1
|
Kopřivová H, Kiss K, Krbal L, Stejskal V, Buday J, Pořízka P, Kaška M, Ryška A, Kaiser J. Imaging the elemental distribution within human malignant melanomas using Laser-Induced Breakdown Spectroscopy. Anal Chim Acta 2024; 1310:342663. [PMID: 38811130 DOI: 10.1016/j.aca.2024.342663] [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: 12/21/2023] [Revised: 03/20/2024] [Accepted: 04/27/2024] [Indexed: 05/31/2024]
Abstract
The diagnosis of malignant melanoma, often an inconspicuous but highly aggressive tumor, is most commonly done by histological examination, while additional diagnostic methods on the level of elements and molecules are constantly being developed. Several studies confirmed differences in the chemical composition of healthy and tumor tissue. Our study presents the potential of the LIBS (Laser-Induced-Breakdown Spectroscopy) technique as a diagnostic tool in malignant melanoma (MM) based on the quantitative changes in elemental composition in cancerous tissue. Our patient group included 17 samples of various types of malignant melanoma and one sample of healthy skin tissue as a control. To achieve a clear perception of results, we have selected two biogenic elements (calcium and magnesium), which showed a dissimilar distribution in cancerous tissue from its healthy surroundings. Moreover, we observed indications of different concentrations of these elements in different subtypes of malignant melanoma, a hypothesis that requires confirmation in a more extensive sample set. The information provided by the LIBS Imaging method could potentially be helpful not only in the diagnostics of tumor tissue but also be beneficial in broadening the knowledge about the tumor itself.
Collapse
Affiliation(s)
- Hana Kopřivová
- Central European Institute of Technology (CEITEC), Brno University of Technology, Purkyňova 123, 612 00, Brno, Czech Republic
| | - Kateřina Kiss
- Charles University, Faculty of Medicine in Hradec Kralove, Šimkova 870, 500 03, Hradec Králové, Czech Republic; Charles University, Third Faculty of Medicine, Department of Plastic Surgery, Ruská 2411, 100 00, Praha 10, Czech Republic; Surgical Department, University Hospital Hradec Králové, Sokolská 571, 500 05, Hradec Králové, Czech Republic
| | - Lukáš Krbal
- Charles University, Faculty of Medicine in Hradec Kralove, Šimkova 870, 500 03, Hradec Králové, Czech Republic; The Fingerland Department of Pathology, Faculty of Medicine at Charles University and University Hospital, Sokolská 581, 500 05, Hradec Králové, Czech Republic
| | - Václav Stejskal
- Charles University, Faculty of Medicine in Hradec Kralove, Šimkova 870, 500 03, Hradec Králové, Czech Republic; The Fingerland Department of Pathology, Faculty of Medicine at Charles University and University Hospital, Sokolská 581, 500 05, Hradec Králové, Czech Republic
| | - Jakub Buday
- Faculty of Mechanical Engineering (FME), Brno University of Technology, Technická 2 896, 616 69, Brno, Czech Republic
| | - Pavel Pořízka
- Central European Institute of Technology (CEITEC), Brno University of Technology, Purkyňova 123, 612 00, Brno, Czech Republic; Faculty of Mechanical Engineering (FME), Brno University of Technology, Technická 2 896, 616 69, Brno, Czech Republic.
