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Lezcano C, Berwick M, Luo L, Barnhill R, Duncan LM, Gerami P, Lowe L, Messina JL, Scolyer RA, Wood B, Yeh I, Zembowicz A, Busam KJ. Interobserver agreement in the histopathological classification of desmoplastic melanomas. Pathology 2023; 55:223-226. [PMID: 36653238 PMCID: PMC9974895 DOI: 10.1016/j.pathol.2022.12.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 01/03/2023]
Abstract
Desmoplastic melanoma is a subtype of melanoma characterised by amelanotic fusiform melanocytes dispersed in a collagenous stroma. Cell-poor and fibrous stroma-rich 'pure' variants have been distinguished from 'mixed' variants with areas of higher cell density and/or less desmoplastic stroma. This distinction is relevant because patients whose tumours display a pure phenotype have a lower risk for regional lymph node metastasis and distant recurrence. However, little is known about interobserver agreement among pathologists in the subclassification of desmoplastic melanoma. To address this issue, we conducted a study in which eleven dermatopathologists independently evaluated whole slide scanned images of excisions from 30 desmoplastic melanomas. The participating pathologists were asked to classify the tumours as pure or mixed. They were also asked to record the presence or absence of neurotropism and angiotropism. We found substantial interobserver agreement between the 11 dermatopathologists in the classification of tumours as pure versus mixed desmoplastic melanoma (kappa=0.64; p<0.0001). There was fair agreement between the 11 dermatopathologists in the evaluation of presence versus absence of neurotropism (kappa=0.26; p<0.0001), and slight agreement in the assessment of angiotropism (kappa=0.13; p<0.0001). The level of concordance in the subclassification of desmoplastic melanomas is encouraging for the acceptance of this prognostic parameter in the real-world practice of melanoma pathology.
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Affiliation(s)
- Cecilia Lezcano
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA.
| | - Marianne Berwick
- Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Li Luo
- Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Raymond Barnhill
- Department of Translational Research, Institut Curie, Université de Paris UFR de Médecine, Paris, France
| | - Lyn M Duncan
- Pathology Service, Dermatopathology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lori Lowe
- Departments of Pathology and Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Jane L Messina
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Benjamin Wood
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, WA, Australia
| | - Iwei Yeh
- Departments of Dermatology and Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Artur Zembowicz
- Dermatopathology Consultations LLC, Lahey Clinic and Tufts Medical School, Boston, MA, USA
| | - Klaus J Busam
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA
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2
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Chu S, Schrom KP, Tripathi R, Conic RR, Ezaldein HH, Scott JF, Honda K. Pure and Mixed Desmoplastic Melanomas: A Retrospective Clinicopathologic Comparison of 33 Cases. Am J Dermatopathol 2021; 43:776-780. [PMID: 33534213 PMCID: PMC8310890 DOI: 10.1097/dad.0000000000001909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pure and mixed desmoplastic melanomas (DMs) may have different natural histories and behaviors. METHODS We conducted a retrospective review of patients diagnosed with DM at our institution between January 1997 and April 2019. A total of 33 unique DMs were identified and subsequently analyzed based on the histologic type (pure vs. mixed). RESULTS The majority (57.6%) of our cases were classified as pure histology. Patients with pure DMs were more likely to be men (P = 0.035) and be older than 65 years (P = 0.019) compared with patients with mixed DMs. Patients with mixed DM were more likely to have mitoses present (P = 0.001) compared with patients with pure DM. There were no differences in ulceration, perineural invasion, vascular invasion, or survival between patients with pure and mixed histologic subtypes. In addition, no differences in sentinel lymph node biopsy, radiation, or chemotherapy were noted between the 2 histologic subtypes. Immunohistochemistry showed that 27.3% of the pure DMs stained with Melan-A and HMB45 were positive for these immunomarkers. CONCLUSIONS Pure and mixed variants of DM were found to have similar clinicopathologic characteristics. Patients with the mixed histologic subtype were more likely to have mitoses, but no difference in the therapeutic management or patient survival was seen between the 2 subtypes.
