1
|
Alos L, Carrasco A, Teixidó C, Szumera-Ciećkiewicz A, Vicente A, Massi D, Carrera C. Melanoma on congenital melanocytic nevi. Pathol Res Pract 2024; 256:155262. [PMID: 38518732 DOI: 10.1016/j.prp.2024.155262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/24/2024]
Abstract
Among nevus-associated melanomas, which overall account for 20%-30% of all melanomas, those arising specifically in congenital melanocytic nevi are infrequent, but can be disproportionately frequent in childhood and adolescence. Congenital melanocytic nevi (CMNi) are common benign melanocytic tumors that are present at birth or become apparent in early childhood. They are classified based on the projected adult size. Small and medium-sized CMNi are frequent, whereas large/giant CMNi (over 20 cm in diameter) are rare, but can be associated with high morbidity due to marked aesthetic impairment and the risk of neurocutaneous syndrome or melanoma development. In this setting, melanomas can appear in early childhood and are very aggressive, while the risk of small-medium CMNi of developing melanoma is low and similar to non-congenital melanocytic nevi. Histologically, most melanomas on CMNi initiate their growth at the epidermal-dermal junction, but in large/giant CMNi they can develop entirely in the dermis, in deeper tissues, or in extracutaneous sites (especially in the central nervous system). Most CMNi harbour an NRAS mutation, but other genes are rarely involved, and gene translocations have recently been described. However, no prognostic implications have been associated with the CMN genotype. Melanomas developed on CMNi harbour additional molecular alterations to which the aggressive clinical course of these tumors has been attributed. This review covers the distinctive clinical and pathological aspects of melanomas on CMNi, and includes the epidemiology, etiopathogenesis, clinical and dermoscopic presentation, histological and molecular characteristics, as well as tumour behaviour.
Collapse
Affiliation(s)
- Llucia Alos
- Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; EORTC (European Organisation for Research and Treatment of Cancer) Melanoma Group
| | - Antonio Carrasco
- Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Cristina Teixidó
- Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Molecular Biology Core, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Anna Szumera-Ciećkiewicz
- EORTC (European Organisation for Research and Treatment of Cancer) Melanoma Group; Maria Sklodowska-Curie National Research Institute of Oncology, Department of Pathology, Warsaw, Poland
| | - Asunción Vicente
- Pediatric Dermatology Department, Hospital Sant Joan de Déu, Esplugues del Llobregat, Barcelona, Spain
| | - Daniela Massi
- EORTC (European Organisation for Research and Treatment of Cancer) Melanoma Group; Pathology Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristina Carrera
- University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Department of Dermatology, Hospital Clínic de Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Spain.
| |
Collapse
|
2
|
Histopathological and Immunohistochemical Features of Small to Big Satellite Nevus Uncover the Nevogenesis of Large/Giant Congenital Melanocytic Nevus. J Immunol Res 2022; 2022:9024548. [DOI: 10.1155/2022/9024548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/11/2022] [Indexed: 12/12/2022] Open
Abstract
The nevogenesis of large/giant congenital melanocytic nevus (lgCMN) is a complex biological process including several integral prenatal stages. Limited by ethical concerns, the debate of whether lgCMN develops from the epidermis to the dermis or in the opposite direction remains controversial. With the present study of the accompanying satellite nevi, we tend to support that lgCMN develops from epidermis to dermis. The satellite nevi were divided into 3 groups: big (diameter >10 mm), medium (>5 mm but ≤10 mm), and small (≤5 mm). Hematoxylin and eosin and immunohistochemical staining (SOX10, Ki67, and p16) were performed to compare the nevocyte infiltration depth as well as the positively stained rates among these satellite nevi. Compared to big satellite nevi, less deeply the nevocytes infiltrated the dermis, as well as more cells expressed SOX10 and Ki67 in the epidermis and fewer cells expressed p16 in the dermis of small satellite nevi. Additionally, two specimens were obtained from each of 4 patients who underwent serial resections of lgCMN at an average interval of 1.75 years to examine the histopathological changes. In the present study, satellite nevi of different sizes represent different stages of lgCMN from early to late, deepening our comprehension of the sequential stages of lgCMN nevogenesis. Initially, abnormal nevocytes seeded, proliferated, and spread along the epidermis. At rete ridges that protrude from the papillary dermis within the epidermis, some nevocytes formed nests and gradually penetrated into the dermis. Eventually, the nevocytes infiltrated the dermis and entered a homeostatic state. This study provides new evidence supporting the theory of epidermal-to-dermal nevogenesis in lgCMN.
