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Park HK, Choi YD, Shim HJ, Choi Y, Chung IJ, Yun SJ. Comparative Whole-Genome Sequencing Analysis of In-situ and Invasive Acral Lentiginous Melanoma: Markedly Increased Copy Number Gains of GAB2, PAK1, UCP2, and CCND1 are Associated with Melanoma Invasion. Am J Surg Pathol 2024:00000478-990000000-00373. [PMID: 38916228 DOI: 10.1097/pas.0000000000002273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Acral lentiginous melanoma (ALM) is the most common subtype of acral melanoma. Even though recent genetic studies are reported in acral melanomas, the genetic differences between in-situ and invasive ALM remain unclear. We aimed to analyze specific genetic changes in ALM and compare genetic differences between in-situ and invasive lesions to identify genetic changes associated with the pathogenesis and progression of ALM. We performed whole genome sequencing of 71 tissue samples from 29 patients with ALM. Comparative analyses were performed, pairing in-situ ALMs with normal tissues and, furthermore, invasive ALMs with normal and in-situ tissues. Among 21 patients with in-situ ALMs, 3 patients (14.3%) had SMIM14, SLC9B1, FRG1, FAM205A, ESRRA, and ESPN mutations, and copy number (CN) gains were identified in only 2 patients (9.5%). Comparing 13 invasive ALMs with in-situ tissues, CN gains were identified in GAB2 in 8 patients (61.5%), PAK1 in 6 patients (46.2%), and UCP2 and CCND1 in 5 patients (38.5%). Structural variants were frequent in in-situ and invasive ALM lesions. Both in-situ and invasive ALMs had very low frequencies of common driver mutations. Structural variants were common in both in-situ and invasive ALMs. Invasive ALMs had markedly increased CN gains, such as GAB2, PAK1, UCP2, and CCND1, compared with in-situ lesions. These results suggest that they are associated with melanoma invasion.
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Affiliation(s)
| | | | - Hyun Jeong Shim
- Internal medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju
| | - Yoonjoo Choi
- Combinatorial Tumor Immunotherapy MRC, Chonnam National University Medical School, Hwasun-gun, Jeonnam, Korea
| | - Ik Joo Chung
- Internal medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju
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Song JY, Ryu YJ, Lee HK, Lee DH, Choi YD, Shim HJ, Yun SJ. Risk factors for sentinel lymph node metastasis in Korean acral and non-acral melanoma patients. Pigment Cell Melanoma Res 2024; 37:332-342. [PMID: 38013393 DOI: 10.1111/pcmr.13153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/27/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
Breslow thickness, ulceration, and mitotic rate are well-known prognostic factors for sentinel lymph node (SLN) metastasis in cutaneous melanoma. We investigated risk factors, including especially the degree of pigmentation, for SLN metastasis in Korean melanoma patients. We enrolled 158, composed of Korean 107 acral and 51 non-acral melanoma patients who underwent SLN biopsy. Clinicopathologic features such as Breslow thickness, ulceration, mitotic rate, and the degree of pigmentation were evaluated. The recurrence-free survival (RFS) rate and date of recurrence were determined. Fifty-four patients (34.2%) had a positive SLN biopsy result. In a multivariate analysis, Breslow thickness (odds ratio [OR] 1.93; 95% confidence interval [CI], 1.12-3.47; p = .022) and heavy pigmentation (OR 13.14; 95% CI, 2.96-95.20, p = .002) were associated with SLN metastasis. Positive SLN patients had a higher rate of loco-regional and/or distant recurrence (hazard ratio 6.32; 95% CI, 3.39-11.79; p < .001). Heavy pigmentation was associated with poor RFS. Heavy pigmentation is an independent predictor of SLN metastasis in both acral and non-acral melanoma. Our results suggest the need for in-depth SLN evaluation of cutaneous melanoma patients with heavy pigmentation and provide clinicians with important information for determining patient prognosis.