| | - Milan Kaška
- Charles University, Faculty of Medicine in Hradec Kralove, Šimkova 870, 500 03, Hradec Králové, Czech Republic; Surgical Department, University Hospital Hradec Králové, Sokolská 571, 500 05, Hradec Králové, Czech Republic
| | - Aleš Ryška
- The Fingerland Department of Pathology, Faculty of Medicine at Charles University and University Hospital, Sokolská 581, 500 05, Hradec Králové, Czech Republic
| | - Jozef Kaiser
- Central European Institute of Technology (CEITEC), Brno University of Technology, Purkyňova 123, 612 00, Brno, Czech Republic; Faculty of Mechanical Engineering (FME), Brno University of Technology, Technická 2 896, 616 69, Brno, Czech Republic
| |
Collapse
|
2
|
Fu S, Kim S, Wasko C. Dermatological guide for primary care physicians: full body skin checks, skin cancer detection, and patient education on self-skin checks and sun protection. Proc AMIA Symp 2024; 37:647-654. [PMID: 38910815 PMCID: PMC11188824 DOI: 10.1080/08998280.2024.2351751] [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: 03/14/2024] [Accepted: 04/20/2024] [Indexed: 06/25/2024] Open
Abstract
Dermatological conditions and skin cancers are common health concerns that require early detection and intervention. Primary care physicians play a crucial role in recognizing these conditions and serving as the first line of defense against skin cancers. This guide provides a systematic approach to conducting thorough skin examinations and enhancing understanding of common presentations of precancerous and cancerous lesions. We emphasize the importance of performing annual full-body skin exams to facilitate early detection and management of skin conditions, including a step-by-step, systematic protocol for conducting these exams, comprising preparing the patient, documenting findings, educating the patient, and considering biopsy or referral for suspicious lesions. Furthermore, we explore the atypical features of skin lesions that raise clinical suspicion and warrant further investigation. We describe the characteristics of common skin cancers, such as basal cell carcinoma, squamous cell carcinoma, and melanoma. We stress the importance of patient education on self-skin checks and sun protection measures. By incorporating the knowledge and skills presented in this guide, primary care physicians can confidently perform thorough full-body skin checks, identify common dermatological findings and early signs of skin cancers, and provide comprehensive care to patients. This will help ensure optimal outcomes in dermatological health.
Collapse
Affiliation(s)
- Shangyi Fu
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Soojung Kim
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
| | - Carina Wasko
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
3
|
Zakhem GA, Pulavarty AN, Lester JC, Stevenson ML. Skin Cancer in People of Color: A Systematic Review. Am J Clin Dermatol 2022; 23:137-151. [PMID: 34902111 DOI: 10.1007/s40257-021-00662-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND People of African, Asian, Hispanic or Latino, Pacific Islander, and Native Indian descent are considered people of color by the Skin of Color Society (SOCS). OBJECTIVES In this study, we assess incidence, risk factors, clinical characteristics, histopathology, treatment, and survival for skin malignancies in people of color as defined by the SOCS, by systematically reviewing the literature. METHODS An electronic literature search of the PubMed, EMBASE, and MEDLINE databases was performed. Articles published from 1 January 1990 through 12 December 2020 were included in the search. RESULTS We identified 2666 publications potentially meeting the study criteria. Titles and abstracts of these studies were reviewed and 2353 were excluded. The full text of 313 articles were evaluated and 251 were included in this review. CONCLUSION Differences in incidence, patterns, treatment, and survival exist among people of color for cutaneous malignancies. Further research and initiatives are needed to account for and mitigate these differences.
Collapse
Affiliation(s)
- George A Zakhem
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Akshay N Pulavarty
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Jenna C Lester
- University of California San Francisco, San Francisco, CA, USA
| | - Mary L Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA.
| |
Collapse
|
4
|
Acral melanoma: a retrospective cohort from the Brazilian National Cancer Institute (INCA). Melanoma Res 2018; 28:458-464. [DOI: 10.1097/cmr.0000000000000476] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
5
|
Al-Hassani F, Chang C, Peach H. Acral lentiginous melanoma – Is inflammation the missing link? JPRAS Open 2017. [DOI: 10.1016/j.jpra.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
6
|
Goldenberg A, Vujic I, Sanlorenzo M, Ortiz-Urda S. Melanoma risk perception and prevention behavior among African-Americans: the minority melanoma paradox. Clin Cosmet Investig Dermatol 2015; 8:423-9. [PMID: 26346576 PMCID: PMC4531028 DOI: 10.2147/ccid.s87645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction Melanoma is the most deadly type of skin cancer with 75% of all skin cancer deaths within the US attributed to it. Risk factors for melanoma include ultraviolet exposure, genetic predisposition, and phenotypic characteristics (eg, fair skin and blond hair). Whites have a 27-fold higher incidence of melanoma than African-Americans (AA), but the 5-year survival is 17.8% lower for AA than Whites. It is reported continuously that AA have more advanced melanomas at diagnosis, and overall lower survival rates. This minority melanoma paradox is not well understood or studied. Objective To explore further, the possible explanations for the difference in melanoma severity and survival in AA within the US. Methods Qualitative review of the literature. Results Lack of minority-targeted public education campaigns, low self-risk perception, low self-skin examinations, intrinsic virulence, vitamin D differences, and physician mistrust may play a role in the melanoma survival disparity among AA. Conclusion Increases in public awareness of melanoma risk among AA through physician and media-guided education, higher index of suspicion among individuals and physicians, and policy changes can help to improve early detection and close the melanoma disparity gap in the future.