Collapse
|
3
|
Cramer SF, Salgado CM, Reyes-Múgica M. The High Multiplicity of Prenatal (Congenital Type) Nevi in Adolescents and Adults. Pediatr Dev Pathol 2017; 19:409-416. [PMID: 26637069 DOI: 10.2350/15-06-1662-oa.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the absence of work on prenatal nevogenesis, it has long been necessary to define congenital melanocytic nevi by clinical detection on neonatal skin examination. They are seen in approximately 1% of newborns, with multiplicity in approximately 3% of cases. Melan-A staining of grossly normal fetal skin recently demonstrated fetal nevi, whose features validated certain traditional histologic criteria for "congenital type" nevi that may not have been detectable at birth. This suggested that many clinically acquired nevi actually formed in utero, like congenital nevi. Prenatal nevi has been suggested as a preferred synonym for "congenital type" nevi. Prenatal nevi were detected in 6 of 25 fetuses (24%), a strikingly higher incidence than congenital nevi in newborns. In this series of 354 patients with prenatal (congenital type) nevi encountered in routine practice at a community hospital, over 30% of both adolescents and adults had multiple prenatal nevi; a strikingly higher rate of multiplicity than congenital nevi in newborns. This high multiplicity may reflect origin beneath the epidermis, with many prenatal nevi working their way up to the surface of the skin decades after birth.
Collapse
Affiliation(s)
- Stewart F Cramer
- 1 Department of Pathology, Rochester General Hospital, University of Rochester School of Medicine, Rochester, NY, USA
| | - Cláudia M Salgado
- 2 Department of Pathology, University of Pittsburgh School of Medicine, and Division of Pediatric Pathology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Miguel Reyes-Múgica
- 2 Department of Pathology, University of Pittsburgh School of Medicine, and Division of Pediatric Pathology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| |
Collapse
|
4
|
Spitz Nevus Intermingling With Hemangioma, Angiomatoid Spitz Nevus, Angiotropism, and Vascular Co-option Viewed With Differing Availability Heuristics. Am J Dermatopathol 2017; 40:465-467. [PMID: 28398920 DOI: 10.1097/dad.0000000000000870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
Moy AP, Duncan LM, Kraft S. Lymphatic invasion and angiotropism in primary cutaneous melanoma. J Transl Med 2017; 97:118-129. [PMID: 27991909 DOI: 10.1038/labinvest.2016.131] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/24/2016] [Accepted: 11/08/2016] [Indexed: 12/20/2022] Open
Abstract
Access of melanoma cells to the cutaneous vasculature either via lymphatic invasion or angiotropism is a proposed mechanism for metastasis. Lymphatic invasion is believed to be a mechanism by which melanoma cells can disseminate to regional lymph nodes and to distant sites and may be predictive of adverse outcomes. Although it can be detected on hematoxylin- and eosin-stained sections, sensitivity is markedly improved by immunohistochemistry for lymphatic endothelial cells. Multiple studies have reported a significant association between the presence of lymphatic invasion and sentinel lymph node metastasis and survival. More recently, extravascular migratory metastasis has been suggested as another means by which melanoma cells can spread. Angiotropism, the histopathologic correlate of extravascular migratory metastasis, has also been associated with melanoma metastasis and disease recurrence. Although lymphatic invasion and angiotropism are not currently part of routine melanoma reporting, the detection of these attributes using ancillary immunohistochemical stains may be useful in therapeutic planning for patients with melanoma.
