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Tan S, Hu H, Li G, Zhao J, Wu D. Prevalence, incidence density and standardized morbidity rate of melanoma among patients with congenital melanocytic naevi: a systematic review. Clin Exp Dermatol 2024; 49:765-773. [PMID: 38380707 DOI: 10.1093/ced/llae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/30/2024] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Congenital melanocytic naevi (CMN) are the result of aberrations in the mitogen-activated protein kinase signal transduction pathway. The risk of melanoma is the most important concern among patients with CMN because of its poor prognosis. However, as a result of the great variability between studies, the reported risk of melanoma varies considerably, making it difficult to provide reliable information. OBJECTIVES To evaluate the prevalence, incidence density and standardized morbidity ratio (SMR) of melanoma among patients with CMN. METHODS We conducted a systematic literature search of studies providing data on the risk of melanoma in patients with CMN following our registered and published protocol (PROSPERO: CRD42022383009). RESULTS Overall, 27 studies with a total of 11 480 patients with CMN and 82 patients developing melanoma were included for analysis. The prevalence of melanoma was 1.84% [95% confidence interval (CI) 1.13-2.99] in patients with CMN and 2.73% (95% CI 1.67-4.43) in the subgroup of patients with large CMN (LCMN). The incidence of melanoma was 237.56 (95% CI 97.79-575.96) per 100 000 person-years in patients with CMN and 585.73 (95% CI 315.39-1085.29) per 100 000 person-years in the LCMN subgroup. The SMR of melanoma was 122.27 (95% CI 11.84-1262.88) among all patients with CMN and 285.97 (95% CI 50.65-1614.59) in the subgroup of patients with LCMN. CONCLUSIONS Our research suggests that the risk of melanoma in the CMN population seems to have been overestimated in previous studies, but it is still significantly higher than that in the general population. In addition to the risk of melanoma, aesthetic improvement and mental health should also be taken into account when making management decisions.
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Affiliation(s)
- Songtao Tan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan, Beijing, China
| | - Haoyue Hu
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
- United Laboratory of Frontier Radiotherapy Technology of Sur Yat-sen University and Chinese Academy of Sciences lon Medical Technology Co, Guangzhou, China
| | - Guiying Li
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan, Beijing, China
| | - Jiaqi Zhao
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan, Beijing, China
| | - Di Wu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan, Beijing, China
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Mologousis MA, Tsai SYC, Tissera KA, Levin YS, Hawryluk EB. Updates in the Management of Congenital Melanocytic Nevi. CHILDREN (BASEL, SWITZERLAND) 2024; 11:62. [PMID: 38255375 PMCID: PMC10814732 DOI: 10.3390/children11010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024]
Abstract
Congenital melanocytic nevi (CMN) carry an increased risk of melanoma and may be disfiguring, and consensus regarding treatment recommendations is lacking. While clinical monitoring is the standard of care, many caregivers are interested in its removal to prevent psychosocial burden or to decrease risk. Although melanoma can occur regardless of CMN removal, there are a variety of treatments that may offer improved cosmesis or local symptom control, including surgical excision, laser therapy, and other superficially destructive techniques. Regardless of the selected management, these patients are monitored for ongoing melanoma risk. An extensive discussion with families regarding the risks and benefits of observation versus active intervention is essential. To facilitate these discussions, we herein summarize current CMN management strategies and considerations.
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Affiliation(s)
- Mia A. Mologousis
- School of Medicine, Tufts University, Boston, MA 02111, USA
- Dermatology Program, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Serena Yun-Chen Tsai
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Harvard University, Boston, MA 02115, USA
| | - Kristin A. Tissera
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Duke University, Durham, NC 27710, USA
| | - Yakir S. Levin
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Harvard University, Boston, MA 02115, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Elena B. Hawryluk
- Dermatology Program, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Harvard University, Boston, MA 02115, USA
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3
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Tan S, Hu H, Xin X, Wu D. A clinical and biologic review of congenital melanocytic nevi. J Dermatol 2024; 51:12-22. [PMID: 37955315 DOI: 10.1111/1346-8138.17025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
Congenital melanocytic nevi (CMN) are the result of aberrations in the mitogen-activated protein kinase signal transduction pathway caused by postzygotic somatic mutations. The estimated incidence of newborns with CMN is 1%-2%. The main complications of CMN include proliferative nodules, melanomas, and neurocutaneous melanosis, and the latter two are the most troublesome issues to address. Treatments are primarily taken into account for aesthetic purposes and the reduction of melanoma risk. Due to the much lower incidence of malignant transformation observed in recent studies than in previous data, clinical management paradigms for CMN patients have gradually shifted towards conservative observation and close monitoring. Surgery and lasers are still the main treatments, and targeted therapy may be a promising strategy to help manage complications. With the increase in awareness of mental health, increasing focus has been placed on the quality of life (QoL) and psychological issues of both CMN patients and their parents. Recent studies have revealed that families coping with CMN might endure intense pressure, a major loss in QoL, and psychological problems after diagnosis and during treatment. Here, we sought to present an overview of genetic basis, complications, treatments, and psychological issues related to CMN and hope to provide better management for patients with CMN.
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Affiliation(s)
- Songtao Tan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haoyue Hu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xin Xin
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Di Wu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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4
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Chen K, McInnis-Smith K, Tiwari N, Moser JC, Ramasubramanian A. BRAF Immunohistochemical Studies of Pediatric Conjunctival Lesions. Cornea 2023; 42:1404-1407. [PMID: 36729648 DOI: 10.1097/ico.0000000000003196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/28/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to analyze the prevalence of an activating mutation in the B-Raf proto-oncogene (BRAF) V600E immunoreactivity in pediatric conjunctival lesions. METHODS This retrospective case-control study included 32 pediatric patients who underwent surgical excision of conjunctival lesions between Jan 2019 and May 2022. The collected data included demographic data, clinical features, and histopathologic characteristics of the lesion, including BRAF V600E positivity. The Student t test and the Fisher exact test were used to determine the significance of the associations between clinical variables and BRAF positivity. RESULTS BRAF immunoreactivity was positive in 11/32 lesions (34%). Age at diagnosis did not correlate with BRAF positivity, with a mean age at diagnosis of 131.7 months for patients with BRAF+ lesions and 134.7 months for those with BRAF- lesions ( P > 0.1). No clinical or pathological features were found to be significantly correlated with BRAF positivity, although there was a trend toward BRAF positivity in the presence of cysts ( P = 0.072). CONCLUSIONS BRAF reactivity was present in approximately one-third of pediatric conjunctival nevi but does not correlate significantly with unique clinical or histopathological features.