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Affiliation(s)
- Sherman Chu
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Northwest, Lebanon, Oregon
| | - Kory P. Schrom
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Raghav Tripathi
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Rosalynn R.Z. Conic
- Department of Family and Preventive Medicine, University of California San Diego, San Diego, California
| | - Harib H. Ezaldein
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeffrey F. Scott
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland
| | - Kord Honda
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Correlative study of epigenetic regulation of tumor microenvironment in spindle cell melanomas and cutaneous malignant peripheral nerve sheath tumors. Sci Rep 2020; 10:12996. [PMID: 32747660 PMCID: PMC7398924 DOI: 10.1038/s41598-020-69787-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022] Open
Abstract
The tumor microenvironment (TME) plays critical roles in tumor growth and progression, however key regulators of gene expression in the TME of cutaneous malignant peripheral nerve sheath tumor (C-MPNST) and spindle cell melanoma (SCM) have not been well elucidated. Herein, we investigate the epigenetic regulation of promoters and gene bodies and their effect on the TME composition of C-MPNSTs and SCMs. A cohort of 30 patients was analyzed using differential gene expression (DGE) and gene set enrichment analysis (GSEA) using the Nanostring platform. Methylation analysis was carried out utilizing an Infinium Methylation EPIC array targeting 866,562 methylation site (CpG) islands. DGE revealed overexpression of genes related to mast cells in the TME of SCMs, and a predominance of exhausted CD8+ T cells and macrophages in the TME of C-MPNSTs. Interestingly, we further observed promoter hypermethylation in key overexpressed genes and corresponding gene body hypomethylation. Analysis using ENCODE ChIP-sequencing data identified CTCF as the common transcription factor at the site of the hypomethylated probe. These findings support that the TME composition of C-MPNSTs and SCMs is at least partially independent on promoter methylation status, suggesting a possible relationship between gene body enhancers and expression of key TME genes in both entities.
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Saggini A, Cerroni L, Casini B, Baciorri F, Cota C. Primary intrafascial desmoplastic melanoma with pseudoglandular differentiation and aberrant cytokeratins expression: An exceptional presentation. Pathol Res Pract 2019; 215:152668. [DOI: 10.1016/j.prp.2019.152668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 11/25/2022]
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Bell PD, Israel AK, Dunn AL, Liao X. Primary Dedifferentiated Amelanotic Anorectal Melanoma: Report of a Rare Case. Int J Surg Pathol 2019; 27:923-928. [DOI: 10.1177/1066896919857148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anorectal melanoma (ARM) is an uncommon aggressive malignancy that comprises 0.5% to 1.6% of all melanoma manifestations. Dedifferentiated melanoma is very rare with loss of all melanocytic differentiation markers and is usually seen in metastatic melanoma of cutaneous origin. In this article, we report the first case of primary dedifferentiated amelanotic ARM in a 68-year-old male who presented with anal discomfort that was initially treated as inflamed hemorrhoids. Physical examination revealed a large protruding anal mass, biopsy of which showed biphasic malignant tumor cells with distinct immunoprofiles: a superficial spindled/sarcomatoid component positive for SOX10 and S100, and a deeper epithelioid/rhabdoid component positive for desmin, AE1/AE3, and EMA. Both components were negative for HMB-45, Melan-A/MART-1, c-Kit, and other lineage markers. Molecular analysis by polymerase chain reaction demonstrated wild-type BRAF and KRAS genes. A diagnosis of dedifferentiated ARM was made based on the coexistence of a differentiated component (spindled: S100 and SOX10 positive) and a dedifferentiated component (epithelioid: all melanoma markers including S100 and SOX10 negative). Shortly afterwards, the patient developed extensive pulmonary and liver metastases and expired 20 days after the diagnosis was rendered, reinforcing the highly aggressive nature of this disease entity.