Collapse
Affiliation(s)
- Andrea P Moy
- Dermatopathology Unit, Pathology Service, Massachusetts General Hospital, Boston, MA, USA
| | - Lyn M Duncan
- Dermatopathology Unit, Pathology Service, Massachusetts General Hospital, Boston, MA, USA
| | - Stefan Kraft
- Dermatopathology Unit, Pathology Service, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
6
|
Cramer SF, Heller DS. Placenta Accreta and Placenta Increta: An Approach to Pathogenesis Based on the Trophoblastic Differentiation Pathway. Pediatr Dev Pathol 2016; 19:320-33. [PMID: 26492199 DOI: 10.2350/15-05-1641-oa.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Morbid adherence remains a puzzling disease. This paper suggests that normal and morbidly adherent placentation may be viewed best in terms of trophoblastic stem cells and the mutually exclusive branches of the trophoblastic differentiation pathway-villous trophoblast (VT), interstitial and endovascular nonvillous trophoblast (NVT) at the implantation site, and a positional variation in the chorion. Based on cases of hysterectomies for morbid adherence seen over 30 years at a community hospital, analyzed with routine keratin stains, with actin and trichrome stains as indicated, and with attempts at ultrasonography-pathology correlation, we present selected observations. In true accreta, the site of morbid adherence was to dilated basal plate vessels infiltrated by endovascular NVT, with scant interstitial NVT, and normal myometrium. It appeared that excess blood flow into the placenta was due to excessively deep keratin-positive endovascular NVT that spread-independently of interstitial NVT-in an angiocentric fashion in both accreta and increta. Retroplacental abnormalities were due to myometrial destruction by interstitial NVT in increta, sometimes requiring actin stains for detection; and to an admixture of markedly dilated endometrial glands and vessels in true accreta, best appreciated with keratin stains. Variations of depth and extent in increta may be due to variations in myometrial tone, and in the protease-antiprotease balance. Morbidly adherent fetal membranes are described, and the role of caesarean section scars in incretas is addressed.
Collapse
Affiliation(s)
- Stewart F Cramer
- Department of Pathology, Rochester General Hospital, University of Rochester School of Medicine, Rochester, NY 14621, USA; and Department of Pathology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Debra S Heller
- Department of Pathology, Rochester General Hospital, University of Rochester School of Medicine, Rochester, NY 14621, USA; and Department of Pathology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| |
Collapse
|
7
|
Abstract
We report on a Spitz nevus intermingling with a hemangioma in the same biopsy from the right thigh of a 10-year-old boy. The hemangioma was made of dilated vessels in superficial areas but of narrow and angulated vessels in the deep and lateral zones. The Spitz nevus was typical, showing maturation, and no worrisome cytological features. The immunohistochemical study demonstrated expression by the vascular component of CD31, CD34, factor VIII-related antigen, and Wilms tumor 1, whereas the vessels did not express D2-40 human herpes virus 8 or glucose transporter-1. The melanocytic component expressed HMB-45 (weakly and mainly in the superficial zones), Melan-A and S-100 protein. A perivascular continuous layer of pericytes expressing smooth muscle actin was also evident.
Collapse
|
8
|
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.
Collapse
|
9
|
Fernandez-Flores A, Cassarino DS. Unusual Histopathological Patterns in Melanocytic Nevi With Some Previously Undescribed Patterns. Am J Dermatopathol 2016; 38:167-85. [PMID: 26894768 DOI: 10.1097/dad.0000000000000381] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Melanocytic nevi are one of the most common diagnoses in the daily practice of any dermatopathologist. Although in the vast majority of cases the final diagnosis is not difficult, there are certain rare and unusual morphologic variations that can elicit some diagnostic problems. Although some of these variations can be considered as mere morphologic oddities, others might lead to a differential diagnosis with melanoma, or with other tumors, including epithelial or neural tumors. In the current report, we review many of these morphologic variations and discuss the main differential diagnosis, when appropriate.
Collapse
Affiliation(s)
- Angel Fernandez-Flores
- *Consultant Histopathologist, Department of Cellular Pathology, Hospital El Bierzo, Ponferrada, Spain; and †Consultant Dermatopathologist, Department of Pathology, Southern California Kaiser Permanente, Los Angeles Medical Center (LAMC), Los Angeles, CA
| | | |
Collapse
|
10
|
Wobser M, Ernestus K, Hamm H. Pädiatrische Dermatohistopathologie - Histologie von Dermatosen im Neugeborenen- und Säuglingsalter. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12651_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marion Wobser
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum Würzburg
| | - Karen Ernestus
- Institut für Pathologie; Julius-Maximilians-Universität Würzburg
| | - Henning Hamm
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum Würzburg
| |
Collapse
|
11
|
Wobser M, Ernestus K, Hamm H. Pediatric dermatohistopathology--histopathology of skin diseases in newborns and infants. J Dtsch Dermatol Ges 2015; 13:535-48. [PMID: 26018366 DOI: 10.1111/ddg.12651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 12/22/2022]
Abstract
While neonatal skin physiology has been thoroughly examined using non-invasive techniques in recent years, only few systematic studies and review articles addressing the histopathology of neonatal skin have been published thus far. In most cases, histopathological findings of dermatoses in neonatal skin do not significantly differ from those seen in adult skin. Nevertheless, a comprehensive knowledge of embryonic and fetal skin development as well as the microanatomical structure of neonatal skin can contribute to a better understanding of various dermatoses of infancy. In the first part of this review article, we present the histopathological features of such skin diseases, which, though generally rare, almost exclusively appear during the first weeks of life due to distinctive structural and functional features of neonatal skin. The second part is dedicated to classic dermatoses of infancy and their histopathological features.
