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Ortega CA, Stevens MN, Lewis JS, Topf MC. Nasal Mucosal Desmoplastic Melanoma: A Case Report with Review of the Literature. Head Neck Pathol 2022; 16:942-946. [PMID: 35257324 PMCID: PMC9424402 DOI: 10.1007/s12105-022-01429-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 02/09/2023]
Abstract
Mucosal melanoma is a rare subtype of melanoma that accounts for 1% of all melanomas. The incidence of nasal mucosal melanomas is 0.3 per million. Desmoplastic melanomas are a subtype of melanoma with a reported incidence of 2.0 per million. Although 50% of desmoplastic melanomas are found in the head and neck region, mucosal desmoplastic melanoma is exceedingly rare. In the present study, we report a case of nasal mucosal desmoplastic melanoma and review the literature. A 79-year-old female presented to an outside otolaryngologist with nasal discomfort accompanied by rhinorrhea and was found to have a nasal vestibule mass. An endonasal incisional biopsy was performed yielding a diagnosis of a SOX-10 positive tumor. The patient was referred to our institution for further management. A blue-tinged lesion was identified at the prior biopsy site, and the mass was resected via an open rhinoplasty approach. Final pathology demonstrated an infiltrative spindle cell neoplasm with immunohistochemical patterns supportive of desmoplastic melanoma arising from the nasal vestibule. Due to positive margins, the patient underwent a re-resection with no tumor identified on the re-resected specimen. To our knowledge, this is the third case of nasal mucosal desmoplastic melanoma. We review the clinicopathologic features and management of this rare entity.
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Affiliation(s)
- Carlos A Ortega
- Vanderbilt University School of Medicine, 37212, Nashville, TN, United States
| | - Madelyn N Stevens
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, 7209 Medical Center East South Tower, 37232-8605, Nashville, TN, United States
| | - James S Lewis
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, 7209 Medical Center East South Tower, 37232-8605, Nashville, TN, United States.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, 37212, Nashville, TN, United States
| | - Michael C Topf
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, 7209 Medical Center East South Tower, 37232-8605, Nashville, TN, United States.
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Hsu EJ, Parsons D, Chiu T, Godley AR, Sher DJ, Vo DT. 3D printed integrated bolus/headrest for radiation therapy for malignancies involving the posterior scalp and neck. 3D Print Med 2022; 8:22. [PMID: 35844030 PMCID: PMC9290275 DOI: 10.1186/s41205-022-00152-w] [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: 04/19/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background Malignancies of the head and neck region, encompassing cutaneous, mucosal, and sarcomatous histologies, are complex entities to manage, comprising of coordination between surgery, radiation therapy, and systemic therapy. Malignancies of the posterior scalp are particular challenging to treat with radiation therapy, given its irregular contours and anatomy as well as the superficial location of the target volume. Bolus material is commonly used in radiation therapy to ensure that the dose to the skin and subcutaneous tissue is appropriate and adequate, accounting for the buildup effect of megavoltage photon treatment. The use of commercially available bolus material on the posterior scalp potentially creates air gaps between the bolus and posterior scalp. Case presentations In this report, we created and utilized a custom 3D-printed integrated bolus and headrest for 5 patients to irradiate malignancies involving the posterior scalp, including those with cutaneous squamous cell carcinoma, melanoma, malignant peripheral nerve sheath tumor, and dermal sarcoma. Treatment setup was consistently reproducible, and patients tolerated treatment well without any unexpected adverse effects. Conclusions We found that the use of this custom 3D-printed integrated bolus/headrest allowed for comfortable, consistent, and reproducible treatment set up while minimizing the risk of creating significant air gaps and should be considered in the radiotherapeutic management of patients with posterior scalp malignancies. Supplementary Information The online version contains supplementary material available at 10.1186/s41205-022-00152-w.
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Affiliation(s)
- Eric J Hsu
- Department of Radiation Oncology, Division of Clinical Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - David Parsons
- Department of Radiation Oncology, Division of Medical Physics and Engineering, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Tsuicheng Chiu
- Department of Radiation Oncology, Division of Medical Physics and Engineering, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Andrew R Godley
- Department of Radiation Oncology, Division of Medical Physics and Engineering, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - David J Sher
- Department of Radiation Oncology, Division of Clinical Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Dat T Vo
- Department of Radiation Oncology, Division of Clinical Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA.
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Dabestani PJ, Dawson AJ, Neumeister MW, Bradbury CM. Radiation Therapy for Local Cutaneous Melanoma. Clin Plast Surg 2021; 48:643-649. [PMID: 34503724 DOI: 10.1016/j.cps.2021.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
While primary treatment for melanoma consists of surgical resection and chemotherapeutics, radiation can be used as either definitive or adjuvant therapy in certain clinical scenarios. This chapter aims to explore the indications for primary definitive radiotherapy as well as adjuvant treatment following resection. Delivery, dose, fractionation, and toxicity of radiation treatment will be discussed. As our understanding of melanoma tumor biology increases, the role of radiotherapy may expand for more effective treatment of oligometastatic disease.
