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From Keratoma to Anaplastic Malignant Melanoma in a Horse's Hoof. Animals (Basel) 2022; 12:ani12223090. [PMID: 36428318 PMCID: PMC9686975 DOI: 10.3390/ani12223090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
Melanomas in horses are most often associated with gray, older horses with an average age of over 16 years. Anaplastic malignant melanoma, however, can very rarely affect non-gray horses. Herein, we report a case of a 16-year-old Wielkopolski gelding with a chronic lameness caused by a mass in the hoof. The first resection of the lesion and histopathological examination confirmed the presence of a keratoma. The regrown mass and persistent lameness resulted in another mass resection. The second histopathological examination result suggested a neoplastic growth of melanocytic origin with a low histological malignancy. Less than 2 years after the first resection, the horse returned to the clinic with deformation of the hoof capsule and severe lameness. The result of the third histopathological examination indicated low-differentiated malignant neoplasm. The result of the immunohistochemically test indicates a tumor of melanocytic origin with high malignancy.
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Abstract
Nail pigmentation in children can cause significant anxiety in parents and clinicians. Different pigments of the nails, such as yellow, orange, and green, can all occur; however, this paper will focus on the dark pigments: brown, gray, and black pigmentation of the nails. Many causes of dark coloration of the nails exist; almost all causes in pediatric patients are benign and require no treatment. Melanoma is the one diagnosis that physicians do not want to miss. Fortunately, this is extremely rare in children.
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Affiliation(s)
- Jane Sanders Bellet
- Departments of Dermatology and Pediatrics, Duke University School of Medicine, Durham, NC, USA
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3
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LaRocca CJ, Lai L, Nelson RA, Modi B, Crawford B. Subungual Melanoma: A Single Institution Experience. Med Sci (Basel) 2021; 9:medsci9030057. [PMID: 34564082 PMCID: PMC8482220 DOI: 10.3390/medsci9030057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Despite the changing paradigms of melanoma treatment in recent years, there remains a relative paucity of data regarding subungual melanoma in the literature. From 2002–2018, 25 patients with subungual melanoma were surgically treated at our facility. A retrospective chart review was conducted to collect relevant demographic, clinical, pathologic, and outcomes data. The median age at diagnosis was 69 years. Most patients (60%) were male, and the melanoma lesion was most often located on the foot (68%). Acral-lentiginous was the most common histologic subtype (59%), and the median Breslow thickness was 3.4 mm. Fifteen patients (63%) underwent a sentinel lymph node biopsy as part of their surgical resection, and four of these patients (27%) had metastatic disease in the lymph nodes. In total, 10 patients underwent lymph node dissection of the involved basin. The median follow up was 21 months in this patient population. Age, gender, tumor location, ulceration, and lesion histology were not significantly associated with recurrence free survival (RFS). Increasing Breslow thickness was found to be significantly associated with shorter RFS (HR: 1.07, CI: 1.03–1.55). In total, 13 patients developed a disease recurrence, and RFS rates were 66% at 1 year and 40% at 3 years. Additionally, 91 and 37% of patients were alive at one year and three years, respectively. Subungual melanomas are rare lesions that often have a more advanced stage at diagnosis, which contributes to the poor prognosis of these cutaneous malignancies.
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Affiliation(s)
- Christopher J. LaRocca
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
- Correspondence: (C.J.L.); (B.C.); Tel.: +1-612-625-2991 (C.J.L.); +1-424-259-9823 (B.C.)
| | - Lily Lai
- City of Hope National Medical Center, Department of Surgery, Duarte, CA 91010, USA; (L.L.); (B.M.)
| | - Rebecca A. Nelson
- City of Hope National Medical Center, Department of Computational and Quantitative Medicine, Duarte, CA 91010, USA;
| | - Badri Modi
- City of Hope National Medical Center, Department of Surgery, Duarte, CA 91010, USA; (L.L.); (B.M.)
| | - Brooke Crawford
- UCLA Medical Center, Department of Orthopedic Surgery, Santa Monica, CA 90404, USA
- Correspondence: (C.J.L.); (B.C.); Tel.: +1-612-625-2991 (C.J.L.); +1-424-259-9823 (B.C.)