Collapse
Affiliation(s)
- Marion Wobser
- Department of Dermatology, Venereology, and Allergology, Würzburg University Hospital
| | - Karen Ernestus
- Institute of Pathology, Julius Maximilian University Würzburg
| | - Henning Hamm
- Department of Dermatology, Venereology, and Allergology, Würzburg University Hospital
| |
Collapse
|
12
|
Charbel C, Fontaine RH, Kadlub N, Coulomb-L'Hermine A, Rouillé T, How-Kit A, Moguelet P, Tost J, Picard A, Aractingi S, Guégan S. Clonogenic cell subpopulations maintain congenital melanocytic nevi. J Invest Dermatol 2014; 135:824-833. [PMID: 25310409 DOI: 10.1038/jid.2014.437] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 09/23/2014] [Accepted: 09/26/2014] [Indexed: 01/09/2023]
Abstract
Large congenital melanocytic nevi (lCMN) are benign melanocytic tumors associated with an increased risk of melanoma transformation. They result predominantly from a post-zygotic somatic NRAS mutation. These lesions persist and even increase after birth proportionally to the child's growth. Therefore, we asked here whether cells with clonogenic and tumorigenic properties persisted postnatally in lCMN. Subpopulations of lCMN cells expressed stem cell/progenitor lineage markers such as Sox10, Nestin, Oct4, and ABCB5. In vitro, 1 in 250 cells from fresh lCMN formed colonies that could be passaged and harbored the same NRAS mutation as the original nevus. In vivo, lCMN specimens xenografted in immunocompromised mice expanded 4-fold. BrdU(+)-proliferating and label-retaining melanocytes were found within the outgrowth skin tissue of these xenografts, which displayed the same benign nested architecture as the original nevus. lCMN cell suspensions were not able to expand when xenografted alone in Rag 2-/- mice. Conversely, when mixed with keratinocytes, these cells reconstituted the architecture of the human nevus with its characteristic melanocyte layout, lentiginous hyperplasia, and nested architecture. Overall, our data demonstrate that, after birth, certain lCMN cell subtypes still display features such as clonogenic potential and expand into nevus-like structures when cooperating with adjacent keratinocytes.
Collapse
Affiliation(s)
- Christelle Charbel
- Saint Antoine Research Center, U938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; Université Pierre et Marie Curie-Paris VI, Paris, France
| | - Romain H Fontaine
- Saint Antoine Research Center, U938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; Université Pierre et Marie Curie-Paris VI, Paris, France
| | - Natacha Kadlub
- Université René Descartes-Paris V, Paris, France; Department of Maxillofacial and Plastic Surgery, Hôpital Necker, Publique-Hôpitaux de Paris, Paris, France
| | - Aurore Coulomb-L'Hermine
- Université Pierre et Marie Curie-Paris VI, Paris, France; Department of Pathology, Hôpital Trousseau, Publique-Hôpitaux de Paris, Paris, France
| | - Thomas Rouillé
- Saint Antoine Research Center, U938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; Université Pierre et Marie Curie-Paris VI, Paris, France
| | - Alexandre How-Kit
- Laboratory for Functional Genomics, Fondation Jean Dausset - CEPH, Paris, France
| | - Philippe Moguelet
- Department of Pathology, Hôpital Tenon, Publique-Hôpitaux de Paris, Paris, France
| | - Jorg Tost
- Laboratory for Functional Genomics, Fondation Jean Dausset - CEPH, Paris, France; Laboratory for Epigenetics & Environment, Centre National de Génotypage, CEA-Institut de Génomique, Evry, France
| | - Arnaud Picard
- Université René Descartes-Paris V, Paris, France; Department of Maxillofacial and Plastic Surgery, Hôpital Necker, Publique-Hôpitaux de Paris, Paris, France
| | - Selim Aractingi
- Saint Antoine Research Center, U938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; Université René Descartes-Paris V, Paris, France; Department of Dermatology, Hôpital Cochin, Publique-Hôpitaux de Paris, Paris, France
| | - Sarah Guégan
- Saint Antoine Research Center, U938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; Université Pierre et Marie Curie-Paris VI, Paris, France; Department of Dermatology, Hôpital Tenon, Publique-Hôpitaux de Paris, Paris, France.