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Affiliation(s)
- Jee Yong Song
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Young Jae Ryu
- Department of General Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Kyun Lee
- Department of General Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Hoon Lee
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun Jeong Shim
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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Park S, Yun SJ. Acral Melanocytic Neoplasms: A Comprehensive Review of Acral Nevus and Acral Melanoma in Asian Perspective. Dermatopathology (Basel) 2022; 9:292-303. [PMID: 35997352 PMCID: PMC9397077 DOI: 10.3390/dermatopathology9030035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Acral melanocytic neoplasms, including acral melanocytic nevus and acral melanoma, are common melanocytic lesions in Asian populations. Both lesions occur on the volar surface of the hands and feet, and on nail units. Acral melanocytic nevi occur on the arch area of the sole, whereas acral melanomas frequently occur on weight-bearing areas of the sole, and on the fingernails. Therefore, the development of acral melanoma may be associated with chronic pressure, physical stress, or trauma. Dermoscopy is a useful adjunctive diagnostic tool for differential diagnosis. Acral melanocytic nevus is characterized by a parallel furrow pattern, whereas acral melanoma has a parallel ridge pattern. Genetic alterations are also different between the two types of lesion. BRAF and NRAS mutations are common in acral melanocytic nevus, whereas acral melanoma shows lower rates of KIT, NF1, BRAF, and NRAS mutations and remarkable copy number variations in genes such as CCND1, CDK4, hTERT, PAK1, and GAB2. Sentinel lymph node biopsy is important for staging and prognosis. Contemporary treatments for melanoma include targeted therapy for mutations and immunotherapy, such as anti-PD1 inhibitors.
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Affiliation(s)
- Sanghyun Park
- Department of Dermatology, Chonnam National University Hwasun Hospital, Hwasun 58128, Korea
| | - Sook-Jung Yun
- Department of Dermatology, Chonnam National University Hwasun Hospital, Hwasun 58128, Korea
- Department of Dermatology, Chonnam National University Medical School, Gwangju 59626, Korea
- Correspondence:
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Shawa HJ, Kazak M, Dahle S, Schulman JM. Acral Amelanotic Melanoma Mimicking a Foot Ulcer. Cureus 2022; 14:e26615. [PMID: 35936139 PMCID: PMC9355838 DOI: 10.7759/cureus.26615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/30/2022] Open
Abstract
Acral amelanotic melanoma can be difficult to diagnose and is often clinically aggressive. The present report describes a case of an acral amelanotic melanoma presenting as a non-healing wound after mimicking a plantar wart for two years. The decision to biopsy a borderline-suspicious lesion on the lower extremity in an elderly individual must be weighed carefully, as lower extremity biopsy carries a risk of poor wound healing and other complications. We discuss clinical and epidemiologic features that can assist in deciding when to perform a biopsy in this setting and can improve the early detection of acral amelanotic melanoma.
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Broit N, Johansson PA, Rodgers CB, Walpole S, Hayward NK, Pritchard AL. Systematic review and meta-analysis of genomic alterations in acral melanoma. Pigment Cell Melanoma Res 2022; 35:369-386. [PMID: 35229492 PMCID: PMC9540316 DOI: 10.1111/pcmr.13034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 11/30/2022]
Abstract
Acral melanoma (AM) tumors arise on the palms, soles, fingers, toes, and nailbeds. A comprehensive systematic meta-analysis of AM genomic aberrations has not been conducted to date. A literature review was carried out to identify studies sequencing AM. Whole-genome/exome data from 181 samples were identified. Targeted panel sequencing data from MSK-IMPACT were included as a validation cohort (n = 92), and studies using targeted hot spot sequencing were also collated for BRAF (n = 26 studies), NRAS (n = 21), and KIT (n = 32). Statistical analysis indicated BRAF, NRAS, PTEN, TYRP1, and KIT as significantly mutated genes. Frequent copy-number aberrations were also found for important cancer genes, such as CDKN2A, KIT, MDM2, CCND1, CDK4, and PAK1, among others. Mapping genomic alterations within the context of the hallmarks of cancer identified four components frequently altered, including (i) sustained proliferative signaling and (ii) evading growth suppression, (iii) genome instability and mutation, and (iv) enabling replicative immortality. This analysis provides the largest analysis of genomic aberrations in AM in the literature to date and highlights pathways that may be therapeutically targetable.
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Affiliation(s)
- Natasa Broit
- Oncogenomics GroupQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Peter A. Johansson
- Oncogenomics GroupQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Chloe B. Rodgers
- Genetics and Immunology GroupUniversity of the Highlands and IslandsInvernessUK
| | - Sebastian T. Walpole
- Oncogenomics GroupQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Nicholas K. Hayward
- Oncogenomics GroupQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Antonia L. Pritchard
- Oncogenomics GroupQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
- Genetics and Immunology GroupUniversity of the Highlands and IslandsInvernessUK
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Ryu GW, Choi YD, Jin S, Chung IJ, Shin MH, Yun SJ. Volar location and degree of pigmentation are associated with poor survival and first metastasis pattern in acral melanoma. Pigment Cell Melanoma Res 2021; 34:1094-1104. [PMID: 33934532 DOI: 10.1111/pcmr.12983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/01/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022]
Abstract
The risk factors affecting acral melanoma metastasis and prognosis remain unclear. The study included 168 patients with invasive acral melanoma who were followed for ≥3 years. We evaluated patient demographics, stages, clinicopathological features, anatomic site of melanoma including nail versus volar surface, and degree of melanoma pigmentations, sentinel lymph node biopsy results, and the first metastasis sites. Of the 168 patients (mean age 64.5 years; 52.4% male), 43 (25.6%) had invasive melanoma without metastasis, 113 (67.3%) had invasive melanoma with a first lymph node metastasis, and 12 (7.1%) had invasive melanoma with invasive melanoma with a first distant metastasis. Advanced T stage, high mitotic rate, ulceration, and the degree of pigmentation were significant risk factors for metastasis. Amelanotic and mild pigmentation of acral melanoma was associated with first distant metastasis, whereas heavy pigmentation was associated with first lymph node metastasis. Advanced TNM stages, high mitotic rate, volar location (hazard ratio = 2.24, 95% confidence interval 1.18-4.26), and low-pigmentation (hazard ratio = 2.02, 95% confidence interval 1.17-3.49) were associated with melanoma-specific mortality.
