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Sargen MR, Barnhill RL, Elder DE, Swetter SM, Prieto VG, Ko JS, Bahrami A, Gerami P, Karunamurthy A, Pappo AS, Schuchter LM, LeBoit PE, Yeh I, Kirkwood JM, Jen M, Dunkel IJ, Durham MM, Christison-Lagay ER, Austin MT, Aldrink JH, Mehrhoff C, Hawryluk EB, Chu EY, Busam KJ, Sondak V, Messina J, Puig S, Colebatch AJ, Coughlin CC, Berrebi KG, Laetsch TW, Mitchell SG, Seynnaeve B. Evaluation and Surgical Management of Pediatric Cutaneous Melanoma and Atypical Spitz and Non-Spitz Melanocytic Tumors (Melanocytomas): A Report From Children's Oncology Group. J Clin Oncol 2024:JCO2401154. [PMID: 39365959 DOI: 10.1200/jco.24.01154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/15/2024] [Accepted: 08/21/2024] [Indexed: 10/06/2024] Open
Abstract
PURPOSE The purpose of this study was to develop recommendations for the diagnostic evaluation and surgical management of cutaneous melanoma (CM) and atypical Spitz tumors (AST) and non-Spitz melanocytic tumors (melanocytomas) in pediatric (age 0-10 years) and adolescent (age 11-18 years) patients. METHODS A Children's Oncology Group-led panel with external, multidisciplinary CM specialists convened to develop recommendations on the basis of available data and expertise. RESULTS Thirty-three experts from multiple specialties (cutaneous/medical/surgical oncology, dermatology, and dermatopathology) established recommendations with supporting data from 87 peer-reviewed publications. RECOMMENDATIONS (1) Excisional biopsies with 1-3 mm margins should be performed when feasible for clinically suspicious melanocytic neoplasms. (2) Definitive surgical treatment for CM, including wide local excision and sentinel lymph node biopsy (SLNB), should follow National Comprehensive Cancer Network Guidelines in the absence of data from pediatric-specific surgery trials and/or cohort studies. (3) Accurate classification of ASTs as benign or malignant is more likely with immunohistochemistry and next-generation sequencing. (4) It may not be possible to classify some ASTs as likely/definitively benign or malignant after clinicopathologic and/or molecular correlation, and these Spitz tumors of uncertain malignant potential should be excised with 5 mm margins. (5) ASTs favored to be benign should be excised with 1- to 3-mm margins if transected on biopsy. (6) Re-excision is not necessary if the AST does not extend to the biopsy margin(s) when complete/excisional biopsy was performed. (7) SLNB should not be performed for Spitz tumors unless a diagnosis of CM is favored on clinicopathologic evaluation. (8) Non-Spitz melanocytomas have a presumed increased risk for progression to CM and should be excised with 1- to 3-mm margins if transected on biopsy. (9) Re-excision of non-Spitz melanocytomas is not necessary if the lesion is completely excised on biopsy.
