050 Bruxelles, Belgium;
| | - Luigi Losco
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081 Salerno, Italy
| | - Alberto Bolletta
- Plastic Surgery and Microsurgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (A.B.); (E.C.)
| | - Emanuele Cigna
- Plastic Surgery and Microsurgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (A.B.); (E.C.)
| | - Michela Schettino
- Service de Chirurgie Plastique, Hôpital CHIREC (Braine L’Alleud-Waterloo, Belgium), 1420 Braine-L’Alleud, Belgium; (V.M.M.); (M.S.)
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Thomsen IMN, Heerfordt IM, Karmisholt KE, Mogensen M. Detection of cutaneous malignant melanoma by tape stripping of pigmented skin lesions - A systematic review. Skin Res Technol 2023; 29:e13286. [PMID: 36973976 PMCID: PMC10155806 DOI: 10.1111/srt.13286] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/13/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Cutaneous malignant melanoma (MM) is potentially aggressive, and numerous clinically suspicious pigmented skin lesions are excised, causing unnecessary mutilation for patients at high healthcare costs, but without histopathological evidence of MM. The high number of excisions may be lowered by using more accurate diagnostics. Tape stripping (TS) of clinically suspicious lesions is a non-invasive diagnostic test of MM that can potentially lower the number needed to biopsy/excise. MATERIALS AND METHODS The aim is to determine the diagnostic accuracy of TS in detecting MM in clinically suspicious pigmented skin lesions. This systematic review following PRISMA guidelines searched PubMed, Web of Science, and Embase (September 2022) using melanoma combined with tape stripping, adhesive patch(es), pigmented lesion assay, or epidermal genetic information retrieval. RESULTS Ten studies were included. Sensitivity ranged from 68.8% (95% confidence interval [CI] 51.5, 82.1) to 100% (95% CI 91.0, 100). Specificity ranged from 69.1% (95% CI 63.8, 74.0) to 100% (95% CI 78.5, 100). A pooled analysis of five studies testing the RNA markers LINC00518 and PRAME found a sensitivity of 86.9% (95% CI 81.7, 90.8) and a specificity of 82.4% (95% CI 80.8, 83.9). CONCLUSION Overall quality of studies was low, and the reliability of sensitivity and specificity is questionable. However, TS may supplement well-established diagnostic methods as pooled analysis of five studies indicates a moderate sensitivity. Future studies are needed to obtain more reliable data as independent studies with no conflict of interest.
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Affiliation(s)
| | - Ida M. Heerfordt
- Department of DermatologyCopenhagen University Hospital – BispebjergCopenhagenDenmark
| | - Katrine Elisabeth Karmisholt
- Department of DermatologyCopenhagen University Hospital – BispebjergCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Mette Mogensen
- Department of DermatologyCopenhagen University Hospital – BispebjergCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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Muacevic A, Adler JR, Witkowski A. Potential Limitations in the Clinical Adoption of 3-GEP Pigmented Lesion Assay for Melanoma Triage by Dermatologists and Advanced Practice Practitioners. Cureus 2022; 14:e31914. [PMID: 36579219 PMCID: PMC9792410 DOI: 10.7759/cureus.31914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 11/27/2022] Open
Abstract
Background A pigmented lesion assay (PLA) is used to non-invasively detect the presence of three genes associated with melanoma (LINC00518, PRAME, and TERT) using adhesive patch testing and has the potential to reduce unnecessary biopsies. However, few studies have evaluated the clinical applicability of PLA testing and its potential limitations in real-world practice. We aim to identify possible barriers that inhibit the clinical utility of PLA testing by dermatologists. Methods Retrospective case-control study analyzing the PLA testing by two pigmented-lesion specialists that underwent PLA testing as part of clinical management. Data was collected from April 2021 to April 2022 from an academic tertiary-level center. Results The total cohort consists of 472 lesions. Genetic analysis failure for LINC00518 and PRAME occurred in 12.5% of cases and in 70.9% of cases for TERT. In 38.5% of cases, PLA results were discrepant with histopathology. The additional time associated with PLA use independent from the patient's visit was 15 min on average. Conclusion The high proportion of non-actionable results and discrepant cases highlights potential barriers to the widespread adoption of PLA testing. The high proportion of genetic analysis failure seen for TERT and limited influence on the proposed risk suggests TERT does not offer significant clinical value.