Collapse
Affiliation(s)
- Alina Goldenberg
- Department of Internal Medicine/Dermatology, University of California, San Diego, CA, USA
| | - Igor Vujic
- Mt Zion Cancer Research Center, University of California San Francisco, San Francisco, CA, USA ; Department of Dermatology, The Rudolfstiftung Hospital, Academic Teaching Hospital, Medical University Vienna, Vienna, Austria
| | - Martina Sanlorenzo
- Mt Zion Cancer Research Center, University of California San Francisco, San Francisco, CA, USA ; Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Susana Ortiz-Urda
- Mt Zion Cancer Research Center, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
7
|
Schulz C, Häfner HM, Breuninger H, Leiter U. Local recurrence and survival in acral lentiginous melanoma comparing 3D histology and conventional histology. J Dtsch Dermatol Ges 2014. [DOI: 10.1111/ddg.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Claudia Schulz
- Department of Dermatology, University Hospital of Tübingen; Germany
| | | | | | - Ulrike Leiter
- Department of Dermatology, University Hospital of Tübingen; Germany
| |
Collapse
|
8
|
Schulz C, Häfner HM, Breuninger H, Leiter U. [Local recurrence and survival in acral lentiginous melanoma comparing 3D histology and conventional histology]. J Dtsch Dermatol Ges 2014; 12:881-90. [PMID: 25262892 DOI: 10.1111/ddg.12448_suppl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/15/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgical treatment of acral lentiginous melanomas with wide excisional margins as recommended often requires amputation of distal extremities. The current study analyzes, if smaller excisions in combination with a complete histological evaluation of the excisional margins (3D histology) have a negative impact on the prognosis. PATIENTS AND METHODS 304 patients were retrospectively evaluated. 192 patients with reduced excisional margins followed by 3D histology (group A) were compared with 112 patients treated with conventional wide margins (group B). The outcome of both groups was compared. RESULTS The median tumor thickness was higher in group A (p = 0.022) and ulcerations occured more frequently (p = 0.017). The median excisional margin was 8 mm in group A and 20 mm in group B (p < 0.0001). 10.9 % (4.2 % invasive) of group A und 8.9 % (4.5 %invasive) of group B (p = 0.577) developed a local recurrence in a median of 40 months.The melanoma specific 10-year survival was 66.8 % in group A und 63.4 % in group B(p = 0.531). Survival of patients with or without local recurrence showed no difference(p = 0.643). CONCLUSIONS Excision with small margins followed by 3D histology is not inferior to conventional surgery with wide margins concerning the rate of local recurrences and has no negative impact on prognosis or the further course of the disease. Local recurrences are rare and do not influence the survival.
Collapse
Affiliation(s)
- Claudia Schulz
- Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | | | | | | |
Collapse
|
9
|
Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, Roberts WE, Draelos ZD, Bhushan R, Taylor SC, Lim HW. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol 2014; 70:748-762. [PMID: 24485530 DOI: 10.1016/j.jaad.2013.11.038] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 11/26/2013] [Accepted: 11/26/2013] [Indexed: 02/07/2023]
Abstract
Skin cancer is less prevalent in people of color than in the white population. However, when skin cancer occurs in non-whites, it often presents at a more advanced stage, and thus the prognosis is worse compared with white patients. The increased morbidity and mortality associated with skin cancer in patients of color compared with white patients may be because of the lack of awareness, diagnoses at a more advanced stage, and socioeconomic factors such as access to care barriers. Physician promotion of skin cancer prevention strategies for all patients, regardless of ethnic background and socioeconomic status, can lead to timely diagnosis and treatment. Public education campaigns should be expanded to target communities of color to promote self-skin examination and stress importance of photoprotection, avoidance of tanning bed use, and early skin cancer detection and treatment. These measures should result in reduction or earlier detection of cutaneous malignancies in all communities. Furthermore, promotion of photoprotection practices may reduce other adverse effects of ultraviolet exposure including photoaging and ultraviolet-related disorders of pigmentation.