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Affiliation(s)
| | | | | | - Justin C Moser
- HonorHealth Research and Innovation Institute, Scottsdale, AZ
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Milman T, Grossniklaus HE, Goldman-Levy G, Kivelä TT, Coupland SE, White VA, Mudhar HS, Eberhart CG, Verdijk RM, Heegaard S, Gill AJ, Jager MJ, Rodríguez-Reyes AA, Esmaeli B, Hodge JC, Cree IA. The 5th Edition of the World Health Organization Classification of Tumours of the Eye and Orbit. Ocul Oncol Pathol 2023; 9:71-95. [PMID: 37900189 PMCID: PMC10601864 DOI: 10.1159/000530730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 10/31/2023] Open
Affiliation(s)
- Tatyana Milman
- Departments of Ophthalmology and Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Hans E. Grossniklaus
- Departments of Ophthalmology and Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Gabrielle Goldman-Levy
- World Health Organization, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Tero T. Kivelä
- Ophthalmic Pathology Laboratory, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sarah E. Coupland
- George Holt Chair of Pathology/Consultant Histopathologist, Liverpool Clinical Laboratories, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Valerie A. White
- World Health Organization, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
| | - Charles G. Eberhart
- Departments of Pathology and Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert M. Verdijk
- Section Ophthalmic Pathology, Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Steffen Heegaard
- Department of Pathology, Eye Pathology Section and Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anthony J. Gill
- Department of Pathology, University of Sydney, Sydney, NSW, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital St Leonards NSW, St Leonards, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards NSW, St Leonards, NSW, Australia
| | - Martine J. Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Abelardo A. Rodríguez-Reyes
- Ophthalmic Pathology Service, Asociación para Evitar la Ceguera en México, I.A.P. Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, MDAnderson Cancer Center, Houston, TX, USA
| | | | - Ian A. Cree
- World Health Organization, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - on behalf of the WHO Classification of Tumours Editorial Board
- Departments of Ophthalmology and Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
- Departments of Ophthalmology and Pathology, Emory University School of Medicine, Atlanta, GA, USA
- World Health Organization, International Agency for Research on Cancer, World Health Organization, Lyon, France
- Ophthalmic Pathology Laboratory, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- George Holt Chair of Pathology/Consultant Histopathologist, Liverpool Clinical Laboratories, Liverpool University Hospitals Foundation Trust, Liverpool, UK
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
- Departments of Pathology and Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Section Ophthalmic Pathology, Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pathology, Eye Pathology Section and Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Pathology, University of Sydney, Sydney, NSW, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital St Leonards NSW, St Leonards, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards NSW, St Leonards, NSW, Australia
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
- Ophthalmic Pathology Service, Asociación para Evitar la Ceguera en México, I.A.P. Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, MDAnderson Cancer Center, Houston, TX, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
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6
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Scard C, Aubert H, Wargny M, Martin L, Barbarot S. Risk of melanoma in congenital melanocytic nevi of all sizes: A systematic review. J Eur Acad Dermatol Venereol 2023; 37:32-39. [PMID: 36149403 DOI: 10.1111/jdv.18581] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
Congenital melanocytic nevi (CMN) are commonly encountered benign skin lesions in newborns. Larger CMN is associated with a higher lifetime risk of developing melanoma. However, the level of risk is unclear when CMN are small or medium-sized. Our objective was to assess melanoma risk in patients with CMN of all size categories. A literature review with meta-analysis was performed. Prevalence and incidence densities of melanoma at onset were calculated in the entire study population and according to CMN size, type of treatment and location of the CMN. A total of 91 melanomas were reported in 7915 patients (1.15%, 95% CI, 0.93-1.41). The overall incidence density was 0.057% person-years (95% CI, 0.044-0.071). The risk ratio of melanoma incidence densities was 21.9 (95% CI, 8.55-56.3) in large to giant CMN compared with small to medium CMN at 15 years of age. The incidence density was higher in CMN located on the trunk and as well as in those which were untreated or partially treated versus complete excision. Our review suggests patients with CMN of medium, large and giant size are at risk of melanoma, whereas the risk remains unknown for small CMN.
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Affiliation(s)
- Camille Scard
- Department of Dermatology, CHU Nantes, Nantes, France
| | - Hélène Aubert
- Department of Dermatology, CHU Nantes, Nantes, France
| | - Matthieu Wargny
- CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des Données, Nantes, France
| | | | - Sebastien Barbarot
- Department of Dermatology, CHU Nantes, Nantes, France.,UMR 1280 PhAN, INRA, Nantes Université, Nantes, France
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7
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Choi YS, Erlich TH, von Franque M, Rachmin I, Flesher JL, Schiferle EB, Zhang Y, Pereira da Silva M, Jiang A, Dobry AS, Su M, Germana S, Lacher S, Freund O, Feder E, Cortez JL, Ryu S, Babila Propp T, Samuels YL, Zakka LR, Azin M, Burd CE, Sharpless NE, Liu XS, Meyer C, Austen WG, Bojovic B, Cetrulo CL, Mihm MC, Hoon DS, Demehri S, Hawryluk EB, Fisher DE. Topical therapy for regression and melanoma prevention of congenital giant nevi. Cell 2022; 185:2071-2085.e12. [PMID: 35561684 DOI: 10.1016/j.cell.2022.04.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/28/2022] [Accepted: 04/15/2022] [Indexed: 12/17/2022]
Abstract
Giant congenital melanocytic nevi are NRAS-driven proliferations that may cover up to 80% of the body surface. Their most dangerous consequence is progression to melanoma. This risk often triggers preemptive extensive surgical excisions in childhood, producing severe lifelong challenges. We have presented preclinical models, including multiple genetically engineered mice and xenografted human lesions, which enabled testing locally applied pharmacologic agents to avoid surgery. The murine models permitted the identification of proliferative versus senescent nevus phases and treatments targeting both. These nevi recapitulated the histologic and molecular features of human giant congenital nevi, including the risk of melanoma transformation. Cutaneously delivered MEK, PI3K, and c-KIT inhibitors or proinflammatory squaric acid dibutylester (SADBE) achieved major regressions. SADBE triggered innate immunity that ablated detectable nevocytes, fully prevented melanoma, and regressed human giant nevus xenografts. These findings reveal nevus mechanistic vulnerabilities and suggest opportunities for topical interventions that may alter the therapeutic options for children with congenital giant nevi.