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Heerfordt IM, Andersen JD, Philipsen PA, Langhans L, Tvedebrink T, Schmidt G, Poulsen T, Lerche CM, Morling N, Wulf HC. Detection of cutaneous malignant melanoma using RNA sampled by tape strips: A study protocol. PLoS One 2022; 17:e0274413. [PMID: 36129945 PMCID: PMC9491607 DOI: 10.1371/journal.pone.0274413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/30/2022] [Indexed: 12/12/2022] Open
Abstract
Background Cutaneous malignant melanoma (CMM) is curable if detected in its early stages. However, the clinical recognition of CMM is challenging. An American research group has shown promising results in detecting CMM based on RNA profiles sampled from suspicious lesions with tape strips. We aim to further develop this technique and validate if RNA profiles sampled with tape strips can detect CMM. Methods This prospective cohort study will include approximately 200 lesions clinically suspected of CMM requiring surgical removal. Tape stripping of the lesions will be performed just before surgical excision. Subsequently, RNA on the tape strips is analyzed using quantitative real-time polymerase chain reaction with TaqMan technology. The results are combined into a binary outcome where positive indicates CMM and negative indicates no CMM. The histopathological diagnosis of the lesions will be used as the gold standard. The main outcome is the results of the RNA test and the histopathological diagnosis, which, combined, provide the sensitivity and specificity of the test. Discussion The accuracy of the clinical examination in CMM diagnostics is limited. This clinical trial will explore the ability to use RNA analysis to improve the management of suspicious lesions by enhancing early diagnostic accuracy. Hopefully, it can reduce the number of benign lesions being surgically removed to rule out CMM and decrease patient morbidity. Trial registration The project was approved by The Committee on Health Research Ethics of the Capital Region of Denmark (H-15010559) and registered at the Danish Data Protection Agency (BFH-2015-065).
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Affiliation(s)
- Ida M. Heerfordt
- Department of Dermatology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- * E-mail:
| | - Jeppe D. Andersen
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter A. Philipsen
- Department of Dermatology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Linnea Langhans
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Torben Tvedebrink
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Mathematical Sciences, Aalborg University, Aalborg, Denmark
| | - Grethe Schmidt
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Thomas Poulsen
- Department of Pathology, Hospital of Southern Jutland, Soenderborg, Denmark
| | - Catharina M. Lerche
- Department of Dermatology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Niels Morling
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Abstract
Adhesive tape has been used in the scientific study of human skin for over 90 years. Using the tape stripping method in dermatology has aided in the research and diagnose of different skin diseases. Basic science, identification, and therapeutic interventions in skin diseases such as psoriasis, atopic dermatitis, non-melanoma skin cancer, and melanoma have been studied using this technique. Among many promising applications that will be discussed throughout this paper, the Pigmented Lesion Assay (PLA) will be discussed in depth in relation to melanoma. This product carries considerable and significant research towards early detection of melanoma. Tape stripping is unique and advantageous in its ability to provide a non-surgical approach to evaluating the human epidermis. The cellular and molecular components of the skin are used to diagnose different skin conditions without invasive skin biopsy.
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Affiliation(s)
- Cara Barber
- Department of Dermatology, Silver Falls Dermatology Good Samaritan Health, Salem, OR
| | - Susan Boiko
- Department of Dermatology, University of California San Diego, San Diego, CA; Pediatric and Adolescent Dermatology, University of California, San Diego, and Rady Children's Hospital, San Diego, CA.
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Marchetti MA, Dusza SW. Response to Rigel et al. J Invest Dermatol 2022; 142:234-235. [PMID: 34273348 PMCID: PMC8688182 DOI: 10.1016/j.jid.2021.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 01/03/2023]
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Jung JM, Cho JY, Lee WJ, Chang SE, Lee MW, Won CH. Emerging Minimally Invasive Technologies for the Detection of Skin Cancer. J Pers Med 2021; 11:951. [PMID: 34683091 PMCID: PMC8538732 DOI: 10.3390/jpm11100951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/23/2022] Open
Abstract
With the increasing incidence of skin cancer, many noninvasive technologies to detect its presence have been developed. This review focuses on reflectance confocal microscopy (RCM), optical coherence tomography (OCT), high-frequency ultrasound (HFUS), electrical impedance spectroscopy (EIS), pigmented lesion assay (PLA), and Raman spectroscopy (RS) and discusses the basic principle, clinical applications, advantages, and disadvantages of each technology. RCM provides high cellular resolution and has high sensitivity and specificity for the diagnosis of skin cancer. OCT provides lower resolution than RCM, although its evaluable depth is deeper than that of RCM. RCM and OCT may be useful in reducing the number of unnecessary biopsies, evaluating the tumor margin, and monitoring treatment response. HFUS can be mainly used to delineate tumor depths or margins and monitor the treatment response. EIS provides high sensitivity but low specificity for the diagnosis of skin malignancies. PLA, which is based on the genetic information of lesions, is applicable for the detection of melanoma with high sensitivity and moderate-to-high specificity. RS showed high accuracy for the diagnosis of skin cancer, although more clinical studies are required. Advances in these technologies for the diagnosis of skin cancer can lead to the realization of optimized and individualized treatments.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.M.J.); (W.J.L.); (S.E.C.); (M.W.L.)
