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Diet G, Lenoir C, Fontaine M, Boussingault L, Orte Cano C, Mtimet L, Liénard D, Sanak D, Moulart F, Bernardi D, Trepant AL, Perez-Anker J, Puig S, Malvehy J, Cinotti E, Tognetti L, Rubegni P, Perrot JL, Marmol VD, Suppa M. The Role of Line-Field Confocal Optical Coherence Tomography in Detecting Extramammary Paget Disease Recurrences: A Pilot Diagnostic Study. Diagnostics (Basel) 2024; 14:1562. [PMID: 39061699 PMCID: PMC11276029 DOI: 10.3390/diagnostics14141562] [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: 06/14/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Extramammary Paget disease (EMPD) is an uncommon adenocarcinoma of apocrine gland-rich areas, presenting significant diagnostic challenges due to its nonspecific clinical appearance and frequent misidentification as benign, inflammatory skin conditions. Traditional diagnostic methods such as biopsy are invasive and uncomfortable, often required repeatedly due to high recurrence rates. Dermoscopy and non-invasive imaging techniques have been used but provide limited diagnostic accuracy due to their constraints in depth penetration and resolution. Recent advancements in imaging technologies, such as line-field confocal optical coherence tomography (LC-OCT), show promise in enhancing diagnostic precision while minimizing invasive procedures. LC-OCT merges high-resolution imaging with deep penetration capabilities, capturing detailed horizontal and vertical skin images akin to histopathology. This study evaluated the diagnostic performance of LC-OCT in detecting EMPD and its recurrence in 17 clinically suspicious anogenital regions, belonging to six patients. Data were collected prospectively at the patient's bedside by an LC-OCT expert with poor training for EMPD, and, then, reviewed retrospectively by an independent LC-OCT expert with adequate training for EMPD and no concerns about time. The prospective examination yielded 64.7% accuracy (11 true results out of 17 total cases), 71.4% sensitivity (10 true positives out of 14 actual positives), and 33.3% specificity (1 true negative out of 3 actual negatives). The retrospective analysis achieved 94.1% accuracy (16 true results out of 17 total cases), 100% sensitivity (14 true positives out of 14 actual positives), and 66.7% specificity (2 true positives out of 3 actual positives), with the only false positive case being a difficult-to-diagnose concomitant presentation of a lichen sclerosus et atrophicus. Despite the need for specialized training, our results suggest that LC-OCT represents a valuable tool for accurately identifying EMPD and improving its management by reducing unnecessary biopsies. Further studies are needed to standardize its clinical application.
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Affiliation(s)
- Gwendoline Diet
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), HUB, 1070 Brussels, Belgium
| | - Clément Lenoir
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), HUB, 1070 Brussels, Belgium
- Melanoma Unit, Hospital Clinic Barcelona, University of Barcelona, 08036 Barcelona, Spain
| | - Margot Fontaine
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), HUB, 1070 Brussels, Belgium
| | - Lucas Boussingault
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), HUB, 1070 Brussels, Belgium
- Department of Dermatology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), HUB, 1070 Brussels, Belgium
| | - Carmen Orte Cano
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), HUB, 1070 Brussels, Belgium
- Department of Dermatology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), HUB, 1070 Brussels, Belgium
| | - Lyna Mtimet
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), HUB, 1070 Brussels, Belgium
| | - Danielle Liénard
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), HUB, 1070 Brussels, Belgium
- Department of Dermatology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), HUB, 1070 Brussels, Belgium
| | - Dilara Sanak
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
| | - Florine Moulart
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
| | - Dana Bernardi
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
| | - Anne-Laure Trepant
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
| | - Javiera Perez-Anker
- Melanoma Unit, Hospital Clinic Barcelona, University of Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Carlos III Health Institute, 28029 Barcelona, Spain
| | - Susana Puig
- Melanoma Unit, Hospital Clinic Barcelona, University of Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Carlos III Health Institute, 28029 Barcelona, Spain
| | - Josep Malvehy
- Melanoma Unit, Hospital Clinic Barcelona, University of Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Carlos III Health Institute, 28029 Barcelona, Spain
| | - Elisa Cinotti
- Unit of Dermatology, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
- Groupe d’Imagerie Cutanée Non Invasive (GICNI) of the Société Française de Dermatologie (SFD), 42055 Paris, France
| | - Linda Tognetti
- Unit of Dermatology, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Pietro Rubegni
- Unit of Dermatology, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Jean-Luc Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - Véronique Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), HUB, 1070 Brussels, Belgium
- Department of Dermatology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), HUB, 1070 Brussels, Belgium
| | - Mariano Suppa
- Department of Dermatology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), HUB, 1070 Brussels, Belgium
- Groupe d’Imagerie Cutanée Non Invasive (GICNI) of the Société Française de Dermatologie (SFD), 42055 Paris, France
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Li GB, Qiu XY, Zhang X, Zhang N, Lin GL. Case report: The application of neoadjuvant chemoradiotherapy in anal adenocarcinoma combined with perianal Paget disease involving vulvar skin. Front Oncol 2023; 13:1327173. [PMID: 38162507 PMCID: PMC10755467 DOI: 10.3389/fonc.2023.1327173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Anal adenocarcinoma combined with perianal Paget's disease (PPD) involving the vulva is rare, and there is no established standard treatment. We present the case of a 69-year-old woman with symptoms of intermittent hematochezia and perianal discomfort for 7 months. Upon examination, we discovered a plaque-like hard mass on the right posterior wall of the anal canal, which extended to encompass the anus and dentate line. The lesion skin also extended forward from the gluteal groove, involving the bilateral labial area. Colonoscopy revealed an extensive protruding lesion on the dentate line, which was confirmed as anal adenocarcinoma (mrT4N0M0). The presence of Paget's cells in perianal and vulvar skins led to the diagnosis of PPD. The strategy of neoadjuvant chemoradiotherapy (nCRT) followed by radical surgery was then made after multi-disciplinary discuss. The scope and extent of perianal and vulvar disease were significantly diminished after nCRT. The patient underwent laparoscopic abdominoperineal resection and vulvar lesion resection, confirming the diagnosis of anal adenocarcinoma (ypT2N0). No evidence of tumor cells was found in perianal and vulvar skin, indicating a complete response. The patient is regularly monitored without recurrence or metastasis.
