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Andea AA. Molecular testing in melanoma for the surgical pathologist. Pathology 2023; 55:245-257. [PMID: 36653236 DOI: 10.1016/j.pathol.2022.12.343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
The diagnostic work-up of melanocytic tumours has undergone significant changes in the last years following the exponential growth of molecular assays. For the practising pathologist it is often difficult to sort through the multitude of different tests that are currently available for clinical use. The molecular tests used in melanocytic pathology can be broadly divided into four categories: (1) tests that predict response to systemic therapy in melanoma; (2) tests that predict prognosis in melanoma; (3) tests useful in determining the type or class of melanocytic tumour; and (4) tests useful in the differential diagnosis of naevus versus melanoma (primarily used as an aid in the diagnosis of histologically ambiguous melanocytic lesions). This review will present an updated synopsis of major molecular ancillary tests used in clinical practice.
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Affiliation(s)
- Aleodor A Andea
- Departments of Pathology and Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
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2
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Geiersbach KB, Gliem TJ, Jenkins SM, Gaitatzes AG, Brodersen PR, Negro ME, Clees MJ, Swanson KE, Boeckman RM, Natrop TJ, Sukov WR, Shah KK, Greipp PT, Rowsey RA, Flotte TJ, Erickson LA, Guo R. Single-Nucleotide Polymorphism Array for Histologically Ambiguous Melanocytic Tumors: Knowns and Unknowns. J Mol Diagn 2022; 24:1160-1170. [PMID: 36115511 DOI: 10.1016/j.jmoldx.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/10/2022] [Accepted: 08/11/2022] [Indexed: 10/14/2022] Open
Abstract
Genome-wide copy number profiling by single-nucleotide polymorphism (SNP) array is increasingly employed in the clinical diagnostic workup of melanocytic tumors. We present our SNP array results on 675 melanocytic tumors, including 615 histologically ambiguous tumors evaluated by our institution's dermatopathology consultation service and a separate validation cohort of 26 known benign nevi and 34 known malignant melanomas. The total number of somatic copy number abnormalities, sub-chromosomal copy number abnormalities, regions of homozygosity, and abnormalities at disease-associated regions was significantly associated with a diagnosis of malignancy across disease categories. In our study, the number of copy number abnormalities was the factor that best discriminated between benign versus malignant diagnoses, confirming recent published research. Histologically ambiguous tumors had a range and spectrum of abnormalities, including recurrent 11p gains, copy state transitions over kinase genes, and 3p deletions overlapping BAP1 in neoplasms with spitzoid morphology. Our data suggest that histologically ambiguous melanocytic neoplasms and early primary melanomas have a range of abnormalities that is intermediate between unambiguous benign or malignant melanocytic neoplasms. Careful technical review and an integrated diagnostic approach are essential for the accurate interpretation of SNP array results on histologically ambiguous melanocytic tumors.
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Affiliation(s)
| | - Troy J Gliem
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sarah M Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | | | - Pamela R Brodersen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Megan E Negro
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Megan J Clees
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Kirsten E Swanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Riley M Boeckman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Travis J Natrop
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - William R Sukov
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Kabeer K Shah
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; SSM Health St. Mary's Hospital, Madison, Wisconsin
| | - Patricia T Greipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ross A Rowsey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Thomas J Flotte
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Ruifeng Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Ricci C, Dika E, Ambrosi F, Lambertini M, Veronesi G, Barbara C. Cutaneous Melanomas: A Single Center Experience on the Usage of Immunohistochemistry Applied for the Diagnosis. Int J Mol Sci 2022; 23:5911. [PMID: 35682589 PMCID: PMC9180684 DOI: 10.3390/ijms23115911] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 12/12/2022] Open
Abstract
Cutaneous melanoma (cM) is the deadliest of all primary skin cancers. Its prognosis is strongly influenced by the stage at diagnosis, with early stages having a good prognosis and being potentially treatable with surgery alone; advanced stages display a much worse prognosis, with a high rate of recurrence and metastasis. For this reason, the accurate and early diagnosis of cM is crucial-misdiagnosis may have extremely dangerous consequences for the patient and drastically reduce their chances of survival. Although the histological exam remains the "gold standard" for the diagnosis of cM, a continuously increasing number of immunohistochemical markers that could help in diagnosis, prognostic characterization, and appropriate therapeutical choices are identified every day, with some of them becoming part of routine practice. This review aims to discuss and summarize all the data related to the immunohistochemical analyses that are potentially useful for the diagnosis of cM, thus rendering it easier to appropriately applicate to routine practice. We will discuss these topics, as well as the role of these molecules in the biology of cM and potential impact on diagnosis and treatment, integrating the literature data with the experience of our surgical pathology department.
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Affiliation(s)
- Costantino Ricci
- Pathology Unit, Ospedale Maggiore, 40139 Bologna, Italy; (C.R.); (F.A.)
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40139 Bologna, Italy;
| | - Emi Dika
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40139 Bologna, Italy;
| | - Francesca Ambrosi
- Pathology Unit, Ospedale Maggiore, 40139 Bologna, Italy; (C.R.); (F.A.)
| | - Martina Lambertini
- Dermatology Unit, IRCCS Policlinico Sant’Orsola-Malpighi, University of Bologna, 40139 Bologna, Italy; (M.L.); (G.V.)
| | - Giulia Veronesi
- Dermatology Unit, IRCCS Policlinico Sant’Orsola-Malpighi, University of Bologna, 40139 Bologna, Italy; (M.L.); (G.V.)
| | - Corti Barbara
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40139 Bologna, Italy
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4
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Andea AA. Molecular testing for melanocytic tumors: a practical update. Histopathology 2021; 80:150-165. [DOI: 10.1111/his.14570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Aleodor A Andea
- Departments of Pathology and Dermatology Michigan Medicine University of Michigan Ann Arbor MI USA
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Harvey NT, Peverall J, Acott N, Mesbah Ardakani N, Leecy TN, Iacobelli J, McCallum D, Van Vliet C, Wood BA. Correlation of FISH and PRAME Immunohistochemistry in Ambiguous Superficial Cutaneous Melanocytic Proliferations. Am J Dermatopathol 2021; 43:913-920. [PMID: 33899766 DOI: 10.1097/dad.0000000000001951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Preferentially expressed antigen in melanoma (PRAME) is a tumor-associated repressor of retinoic acid signaling which is expressed in melanoma and has emerged as a potential biomarker for malignant behavior in melanocytic neoplasms. Although ancillary molecular techniques such as fluorescence in situ hybridization (FISH) are established techniques in the diagnosis of problematic cutaneous melanocytic proliferations, they are expensive, time-consuming, and require appropriate infrastructure, which places them out of reach of some laboratories. The advent of readily available commercial antibodies to PRAME has the potential to provide a more accessible alternative. The aim of this study was to determine whether immunohistochemistry for PRAME could serve as a surrogate for FISH analysis in a subgroup of challenging superficial melanocytic proliferations. Cases which had previously been submitted for FISH analysis were stained for PRAME and interpreted by a panel of at least 3 dermatopathologists is a blinded fashion. Of a study set of 55 cases, 42 (76%) showed a pattern of PRAME immunostaining which was concordant with the cytogenetic interpretation, with an unweighted kappa of 0.42 (representing mild-to-moderate agreement). Thus, although there was a correlation between positive immunohistochemistry for PRAME and abnormal findings on FISH analysis, in our view, the concordance was not sufficient to enable PRAME immunohistochemistry to act as a surrogate for FISH testing. Our findings reiterate the principle that interpretation of problematic superficial melanocytic proliferations requires a synthesis of all the available data, including clinical scenario, morphological features, immunohistochemistry, and ancillary molecular investigations.
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Affiliation(s)
- Nathan T Harvey
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
- Division of Pathology and Laboratory Medicine, Medical School, University of Western, Perth, Australia
| | - Joanne Peverall
- Department of Diagnostic Genomics, PathWest Laboratory Medicine, Perth, WA, Australia; and
| | - Nathan Acott
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
| | - Nima Mesbah Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
- College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
| | - Tamazin N Leecy
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
| | - Jean Iacobelli
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
| | - Dugald McCallum
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
| | - Chris Van Vliet
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
| | - Benjamin A Wood
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
- Division of Pathology and Laboratory Medicine, Medical School, University of Western, Perth, Australia
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Abstract
Conventional histopathology is the primary means of melanoma diagnosis. Both architectural and cytologic features aid in discrimination of melanocytic nevi from melanoma. Communication between the clinician and pathologist regarding the history, examination, differential diagnosis, prior biopsy findings, method of sampling, and specimen orientation is critical to an accurate diagnosis. A melanoma pathology report includes multiple prognostic indicators to guide surgical and medical management. In challenging cases, immunohistochemistry and molecular diagnostics may be of benefit.
