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Cheng TW, Hartsough E, Giubellino A. Sentinel lymph node assessment in melanoma: current state and future directions. Histopathology 2023; 83:669-684. [PMID: 37526026 DOI: 10.1111/his.15011] [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: 04/01/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 08/02/2023]
Abstract
Assessment of sentinel lymph node status is an important step in the evaluation of patients with melanoma for both prognosis and therapeutic management. Pathologists have an important role in this evaluation. The methodologies have varied over time, from the evaluation of dimensions of metastatic burden to determination of the location of the tumour deposits within the lymph node to precise cell counting. However, no single method of sentinel lymph node tumour burden measurement can currently be used as a sole independent predictor of prognosis. The management approach to sentinel lymph node-positive patients has also evolved over time, with a more conservative approach recently recognised for selected cases. This review gives an overview of past and current status in the field with a glimpse into future directions based on prior experiences and clinical trials.
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Affiliation(s)
- Tiffany W Cheng
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Emily Hartsough
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Alessio Giubellino
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
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2
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Grillini M, Ricci C, Pino V, Pedrini S, Fiorentino M, Corti B. HMB45/PRAME, a Novel Double Staining for the Diagnosis of Melanocytic Neoplasms: Technical Aspects, Results, and Comparison With Other Commercially Available Staining (PRAME and Melan A/PRAME). Appl Immunohistochem Mol Morphol 2022; 30:14-18. [PMID: 34508017 PMCID: PMC9575561 DOI: 10.1097/pai.0000000000000972] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/19/2021] [Indexed: 11/26/2022]
Abstract
PRAME (PReferentially expressed Antigen in MElanoma) is a tumor-associated antigen that was recently found to be expressed by malignant melanocytic lesions but not by benign ones, thus resulting useful in this diagnostic field. PRAME could also be expressed by some normal tissues and nonmelanocytic tumors, suggesting as caution should be adopted to use PRAME as a "pan-melanoma" marker for the differential diagnosis with other malignant tumors. Until now, PRAME expression was exclusively investigated through single staining with a monoclonal antibody targeting PRAME and with double staining for Melan A/PRAME found to be useful in specific diagnostic sets. Herein, we studied the expression of PRAME in 40 melanocytic lesions and 23 nonmelanocytic ones using PRAME, Melan A/PRAME, and novel double staining for HMB45/PRAME. Although our results need to be validated, they support the adoption of HMB45/PRAME, alone or in combination with PRAME and Melan A/PRAME, as a helpful marker in the diagnosis of melanocytic neoplasms with a high concordance rate between primary melanoma and corresponding metastases.
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Affiliation(s)
- Marco Grillini
- Pathology Unit, IRCSS Sant’Orsola-Malpighi Hospital and University of Bologna
| | - Costantino Ricci
- Pathology Unit, Maggiore Hospital
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Vincenzo Pino
- Pathology Unit, IRCSS Sant’Orsola-Malpighi Hospital and University of Bologna
| | - Silvia Pedrini
- Pathology Unit, IRCSS Sant’Orsola-Malpighi Hospital and University of Bologna
| | - Michelangelo Fiorentino
- Pathology Unit, IRCSS Sant’Orsola-Malpighi Hospital and University of Bologna
- Pathology Unit, Maggiore Hospital
| | - Barbara Corti
- Pathology Unit, IRCSS Sant’Orsola-Malpighi Hospital and University of Bologna
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3
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Gambichler T, Rohrmoser EM, Horny K, Sucker A, Schadendorf D, Skrygan M, Susok L, Stücker M, Becker JC. Comparison of mutation profiles in primary melanomas and corresponding nodal naevi using next-generation sequencing. Clin Exp Dermatol 2021; 47:373-380. [PMID: 34591998 DOI: 10.1111/ced.14951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Nodal naevi (NN) represent aggregates of melanocytes within peripheral lymph nodes. NN are relatively often found in patients with malignant melanoma (MM), and may mimic metastatic disease. AIM To study mutation profiles in MM and NN to find out whether NN descend from a primary MM. METHODS Next-generation sequencing was performed on formalin-fixed paraffin-embedded tissue of 26 pairs of primary MM and corresponding NN detected by sentinel lymph node biopsy, and 29 MM-characteristic genes were investigated. RESULTS In this study, 90% of mutations were detected exclusively in either MM or NN, but not both, in the same patient; the percentage of identical NN and MM mutations in the same individual was only 10%. The most frequently discovered shared mutations were a C>G substitution in the CDKN2A gene and in-frame deletion in ARID1A. Oncogenic driver mutations were frequently observed in MM but only rarely in NN. About three-quarters of mutations in both MM and NN were characterized by C>T or G>A substitutions. The detected rate of ultraviolet (UV)-related C>T base changes was comparably high in both primary MM (35%) and NN (32%). CONCLUSIONS Based on our data, it seems that NN descend from previously UV-exposed BRAF wildtype cutaneous melanocytes, rather than from primary MM or arrested progenitor cells.