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Affiliation(s)
| | | | | | | | - Guo-le Lin
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
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Xiao J, Zhang L, Chen L. An asymptomatic erythematous plaque on the cheek. Indian J Dermatol Venereol Leprol 2023; 89:606-608. [PMID: 35962489 DOI: 10.25259/ijdvl_1165_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/01/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Jing Xiao
- Department of Dermatology, Wuhan No 1 Hospital, Wuhan, Hubei Province, People's Republic of China
| | - Liang Zhang
- Department of Dermatology, Wuhan No 1 Hospital, Wuhan, Hubei Province, People's Republic of China
| | - Liuqing Chen
- Department of Dermatology, Wuhan No 1 Hospital, Wuhan, Hubei Province, People's Republic of China
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Chen L, Yang N, Jiang F, Shao J, Ye Y, Zhu J, Li Z, Liu J. Clinical and dermoscopic features of extramammary Paget's disease: A retrospective analysis of 49 cases. Photodiagnosis Photodyn Ther 2022; 40:103105. [PMID: 36075520 DOI: 10.1016/j.pdpdt.2022.103105] [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: 06/27/2022] [Revised: 08/20/2022] [Accepted: 08/31/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Extramammary Paget's disease (EMPD) is a rare cutaneous malignancy that can be easily confused with other diseases due to its diverse clinical manifestations, delaying the timing of treatment. Therefore, early diagnosis is extremely important. It has been reported that dermoscopy can be used to evaluate superficial skin tumors. OBJECTIVE To investigate the dermoscopic characteristics of EMPD diagnosed by histopathology and to develop a decision tree model that can provide clinicians with a reference to facilitate early diagnosis. METHODS All patients were evaluated by dermoscopic and histopathologic examinations. Dermoscopic images were assessed, and a decision tree model was constructed using SPSS (version 25.0). RESULTS A total of 49 patients were included in this study. We found that EMPD was most likely to be misdiagnosed when the disease duration was less than 2.5 years. Porcelain-white patches were the only key clinical feature other varying dermoscopic features could not be differentiated from those of EMPD-mimicking diseases. Polymorphic vessels were considered to be significant when the duration of the disease ranged from 0.1 year to 2.5 years. However, when the duration was >2.5 years, present (or absent) glomerular vessels were all considered EMPD. CONCLUSIONS Dermoscopy can be used as an auxiliary diagnostic tool for the diagnosis and management of EMPD. The decision tree can guide clinical diagnosis further validation studies are necessary due to the limited number of cases.
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Affiliation(s)
- Lele Chen
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Nali Yang
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Fan Jiang
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Junyi Shao
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Yahui Ye
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Jiling Zhu
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Zhiming Li
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
| | - Jingjing Liu
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
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Tan L, Huang J, Zhang Y, Zeng L, Tong X, Gao L, Zeng J. Evaluation of in vivo reflectance confocal microscopy in the diagnosis of extramammary Paget's disease. Microsc Res Tech 2021; 85:283-289. [PMID: 34378833 DOI: 10.1002/jemt.23903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/08/2021] [Accepted: 08/01/2021] [Indexed: 11/08/2022]
Abstract
Extramammary Paget's disease (EMPD) is a rare cutaneous malignancy that most commonly affects the apocrine glands of older men and women. Because it is associated with other cancers, early diagnosis and evaluation are needed. This study is to evaluate the value of reflectance confocal microscopy (RCM) in diagnosing EMPD. A total of 73 patients with clinically suspicious diagnosis of EMPD were enrolled in this study, and the RCM device imaged their lesions. Moreover, 67 patients underwent skin biopsies to confirm the diagnosis. We retrospectively analyzed the results of RCM and histological diagnosis and then evaluated the RCM value of biopsy-confirmed lesions. Based on the RCM image analysis, 54 of 73 (74.0%) patients were diagnosed with EMPD. Of all 67 biopsied lesions, 52 (77.6%) were EMPD. Then, we analyzed the RCM characteristics of 52 cases of biopsy-confirmed EMPD, compared their RCM image characteristics of three different lesions of EMPD, and further concluded the key points of EMPD under RCM microscopy based on the 52 EMPD cases. Finally, we focused on the differential diagnosis of EMPD from other skin diseases. RCM showed great diagnostic value in diagnosing EMPD.
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Affiliation(s)
- Lina Tan
- Department of Dermatology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jian Huang
- Department of Dermatology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuezhong Zhang
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Liyue Zeng
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Xiaoliang Tong
- Department of Dermatology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lihua Gao
- Department of Dermatology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jinrong Zeng
- Department of Dermatology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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Huang L, Wang Y, Wu M, Zhao J, Zhang W, Zhao L, Mo X, Fang F. Diagnosis of subclinical extramammary Paget's disease with a combination of noninvasive photodynamic diagnosis and reflectance confocal microscopy. Indian J Dermatol Venereol Leprol 2021; 87:371-374. [PMID: 30829297 DOI: 10.4103/ijdvl.ijdvl_895_17] [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: 12/01/2017] [Accepted: 07/01/2018] [Indexed: 11/04/2022]
Abstract
Extramammary Paget's disease is a rare skin malignancy, and its diagnosis requires invasive biopsy and histopathological examination. Surgery is the standard treatment for extramammary Paget's disease patients; however, as incision boundaries and the depth of tumor cell infiltration are often unclear, the postoperative recurrence rate is high. We present a case in which we used photodynamic diagnosis in combination with reflectance confocal microscopy before surgery to detect an extramammary Paget's disease lesion that was located 3 cm away from the classical lesion. This secondary lesion exhibited a subclinical presentation, and it was eventually confirmed as an extramammary Paget's disease lesion by pathological examination. During detection using our technique, we delineated the boundaries of the extramammary Paget's disease lesion as a guide for surgical excision. The findings of our case demonstrate that photodynamic diagnosis combined with reflectance confocal microscopy can be used for the noninvasive diagnosis of subclinical extramammary Paget's disease and may be used to guide strategies for planning treatment and preventing relapse.