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Al-Rohil RN, Moore JL, Patterson NH, Nicholson S, Verbeeck N, Claesen M, Muhammad JZ, Caprioli RM, Norris JL, Kantrow S, Compton M, Robbins J, Alomari AK. Diagnosis of melanoma by imaging mass spectrometry: Development and validation of a melanoma prediction model. J Cutan Pathol 2021; 48:1455-1462. [PMID: 34151458 DOI: 10.1111/cup.14083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/24/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The definitive diagnosis of melanocytic neoplasia using solely histopathologic evaluation can be challenging. Novel techniques that objectively confirm diagnoses are needed. This study details the development and validation of a melanoma prediction model from spatially resolved multivariate protein expression profiles generated by imaging mass spectrometry (IMS). METHODS Three board-certified dermatopathologists blindly evaluated 333 samples. Samples with triply concordant diagnoses were included in this study, divided into a training set (n = 241) and a test set (n = 92). Both the training and test sets included various representative subclasses of unambiguous nevi and melanomas. A prediction model was developed from the training set using a linear support vector machine classification model. RESULTS We validated the prediction model on the independent test set of 92 specimens (75 classified correctly, 2 misclassified, and 15 indeterminate). IMS detects melanoma with a sensitivity of 97.6% and a specificity of 96.4% when evaluating each unique spot. IMS predicts melanoma at the sample level with a sensitivity of 97.3% and a specificity of 97.5%. Indeterminate results were excluded from sensitivity and specificity calculations. CONCLUSION This study provides evidence that IMS-based proteomics results are highly concordant to diagnostic results obtained by careful histopathologic evaluation from a panel of expert dermatopathologists.
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Affiliation(s)
- Rami N Al-Rohil
- Departments of Pathology and Dermatology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Nathan Heath Patterson
- Frontier Diagnostics, LLC, Nashville, Tennessee, USA.,Mass Spectrometry Research Center, Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, USA
| | | | | | | | | | - Richard M Caprioli
- Frontier Diagnostics, LLC, Nashville, Tennessee, USA.,Mass Spectrometry Research Center, Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, USA
| | - Jeremy L Norris
- Frontier Diagnostics, LLC, Nashville, Tennessee, USA.,Mass Spectrometry Research Center, Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, USA
| | - Sara Kantrow
- Pathology Associates of Saint Thomas, Nashville, Tennessee, USA
| | - Margaret Compton
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jason Robbins
- Pathology Associates of Saint Thomas, Nashville, Tennessee, USA
| | - Ahmed K Alomari
- Departments of Pathology and Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Deacon DC, Smith EA, Judson-Torres RL. Molecular Biomarkers for Melanoma Screening, Diagnosis and Prognosis: Current State and Future Prospects. Front Med (Lausanne) 2021; 8:642380. [PMID: 33937286 PMCID: PMC8085270 DOI: 10.3389/fmed.2021.642380] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/17/2021] [Indexed: 12/22/2022] Open
Abstract
Despite significant progress in the development of treatment options, melanoma remains a leading cause of death due to skin cancer. Advances in our understanding of the genetic, transcriptomic, and morphologic spectrum of benign and malignant melanocytic neoplasia have enabled the field to propose biomarkers with potential diagnostic, prognostic, and predictive value. While these proposed biomarkers have the potential to improve clinical decision making at multiple critical intervention points, most remain unvalidated. Clinical validation of even the most commonly assessed biomarkers will require substantial resources, including limited clinical specimens. It is therefore important to consider the properties that constitute a relevant and clinically-useful biomarker-based test prior to engaging in large validation studies. In this review article we adapt an established framework for determining minimally-useful biomarker test characteristics, and apply this framework to a discussion of currently used and proposed biomarkers designed to aid melanoma detection, staging, prognosis, and choice of treatment.
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Affiliation(s)
- Dekker C. Deacon
- Department of Dermatology, University of Utah, Salt Lake City, UT, United States
| | - Eric A. Smith
- Department of Pathology, University of Utah, Salt Lake City, UT, United States
| | - Robert L. Judson-Torres
- Department of Dermatology, University of Utah, Salt Lake City, UT, United States
- Huntsman Cancer Institute, Salt Lake City, UT, United States
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9
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Through the looking glass and what you find there: making sense of comparative genomic hybridization and fluorescence in situ hybridization for melanoma diagnosis. Mod Pathol 2020; 33:1318-1330. [PMID: 32066861 DOI: 10.1038/s41379-020-0490-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 12/11/2022]
Abstract
Melanoma is the leading cause of death among cutaneous neoplasms. Best outcome relies on early detection and accurate pathologic diagnosis. For the great majority of melanocytic tumors, histopathologic examination can reliably distinguish nevi from melanomas. However, there is a subset of melanocytic tumors that cannot be definitively classified as benign or malignant using histopathological criteria alone. These tumors are usually diagnosed using terms that imply various degrees of uncertainty in regards to their malignant potential and create the possibility for over or undertreatment. For such tumors, additional ancillary tests would be beneficial in adjudicating a more definitive diagnosis. In recent years, DNA-based molecular ancillary tests, specifically comparative genomic hybridization and fluorescence in situ hybridization, have been developed to help guide the diagnosis of ambiguous melanocytic proliferations. This study will present an updated overview of these two major ancillary tests, which are currently being used in clinical practice to assist in the diagnosis of challenging melanocytic neoplasms.
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Clarke LE, Mabey B, Flake Ii DD, Meek S, Cassarino DS, Duncan LM, High WA, Napekoski KM, Prieto VG, Tetzlaff MT, Vitale P, Elder DE. Clinical validity of a gene expression signature in diagnostically uncertain neoplasms. Per Med 2020; 17:361-371. [PMID: 32915688 DOI: 10.2217/pme-2020-0048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Aim: Evaluate the accuracy of a 23-gene expression signature in differentiating benign nevi from melanoma by comparing test results with clinical outcomes. Materials & methods: Seven dermatopathologists blinded to gene expression test results and clinical outcomes examined 181 lesions to identify diagnostically uncertain cases. Participants independently recorded diagnoses and responses to questions quantifying diagnostic certainty. Test accuracy was determined through comparison with clinical outcomes (sensitivity and percent negative agreement). Results: Overall, 125 cases fulfilled criteria for diagnostic uncertainty (69.1%; 95% CI: 61.8-75.7%). Test sensitivity and percent negative agreement in these cases were 90.4% (95% CI: 79.0-96.8%) and 95.5% (95% CI: 87.3-99.1%), respectively. Conclusion: The 23-gene expression signature has high diagnostic accuracy in diagnostically uncertain cases when evaluated against clinical outcomes.
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Affiliation(s)
- Loren E Clarke
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - Brent Mabey
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - Darl D Flake Ii
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - Stephanie Meek
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - David S Cassarino
- Kaiser Permanente, Los Angeles Medical Center Bldg., Los Angeles, CA 90027, USA
| | - Lyn M Duncan
- Pathology Associates, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Whitney A High
- Department of Dermatology, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Victor G Prieto
- Departments of Pathology & Translational & Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael T Tetzlaff
- Departments of Pathology & Translational & Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Patricia Vitale
- Departments of Dermatology and Pathology, University of Utah Health, Salt Lake City, UT 84132, USA
| | - David E Elder
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Lai Y, Wu Y, Liu R, Lu A, Zhou L, Jia L, Diao X, Li Z. Four-color fluorescence in-situ hybridization is useful to assist to distinguish early stage acral and cutaneous melanomas from dysplastic junctional or compound nevus. Diagn Pathol 2020; 15:51. [PMID: 32393283 PMCID: PMC7216650 DOI: 10.1186/s13000-020-00937-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background/objective Acral and cutaneous melanomas are usually difficult to accurately diagnose in the early stage, owing to the similarity in clinical manifestations and morphology with those of dysplastic nevus (DN). In this study, we aimed to evaluate the diagnostic value of four-color fluorescence in-situ hybridization (FISH) probes specific to the RREB1,CCND1,and MYB genes, and centromere of chromosome 6, in distinguishing DN and melanoma. Methods Fifty one DN and 58 melanoma cases were collected and tested with four-color FISH. Histological features were reviewed and concordant morphologic diagnosis by three pathologists was considered the golden criterion. Results Fifty DN and 59 melanoma cases, with 37 melanomas in situ and 22 melanomas in Clark level 2, were confirmed finally; among them, 42 (71.2%) cases were acral. A comparison of clinicopathological features between the two entities showed that several features were considerably more frequently observed in the melanoma group, including more mitotic figures, stratum corneum pigmentation, lymphocyte infiltration, cell atypia, successive or pagetoid melanocyte growth pattern in the epidermis, larger tumor size, and older age at diagnosis. FISH was positive in 3 (6.0%) DN and 56 (94.9%) melanoma cases according to Gerami’s criteria. In distinguishing the two groups, the sensitivity of the four-color FISH was 94.9% and specificity was 94.0%.We found that CCND1 gain was the most sensitive, either in Gerami’s or Gaiser’s criteria. Further analysis showed that CCND1gain was more obvious in the acral group of melanoma. Conclusions We conclude that the four-color FISH test was highly sensitive and specific in distinguishing early-stage acral and cutaneous melanomas from dysplastic nevus in Chinese population, and the most sensitive criterion was the gain of CCND1.