Collapse
Affiliation(s)
- Oma N Agbai
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Kesha Buster
- Department of Dermatology, Via Christi Clinic, Wichita, Kansas
| | - Miguel Sanchez
- Department of Dermatology, New York University Medical Center, New York, New York
| | - Claudia Hernandez
- Department of Dermatology, University of Illinois College of Medicine, Chicago, Illinois
| | - Roopal V Kundu
- Northwestern Center for Ethnic Skin, Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Melvin Chiu
- Division of Dermatology, University of California Los Angeles Medical Center, Los Angeles, California
| | | | - Zoe D Draelos
- Dermatology Consulting Services, High Point, North Carolina
| | - Reva Bhushan
- American Academy of Dermatology, Schaumburg, Illinois.
| | - Susan C Taylor
- Society Hill Dermatology and Cosmetic Center, Philadelphia, Pennsylvania
| | - Henry W Lim
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| |
Collapse
|
10
|
Abstract
Cutaneous malignancies are the most common malignancies in Whites; traditionally considered rare among Blacks, their occurrence in sub-Saharan Africa is yet to be fully characterized.Data on specimens submitted between 1992 and April 2008 on all histologically proven primary cutaneous malignancies were collected from the Pathology Department, including patient age, sex, anatomic site of malignancy, and histologic diagnosis. There were 1900 patients with primary cutaneous malignancies, aged between 8 months and 110 years, with a mean age of 49 years. There were 14 different types of malignancies found, with squamous cell carcinoma representing 45% of the total. A number of the rarer types have not been reported previously, from this region.Cutaneous malignancies in Africa present a number of management challenges including the following: difficulties in early diagnosis in the dark skin, late presentation, access to treatment, and the ability to pay for the appropriate treatment. The current human immunodeficiency virus/acquired immune deficiency syndrome scourge on the continent may lead a significant increase in cutaneous malignancies, posing even bigger challenges.
Collapse
|
11
|
Lichte V, Breuninger H, Metzler G, Haefner H, Moehrle M. Acral lentiginous melanoma: conventional histology vs. three-dimensional histology. Br J Dermatol 2009; 160:591-9. [DOI: 10.1111/j.1365-2133.2008.08954.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
12
|
Nagore E, Pereda C, Botella-Estrada R, Requena C, Guillén C. Acral lentiginous melanoma presents distinct clinical profile with high cancer susceptibility. Cancer Causes Control 2008; 20:115-9. [DOI: 10.1007/s10552-008-9221-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 08/13/2008] [Indexed: 10/21/2022]
|
13
|
Phan A, Touzet S, Dalle S, Ronger-Savlé S, Balme B, Thomas L. Acral lentiginous melanoma: a clinicoprognostic study of 126 cases. Br J Dermatol 2007; 155:561-9. [PMID: 16911282 DOI: 10.1111/j.1365-2133.2006.07368.x] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although the histopathological subtype of melanoma has not been clearly proven to carry independent prognostic significance, acral lentiginous melanoma (ALM) seems to confer a poorer prognosis mainly because disease is often more advanced at the time of diagnosis. OBJECTIVES To investigate the distinctive epidemiological and clinical characteristics of ALM, a peculiar histological entity, and to identify prognostic factors. METHODS We performed a register-based review of cases from a single large referral centre, the University Hospital Department of Dermatology, Lyons, France. We reviewed patient demographics, the initial presentation of the lesion, and clinical outcome. ALM-specific and disease-free survival were estimated using the KaplanMeier method and compared using the log-rank test. A Cox model was used to identify prognostic factors. RESULTS One hundred and twenty-six patients were identified as having histopathology-proven ALM in our melanoma patient register from 1996 to 2004. There were 46 (37%) subungual ALM and 80 (63%) ALM on soles, palms and nonvolar sites. The mean age at diagnosis was 63 years. There were 44 (35%) men and 82 (65%) women, sex ratio M/F 1 : 1.86. The mean Breslow thickness was 2.51 mm (range: in situ to 20 mm). There was no evidence of overexposure to ultraviolet radiation, nor was there found a predisposing genetic trait. Only 16 (13%) patients recalled a history of trauma. Thirty-four ALM (28%) were unpigmented. The median ALM-specific and disease-free survival were 13.5 and 10.1 years, respectively. The 5-year survival rate was 76%. Multivariate analysis identified tumour thickness, male gender and amelanosis as independent clinical prognostic factors for both ALM-specific and disease-free survival. CONCLUSIONS Our study provides specific information on the clinical characteristics and outcome of this uncommon histological subtype of melanoma. However, the pathogenesis remains unknown. Breslow thickness, male gender and amelanosis were significantly associated with a poorer prognosis.
