1
|
O'Hern K, Crum OM, Demer AM, Brewer JD. Intraoperative Immunohistochemistry During Mohs Micrographic Surgery and Staged Excision Decreases Local Recurrence Rates for Invasive Cutaneous Melanoma: A Systematic Review and Meta-Analysis. Dermatol Surg 2024; 50:601-610. [PMID: 38530980 DOI: 10.1097/dss.0000000000004164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) is increasingly used to treat cutaneous melanoma. However, it is unclear whether intraoperative immunohistochemistry (IHC) improves surgical outcomes. OBJECTIVE To determine whether intraoperative IHC during MMS and staged excision is associated with a decreased risk of poor surgical outcomes. MATERIALS AND METHODS Search of 6 databases identified comparative and noncomparative studies that reported local recurrence after MMS or staged excision with or without IHC for melanoma. Random-effects meta-analysis was used to estimate pooled local recurrence rates, nodal recurrence, distant recurrence, and disease-specific mortality. RESULTS Overall, 57 studies representing 12,043 patients with cutaneous melanoma and 12,590 tumors met inclusion criteria. Combined MMS and staged excision with IHC was associated with decreased local recurrence in patients with invasive melanoma (0.3%, 95% CI: 0-0.6) versus hematoxylin and eosin alone (1.8%, 95% CI: 0.8%-2.8%) [ p < .001]. Secondary outcomes including nodal recurrence, distant recurrence, and disease-specific mortality were not significantly different between these 2 groups. Study heterogeneity was moderately-high. CONCLUSION Local recurrence of invasive melanoma is significantly lower after MMS and staged excision with IHC as opposed to without IHC. These findings suggest that the use of intraoperative IHC during MMS or staged excision should strongly be considered, particularly for invasive melanoma.Trial Registration PROSPERO Identifier: CRD42023435630.
Collapse
Affiliation(s)
- Keegan O'Hern
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Olivia M Crum
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Addison M Demer
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jerry D Brewer
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
2
|
Godse R, Rodriguez O, Ayoade KO, Rubin AI. Update on nail unit histopathology. Hum Pathol 2023; 140:214-232. [PMID: 36921726 DOI: 10.1016/j.humpath.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
Histopathologic evaluation of the nail unit is an essential component in the diagnosis of nail unit disorders. This review highlights recent updates in nail unit histopathology and discusses literature covering a wide range of nail disorders including melanoma/melanocytic lesions, squamous cell carcinoma, onychomatricoma, onychopapilloma, onychomycosis, lichen planus, and other inflammatory conditions. Herein we also discuss recent literature on nail clipping histopathology, a useful and noninvasive diagnostic tool that continues to grow in popularity and importance to both dermatologists and dermatopathologists.
Collapse
Affiliation(s)
- Rama Godse
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Olaf Rodriguez
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine Omueti Ayoade
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
3
|
Zhang S, Wang Y, Fang K, Jia Q, Zhang H, Qu T. Slow Mohs micrographic surgery for nail apparatus melanoma in situ. Int J Dermatol 2023; 62:1170-1175. [PMID: 37350436 DOI: 10.1111/ijd.16748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/18/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Nail apparatus melanoma is a malignant tumor with a high incidence in Chinese melanoma patients. Slow Mohs micrographic surgery is an emerging technique for treating nail apparatus melanoma in situ (NAMIS). OBJECTIVE This study evaluated the efficacy and safety of slow Mohs micrographic surgery for treating NAMIS. METHODS Patients were enrolled in this retrospective study and treated in a single center from October 1, 2016, to June 30, 2022. Each patient underwent standard slow Mohs micrographic surgery, and follow-up was regularly conducted at clinics. RESULTS Ten patients were enrolled in the study. Two patients underwent one Mohs stage, seven underwent two Mohs stages, and one underwent seven Mohs stages. The resection margin ranged from 5 to 25 mm. No severe complications were reported in the treatment, and recurrence of NAMIS was not observed during the follow-up period. CONCLUSION Slow Mohs micrographic surgery is a valuable surgical method to treat NAMIS that preserves digit function and can be well tolerated by patients.