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Affiliation(s)
- T Gambichler
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - E-M Rohrmoser
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - K Horny
- Department of Dermatology, Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, University Duisburg-Essen, Essen, Germany.,Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - A Sucker
- Department of Dermatology, Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, University Duisburg-Essen, Essen, Germany.,Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - D Schadendorf
- Department of Dermatology, Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, University Duisburg-Essen, Essen, Germany.,Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany.,Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - M Skrygan
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - L Susok
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - M Stücker
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - J C Becker
- Department of Dermatology, Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, University Duisburg-Essen, Essen, Germany.,Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany.,Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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4
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Three Types of Nodal Melanocytic Nevi in Sentinel Lymph Nodes of Patients With Melanoma: Pitfalls, Immunohistochemistry, and a Review of the Literature. Am J Dermatopathol 2021; 42:739-744. [PMID: 32271206 DOI: 10.1097/dad.0000000000001645] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The presence or absence of metastasis in sentinel lymph nodes often drives melanoma staging, prognosis, and treatment. However, distinguishing between metastatic melanoma cells and clusters of benign melanocytic nevus cells is not always straightforward. When morphologic hematoxylin and eosin interpretation alone is not sufficient, additional hematoxylin and eosin sections and immunohistochemical (IHC) studies may be beneficial. This review and small cases series of 3 diagnostically challenging melanocytic sentinel lymph node cases highlights the IHC approach to evaluate intraparenchymal nodal melanocytic nevi, coexistent metastatic melanoma with adjacent melanocytic nevi cells, and nodal blue nevi. In challenging cases, cytological morphology of the melanocytes, location within the lymph node, and IHC studies may assist in diagnosis. If these tools yield conflicting results, expert opinion is recommended.
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Lu YP, Fan S, Liang Z, Song Y, Liu K, Zhou K, Wang X, Kang J, Yang Y, Liu X. Phosphodiesterase Type 5 Inhibitors and Risk of Skin Cancers in Men: A Meta-Analysis and Trial Sequential Analysis Involving 7,479,852 Subjects. World J Mens Health 2020; 39:683-696. [PMID: 33151043 PMCID: PMC8443994 DOI: 10.5534/wjmh.200082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/29/2020] [Accepted: 08/02/2020] [Indexed: 01/11/2023] Open
Abstract
Purpose We conducted a systematic review and meta-analysis to quantify the association between phosphodiesterase type 5 inhibitors (PDE5Is) use and skin cancers and we also examined whether down-expression of the PDE5A gene was related to worse prognosis for malignant melanoma (MM) patients. Materials and Methods The PubMed, Cochrane Library, Web of Science, EMBASE, and ClinicalTrails.gov databases were searched. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the association between PDE5Is use and risk of skin cancers. Cumulative meta-analysis and trial sequential analysis (TSA) were also conducted. Survival outcomes were analyzed online. Results After pooling all 8 eligible studies comprising 7,479,852 subjects, we found that PDE5Is use was significantly associated with slightly increased risk of developing MM (OR: 1.13, 95% CI: 1.05 to 1.21, I2=67.1%), basal cell carcinoma (OR: 1.16, 95% CI: 1.13 to 1.19, I2=49.6%), and squamous cell carcinoma (OR: 1.07, 95% CI: 1.01 to 1.13, I2=0.0%). Totally, PDE5Is increased the risk of developing skin cancers (OR: 1.13, 95% CI: 1.09 to 1.17, I2=70.8%). TSA results showed that the sample size was enough to reach a positive conclusion. Conclusions The use of PDE5Is may be slightly associated with increased risk of developing skin cancers. There should be a balance between drug benefits and potential safety issues. However, the pooled results should be considered tentative until confounding factors such as sun exposure and lifestyle are well-controlled in further studies.