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Affiliation(s)
- Liming Huang
- Department of Dermatologic Surgery, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Yan Wang
- Department of Dermatologic Surgery, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Minzhi Wu
- Department of Dermatology, The Fifth People's Hospital of Suzhou, The Affiliated Hospital of Infectious Diseases of Soochow University, Suzhou, China
| | - Jun Zhao
- Department of Dermatology, Changshu No. 1 People's Hospital, Changshu, Jiangsu Province, China
| | - Wei Zhang
- Department of Dermatologic Surgery, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Liang Zhao
- Department of Dermatologic Surgery, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Xingfan Mo
- Department of Dermatology, The Fifth People's Hospital of Suzhou, The Affiliated Hospital of Infectious Diseases of Soochow University, Suzhou, China
| | - Fang Fang
- Department of Dermatologic Surgery, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
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7
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Navarrete-Dechent C, Aleissa S, Cordova M, Hibler BP, Erlendsson AM, Polansky M, Cordova F, Lee EH, Busam KJ, Hollmann T, Lezcano C, Moy A, Pulitzer M, Leitao MM, Rossi AM. Treatment of Extramammary Paget Disease and the Role of Reflectance Confocal Microscopy: A Prospective Study. Dermatol Surg 2021; 47:473-479. [PMID: 33625139 PMCID: PMC10599152 DOI: 10.1097/dss.0000000000002934] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Extramammary Paget disease (EMPD) poses treatment challenges. Invasive and noninvasive treatment modalities exist with variable success reported. Reflectance confocal microscopy (RCM) is emerging as an adjuvant diagnostic tool. OBJECTIVE To evaluate the treatment of EMPD patients and the role of RCM. METHODS Prospective study. Demographic and tumor characteristics were recorded. Handheld-RCM was performed and correlated with histology. Treatment, clearance, pathology, and follow-up were all recorded. RESULTS Thirty-six EMPD lesions in 33 patients were included. Mean age was 71.7 years, and 23 were men. Mean number of surgical stages needed to clear margins was 1.9 (SD, 0.9; 1.0-3.0 stages), and mean margin needed to clear was 1.8 cm. Reflectance confocal microscopy correlated well with scouting punch biopsies (kappa, 0.93; p < .001). Disruption of the dermoepidermal junction was associated with invasive EMPD versus in situ (83.3% vs 25.9%) on histology (p = .01). LIMITATIONS Relatively small sample size. CONCLUSION Extramammary Paget disease is challenging, and lesion demarcation is of the utmost importance. Using a staged surgical excision approach, the mean margins needed were 1.8 cm, less than previously reported. Nonsurgical modalities, including radiation therapy, imiquimod, or photodynamic therapy can be considered if surgery is not pursued. Reflectance confocal microscopy is a valuable noninvasive imaging modality for the management of EMPD.
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Affiliation(s)
- Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Saud Aleissa
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian P. Hibler
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andres M. Erlendsson
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Max Polansky
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Frank Cordova
- Department of Biology, Stony Brook University, Stony Brook, NY, USA
| | - Erica H. Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Klaus J. Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Travis Hollmann
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cecilia Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Moy
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthony M. Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
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Wu M, Huang L, Lu X, Li J, Wang Y, Zang J, Mo X, Shao X, Wang L, Cheng W, He F, Zhang Q, Zhang W, Zhao L. Utility of photodynamic diagnosis plus reflectance confocal microscopy in detecting the margins of extramammary Paget disease. Indian J Dermatol Venereol Leprol 2021; 87:207-213. [PMID: 33769727 DOI: 10.25259/ijdvl_90_20] [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: 01/01/2020] [Accepted: 04/01/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Due to the clinically poorly delineated unclear margin of extramammary Paget disease, the recurrence rate after surgical resection is high. AIMS To compare photodynamic diagnosis and photodynamic plus reflectance confocal microscopy diagnosis in determining the tumor margins in patients with extramammary Paget disease. METHODS Thirty-six patients with histopathologically confirmed primary extramammary Paget disease between January 2017 to June 2018 were included in the study. The skin lesion margins were preoperatively observed by the naked eye and with photodynamic diagnosis and photodynamic diagnosis plus reflectance confocal microscopy and they were compared to the postoperative histopathological examination results. RESULTS Among the 130 sections taken from 36 patients, 83 sections (63.8%, 83/130) had tumor margins beyond the macroscopic line with a distance of 3.5 ± 3.1mm and a median of 2.7mm. Forty-six sections (35.4%, 46/130) exceeded the photodynamic diagnosis marker line with a distance of 2.1 ± 1.7mm and a median of 1.5mm. Twenty seven sections (20.8%, 27/130) were obtained beyond the photodynamic diagnosis plus reflectance confocal microscopy marker line with a distance of 1.4 ± 1.2mm and a median of 0.9mm. LIMITATIONS Photodynamic diagnosis and reflectance confocal microscopy detection can be used to observe only the superficial margin of the tumor and not the deep part. Moreover, reflectance confocal microscopy was not used alone as a control. CONCLUSION In terms of determining the extramammary Paget disease margin invasively, photodynamic diagnosis and photodynamic diagnosis plus reflectance confocal microscopy were found superior to observations made with the naked eye, while photodynamic diagnosis plus reflectance confocal microscopy was superior to photodynamic diagnosis alone.