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Takei I, Sawamura S, Kimura T, Makino T, Aoi J, Kajihara I, Nishimura Y, Igata T, Masuguchi S, Fukushima S. Amelanotic melanoma of the nail apparatus complicated with digital mucous cyst. Australas J Dermatol 2021; 63:e95-e96. [PMID: 34374431 DOI: 10.1111/ajd.13679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Itsuki Takei
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Soichiro Sawamura
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshihiro Kimura
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takamitsu Makino
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Jun Aoi
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ikko Kajihara
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuki Nishimura
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshikatsu Igata
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinichi Masuguchi
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Fukushima
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Yoo H, Kim H, Kwon ST, Jo SJ, Mun JH, Lee C, Kwak Y, Kim BJ. Tumor invasion in the hyponychium is associated with distant metastasis and poor prognosis in subungual melanoma: A histologic landscape of 44 cases. J Am Acad Dermatol 2021; 86:1027-1034. [PMID: 34153394 DOI: 10.1016/j.jaad.2021.06.847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Subungual melanoma (SUM) has a poor prognosis because of delayed diagnosis. Its progression, consensus on surgical treatment, and correlation with clinical outcomes remain unclear. OBJECTIVE We aimed to identify the pattern of dermal invasion in different locations of the nail apparatus and its relationship with prognosis. METHODS In this retrospective review of surgically treated SUM patients between January 2011 and April 2019, the nail apparatus was divided into 5 anatomic subunits: the dorsal roof of proximal nail fold, ventral floor of proximal nail fold, germinal matrix, nail bed, and hyponychium. Invasions in the subunits were categorized using 3 criteria: no tumor, in situ tumor, or invasion. RESULTS Among 44 cases of SUM, dermal invasion occurred mostly in the distal areas, with 11, 30, 18, 7, and 4 in the hyponychium, nail bed, germinal matrix, ventral floor of proximal nail fold, and dorsal roof of proximal nail fold, respectively. The patients with hyponychial invasion showed a significantly greater Breslow depth (P = .009), a higher rate of lymph node metastasis (P = .019), distant metastasis (P = .036), and shorter disease-free survival (P = .001). CONCLUSION Hyponychial invasion is an important prognostic predictor of SUM, given its strong association with invasion depth, metastatic progression, and disease-free survival. Patients with invasion in the hyponychium should undergo more strict workup, treatment, and surveillance.
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Affiliation(s)
- Hyokyung Yoo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Sung Tack Kwon
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Cheol Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Byung Jun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Ríos-Viñuela E, Nájera-Botello L, Requena L, Nagore E, Requena C. Subungual Melanocytic Lesions: Key Clinical and Pathologic Concepts and Biopsy Techniques. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S1578-2190(21)00166-9. [PMID: 34053897 DOI: 10.1016/j.adengl.2021.05.007] [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: 11/09/2020] [Accepted: 12/26/2020] [Indexed: 11/15/2022] Open
Abstract
Both dermatologists and pathologists sometimes find daunting the evaluation of melanonychia (especially subungual melanocytic lesions) because of the fear of performing nail surgery due to the risk of dystrophy, difficulties processing and interpreting nail biopsy specimens, and a general lack of experience in the field. Nevertheless, mastery of nail biopsy techniques, correct processing and orientation of specimens, and familiarity with the histologic particularities of the nail apparatus can attenuate the undoubted complexity and facilitate the tasks involved. Longitudinal excision is the biopsy technique that ensures the simplest histologic interpretation, and it is associated with a low risk of nail dystrophy when performed correctly. Clinical and epidemiological data are crucial. Subungual melanoma in childhood, for instance, is very rare and even lesions with atypical clinical and/or histologic features are probably benign. The presence of suprabasal melanocytes and other findings that would suggest malignancy at other sites are considered normal in the nail apparatus. Subungual melanoma shows a lentiginous pattern in the early stages of disease, and detection of an inflammatory infiltrate accompanying atypical lentiginous subungual lesions would appear to be one of the first diagnostic findings.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta del Hierro, Madrid, Spain
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, Spain
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
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Abstract
Nail unit melanoma is an uncommon form of melanoma with worse prognosis compared with nonacral cutaneous melanoma. Nail unit melanoma is often diagnosed at a late stage. Clinical and dermoscopic features may suggest a diagnosis of nail unit melanoma, but confirmation requires histologic analysis. Like the clinical diagnosis, histopathologic diagnosis of nail unit melanoma is also difficult. The surgical management of nail unit melanoma has evolved from aggressive amputations to digit-sparing approaches. This article reviews the clinical presentation, diagnosis, and surgical treatment of nail unit melanoma to promote early diagnosis and rational surgery.