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Affiliation(s)
- Yumei Lai
- Department of Pathology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, 100142, People's Republic of China
| | - Yan Wu
- Department of Pathology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, 100142, People's Republic of China
| | - Ruping Liu
- Beijing Institute of Graphic Communication, Beijing, 102600, People's Republic of China
| | - Aiping Lu
- Department of Pathology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, 100142, People's Republic of China
| | - Lixin Zhou
- Department of Pathology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, 100142, People's Republic of China
| | - Lin Jia
- Department of Pathology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, 100142, People's Republic of China
| | - Xinting Diao
- Department of Pathology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, 100142, People's Republic of China
| | - Zhongwu Li
- Department of Pathology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, 100142, People's Republic of China.
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Ogawa K, Kobayashi N, Miyagawa F, Nakai T, Fukumoto T, Mitsui Y, Arai E, Asada H. Case of nodal nevus with melanocytic cell aggregates in the lymphatic hilum: A potential diagnostic pitfall that requires differentiation from metastatic melanoma of the lymph node. J Dermatol 2020; 47:e242-e244. [PMID: 32201978 DOI: 10.1111/1346-8138.15325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kohei Ogawa
- Department of Dermatology, School of Medicine, Nara Medical University, Kashihara, Japan
| | - Nobuhiko Kobayashi
- Department of Dermatology, School of Medicine, Nara Medical University, Kashihara, Japan
| | - Fumi Miyagawa
- Department of Dermatology, School of Medicine, Nara Medical University, Kashihara, Japan
| | - Tokiko Nakai
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Takaya Fukumoto
- Department of Dermatology, School of Medicine, Nara Medical University, Kashihara, Japan
| | - Yasuhiro Mitsui
- Department of Dermatology, School of Medicine, Nara Medical University, Kashihara, Japan
| | - Eiichi Arai
- Department of Diagnostic Pathology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hideo Asada
- Department of Dermatology, School of Medicine, Nara Medical University, Kashihara, Japan
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14
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Abstract
CONTEXT.— The steady rise in the incidence of cutaneous malignant melanoma and its inherently difficult-to-interpret histopathology continues to fuel an increasing demand for diagnostically and prognostically insightful adjunctive molecular tests among both clinicians and dermatopathologists. A number of DNA, RNA, and epigenetically based assays have now been developed and are at various stages of experimental and/or clinical use. OBJECTIVE.— To examine the evidence for the utility and limitations of these leading candidates for the diagnosis and risk stratification of melanoma and related melanocytic neoplasms. DATA SOURCES.— The available English medical literature was reviewed in the preparation of this manuscript. CONCLUSIONS.— Comparative genomic hybridization, fluorescence in situ hybridization, RNA-based gene expression profiling, and immunohistochemical assays for novel genetic and epigenetic markers will help bring diagnostic and prognostic accuracy to the assessment of melanocytic neoplasms.
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Affiliation(s)
- Jonathan J Lee
- From the Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Lee); and the Program in Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Drs Lee and Lian)
| | - Christine G Lian
- From the Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Lee); and the Program in Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Drs Lee and Lian)
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15
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Ko JS, Clarke LE, Minca EC, Brown K, Flake DD, Billings SD. Correlation of melanoma gene expression score with clinical outcomes on a series of melanocytic lesions. Hum Pathol 2019; 86:213-221. [DOI: 10.1016/j.humpath.2018.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/30/2018] [Accepted: 12/07/2018] [Indexed: 01/06/2023]
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Comparison of melanoma gene expression score with histopathology, fluorescence in situ hybridization, and SNP array for the classification of melanocytic neoplasms. Mod Pathol 2018; 31:1733-1743. [PMID: 29955141 PMCID: PMC6631355 DOI: 10.1038/s41379-018-0087-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/03/2018] [Accepted: 05/13/2018] [Indexed: 12/12/2022]
Abstract
While most melanomas can be distinguished from nevi by histopathology, the histology is ambiguous for some melanocytic tumors, contributing to diagnostic uncertainty. Therefore molecular assays, including FISH or SNP array, and more recently a gene expression test (myPath, Myriad Genetics) have been proposed to aid in the work-up of ambiguous tumors. Two hundred and sixty-eight prospectively submitted cases were gathered, with the goal of comparing the myPath assay to morphologic diagnosis in (1) morphologically unequivocal cases (198), and to morphologic diagnosis and FISH in (2) morphologically ambiguous cases (70). Melanoma FISH was performed using probes for 6p25, 6q23, 11q13, Cep6, 9p21, and Cep9 and scored according to established criteria. The myPath assay was scored by the manufacturer as benign, indeterminate, or malignant. In the unequivocal group, myPath assay showed 75% agreement with morphologic diagnosis, with 67% sensitivity and 81% specificity. In the ambiguous group, FISH and myPath showed 69% inter-test agreement. For these cases agreement with histopathologic interpretation was 84% for FISH and 74% for myPath. Sensitivity and specificity of FISH was 61 and 100%, 50 and 93% for myPath, respectively. Cases from both groups in which myPath was discordant with either morphologic diagnosis and/or FISH (81/268 cases), were submitted for evaluation by two experienced dermatopathologist and also by SNP-array. SNP-array results correlated better than FISH, which correlated better than myPath, with the morphologic interpretation. Our findings document that molecular diagnostics show good correlation with consensus diagnoses, but discordant results occur, and vary in level of correlation with consensus interpretations. Studies with long-term outcomes data within specific ambiguous lesion subsets are required to establish the accuracy of this test, as each molecular diagnostic technique has limitations based on both lack of clinical outcomes data in ambiguous melanocytic tumors and in terms of their sensitivity and specificity in melanocytic lesion subtypes.
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Emanuel PO, Andea AA, Vidal CI, Missall TA, Novoa RA, Bohlke AK, Hughes SR, Hurley MY, Kim J. Evidence behind the use of molecular tests in melanocytic lesions and practice patterns of these tests by dermatopathologists. J Cutan Pathol 2018; 45:839-846. [DOI: 10.1111/cup.13327] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 06/24/2018] [Accepted: 07/05/2018] [Indexed: 12/21/2022]
Affiliation(s)
| | - Aleodor A. Andea
- Departments of Dermatology and Pathology; University of Michigan Medical Center; Ann Arbor Michigan
| | - Claudia I. Vidal
- Departments of Dermatology and Pathology; Saint Louis University School of Medicine; St. Louis Missouri
| | - Tricia A. Missall
- Departments of Dermatology and Pathology; Saint Louis University School of Medicine; St. Louis Missouri
| | - Roberto A. Novoa
- Departments of Dermatology and Pathology; Stanford University School of Medicine; Stanford California
| | | | - Sarah R. Hughes
- Department of Pathology; Gundersen Health System; La Crosse Wisconsin
| | - Maria Y. Hurley
- Departments of Dermatology and Pathology; Saint Louis University School of Medicine; St. Louis Missouri
| | - Jinah Kim
- Departments of Dermatology and Pathology; Stanford University School of Medicine; Stanford California
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18
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Sclerosing Melanocytic Lesions (sclerosing Melanomas with Nevoid Features and Sclerosing Nevi with Pseudomelanomatous Features) - An Analysis of 90 Lesions. Radiol Oncol 2018; 52:220-228. [PMID: 30018527 PMCID: PMC6043882 DOI: 10.2478/raon-2018-0003] [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: 10/17/2017] [Accepted: 12/20/2017] [Indexed: 11/21/2022] Open
Abstract
Background Sclerosing melanocytic lesions, which are characterized by either focal or diffuse sclerosis in the dermal component and atypical proliferation of predominantly nevoid melanocytes, remain poorly defined. Our aim was to analyze systematically their morphologic spectrum, especially the distinction between sclerosing melanocytic nevus and sclerosing melanoma, which has not been well documented. Patients and methods We collected 90 sclerosing melanocytic lesions, occurring in 82 patients (49 male, 33 female; age range from 21 to 89 years). A four probe fluorescent in situ hybridization (FISH) assay was performed in 41 lesions to substantiate the diagnosis of sclerosing melanomas. Results A prominent full-thickness pagetoid spread of melanocytes was identified in 44 (48%) lesions, and a melanoma in situ adjacent to the sclerosis in 55 (61%) lesions. In the intrasclerotic component, maturation was absent in 40 (44%) and mitotic figures were identified in 18 (20%) lesions. Of the 90 lesions, 26 (29%) were diagnosed morphologically as nevi and 64 (71%) as melanomas (Breslow thickness from 0.4 to 1.8 mm), including 45 (50%) melanomas with an adjacent nevus. A four-probe FISH assay was positive in the sclerotic component in 14 of 25 lesions diagnosed morphologically as melanomas and none of 16 nevi. A sentinel lymph node biopsy was performed for 17 lesions and was negative in all cases. Conclusions Sclerosing melanocytic lesions form a morphologic spectrum and include both nevi and melanomas. The pathogenesis of sclerosis remains obscure but seems to be induced by melanocytes or an unusual host response in at least a subset of lesions.