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Affiliation(s)
| | | | - Andrew L. Dunn
- University of Rochester Medical Center, Rochester, NY, USA
| | - Xiaoyan Liao
- University of Rochester Medical Center, Rochester, NY, USA
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Huayllani MT, Sisti A, Restrepo DJ, Boczar D, Cochuyt JJ, Spaulding AC, Bagaria SP, Rinker BD, Forte AJ. Desmoplastic Melanoma: Clinical Characteristics and Survival in the US Population. Cureus 2019; 11:e4931. [PMID: 31431837 PMCID: PMC6695240 DOI: 10.7759/cureus.4931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective Desmoplastic melanoma (DM) is a rare variant of invasive malignancy of the skin pigmented cells. We present a comprehensive study reporting on US demographics, disease characteristics, and survival, to contribute to the current knowledge and raise awareness of this rare disease. Materials and methods The demographics of DM patients diagnosed from January 1, 2004, to December 31, 2015, were obtained by querying the National Cancer Database. The characteristics of DM were compared with common malignant melanoma (CMM) using univariate and multivariate regression models. Five-year overall survival (OS) curves were estimated using Kaplan-Meier analyses and the Cox proportional regression model. Results Our query found 5,895 patients diagnosed with DM and 292,939 patients with CMM. DM tended to present at an older age, a more advanced stage, and with a Breslow depth greater than 4 mm at diagnosis (P<.05). The Kaplan-Meier survival analysis demonstrated a five-year OS for DM and CMM of 75% and 76%, respectively, without any statistical difference (P=.07). Cox regression analysis demonstrated that age at diagnosis and comorbidities were independent predictors of five-year OS for DM (P<.001). Conclusions Older age, advanced stage, and higher Breslow depth were found to be independent positive factors associated with DM.
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Affiliation(s)
- Maria T Huayllani
- Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Florida, Jacksonville, USA
| | - Andrea Sisti
- Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Florida, Jacksonville, USA
| | - David J Restrepo
- Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Florida, Jacksonville, USA
| | - Daniel Boczar
- Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Florida, Jacksonville, USA
| | | | | | | | - Brian D Rinker
- Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Florida, Jacksonville, USA
| | - Antonio J Forte
- Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Florida, Jacksonville, USA
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7
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Merelo Alcocer V, Flamm A, Chen G, Helm K. SOX10 Immunostaining in granulomatous dermatoses and benign reactive lymph nodes. J Cutan Pathol 2019; 46:586-590. [PMID: 30957251 DOI: 10.1111/cup.13470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND SOX10 immunostaining has been considered a highly sensitive and specific marker for melanoma. But there is evidence suggesting that SOX10 positive cells can be present in dermal scars. Therefore, we investigated whether non-melanocytic cell types present in chronic inflammatory processes or benign lymph nodes express SOX10. METHODS We retrospectively selected 20 benign lymph nodes and 20 cutaneous granulomatous dermatoses. SOX10, CD68, and Melan-A immunohistochemistry was performed in all cases. RESULTS Scattered SOX10 positivity was found in 85% of lymph nodes, specifically in subcapsular and medullary sinuses and in 85% of granulomatous dermatoses. In granulomatous dermatoses, the Melan-A stain did not label the scattered SOX10 positive cells and it was difficult to determine if CD68 was co-expressed on the SOX10 positive cells. In the lymph nodes, the SOX10 positive cells did not co-express Melan-A or CD68. CONCLUSIONS We report SOX10 positive cells detected in granulomatous dermatoses and benign lymph nodes. In lymph nodes, SOX10 positive cells were exclusively in subcapsular and medullary sinuses. Therefore, SOX10 is an excellent stain for evaluation of metastatic melanoma with the caveat that positivity in subcapsular and medullary sinuses can be of non-melanocytic origin; the use of additional melanocytic markers is recommended in this situations.
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Affiliation(s)
- Veronica Merelo Alcocer
- Department of Pathology and Laboratory Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Alexandra Flamm
- Department of Pathology and Laboratory Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.,Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Guoli Chen
- Department of Pathology and Laboratory Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Klaus Helm
- Department of Pathology and Laboratory Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.,Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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9
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Miura K, Namiki T, Akashi T, Uemura N, Mori H, Yokozeki H, Okazaki M. Desmoplastic transformation of a nodular melanoma arising from a speckled lentiginous nevus. J Dermatol 2018; 45:e230-e231. [PMID: 29464760 DOI: 10.1111/1346-8138.14266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Keiko Miura
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Namiki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takumi Akashi
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Noriko Uemura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroki Mori
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroo Yokozeki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mutsumi Okazaki
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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10
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Choi JH, Ro JY. Cutaneous Spindle Cell Neoplasms: Pattern-Based Diagnostic Approach. Arch Pathol Lab Med 2018; 142:958-972. [DOI: 10.5858/arpa.2018-0112-ra] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Spindle cell neoplasms arising in the skin comprise a heterogeneous group of tumors with divergent lineages. Cutaneous spindle cell neoplasms are relatively common and present surgical pathologists with diagnostic challenges. Recognition of their histopathologies is important for correct diagnosis and management. The current review presents a pattern-based diagnostic approach to common cutaneous spindle cell neoplasms that often cause diagnostic difficulties.