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Ríos-Viñuela E, Nájera-Botello L, Requena L, Nagore E, Requena C. Subungual Melanocytic Lesions: Key Clinical and Pathologic Concepts and Biopsy Techniques. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00003-X. [PMID: 33465340 DOI: 10.1016/j.ad.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/11/2020] [Accepted: 12/26/2020] [Indexed: 12/11/2022] Open
Abstract
Both dermatologists and pathologists sometimes find daunting the evaluation of melanonychia (especially subungual melanocytic lesions) because of the fear of performing nail surgery due to the risk of dystrophy, difficulties processing and interpreting nail biopsy specimens, and a general lack of experience in the field. Nevertheless, mastery of nail biopsy techniques, correct processing and orientation of specimens, and familiarity with the histologic particularities of the nail apparatus can attenuate the undoubted complexity and facilitate the tasks involved. Longitudinal excision is the biopsy technique that ensures the simplest histologic interpretation, and it is associated with a low risk of nail dystrophy when performed correctly. Clinical and epidemiological data are crucial. Subungual melanoma in childhood, for instance, is very rare and even lesions with atypical clinical and/or histologic features are probably benign. The presence of suprabasal melanocytes and other findings that would suggest malignancy at other sites are considered normal in the nail apparatus. Subungual melanoma shows a lentiginous pattern in the early stages of disease, and detection of an inflammatory infiltrate accompanying atypical lentiginous subungual lesions would appear to be one of the first diagnostic findings.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España.
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta de Hierro, Madrid, España
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
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Chakera AH, Quinn MJ, Lo S, Drummond M, Haydu LE, Bond JS, Stretch JR, Saw RPM, Lee KJ, McCarthy WH, Scolyer RA, Thompson JF. Subungual Melanoma of the Hand. Ann Surg Oncol 2018; 26:1035-1043. [DOI: 10.1245/s10434-018-07094-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Indexed: 01/06/2023]
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10
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Ozdemir F, Errico MA, Yaman B, Karaarslan I. Acral lentiginous melanoma in the Turkish population and a new dermoscopic clue for the diagnosis. Dermatol Pract Concept 2018; 8:140-148. [PMID: 29785333 PMCID: PMC5955083 DOI: 10.5826/dpc.0802a14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/07/2018] [Indexed: 11/19/2022] Open
Abstract
Background The incidence of acral lentiginous melanoma (ALM) in the white population is low. Dermoscopy enhances diagnosis of ALM; however, diagnostic accuracy may sometimes be poor due to the considerable proportion of amelanotic ALM variants. Objectives To calculate the proportion of ALM among all melanoma subtypes and to determine the frequency of dermoscopic features of ALM in the Turkish population. Methods Out of 612 melanomas, there were 70 cases of ALM, of which 46 showed sufficient image quality for retrospective study of dermoscopic features. Data from patients and their lesions was classified according to clinical features and histopathologic parameters. The dermoscopic variables evaluated were based on pertinent literature on dermoscopy of acral melanocytic neoplasms. Results The prevalence of ALM among all melanoma subtypes was 11.4%. Parallel-ridge pattern (PRP) was detected in 60.8% of cases and irregular diffuse pigmentation (IDP) in 28.3%. The ALMs were amelanotic in 24%, showing an atypical vascular pattern in all cases; a new dermoscopic pattern, named “vascularized parallel-ridge pattern” (VPRP), was detected in 13% of ALMs. Irregular lines were observed in 81.8% of subungual melanomas and were often associated with a multicolored background. Conclusions ALM has site-specific dermoscopic patterns, with PRP being the most prevalent pattern. The newly described VPRP pattern may be an additional clue for ALM diagnosis, especially in thin amelanotic melanomas.