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Affiliation(s)
- Yeon Sook Choi
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Tal H Erlich
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Max von Franque
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA; Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139
| | - Inbal Rachmin
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jessica L Flesher
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Erik B Schiferle
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Yi Zhang
- Department of Data Science, Dana Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Boston, MA 02215
| | - Marcello Pereira da Silva
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Alva Jiang
- Department of Data Science, Dana Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Boston, MA 02215
| | - Allison S Dobry
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Mack Su
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sharon Germana
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sebastian Lacher
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Orly Freund
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ezra Feder
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Jose L Cortez
- Department of Dermatology, University of New Mexico, Albuquerque, NM 87106, USA
| | - Suyeon Ryu
- Department of Translational Molecular Medicine, Saint John's Cancer Institute Providence Health and System, Santa Monica, CA 90404
| | - Tamar Babila Propp
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Yedidyah Leo Samuels
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Labib R Zakka
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Marjan Azin
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Christin E Burd
- Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
| | - Norman E Sharpless
- National Cancer Institute, National Institute of Health, Bethesda, MD 20892
| | - X Shirley Liu
- Department of Data Science, Dana Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Boston, MA 02215
| | - Clifford Meyer
- Department of Data Science, Dana Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Boston, MA 02215
| | - William Gerald Austen
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Division of Plastic Surgery, Shriners Hospital for Children, Boston, Harvard Medical School, Boston, MA 02114, USA
| | - Branko Bojovic
- National Cancer Institute, National Institute of Health, Bethesda, MD 20892; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Curtis L Cetrulo
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Division of Plastic Surgery, Shriners Hospital for Children, Boston, Harvard Medical School, Boston, MA 02114, USA
| | - Martin C Mihm
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Dave S Hoon
- Department of Translational Molecular Medicine, Saint John's Cancer Institute Providence Health and System, Santa Monica, CA 90404
| | - Shadmehr Demehri
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Elena B Hawryluk
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - David E Fisher
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
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8
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Giant Congenital Melanocytic Nevus in a Pediatric Patient: Case Report. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3940. [PMID: 34804761 PMCID: PMC8598223 DOI: 10.1097/gox.0000000000003940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
The giant congenital melanocytic nevus is a rare entity with an extremely low incidence that appears at the time of birth and generally involves the dermis but may also affect other skin layers. According to its clinical evolution, the probability of malignancy may vary, so proper follow-up is essential for potential management. There is no consensus in the literature about the greater benefit of surgical versus nonsurgical management. In this case report, we present the surgical management of a school-aged patient using dermal substitutes and skin grafts, subjectively obtaining an improvement in his quality of life.
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9
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Wertheim-Tysarowska K, Szczygielski O, Seliga K, Tysarowski A, Bal J, Michalak E, Rygiel AM, Sawicka E. The retrospective molecular analysis of large or giant congenital melanocytic nevi in a group of Polish children. JOURNAL OF MOTHER AND CHILD 2021; 25:19-24. [PMID: 34643354 PMCID: PMC8603851 DOI: 10.34763/jmotherandchild.20212501.d-21-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/22/2021] [Indexed: 11/22/2022]
Abstract
Background Large and giant congenital melanocytic nevi (CMN), benign naevomelanocytic proliferations derived from neural crests, with a projected adult size (PAS) ≥ 20 cm, are connected to a high risk of melanoma and neurocutaneous melanosis. Among several factors, genetic alterations seem to be involved in tumorigenesis. The aim of the present study was to analyse the mutation status of NRAS and BRAF genes in resection specimens from large or giant CMN in a group of Polish patients. Material and methods The formalin-fixed, paraffin-embedded resection specimens from 18 patients, fixed in the years of 2006 to 2017, were included in the study. The regions containing the highest load of melanocytes were macrodissected prior to DNA isolation. The NRAS and BRAF mutation status was evaluated using qPCR. Results We detected activating mutations in NRAS gene (codons: 12 and 61) in 7 out of the 18 (38.9%) patients. No BRAF mutations were found. Conclusion Our study, the first molecular analysis of large/giant CMN in Polish patients, supports the hypothesis that NRAS mutation in codon 61 are frequent, recurrent mutations in large/giant CMN. Moreover, we show, for the first time, that NRAS mutations in codon 12 (p.Gly12Asp) can be also detected in giant CMN. The exact role of these genetic alterations in CMN formation remains to be elucidated.