| | - Ji Young Cho
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea;
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.M.J.); (W.J.L.); (S.E.C.); (M.W.L.)
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.M.J.); (W.J.L.); (S.E.C.); (M.W.L.)
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.M.J.); (W.J.L.); (S.E.C.); (M.W.L.)
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.M.J.); (W.J.L.); (S.E.C.); (M.W.L.)
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8
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Pigmented Lesion Assay for Suspected Melanoma Lesions: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2021; 21:1-81. [PMID: 34188732 PMCID: PMC8196402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Early detection of melanoma is key, as survival rates are substantially better when the cancer is detected in its early stages. Currently, the standard of care is to biopsy any lesion suspected of melanoma for diagnostic confirmation by histopathology. As a result, most people who undergo biopsy receive negative melanoma results. If effective, a non-invasive alternative, such as pigmented lesion assay, could minimize the number of unnecessary biopsies performed. We conducted a health technology assessment of pigmented lesion assay for people with suspected melanoma lesions, which included an evaluation of diagnostic accuracy, clinical utility, the budget impact of publicly funding pigmented lesion assay, and the preferences and values of people who have undergone biopsy for suspected melanoma. METHODS We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS). We assessed the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic literature search of the economic evidence. We also analyzed the budget impact of publicly funding pigmented lesion assay in adults with suspected melanoma in Ontario. To contextualize the potential value of pigmented lesion assay, we spoke with people who had undergone skin biopsy for melanoma. We also used the qualitative research synthesis from a report by the Canadian Agency for Drugs and Technologies in Health to provide context for the preferences and values of those with suspected melanoma. RESULTS We included seven studies in the clinical evidence review. Pigmented lesion assay has a sensitivity of 79% (95% confidence interval [CI] 58%-93%) and a specificity of 80% (95% CI 73%-85%; GRADE: Low). We found one published cost-effectiveness study with potentially serious limitations. Therefore, the cost-effectiveness of pigmented lesion assay compared with the standard care pathway is currently uncertain. Assuming a very low uptake, we estimated that the budget impact of publicly funding pigmented lesion assay in Ontario over the next 5 years is about $3.44 million if the test is used exclusively by primary care providers, or about $2.56 million if it is used exclusively by specialists. The people with whom we spoke who had experienced biopsy for suspected melanoma responded positively to the potential benefits of pigmented lesion assay, emphasizing its ease-of-use, potential increase in early detection of melanoma, and reduction in physical and emotional burden of unnecessary biopsies. Participants also felt that the accuracy of this tool was essential to ensure minimal false negatives. CONCLUSIONS There is uncertainty because of the low-quality evidence for the diagnostic accuracy of pigmented lesion assay. The cost-effectiveness of pigmented lesion assay compared with standard care is also uncertain. We estimated that publicly funding pigmented lesion assay in Ontario over the next 5 years would result in additional costs of $3.44 million (if used exclusively by primary care providers) or $2.56 million (if used exclusively by specialists). For people who had experienced biopsy for suspected melanoma, it was felt that pigmented lesion assay could represent an effective tool to increase early detection and avoid unnecessary biopsies, if the tool was accurate.