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Affiliation(s)
- Fezal Ozdemir
- Ege University, Medical Faculty, Dermato-Oncology Unit, Department of Dermatology, Izmir, Turkey
| | - Micol A Errico
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Banu Yaman
- Ege University, Medical Faculty, Department of Pathology, Izmir, Turkey
| | - Isil Karaarslan
- Ege University, Medical Faculty, Dermato-Oncology Unit, Department of Dermatology, Izmir, Turkey
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11
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Han SS, Kim MS, Lim W, Park GH, Park I, Chang SE. Classification of the Clinical Images for Benign and Malignant Cutaneous Tumors Using a Deep Learning Algorithm. J Invest Dermatol 2018; 138:1529-1538. [PMID: 29428356 DOI: 10.1016/j.jid.2018.01.028] [Citation(s) in RCA: 273] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/21/2018] [Accepted: 01/26/2018] [Indexed: 01/04/2023]
Abstract
We tested the use of a deep learning algorithm to classify the clinical images of 12 skin diseases-basal cell carcinoma, squamous cell carcinoma, intraepithelial carcinoma, actinic keratosis, seborrheic keratosis, malignant melanoma, melanocytic nevus, lentigo, pyogenic granuloma, hemangioma, dermatofibroma, and wart. The convolutional neural network (Microsoft ResNet-152 model; Microsoft Research Asia, Beijing, China) was fine-tuned with images from the training portion of the Asan dataset, MED-NODE dataset, and atlas site images (19,398 images in total). The trained model was validated with the testing portion of the Asan, Hallym and Edinburgh datasets. With the Asan dataset, the area under the curve for the diagnosis of basal cell carcinoma, squamous cell carcinoma, intraepithelial carcinoma, and melanoma was 0.96 ± 0.01, 0.83 ± 0.01, 0.82 ± 0.02, and 0.96 ± 0.00, respectively. With the Edinburgh dataset, the area under the curve for the corresponding diseases was 0.90 ± 0.01, 0.91 ± 0.01, 0.83 ± 0.01, and 0.88 ± 0.01, respectively. With the Hallym dataset, the sensitivity for basal cell carcinoma diagnosis was 87.1% ± 6.0%. The tested algorithm performance with 480 Asan and Edinburgh images was comparable to that of 16 dermatologists. To improve the performance of convolutional neural network, additional images with a broader range of ages and ethnicities should be collected.
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Affiliation(s)
| | - Myoung Shin Kim
- Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Woohyung Lim
- SK Telecom, Human Machine Interface Technology Laboratory, Seoul, Korea
| | - Gyeong Hun Park
- Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Dongtan, Korea
| | - Ilwoo Park
- Department of Radiology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.
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12
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Teramoto Y, Keim U, Gesierich A, Schuler G, Fiedler E, Tüting T, Ulrich C, Wollina U, Hassel JC, Gutzmer R, Goerdt S, Zouboulis C, Leiter U, Eigentler TK, Garbe C. Acral lentiginous melanoma: a skin cancer with unfavourable prognostic features. A study of the German central malignant melanoma registry (CMMR) in 2050 patients. Br J Dermatol 2018; 178:443-451. [PMID: 28707317 DOI: 10.1111/bjd.15803] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acral lentiginous melanoma (ALM) is one of the four major subtypes in cutaneous melanoma (CM). Although ALM has a poorer prognosis than other CM subtypes, the prognostic factors associated with ALM have only been verified in small-sized cohorts because of the low incidence of ALM worldwide. OBJECTIVES To investigate the clinical characteristics of ALM and to evaluate their prognostic values based on a large dataset from the Central Malignant Melanoma Registry (CMMR) of the German Dermatologic Society. METHODS The Kaplan-Meier method was used to estimate the potential influence of clinical and histological parameters on ALM disease-specific survival (DSS) curves, which were compared using the log-rank test. A Cox proportional hazards model was used to identify independent prognostic factors for DSS. RESULTS In total, 2050 patients with ALM were identified from 58 949 patients with CM recorded by the CMMR with follow-up data. In multivariate analyses, age (P = 0·006), ulceration (P = 0·013), tumour thickness (P < 0·001) and tumour spread (P < 0·001) turned out to be significant prognostic factors for DSS in ALM whereas sex, nevus association and level of invasion were not independent factors. CONCLUSIONS ALM has the same prognostic factors as other subtypes of melanoma. Unfavourable prognosis probably derives from the delay in diagnosis in comparison with other melanoma subtypes.