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Affiliation(s)
- Geon Wook Ryu
- Departments of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Yoo Duk Choi
- Departments of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Suna Jin
- Departments of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Ik-Joo Chung
- Departments of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Min-Ho Shin
- Departments of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sook Jung Yun
- Departments of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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Bernardes SS, Ferreira I, Elder DE, Nobre AB, Martínez‐Said H, Adams DJ, Robles‐Espinoza CD, Possik PA. More than just acral melanoma: the controversies of defining the disease. J Pathol Clin Res 2021; 7:531-541. [PMID: 34213090 PMCID: PMC8503895 DOI: 10.1002/cjp2.233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/13/2021] [Accepted: 06/09/2021] [Indexed: 01/17/2023]
Abstract
Acral melanoma (AM) is a malignant cutaneous melanocytic tumour specifically located on the palms, soles, and nail apparatus, which are areas of glabrous (hairless) skin. Acral lentiginous melanoma, a subtype of AM, represents a histopathological subtype diagnosis of cutaneous melanoma with unique morphological and structural features. Despite clear definitions, the misuse of these terms and the inconsistency in reporting the histopathological features of AM cases have become a major obstacle to the study of the disease. In this review, we discuss the epidemiology, histopathological features, prognosis, and genetic profile of AM, highlighting the differences observed when histopathological subtypes are considered. The increasing global effort to characterise AM cases from ethnically diverse populations would benefit greatly from a more consistent classification of the disease.
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Affiliation(s)
- Sara S Bernardes
- Program of Immunology and Tumour BiologyBrazilian National Cancer InstituteRio de JaneiroBrazil
- Tissue Microenvironment Laboratory, Department of General PathologyFederal University of Minas GeraisBelo HorizonteBrazil
| | - Ingrid Ferreira
- Experimental Cancer GeneticsWellcome Sanger InstituteHinxtonUK
- Université Libre de BruxellesBrusselsBelgium
| | - David E Elder
- Division of Anatomic PathologyHospital of the University of PennsylvaniaPhiladelphiaPAUSA
| | - Aretha B Nobre
- Division of PathologyBrazilian National Cancer InstituteRio de JaneiroBrazil
- Serviço de Patologia, Maternidade EscolaUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil
| | - Héctor Martínez‐Said
- Servicio de Piel y Partes BlandasInstituto Nacional de CancerologíaCiudad de MéxicoMexico
| | - David J Adams
- Experimental Cancer GeneticsWellcome Sanger InstituteHinxtonUK
| | - Carla Daniela Robles‐Espinoza
- Experimental Cancer GeneticsWellcome Sanger InstituteHinxtonUK
- Laboratorio Internacional de Investigación sobre el Genoma HumanoUniversidad Nacional Autónoma de MéxicoSantiago de QuerétaroMexico
| | - Patricia A Possik
- Program of Immunology and Tumour BiologyBrazilian National Cancer InstituteRio de JaneiroBrazil
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The role of UVA radiation in ketoprofen-mediated BRAF-mutant amelanotic melanoma cells death - A study at the cellular and molecular level. Toxicol In Vitro 2021; 72:105108. [PMID: 33545343 DOI: 10.1016/j.tiv.2021.105108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/08/2021] [Accepted: 02/01/2021] [Indexed: 12/27/2022]
Abstract
Malignant melanoma is the cause of 80% of deaths in skin cancer patients. Treatment of melanoma in the 4th stage of clinical advancement, in which inoperable metastasis occur, does not provide sufficient effects. Ketoprofen has phototoxic properties and it can be used as a new treatment option for skin cancers as a part of photochemotherapy. The present study was designed to investigate whether ketoprofen in combination with UVA induces cytotoxic, anti-proliferative and pro-apoptotic effects on melanoma cells. It was stated that co-treatment with 1.0 mM ketoprofen and UVA irradiation disturbed homeostasis of C32 melanoma cells by lowering its vitality (decrease of GSH level). Contrary to C32 cells, melanocytes showed low sensitivity to ketoprofen and UVA radiation, pointing selectivity in the mode of action towards melanoma cells. Co-treatment with ketoprofen and UVA irradiation has cytotoxic and anti-proliferative and pro-apoptotic effect on C32. The co-treatment triggered the DNA fragmentation and changed the cell cycle in C32 cells. In conclusion, it could be stated that local application of ketoprofen in combination with UVA irradiation may be used to support the treatment of melanoma and creates the possibility of reducing the risk of cancer recurrence and metastasis.