| |
Collapse
|
13
|
Viana ACL, Gontijo B, Bittencourt FV. Giant congenital melanocytic nevus. An Bras Dermatol 2014; 88:863-78. [PMID: 24474093 PMCID: PMC3900335 DOI: 10.1590/abd1806-4841.20132233] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 12/20/2012] [Indexed: 11/29/2022] Open
Abstract
Giant congenital melanocytic nevus is usually defined as a melanocytic lesion present
at birth that will reach a diameter ≥ 20 cm in adulthood. Its incidence is estimated
in <1:20,000 newborns. Despite its rarity, this lesion is important because it may
associate with severe complications such as malignant melanoma, affect the central
nervous system (neurocutaneous melanosis), and have major psychosocial impact on the
patient and his family due to its unsightly appearance. Giant congenital melanocytic
nevus generally presents as a brown lesion, with flat or mammilated surface,
well-demarcated borders and hypertrichosis. Congenital melanocytic nevus is primarily
a clinical diagnosis. However, congenital nevi are histologically distinguished from
acquired nevi mainly by their larger size, the spread of the nevus cells to the deep
layers of the skin and by their more varied architecture and morphology. Although
giant congenital melanocytic nevus is recognized as a risk factor for the development
of melanoma, the precise magnitude of this risk is still controversial. The estimated
lifetime risk of developing melanoma varies from 5 to 10%. On account of these
uncertainties and the size of the lesions, the management of giant congenital
melanocytic nevus needs individualization. Treatment may include surgical and
non-surgical procedures, psychological intervention and/or clinical follow-up, with
special attention to changes in color, texture or on the surface of the lesion. The
only absolute indication for surgery in giant congenital melanocytic nevus is the
development of a malignant neoplasm on the lesion.
Collapse
Affiliation(s)
- Ana Carolina Leite Viana
- Minas Gerais Federal University, Teaching Hospital, dermatology service, Belo HorizonteMG, Brazil, MD, MSc - Voluntary dermatologist at the dermatology service at Minas Gerais Federal University Teaching Hospital (UFMG) - Belo Horizonte (MG), Brazil
| | - Bernardo Gontijo
- Minas Gerais Federal University, Medical School, Belo HorizonteMG, Brazil, MD, PhD - Associate Professor of dermatology at Minas Gerais Federal University Medical School (UFMG) - Belo Horizonte (MG), Brazil
| | - Flávia Vasques Bittencourt
- Minas Gerais Federal University, Medical School, Belo HorizonteMG, Brazil, MD, PhD - Adjunct Professor of dermatology at Minas Gerais Federal University Medical School (UFMG) - Belo Horizonte (MG), Brazil
| |
Collapse
|
14
|
Kinsler VA, Anderson G, Latimer B, Natarajan D, Healy E, Moore GE, Sebire NJ. Immunohistochemical and ultrastructural features of congenital melanocytic naevus cells support a stem-cell phenotype. Br J Dermatol 2014; 169:374-83. [PMID: 23517330 PMCID: PMC3838625 DOI: 10.1111/bjd.12323] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2013] [Indexed: 01/23/2023]
Abstract
Background Multiple congenital melanocytic naevi (CMN) in one individual are caused by somatic mosaicism for NRAS mutations; however, the lineage of the mutated cells remains uncertain. Objectives To test the hypothesis that CMN may be derived from cutaneous stem cells. Methods Sixty-six CMN samples from 44 patients were stained for immunohistochemical (IHC) markers of melanocytic differentiation (TYR, TRP1, TRP2, LEF1, MITF, cKit), pluripotency (nestin, fascin, CD133, CD20, CD34), monocyte/macrophage lineage (CD68, CD163, CD14), proliferation (Ki67) and MTOR/Wnt-signalling pathway activation (pS6, β-catenin). Semiquantitative scoring compared samples with naevus cell nesting (group 1) with those with only diffuse dermal infiltration (group 2). Transmission electron microscopy (TEM) was performed on 10 samples. Results A normal melanocyte population was seen overlying many dermal CMN. Group 1 samples were significantly more likely to express melanocytic differentiation markers than group 2, and expression decreased significantly with depth. Expression of these markers was correlated with each other, and with nestin and fascin. CD20 staining was positive in a substantial proportion and was stronger superficially. Expression of β-catenin and pS6 was almost universal. Some samples expressed monocyte/macrophage markers. TEM revealed variable naevus cell morphology, striking macromelanosomes, double cilia and microvilli. Conclusions Congenital melanocytic naevi development frequently coexists with normal overlying melanocyte development, leading us to hypothesize that in these cases CMN are likely to develop from a cell present in the skin independent of, or remaining after, normal melanocytic migration. IHC and TEM findings are compatible with CMN cells being of cutaneous stem-cell origin, capable of some degree of melanocytic differentiation superficially.