Objective.—
To provide a useful guide for diagnosis of cutaneous spindle cell neoplasms.
Data Sources.—
PubMed (US National Library of Medicine) reports and the authors' personal experiences are reviewed.
Conclusions.—
The authors briefly summarize the histologic features and differential diagnoses of common cutaneous spindle cell neoplasms.
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Affiliation(s)
| | - Jae Y. Ro
- From the Department of Pathology, Yeungnam University College of Medicine, Daegu City, Korea (Dr Choi); and the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas (Dr Ro)
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11
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Thakar S, Kandl T, Sagiv O, Tripathy D, Tetzlaff MT, Kapur S, Myers J, Hwu WJ, Jaber BMY, Esmaeli B. Desmoplastic Melanoma of the Periorbital Region. Ophthalmic Plast Reconstr Surg 2018; 34:e48-e52. [PMID: 29194286 DOI: 10.1097/iop.0000000000001015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Desmoplastic melanoma (DM) is a rare subtype of melanoma and an even smaller proportion of periocular melanomas. Here, the authors report 2 cases of DM in the periocular region. Staged according to the American Joint Committee on Cancer (AJCC) eighth edition classification, patient 1 presented with a stage IIIC (pT4apN1cM0) DM in the left lateral canthus with upper and lower eyelid and patient 2 presented with a stage IIIB (T4aN1bM0) DM in the left brow and supraorbital region with a parotid lymph node metastasis. In both patients, the lesions were amelanotic, with inflammatory appearance, and had been noted for several years before the correct diagnosis was made. In both patients, wide excision led to large surgical defects, and perineural invasion prompted adjuvant radiation therapy postoperatively. Patient 2 was treated with an immune checkpoint inhibitor for his parotid metastasis. Ophthalmologists should be aware of DM, its neurotrophic nature, and potential to metastasize with locally advanced lesions.
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Affiliation(s)
- Sudip Thakar
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, Department of Pathology, Department of Translational and Molecular Pathology, Department of Head and Neck Surgery, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A, and St. John of Jerusalem Eye Hospital Group, East Jerusalem, Israel
| | - Thomas Kandl
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, Department of Pathology, Department of Translational and Molecular Pathology, Department of Head and Neck Surgery, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A, and St. John of Jerusalem Eye Hospital Group, East Jerusalem, Israel
| | - Oded Sagiv
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, Department of Pathology, Department of Translational and Molecular Pathology, Department of Head and Neck Surgery, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A, and St. John of Jerusalem Eye Hospital Group, East Jerusalem, Israel
| | - Devjyoti Tripathy
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, Department of Pathology, Department of Translational and Molecular Pathology, Department of Head and Neck Surgery, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A, and St. John of Jerusalem Eye Hospital Group, East Jerusalem, Israel
| | | | - Sahil Kapur
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, Department of Pathology, Department of Translational and Molecular Pathology, Department of Head and Neck Surgery, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A, and St. John of Jerusalem Eye Hospital Group, East Jerusalem, Israel
| | - Jeffrey Myers
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, Department of Pathology, Department of Translational and Molecular Pathology, Department of Head and Neck Surgery, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A, and St. John of Jerusalem Eye Hospital Group, East Jerusalem, Israel
| | - Wen-Jen Hwu
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, Department of Pathology, Department of Translational and Molecular Pathology, Department of Head and Neck Surgery, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A, and St. John of Jerusalem Eye Hospital Group, East Jerusalem, Israel
| | | | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, Department of Pathology, Department of Translational and Molecular Pathology, Department of Head and Neck Surgery, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A, and St. John of Jerusalem Eye Hospital Group, East Jerusalem, Israel
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Harvey NT, Wood BA. A Practical Approach to the Diagnosis of Melanocytic Lesions. Arch Pathol Lab Med 2018; 143:789-810. [PMID: 30059258 DOI: 10.5858/arpa.2017-0547-ra] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Melanocytic lesions are common in routine surgical pathology. Although the majority of these lesions can be confidently diagnosed using well-established morphologic criteria, there is a significant subset of lesions that can be diagnostically difficult. These can be a source of anxiety for patients, clinicians, and pathologists, and the potential consequences of a missed diagnosis of melanoma are serious. OBJECTIVE.— To provide a practical approach to the diagnosis of melanocytic lesions, including classic problem areas as well as suggestions for common challenges and appropriate incorporation of ancillary molecular techniques. DATA SOURCES.— Literature search using PubMed and Google Scholar, incorporating numerous search terms relevant to the particular section, combined with contemporaneous texts and lessons from personal experience. CONCLUSIONS.— Although a subset of melanocytic lesions can be diagnostically challenging, the combination of a methodical approach to histologic assessment, knowledge of potential diagnostic pitfalls, opinions from trusted colleagues, and judicious use of ancillary techniques can help the pathologist navigate this difficult area.