Collapse
Affiliation(s)
- A Phan
- Department of Dermatology, Hôtel Dieu, Claude Bernard University, 69288 Lyon cedex 02, France
| | | | | | | | | | | |
Collapse
|
14
|
Multiple Primary Acral Melanomas in African-Americans. Dermatol Surg 2007. [DOI: 10.1097/00042728-200701000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Hutcheson ACS, McGowan JW, Maize JC, Cook J. Multiple Primary Acral Melanomas in African-Americans: A Case Series and Review of the Literature. Dermatol Surg 2007; 33:1-10. [PMID: 17214672 DOI: 10.1111/j.1524-4725.2007.33000.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although melanoma accounts for only 4% to 5% of all skin cancers in the United States, it causes most skin cancer-related deaths. We describe a unique group of African-American patients with multiple primary acral lentiginous melanomas (ALMs). OBJECTIVE The purpose of this study was to review the case histories and management of a cohort of patients in the Mohs practice of our dermatologic surgeon with multiple primary ALM. METHODS This is a case series of patients with multiple ALM identified by chart review from 2000 to 2005. A thorough review of the literature was performed. RESULTS Four patients, all African-American, were identified with multiple ALM. All patients were managed with excision or Mohs micrographic surgery utilizing permanent sections. None of the patients with ALM had melanomas at nonacral sites or other types of skin cancer. Several had acral melanosis. Information in the literature on patients with multiple primary acral melanomas was insufficient. CONCLUSION Patients with multiple acral melanomas have not, to our knowledge, been reported thus far. It can be extrapolated from current literature, however, that appropriate management of these patients, including staging work and surgical intervention, is to be determined by the individual characteristics of the melanoma and the patient's concomitant risk factors, if any.
Collapse
Affiliation(s)
- Angela C S Hutcheson
- Department of Dermatology, Medical University of South Carolina, Chareston, South Carolina 29425, USA
| | | | | | | |
Collapse
|
16
|
Gloster HM, Neal K. Skin cancer in skin of color. J Am Acad Dermatol 2006; 55:741-60; quiz 761-4. [PMID: 17052479 DOI: 10.1016/j.jaad.2005.08.063] [Citation(s) in RCA: 353] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Revised: 08/06/2005] [Accepted: 08/30/2005] [Indexed: 11/23/2022]
Abstract
UNLABELLED Skin cancer is less common in persons with skin of color than in light-skinned Caucasians but is often associated with greater morbidity and mortality. Thus, it is crucial that physicians become familiar with skin cancer in persons of color so as to maximize the likelihood of early detection of these tumors. In dark-skinned ethnic groups, squamous cell carcinoma is most common; squamous cell carcinoma and melanoma usually occur on nonsun-exposed sites; and ultraviolet radiation is not an important etiologic factor for skin cancer with the exception of basal cell carcinoma. Races of intermediate pigmentation, such as Hispanics and Asians, share epidemiologic and clinical features of dark-skinned ethnic groups and Caucasians. Skin cancers pose a significant risk in skin of color and clinicians should focus on preventive measures in these groups such as regular skin exams, self-examination, public education, and screening programs. LEARNING OBJECTIVE At the completion of this learning activity, participants should be familiar with the epidemiology and unique clinical features of skin cancer in skin of color and be aware of strategies to prevent skin cancer in skin of color.