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Tod BM, Schneider JW, Bowcock AM, Visser WI, Kotze MJ. The tumor genetics of acral melanoma: What should a dermatologist know? JAAD Int 2020; 1:135-147. [PMID: 34355205 PMCID: PMC8329760 DOI: 10.1016/j.jdin.2020.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2020] [Indexed: 02/06/2023] Open
Abstract
Dermatologists stand at the gateway of individualization of classification, treatment, and outcomes of acral melanoma patients. The acral melanoma genetic landscape differs in vital ways from that of other cutaneous melanomas. These differences have important implications in understanding pathogenesis, treatment, and prognosis. The selection of molecularly targeted therapy must be adapted for acral melanoma. It is also critical to recognize that tumor development is far more complex than an isolated event, reliably treated by a medication acting on a single target. Tumors exhibit intratumor genetic heterogeneity, metastasis may have different genetic or epigenetic features than primary tumors, and tumor resistance may develop because of the activation of alternative genetic pathways. Microenvironmental, immune, and epigenetic events contribute and sustain tumors in complex ways. Treatment strategies with multiple targets are required to effectively disrupt the tumor ecosystem. This review attempts to translate the current molecular understanding of acral melanoma into digestible concepts relevant to the practice of dermatology. The focus is tumor genetics defining potentially treatable cancer pathways, contextualized within the relevant pathologic and molecular features.
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Affiliation(s)
- Bianca M. Tod
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Johann W. Schneider
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Anne M. Bowcock
- Departments of Dermatology, Oncological Sciences and Genetics and Genome Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Willem I. Visser
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Maritha J. Kotze
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Academic Hospital, Cape Town, South Africa
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Gong H, Zheng H, Li J. Clinicopathological characteristics and prognosis of amelanotic acral melanoma: A comparative study with pigmented acral melanoma. Australas J Dermatol 2020; 61:358-361. [DOI: 10.1111/ajd.13344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Hui‐Zi Gong
- Department of Dermatology Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - He‐Yi Zheng
- Department of Dermatology Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Jun Li
- Department of Dermatology Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Mohammed Saeed D, Braniecki M, Groth JV. A rare case of acral amelanotic melanoma, nodular type. Int Wound J 2019; 16:1445-1449. [PMID: 31531925 PMCID: PMC7948552 DOI: 10.1111/iwj.13212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 08/18/2019] [Indexed: 11/28/2022] Open
Abstract
Amelanotic melanoma is a rare melanoma subtype, and it is even more rare when it occurs at an acral site. We here present a case of a nodular amelanotic acral melanoma (NAAM) occurring on the heel of an 83-year old female. It presented as an ulcerated pink nodular growth on the heel, which clinically mimicked other nodular non-pigmented lesions, causing a delay in diagnosis until it was biopsied. This case is a demonstration of the critical importance to include NAAM in the differential diagnosis of nodular non-pigmented skin lesions as to avoid delay in diagnosis and disease progression, in which early detection can provide the most modifiable prognostic factor.
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Affiliation(s)
| | - Marylee Braniecki
- Department of PathologyUniversity of Illinois at ChicagoChicagoIllinois
| | - John V. Groth
- Department of PathologyUniversity of Illinois at ChicagoChicagoIllinois
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12
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Translational pathology, genomics and the development of systemic therapies for acral melanoma. Semin Cancer Biol 2019; 61:149-157. [PMID: 31689494 DOI: 10.1016/j.semcancer.2019.10.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 12/29/2022]
Abstract
Acral melanomas arise on the non-hair bearing skin of the palms, soles and in the nail beds. These rare tumors comprise 2-3 % of all melanomas, are not linked to UV-exposure, and represent the most frequent subtype of melanomas in patients of Asian, African and Hispanic origin. Although recent work has revealed candidate molecular events that underlie acral melanoma development, this knowledge is not yet been translated into efficacious local, regional, or systemic therapies. In the current review, we describe the clinical characteristics of acral melanoma and outline the genetic basis of acral melanoma development. Further discussion is given to the current status of systemic therapy for acral melanoma with a focus on ongoing developments in both immunotherapy and targeted therapy for the treatment of advanced disease.