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Affiliation(s)
- Michael R Sargen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Raymond L Barnhill
- Department of Translational Research, Institut Curie, Unit of Formation and Research of Medicine University of Paris Cité, Paris, France
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Susan M Swetter
- Department of Dermatology/Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA
| | - Victor G Prieto
- Departments of Anatomic Pathology and Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jennifer S Ko
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH
| | - Armita Bahrami
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Pedram Gerami
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | - Lynn M Schuchter
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Philip E LeBoit
- Departments of Dermatology and Pathology, Helen Diller Family Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Iwei Yeh
- Departments of Dermatology and Pathology, Helen Diller Family Cancer Center, University of California, San Francisco, San Francisco, CA
| | - John M Kirkwood
- University of Pittsburgh Medical Center Hillman Cancer Center Melanoma Program, Pittsburgh, PA
| | - Melinda Jen
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ira J Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Megan M Durham
- Department of Surgery, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA
| | - Emily R Christison-Lagay
- Division of Pediatric Surgery, Yale School of Medicine, Yale New-Haven Children's Hospital, New Haven, CT
| | - Mary T Austin
- Division of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Casey Mehrhoff
- Huntsman Cancer Institute, University of Utah Hospital, Salt Lake City, UT
| | - Elena B Hawryluk
- Department of Dermatology, Massachusetts General Hospital, Boston, MA
- Dermatology Program, Department of Allergy and Immunology, Boston Children's Hospital, Boston, MA
| | - Emily Y Chu
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Klaus J Busam
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vernon Sondak
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Jane Messina
- Department of Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunye, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Andrew J Colebatch
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Carrie C Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, Washington University School of Medicine in St Louis, St Louis, MO
| | - Kristen G Berrebi
- Departments of Dermatology and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Theodore W Laetsch
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia and Department of Pediatrics and Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Sarah G Mitchell
- Department of Pediatrics, Emory University School of Medicine, Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Brittani Seynnaeve
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Abu Shtaya A, Kedar I, Bazak L, Basel-Salmon L, Barhom SF, Naftali M, Eskin-Schwartz M, Birk OS, Polager-Modan S, Keidar N, Reznick Levi G, Levi Z, Yablonski-Peretz T, Mahamid A, Segol O, Matar R, Bareli Y, Azoulay N, Goldberg Y. A POT1 Founder Variant Associated with Early Onset Recurrent Melanoma and Various Solid Malignancies. Genes (Basel) 2024; 15:355. [PMID: 38540414 PMCID: PMC10970179 DOI: 10.3390/genes15030355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 06/14/2024] Open
Abstract
POT1 (Protection of Telomeres 1) is a key component of the six-membered shelterin complex that plays a critical role in telomere protection and length regulation. Germline variants in the POT1 gene have been implicated in predisposition to cancer, primarily to melanoma and chronic lymphocytic leukemia (CLL). We report the identification of POT1 p.(I78T), previously ranked with conflicting interpretations of pathogenicity, as a founder pathogenic variant among Ashkenazi Jews (AJs) and describe its unique clinical landscape. A directed database search was conducted for individuals referred for genetic counselling from 2018 to 2023. Demographic, clinical, genetic, and pathological data were collected and analyzed. Eleven carriers, 25 to 67 years old, from ten apparently unrelated families were identified. Carriers had a total of 30 primary malignancies (range 1-6); nine carriers (82%) had recurrent melanoma between the ages of 25 and 63 years, three carriers (27%) had desmoid tumors, three (27%) had papillary thyroid cancer (PTC), and five women (63% of female carriers) had breast cancer between the ages of 44 and 67 years. Additional tumors included CLL; sarcomas; endocrine tumors; prostate, urinary, and colorectal cancers; and colonic polyps. A review of a local exome database yielded an allelic frequency of the variant of 0.06% among all ethnicities and of 0.25% in AJs. A shared haplotype was found in all carriers tested. POT1 p.(I78T) is a founder disease-causing variant associated with early-onset melanoma and additional various solid malignancies with a high tumor burden. We advocate testing for this variant in high-risk patients of AJ descent. The inclusion of POT1 in germline panels for various types of cancer is warranted.
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Affiliation(s)
- Aasem Abu Shtaya
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (A.A.S.); (I.K.); (L.B.); (L.B.-S.); (S.F.B.); (R.M.); (Y.B.); (N.A.)