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Affiliation(s)
- Y Teramoto
- Division for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
- Department of Skin Oncology/Dermatology, Comprehensive Cancer Centre, Saitama Medical University International Medical Centre, Saitama, Japan
| | - U Keim
- Division for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
- Central Malignant Melanoma Registry, University Hospital Tuebingen, Tuebingen, Germany
| | - A Gesierich
- Department of Dermatology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - G Schuler
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - E Fiedler
- Skin Cancer Centre, Department of Dermatology, University Hospital Halle, Halle, Germany
| | - T Tüting
- Department of Dermatology, University Hospital Magdeburg, Magdeburg, Germany
| | - C Ulrich
- Skin Cancer Centre, Department of Dermatology, Charité Berlin, Berlin, Germany
| | - U Wollina
- Department of Dermatology and Allergology, Hospital Dresden Friedrichsstadt, Dresden, Germany
| | - J C Hassel
- Department of Dermatology and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - R Gutzmer
- Skin Cancer Centre, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - S Goerdt
- Department of Dermatology, University Hospital Mannheim, Mannheim, Germany
| | - C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Centre, Medical University of Brandenburg, Dessau, Germany
| | - U Leiter
- Division for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - T K Eigentler
- Division for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - C Garbe
- Division for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
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13
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Starace M, Dika E, Fanti P, Patrizi A, Misciali C, Alessandrini A, Bruni F, Piraccini B. Nail apparatus melanoma: dermoscopic and histopathologic correlations on a series of 23 patients from a single centre. J Eur Acad Dermatol Venereol 2017; 32:164-173. [DOI: 10.1111/jdv.14568] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 07/31/2017] [Indexed: 11/29/2022]
Affiliation(s)
- M. Starace
- Dermatology; Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - E. Dika
- Dermatology; Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - P.A. Fanti
- Dermatology; Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - A. Patrizi
- Dermatology; Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - C. Misciali
- Dermatology; Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - A. Alessandrini
- Dermatology; Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - F. Bruni
- Dermatology; Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - B.M. Piraccini
- Dermatology; Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
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14
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Kim JY, Kim MB, Park BC, Chung KY, Kim YC, Yun SJ, Won CH, Han MH, Lee WK, Lee SJ. Proximal nail plate destruction in subungual melanoma could be a possible predictor of invasiveness thicker than 1.25 mm. J Dermatol 2017; 45:83-86. [DOI: 10.1111/1346-8138.14027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 07/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jun Young Kim
- Department of Dermatology; Kyungpook National University School of Medicine; Daegu Korea
| | - Moon-Bum Kim
- Department of Dermatology; Pusan National University School of Medicine; Busan Korea
| | - Byung Cheol Park
- Department of Dermatology; College of Medicine; Dankook University; Cheonan Korea
| | - Kee Yang Chung
- Department of Dermatology; Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - You Chan Kim
- Department of Dermatology; Ajou University School of Medicine; Suwon Korea
| | - Sook Jung Yun
- Department of Dermatology; Chonnam National University Medical School; Gwangju Korea
| | - Chong Hyun Won
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Man-Hoon Han
- Department of Pathology; Kyungpook National University School of Medicine; Daegu Korea
| | - Won Kee Lee
- Center of Biostatistics; Kyungpook National University School of Medicine; Daegu Korea
| | - Seok-Jong Lee
- Department of Dermatology; Kyungpook National University School of Medicine; Daegu Korea
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15
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Abstract
Nail neoplasms include all tumors occurring in the nail or periungual apparatus tissue. While some nail tumors can be similar to tumors located on the skin, others are unique. Both benign and malignant lesions can affect the nail apparatus. In particular, early malignant tumors like melanoma and squamous cell carcinoma can present similarly to onychomycosis or benign melanonychia and frequently missed by clinicians. Therefore, physicians should be aware of nail structures and the characteristics of nail tumors. Our review covers the normal nail structure and the most common nail tumors from benign to malignant.
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Affiliation(s)
- Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Noori Kim
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Acral Melanoma in Chinese: A Clinicopathological and Prognostic Study of 142 cases. Sci Rep 2016; 6:31432. [PMID: 27545198 PMCID: PMC4992860 DOI: 10.1038/srep31432] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/19/2016] [Indexed: 01/09/2023] Open
Abstract
Acral melanoma (AM), as a peculiar subgroup of melanoma, is rare in Caucasians but has higher incidence in Asians. Large series of study on AM with clinicopathological features and prognostic factors is still limited, especially in Asian population. We retrospectively collected clinical, pathological and follow-up data of 142 AM cases. All patients were Chinese, with the age ranging from 24 to 87 years (mean 62.0; median 62.0). The Breslow thickness of primary lesions ranged from 0.6 to 16.3 mm (mean 4.9; median 3.7). 85.9% of the patients had acral lentiginous histologic subtype. Plantar was the most frequently involved site, followed by heels. Statistically, duration of the lesion before diagnosis (≤2.5 years), Breslow thickness >4.0 mm (T4), high mitotic index (>15 mm−2), presence of vascular invasion, regional lymph node metastasis at diagnosis and pathologic stage (II/III/IV) were found to be independent prognostic factors in both univariate and multivariate analyses. The prognosis of AM in Chinese is extremely poor. Our 5- and 10-year disease-specific survival (DSS) rates were 53.3% and 27.4%, respectively. Therefore, AM in Asians represents a more biologically aggressive melanoma subtype and is thought to carry a worse prognosis when compared with other races or cutaneous melanomas in other anatomic sites.