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Bohara S, Kumar A, Gupta SK, Gupta V. Unsuspected Amelanotic Melanoma in an Elephantiasis Foot. Indian Dermatol Online J 2018; 9:202-203. [PMID: 29854646 PMCID: PMC5956873 DOI: 10.4103/idoj.idoj_251_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sangita Bohara
- Department of Pathology, Hind Institute of Medical Sciences, Safedabad, Barabanki, Uttar Pradesh, India
| | - Ajay Kumar
- Department of Surgery, Hind Institute of Medical Sciences, Safedabad, Barabanki, Uttar Pradesh, India
| | - Sunil K Gupta
- Department of Dermatology, Hind Institute of Medical Sciences, Safedabad, Barabanki, Uttar Pradesh, India
| | - Vivek Gupta
- Department of Pathology, Hind Institute of Medical Sciences, Safedabad, Barabanki, Uttar Pradesh, India
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15
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Moon KR, Choi YD, Kim JM, Jin S, Shin MH, Shim HJ, Lee JB, Yun SJ. Genetic Alterations in Primary Acral Melanoma and Acral Melanocytic Nevus in Korea: Common Mutated Genes Show Distinct Cytomorphological Features. J Invest Dermatol 2018; 138:933-945. [PMID: 29191620 DOI: 10.1016/j.jid.2017.11.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/31/2017] [Accepted: 11/14/2017] [Indexed: 12/18/2022]
Abstract
Acral melanoma occurring on the palms, soles, and nails is the most common subtype of cutaneous melanoma in Asians. Genetic alterations in acral melanoma and acral melanocytic nevus are not well known. We performed next-generation sequencing and evaluated the correlations between genetic information and the clinicopathologic characteristics from 85 Korean patients with acral melanocytic neoplasms. Of the 64 patients with acral melanoma, most had lesions at the T2 stage or higher, and the heel was the most common anatomical site of melanoma (n = 34 [53.1%]). The five most common mutations were BRAF (22 [34.4%]), NRAS (14, [21.9%]), NF1 (11, [17.2%]), GNAQ (12, [17.2%]), and KIT (7, [10.9%]). In the 21 acral melanocytic nevi, those five gene mutations were also common. Copy number variations were also frequently detected in 75% of acral melanomas and 47.6% of acral melanocytic nevi, and amplification was more common than deletion in both lesions. BRAF mutation was associated with round epithelioid cells and NRAS and NF1 mutations with bizarre cells. NF1 and GNAQ mutations showed elongated and spindle cells with prominent dendrites in acral melanomas. KIT mutations were common in amelanotic acral melanoma. This study suggests that common mutated genes are associated with distinct cytomorphological features in acral melanocytic lesions.
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Affiliation(s)
- Ki Rang Moon
- Department of Dermatology, Chonnam National University Medical School, Gwangju, South Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
| | - Jung Min Kim
- Department of Pharmacology, Chonnam National University Medical School, Gwangju, South Korea
| | - Suna Jin
- Department of Dermatology, Chonnam National University Medical School, Gwangju, South Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyun-Jeong Shim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Jee-Bum Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, South Korea
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, South Korea.
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16
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Desai A, Ugorji R, Khachemoune A. Acral melanoma foot lesions. Part 2: clinical presentation, diagnosis, and management. Clin Exp Dermatol 2018; 43:117-123. [PMID: 29235153 DOI: 10.1111/ced.13323] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2017] [Indexed: 12/28/2022]
Abstract
Acral melanoma (AM) is a rare subtype of cutaneous malignant melanoma found on acral skin, primarily on the soles of the feet. Although rare, it is the most common subtype of melanoma found in patients of African or Asian ethnicity and has a poor prognosis, often because of the more advanced stage of presentation at diagnosis. In the second of this two-part series, we review the clinical presentation, histopathology, diagnosis and management of AM. Clinically, AM presents as a variegated lesion with blue-black pigment and irregular borders on acral skin. A parallel-ridge pattern is a very specific dermoscopic finding for AM. The differential diagnoses of AM include acral naevus, pyoderma gangrenosum, pyogenic granuloma, verrucous carcinoma and peripheral neuropathy-induced foot ulcers. If there is a clinical suspicion of AM, an excisional biopsy should be taken. Once diagnosis is confirmed by histology, surgical excision is the standard treatment. Overall, dermoscopy and histopathology are key tools in the diagnosis of AM. A greater emphasis on melanoma screening and awareness is essential in minority populations to improve survival outcomes in AM.