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Affiliation(s)
| | - Orest Szczygielski
- Clinic of Surgery of Children and Adolescents, Kasprzaka 17a, PL 01-211, Warsaw, Poland
| | - Katarzyna Seliga
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Translational and Molecular Oncology Department, W. K. Roentgena 5, PL 02-781, Warsaw Poland
| | - Andrzej Tysarowski
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Translational and Molecular Oncology Department, W. K. Roentgena 5, PL 02-781, Warsaw Poland
| | - Jerzy Bal
- Institute of Mother and Child, Medical Genetics Department, Kasprzaka 17a, PL 01-211, Warsaw, Poland
| | - Elżbieta Michalak
- Institute of Mother and Child, Department of Pathology, Kasprzaka 17a, PL 01-211, Warsaw, Poland
| | | | - Ewa Sawicka
- Clinic of Surgery of Children and Adolescents, Kasprzaka 17a, PL 01-211, Warsaw, Poland
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10
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Farabi B, Akay BN, Goldust M, Wollina U, Atak MF, Rao B. Congenital melanocytic naevi: An up-to-date overview. Australas J Dermatol 2021; 62:e178-e191. [PMID: 33591589 DOI: 10.1111/ajd.13535] [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: 10/03/2020] [Revised: 11/13/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022]
Abstract
Congenital melanocytic naevi are hamartomas of the neuroectoderm caused by genetic mosaicism. Congenital melanocytic naevi are seen in 1-6% of all live births and commonly classified based on the projected size in adults. Congenital melanocytic naevi appear in different colours, shapes, and sizes, and occasionally present with complications. In this review, we sought to evaluate congenital melanocytic naevi, their clinical, dermatoscopic, and reflectance confocal microscopic features, behavioural pattern over time, new trends in classification, underlying genetic factors and their influence on clinical manifestations and management, associated risks, complications, magnetic resonance imaging findings and their management in the light of recent literature.
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Affiliation(s)
- Banu Farabi
- Dermatology and Venerology Department, Ankara University School of Medicine, Ankara, Turkey.,Department of Dermatology, Robert Wood Johnson Medical Centre, Rutgers University, New Brunswick, New Jersey, USA
| | - Bengu Nisa Akay
- Dermatology and Venerology Department, Ankara University School of Medicine, Ankara, Turkey
| | - Mohamad Goldust
- Department of Dermatology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | - Mehmet Fatih Atak
- Dermatology and Venerology Department, Ankara University School of Medicine, Ankara, Turkey
| | - Babar Rao
- Department of Dermatology, Robert Wood Johnson Medical Centre, Rutgers University, New Brunswick, New Jersey, USA
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11
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Zhang X, Tang W, Yi L, Xu L, Xu C, Liu Y. Divided Eyelid Nevus: Surgical Repair Discussion and Case Reports From Northwestern China. Plast Surg (Oakv) 2020; 28:249-253. [PMID: 33215040 DOI: 10.1177/2292550320928559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Currently, due to the lack of long-term postoperative follow-up outcomes of the congenital divided eyelid nevus, we described our surgical approaches and presented the functional and cosmetic results of 13 patients with an average of 5-year follow-up. Based on the surgical treatments and the follow-ups, the selection of total or subtotal excision depends on the lesion location and the use of blepharoplasty approaches is determined by defect size. The CO2 laser may be a useful second-stage procedure to ablate remnant lesions, but long-term monitoring is required.
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Affiliation(s)
- Xianying Zhang
- Center of Burns and Plastic Surgery, Chinese People's Liberation Army Lanzhou, General Hospital of Lanzhou Command, Gansu, China
| | - Wen Tang
- General Hospital of Lanzhou Command, Gansu, China
| | - Liu Yi
- Center of Burns and Plastic Surgery, Chinese People's Liberation Army Lanzhou, General Hospital of Lanzhou Command, Gansu, China
| | - Liwei Xu
- Center of Burns and Plastic Surgery, Chinese People's Liberation Army Lanzhou, General Hospital of Lanzhou Command, Gansu, China
| | - Chengxin Xu
- Center of Burns and Plastic Surgery, Chinese People's Liberation Army Lanzhou, General Hospital of Lanzhou Command, Gansu, China
| | - Yan Liu
- Center of Burns and Plastic Surgery, Chinese People's Liberation Army Lanzhou, General Hospital of Lanzhou Command, Gansu, China
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12
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AlZahrani F, Kuzel P, Metelitsa A, Smylie M, Dover D, Fiorillo L. A Clinicoepidemiological Study of Melanoma in Young Patients (20 Years of Age or Less) in Alberta, Canada, From 1992 to 2011. J Cutan Med Surg 2020; 25:133-141. [PMID: 33095029 DOI: 10.1177/1203475420963658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The epidemiological trends of malignant melanoma have been well described in the literature. However, there remains a paucity of population-based studies assessing melanoma epidemiology in our younger patients (20 years of age or less). Other studies indicate that melanoma incidence has risen in pediatric populations over the last several decades and that these tumors may display different clinical characteristics from those arising in adult populations. We conducted a retrospective, population-based analysis of all incident cases of melanoma occurring in young patients aged ≤20 years in Alberta from 1992 to 2011. Information, including patient age, sex, anatomical location, date of diagnosis, histological subtype (if available), level of invasion, and date of death (if applicable), was obtained from the Alberta Cancer Registry. All cases occurring during a 10-year period from 1993 to 2011 have been reviewed. A total of 71 cases were diagnosed during this time (63% female and 37% male). Age range was 0-20 years (mean of 17.5 years). Truncal melanomas made up 36% of cases, while 28% occurred on the lower limbs, 17% on the upper limbs, and 18% in the head and neck region. Average Breslow thickness was 1.97 mm; 67% of tumors were less than 1 mm thick. Unfortunately, 8 of 71 patients died from their disease. Overall, the incidence of melanoma in patients aged ≤20 years appeared to decrease in Alberta in the past 20 years; however, there has been an increase in the thickness of melanoma at diagnosis, which needs to be addressed.