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Affiliation(s)
- Minzhi Wu
- Department of Dermatology, The Fifth People's Hospital of Suzhou, The Affiliated Hospital of Infectious Diseases of Soochow University, Suzhou
| | - Liming Huang
- Department of Dermatologic Surgery, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - Xinfeng Lu
- Department of Dermatology, Jingjiang People's Hospital, Jingjiang, Jiangsu Province, China
| | - Jingjing Li
- Department of Dermatology, The Fifth People's Hospital of Suzhou, The Affiliated Hospital of Infectious Diseases of Soochow University, Suzhou
| | - Yan Wang
- Department of Dermatologic Surgery, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - Jie Zang
- Department of Dermatologic Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - Xingfan Mo
- Department of Dermatology, The Fifth People's Hospital of Suzhou, The Affiliated Hospital of Infectious Diseases of Soochow University, Suzhou
| | - Xuebao Shao
- Department of Dermatologic Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - Lili Wang
- Department of Dermatologic Surgery, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - Wei Cheng
- Department of Dermatologic Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - Fanghua He
- Department of Dermatology, The Fifth People's Hospital of Suzhou, The Affiliated Hospital of Infectious Diseases of Soochow University, Suzhou
| | - Qian Zhang
- Department of Dermatologic Surgery, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - Wei Zhang
- Department of Dermatologic Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - Liang Zhao
- Department of Dermatologic Surgery, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
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Chakraborty G, Patail NK, Hirani R, Nandakumar S, Mazzu YZ, Yoshikawa Y, Atiq M, Jehane LE, Stopsack KH, Lee GSM, Abida W, Morris MJ, Mucci LA, Danila D, Kantoff PW. Attenuation of SRC Kinase Activity Augments PARP Inhibitor-mediated Synthetic Lethality in BRCA2-altered Prostate Tumors. Clin Cancer Res 2021; 27:1792-1806. [PMID: 33334906 PMCID: PMC7956224 DOI: 10.1158/1078-0432.ccr-20-2483] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/04/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Alterations in DNA damage repair (DDR) pathway genes occur in 20%-25% of men with metastatic castration-resistant prostate cancer (mCRPC). Although PARP inhibitors (PARPis) have been shown to benefit men with mCRPC harboring DDR defects due to mutations in BRCA1/2 and ATM, additional treatments are necessary because the effects are not durable. EXPERIMENTAL DESIGN We performed transcriptomic analysis of publicly available mCRPC cases, comparing BRCA2 null with BRCA2 wild-type. We generated BRCA2-null prostate cancer cells using CRISPR/Cas9 and treated these cells with PARPis and SRC inhibitors. We also assessed the antiproliferative effects of combination treatment in 3D prostate cancer organoids. RESULTS We observed significant enrichment of the SRC signaling pathway in BRCA2-altered mCRPC. BRCA2-null prostate cancer cell lines had increased SRC phosphorylation and higher sensitivity to SRC inhibitors (e.g., dasatinib, bosutinib, and saracatinib) relative to wild-type cells. Combination treatment with PARPis and SRC inhibitors was antiproliferative and had a synergistic effect in BRCA2-null prostate cancer cells, mCRPC organoids, and Trp53/Rb1-null prostate cancer cells. Inhibition of SRC signaling by dasatinib augmented DNA damage in BRCA2-null prostate cancer cells. Moreover, SRC knockdown increased PARPi sensitivity in BRCA2-null prostate cancer cells. CONCLUSIONS This work suggests that SRC activation may be a potential mechanism of PARPi resistance and that treatment with SRC inhibitors may overcome this resistance. Our preclinical study demonstrates that combining PARPis and SRC inhibitors may be a promising therapeutic strategy for patients with BRCA2-null mCRPC.
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Affiliation(s)
- Goutam Chakraborty
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nabeela Khan Patail
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rahim Hirani
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Subhiksha Nandakumar
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ying Z. Mazzu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yuki Yoshikawa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mohammad Atiq
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lina E. Jehane
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Konrad H. Stopsack
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Wassim Abida
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael J. Morris
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Daniel Danila
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Philip W. Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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10
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Komatsu-Fujii T, Nomura T, Kaku Y, Yamamura K, Yoshikawa Y, Endo Y, Honda T, Kabashima K. In vivo identification of tumor cells of the basal layer of the epidermis in an early lesion of extramammary Paget disease: A reflectance confocal microscopic analysis. JAAD Case Rep 2021; 11:1-2. [PMID: 33869703 PMCID: PMC8042428 DOI: 10.1016/j.jdcr.2021.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Takayoshi Komatsu-Fujii
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Dermatology, Tenri Hospital, Tenri, Japan
| | - Takashi Nomura
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yo Kaku
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Dermatology, Kagawa University Faculty of Medicine, Kita-gun, Japan
| | - Kentaro Yamamura
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | | | - Yuichiro Endo
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tetsuya Honda
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Singapore Immunology Network (SIgN) and Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
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11
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Preoperative Evaluation through Dermoscopy and Reflectance Confocal Microscopy of the Lateral Excision Margins for Primary Basal Cell Carcinoma. Diagnostics (Basel) 2021; 11:diagnostics11010120. [PMID: 33466602 PMCID: PMC7828674 DOI: 10.3390/diagnostics11010120] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 12/30/2020] [Accepted: 01/12/2021] [Indexed: 12/11/2022] Open
Abstract
Complete removal of malignant skin lesions with minimal impact on the aesthetic and functional aspects is the ideal of every dermatologic surgeon. Incomplete surgical excisions and tumor recurrences of basal cell carcinomas (BCC) commonly occur due to the subclinical extension of tumor lateral margins. Presently, the lateral excision margins for BCC cannot be objectively assessed preoperatively, dermoscopy proving to be relatively inefficient in this respect. The question is whether BCC lateral excision margins can be precisely determined preoperatively through the use of complementary non-invasive imaging techniques such as dermoscopy and reflectance confocal microscopy (RCM), thus permitting the complete removal of the lesion in a single stage, estimation of the post-excisional defect, and planning an appropriate reconstruction, especially in medical centers where Mohs micrographic surgery is not available. We present the results of a prospective, histopathologically controlled study designed to determine the feasibility of preoperative, non-invasive, in vivo evaluation of the lateral excision margins for primary basal cell carcinoma, through dermoscopy and RCM.