Collapse
Affiliation(s)
- V A Kinsler
- Paediatric Dermatology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
| | | | | | | | | | | | | |
Collapse
|
15
|
Lugassy C, Barnhill RL. Angiotropism and extravascular migratory metastasis in melanoma: from concept to gene expression. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.11.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
16
|
High prevalence of angiotropism in congenital melanocytic nevi: an analysis of 53 cases. Am J Dermatopathol 2013; 35:180-3. [PMID: 22771898 DOI: 10.1097/dad.0b013e318260908c] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The mechanisms responsible for the development of congenital melanocytic nevi (CMN) have yet to be elucidated. A potential clue to their origin is the observation of angiotropism of nevus cells in CMN. Interestingly, neural crest stem cells (NCSCs), the precursors of melanocytes, demonstrate angiotropism in the embryo. There is accumulating evidence that NCSCs migrate along the external surfaces of vessels during a portion of their journey to the skin. Comparable angiotropism and migration of melanoma cells have been described as extravascular migratory metastasis in melanoma. In this report, we systematically examined for the first time, the frequency of angiotropism in 53 CMN. The lesions originated from 27 females and 26 males with an average age of 9.81 years (range 0.42-28 years). The mean nevus size was 7.43 cm (range 0.3-40 cm). Twenty-seven (50.9%) of the 53 lesions were less than 1.5 cm in diameter. Sixteen nevi (30.2%) were medium sized (1.5-19.9 cm), and 10 CMN (18.9%) were large/giant (>20 cm in diameter). The trunk was the most common location (23/53) followed by the head and neck (17/53). Thirty-eight (71.7%) of the 53 lesions were compound melanocytic nevi, and 15 (28.3%) of the 53 lesions were dermal nevi. In summary, angiotropism was observed in 50 (94.3%) of 53 cases. Consequently, such angiotropism may potentially explain the origin of the precursor cells giving rise to CMN. Further explanations concerning dysregulated growth are clearly needed for the actual appearance of CMN and their physical characteristics.
Collapse
|
17
|
Alikhan A, Ibrahimi OA, Eisen DB. Congenital melanocytic nevi: where are we now? Part I. Clinical presentation, epidemiology, pathogenesis, histology, malignant transformation, and neurocutaneous melanosis. J Am Acad Dermatol 2012; 67:495.e1-17; quiz 512-4. [PMID: 22980258 DOI: 10.1016/j.jaad.2012.06.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 06/04/2012] [Accepted: 06/07/2012] [Indexed: 11/15/2022]
Abstract
Congenital melanocytic nevi (CMN) are present at birth or arise during the first few weeks of life. They are quite common, may have a heritable component, and can present with marked differences in size, shape, color, and location. Histologic and dermatoscopic findings may help suggest the diagnosis, but they are not entirely specific. CMN are categorized based on size, and larger lesions can have a significant psychosocial impact and other complications. They are associated with a variety of dermatologic lesions, ranging from benign to malignant. The risk of malignant transformation varies, with larger CMN carrying a significantly higher risk of malignant melanoma (MM), although with an absolute risk that is lower than is commonly believed. They may also be associated with neuromelanosis, which may be of greater concern than cutaneous MM. The information presented herein aims to help dermatologists determine when it is prudent to obtain a biopsy specimen or excise these lesions, to obtain radiographic imaging, and to involve other specialists (eg, psychiatrists and neurologists) in the patient's care.