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Affiliation(s)
- A Desai
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - R Ugorji
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - A Khachemoune
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
- Department of Dermatology, Veterans Health Administration, Brooklyn, NY, USA
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17
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Desai A, Ugorji R, Khachemoune A. Acral melanoma foot lesions. Part 1: epidemiology, aetiology, and molecular pathology. Clin Exp Dermatol 2017; 42:845-848. [PMID: 28940724 DOI: 10.1111/ced.13243] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 01/16/2023]
Abstract
Acral melanoma (AM) is a rare subtype of cutaneous malignant melanoma (MM) found on acral skin, primarily on the soles of the feet. Although rare, it is the most common subtype of MM found in patients of African or East Asian ethnicity and has a poor prognosis, often because of the more advanced stage of presentation at diagnosis. The pathogenesis of AM is unclear, but genetic alterations, including mutations in BRAF, NRAS, and KIT have been implicated. Early diagnosis of AM is important for a better prognosis, but its identification is often challenging, leading to easy misdiagnosis. In the first of this two-part review, we review the history, epidemiology, aetiology and molecular pathology of AM; in part 2 we will review diagnosis and management.
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Affiliation(s)
- A Desai
- Department of Dermatology, State University of New York Downstate Medical Center, Department of Dermatology, Brooklyn, NY, USA
| | - R Ugorji
- Department of Dermatology, State University of New York Downstate Medical Center, Department of Dermatology, Brooklyn, NY, USA
| | - A Khachemoune
- Department of Dermatology, State University of New York Downstate Medical Center, Department of Dermatology, Brooklyn, NY, USA
- Department of Dermatology, Veterans Health Administration, Department of Dermatology, Brooklyn, NY, USA
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18
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Neiswender JV, Kortum RL, Bourque C, Kasheta M, Zon LI, Morrison DK, Ceol CJ. KIT Suppresses BRAF V600E-Mutant Melanoma by Attenuating Oncogenic RAS/MAPK Signaling. Cancer Res 2017; 77:5820-5830. [PMID: 28947418 DOI: 10.1158/0008-5472.can-17-0473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/17/2017] [Accepted: 09/08/2017] [Indexed: 12/30/2022]
Abstract
The receptor tyrosine kinase KIT promotes survival and migration of melanocytes during development, and excessive KIT activity hyperactivates the RAS/MAPK pathway and can drive formation of melanomas, most notably of rare melanomas that occur on volar and mucosal surfaces of the skin. The much larger fraction of melanomas that occur on sun-exposed skin is driven primarily by BRAF- or NRAS-activating mutations, but these melanomas exhibit a surprising loss of KIT expression, which raises the question of whether loss of KIT in these tumors facilitates tumorigenesis. To address this question, we introduced a kit(lf) mutation into a strain of Tg(mitfa:BRAFV600E); p53(lf) melanoma-prone zebrafish. Melanoma onset was accelerated in kit(lf); Tg(mitfa:BRAFV600E); p53(lf) fish. Tumors from kit(lf) animals were more invasive and had higher RAS/MAPK pathway activation. KIT knockdown also increased RAS/MAPK pathway activation in a BRAFV600E-mutant human melanoma cell line. We found that pathway stimulation upstream of BRAFV600E could paradoxically reduce signaling downstream of BRAFV600E, and wild-type BRAF was necessary for this effect, suggesting that its activation can dampen oncogenic BRAFV600E signaling. In vivo, expression of wild-type BRAF delayed melanoma onset, but only in a kit-dependent manner. Together, these results suggest that KIT can activate signaling through wild-type RAF proteins, thus interfering with oncogenic BRAFV600E-driven melanoma formation. Cancer Res; 77(21); 5820-30. ©2017 AACR.
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Affiliation(s)
- James V Neiswender
- Program in Molecular Medicine, Department of Molecular, Cell, and Cancer Biology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert L Kortum
- Laboratory of Cell and Developmental Signaling, National Cancer Institute at Frederick, Frederick, Maryland.,Department of Pharmacology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Caitlin Bourque
- Howard Hughes Medical Institute, Stem Cell Program and Division of Hematology/Oncology, Boston Children's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Melissa Kasheta
- Program in Molecular Medicine, Department of Molecular, Cell, and Cancer Biology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Leonard I Zon
- Howard Hughes Medical Institute, Stem Cell Program and Division of Hematology/Oncology, Boston Children's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Deborah K Morrison
- Laboratory of Cell and Developmental Signaling, National Cancer Institute at Frederick, Frederick, Maryland
| | - Craig J Ceol
- Program in Molecular Medicine, Department of Molecular, Cell, and Cancer Biology, University of Massachusetts Medical School, Worcester, Massachusetts.