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12
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Chuchvara N, Reilly C, Haroon A, Wassef C, Maghari A, Rao B. Atypical cells on reflectance confocal microscopy may not represent melanoma: A case of axillary pigmented extramammary Paget disease. J Cutan Pathol 2020; 47:1170-1174. [DOI: 10.1111/cup.13804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/12/2020] [Accepted: 07/05/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Nadiya Chuchvara
- Center for Dermatology Rutgers Robert Wood Johnson Medical School Somerset NJ USA
| | - Catherine Reilly
- Center for Dermatology Rutgers Robert Wood Johnson Medical School Somerset NJ USA
| | - Attiya Haroon
- Center for Dermatology Rutgers Robert Wood Johnson Medical School Somerset NJ USA
| | - Cindy Wassef
- Center for Dermatology Rutgers Robert Wood Johnson Medical School Somerset NJ USA
| | - Amin Maghari
- Department of Pathology and Laboratory Medicine Rutgers Robert Wood Johnson Medical School New Brunswick NJ USA
| | - Babar Rao
- Center for Dermatology Rutgers Robert Wood Johnson Medical School Somerset NJ USA
- Department of Dermatology Weill Cornell Medicine New York NY USA
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13
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Wang JY, Wang YJ, Wu YH. In vivo characterization of extramammary Paget's disease by ultra-high cellular resolution optical coherence tomography. Skin Res Technol 2020; 27:114-117. [PMID: 32767528 DOI: 10.1111/srt.12914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/02/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jen-Yu Wang
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yen-Jen Wang
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Yu-Hung Wu
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
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14
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Bayan CAY, Khanna T, Rotemberg V, Samie FH, Zeitouni NC. A review of non-invasive imaging in extramammary Paget's disease. J Eur Acad Dermatol Venereol 2018; 32:1862-1873. [PMID: 29763511 DOI: 10.1111/jdv.15072] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 04/30/2018] [Indexed: 01/04/2023]
Abstract
Extramammary Paget's Disease (EMPD) is a rare intraepithelial adenocarcinoma that classically manifests with pruritic, erythematous and scaling plaques. The clinical picture frequently mimics inflammatory or infectious conditions and is thus commonly misdiagnosed. The assessment of tumour margins is equally challenging as tumours have a propensity to spread beyond clinically visible boundaries. Appropriate non-invasive diagnostic tools can assist in the early detection, diagnosis and management of EMPD. This paper will review the literature on non-invasive imaging modalities used in EMPD. Articles from the PubMed database were selected based on relevance to the topic of this review. Articles that were not specific to EMPD and non-invasive imaging were excluded. Search strategy is further described in the methods section below. Eighteen articles were selected for this review: six PET/CT, five reflectance confocal microscopy (RCM), two photodynamic diagnosis (PDD), two dermoscopy, two MRI and one optical coherence tomography (OCT) paper(s). Dermoscopy, PDD, RCM and OCT can help to distinguish malignant conditions, including EMPD, from benign conditions. RCM and OCT can identify atypical cells in real-time, and have the potential to improve the accuracy of surgical margins intraoperatively and overall management. Distinctive confocal characteristics of EMPD have been described using RCM. The sensitivity and specificity of these findings require additional validation. Radiographic techniques also play a central role in the diagnosis of EMPD and assessment of disease spread. PET/CT and MRI can detect primary disease, nodal and distant metastases, with superior delineation of disease spread on MRI. Limitations of PET/CT are mainly related to primary tumour thickness, and size and FDG-avidity of nodal and distant metastases. Limitations of MRI include the fact that few studies have examined its use in EMPD; additional research is warranted. Randomized controlled trials and large prospective studies evaluating the use of non-invasive imaging in EMPD are needed.
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Affiliation(s)
- C-A Y Bayan
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - T Khanna
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - V Rotemberg
- Department of Dermatology, Columbia University Medical Center, New York, NY, USA
| | - F H Samie
- Department of Dermatology, Columbia University Medical Center, New York, NY, USA
| | - N C Zeitouni
- Department of Dermatology, University of Arizona and University of Arizona Cancer Center at Dignity Health, Phoenix, AZ, USA
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15
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Ito T, Kaku-Ito Y, Furue M. The diagnosis and management of extramammary Paget's disease. Expert Rev Anticancer Ther 2018; 18:543-553. [PMID: 29575944 DOI: 10.1080/14737140.2018.1457955] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Extramammary Paget's disease (EMPD) is a rare neoplastic condition that commonly affects the anogenital area in the elderly. Owing to its low incidence, limited data regarding EMPD's diagnosis and treatment have been available. This review article aims to explore the current knowledge of EMPD to improve the management of this disease. Areas covered: This review outlines the diagnosis and management of EMPD. Articles on this issue that had been published in PubMed were identified and surveyed. We provide an overview of the reported studies, focusing on the recent advances in this field. Expert commentary: A new TNM staging system specific for EMPD has been proposed in Japan; the T category was classified by tumor thickness and lymphovascular invasion, the N category by the number of metastatic lymph nodes, and the M category by systemic metastases. As new diagnostic tools for EMPD, dermoscopy and reflectance confocal microscopy have emerged. Recent reports about Mohs micrographic surgery, mapping biopsy, radiation therapy, photodynamic therapy, topical imiquimod, conventional chemotherapy, and targeted therapy are also discussed. Despite the increasing publications of EMPD, limited information on this condition is available and the accumulation of more data is required.