Collapse
Affiliation(s)
- Hugh M Gloster
- Department of Dermatology, University of Cincinnati, School of Medicine, Cincinnati, Ohio 45242, USA.
| | | |
Collapse
|
17
|
Gray RJ, Pockaj BA, Vega ML, Connolly SM, DiCaudo DJ, Kile TA, Buchel EW. Diagnosis and treatment of malignant melanoma of the foot. Foot Ankle Int 2006; 27:696-705. [PMID: 17038281 DOI: 10.1177/107110070602700908] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients diagnosed with melanoma of the foot have been reported to have a poor prognosis. We reviewed our experience at a tertiary-care medical clinic to determine the disease course in patients diagnosed with melanoma of the foot. METHODS A retrospective review was performed of 38 patients with a diagnosis of primary or locally recurrent melanoma of the foot treated between January, 1988, and July, 2004. The main outcome measures included methods of diagnosis, clinical and histopathologic features, and patterns of recurrence. RESULTS The mean age at diagnosis was 61 years; most were women (58%) and Caucasian (95%). The average time to diagnosis was 17 months. Initial clinical diagnosis had been considered benign in 12 (32%). The median Breslow thickness was 1.75 mm, T1 lesions were the most common, and acral lentiginous melanoma accounted for 42%. Thirteen patients (34%) had ulcerated lesions. Sentinel lymph node biopsy specimens of 25 patients identified four (16%) with metastatic disease. Surgical complications occurred in 12 patients, usually after skin graft or soft-tissue flap reconstruction. Systemic recurrence developed in six patients, four of whom also had regional recurrence. CONCLUSIONS Most patients were elderly Caucasian women and most presented with early-stage disease, but diagnosis can be difficult and a subgroup presented with thick melanomas. Reconstructive surgical procedures had a high rate of complications; however, overall functional outcomes were good. Stage of cancer at diagnosis was associated with systemic metastases.
Collapse
Affiliation(s)
- Richard J Gray
- Division of General Surgery, Mayo Clinic, Scottsdale, AZ 85259, USA
| | | | | | | | | | | | | |
Collapse
|
18
|
Garzino-Demo P, Fasolis M, Maggiore GMLT, Pagano M, Berrone S. Oral mucosal melanoma: a series of case reports. J Craniomaxillofac Surg 2004; 32:251-7. [PMID: 15262258 DOI: 10.1016/j.jcms.2003.12.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2003] [Accepted: 12/12/2003] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Due to the rarity of oral malignant melanomas case reports are a necessary source of information. Ten new cases are reported with a minimum follow-up of 3 years. PATIENTS AND METHODS Patients were treated during a period of 10 years. Clinical, demographic and pathologic findings were examined. RESULTS In 6 males (60%) and 4 females with a mean age of 64.3 years the tumour locations were: hard palate-maxillary gingiva (3 cases), maxillary gingiva (2), lower gingiva (2), tongue (2), hard/soft palate-buccal mucosa (1). Pre-existing melanotic pigmentation had been present in 4 patients. Four patients were in stage I, 5 in stage II, and 1 in stage III. Surgical excision was the primary treatment in 9 cases. Five patients underwent simultaneous neck dissections. All patients received radiation and multimode adjuvant therapies. After a 3-year follow-up 3 patients are still alive (50% (2/4) of those presenting in stage I and 20% (1/5) in stage II). CONCLUSIONS Due to the rarity of oral melanoma, individual experience is limited. The poor prognosis and the different treatments reflect this situation.
Collapse
|
19
|
Abstract
Skin cancer prevalence in ethnic skin is low. Squamous cell carcinoma, hypopigmented mycosis fungoides, and acral lentiginous melanoma are the most serious types of skin cancer noted in the darker-skinned population. Photoaging occurs less frequently and is less severe in ethnic skin.