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Affiliation(s)
- Nathan T Harvey
- From the Dermatopathology Group, Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia; and the Division of Pathology and Laboratory Medicine, Medical School, University of Western Australia, Perth, Australia
| | - Benjamin A Wood
- From the Dermatopathology Group, Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia; and the Division of Pathology and Laboratory Medicine, Medical School, University of Western Australia, Perth, Australia
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14
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Khan F, Strohl A, Allen PD, Doerr TD. Desmoplastic Melanoma of the Head and Neck: Incidence and Survival, 1992-2013. Otolaryngol Head Neck Surg 2017; 157:648-656. [PMID: 28828926 DOI: 10.1177/0194599817725696] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 07/21/2017] [Indexed: 12/16/2023]
Abstract
Objective To describe the epidemiological characteristics and survival of desmoplastic melanoma of the head and neck (DMHN) and discuss the factors influencing survival variation among DMHN, DM of other sites (DMnHN), and conventional melanoma of the head and neck (CMHN). Study Design Retrospective cohort study. Setting Surveillance, Epidemiology, and End Results (SEER) database (years 1992-2013). Subjects and Methods Incidence and survival data for 1095 patients with DMHN, 1139 patients with DMnHN, and 40,257 patients with CMHN were obtained. Kaplan-Meier and Cox proportional hazards regression models were used to calculate survival outcomes. Results Patients with DMHN were diagnosed at greater Breslow thickness ( P < .001), stage ( P < .001), and Clark's level ( P < .001) compared to DMnHN and CMHN. Kaplan-Meier survival analysis demonstrated disease-specific survival (DSS) at 5 and 10 years for DMHN to be 80.5% and 74.7%, respectively, compared with 89.1% and 86%, respectively, for DMnHN and 88.1% and 83%, respectively, for CMHN (log-rank test; P < .001). On multivariate Cox regression analysis, age at diagnosis ( P < .001), Breslow depth >4.00 mm ( P = .006), lymph node status ( P < .001), and presence of ulceration ( P < .001) were found to be independent predictors of DSS for DMHN. Conclusion The increasing incidence and poor survivability of DMHN compared to DMnHN and CMHN are parsimoniously explained by the later stage of disease and depth of invasion at diagnosis, highlighting the importance of improved diagnosis and awareness of DMHN.
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Affiliation(s)
- Fatima Khan
- 1 University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Alexis Strohl
- 2 Department of Otolaryngology Head and Neck Surgery, SUNY Upstate Medical Center, Syracuse, New York, USA
| | - Paul D Allen
- 3 Department of Otolaryngology Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Timothy D Doerr
- 3 Department of Otolaryngology Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
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15
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Machado I, Llombart B, Cruz J, Traves V, Requena C, Nagore E, Parafioriti A, Monteagudo C, Llombart-Bosch A. Desmoplastic melanoma may mimic a cutaneous peripheral nerve sheath tumor: Report of 3 challenging cases. J Cutan Pathol 2017; 44:632-638. [DOI: 10.1111/cup.12949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/06/2017] [Accepted: 04/08/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Isidro Machado
- Department of Pathology; Instituto Valenciano de Oncología; Valencia Spain
| | - Beatriz Llombart
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - Julia Cruz
- Department of Pathology; Instituto Valenciano de Oncología; Valencia Spain
| | - Víctor Traves
- Department of Pathology; Instituto Valenciano de Oncología; Valencia Spain
| | - Celia Requena
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - Eduardo Nagore
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - Antonina Parafioriti
- Department of Pathology; ASST - Centro Specialistico Ortopedico Traumatologico Gaetano PINI - CTO; Milano Italy
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16
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SOX10 expression in cutaneous scars: a potential diagnostic pitfall in the evaluation of melanoma re-excision specimens. Pathology 2016; 48:626-8. [DOI: 10.1016/j.pathol.2016.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 06/16/2016] [Indexed: 12/28/2022]