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Affiliation(s)
- Yi Patrick Lu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Shujun Fan
- 7th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhen Liang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuxuan Song
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Kang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Kechong Zhou
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiao Wang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiaqi Kang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yongjiao Yang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China.
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Yamashita TS, Pockaj BA, Bagaria SP, Flotte TJ, Fahy AS, de Azevedo RU, Harmsen WS, Block MS, Jakub JW. Clinical significance of SLN benign capsular nevi in patients with melanoma. J Surg Oncol 2020; 122:1043-1049. [PMID: 33616952 DOI: 10.1002/jso.26135] [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: 05/18/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Benign capsular nevi (BCN) are not infrequent in sentinel lymph nodes (SLN) of patients with melanoma. Their prognostic significance is unknown and the literature is limited. This study evaluated the clinical significance of incidentally found BCN in these patients. METHODS A multi-institutional retrospective review of patients undergoing SLN biopsy for cutaneous melanoma between 2000 and 2016. Patients were divided into the following groups: (a) negative SLN and no BCN, (b) negative SLN and presence of BCN, (c) positive SLN seen only on immunohistochemistry (IHC), and (d) positive SLN via hematoxylin and eosin (H&E). Outcomes measured were overall survival and any recurrence. RESULTS A total of 1253 patients were identified (group 1 = 978, group 2 = 56, group 3 = 32, and group 4 = 187). Fifty-seven percent were male and the mean age was 59.3 years. BCN was identified in 77 patients (6.2%), of which the majority was in the node-negative group (72%). Multivariable analysis showed that BCN was associated with lower recurrence rates, though not statistically significant (hazard ratio [HR] = 0.5; P = .06). IHC- and H&E-positive SLNs were associated with a higher risk of recurrence (HR = 2.4; P = .02 and 2.0, P < .0001, respectively). CONCLUSION Patients with BCN and negative SLN had lower recurrence rates than patients with negative SLN and no BCN. Our data suggest a possible protective effect against recurrence.
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Affiliation(s)
| | | | | | - Thomas J Flotte
- Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | | | | | - William S Harmsen
- Department of Clinical Statistics, Mayo Clinic, Rochester, Minnesota
| | - Matthew S Block
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Richetta AG, Valentini V, Marraffa F, Paolino G, Rizzolo P, Silvestri V, Zelli V, Carbone A, Di Mattia C, Calvieri S, Frascione P, Donati P, Ottini L. Metastases risk in thin cutaneous melanoma: prognostic value of clinical-pathologic characteristics and mutation profile. Oncotarget 2018; 9:32173-32181. [PMID: 30181807 PMCID: PMC6114949 DOI: 10.18632/oncotarget.25864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/13/2018] [Indexed: 11/25/2022] Open
Abstract
Background A high percentage of patients with thin melanoma (TM), defined as lesions with Breslow thickness ≤1 mm, presents excellent long-term survival, however, some patients develop metastases. Existing prognostic factors cannot reliably differentiate TM patients at risk for metastases. Objective We aimed at characterizing the clinical-pathologic and mutation profile of metastatic and not-metastatic TM in order to distinguish lesions at risk of metastases. Methods Clinical-pathologic characteristics were recorded for the TM cases analyzed. We used a Next Generation Sequencing (NGS) multi-gene panel to characterize TM for multiple somatic mutations. Results A statistically significant association emerged between the presence of metastases and Breslow thickness ≥0.6 mm (p=0.003). None of TM with lymph-node involvement had Breslow thickness <0.6 mm. Somatic mutations were identified in 19 of 21 TM analyzed (90.5%). No mutations were observed in two not-metastatic cases with the lowest Breslow thickness (≤0.4 mm), whereas mutations in more than one gene were detected in one metastatic case with the highest Breslow thickness (1.00 mm). Conclusion Our study indicates Breslow thickness ≥0.6 mm as a valid prognostic factor to distinguish TM at risk for metastases.
