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Casalou C, Moreiras H, Mayatra JM, Fabre A, Tobin DJ. Loss of 'Epidermal Melanin Unit' Integrity in Human Skin During Melanoma-Genesis. Front Oncol 2022; 12:878336. [PMID: 35574390 PMCID: PMC9097079 DOI: 10.3389/fonc.2022.878336] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/09/2022] [Indexed: 12/13/2022] Open
Abstract
Cutaneous melanoma can be a most challenging neoplasm of high lethality, in part due to its extreme heterogeneity and characteristic aggressive and invasive nature. Indeed, its moniker 'the great masquerader' reflects that not all melanomas are created equal in terms of their originating cellular contexts, but also that melanoma cells in the malignant tumor can adopt a wide range of different cell states and variable organotropism. In this review, we focus on the early phases of melanomagenesis by discussing how the originating pigment cell of the melanocyte lineage can be influenced to embark on a wide range of tumor fates with distinctive microanatomical pathways. In particular, we assess how cells of the melanocyte lineage can differ by maturation status (stem cell; melanoblast; transiently amplifying cell; differentiated; post-mitotic; terminally-differentiated) as well as by micro-environmental niche (in the stratum basale of the epidermis; within skin appendages like hair follicle, eccrine gland, etc). We discuss how the above variable contexts may influence the susceptibility of the epidermal-melanin unit (EMU) to become unstable, which may presage cutaneous melanoma development. We also assess how unique features of follicular-melanin unit(s) (FMUs) can, by contrast, protect melanocytes from melanomagenesis. Lastly, we postulate how variable melanocyte fates in vitiligo, albinism, psoriasis, and alopecia areata may provide new insights into immune-/non immune-mediated outcomes for melanocytes in cutaneous melanin units.
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Affiliation(s)
- Cristina Casalou
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin, Ireland
| | - Hugo Moreiras
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin, Ireland
| | - Jay M Mayatra
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin, Ireland
| | - Aurelie Fabre
- Department of Histopathology, St Vincent's University Hospital, Dublin, Ireland.,UCD School of Medicine, University College Dublin, Dublin, Ireland.,The Conway Institute of Biomedical and Biomolecular Science, University College Dublin, Dublin, Ireland
| | - Desmond J Tobin
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin, Ireland.,The Conway Institute of Biomedical and Biomolecular Science, University College Dublin, Dublin, Ireland
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Mejbel HA, Nelson KC, Pradhan D, Ivan D, Zaleski M, Nagarajan P, Tetzlaff MT, Curry JL, Torres-Cabala CA, Prieto VG, Aung PP. Cutaneous neoplasms composed of melanoma and carcinoma: A rare but important diagnostic pitfall and review of the literature. J Cutan Pathol 2020; 47:36-46. [PMID: 31361351 DOI: 10.1111/cup.13551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 01/03/2023]
Abstract
We report two cases of combined cutaneous tumors composed of melanoma and carcinoma. The first tumor presented as a 5-mm pink-blue macule over the right zygomatic arch in an 85-year-old man. Shave biopsy and immunohistochemical studies revealed that the tumor was composed of melanoma (highlighted by SOX10 and MART-1, with high Ki-67 proliferative index) intermixed with nodular basal cell carcinoma (highlighted by pan-cytokeratin and Ber-EP4). The neoplastic melanocytes were confined to the basal cell carcinoma nodules, and a diagnosis of combined melanoma in situ and basal cell carcinoma was rendered. After therapeutic excision, the patient was disease-free at 9 months after the initial diagnosis. The second tumor presented as a 6-mm pink-brown crusted papule on the right forehead in an 89-year-old man. Shave biopsy and immunohistochemical studies revealed that the tumor was composed of malignant melanoma (MM) (highlighted by S100 and MART-1) intermixed with squamous cell carcinoma (SCC) (highlighted by cytokeratin and p63), and a diagnosis of combined MM-SCC was rendered. These two cases highlight the importance of recognizing these rare types of melanocytic-epithelial cutaneous neoplasms to arrive at an accurate diagnosis that may inform appropriate disease stage and therapy.
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MESH Headings
- Aged, 80 and over
- Biomarkers, Tumor/metabolism
- Carcinoma, Basal Cell/diagnosis
- Carcinoma, Basal Cell/metabolism
- Carcinoma, Basal Cell/pathology
- Diagnosis, Differential
- Humans
- Male
- Melanoma/diagnosis
- Melanoma/metabolism
- Melanoma/pathology
- Neoplasm Proteins/metabolism
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/metabolism
- Neoplasms, Second Primary/pathology
- Skin Neoplasms/diagnosis
- Skin Neoplasms/metabolism
- Skin Neoplasms/pathology
- Melanoma, Cutaneous Malignant
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Affiliation(s)
- Haider A Mejbel
- Department of Pathology, East Tennessee State University, Johnson City, Tennessee
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dinesh Pradhan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Doina Ivan
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael Zaleski
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan L Curry
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos A Torres-Cabala
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Victor G Prieto
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Dinehart M, Abate MS, Jennings T, Kaley JR, Shalin SC. Colliding, colonizing or combining? Four cases illustrating the unique challenges presented by melanoma arising in conjunction with basal cell carcinoma. J Cutan Pathol 2018; 45:443-452. [PMID: 29484694 DOI: 10.1111/cup.13137] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 11/30/2022]
Abstract
Biphasic lesions comprised of melanocytic and epithelial components are rare entities believed to arise either as a collision of 2 histologically distinct lesions in the same anatomic location or as a singular progenitor tumor differentiating along 2 differing lineages. Regardless of mechanism of origin, these tumors present unique challenges in pathologic interpretation and in determining appropriate measurements, which assigns subsequent prognosis to the patient. We present 4 tumors of melanoma co-existing with basal cell carcinoma (BCC) and discuss relevant literature regarding these biphasic entities. Patients consisted of 3 males and 1 female, ranging in age from 62 to 93, with lesions located on the shoulder, frontal scalp, forearm and nose. Three of 4 lesions showed melanoma cells limited to BCC tumor lobules, without evidence of direct dermal invasion by melanoma cells, raising the question of whether or not these tumors should be classified as in situ or invasive melanoma. These cases highlight the complexity that such lesions pose to dermatopathologists, in terms of their uncertain origin and variable microscopic appearance. In the absence of data regarding outcomes for these tumors (given their rarity), it is important to utilize a case-by-case approach, with careful clinical correlation and appropriate use of ancillary techniques.
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Affiliation(s)
- Matthew Dinehart
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mallory S Abate
- Department of Dermatology, Saint Louis University, St. Louis, Missouri
| | - Thomas Jennings
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jennifer R Kaley
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sara C Shalin
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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