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Metastatic Malignant Melanoma With Complete Loss of Differentiation Markers (Undifferentiated/Dedifferentiated Melanoma): Analysis of 14 Patients Emphasizing Phenotypic Plasticity and the Value of Molecular Testing as Surrogate Diagnostic Marker. Am J Surg Pathol 2016; 40:181-91. [PMID: 26448190 DOI: 10.1097/pas.0000000000000527] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Metastatic malignant melanoma is notorious for its phenotypic diversity and loss of differentiation markers. We herein summarized our experience with 14 metastatic melanomas showing complete loss of immunohistochemical melanocytic markers (with or without heterologous differentiation). Patients included 11 men and 3 women aged 24 to 78 years (median, 67 y). Thirteen patients had histologically confirmed primary skin melanoma, and 1 had metastatic melanoma of unknown primary. Undifferentiated metastasis was diagnosed synchronous to primary tumor (n=1), following skin melanoma by 3 months to 9 years (n=11) and preceding it by 1 year (n=1). Sites of undifferentiated metastases were axillary (3), inguinal (1), or submandibular (1) lymph nodes, digestive tract (2), bone/soft tissue (2), lung/pleura (2), and disseminated (n=3). Histology of metastases mimicked undifferentiated pleomorphic or spindle cell sarcoma with variable myxoid and giant cell areas (n=10) and cytokeratin-positive undifferentiated small cell sarcoma (n=1). Three cases showed heterologous dedifferentiation: pleomorphic rhabdomyosarcoma (n=1), teratocarcinosarcoma-like with prominent rhabdomyoblasts (n=1), and adenocarcinoma-like with metaplastic bone (n=1). All cases were negative for S100, melanoma cocktail, HMB45, Melan A, and SOX10. Other markers showed following results: smooth muscle actin (1/14), p16 (1/14), TP53 (2/12), pancytokeratin (4/14), desmin (5/14), h-caldesmon (0/9), and MDM2/CDK4 (0/5). SMARCB1 was intact in 8/8 cases. Genotyping showed BRAF(V600E) mutation (5/14), NRAS mutation (5/14), and BRAF/NRAS wild-type (4/14). In conclusion, undifferentiated/dedifferentiated metastatic melanoma is likely underrecognized and frequently mistaken for undifferentiated sarcoma or other neoplasms. Diagnosis of undifferentiated sarcoma at sites where melanoma metastasis are frequent (eg, inguinal and axillary region) should be made with great caution and warrants exploration of the remote history. Genotyping is a helpful surrogate marker in classifying such difficult cases. In the light of available targeted therapies, recognition of undifferentiated/dedifferentiated metastatic melanoma is mandatory for appropriate treatment.
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Restrepo CE, Spinner RJ, Howe BM, Jentoft ME, Markovic SN, Lachance DH. Perineural spread of malignant melanoma from the mandible to the brachial plexus: case report. J Neurosurg 2015; 122:784-90. [DOI: 10.3171/2014.12.jns14852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Perineural spread is a well-known mechanism of dissemination of head and neck malignancies. There are few reports of melanoma involving the brachial plexus in the literature. To their knowledge, the authors report the first known case of perineural spread of malignant melanoma to the brachial plexus. Clinicoradiological and anatomopathological correlation is presented, highlighting the importance of peripheral nerve communications in perineural spread.
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Azoury SC, Lange JR. Epidemiology, risk factors, prevention, and early detection of melanoma. Surg Clin North Am 2014; 94:945-62, vii. [PMID: 25245960 DOI: 10.1016/j.suc.2014.07.013] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The incidence of melanoma has increased over the past several decades. Despite improved case mortality, overall deaths from melanoma have increased because of the large increase in incidence. Although we have a better understanding of the pathogenesis of melanoma and improved early diagnostic capabilities, the burden of disease and societal costs remain high. This article provides an update on the epidemiology of cutaneous melanoma worldwide and the common risk factors including heritable and modifiable risks, emphasizing the importance of education, early detection, and prevention in reducing the disease burden.
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Affiliation(s)
- Saïd C Azoury
- Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins Medicine, 600 North Wolfe Street, Blalock 610, Baltimore, MD 21287, USA
| | - Julie R Lange
- Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins Medicine, 600 North Wolfe Street, Blalock 610, Baltimore, MD 21287, USA.
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