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Affiliation(s)
- Takamichi Ito
- a Department of Dermatology, Graduate School of Medical Sciences , Kyushu University , Fukuoka , Japan
| | - Yumiko Kaku-Ito
- a Department of Dermatology, Graduate School of Medical Sciences , Kyushu University , Fukuoka , Japan
| | - Masutaka Furue
- a Department of Dermatology, Graduate School of Medical Sciences , Kyushu University , Fukuoka , Japan
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16
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Ozdemir F, Turk BG, Yaman B, Pellecani G, Ozdemir N, Karaarslan I, Farnetani F. Reflectance confocal microscopy of mammary Paget disease. Dermatol Pract Concept 2017; 7:75-80. [PMID: 29214113 PMCID: PMC5718130 DOI: 10.5826/dpc.0704a15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/31/2017] [Indexed: 11/03/2022] Open
Abstract
Mammary Paget disease is the intraepidermal adenocarcinoma of the nipple area which is characterized usually by a well-demarcated eczematous plaque. Reflectance confocal microscopy (RCM), is an in vivo noninvasive diagnostic tool with a high-resolution imaging of the skin, almost comparable to conventional histology. RCM findings of Paget disease are limited in the literature. Most of the reported cases are the extramammary type. In this report, we aimed to evaluate the RCM findings of a non-pigmented mammary Paget disease in a 65 year-old woman.
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Affiliation(s)
- Fezal Ozdemir
- Department of Dermatology and Venereology, Ege University Medical Faculty, Izmir, Turkey
| | - Bengu G Turk
- Department of Dermatology and Venereology, Ege University Medical Faculty, Izmir, Turkey
| | - Banu Yaman
- Department of Pathology, Ege University Medical Faculty, Izmir, Turkey
| | - Giovanni Pellecani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Necmettin Ozdemir
- Department of Pathology, Ege University Medical Faculty, Izmir, Turkey
| | - Isil Karaarslan
- Department of Dermatology and Venereology, Ege University Medical Faculty, Izmir, Turkey
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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17
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Clinical Benefits of Preoperative Conventional Fluorescence Diagnosis in Surgical Treatment of Extramammary Paget Disease. Dermatol Surg 2017; 44:375-382. [PMID: 28945622 DOI: 10.1097/dss.0000000000001329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In extramammary Paget disease (EMPD), initial margins of surgical excision are difficult to determine preoperatively. Fluorescence diagnosis (FD) may have utility as a noninvasive method for delineating tumor boundaries. OBJECTIVE The relationship between FD-delineated borders and results of multiple scouting biopsies (MSBs) in EMPD was investigated, evaluating the potential clinical role of FD. MATERIALS AND METHODS A cohort of 21 patients was studied, looking for consistencies between FD and MSB results. Initial surgical margins were determined by FD or FD plus MSB. All margins were subjected to frozen section analysis. RESULTS Paget cells were identified in 88 of 117 (71.8%) biopsies obtained from FD borders. When used preoperatively with MSB in 9 patients, 96.4% of margins proved negative at initial resection stage. Using a 6-mm margin beyond FD borders in another 9 patients, 86.7% of margins were negative at initial stage. The maximum distance of excision beyond FD border was 12 mm. CONCLUSION Fluorescence diagnosis borders (identified visually) correlated well with MSB histopathology. Fluorescence diagnosis is a useful method to delineate initial margins for surgical resection of EMPD.
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18
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Yélamos O, Hibler BP, Cordova M, Hollmann TJ, Kose K, Marchetti MA, Myskowski PL, Pulitzer MP, Rajadhyaksha M, Rossi AM, Jain M. Handheld Reflectance Confocal Microscopy for the Detection of Recurrent Extramammary Paget Disease. JAMA Dermatol 2017; 153:689-693. [PMID: 28492924 DOI: 10.1001/jamadermatol.2017.0619] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Extramammary Paget disease (EMPD) is commonly refractory to surgical and nonsurgical therapies. Identifying recurrent or persistent EMPD is challenging because the disease is multifocal, and multiple blind scouting biopsies are usually performed in this setting. Handheld reflectance confocal microscopy (HRCM) has been used to diagnose and map primary EMPD and therefore may be used to identify EMPD recurrences. Objective To evaluate HRCM's diagnostic accuracy in the setting of recurrent or persistent EMPD as well as its potential diagnostic pitfalls. Design, Setting, and Participants This prospective case series study included patients referred to the Dermatology Service at Memorial Sloan Kettering Cancer Center between January 1, 2014, and December 31, 2016, with biopsy-proven EMPD in whom HRCM was used to monitor treatment response. Five patients were included, and 22 sites clinically concerning for recurrent or persistent disease were evaluated using HRCM and histopathologic examination. In 2 patients, video mosaics were created to evaluate large areas. Main Outcomes and Measures Sensitivity and specificity of HRCM in identifying recurrent or persistent EMPD; causes for false-negative results according to their location, histopathologic findings, and previous treatments. Results Of the 22 clinically suspicious sites evaluated in 5 patients (4 men, 1 woman; median [range] age, 70 [56-77] years), 9 (40.9%) were positive for recurrent disease on HRCM and histopathologically confirmed, and 13 (59.1%) sites were negative on HRCM, but 3 of the 13 were positive for EMPD on histopathological examination. In general, HRCM had a sensitivity of 75% and a specificity of 100% in identifying recurrent or persistent EMPD. False-negative results were found in 2 patients and occurred at the margins of EMPD, close to previous biopsy sites. Creating video mosaics (or video mosaicking) seemed to improve the detection of EMPD. Conclusions and Relevance Handheld reflectance confocal microscopy is a useful auxiliary tool for diagnosing EMPD recurrences and can be used to guide scouting biopsies, thus reducing the number of biopsies needed to render a correct diagnosis.