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Affiliation(s)
- Fatmah AlZahrani
- 3158 Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Paul Kuzel
- 3158 Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Andrei Metelitsa
- 2129 Division of Dermatology, University of Calgary, Alberta, Canada.,Department of Dermatology, Beacon Dermatology, Calgary, Alberta, Canada
| | - Michael Smylie
- Division of Medical Oncology, Department of Oncology, University of Alberta, Edmonton, Canada
| | - Douglas Dover
- Alberta Health and Wellness, Community and Population Health Division, Surveillance and Assessment, University of Alberta, Edmonton, Alberta, Canada
| | - Loretta Fiorillo
- 3158 Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, Canada
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13
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EGFR and BRAF mutations in inverted sinonasal papilloma - a more complex landscape? Virchows Arch 2020; 478:915-924. [PMID: 33048186 PMCID: PMC8286953 DOI: 10.1007/s00428-020-02945-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 09/01/2020] [Accepted: 10/05/2020] [Indexed: 12/23/2022]
Abstract
Inverted (Schneiderian) sinonasal papilloma (ISP) is a neoplasm derived from mucosa of the sinonasal tract characterized by local aggressive growth, a tendency to recur and an association with sinonasal carcinoma. The etiology of ISP remains unclear. Recently, identical mutations in exons 19 and 20 of the oncogene EGFR were reported in ISP and ISP-associated sinonasal carcinoma. Nevertheless, it remains unclear whether recurring ISPs show identical EGFR mutations at different time points or whether these mutations are identical throughout the respective ISP sample. We used Sanger sequencing to test 60 formalin-fixed paraffin embedded ISP samples from 40 patients regarding mutations in exons 19 and 20 of EGFR—together with exon 15 of BRAF. Overall, 32 samples of 22 patients showed a mutation in EGFR exon 20, whereas 28 samples of 18 patients showed none. No mutation in EGFR exon 19 was found in any sample. Four samples of four patients showed a BRAF exon 15 mutation. Interestingly, samples of four patients exhibited genetic heterogeneity, enabling us to report this in ISP for the first time.
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14
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Ruggieri M, Polizzi A, Catanzaro S, Bianco ML, Praticò AD, Di Rocco C. Neurocutaneous melanocytosis (melanosis). Childs Nerv Syst 2020; 36:2571-2596. [PMID: 33048248 DOI: 10.1007/s00381-020-04770-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/23/2020] [Indexed: 02/03/2023]
Abstract
Neurocutaneous melanosis (NCM; MIM # 249400; ORPHA: 2481], first reported by the Bohemian pathologist Rokitansky in 1861, and now more precisely defined as neurocutaneous melanocytosis, is a rare, congenital syndrome characterised by the association of (1) congenital melanocytic nevi (CMN) of the skin with overlying hypertrichosis, presenting as (a) large (LCMN) or giant and/or multiple (MCMN) melanocytic lesions (or both; sometimes associated with smaller "satellite" nevi) or (b) as proliferative melanocytic nodules; and (2) melanocytosis (with infiltration) of the brain parenchyma and/or leptomeninges. CMN of the skin and leptomeningeal/nervous system infiltration are usually benign, more rarely may progress to melanoma or non-malignant melanosis of the brain. Approximately 12% of individuals with LCMN will develop NCM: wide extension and/or dorsal axial distribution of LCMN increases the risk of NCM. The CMN are recognised at birth and are distributed over the skin according to 6 or more patterns (6B patterns) in line with the archetypical patterns of distribution of mosaic skin disorders. Neurological manifestations can appear acutely in infancy, or more frequently later in childhood or adult life, and include signs/symptoms of intracranial hypertension, seizures/epilepsy, cranial nerve palsies, motor/sensory deficits, cognitive/behavioural abnormalities, sleep cycle anomalies, and eventually neurological deterioration. NMC patients may be symptomatic or asymptomatic, with or without evidence of the typical nervous system changes at MRI. Associated brain and spinal cord malformations include the Dandy-Walker malformation (DWM) complex, hemimegalencephaly, cortical dysplasia, arachnoid cysts, Chiari I and II malformations, syringomyelia, meningoceles, occult spinal dysraphism, and CNS lipoma/lipomatosis. There is no systemic involvement, or only rarely. Pathogenically, single postzygotic mutations in the NRAS (neuroblastoma RAS viral oncogene homologue; MIM # 164790; at 1p13.2) proto-oncogene explain the occurrence of single/multiple CMNs and melanocytic and non-melanocytic nervous system lesions in NCM: these disrupt the RAS/ERK/mTOR/PI3K/akt pathways. Diagnostic/surveillance work-ups require physical examination, ophthalmoscopy, brain/spinal cord magnetic resonance imaging (MRI) and angiography (MRA), positron emission tomography (PET), and video-EEG and IQ testing. Treatment strategies include laser therapy, chemical peeling, dermabrasion, and surgical removal/grafting for CMNs and shunt surgery and surgical removal/chemo/radiotherapy for CNS lesions. Biologically targeted therapies tailored (a) BRAF/MEK in NCM mice (MEK162) and GCMN (trametinib); (b) PI3K/mTOR (omipalisib/GSK2126458) in NMC cells; (c) RAS/MEK (vemurafenib and trametinib) in LCMNs cells; or created experimental NMC cells (YP-MEL).
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Affiliation(s)
- Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy.
| | - Agata Polizzi
- Chair of Pediatrics, Department of Educational Sciences, University of Catania, Catania, Italy
| | - Stefano Catanzaro
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
- Unit of Neonatology and Neonatal Intensive Care Unit (NICU), AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - Manuela Lo Bianco
- Postgraduate Programme in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea D Praticò
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Concezio Di Rocco
- Pediatric Neurosurgery, International Neuroscience Institute (INI), Hannover, Germany
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15
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Martínez-Glez V, Tenorio J, Nevado J, Gordo G, Rodríguez-Laguna L, Feito M, de Lucas R, Pérez-Jurado LA, Ruiz Pérez VL, Torrelo A, Spinner NB, Happle R, Biesecker LG, Lapunzina P. A six-attribute classification of genetic mosaicism. Genet Med 2020; 22:1743-1757. [PMID: 32661356 PMCID: PMC8581815 DOI: 10.1038/s41436-020-0877-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 01/23/2023] Open
Abstract
Mosaicism denotes an individual who has at least two populations of cells with distinct genotypes that are derived from a single fertilized egg. Genetic variation among the cell lines can involve whole chromosomes, structural or copy number variants, small or single nucleotide variants, or epigenetic variants. The mutational events that underlie mosaic variants occur during mitotic cell divisions after fertilization and zygote formation. The initiating mutational event can occur in any types of cell at any time in development, leading to enormous variation in the distribution and phenotypic effect of mosaicism. A number of classification proposals have been put forward to classify genetic mosaicism into categories based on the location, pattern, and mechanisms of the disease. We here propose a new classification of genetic mosaicism that considers the affected tissue, the pattern and distribution of the mosaicism, the pathogenicity of the variant, the direction of the change (benign to pathogenic vs. pathogenic to benign), and the postzygotic mutational mechanism. The accurate and comprehensive categorization and subtyping of mosaicisms is important and has potential clinical utility to define the natural history of these disorders, tailor follow-up frequency and interventions, estimate recurrence risks, and guide therapeutic decisions.