Collapse
Affiliation(s)
- Shu Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Yuanzhuo Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Kai Fang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Qiannan Jia
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Hanlin Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Tao Qu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| |
Collapse
|
4
|
Le M, Gabrielli S, Zloty D. Mohs Micrographic Surgery Is Equivalent to Nail Unit Excision or Amputation for Melanoma In Situ of the Nail Unit: A Systematic Review and Meta-Analysis. Dermatol Surg 2023; 49:755-758. [PMID: 37249515 DOI: 10.1097/dss.0000000000003840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Local recurrence (LR) rates of melanoma in situ (MIS) of the nail apparatus treated with different surgical modalities are unknown. OBJECTIVE To evaluate the differences in LR rates of nail apparatus MIS treated with Mohs micrographic surgery (MMS) versus nail unit excision (NUE) versus amputation. METHODS Studies of nail/subungual MIS treated with MMS, NUE, or amputation were identified through multiple literature databases, including PubMed, MEDLINE, Embase, Web of Science, and Cochrane Library. Pooled data were assessed through meta-analyses and Fisher exact test. RESULTS Of 280 studies identified, 20 met inclusion criteria (7 comparative studies and 13 single-arm studies). Among the 7 comparative studies, the LR was 4.38% (5/114) after NUE and 2.94% (1/34) after amputation (odds ratio: 0.937; 95% CI: 0.237-3.703). In the 13 noncomparative studies, 23 patients underwent MMS (pooled LR estimate: 11.07%; 95% CI: 3.22%-31.81%) and 140 patients underwent NUE (pooled LR estimate:8.04%, 95% CI: 4.43%-14.16%). The difference in LR rate between MMS, NUE, and amputation was not statistically significant ( p = .578). CONCLUSION Local recurrence of nail/subungual MIS in cases treated with MMS was not statistically different than in cases treated with NUE and was comparable to amputation. Further studies investigating the use of MMS for the treatment of nail/subungual MIS are warranted.
Collapse
Affiliation(s)
- Michelle Le
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sofianne Gabrielli
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - David Zloty
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
5
|
Conway J, Bellet JS, Rubin AI, Lipner SR. Adult and Pediatric Nail Unit Melanoma: Epidemiology, Diagnosis, and Treatment. Cells 2023; 12:cells12060964. [PMID: 36980308 PMCID: PMC10047828 DOI: 10.3390/cells12060964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Nail unit melanoma (NUM) is an uncommon form of melanoma and is often diagnosed at later stages. Approximately two-thirds of NUMs are present clinically as longitudinal melanonychia, but longitudinal melanonychia has a broad differential diagnosis. Clinical examination and dermoscopy are valuable for identifying nail findings concerning malignancy, but a biopsy with histopathology is necessary to confirm a diagnosis of NUM. Surgical treatment options for NUM include en bloc excision, digit amputation, and Mohs micrographic surgery. Newer treatments for advanced NUM include targeted and immune systemic therapies. NUM in pediatric patients is extremely rare and diagnosis is challenging since both qualitative and quantitative parameters have only been studied in adults. There is currently no consensus on management in children; for less concerning melanonychia, some physicians recommend close follow-up. However, some dermatologists argue that the "wait and see" approach can cause delayed diagnosis. This article serves to enhance the familiarity of NUM by highlighting its etiology, clinical presentations, diagnosis, and treatment options in both adults and children.