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Affiliation(s)
- Oriol Yélamos
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York2Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Brian P Hibler
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Travis J Hollmann
- Pathology Department, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kivanc Kose
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Patricia L Myskowski
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa P Pulitzer
- Pathology Department, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Milind Rajadhyaksha
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Manu Jain
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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19
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Urvanegia AC, Tavoloni Braga JC, Shitara D, Fregnani JH, Neves JI, Pinto CA, Marghoob AA, Duprat JP, Rezze GG. Reflectance confocal microscopy features of BRAF V600E mutated thin melanomas detected by immunohistochemistry. PLoS One 2017; 12:e0179745. [PMID: 28662062 PMCID: PMC5491027 DOI: 10.1371/journal.pone.0179745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/02/2017] [Indexed: 12/17/2022] Open
Abstract
The classification of melanoma into four histological subtypes has been questioned regarding its clinical validity in providing relevant information for treatment for metastatic tumors. Specific genetic alterations are associated with particular clinical and histopathological features, suggesting that these could be helpful in refining existing melanoma classification schemes. We analyzed BRAF V600E mutated melanomas to explore the Reflectance confocal microscopy (RCM) utility as a screening aid in the evaluation of the most appropriate patients for genetic testing. Thus, 32 melanomas were assessed regarding their BRAF V600E mutational status. Experts blinded to dermoscopic images and V600E immunohistochemistry results evaluated RCM images regarding previously described melanoma features. BRAF positive melanomas were related to younger age (p = 0.035), invasive melanomas (p = 0.03) and to the presence of hiporreflective cells (p = 0.02), epidermal nests (p = 0.02), dermal-epidermal junction nests (p = 0.05), edged papillae (p = 0.05), and bright dots (p = 0.05), and to absence of junctional thickening due to isolated cells (p = 0.01) and meshwork (p = 0.02). This study can not characterize other mutations in the BRAF, because the immunohistochemistry is specific to the type V600E. The findings should encourage the genetic evaluation of BRAF mutation. This study highlights the potential of RCM as a supplementary tool in the screening of BRAF-mutated melanomas.
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Affiliation(s)
| | | | | | | | | | | | - Ashfaq A. Marghoob
- Dermatology Service, Memorial Sloan Kettering Skin Cancer Center, New York, United States of America
| | | | - Gisele Gargantini Rezze
- Cutaneous Oncology Department, AC Camargo Cancer Center, São Paulo, Brazil
- Dermaimage Medical Associates, São Paulo, Brazil
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20
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21
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Yang J, Wang S, Dong L, An X, Li Y, Li J, Tu Y, Tao J. Skin healing and collagen changes of rats after fractional erbium:yttrium aluminum garnet laser: observation by reflectance confocal microscopy with confirmed histological evidence. Lasers Med Sci 2016; 31:1251-60. [PMID: 27272747 DOI: 10.1007/s10103-016-1983-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 06/01/2016] [Indexed: 12/01/2022]
Abstract
The fractional erbium:yttrium aluminum garnet (Er:YAG) laser is widely applied. Microstructural changes after laser treatment have been observed with histopathology. Epidermal and dermal microstructures have also been analyzed using reflectance confocal microscopy (RCM). However, no studies have compared these two types of microstructural changes in the same subject at multiple time points after irradiation, and it is unclear if these two types of changes are consistent. We use RCM to observe the effect of different laser energies on skin healing and collagen changes in the skin of Sprague-Dawley rats that had been irradiated by fractional Er:YAG lasering at different energies. RCM was used to observe skin healing and detect collagen changes at different time points. Collagen changes were observed using hematoxylin and eosin (H&E) staining and quantitatively analyzed by western blot. RCM showed that, irrespective of laser energy, microscopic treatment zones (MTZs) were larger at 1 day after irradiation. The MTZs then reduced in size from 3 to 7 days after irradiation. The higher the energy, the larger the MTZ area. The amount of collagen also increased with time from 1 day to 8 weeks. However, the increase in the collagen amount on both RCM and H&E staining was not influenced by the laser energy. Western blotting confirmed that the amount of type I and type III collagens increased over time, but there were no significant differences between the different energy groups (p > 0.05). In conclusion, RCM is a reliable technique for observing and evaluating skin healing and collagen expression after laser irradiation.
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Affiliation(s)
- Jing Yang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China
| | - Sha Wang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China
| | - Liyun Dong
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China
| | - Xiangjie An
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China
| | - Yan Li
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China
| | - Jun Li
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China
| | - Yating Tu
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China
| | - Juan Tao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China.
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22
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Venturini M, Gualdi G, Zanca A, Lorenzi L, Pellacani G, Calzavara-Pinton PG. A new approach for presurgical margin assessment by reflectance confocal microscopy of basal cell carcinoma. Br J Dermatol 2015; 174:380-5. [PMID: 26498991 DOI: 10.1111/bjd.14244] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgical excision represents the most common elective treatment for basal cell carcinoma (BCC). Several noninvasive approaches have been proposed for in vivo determination of tumour margin, in order to achieve radical removal. OBJECTIVES To propose a new approach through the combination of dermoscopy and reflectance confocal microscopy (RCM) for lateral margin detection in BCC. METHODS Ten patients with lesions clinically suggestive of nonpigmented BCCs with ill-defined margins were enrolled. All BCCs were dermoscopically evaluated first and the ill-defined margins were marked with a superficial cut and then inspected using RCM. RESULTS RCM evaluation showed BCC foci beyond the presurgical marker in three out of 10 lesions. Histology confirmed the RCM results: the presence of BCC features across the cut, corresponding to two superficial BCCs and a morpheaform BCC. CONCLUSIONS This new procedure helped to improve the identification of proper margins for surgical excision in nonpigmented BCC with clinically and dermoscopically ill-defined margins.