Collapse
Affiliation(s)
- Ali Alikhan
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | |
Collapse
|
18
|
Cramer SF, Fesyuk A. On the development of neurocutaneous units--implications for the histogenesis of congenital, acquired, and dysplastic nevi. Am J Dermatopathol 2012; 34:60-81. [PMID: 22197860 DOI: 10.1097/dad.0b013e31822d071a] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study of spontaneous abortions and fetal deaths in utero used immunostains to evaluate the structure of developing cutaneous nerves. Melan-A immunostains were also used to screen 25 cases of grossly normal fetal skin for occult fetal nevi. Discrete portions of epidermis were generally supplied by branches emanating from regularly spaced deep cutaneous nerves, producing a wedge shape, interpreted as neurocutaneous units (NCU). Deeper nerves embraced broader portions of epidermis. Some nerves ran parallel to epidermis, especially near the superficial vascular plexus at the junction of superficial and deep dermis. Nerve sheath stem cells in each NCU may supply the melanocytes needed by the corresponding portion of epidermis. Transformed nerve sheath stem cells may lead to formation of occult prenatal nevi, whose histology and histogenesis may best be understood in terms of NCUs. In particular, the size and shape of a nevus may be largely determined by its NCU of origin. Six fetal nevi were detected, and 3 occult lumbosacral Mongolian spots; all in deep dermis, no later than the middle of the second trimester, mainly with a pattern of singly dispersed deep dermal melanocytes. These findings suggest that congenital (prenatal) nevi begin as intradermal nevi. In addition to explaining congenital nevi, these findings have implications for the histogenesis of acquired (postnatal) nevi and dysplastic nevi.
Collapse
Affiliation(s)
- Stewart F Cramer
- Department of Pathology, Rochester General Hospital, University of Rochester School of Medicine, Rochester, NY 14621, USA.
| | | |
Collapse
|
19
|
Atypical spitzoid melanocytic neoplasms with angiotropism: a potential mechanism of locoregional involvement. Am J Dermatopathol 2011; 33:236-43. [PMID: 21389834 DOI: 10.1097/dad.0b013e3181f8c0e1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Atypical spitzoid melanocytic neoplasms (ASMN) may prove difficult to distinguish microscopically from melanoma, and their biological behavior may be unpredictable. ASMN may result in regional lymph node (LN) metastases and frequent sentinel lymph node (SLN) deposits. Angiotropism and extravascular migratory metastasis may account for locoregional metastases in melanoma and thus may potentially explain such locoregional involvement in ASMN. Nine ASMN with angiotropism from 2006 to 2010 were studied. Angiotropism was defined as melanocytes closely opposed to the external surfaces of microvascular channels without intravasation. There were 5 women and 4 men aged 6-40 (mean 18.7) years with ASMN involving the head and neck (5), the extremities (3), and the trunk (1), and the lesions ranged in diameters from 3.5 to 10 (mean 6.2) mm. Breslow thicknesses ranged from 0.66 to 5.35 (mean 3.21) mm, 5 lesions Clark level IV and 4 level V, and dermal mitotic rates varied from 1 to 5 (mean 2.4) per square millimeter. Despite follow-up of 6 months or less in 4 subjects, 5 patients showed regional tumor spread based on detection of SLN deposits, local recurrence, or clinical satellite and LN metastases. Four of 5 patients (80%) undergoing SLN biopsy showed nodal positivity with 2 SLN deposits of >6 mm. Among 4 patients not having SLN biopsy, 1 patient developed local LN metastases after 2 years. We report for the first time angiotropism in ASMN and suggest that such angiotropism seems to correlate with and may explain regional tumor spread in this neoplastic system.
Collapse
|
20
|
Perivascular migration: a clue to the histogenesis of PEComas? Am J Dermatopathol 2011; 33:528-9. [PMID: 21587036 DOI: 10.1097/dad.0b013e3181f87d52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Gene expression profiling of human angiotropic primary melanoma: Selection of 15 differentially expressed genes potentially involved in extravascular migratory metastasis. Eur J Cancer 2011; 47:1267-75. [DOI: 10.1016/j.ejca.2011.01.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Revised: 01/06/2011] [Accepted: 01/20/2011] [Indexed: 01/06/2023]
|