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Marchetti MA, Nanda JK, Mancebo SE, Dusza SW. Real-World Application of a Noninvasive Two-Gene Expression Test for Melanoma Diagnosis. J Invest Dermatol 2021; 141:2303-2305. [PMID: 33744297 DOI: 10.1016/j.jid.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/16/2021] [Accepted: 03/01/2021] [Indexed: 01/30/2023]
Affiliation(s)
- Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
| | - Japbani K Nanda
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Silvia E Mancebo
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Morgado-Carrasco D, Fustà-Novell X, Bosch-Amate X, Giavedoni P. RF - New Technologies That Promise to Revolutionize the Diagnosis of Cutaneous Melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2018.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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11
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Morgado-Carrasco D, Fustà-Novell X, Bosch-Amate X, Giavedoni P. FR - Nuevas tecnologías que prometen revolucionar el diagnóstico del melanoma cutáneo. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:329-330. [DOI: 10.1016/j.ad.2018.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 11/26/2022] Open
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Fried L, Tan A, Bajaj S, Liebman TN, Polsky D, Stein JA. Technological advances for the detection of melanoma: Advances in molecular techniques. J Am Acad Dermatol 2020; 83:996-1004. [PMID: 32360759 DOI: 10.1016/j.jaad.2020.03.122] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 03/02/2020] [Accepted: 03/22/2020] [Indexed: 12/20/2022]
Abstract
The growth of molecular technologies analyzing skin cells and inherited genetic variations has the potential to address current gaps in both diagnostic accuracy and prognostication in patients with melanoma or in individuals who are at risk for developing melanoma. In the second article in this continuing medical education series, novel molecular technologies are reviewed. These have been developed as adjunct tools for melanoma management and include the Pigmented Lesion Assay, myPath Melanoma, and DecisionDx-Melanoma tests, and genetic testing in patients with a strong familial melanoma history. These tests are commercially available and marketed as ancillary tools for clinical decision-making, diagnosis, and prognosis. We review fundamental principles behind each test, discuss peer-reviewed literature assessing their performance, and highlight the utility and limitations of each assay. The goal of this article is to provide a comprehensive, evidence-based foundation for clinicians regarding the management of patients with difficult pigmented lesions.
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Affiliation(s)
- Lauren Fried
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Andrea Tan
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Shirin Bajaj
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Tracey N Liebman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - David Polsky
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
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13
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Azimi A, Kaufman KL, Kim J, Ali M, Mann GJ, Fernandez-Penas P. Proteomics: An emerging approach for the diagnosis and classification of cutaneous squamous cell carcinoma and its precursors. J Dermatol Sci 2020; 99:9-16. [PMID: 32312638 DOI: 10.1016/j.jdermsci.2020.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/01/2020] [Accepted: 03/26/2020] [Indexed: 12/19/2022]
Abstract
Cutaneous squamous cell carcinoma (cSCC) and its precursors, actinic keratosis (AK) and Bowen's disease (BD), are the most common types of keratinocytic skin lesions (KSL) which account for the majority of non-melanoma skin cancer lethality. Currently, clinical and histopathological criteria are used for the diagnosis, classification and therapeutic intervention of KSLs, however discrepancies exist between the clinical presentations and histologic analyses of these lesions, making the diagnosis difficult. The identification of biomarkers as companion diagnostics for accurately stratifying KSL types is required to support the paradigm shift in current cancer care to personalised, precision medicine and ameliorate the negative impact of misdiagnoses or delayed diagnoses on patient outcome. Also, it is essential to elaborate on the poorly defined molecular modifications required for the initiation, development and progression of KSL from normal keratinocytes. By harnessing recent technological advances in molecular profiling techniques, it is anticipated that greater insight into the various combinations of proteomic events or alternative pathways underlying carcinogenesis will be gained. This review will explore recent genomic studies in KSL followed by assessing the feasibility and significance of mass spectrometry-based proteomics profiling as a promising approach to a better understanding of the oncogenic pathways underpinning the formation and progression of KSL lesions and in aiding the identification of novel biomarkers and new therapeutic targets. The development of non-invasive tools such as tape-stripping coupled with proteomic analysis alone or in conjunction with imaging and genomic technologies will complement existing clinical and histopathological parameters, leading to an improvement in patient outcomes.
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Affiliation(s)
- Ali Azimi
- Centre for Translational Skin Research, The University of Sydney, Westmead, Australia; Department of Dermatology, Westmead Hospital, Westmead, Australia
| | - Kimberley L Kaufman
- Department of Neurosurgery, Chris O'Brien Lifehouse, Camperdown, Australia; Discipline of Pathology, The University of Sydney, Camperdown, Australia
| | - Jennifer Kim
- Department of Tissue Pathology and Diagnostic Oncology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, Australia
| | - Marina Ali
- Centre for Translational Skin Research, The University of Sydney, Westmead, Australia; Department of Dermatology, Westmead Hospital, Westmead, Australia
| | - Graham J Mann
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia; Melanoma Institute Australia, The University of Sydney, Wollstonecraft, Australia
| | - Pablo Fernandez-Penas
- Centre for Translational Skin Research, The University of Sydney, Westmead, Australia; Department of Dermatology, Westmead Hospital, Westmead, Australia.