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Affiliation(s)
- M Venturini
- Department of Dermatology, University of Brescia, Brescia, Italy
| | - G Gualdi
- Department of Dermatology, University of Brescia, Brescia, Italy
| | - A Zanca
- Department of Dermatology, University of Brescia, Brescia, Italy
| | - L Lorenzi
- Department of Pathology, University of Brescia, Brescia, Italy
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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23
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24
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Suppa M, Marneffe A, Miyamoto M, Rorive S, Boone M, Del Marmol V. [Contribution of reflectance confocal microscopy in the diagnosis of extra-mammary Paget's disease]. Ann Dermatol Venereol 2014; 142:70-3. [PMID: 25600799 DOI: 10.1016/j.annder.2014.09.608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 08/17/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022]
Affiliation(s)
- M Suppa
- Service de dermatologie, hôpital Erasme, université Libre de Bruxelles, route de Lennik 808, 1070 Bruxelles, Belgique.
| | - A Marneffe
- Service de dermatologie, hôpital Erasme, université Libre de Bruxelles, route de Lennik 808, 1070 Bruxelles, Belgique
| | - M Miyamoto
- Service de dermatologie, hôpital Erasme, université Libre de Bruxelles, route de Lennik 808, 1070 Bruxelles, Belgique
| | - S Rorive
- Service de dermatologie, hôpital Erasme, université Libre de Bruxelles, route de Lennik 808, 1070 Bruxelles, Belgique
| | - M Boone
- Service de dermatologie, hôpital Erasme, université Libre de Bruxelles, route de Lennik 808, 1070 Bruxelles, Belgique
| | - V Del Marmol
- Service de dermatologie, hôpital Erasme, université Libre de Bruxelles, route de Lennik 808, 1070 Bruxelles, Belgique
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25
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Losi A, Longo C, Cesinaro A, Benati E, Witkowski A, Guitera P, Pellacani G. Hyporeflective pagetoid cells: a new clue for amelanotic melanoma diagnosis by reflectance confocal microscopy. Br J Dermatol 2014; 171:48-54. [DOI: 10.1111/bjd.12781] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2013] [Indexed: 11/27/2022]
Affiliation(s)
- A. Losi
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - C. Longo
- Skin Cancer Unit; Arcispedale Santa Maria Nuova - IRCCS; Viale Risorgimento 80 42100 Reggio Emilia Italy
| | - A.M. Cesinaro
- Department of Pathology; University of Modena and Reggio Emilia; Modena Italy
| | - E. Benati
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - A. Witkowski
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - P. Guitera
- Melanoma Institute Australia; The University of Sydney and Sydney Melanoma Diagnostic Centre; Royal Prince Alfred Hospital; Sydney NSW Australia
| | - G. Pellacani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
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Agozzino M, Guichard A, Ardigò M. Dermoscopy and confocal microscopy correlates in inflammatory skin conditions. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.13.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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27
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Ren J, Qian H, Xiang L, Pan Z, Zhong L, Yan S, Gold MH. The assessment of pulsed dye laser treatment of port-wine stains with reflectance confocal microscopy. J COSMET LASER THER 2013; 16:21-5. [PMID: 24215420 DOI: 10.3109/14764172.2013.862552] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) is a noninvasive technique for evaluating cutaneous lesions with cellular level resolution close to conventional histopathology. The aim of this study is to observe the vascular changes in Port-wine (PWS) lesions and assess the clinical efficacy of Pulsed Dye Laser (PDL) treatment by examining vessel diameter and density with RCM. MATERIALS AND METHODS Eleven adult patients with PWS, each had four test patches carried out with different pulse durations (1.5, 3, 6, and 10 ms), respectively; fluences of 9-12 J/cm²; and a spot size of 7 mm. The PDL treatment was repeated 3-5 times at a 2-month interval. Photographs and measurements with RCM were taken before each treatment and 2 months after the last treatment. RESULTS The PDL treatment exhibited increasing clearance with reducing pulse durations. Vessel diameters and densities were significantly decreased in the same pulse-duration groups after treatment. There was significant difference between 1.5 ms pulse-duration group and other pulse-duration groups in reducing blood vessel diameter at the depth of 150 μm. CONCLUSIONS RCM can be used to assess the clinical efficacy of PDL treatment.
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Affiliation(s)
- Jie Ren
- Department of Dermatology, Huashan Hospital, Fudan University , Shanghai , P. R. China
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28
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Cinotti E, Perrot J, Labeille B, Cambazard F. Apport de la microscopie confocale par réflectance dans le diagnostic de la maladie de Paget mammaire. Ann Dermatol Venereol 2013; 140:829-32. [DOI: 10.1016/j.annder.2013.10.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 09/23/2013] [Accepted: 10/04/2013] [Indexed: 11/17/2022]
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29
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Bahadoran P. [In vivo confocal reflectance microscopy (CRM) and the prospect of virtual cutaneous biopsy]. Ann Dermatol Venereol 2013; 140:675-7. [PMID: 24206801 DOI: 10.1016/j.annder.2013.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- P Bahadoran
- Service de dermatologie, centre de recherche clinique (CRC), Inserm U1065 équipe 1, groupe hospitalier Archet, CHU de Nice, 151, route Saint-Antoine-de-Ginestiere, 06204 Nice cedex 3, France.
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30
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Pan ZY, Lin JR, Cheng TT, Wu JQ, Wu WY. In vivo reflectance confocal microscopy of Basal cell carcinoma: feasibility of preoperative mapping of cancer margins. Dermatol Surg 2012; 38:1945-50. [PMID: 23039159 PMCID: PMC3546396 DOI: 10.1111/j.1524-4725.2012.02587.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Reflectance confocal microscopy (RCM) images skin at cellular resolution and has shown utility for the diagnosis of nonmelanoma skin cancer in vivo. It has the potential to define lesion margins before surgical therapy.
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Affiliation(s)
- Zhan-Yan Pan
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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