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Affiliation(s)
- Víctor Martínez-Glez
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain. .,Institute of Medical and Molecular Genetics (INGEMM)-IdiPAZ, Hospital Universitario La Paz-UAM, Madrid, Spain. .,ITHACA, European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium.
| | - Jair Tenorio
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,Institute of Medical and Molecular Genetics (INGEMM)-IdiPAZ, Hospital Universitario La Paz-UAM, Madrid, Spain.,ITHACA, European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium
| | - Julián Nevado
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,Institute of Medical and Molecular Genetics (INGEMM)-IdiPAZ, Hospital Universitario La Paz-UAM, Madrid, Spain.,ITHACA, European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium
| | - Gema Gordo
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,Institute of Medical and Molecular Genetics (INGEMM)-IdiPAZ, Hospital Universitario La Paz-UAM, Madrid, Spain
| | - Lara Rodríguez-Laguna
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,Institute of Medical and Molecular Genetics (INGEMM)-IdiPAZ, Hospital Universitario La Paz-UAM, Madrid, Spain
| | - Marta Feito
- Department of Pediatric Dermatology, Hospital Universitario La Paz-UAM, Madrid, Spain
| | - Raúl de Lucas
- Department of Pediatric Dermatology, Hospital Universitario La Paz-UAM, Madrid, Spain
| | - Luis A Pérez-Jurado
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,Genetics Unit, Universitat Pompeu Fabra and Hospital del Mar Research Institute (IMIM), Barcelona, Spain.,Women's and Children's Hospital, South Australia Medical and Health Research Institute (SAHMRI) and University of Adelaide, Adelaide, SA, Australia
| | - Víctor L Ruiz Pérez
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,ITHACA, European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium.,Instituto de Investigaciones Biomédicas de Madrid (CSIC-UAM), Madrid, Spain
| | - Antonio Torrelo
- Department of Pediatrics, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Nancy B Spinner
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicines at The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rudolf Happle
- Department of Dermatology, Medical Center-University of Freiburg, Freiburg, Germany
| | - Leslie G Biesecker
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute (NHGRI), National Institutes of Health, Bethesda, MD, USA
| | - Pablo Lapunzina
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain. .,Institute of Medical and Molecular Genetics (INGEMM)-IdiPAZ, Hospital Universitario La Paz-UAM, Madrid, Spain. .,ITHACA, European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium.
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16
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Kumari M, Singh M, Punhani P. Malignant melanoma in a child with giant congenital melanocytic nevus and satellite flekers: A rare entity. Diagn Cytopathol 2020; 48:564-566. [PMID: 32181594 DOI: 10.1002/dc.24408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/22/2020] [Accepted: 02/26/2020] [Indexed: 12/23/2022]
Abstract
Malignant melanomas in the pediatric age are remarkably rare representing 0.9% of various pediatric malignancies. Congenital nevi occur in 1 in 100 newborns, whereas giant congenital melanocytic nevus (GCMN) measuring more than 20 cm is seen in 1 in 20 000 cases. Very few cases of malignant melanoma arising from GCMN have been described in English literature. The risk of developing malignant melanoma from GCMN is believed to be directly proportional to the size of the nevus and varies from 2.6% to 20% depending on the size of nevus. We present a case of malignant melanoma in a 12-year-old female child who had a congenital giant nevus and multiple satellite flekers all over the body.
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Affiliation(s)
- Manju Kumari
- Department of Pathology, V.M.M.C and Safdarjung Hospital, New Delhi, India
| | - Mukul Singh
- Department of Pathology, V.M.M.C and Safdarjung Hospital, New Delhi, India
| | - Pallavi Punhani
- Department of Pathology, V.M.M.C and Safdarjung Hospital, New Delhi, India
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17
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Pavone P, Falsaperla R, Marino S, Ruggieri M, Praticò AD, Nardone B. Giant melanocytic nevi and soft tissue undergrowth in the left leg: Pathogenetic hypothesis. Pediatr Rep 2019; 11:8184. [PMID: 31595185 PMCID: PMC6778840 DOI: 10.4081/pr.2019.8184] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 06/03/2019] [Indexed: 11/22/2022] Open
Abstract
Congenital melanocytic nevi (CMN) are observed frequently in children. The anomalous skin shows a widely variable clinical expression not only in the anatomic location, but also in color, morphology and superficial structure. According to the width CMN are distinguished in small, medium, large or giant. Aside the cosmetic problem and its psychological implications, CMN may present with severe complications consisting of malignant transformation and/or central nervous system involvement. We report on a 3-month old infant with an extensive CMN in the left leg, which extended from the lower portion of the knee to the foot, with satellite nevi. Concomitant with the extensive nevi in the same district a remarkable reduction in size was present, and involved the adipose and muscle tissues, contributing to a counterpart diameter difference of 5 cm, without bone involvement. Melanocytic nevi and soft tissue undergrowth in the leg is a usual association; a pathogenic explanation on the anomaly involving concomitantly the skin and the underneath soft tissues is advanced.