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19
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Luo C, Shen J. Research progress in advanced melanoma. Cancer Lett 2017; 397:120-126. [DOI: 10.1016/j.canlet.2017.03.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 12/12/2022]
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20
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Cinotti E, Chevallier J, Labeille B, Cambazard F, Thomas L, Balme B, Leccia MT, D'Incan M, Vercherin P, Douchet C, Rubegni P, Perrot JL. Mucosal melanoma: clinical, histological and c-kit gene mutational profile of 86 French cases. J Eur Acad Dermatol Venereol 2017; 31:1834-1840. [PMID: 28543798 DOI: 10.1111/jdv.14353] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/24/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mucosal melanomas are rare and highly aggressive tumours. Few studies evaluated mucosal melanomas of locations other than the head and neck region, and other than those of the Asian population. OBJECTIVES The objective of this study was to analyse the clinical and histological features, as well as the mutational status of c-kit and b-raf gene of mucosal melanoma in any localization in a French series. METHODS We investigated clinical (sex, age, performance status, survival, treatment of the patients and lack of pigmentation of the tumours) and histopathological features (ulceration, Breslow's index, mitotic rate), as well as the mutational status of c-kit and b-raf of 86 mucosal melanomas diagnosed in 15 years in four French University Hospitals. RESULTS Most melanomas affected women (72%) and the genital region (46.5%). A fifth of melanomas were amelanotic. 81% of melanomas had a Breslow's index ≥1, whereas all glans melanomas, and most vulvar melanomas had a Breslow index ≤1 mm. Overall survival was 54% at 3 years; 11.6% of the 43 tested mucosal melanomas were c-kit-mutated while the 15 tested genital melanomas were not. The c-kit gene mutation did not influence the overall survival. Age ≥ 50, amelanotic type and performance status ≥1 were not poor prognostic factors in our series. CONCLUSION This study confirmed that mucosal melanomas are rare and could be difficult to diagnose being often amelanotic and in hidden sites. Most melanomas were thick at the diagnosis, but glans and vulvar melanomas were thinner probably because of their greater visibility. The frequency of the c-kit mutation varied depending on the initial tumour site. In our series, the prognosis was poor, independently from c-kit mutations and the patient's general health and age. The presence of metastasis at diagnosis was associated with a worse prognosis indicating the importance of an early diagnosis.
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Affiliation(s)
- E Cinotti
- Department of Dermatology, University Hospital of Saint Etienne, Saint Etienne, France.,Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - J Chevallier
- Department of Dermatology, University Hospital of Saint Etienne, Saint Etienne, France
| | - B Labeille
- Department of Dermatology, University Hospital of Saint Etienne, Saint Etienne, France
| | - F Cambazard
- Department of Dermatology, University Hospital of Saint Etienne, Saint Etienne, France
| | - L Thomas
- Dermatology Department, University Hospital of Lyon Sud, Pierre Bénite, France
| | - B Balme
- Dermatopathology Department, University Hospital of Lyon Sud, Pierre Bénite, France
| | - M T Leccia
- Department of Dermatology, University Hospital of Grenoble, Grenoble, France
| | - M D'Incan
- Dermatology Department, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - P Vercherin
- Department of Public Health and Medical Information, University Hospital of Saint Etienne, Saint Etienne, France
| | - C Douchet
- Department of Pathology, University Hospital of Saint Etienne, Saint Etienne, France
| | - P Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - J L Perrot
- Department of Dermatology, University Hospital of Saint Etienne, Saint Etienne, France
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21
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Shim JH, Shin HT, Park J, Park JH, Lee JH, Yang JM, Kim DH, Jang KT, Lee DY. Mutational profiling of acral melanomas in Korean populations. Exp Dermatol 2017; 26:883-888. [DOI: 10.1111/exd.13321] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Joon Ho Shim
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
- Samsung Genome Institute; Samsung Medical Center; Seoul Korea
| | - Hyun-Tae Shin
- Samsung Genome Institute; Samsung Medical Center; Seoul Korea
| | - Jiho Park
- Department of Health Sciences and Technology; Samsung Advanced Institute for Health Sciences and Technology; Sungkyunkwan University; Seoul Korea
| | - Ji-Hye Park
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jong-Hee Lee
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
- Department of Medical Device Management & Research; Samsung Advanced Institute for Health Sciences and Technology; Sungkyunkwan University; Seoul Korea
| | - Jun-Mo Yang
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Duk-Hwan Kim
- Department of Molecular Cell Biology; Samsung Biomedical Research Institute; Sungkyunkwan University School of Medicine; Suwon Korea
| | - Kee-Taek Jang
- Department of Pathology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Dong-Youn Lee
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
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22
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Kim YJ, Waller K, Keo V, Soum R, Gollogly JG. Clinical report. Acral melanoma in Cambodia: challenges associated with a rare and aggressive disease encountered in a developing country setting. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0806.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Melanoma is a highly malignant skin cancer. Acral lentiginous melanoma (ALM) is most common among Asians. The prevalence of ALM among melanoma cases in Cambodian is not known.