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Review of diagnostic, prognostic, and predictive biomarkers in melanoma. Clin Exp Metastasis 2018; 35:487-493. [PMID: 29722000 DOI: 10.1007/s10585-018-9892-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/16/2018] [Indexed: 12/28/2022]
Abstract
Melanoma is an aggressive cutaneous malignancy with rapidly rising incidence. Diagnosis of controversial melanocytic lesions, correct prognostication of patients, selection of appropriate adjuvant and systemic therapies, and prediction of response to a given therapy remain very real challenges. Despite these challenges, multiple high throughput, nucleic-acid based biomarkers have been developed that can be assayed from histologic tissue specimens. FISH, CGH, Decision-Dx, and other multi-marker assays have been combined to improve overall predictability. This review discusses some of the most promising nucleic acid based assays that can be obtained from tissue specimens to assist with diagnosis, prognostication, and prediction of treatment response.
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20
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Reevaluation of established and new criteria in differential diagnosis of Spitz nevus and melanoma. Arch Dermatol Res 2018; 310:329-342. [DOI: 10.1007/s00403-018-1818-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/24/2017] [Accepted: 01/23/2018] [Indexed: 12/24/2022]
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21
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Fluorescence in situ hybridisation as an ancillary tool in the diagnosis of acral melanoma: a review of 44 cases. Pathology 2017; 49:740-749. [DOI: 10.1016/j.pathol.2017.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 08/05/2017] [Accepted: 08/14/2017] [Indexed: 12/19/2022]
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22
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Winkelmann RR, Farberg AS, Glazer AM, Cockerell CJ, Sober AJ, Siegel DM, Leachman SA, High WA, Markowitz O, Berman B, Pariser DM, Goldenberg G, Rosen T, Rigel DS. Integrating Skin Cancer–Related Technologies into Clinical Practice. Dermatol Clin 2017; 35:565-576. [DOI: 10.1016/j.det.2017.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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23
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24
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Leachman SA, Mengden Koon S, Korcheva VB, White KP. Assessing Genetic Expression Profiles in Melanoma Diagnosis. Dermatol Clin 2017; 35:537-544. [PMID: 28886810 DOI: 10.1016/j.det.2017.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Most melanocytic tumors can be characterized as a benign nevus or a melanoma by a trained pathologist using traditional histopathological methods. However, a minority demonstrates ambiguous features and continues to be a diagnostic challenge. Genetic expression profiling (GEP) assays have been developed in an effort to resolve this dilemma. These assays measure mRNA levels of specified genes using reverse transcription quantitative polymerase chain reaction technology. The development of GEP assays, methodology, challenges associated with GEP validation and testing, and the suitability of a currently available GEP test for clinical use are reviewed.
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Affiliation(s)
- Sancy A Leachman
- Melanoma and Skin Cancer Program, Department of Dermatology, OHSU Knight Cancer Institute, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, OR 97239, USA.
| | - Stephanie Mengden Koon
- Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, OR 97239, USA
| | - Veselina B Korcheva
- Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, OR 97239, USA
| | - Kevin P White
- Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, OR 97239, USA
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25
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Kraft S, Moore JB, Muzikansky A, Scott KL, Duncan LM. Differential UBE2C and HOXA1 expression in melanocytic nevi and melanoma. J Cutan Pathol 2017; 44:843-850. [DOI: 10.1111/cup.12997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 06/16/2017] [Accepted: 06/22/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Stefan Kraft
- Pathology Service and Dermatopathology Unit; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Johanna B. Moore
- Pathology Service and Dermatopathology Unit; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
- Department of Dermatopathology; Western Pathology Inc; San Luis Obispo California
| | - Alona Muzikansky
- Biostatistics Center; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Kenneth L. Scott
- Department of Molecular and Human Genetics; Baylor College of Medicine; Houston Texas
| | - Lyn M. Duncan
- Pathology Service and Dermatopathology Unit; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
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26
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Ko JS, Matharoo-Ball B, Billings SD, Thomson BJ, Tang JY, Sarin KY, Cai E, Kim J, Rock C, Kimbrell HZ, Flake DD, Warf MB, Nelson J, Davis T, Miller C, Rushton K, Hartman AR, Wenstrup RJ, Clarke LE. Diagnostic Distinction of Malignant Melanoma and Benign Nevi by a Gene Expression Signature and Correlation to Clinical Outcomes. Cancer Epidemiol Biomarkers Prev 2017; 26:1107-1113. [DOI: 10.1158/1055-9965.epi-16-0958] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 11/18/2016] [Accepted: 03/09/2017] [Indexed: 11/16/2022] Open
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Weissinger SE, Frick M, Möller P, Horst BA, Lennerz JK. Performance Testing of RREB1, MYB, and CCND1 Fluorescence In Situ Hybridization in Spindle-Cell and Desmoplastic Melanoma Argues for a Two-Step Test Algorithm. Int J Surg Pathol 2017; 25:148-157. [PMID: 27899693 DOI: 10.1177/1066896916680072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diagnostic confirmation of spindle-cell melanoma (SM) or desmoplastic melanoma (DM) as a melanoma can be challenging. In conventional melanoma (CM), a recently established fluorescence in situ hybridization (FISH) assay for RREB1, MYB, CCND1 can be helpful. Here, we determined the presence of RREB1, MYB, and CCND1 abnormalities in an SM/DM/mixed cohort. METHODS We assembled 49 cases and performed 3 separate hybridizations for RREB1/MYB/CCND1. We assessed clinical utility in diagnostically challenging cases and performed a cost and turnaround time analysis. RESULTS With regard to the diagnosis of melanoma, the FISH assay is 76% sensitive (n = 31/41 true positives melanomas) and 88% specific (n = 1/8 false positive desmoplastic nevi). The prevalence of abnormalities in DM is lower (12/19 cases, 63%; P = .03) than in SM (15/18 cases, 83%; P = .27), mixed (4 of 4 cases), or the reported sensitivity in CM (345/411 cases, 84%). The implied genetic differences in DM result in a higher false negative rate in DM (37%). Despite these limitations, when restricted to diagnostically challenging cases (n = 23), the FISH assay and, in particular, RREB1 was able to confirm melanoma in 70% (n = 16/23). Individual probe sensitivities ( RREB1 > MYB > CCND1) and a cost and turnaround time analysis argues for a 2-step test algorithm that reduces the economic impact of FISH testing considerably (~55%; n = 69 vs 123 hybridizations). CONCLUSION We propose a step-by-step genetic testing algorithm to support the diagnosis of melanoma in the setting of SM/DM and show that FISH testing is useful in diagnostically challenging cases.
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Affiliation(s)
| | | | | | - Basil A Horst
- 2 Columbia University Medical Center, New York, NY, USA
| | - Jochen K Lennerz
- 1 University of Ulm, Ulm, Germany
- 3 Massachusetts General Hospital/Harvard Medical, Boston, MA, USA
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28
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Clarke LE, Flake DD, Busam K, Cockerell C, Helm K, McNiff J, Reed J, Tschen J, Kim J, Barnhill R, Elenitsas R, Prieto VG, Nelson J, Kimbrell H, Kolquist KA, Brown KL, Warf MB, Roa BB, Wenstrup RJ. An independent validation of a gene expression signature to differentiate malignant melanoma from benign melanocytic nevi. Cancer 2017; 123:617-628. [PMID: 27768230 PMCID: PMC5324582 DOI: 10.1002/cncr.30385] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/22/2016] [Accepted: 09/19/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Recently, a 23-gene signature was developed to produce a melanoma diagnostic score capable of differentiating malignant and benign melanocytic lesions. The primary objective of this study was to independently assess the ability of the gene signature to differentiate melanoma from benign nevi in clinically relevant lesions. METHODS A set of 1400 melanocytic lesions was selected from samples prospectively submitted for gene expression testing at a clinical laboratory. Each sample was tested and subjected to an independent histopathologic evaluation by 3 experienced dermatopathologists. A primary diagnosis (benign or malignant) was assigned to each sample, and diagnostic concordance among the 3 dermatopathologists was required for inclusion in analyses. The sensitivity and specificity of the score in differentiating benign and malignant melanocytic lesions were calculated to assess the association between the score and the pathologic diagnosis. RESULTS The gene expression signature differentiated benign nevi from malignant melanoma with a sensitivity of 91.5% and a specificity of 92.5%. CONCLUSIONS These results reflect the performance of the gene signature in a diverse array of samples encountered in routine clinical practice. Cancer 2017;123:617-628. © 2016 American Cancer Society.