Collapse
Affiliation(s)
- Rebat M Halder
- Departament of Dermatology, Howard University College of Medicine, 2041 Georgia Avenue, NW, Washington, DC 20060, USA
| | | |
Collapse
|
20
|
Abstract
Malignant melanoma is increasing at a rate faster than any other cancer in the United States. Location of the primary tumor on the foot is associated with poorer prognosis. This study evaluates a cohort of 148 patients with melanoma of the lower extremity (37 foot or ankle and 111 leg, knee, or thigh) diagnosed at a university medical center during a 32-year period. The mean follow-up for the foot/ankle patients was 44 months. The overall 5-year survival rate was 52% for patients with a primary melanoma of the foot/ankle compared with 84% for patients with a primary melanoma elsewhere on the lower extremity. Although the study period extended over 32 years, nearly 65% of the foot/ankle patients were diagnosed in the last decade. This increase is most likely because of the documented increase in incidence of melanoma in the United States and an increasing referral pattern at our institution.
Collapse
Affiliation(s)
- Susan M Walsh
- Department of Orthopedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA.
| | | | | |
Collapse
|
21
|
Soon SL, Solomon AR, Papadopoulos D, Murray DR, McAlpine B, Washington CV. Acral lentiginous melanoma mimicking benign disease: the Emory experience. J Am Acad Dermatol 2003; 48:183-8. [PMID: 12582386 DOI: 10.1067/mjd.2003.63] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Plantar and subungual melanoma exhibits a higher misdiagnosis rate relative to other anatomic sites. Misdiagnosis and delay in diagnosis are statistically associated with poorer patient outcome. Awareness of atypical presentations of acral melanoma may, thus, be important to decrease misdiagnosis rates and improve patient outcome. METHODS We conducted a retrospective case review of plantar or lower-extremity subungual melanoma performed at Winship Cancer Center, a tertiary care, referral center affiliated with Emory University, between 1985 and 2001. RESULTS A total of 53 cases of plantar or lower-extremity subungual melanoma were identified. Of 53 cases with a final diagnosis of melanoma, 18 were initially misdiagnosed. Misdiagnoses included wart, callous, fungal disorder, foreign body, crusty lesion, sweat gland condition, blister, nonhealing wound, mole, keratoacanthoma, subungual hematoma, onychomycosis, ingrown toenail, and defective/infected toenail. Of the 18 misdiagnosed cases, 9 were clinically amelanotic. CONCLUSION Awareness that amelanotic variants of acral melanoma may assume the morphology of benign hyperkeratotic dermatoses may increase the rate of correct diagnosis and improve patient outcome.
Collapse
Affiliation(s)
- Seaver L Soon
- Department of Dermatology, Emory University School of Medicine, 5001 Woodruff Memorial Building, Atlanta, GA 30322, USA
| | | | | | | | | | | |
Collapse
|
22
|
Abstract
BACKGROUND Acral lentiginous melanoma (ALM) is a subtype of melanoma initially described only two and half decades ago, but well-recognized by dermatologists today. However, several areas of controversy surround this entity. OBJECTIVE The primary aims of this article are to review the literature, highlight recent advances, and review some of the ongoing controversies in ALM. METHODS A review of the English language literature was performed. RESULTS Controversy continues to surround ALM, particularly in regard to diagnostic histologic and clinical criteria. This leads to difficulties when reviewing studies that evaluate the epidemiology, etiology, and prognosis of ALM. CONCLUSION Progress in understanding ALM requires the development of standardized diagnostic criteria.
Collapse
Affiliation(s)
- Jennifer R Stalkup
- Department of Dermatology, Baylor College of Medicine, Houston, Texas 77030, USA
| | | | | |
Collapse
|
23
|
STALKUP JENNIFERR, ORENGO IDAF, KATTA RAJANI. Controversies in Acral Lentiginous Melanoma. Dermatol Surg 2002. [DOI: 10.1097/00042728-200211000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Abstract
Acral lentiginous melanoma is a very aggressive, malignant cutaneous tumor which has a predilection for the plantar surface of the feet, palms of the hand, and the digits. The lesion presents as a rapidly spreading, darkly pigmented patch and may display varying degrees of pigmentation. These lesions have a propensity to metastasize to the central nervous system, liver, lungs, bone, and lymph nodes. Due to the aggressive nature of these lesions, early recognition and treatment, consisting of excision in toto with clean margins, are imperative. The authors present a thorough review of the literature and an illustrative case of acral lentiginous melanoma of the lower extremity.