Objective: To describe the prevalence of ALM among cases of melanoma and the stage of disease at presentation to the health facilities and health providers.
Method: Electronic clinical records were obtained from Children’s Surgical Centre (CSC) database between January 2002 and April 2014. Types and stages melanoma at presentation were documented.
Result: A total of 10 out of 26 melanoma patients had ALM. Their average age at diagnosis was 65.3 years. Most primary lesions were located on the plantar or lateral surfaces of the foot. Most histopathological descriptions were consistent with ALM. Seventy percent had lymph node metastases.
Conclusion: A high proportion of ALM was found associated with trauma as a potential risk factor. Most frequency presented at a late stage of disease. Providers must be made aware of the disease and render appropriate management early for good outcome.
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Affiliation(s)
| | - Karen Waller
- Children’s Surgical Centre, Phnom Penh, Cambodia
| | - Vanna Keo
- Children’s Surgical Centre, Phnom Penh, Cambodia
| | - Ratha Soum
- Children’s Surgical Centre, Phnom Penh, Cambodia
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23
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Kim SY, Yun SJ. Cutaneous Melanoma in Asians. Chonnam Med J 2016; 52:185-93. [PMID: 27689028 PMCID: PMC5040767 DOI: 10.4068/cmj.2016.52.3.185] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/17/2016] [Accepted: 06/28/2016] [Indexed: 02/05/2023] Open
Abstract
Malignant melanoma is a rare disease in Asians but potentially the most aggressive form of skin cancer worldwide. It can occur in any melanocyte-containing anatomic site. Four main cutaneous melanoma subtypes are recognized: lentigo maligna melanoma, superficial spreading melanoma, acral lentiginous melanoma (ALM), and nodular melanoma. Generally, excessive exposure to ultraviolet (UV) radiation increases the risk of melanoma. The exception is ALM, which is the most common melanoma subtype in Asians and is not associated with UV radiation. ALM presents as dark brownish to black, irregular maculopatches, nodules, or ulcers on the palms, soles, and nails. The lesions may be misdiagnosed as more benign lesions, such as warts, ulcers, hematomas, foreign bodies, or fungal infections, especially in amelanotic acral melanomas where black pigments are absent. The aim of this brief review is to improve understanding and the rate of early detection thereby reducing mortality, especially regarding cutaneous melanoma in Asians.
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Affiliation(s)
- Sang Yub Kim
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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24
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Kim YJ, Lee JB, Kim SJ, Lee SC, Won YH, Yun SJ. Amelanotic Acral Melanoma Associated with KIT Mutation and Vitiligo. Ann Dermatol 2015; 27:201-5. [PMID: 25834362 PMCID: PMC4377412 DOI: 10.5021/ad.2015.27.2.201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/22/2014] [Accepted: 10/07/2014] [Indexed: 12/14/2022] Open
Abstract
Amelanotic acral melanoma is rare and difficult to diagnose, both clinically and pathologically. KIT mutations are frequently found in acral melanomas and are considered a risk factor for poor prognosis. The presence of vitiligo in melanoma has been reported, and KIT is thought to be partly responsible for the dysfunction and loss of melanocytes observed in vitiligo. We report a case of amelanotic subungual melanoma with multiple metastases that was associated with KIT mutation and vitiligo. An 85-year-old man presented with a 3-year history of a tender erythematous ulcerated tumor on the left third fingertip and developed hypopigmented patches on the face and trunk. Histopathological examination of the ulcerative tumor showed aggregates of tumor cells that were pleomorphic epithelioid cells. Immunohistochemical staining of the tumor cells was positive for S100, HMB45, and c-Kit. Histopathological findings from the hypopigmented patch on the face were consistent with vitiligo. Mutation analysis showed a KIT mutation in exon 17 (Y823D). The patient had metastasis to the brain, liver, bone, and both lungs. The patient refused chemotherapy, and died 3 months after the first visit.
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Affiliation(s)
- Young Jee Kim
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Jee-Bum Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Seong-Jin Kim
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung-Chul Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Young Ho Won
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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