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Affiliation(s)
| | | | - Klaus Busam
- Memorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Clay Cockerell
- The University of Texas Southwestern Medical CenterDallasTexas
| | - Klaus Helm
- Penn State Hershey DermatologyHersheyPennsylvania
| | | | - Jon Reed
- CellNetix Pathology and Laboratories LLCSeattleWashington
| | | | - Jinah Kim
- Department of PathologyStanford School of MedicineStanfordCalifornia
| | - Raymond Barnhill
- Department of PathologyUniversity of California Los AngelesLos AngelesCalifornia
| | - Rosalie Elenitsas
- Department of DermatologyUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Victor G. Prieto
- Department of PathologyThe University of Texas MD Anderson Cancer CenterHoustonTexas
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Mahas A, Potluri K, Kent MN, Naik S, Markey M. Copy number variation in archival melanoma biopsies versus benign melanocytic lesions. Cancer Biomark 2017; 16:575-97. [PMID: 27002761 DOI: 10.3233/cbm-160600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Skin melanocytes can give rise to benign and malignant neoplasms. Discrimination of an early melanoma from an unusual/atypical benign nevus can represent a significant challenge. However, previous studies have shown that in contrast to benign nevi, melanoma demonstrates pervasive chromosomal aberrations. OBJECTIVE This substantial difference between melanoma and benign nevi can be exploited to discriminate between melanoma and benign nevi. METHODS Array-comparative genomic hybridization (aCGH) is an approach that can be used on DNA extracted from formalin-fixed paraffin-embedded (FFPE) tissues to assess the entire genome for the presence of changes in DNA copy number. In this study, high resolution, genome-wide single-nucleotide polymorphism (SNP) arrays were utilized to perform comprehensive and detailed analyses of recurrent copy number aberrations in 41 melanoma samples in comparison with 21 benign nevi. RESULTS We found statistically significant copy number gains and losses within melanoma samples. Some of the identified aberrations are previously implicated in melanoma. Moreover, novel regions of copy number alterations were identified, revealing new candidate genes potentially involved in melanoma pathogenesis. CONCLUSIONS Taken together, these findings can help improve melanoma diagnosis and introduce novel melanoma therapeutic targets.
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Affiliation(s)
- Ahmed Mahas
- Department of Biochemistry and Molecular Biology, Wright State University, Dayton, OH, USA
| | - Keerti Potluri
- Department of Biochemistry and Molecular Biology, Wright State University, Dayton, OH, USA
| | - Michael N Kent
- Department of Dermatology, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.,Dermatopathology Laboratory of Central States, Dayton, OH, USA
| | - Sameep Naik
- Dermatopathology Laboratory of Central States, Dayton, OH, USA
| | - Michael Markey
- Department of Biochemistry and Molecular Biology, Wright State University, Dayton, OH, USA
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Use of New Techniques in Addition to IHC Applied to the Diagnosis of Melanocytic Lesions, With Emphasis on CGH, FISH, and Mass Spectrometry. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:17-30. [DOI: 10.1016/j.ad.2016.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/03/2016] [Accepted: 05/09/2016] [Indexed: 02/08/2023] Open
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31
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Nagarajan P, Tetzlaff M, Curry J, Prieto V. Use of New Techniques in Addition to IHC Applied to the Diagnosis of Melanocytic Lesions, With Emphasis on CGH, FISH, and Mass Spectrometry. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2016.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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32
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The correlation of the standard 5 probe FISH assay with melanocytic tumors of uncertain malignant potential. Ann Diagn Pathol 2016. [PMID: 28648937 DOI: 10.1016/j.anndiagpath.2016.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND FISH has recently emerged as a technique to better assess the malignant potential of histologically ambiguous melanocytic lesions. However, the usefulness of FISH has not been conclusively established. The purpose of this study was to further explore the diagnostic value of FISH in distinguishing the borderline melanocytic tumor (BMT) from melanoma. METHOD 73 cases with BMT were analyzed retrospectively from a dermatopathology database between 2010-2015. FISH studies were conducted in each case using probes targeting 5 loci including CCND1 on 11q13, RREB1 on 6p25, MYB on 6q23, CDKN2A on 9p21, and CEP 6 control probe for chromosome 6. RESULTS The study was composed of 50 females and 23 males with an age range of 1-73 and a mean age of 35years. Of the 6 cases in the superficial atypical Spitz tumor (AST) category, 2 had indeterminate results due to polyploidy. In the conventional atypical Spitz tumor cases, FISH was positive in 3 of 15 cases. Of the 27 cases in the borderline nevoid tumor (BNM) category, 3 showed positive FISH and 3 were equivocal due to the possibility of polyploidy. 3 of 13 cases of the borderline tumor of deep penetrating nevus variant (B-DPN) were positive for FISH. Neither of the 2 pigmented epithelioid melanocytoma (PEM) cases had positive FISH result. Of the 4 cases in the superficial atypical dermoepidermal nevomelanocytic proliferation group, only 1 met the FISH diagnostic criteria for melanoma. None of the 6 borderline tumors with overlapping features met FISH criteria diagnostic of melanoma. Clinical follow up was available on 55 patients. None of the patients had recurrence nor died of the disease. Lymph node biopsy was performed on five patients without evidence of metastasis. CONCLUSION Despite the benefits of FISH, it is limited by the fact that melanomas are not genetically identical whereby certain genetic abnormalities are only seen in specific subtypes. Additionally, FISH only targets specific chromosomes resulting in limitations in sensitivity and specificity. Although FISH has proven to be highly sensitive and specific in distinguishing unequivocally benign from malignant lesions, in cases of histopathological ambiguity, these parameters cannot be assessed with great confidence because the histopathological diagnosis (gold standard) is not without uncertainty. The 4-probe set (excluding 9p21) consistently showed chromosomal aberrations throughout all groups, but only 10 of the 73 total cases (13%) met the diagnostic criteria for melanoma. Moreover, it would be wise to establish new cytogenetic reference values that incorporate these borderline lesions in an effort to better assess the possibility of malignant behavior and or define a cytogenetic profile supportive of its categorization as an indeterminate proliferation. Polyploidy is another inherent limitation, which leads to false positives due to the absolute signal counts incorrectly reflecting relative imbalances in the tumor genome.
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Davis J, Patil J, Aydin N, Mishra A, Misra S. Capsular nevus versus metastatic malignant melanoma - a diagnostic dilemma. Int J Surg Case Rep 2016; 29:20-24. [PMID: 27810606 PMCID: PMC5094157 DOI: 10.1016/j.ijscr.2016.10.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/14/2016] [Accepted: 10/15/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION A positive finding of metastatic melanoma in a sentinel lymph node is an ominous sign and a strong predictor of overall survival. In contrast, current data trends have shown that patients with benign nevus cells in the sentinel nodes do not require additional therapy since their prognosis has been shown to be similar to that of patients with negative lymph nodes. Distinguishing between benign capsular nevi and metastatic melanoma often proves to be diagnostically problematic. CASE PRESENTATION In this case report we present two cases of melanoma in which sentinel lymph node biopsies proved to be difficult in distinguishing metastatic melanocytes from capsular nevus cells. In both cases, further workup was necessary for accurate diagnoses. DISCUSSION A lack of standardized distinctions of benign nevus cell from melanoma pose a diagnostic pitfall. Assigning a diagnosis of malignant melanoma might seem like the safer approach to avoid a false negative, but the resultant treatment, including the possibility of additional surgical complications, may cause anxiety, discomfort, and financial instability for the patient. Current methods of distinguishing the two based solely on histology may be insufficient due to similar pathologic patterns. CONCLUSION To avoid misdiagnosing a patient and performing unnecessary therapy, it would be beneficial to get a second opinion by additional histopathologists at a high volume center. Additionally, immunohistochemical staining should be carefully employed due to some overlap in commonly used markers. Using tissue morphology in conjunction with immunohistochemical staining may be the best way to make the most accurate diagnosis.
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Affiliation(s)
- Justin Davis
- Texas Tech Health Sciences Center, Amarillo, TX, United States
| | | | - Nail Aydin
- Texas Tech Health Sciences Center, Amarillo, TX, United States
| | | | - Subhasis Misra
- Texas Tech Health Sciences Center, Amarillo, TX, United States.