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Affiliation(s)
- Parinaz J Dabestani
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA
| | | | - Michael W Neumeister
- Southern Illinois University School of Medicine, Institute for Plastic Surgery, 747 N. Rutledge St #3, Springfield, IL 62702, USA
| | - C Matthew Bradbury
- Springfield Clinic Cancer Center and Southern Illinois University School of Medicine, 900 N. 1st Street, Springfield, IL 62702, USA
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Fan Y, Xu M, Liang Y, Wu N, Wang F, Du Q, Bai Y, Liu Y. Desmoplastic Melanoma: A Clinicopathological Analysis of Three Cases in the Chinese Population. Onco Targets Ther 2021; 14:2651-2660. [PMID: 33883908 PMCID: PMC8055249 DOI: 10.2147/ott.s295716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/25/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose To investigate the clinicopathological characteristics and immunophenotype of desmoplastic melanoma (DM) in the Chinese population. Patients and Methods We report three cases of DM diagnosed by the Pathology Department of Shanghai Dermatology Hospital. We describe the clinical and pathological characteristics of the three cases and examine molecular markers used in the diagnosis of DM. Finally, we summarize the current literature in the DM field. Results Clinically, lesions in the three DM patients were characterized by non-pigmented nodules or papules. Microscopically, we observed an abundance of fibrous interstitium mixed with spindle cells exhibiting various degrees of atypia. Occasionally, these structures exhibited changes in lentigo maligna at the epidermal junction, accompanied by the presence of lymphoid follicular structures and neurophilic behavior. Diagnosis of DM was confirmed by immunohistochemical staining, which revealed high expression levels of S-100 and SOX-10. Melanocyte markers were focally positive or negative. Unlike DMs from other populations, our three patients were negative for WT-1 and P53. All three cases received surgical resection, which is the preferred treatment for DM, and none of the patients experienced recurrence. Conclusion DM in these Chinese patients was similar to that observed in other DM populations in terms of immunophenotype and clinical and histological features. A notable absence in p53 staining was observed in the three cases reported here, suggesting that p53 negativity should not exclude the diagnosis of DM in the Chinese population.
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Affiliation(s)
- Yaqi Fan
- Department of Pathology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200050, People's Republic of China
| | - Mingyuan Xu
- Shanghai Skin Disease Hospital, Shanghai, 200443, People's Republic of China
| | - Yulin Liang
- Shanghai Skin Disease Hospital, Shanghai, 200443, People's Republic of China
| | - Nanhui Wu
- Shanghai Skin Disease Hospital, Shanghai, 200443, People's Republic of China
| | - Feiyan Wang
- Shanghai Skin Disease Clinical College of Anhui Medical University, Shanghai Skin Disease Hospital, Shanghai, 200443, People's Republic of China
| | - Qian Du
- Shanghai Skin Disease Hospital, Shanghai, 200443, People's Republic of China
| | - Yun Bai
- Department of Pathology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200050, People's Republic of China
| | - Yeqiang Liu
- Department of Pathology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200050, People's Republic of China
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Huayllani MT, Sisti A, Restrepo DJ, Boczar D, Cochuyt JJ, Spaulding AC, Bagaria SP, Rinker BD, Forte AJ. Desmoplastic Melanoma: Clinical Characteristics and Survival in the US Population. Cureus 2019; 11:e4931. [PMID: 31431837 PMCID: PMC6695240 DOI: 10.7759/cureus.4931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective Desmoplastic melanoma (DM) is a rare variant of invasive malignancy of the skin pigmented cells. We present a comprehensive study reporting on US demographics, disease characteristics, and survival, to contribute to the current knowledge and raise awareness of this rare disease. Materials and methods The demographics of DM patients diagnosed from January 1, 2004, to December 31, 2015, were obtained by querying the National Cancer Database. The characteristics of DM were compared with common malignant melanoma (CMM) using univariate and multivariate regression models. Five-year overall survival (OS) curves were estimated using Kaplan-Meier analyses and the Cox proportional regression model. Results Our query found 5,895 patients diagnosed with DM and 292,939 patients with CMM. DM tended to present at an older age, a more advanced stage, and with a Breslow depth greater than 4 mm at diagnosis (P<.05). The Kaplan-Meier survival analysis demonstrated a five-year OS for DM and CMM of 75% and 76%, respectively, without any statistical difference (P=.07). Cox regression analysis demonstrated that age at diagnosis and comorbidities were independent predictors of five-year OS for DM (P<.001). Conclusions Older age, advanced stage, and higher Breslow depth were found to be independent positive factors associated with DM.
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Affiliation(s)
- Maria T Huayllani
- Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Florida, Jacksonville, USA
| | - Andrea Sisti
- Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Florida, Jacksonville, USA
| | - David J Restrepo
- Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Florida, Jacksonville, USA
| | - Daniel Boczar
- Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Florida, Jacksonville, USA
| | | | | | | | - Brian D Rinker
- Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Florida, Jacksonville, USA
| | - Antonio J Forte
- Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Florida, Jacksonville, USA
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Mureb M, Benjamin C, Sen C, Spino M, Krasnozhen-Ratush O, Zagzag D, Pavlick AC, Kondziolka D. Gamma Knife Radiosurgery and Immunotherapy as Primary Treatment for a Malignant Tumor of the Cranial Base Beginning as Lentigo Maligna: A Case Report. Pract Radiat Oncol 2019; 9:e608-e612. [PMID: 31129314 DOI: 10.1016/j.prro.2019.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Monica Mureb
- Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Carolina Benjamin
- Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Chandranath Sen
- Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Marissa Spino
- Department of Pathology, New York University School of Medicine, New York, New York
| | | | - David Zagzag
- Department of Neurosurgery, New York University School of Medicine, New York, New York; Department of Pathology, New York University School of Medicine, New York, New York
| | - Anna C Pavlick
- Department of Medical Oncology, New York University School of Medicine, New York, New York
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University School of Medicine, New York, New York.
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