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14
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Shah A, Hyngstrom J, Florell SR, Grossman D. Use of the Pigmented Lesion Assay to rapidly screen a patient with numerous clinically atypical pigmented lesions. JAAD Case Rep 2019; 5:1048-1050. [PMID: 31768410 PMCID: PMC6872771 DOI: 10.1016/j.jdcr.2019.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Aatman Shah
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah
| | - John Hyngstrom
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.,Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - Scott R Florell
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Douglas Grossman
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah.,Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Oncological Sciences, University of Utah School of Medicine, Salt Lake City, Utah
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16
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Ferris LK, Moy RL, Gerami P, Sligh JE, Jansen B, Yao Z, Cockerell CJ. Noninvasive Analysis of High-Risk Driver Mutations and Gene Expression Profiles in Primary Cutaneous Melanoma. J Invest Dermatol 2019; 139:1127-1134. [PMID: 30500343 DOI: 10.1016/j.jid.2018.10.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 01/28/2023]
Abstract
Tools that help reduce the number of surgical biopsies performed on benign lesions have the potential to improve patient care. The pigmented lesion assay (PLA) is a noninvasive tool validated against histopathology that helps rule out melanoma and the need for surgical biopsies of atypical pigmented skin lesions. Genetic information is collected using adhesive patches and the expression of two genes, LINC and PRAME, is measured. By using genetic material collected noninvasively and to further validate the PLA, somatic hotspot mutations in genes known to be drivers of early melanoma development (BRAF other than V600E, NRAS, and the TERT promoter) can also be identified. The frequency of these hotspot mutations in samples of early melanoma was 77%, which is higher than the 14% found in nonmelanoma samples (P < 0.0001). TERT promoter mutations were the most prevalent mutation type in PLA-positive melanomas; 82% of PLA-negative lesions had no mutations, and 97% of histopathologically confirmed melanomas were PLA and/or mutation positive (cohort 1, n = 103). Mutation frequencies were similar in prospectively collected real-world PLA samples (cohort 2, n = 519), in which 88% of PLA-negative samples had no mutations. Combining gene expression and mutation analyses enhances the ability to noninvasively detect early cutaneous melanoma.
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Affiliation(s)
- Laura K Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Ronald L Moy
- RodeoDerm Moy Fincher Chips, Beverly Hills, California, USA
| | - Pedram Gerami
- Department of Dermatology, Northwestern University, Chicago, Illinois, USA
| | - James E Sligh
- Southern Arizona Veterans Affairs Healthcare System and University of Arizona, Tucson, Arizona, USA
| | | | - Zuxu Yao
- DermTech, Inc., La Jolla, California, USA
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17
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Mancera N, Smalley KSM, Margo CE. Melanoma of the eyelid and periocular skin: Histopathologic classification and molecular pathology. Surv Ophthalmol 2019; 64:272-288. [PMID: 30578807 DOI: 10.1016/j.survophthal.2018.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 12/29/2022]
Abstract
Cutaneous melanoma, a potentially lethal malignancy of the periocular skin, represents only a small proportion of the roughly 87,000 new cases of cutaneous melanoma diagnosed annually in the United States. Most of our understanding of melanoma of the eyelid skin is extrapolated from studies of cutaneous melanoma located elsewhere. Recent years have witnessed major breakthroughs in molecular biology and genomics of cutaneous melanoma, some of which have led to the development of targeted therapies. The molecular insights have also kindled interest in rethinking how cutaneous melanomas are classified and assessed for risk. We provide a synopsis of the epidemiology, histopathologic classification, and clinical experience of eyelid melanoma since 1990 and then review major advances in the molecular biology of cutaneous melanoma, exploring how this impacts our understanding of classification and predicting risk.
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Affiliation(s)
- Norberto Mancera
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
| | - Keiran S M Smalley
- Departments of Tumor Biology, The Moffitt Cancer Center & Research Institute, Tampa, Florida, USA; Cutaneous Oncology The Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Curtis E Margo
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA; Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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18
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Affiliation(s)
- Meghan Beatson
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
- Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island
- George Washington University School of Medicine, Washington, DC
| | - Martin A. Weinstock
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
- Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island
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19
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Siegel DM, Hornberger J. Further Consideration of the Pigmented Lesion Assay—Reply. JAMA Dermatol 2019; 155:393-394. [DOI: 10.1001/jamadermatol.2018.4377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Daniel M. Siegel
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - John Hornberger
- Department of Internal Medicine, Stanford University, Palo Alto, California
- Cedar Associates, Menlo Park, California
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