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Minca EC, Al-Rohil RN, Wang M, Harms PW, Ko JS, Collie AM, Kovalyshyn I, Prieto VG, Tetzlaff MT, Billings SD, Andea AA. Comparison between melanoma gene expression score and fluorescence in situ hybridization for the classification of melanocytic lesions. Mod Pathol 2016; 29:832-43. [PMID: 27174586 DOI: 10.1038/modpathol.2016.84] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 11/09/2022]
Abstract
Melanoma accounts for most skin cancer-related deaths and has an increasing incidence. Accurate diagnosis and distinction from atypical nevi can be at times difficult using light microscopy alone. Fluorescence in situ hybridization (FISH) and melanoma gene expression score (myPath, Myriad Genetics) have emerged as ancillary tools to further aid in this differential diagnosis. Our aim in this study was to correlate FISH results, gene expression score, consensus histopathologic impression and clinical outcome on a series of 117 challenging melanocytic lesions collected from three separate institutions. The lesions were separated into two groups: 39 histopathologically unequivocal lesions (15 malignant, 24 benign) and 78 challenging lesions interpreted by expert consensus (27 favor malignant, 30 favor benign, and 21 ambiguous). Melanoma-FISH was performed using probes for 6p25, 11q13, 8q24, and 9p21/CEP9 and scored according to established criteria. Analysis by myPath gene expression score was performed and interpreted by the manufacturer as 'benign', 'indeterminate,' or 'malignant'. In the unequivocal group, melanoma-FISH and myPath score showed 97 and 83% agreement with the histopathologic diagnosis, respectively, with 93 and 62% sensitivity, 100 and 95% specificity, and 80% inter-test agreement. In the challenging group, FISH and the myPath score showed 70 and 64% agreement with the histopathologic interpretation, respectively, with 70% inter-test agreement and similar sensitivities and specificities. The inter-test agreement was 73% overall, excluding indeterminate results. Discordant test results occurred in 27/117 cases from both unequivocal and challenging groups. Melanoma-FISH and gene expression score are valuable ancillary tools, though both have limitations and return discordant results in a subset of cases. Follow-up studies with more extensive clinical outcome data are warranted to establish the accuracy of these tests for the classification of melanocytic lesions.
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Affiliation(s)
- Eugen C Minca
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.,Department of Dermatology, Cleveland Clinic, Cleveland, OH, USA
| | - Rami N Al-Rohil
- Department of Pathology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Min Wang
- Department of Pathology, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Paul W Harms
- Department of Pathology, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Jennifer S Ko
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.,Department of Dermatology, Cleveland Clinic, Cleveland, OH, USA
| | - Angela M Collie
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.,Department of Dermatology, Cleveland Clinic, Cleveland, OH, USA
| | - Ivanka Kovalyshyn
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.,Department of Dermatology, Cleveland Clinic, Cleveland, OH, USA
| | - Victor G Prieto
- Department of Pathology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.,Department of Dermatology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Michael T Tetzlaff
- Department of Pathology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.,Department of Tanslational and Molecular Pathology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Steven D Billings
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.,Department of Dermatology, Cleveland Clinic, Cleveland, OH, USA
| | - Aleodor A Andea
- Department of Pathology, University of Michigan Medical Center, Ann Arbor, MI, USA
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Latchana N, del Campo SEM, Grignol VP, Clark JR, Albert SP, Zhang J, Wei L, Aldrink JH, Nicol KK, Ranalli MA, Peters SB, Gru A, Trihka P, Payne PRO, Howard JH, Carson WE. Classification of Indeterminate Melanocytic Lesions by MicroRNA Profiling. Ann Surg Oncol 2016; 24:347-354. [DOI: 10.1245/s10434-016-5476-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Indexed: 11/18/2022]
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Latchana N, Regan K, Howard JH, Aldrink JH, Ranalli MA, Peters SB, Zhang X, Gru A, Payne PRO, Suarez-Kelly LP, Carson WE. Global microRNA profiling for diagnostic appraisal of melanocytic Spitz tumors. J Surg Res 2016; 205:350-358. [PMID: 27664883 DOI: 10.1016/j.jss.2016.06.085] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/27/2016] [Accepted: 06/26/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Melanoma skin cancer remains the leading cause of skin cancer-related deaths. Spitz lesions represent a subset of melanocytic skin lesions characterized by epithelioid or spindled melanocytes organized in nests. These lesions occupy a spectrum ranging from benign Spitz and atypical Spitz lesions all the way to malignant Spitz tumors. Appropriate management is reliant on accurate diagnostic classification, yet this effort remains challenging using current light microscopic techniques. The discovery of novel biomarkers such as microRNAs (miR) may ultimately be a useful diagnostic adjunct for the evaluation of Spitz lesions. miR expression profiles have been suggested for non-Spitz melanomas but have yet to be ascribed to Spitz lesions. We hypothesized that distinct miR expression profiles would be associated with different lesions along the Spitz spectrum. MATERIALS AND METHODS RNAs extracted from paraffin-embedded, formalin-fixed tissues of 11 resected skin lesions including benign nevi (n = 2), benign Spitz lesions (n = 3), atypical Spitz lesions (n = 3), and malignant Spitz tumors (n = 3) were analyzed by the NanoString platform for simultaneous evaluation of over 800 miRs in each patient sample. RESULTS Benign Spitz lesions had increased expression of miR-21-5p and miR-363-3p compared with those of benign nevi. Malignant Spitz lesions exhibited overexpression of miR-21-5p, miR-155-5p, and miR-1283 relative to both benign nevi and benign Spitz tumors. Notably, atypical Spitz tumors had increased expression of miR-451a and decreased expression of miR-155-5p expression relative to malignant Spitz lesions. Conversely, atypical Spitz lesions had increased expression of miR-21-5p, miR-34a-5p, miR-451a, miR-1283, and miR-1260a relative to benign Spitz tumors. CONCLUSIONS Overall, distinct miR profiles are suggested among Spitz lesions of varying malignant potential with some similarities to non-Spitz melanoma tumors. This work demonstrates the feasibility of this analytic method and forms the basis for further validation studies.
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Affiliation(s)
- Nicholas Latchana
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
| | - Kelly Regan
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH
| | - J Harrison Howard
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
| | - Jennifer H Aldrink
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Mark A Ranalli
- Department of Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH
| | - Sara B Peters
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Xiaoli Zhang
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Alejandro Gru
- Department of Pathology, University of Virgina, Charlottesville, VA
| | - Philip R O Payne
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH
| | - Lorena P Suarez-Kelly
- Department of Molecular Virology, Immunology and Medical Genetics, The Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - William E Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH.,Department of Molecular Virology, Immunology and Medical Genetics, The Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
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Cho-Vega JH. A diagnostic algorithm for atypical spitzoid tumors: guidelines for immunohistochemical and molecular assessment. Mod Pathol 2016; 29:656-70. [PMID: 27102343 DOI: 10.1038/modpathol.2016.70] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 02/28/2016] [Accepted: 03/06/2016] [Indexed: 11/09/2022]
Abstract
Atypical spitzoid tumors are a morphologically diverse group of rare melanocytic lesions most frequently seen in children and young adults. As atypical spitzoid tumors bear striking resemblance to Spitz nevus and spitzoid melanomas clinically and histopathologically, it is crucial to determine its malignant potential and predict its clinical behavior. To date, many researchers have attempted to differentiate atypical spitzoid tumors from unequivocal melanomas based on morphological, immonohistochemical, and molecular diagnostic differences. A diagnostic algorithm is proposed here to assess the malignant potential of atypical spitzoid tumors by using a combination of immunohistochemical and cytogenetic/molecular tests. Together with classical morphological evaluation, this algorithm includes a set of immunohistochemistry assays (p16(Ink4a), a dual-color Ki67/MART-1, and HMB45), fluorescence in situ hybridization (FISH) with five probes (6p25, 8q24, 11q13, CEN9, and 9p21), and an array-based comparative genomic hybridization. This review discusses details of the algorithm, the rationale of each test used in the algorithm, and utility of this algorithm in routine dermatopathology practice. This algorithmic approach will provide a comprehensive diagnostic tool that complements conventional histological criteria and will significantly contribute to improve the diagnosis and prediction of the clinical behavior of atypical spitzoid tumors.
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Affiliation(s)
- Jeong Hee Cho-Vega
- Department of Pathology, Dermatopathology, University of Miami Miller School of Medicine, Miami, FL, USA
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Al-Rohil RN, Curry JL, Torres-Cabala CA, Nagarajan P, Ivan D, Aung PP, Lyons GF, Bassett RL, Prieto VG, Tetzlaff MT. Proliferation indices correlate with diagnosis and metastasis in diagnostically challenging melanocytic tumors. Hum Pathol 2016; 53:73-81. [DOI: 10.1016/j.humpath.2016.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/11/2016] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
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Urso C. Time to reconsider Spitzoid neoplasms? Dermatol Pract Concept 2016; 6:43-8. [PMID: 27222771 PMCID: PMC4866626 DOI: 10.5826/dpc.0602a08] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/12/2016] [Indexed: 01/10/2023] Open
Abstract
Background: Spitzoid neoplasms may pose significant diagnostic problems because in a fraction of them it is quite difficult or impossible to establish if they are benign or malignant lesions. An extraordinarily large number of studies have been made in attempts to solve this problem; regrettably, the histological criteria proposed and the various special sophisticated techniques employed have proven to be ineffective in making this distinction with confidence. Objectives: To explore the possible causes for this diagnostic failure and an attempt to identify the source of this problem. Method: A historical and technical analysis of the specialized literature is performed, critically evaluating the main points of this controversial topic. Results: The reasons for the diagnostic failure in Spitzoid neoplasms are not clear but could be the result of inappropriate conceptual representation. The analysis of available data and a rational review of old and new assumptions and concepts may suggest a different representation for Spitzoid neoplasms: Spitz nevus, atypical Spitz tumor and Spitzoid melanoma, rather than being three different tumors that are difficult or impossible to distinguish with assurance, could be viewed as one unique entity, Spitz tumor (ST). This tumor is a low-grade malignant neoplasm, in which the amount of intrinsic risk is variable, ranging from very low to high (ST1, ST2, ST3), and malignant potential could be estimated. Conclusions: The proposed alternative representation of Spitzoid neoplasms as a unique tumor may help in overcoming the difficulty in diagnosis of these tumors.