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Harada K, Mine S, Yamada K, Shigaki H, Oya S, Baba H, Watanabe M. Long-term outcome of esophagectomy for primary malignant melanoma of the esophagus: a single-institute retrospective analysis. Dis Esophagus 2016; 29:314-9. [PMID: 25708974 DOI: 10.1111/dote.12331] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary malignant melanoma of the esophagus (PMME) is a highly malignant tumor with a poor prognosis. Because PMME is an extremely rare disease, therapeutic strategies against the tumor have yet to be established, and the efficacy of esophagectomy remains unclear. The objective of this study was to evaluate the post-esophagectomy survival of PMME patients. Ten patients who underwent esophagectomy for PMME between March 2005 and April 2013 at the Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan, were identified from the institutional database. We retrospectively retrieved clinical information and data on the long-term outcomes from the patients' records. Survival rates after esophagectomy were calculated by the Kaplan-Meier method, and the hazard ratios of mortality were determined using the Cox's model. A follow-up study of the 10 patients revealed 7 cancer recurrences and 5 deaths. Median survival time was 34.5 months, and 5 of 10 patients survived longer than 2 years. The 1-year disease-free survival rate was 40%, and the 1- and 3-year overall survival rates were 70% and 60%, respectively. Importantly, all three of the non-relapsing patients were histologically confirmed as free of lymph node involvement. The four patients with lymph node metastasis relapsed within 1 year. The disease-free survival was significantly shorter in patients with lymph node involvement than in those without lymph node involvement (univariate hazard ratio = 13.3, 95% confidence interval 1.85-266.4; P = 0.009). In conclusion, esophagectomy might benefit PMME patients with no lymph node metastasis. Further large-scale cohort studies are needed to establish the treatment strategy for PMME.
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Affiliation(s)
- K Harada
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan.,Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - S Mine
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - K Yamada
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - H Shigaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - S Oya
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - M Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
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Lee WJ, Lee JH, Won CH, Chang SE, Choi JH, Moon KC, Lee MW. Nail apparatus melanoma: A comparative, clinicoprognostic study of the initial clinical and morphological characteristics of 49 patients. J Am Acad Dermatol 2015; 73:213-20. [DOI: 10.1016/j.jaad.2015.04.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 02/09/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
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Boni A, Chu EY, Rubin AI. Routine nail clipping leads to the diagnosis of amelanotic nail unit melanoma in a young construction worker. J Cutan Pathol 2015; 42:505-9. [PMID: 26272255 DOI: 10.1111/cup.12558] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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20
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Kim JH, Park JH, Lee DY. Site distribution of cutaneous melanoma in South Korea: a retrospective study at a single tertiary institution. Int J Dermatol 2014; 54:e38-9. [DOI: 10.1111/ijd.12572] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jun-Hwan Kim
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Ji-Ho Park
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Dong-Youn Lee
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
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De Giorgi V, Saggini A, Grazzini M, Gori A, Rossari S, Scarfì F, Verdelli A, Chimenti S, Lotti T, Massi D. Specific challenges in the management of subungual melanoma. Expert Rev Anticancer Ther 2014; 11:749-61. [DOI: 10.1586/era.10.216] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fanti PA, Dika E, Misciali C, Vaccari S, Barisani A, Piraccini BM, Cavrin G, Maibach HI, Patrizi A. Nail apparatus melanoma: is trauma a coincidence? Is this peculiar tumor a real acral melanoma? Cutan Ocul Toxicol 2013; 32:150-3. [PMID: 23153047 DOI: 10.3109/15569527.2012.740118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Nail Apparatus Melanoma (NAM) is rare, particularly in Caucasians. Understanding its pathogenesis and collecting epidemiologic data may be difficult due to its location and the exiguity of the case series of this cancer. Cutaneous melanoma has been thought related to UV radiation, and NAM is considered an acral variant of melanoma, even if the nail presents a specific anatomy. Little is reported about pathogenesis, except reports suggesting traumatic injuries as a causal factor. UV exposure is debated in nail melanoma because of its structure. The nail is, in fact, a unique structure with sun-exposed and non exposed melanocytes. NAM arises from the nail melanocytes, located in the nail matrix, which is the germinative part of the nail and composed of a proximal and distal portion. The proximal nail matrix lays under the proximal nail fold that covers it and is non-sun exposed, while the distant nail matrix, clinically visible as the lunula, is sun-exposed, though lying underneath the nail plate. According to these anatomical data, NAM is a distinct melanoma type, and studies need to classify it as acral melanoma or as a particular type of melanoma with its own pathogenesis and prognostic criteria. This study investigates potential risk factors of NAM, emphasizing (i) trauma and (ii) UV exposure among our NAM patients.