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Affiliation(s)
- Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Pediatric Emergency, University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Italy
| | - Silvia Marino
- Unit of Pediatrics and Pediatric Emergency, University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Italy
| | - Martino Ruggieri
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Italy
| | - Andrea D. Praticò
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Italy
| | - Beatrice Nardone
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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18
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Merkel EA, Mohan LS, Shi K, Panah E, Zhang B, Gerami P. Paediatric melanoma: clinical update, genetic basis, and advances in diagnosis. THE LANCET. CHILD & ADOLESCENT HEALTH 2019; 3:646-654. [PMID: 31204309 DOI: 10.1016/s2352-4642(19)30116-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/25/2019] [Accepted: 04/02/2019] [Indexed: 02/04/2023]
Abstract
Paediatric melanoma is rare and challenging to diagnose. The three subtypes are Spitzoid melanoma, melanoma arising in a congenital melanocytic nevus, and conventional (also known as adult-type) melanoma. Spitzoid melanomas have characteristic histopathological and genomic aberrations. Despite frequent involvement of the sentinel lymph nodes, most cases have an uneventful clinical course. Among congenital nevi, the risk of melanoma varies by projected size in adulthood, with the greatest risk in large or giant nevi. The clinical course is generally aggressive and accounts for most melanoma-related deaths in childhood. In conventional melanoma, superficial spreading and nodular melanoma account for most cases, with risk factors and presentation largely similar to adult disease. In this Review, we discuss advances in histological diagnosis using adjunctive molecular assays, and summarise the genetic basis of paediatric melanoma.
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Affiliation(s)
- Emily A Merkel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lauren S Mohan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Katherine Shi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elnaz Panah
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bin Zhang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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19
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Cotton CH, Goldberg GN. Evolution of congenital melanocytic nevi toward benignity: A case series. Pediatr Dermatol 2019; 36:227-231. [PMID: 30840320 DOI: 10.1111/pde.13745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report on four children born with medium to large congenital melanocytic nevi (CMN) with color heterogeneity and irregular surface rugosity. As these patients aged, their nevi evolved to become more homogeneous and lighter in color, and developed a smoother, more even texture. We propose that given this evolution toward benignity, conservative monitoring and management may be appropriate even in the context of atypical-appearing features at birth. Such knowledge regarding the evolution of these CMN can more accurately guide parents and clinicians in determining whether to biopsy or remove an atypical-looking lesion early in life for medical or cosmetic reasons.
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Affiliation(s)
- Colleen H Cotton
- Division of Dermatology, University of Arizona College of Medicine, Tucson, Arizona
| | - Gerald N Goldberg
- Division of Dermatology, University of Arizona College of Medicine, Tucson, Arizona.,Pima Dermatology, Tucson, Arizona
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20
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Belysheva TS, Vishnevskaya YV, Nasedkina TV, Emelyanova MA, Abramov IS, Orlova KV, Lubchenko LN, Utyashev IA, Doroshenko MB, Demidov LV, Aliev MD. Melanoma arising in a Giant congenital melanocytic nevus: two case reports. Diagn Pathol 2019; 14:21. [PMID: 30782194 PMCID: PMC6381634 DOI: 10.1186/s13000-019-0797-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/10/2019] [Indexed: 12/22/2022] Open
Abstract
Background A giant congenital melanocytic nevus (GCMN) is found in 0.1% of live-born infants. If present, the lesion has a chance of about 6% to develop into malignant melanoma. Both children and adults can be affected by malignant melanoma arising in a giant congenital nevus. Up to 95% of GCMNs harbor NRAS mutations, and mutations in the BRAF, MC1R, TP53, and GNAQ genes have also been described. The individualization of therapy is required, but diagnostic and prognostic criteria remain controversial. Case presentations We report two cases: 1) melanoma arising in a giant congenital nevus during the first month of life complicated with neurocutaneous melanosis (NCM), and 2) melanoma arising in a giant congenital nevus during the first 6 months of life. Pathology, immunohistochemistry, and genetic analyses of tumor tissue were performed. The first case revealed only a non-pathogenic P72R polymorphism of the TP53 gene in the homozygote condition. For the second case, a Q61K mutation was detected in the NRAS gene. Conclusion Malignant melanoma associated with GCMN is rare and therefore poorly understood. Outcomes have been linked to the stage at diagnosis, but no additional pathological prognostic factors have been identified. The most frequent genetic event in giant CMNs is NRAS mutations, which was discovered in one of our cases. To accumulate evidence to improve disease prognosis and outcomes, children with congenital melanocytic nevus should be included in a systemic follow-up study from birth.
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Affiliation(s)
- Tatiana S Belysheva
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Yana V Vishnevskaya
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Tatiana V Nasedkina
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation.,Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russian Federation
| | - Marina A Emelyanova
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russian Federation
| | - Ivan S Abramov
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation.,Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russian Federation
| | - Kristina V Orlova
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation.
| | - Ludmila N Lubchenko
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Igor A Utyashev
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Marina B Doroshenko
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Lev V Demidov
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Mamed D Aliev
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
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21
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König TT, Muensterer OJ. Schnappschüsse aus der kinderchirurgischen Sprechstunde – klinische Diagnosen von Kopf bis Fuß. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Francis JH, Grossniklaus HE, Habib LA, Marr B, Abramson DH, Busam KJ. BRAF, NRAS, and GNAQ Mutations in Conjunctival Melanocytic Nevi. Invest Ophthalmol Vis Sci 2018; 59:117-121. [PMID: 29332123 PMCID: PMC6110167 DOI: 10.1167/iovs.17-22517] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate BRAF, NRAS, and GNAQ mutations in surgical specimens of common and blue conjunctival melanocytic nevi. Methods Surgical specimens from 25 conjunctival melanocytic nevi (23 common and 2 blue) of 25 patients were evaluated. All common nevi were analyzed immunohistochemically for the expression of BRAF V600E or NRAS Q61R. One lesion with negative immunoreactivity and for all blue nevi, a hybridization capture-based next-generation sequencing method was employed for mutation analysis. For common nevi, genetic features were compared with clinical and histopathologic findings. Continuous variables (age at excision and largest basal diameter) were compared with a Students's t-test and all categoric variables were compared with Fisher's Exact Test. Results Of common melanocytic nevi, 9 (39.1%) were immunoreactive for NRASQ61R and 13 (56.5%) were immunoreactive for BRAFV600E. One common nevus, which was immunonegative for both BRAFV600E and NRASQ61R was found to harbor an NRASQ61K mutation by sequence analysis. Patients with NRAS-mutated nevi were more likely to report occurrence of the lesion prior to 18-years old and more likely to have intrinsic cysts. The mean largest basal diameter was 6.0 and 3.5 mm for NRAS- and BRAF-immunoreactive lesions, respectively (P = 0.003). GNAQ mutations were identified in each of the two blue nevi of this study. Conclusions These findings document that common conjunctival melanocytic nevi have mutually exclusive mutations in BRAF and NRAS. The two conjunctival blue nevi harbored GNAQ mutations. This suggests the driver mutations of conjunctival nevi are similar to those of nevi of the skin. At the molecular level, conjunctival nevi appear more like cutaneous nevi than choroidal nevi.