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Affiliation(s)
- Carmelo Urso
- Department of Anatomic Pathology, Dermatopathology Section, SM Annunziata Hospital, AUSL Toscana Centro, Florence, Italy
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Stefanaki C, Stefanaki K, Chardalias L, Soura E, Stratigos A. Differential diagnosis of Spitzoid melanocytic neoplasms. J Eur Acad Dermatol Venereol 2016; 30:1269-77. [DOI: 10.1111/jdv.13665] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/02/2016] [Indexed: 01/21/2023]
Affiliation(s)
- C. Stefanaki
- 1st Dermatology Clinic; ‘Andreas Sygros’ University Skin Hospital; Athens Greece
| | - K. Stefanaki
- Pathology Department; Agia Sofia Children's Hospital; Athens Greece
| | - L. Chardalias
- 1st Dermatology Clinic; ‘Andreas Sygros’ University Skin Hospital; Athens Greece
- Medical student; Kapodistriako University of Athens; Greece
| | - E. Soura
- 1st Dermatology Clinic; ‘Andreas Sygros’ University Skin Hospital; Athens Greece
| | - A. Stratigos
- 1st Dermatology Clinic; ‘Andreas Sygros’ University Skin Hospital; Athens Greece
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Metastatic melanoma in association with a giant congenital melanocytic nevus in an adult: controversial CGH findings. Am J Dermatopathol 2016; 37:487-94. [PMID: 25062263 DOI: 10.1097/dad.0000000000000152] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Giant congenital melanocytic nevi (GCMNs) represent a distress to patients for 2 reasons: one is disfigurement, and the other is the increased risk of developing secondary melanocytic tumors, such as benign proliferative nodules (BPNs) and malignant melanoma (MM). BPN present as a rapid growth nodule arising within a congenital melanocytic nevus (CMN) that often ulcerates, occurs in children younger than 2 years of age. BPNs arising within a CMN are exceedingly rare after childhood, and very few cases have been described in adults. Despite the worrisome clinical and histologic findings of BPN, most laboratory investigations seem to support their benignity. The distinction between MM and BPN is extremely important, but the histopathology of BPN of GCMN can be a challenge to differentiate from MM. In the recent years, molecular tests that investigate DNA copy number alterations such as fluorescence in situ hybridization and comparative genomic hybridization have shown promise to help guide the diagnosis of ambiguous melanocytic proliferations arising within CMNs. We report the case of a 22-year-old woman with a nodule arising in a GCMN and with an axillary mass suggesting a nodal metastasis of melanoma, and discuss the unusual clinical, histopathologic, and molecular findings that make this case particularly interesting.
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Wiesner T, Kutzner H, Cerroni L, Mihm MC, Busam KJ, Murali R. Genomic aberrations in spitzoid melanocytic tumours and their implications for diagnosis, prognosis and therapy. Pathology 2016; 48:113-31. [PMID: 27020384 DOI: 10.1016/j.pathol.2015.12.007] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 01/07/2023]
Abstract
Histopathological evaluation of melanocytic tumours usually allows reliable distinction of benign melanocytic naevi from melanoma. More difficult is the histopathological classification of Spitz tumours, a heterogeneous group of tumours composed of large epithelioid or spindle-shaped melanocytes. Spitz tumours are biologically distinct from conventional melanocytic naevi and melanoma, as exemplified by their distinct patterns of genetic aberrations. Whereas common acquired naevi and melanoma often harbour BRAF mutations, NRAS mutations, or inactivation of NF1, Spitz tumours show HRAS mutations, inactivation of BAP1 (often combined with BRAF mutations), or genomic rearrangements involving the kinases ALK, ROS1, NTRK1, BRAF, RET, and MET. In Spitz naevi, which lack significant histological atypia, all of these mitogenic driver aberrations trigger rapid cell proliferation, but after an initial growth phase, various tumour suppressive mechanisms stably block further growth. In some tumours, additional genomic aberrations may abrogate various tumour suppressive mechanisms, such as cell-cycle arrest, telomere shortening, or DNA damage response. The melanocytes then start to grow in a less organised fashion and may spread to regional lymph nodes, and are termed atypical Spitz tumours. Upon acquisition of even more aberrations, which often activate additional oncogenic pathways or alter cell differentiation, the neoplastic cells become entirely malignant and may colonise and take over distant organs (spitzoid melanoma). The sequential acquisition of genomic aberrations suggests that Spitz tumours represent a continuous biological spectrum, rather than a dichotomy of benign versus malignant, and that tumours with ambiguous histological features (atypical Spitz tumours) might be best classified as low-grade melanocytic tumours. The number of genetic aberrations usually correlates with the degree of histological atypia and explains why existing ancillary genetic techniques, such as array comparative genomic hybridisation (CGH) or fluorescence in situ hybridisation (FISH), are usually capable of accurately classifying histologically benign and malignant Spitz tumours, but are not very helpful in the diagnosis of ambiguous melanocytic lesions. Nevertheless, we expect that progress in our understanding of tumour progression will refine the classification of spitzoid melanocytic tumours in the near future. By integrating clinical, pathological, and genetic criteria, distinct tumour subsets will be defined within the heterogeneous group of Spitz tumours, which will eventually lead to improvements in diagnosis, prognosis and therapy.
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Affiliation(s)
- Thomas Wiesner
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, United States; Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria.
| | - Heinz Kutzner
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria; Dermatopathologie Friedrichshafen, Friedrichshafen, Germany
| | - Lorenzo Cerroni
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Martin C Mihm
- Melanoma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, United States
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Rajmohan Murali
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, United States; Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
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Harms KL, Lowe L, Fullen DR, Harms PW. Atypical Spitz Tumors: A Diagnostic Challenge. Arch Pathol Lab Med 2016; 139:1263-70. [PMID: 26414472 DOI: 10.5858/arpa.2015-0207-ra] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Spitzoid melanocytic lesions encompass a spectrum from benign Spitz nevi to malignant spitzoid melanomas. Spitzoid melanocytic neoplasms have significant morphologic and molecular differences from conventional melanocytic lesions, and prediction of biologic behavior and metastatic risk may be difficult. Most challenging is the atypical Spitz tumor, a borderline spitzoid melanocytic lesion of uncertain malignant potential that has overlapping histologic features with conventional Spitz nevus and spitzoid melanoma. Atypical Spitz tumors involve the sentinel lymph nodes at a greater frequency than conventional melanoma and frequently harbor chromosomal copy number changes, yet most cases follow an indolent course. Herein we review the clinical, microscopic, and molecular features of atypical Spitz tumors, including recent molecular advances, including the potential prognostic significance of chromosomal abnormalities, such as homozygous CDKN2A loss.
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Affiliation(s)
- Kelly L Harms
- From the Department of Dermatology (Drs K. L. Harms, Lowe, Fullen, and P. W. Harms), the Comprehensive Cancer Center (Dr K. L. Harms), and the Department of Dermatology and Pathology (Drs Lowe, Fullen, and P. W. Harms), University of Michigan Medical School, Ann Arbor
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Foth M, Wouters J, de Chaumont C, Dynoodt P, Gallagher WM. Prognostic and predictive biomarkers in melanoma: an update. Expert Rev Mol Diagn 2015; 16:223-37. [PMID: 26620320 DOI: 10.1586/14737159.2016.1126511] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Malignant melanoma is one of the most aggressive cancers. Several new therapeutic strategies that focus on immuno- and/or targeted therapy have been developed, which have entered clinical trials or already been approved. This review provides an update on prognostic and predictive biomarkers in melanoma that may be used to improve the clinical management of patients. Prognostic markers include conventional histopathological characteristics, chromosomal aberrations, gene expression patterns and miRNA profiles. There is a trend towards multi-marker assays and whole-genome molecular screening methods to determine the prognosis of individual patients. Predictive biomarkers, including targeted components of signal transduction, developmental or transcriptional pathways, can be used to determine patient response towards a particular treatment or combination thereof. The rapid evolution of sequencing technologies and multi-marker screening will change the spectrum of patients who become candidates for therapeutic agents, and in addition create new ethical and regulatory challenges.