Collapse
Affiliation(s)
- Jade Conway
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Jane S Bellet
- Department of Dermatology and Pediatrics, Duke University School of Medicine, Durham, NC 27710, USA
| | - Adam I Rubin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
- Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY 10021, USA
| |
Collapse
|
6
|
Approaches to Tumors of the Nail Unit and Genitalia. Dermatol Clin 2022; 41:163-174. [DOI: 10.1016/j.det.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
7
|
Falotico JM, Lipner SR. The pharmacotherapeutic management of nail unit and acral melanomas. Expert Opin Pharmacother 2022; 23:1273-1289. [PMID: 35702037 DOI: 10.1080/14656566.2022.2088279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/07/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Acral and nail unit melanomas are rare subtypes of melanoma, which have poor prognoses. Current guidelines for optimal treatment are lacking. Recent clinical trials have evaluated new pharmacotherapeutic agents for melanoma treatment, with dramatically improved survival rates; however, studies on acral and nail unit melanomas are limited in comparison to trials on cutaneous melanoma. AREAS COVERED This is a comprehensive review of the literature regarding the available treatment options for acral and nail unit melanomas, with consideration of safety and tolerability. EXPERT OPINION Programmed cell death protein 1 inhibitors are more efficacious than cytotoxic T lymphocyte-associated antigen-4 blockers in acral and nail unit melanomas, although both are well-tolerated. Tyrosine kinase inhibitors have good clinical activity, however, data on safety is relatively limited. There is minimal data on high dose interferon α-2b and cyclin-dependent kinase 4 and 6 inhibitors, and efficacy and safety must be evaluated in future trials before they can be recommended for use in this patient population. Prospective clinical trials on acral and nail unit melanomas are lacking, and must be performed in large patient populations, with international collaboration likely necessary in order to enroll adequate participants.
Collapse
Affiliation(s)
- Julianne M Falotico
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
8
|
Darmawan CC, Ohn J, Mun J, Kim S, Lim Y, Jo SJ, Kim Y, Kim B, Seong M, Kim BJ, Lee C, Kwak Y, Chung HJ, Virós A, Lee D. Diagnosis and treatment of nail melanoma: A review of the clinicopathologic, dermoscopic, and genetic characteristics. J Eur Acad Dermatol Venereol 2022; 36:651-660. [DOI: 10.1111/jdv.17975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/20/2021] [Accepted: 01/07/2022] [Indexed: 12/01/2022]
Affiliation(s)
- C. C. Darmawan
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - J. Ohn
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - J.‐H. Mun
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Skin Cancer/Chemotherapy Skin Care Center Seoul National University Cancer Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - S. Kim
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - Y. Lim
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Skin Cancer/Chemotherapy Skin Care Center Seoul National University Cancer Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - S. J. Jo
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Skin Cancer/Chemotherapy Skin Care Center Seoul National University Cancer Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - Y.‐g. Kim
- Department of Laboratory Medicine Green Cross Genomic Laboratories 107 Ihyeonro 30beon‐gil Giheng‐gu Yongin‐Si Gyeonggi‐do 16924 Korea
| | - B. Kim
- Department of Laboratory Medicine Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - M.‐W. Seong
- Department of Laboratory Medicine Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - B. J. Kim
- Department of Plastic and Reconstructive Surgery Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - C. Lee
- Department of Pathology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - Y. Kwak
- Department of Pathology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - H. J. Chung
- Department of Dermatology Harvard Medical School Boston Massachusetts 02215 USA
| | - A. Virós
- Skin Cancer and Ageing Lab Cancer Research UK Manchester Institute The University of Manchester Manchester SK10 4TG UK
| | - D.Y. Lee
- Department of Dermatology Samsung Medical Center Sungkyunkwan University 81 Irwon‐Ro, Gangnam‐gu Seoul 06351 Korea
| |
Collapse
|
9
|
Rubin AI. Commentary on Mohs Micrographic Surgery Using MART-1 Immunostaining for Nail Unit Melanoma in Situ. Dermatol Surg 2021; 47:263. [PMID: 32897939 DOI: 10.1097/dss.0000000000002754] [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]
Affiliation(s)
- Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, Section of Dermatology, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
10
|
Commentary on Nail Unit Melanoma In Situ Treated With Mohs Micrographic Surgery. Dermatol Surg 2021; 47:264-265. [PMID: 32897945 DOI: 10.1097/dss.0000000000002755] [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]
|