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Affiliation(s)
- P A Fanti
- Internal Medicine Aging and Nephrologic Disease Department, Dermatology Division, Ospedale Sant'Orsola-Malpighi, Università degli Studi di Bologna, Bologna, Italy
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Subungual acrolentiginous amelanotic melanoma treated with amputation of the distal and middle phalanges. Wien Med Wochenschr 2013; 163:368-71. [PMID: 23591855 DOI: 10.1007/s10354-013-0194-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 03/13/2013] [Indexed: 10/26/2022]
Abstract
Acral lentiginous melanoma (ALM) is an uncommon melanoma type among Caucasions. ALM bears an unfavorable prognosis because of late presentation or common misdiagnosis. Amelanotic variants, albeit rare, may pose an additional clinical challenge and may further delay the diagnosis and treatment. Thus, the threshold for biopsying even marginally suspicious lesions should be low. We present two cases of Caucasian patients with amelanotic subungual ALM, stage 2a and 2c respectively, successfully treated with a functional amputation.
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Nakayama S, Yokote T, Iwaki K, Akioka T, Miyoshi T, Hirata Y, Takayama A, Nishiwaki U, Masuda Y, Tsuji M, Hanafusa T. A rare case of primary clear cell sarcoma of the pubic bone resembling small round cell tumor: an unusual morphological variant. BMC Cancer 2012; 12:538. [PMID: 23170958 PMCID: PMC3517754 DOI: 10.1186/1471-2407-12-538] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 11/19/2012] [Indexed: 11/18/2022] Open
Abstract
Background Clear cell sarcoma (CCS) and malignant melanoma share overlapping immunohistochemistry with regard to the melanocytic markers HMB45, S100, and Melan-A. However, the translocation t(12; 22)(q13; q12) is specific to CCS. Therefore, although these neoplasms are closely related, they are now considered to be distinct entities. However, the translocation is apparently detectable only in 50%–70% of CCS cases. Therefore, the absence of a detectable EWS/AFT1 rearrangement may occasionally lead to erroneous exclusion of a translocation-negative CCS. Therefore, histological assessment is essential for the correct diagnosis of CCS. Primary CCS of the bone is exceedingly rare. Only a few cases of primary CCS arising in the ulna, metatarsals, ribs, radius, sacrum, and humerus have been reported, and primary CCS arising in the pubic bone has not been reported till date. Case presentation We present the case of an 81-year-old man with primary CCS of the pubic bone. Histological examination of the pubic bone revealed monomorphic small-sized cells arranged predominantly as a diffuse sheet with round, hyperchromatic nuclei and inconspicuous nucleoli. The cells had scant cytoplasm, and the biopsy findings indicated small round cell tumor (SRCT). Immunohistochemical staining revealed the tumor cells to be positive for HMB45, S100, and Melan-A but negative for cytokeratin (AE1/AE3) and epithelial membrane antigen. To the best of our knowledge, this is the first case report of primary CCS of the pubic bone resembling SRCT. This ambiguous appearance underscores the difficulties encountered during the histological diagnosis of this rare variant of CCS. Conclusion Awareness of primary CCS of the bone is clinically important for accurate diagnosis and management when the tumor is located in unusual locations such as the pubic bone and when the translocation t(12; 22)(q13; q12) is absent.
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Affiliation(s)
- Shoko Nakayama
- Department of Internal Medicine I, Osaka Medical College, 2-7 Daigakumachi, Takatsuki City, Osaka 569-0801, Japan.