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Affiliation(s)
- Antonio G Richetta
- Department of Internal Medicine and Medical Specialties, Unit of Dermatology, "Sapienza" University of Rome, Rome, Italy
| | - Virginia Valentini
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Federica Marraffa
- Department of Internal Medicine and Medical Specialties, Unit of Dermatology, "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Paolino
- Department of Internal Medicine and Medical Specialties, Unit of Dermatology, "Sapienza" University of Rome, Rome, Italy.,Unit of Dermatology and Cosmetology, IRCCS, University Vita-Salute San Raffaele, Milan, Italy
| | - Piera Rizzolo
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Valentina Silvestri
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Veronica Zelli
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Anna Carbone
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Cinzia Di Mattia
- Laboratory of Cutaneous Histopathology, San Gallicano Dermatologic Institute, Rome, Italy
| | - Stefano Calvieri
- Department of Internal Medicine and Medical Specialties, Unit of Dermatology, "Sapienza" University of Rome, Rome, Italy
| | - Pasquale Frascione
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Pietro Donati
- Laboratory of Cutaneous Histopathology, San Gallicano Dermatologic Institute, Rome, Italy
| | - Laura Ottini
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
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Han X, Han Y, Zheng Y, Sun Q, Ma T, Dai L, Zhang J, Xu L. Use of phosphodiesterase type 5 inhibitors and risk of melanoma: a meta-analysis of observational studies. Onco Targets Ther 2018; 11:711-720. [PMID: 29440918 PMCID: PMC5804137 DOI: 10.2147/ott.s142637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Phosphodiesterase type 5 inhibitor (PE5i) administration may stimulate the proliferation and survival of melanocytes. However, discrepancies remain regarding the association between PDE5i use and melanoma risk in observational studies in humans. Aim To evaluate the association between PDE5i use and melanoma in a meta-analysis. Materials and methods Studies were identified by searching the PubMed and Embase databases. A random-effects model was applied to synthesize the data. A stratified study was performed to evaluate the influence of study characteristics on outcomes. Results Four prospective cohort studies and three case–control studies with 1,534,615 male participants and 16,053 melanoma cases were incorporated. Patients who received a PDE5i had a significantly increased risk for melanoma (adjusted risk ratio [RR] =1.12, 95% CI =1.03–1.33, P=0.008) with moderate heterogeneity (I2=54%). Cohort studies (adjusted RR =1.22, 95% CI =1.02–1.46, P=0.03) largely contributed to this result rather than case–control studies. Subsequent stratified analyses revealed that sildenafil was associated with an increased risk of melanoma (adjusted RR =1.26, 95% CI =1.07–1.50, P=0.007), but tadalafil and vardenafil were not. Also, PDE5i use was associated with a significantly increased risk of in situ melanoma (adjusted RR =1.31, 95% CI =1.01–1.69, P=0.04), but not of localized or nonlocalized melanoma. Conclusion PDE5i use may be associated with a significantly increased risk for melanoma in men. However, further research is needed to determine whether the association is causative.
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Affiliation(s)
- Xinming Han
- Plastic Surgery Department, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Yan Han
- Plastic and Reconstructive Surgery Department, Chinese PLA General Hospital, Beijing, China
| | - Yongsheng Zheng
- Plastic Surgery Department, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Qiang Sun
- Plastic Surgery Department, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Tao Ma
- Plastic Surgery Department, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Li Dai
- Plastic Surgery Department, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Junyi Zhang
- Plastic Surgery Department, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Lianji Xu
- Plastic Surgery Department, Beijing Tongren Hospital, Capital Medical University, Beijing
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