Collapse
Affiliation(s)
- E S Harmelin
- South Miami Hospital Podiatric Residency Program, Fl, USA
| | | | | | | | | |
Collapse
|
25
|
Nakano J, Muto M, Shimizu T, Hirota T, Ichimiya M, Asagami C. Ganglioside expression in melanomas from Japanese individuals: unusual pattern in two patients with metastatic lesions of acral lentiginous melanomas. PIGMENT CELL RESEARCH 1997; 10:201-5. [PMID: 9263326 DOI: 10.1111/j.1600-0749.1997.tb00485.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Melanoma among Japanese is rare, and differs in its clinical and histological characteristics from that found in Caucasians. In this study, the ganglioside expression of melanoma specimens obtained from Japanese was determined and compared with previously published data on Caucasians. The ganglioside composition of 25 biopsy melanoma specimens, including 13 primary and 12 metastatic lesions, was studied using thin layer chromatography. Four gangliosides (GM3, GD3, GM2, GD2) were most commonly expressed in melanomas in Japanese. The expression of gangliosides was quite variable in both primary and metastatic melanomas as seen in previous reports. No significant differences were observed between gangliosides from primary and metastatic sites. A new type of ganglioside expression, in which GM3 was nearly the only ganglioside (> 95%), was found in metastatic tumors from two Japanese patients with acral lentiginous melanoma (ALM), which is the most common clinical and histopathological type of melanoma among Japanese but is very unusual among Caucasians. The patterns of expression were similar to those in Caucasians except for the detection of a "new" pattern.
Collapse
Affiliation(s)
- J Nakano
- Department of Dermatology, Yamaguchi University School of Medicine, Ube, Japan
| | | | | | | | | | | |
Collapse
|
26
|
Abstract
Melanomas of the hand are relatively rare, and much confusion exists concerning their pathology and treatment. We reviewed our experience with 39 patients diagnosed with melanoma of the hand. The data were categorized by site, histology, and type of treatment. Most primaries were on the digits, with a few tumors arising on the palm. The most common histology was superficial spreading melanoma, even in the subungual location. Acral lentiginous melanoma accounted for only 8 of 39 cases. Most patients could be treated without radical amputations, even for melanomas on the digits. Review of our patients emphasized the need for early diagnosis. Biopsy of all unexplained pigmented lesions on the hands can lead to early diagnosis, relatively nondeforming treatment, and good survival.
Collapse
Affiliation(s)
- M Warso
- Department of Surgical Oncology, University of Illinois at Chicago 60612, USA
| | | | | |
Collapse
|
27
|
Abstract
In a consecutive series of 165 plantar naevi, a group of 36 benign naevi with sufficiently distinctive histopathological features to justify their classification as a special entity, here designated acral-lentiginous naevus, was identified. The main morphological features distinguishing the acral-lentiginous naevi from other acral non-lentiginous naevi are: elongation of rete ridges, continuous proliferation of melanocytes at the dermo-epidermal junction, presence of single scattered melanocytes, or less commonly small clusters, within the upper epidermis, poor or absent lateral circumscription, melanocytes with abundant pale cytoplasm and round to oval, sometimes hyperchromatic, nuclei and prominent nucleoli present at the dermo-epidermal junction. Some histological features of acral-lentiginous naevi are similar to those of dysplastic naevi: however, anastomosing rete ridges, cytological atypia and well-formed lamellar fibroplasia are absent. The histopathological criteria to distinguish these naevi from melanoma are: the lack of pagetoid lateral spread, the absence of mitotic activity in the deep dermal component and the evidence of dermal naevocytic differentiation. The identification of this benign acral naevus, that we have identified as the benign counterpart of acral lentiginous melanoma, is important in order to avoid misdiagnoses and consequent under- or over-treatment of doubtful pigmented lesions of acral skin.
Collapse
Affiliation(s)
- C Clemente
- Division of Anatomic Pathology and Cytopathology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy
| | | | | | | | | | | |
Collapse
|
28
|
|