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Affiliation(s)
- Mona Foth
- a OncoMark Ltd., NovaUCD, Bellfield , University College Dublin , Dublin , Ireland.,b Cancer Research UK, Beatson Institute , Glasgow , United Kingdom
| | - Jasper Wouters
- a OncoMark Ltd., NovaUCD, Bellfield , University College Dublin , Dublin , Ireland.,c Translational Cell & Tissue Research , Department of Imaging and Pathology, Katholieke Universiteit Leuven , Leuven , Belgium
| | - Ciaran de Chaumont
- a OncoMark Ltd., NovaUCD, Bellfield , University College Dublin , Dublin , Ireland.,d Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Peter Dynoodt
- a OncoMark Ltd., NovaUCD, Bellfield , University College Dublin , Dublin , Ireland
| | - William M Gallagher
- a OncoMark Ltd., NovaUCD, Bellfield , University College Dublin , Dublin , Ireland.,e UCD Cancer Biology and Therapeutics Laboratory, School of Biomolecular and Biomedical Science, Conway Institute of Biomolecular and Biomedical Research , University College Dublin , Dublin , Ireland
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March J, Hand M, Truong A, Grossman D. Practical application of new technologies for melanoma diagnosis: Part II. Molecular approaches. J Am Acad Dermatol 2015; 72:943-58; quiz 959-60. [PMID: 25980999 DOI: 10.1016/j.jaad.2015.02.1140] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/13/2015] [Accepted: 02/23/2015] [Indexed: 10/23/2022]
Abstract
The criterion standard for diagnosing cutaneous melanoma continues to be histologic examination. However, classifying some melanocytic lesions by conventional microscopy can be problematic if they exhibit some architectural or morphologic characteristics of both nevus and melanoma. Moreover, histologic appearance does not always predict biologic behavior. There is therefore a need and opportunity to develop new technologies that can facilitate the histologic diagnosis of melanoma and potentially help distinguish lesions with a lesser or greater risk of metastasis. In part II of this 2-part continuing medical education article, we will review the molecular technologies currently available for facilitating melanoma diagnosis, including comparative genomic hybridization, fluorescence in situ hybridization, and epidermal genetic retrieval. Our goal is to provide the clinician with an up to date understanding of these molecular approaches so that they can be applied to their management of challenging melanocytic lesions.
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Affiliation(s)
- Jordon March
- University of Nevada School of Medicine, Reno, Nevada
| | - Matthew Hand
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Amanda Truong
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Douglas Grossman
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah.
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Comparison of the expression of vimentin and actin in spitz nevi and spitzoid malignant melanomas. Am J Dermatopathol 2015; 37:46-51. [PMID: 25548991 DOI: 10.1097/dad.0000000000000147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The differentiation between Spitz nevi (SN) and Spitzoid malignant melanomas (SMM) represents a challenge to dermatopathologists. We recently demonstrated differential expression of vimentin and Actin in SN and SMM by mass spectrometry (MS). We sought to investigate whether this differential expression could be detected using conventional immunohistochemistry or automated quantitative analysis (AQUA) of histological sections. METHODS Cases of SN and SMM, which were previously studied by MS and have readily available blocks and enough material in the block, were selected from the Yale Spitzoid Neoplasm Repository. The cases were stained for vimentin and muscle-specific actin using standard protocols. H-scores were calculated by multiplying the percentage of cells staining and the intensity of staining. Selected cases were also studied for quantitative immunofluorescent staining using the AQUA method. RESULTS All 21 cases of SN showed strong and diffuse staining for vimentin; 19 of 21 (91%) cases had an H-score of 300 (average, 294). Similar staining results were observed in SMM; 13 of 14 (93%) cases had an H-score of 300 (average, 297). Muscle-specific actin was weakly and focally positive in 5 of 21 (24%) SN (H-score = 3.3) and 5 of 14 (39%) SMM (H-score = 3.5). The AQUA method showed no significant difference in the staining intensity of SN and SMM for both vimentin and actin. CONCLUSIONS There was no difference in the expression of vimentin and actin in SN and SMM shown by conventional immunohistochemistry or the AQUA method. This study shows that MS has much grater sensitivity in detecting the differential expression of these proteins.
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Poorman K, Borst L, Moroff S, Roy S, Labelle P, Motsinger-Reif A, Breen M. Comparative cytogenetic characterization of primary canine melanocytic lesions using array CGH and fluorescence in situ hybridization. Chromosome Res 2015; 23:171-86. [PMID: 25511566 PMCID: PMC5462112 DOI: 10.1007/s10577-014-9444-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/07/2014] [Accepted: 10/14/2014] [Indexed: 02/03/2023]
Abstract
Melanocytic lesions originating from the oral mucosa or cutaneous epithelium are common in the general dog population, with up to 100,000 diagnoses each year in the USA. Oral melanoma is the most frequent canine neoplasm of the oral cavity, exhibiting a highly aggressive course. Cutaneous melanocytomas occur frequently, but rarely develop into a malignant form. Despite the differential prognosis, it has been assumed that subtypes of melanocytic lesions represent the same disease. To address the relative paucity of information about their genomic status, molecular cytogenetic analysis was performed on the three recognized subtypes of canine melanocytic lesions. Using array comparative genomic hybridization (aCGH) analysis, highly aberrant distinct copy number status across the tumor genome for both of the malignant melanoma subtypes was revealed. The most frequent aberrations included gain of dog chromosome (CFA) 13 and 17 and loss of CFA 22. Melanocytomas possessed fewer genome wide aberrations, yet showed a recurrent gain of CFA 20q15.3-17. A distinctive copy number profile, evident only in oral melanomas, displayed a sigmoidal pattern of copy number loss followed immediately by a gain, around CFA 30q14. Moreover, when assessed by fluorescence in situ hybridization (FISH), copy number aberrations of targeted genes, such as gain of c-MYC (80 % of cases) and loss of CDKN2A (68 % of cases), were observed. This study suggests that in concordance with what is known for human melanomas, canine melanomas of the oral mucosa and cutaneous epithelium are discrete and initiated by different molecular pathways.
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Affiliation(s)
- Kelsey Poorman
- Department of Molecular Biomedical Science, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
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Abstract
Melanoma is a common cancer in the Western world with an increasing incidence. Sun exposure is still considered to be the major risk factor for melanoma. The prognosis of patients with malignant (advanced-stage) melanoma differs widely between countries, but public campaigns advocating early detection have led to significant reductions in mortality rates. As well as sun exposure, distinct genetic alterations have been identified as associated with melanoma. For example, families with melanoma who have germline mutations in CDKN2A are well known, whereas the vast majority of sporadic melanomas have mutations in the mitogen-activated protein kinase cascade, which is the pathway with the highest oncogenic and therapeutic relevance for this disease. BRAF and NRAS mutations are typically found in cutaneous melanomas, whereas KIT mutations are predominantly observed in mucosal and acral melanomas. GNAQ and GNA11 mutations prevail in uveal melanomas. Additionally, the PI3K-AKT-PTEN pathway and the immune checkpoint pathways are important. The finding that programmed cell death protein 1 ligand 1 (PDL1) and PDL2 are expressed by melanoma cells, T cells, B cells and natural killer cells led to the recent development of programmed cell death protein 1 (PD1)-specific antibodies (for example, nivolumab and pembrolizumab). Alongside other new drugs - namely, BRAF inhibitors (vemurafenib and dabrafenib) and MEK inhibitors (trametinib and cobimetinib) - these agents are very promising and have been shown to significantly improve prognosis for patients with advanced-stage metastatic disease. Early signs are apparent that these new treatment modalities are also improving long-term clinical benefit and the quality of life of patients. This Primer summarizes the current understanding of melanoma, from mechanistic insights to clinical progress. For an illustrated summary of this Primer, visit: http://go.nature.com/vX2N9s.
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Abstract
The last few years have witnessed the dawn of the molecular era in melanoma treatment. With the advent of successful therapy targeting mutant BRAF, melanoma is leading the field of cancer research in the molecular approach to therapy of advanced disease. Attempting to keep pace with advances in therapy are advances in the molecular assessment of melanoma progression, facilitated by the availability of genome-wide approaches to interrogate the malignant phenotype. At the DNA level, this has included approaches such as comparative genomic hybridization. At the RNA level, this has consisted of gene expression profiling using various assay methodologies. In certain instances, markers identified using these platforms have been further examined and developed using fluorescence in situ hybridization and immunohistochemical analysis. In this article, we will review recent progress in the development of novel molecular markers for melanoma that are nearing clinical application. We will review developments in the molecular classification of melanoma, in the molecular diagnosis of melanoma, and in the molecular assessment of melanoma prognosis.
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Affiliation(s)
- M Kashani-Sabet
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, 475 Brannan St., Suite 220, San Francisco, CA, 94107, U.S.A
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