- Unit of Gastroenterology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel;
| | - Inbal Kedar
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (A.A.S.); (I.K.); (L.B.); (L.B.-S.); (S.F.B.); (R.M.); (Y.B.); (N.A.)
| | - Lily Bazak
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (A.A.S.); (I.K.); (L.B.); (L.B.-S.); (S.F.B.); (R.M.); (Y.B.); (N.A.)
| | - Lina Basel-Salmon
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (A.A.S.); (I.K.); (L.B.); (L.B.-S.); (S.F.B.); (R.M.); (Y.B.); (N.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Felsenstein Medical Research Center, Petach Tikva 4920235, Israel
- Pediatric Genetic Unit, Schneider Children’s Medical Center of Israel, Petch Tikva 4920235, Israel;
| | - Sarit Farage Barhom
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (A.A.S.); (I.K.); (L.B.); (L.B.-S.); (S.F.B.); (R.M.); (Y.B.); (N.A.)
| | | | - Marina Eskin-Schwartz
- Genetics Institute, Soroka University Medical Center, Beer Sheva 8410101, Israel; (M.E.-S.); (O.S.B.)
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410101, Israel
| | - Ohad S. Birk
- Genetics Institute, Soroka University Medical Center, Beer Sheva 8410101, Israel; (M.E.-S.); (O.S.B.)
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410101, Israel
| | | | - Nitzan Keidar
- Pediatric Genetic Unit, Schneider Children’s Medical Center of Israel, Petch Tikva 4920235, Israel;
| | - Gili Reznick Levi
- Genetics Institute, Rambam Health Care Campus, Haifa 3525408, Israel;
| | - Zohar Levi
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Division of Gastroenterology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel
| | - Tamar Yablonski-Peretz
- Oncology Institute, Hadassah Medical Center, Jerusalem 9112001, Israel;
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
| | - Ahmad Mahamid
- Department of Surgery B, Carmel Medical Center, Haifa 3436212, Israel;
| | - Ori Segol
- Unit of Gastroenterology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel;
| | - Reut Matar
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (A.A.S.); (I.K.); (L.B.); (L.B.-S.); (S.F.B.); (R.M.); (Y.B.); (N.A.)
| | - Yifat Bareli
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (A.A.S.); (I.K.); (L.B.); (L.B.-S.); (S.F.B.); (R.M.); (Y.B.); (N.A.)
| | - Noy Azoulay
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (A.A.S.); (I.K.); (L.B.); (L.B.-S.); (S.F.B.); (R.M.); (Y.B.); (N.A.)
| | - Yael Goldberg
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (A.A.S.); (I.K.); (L.B.); (L.B.-S.); (S.F.B.); (R.M.); (Y.B.); (N.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
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Zilberg C, Ferguson AL, Lyons JG, Gupta R, Fuller SJ, Damian DL. Cutaneous malignancies in chronic lymphocytic leukemia. J Dermatol 2024; 51:353-364. [PMID: 38291978 DOI: 10.1111/1346-8138.17126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/28/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
Chronic lymphocytic leukemia (CLL) is a common lymphoid malignancy that is associated with an increased risk of developing cutaneous malignancies. Clinical outcomes for these malignancies, including melanoma and keratinocyte cancers (KC), are worse for patients with CLL. Individuals with CLL develop an immunodeficiency of both the adaptive and innate immune system, which plays a role in the increased prevalence of skin cancers. This review focuses on the complex interplay between genetics, immunity, and pathogens that influence the cellular composition and biology of skin tumors and their microenvironment in CLL patients, and in comparison with other chronic hematological malignancies. It is paramount for dermatologists to be aware of the association between CLL (and chronic hematological malignancies more broadly) and cutaneous malignancies. This is a high-risk population who require regular and vigorous dermatologic follow-up.
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Affiliation(s)
- Catherine Zilberg
- Department of Dermatology, The University of Sydney at Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Angela L Ferguson
- Centenary Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - James G Lyons
- Department of Dermatology, The University of Sydney at Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Centenary Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Camperdown, New South Wales, Australia
| | - Stephen J Fuller
- Sydney Medical School, Nepean Clinical School, The Faculty of Medicine and Health, The University of Sydney, Kingswood, New South Wales, Australia
- Nepean Hospital, Kingswood, New South Wales, Australia
| | - Diona L Damian
- Department of Dermatology, The University of Sydney at Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
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