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Affiliation(s)
- Jasmine H Francis
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States.,Department of Ophthalmology, Weill-Cornell Medical Center, New York, New York, United States
| | - Hans E Grossniklaus
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Larissa A Habib
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Brian Marr
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States.,Department of Ophthalmology, Weill-Cornell Medical Center, New York, New York, United States
| | - David H Abramson
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States.,Department of Ophthalmology, Weill-Cornell Medical Center, New York, New York, United States
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States.,Department of Pathology, Weill-Cornell Medical Center, New York, New York, United States
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23
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Endomba FT, Mbega CR, Tochie JN, Petnga SJN. Giant congenital melanocytic nevus in a Cameroonian child: a case report. J Med Case Rep 2018; 12:175. [PMID: 29933750 PMCID: PMC6015456 DOI: 10.1186/s13256-018-1707-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 05/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Giant congenital melanocytic nevus is a very rare condition characterized by a large skin lesion and an increased risk of complications like neurocutaneous melanosis and malignant transformation. Reports of giant congenital melanocytic nevus are scarce in the sub-Saharan African literature and here we present a case of this disease in a Cameroonian adolescent. CASE PRESENTATION A 12-year-old Cameroonian girl from the "Baka" ethnic group, with no relevant family and medical histories presented with a progressively extensive brownish-black nodular hypertrophic skin lesion of approximately 45 cm, which she had had since she was 2-days old. The lesion covered her entire back giving an appearance of "turtle child", which was highly suggestive of a giant congenital melanocytic nevus. She was booked in for a surgical intervention organized by a health campaign within her community. Meanwhile she was provided with psychological support and her family was counseled on warning signs of complications which would warrant an urgent consultation. CONCLUSIONS Here we presented a case of giant congenital melanocytic nevus, apparently the first in the Cameroonian literature. In view of the potential severe complications as well as psychological trauma of this pathology, we draw clinicians' attention to this extremely rare but real pathology in our country, for a timely diagnosis and management.
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Affiliation(s)
- Francky Teddy Endomba
- Department of Internal Medicine and Sub-specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon. .,Specialized Internship Program, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaoundé, Cameroon.
| | - Charlie Romain Mbega
- Department of Internal Medicine and Sub-specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Joel Noutakdie Tochie
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Health and Human Development (2HD) Research Group, Douala, Littoral Region, Cameroon
| | - Saint-Just N Petnga
- Department of Internal Medicine and Sub-specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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24
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Stefanaki C, Chardalias L, Soura E, Katsarou A, Stratigos A. Paediatric melanoma. J Eur Acad Dermatol Venereol 2017; 31:1604-1615. [PMID: 28449284 DOI: 10.1111/jdv.14299] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/03/2017] [Indexed: 02/06/2023]
Abstract
Paediatric melanoma, although rare, is the most common skin cancer in children. Our current knowledge on paediatric melanoma incidence trends is expanding, as several studies have addressed this issue with conflicting results. Known risk factors for paediatric melanoma include family history of melanoma, a previous history of malignancy, large congenital nevi, numerous melanocytic nevi, sunburns, increased UV exposure and a sun-sensitive phenotype. In younger children, melanoma more often presents with atypical features, such as a changing, amelanotic or uniformly coloured, often bleeding lesion, not fulfilling in most cases the conventional ABCDE criteria. The major differential diagnoses are melanocytic nevi, proliferative nodules in congenital nevi and atypical Spitz tumours. Moreover, in the younger age group non-Caucasian children are over-represented, tumours tend to be thicker and lymph nodes are often involved. Despite the frequent diagnosis at an advanced stage, the overall survival is fair in paediatric melanoma. Specific guidelines for management of melanoma in children do not exist, and most often the disease is treated similarly to melanoma in adults.
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Affiliation(s)
- C Stefanaki
- University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, Athens, Greece
| | - L Chardalias
- University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, Athens, Greece
| | - E Soura
- University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, Athens, Greece
| | - A Katsarou
- University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, Athens, Greece
| | - A Stratigos
- University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, Athens, Greece
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Lee JH, Wishkoski R, Aase L, Meas P, Hubbles C. Understanding users of cloud music services: Selection factors, management and access behavior, and perceptions. J Assoc Inf Sci Technol 2016. [DOI: 10.1002/asi.23754] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jin Ha Lee
- Information School, University of Washington; Mary Gates Hall, Suite 370 Seattle WA
| | - Rachel Wishkoski
- Information School, University of Washington; Mary Gates Hall, Suite 370 Seattle WA
| | - Lara Aase
- Information School, University of Washington; Mary Gates Hall, Suite 370 Seattle WA
| | - Perry Meas
- Information School, University of Washington; Mary Gates Hall, Suite 370 Seattle WA
| | - Chris Hubbles
- Information School, University of Washington; Mary Gates Hall, Suite 370 Seattle WA
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