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Yu H, Huang XY, Li Y, Xie X, Zhou JL, Zhang LJ, Fu JH, Wang X. Primary malignant melanoma of the esophagus: a study of clinical features, pathology, management and prognosis. Dis Esophagus 2011; 24:109-13. [PMID: 21040150 DOI: 10.1111/j.1442-2050.2010.01111.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary malignant melanoma of the esophagus (PMME) is a rare disease that is characterized by aggressive invasion, early metastasis, and poor prognosis. Treatment protocols are not well-established. To understand this condition more precisely, we performed a retrospective review of eight cases of PMME diagnosed at the Thoracic Department of the Cancer Center at Sun Yat-Sen University between 1985 and 2009. Eight PMME patients (five men and three women) with a mean age of 58 years (range: 48 to 72 years) were included. Dysphagia was the most common presenting symptom. All patients underwent an Ivor-Lewis esophagogastrectomy and lymph node dissection with postoperative adjuvant chemotherapy. One patient with stage III/pT4N0M0 underwent postoperative chemotherapy plus radiotherapy. Four patients died of distant metastases. The median survival time was 28 months (range: 11 months to 6 years). Our data confirm that PMME is a highly aggressive disease with a poor prognosis. If the diagnosis is suspected or confirmed as PMME, and the patients have no distal metastases or extensive lymph node enlargement, we suggest that surgery should be the first choice of treatment. With regard to adjuvant therapy, we recommend the addition of chemotherapy. The role of radiotherapy remains questionable and requires further investigation.
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Affiliation(s)
- H Yu
- State Key Laboratory of Oncology in South China, Department of Thoracic Surgery, Cancer Center, Sun Yat-Sen University, Guangzhou, China
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Rex J, Paradelo C, Mangas C, Hilari JM, Fernández-Figueras MT, Ferrándiz C. Management of Primary Cutaneous Melanoma of the Hands and Feet. Dermatol Surg 2009; 35:1505-13. [DOI: 10.1111/j.1524-4725.2009.01265.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lichte V, Breuninger H, Metzler G, Haefner H, Moehrle M. Acral lentiginous melanoma: conventional histology vs. three-dimensional histology. Br J Dermatol 2009; 160:591-9. [DOI: 10.1111/j.1365-2133.2008.08954.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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30
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Shin S, Palis BE, Phillips JL, Stewart AK, Perry RR. Cutaneous melanoma in Asian-Americans. J Surg Oncol 2009; 99:114-8. [PMID: 19034932 DOI: 10.1002/jso.21195] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is little information available on melanoma in non-white populations. Our objective was to characterize melanoma in Asian-Americans (AsA) and compare patient demographics and tumor characteristics with the non-Hispanic White (NHW) population. METHODS 483,050 cutaneous melanoma patients diagnosed between 1986 and 2005 were identified using the National Cancer Data Base (NCDB); 1,237 were AsA, and 409,564 were NHW. Age, gender, site, histologic type, tumor thickness, AJCC stage, and survival were compared. RESULTS AsA were more likely to be diagnosed with acral lentiginous tumors (6.7%) than NHW (0.8%, P < 0.001). A greater proportion of AsA were diagnosed with T4 tumors (15.6%) than NHW (8.5%, P < 0.001). AsA presented with fewer early stage I-II tumors and more late stage III-IV tumors than NHW (P < 0.001). Survival was similar for AsA and NHW. CONCLUSIONS This is the largest study to date on melanoma in AsA. Compared to NHW, AsA are more likely to have acral lentinginous tumors, thick tumors, and higher stage. Despite this, their survival is similar to the NHW population.
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Affiliation(s)
- Susanna Shin
- Department of Surgery, Division of Surgical Oncology, Eastern Virginia Medical School, Norfolk, VA, USA
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31
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KATO T, TABATA N, SUETAKE T, TAGAMI H. Non-pigmented modular plantar melanoma in 12 Japanese patients. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1997.d01-1170.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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32
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Cohen T, Busam KJ, Patel A, Brady MS. Subungual melanoma: management considerations. Am J Surg 2008; 195:244-8. [DOI: 10.1016/j.amjsurg.2007.03.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 03/20/2007] [Accepted: 03/20/2007] [Indexed: 10/22/2022]
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De Giorgi V, Sestini S, Massi D, Panelos J, Papi F, Dini M, Lotti T. Subungual melanoma: a particularly invasive "onychomycosis". J Am Geriatr Soc 2008; 55:2094-6. [PMID: 18081682 DOI: 10.1111/j.1532-5415.2007.01438.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kawada K, Kawano T, Nagai K, Nishikage T, Nakajima Y, Tokairin Y, Ogiya K, Tanaka K, Iwai T. Local injection of interferon beta in malignant melanoma of the esophagus as adjuvant of systemic pre- and postoperative DAV chemotherapy: case report with 7 years of long-term survival. Gastrointest Endosc 2007; 66:408-10. [PMID: 17643724 DOI: 10.1016/j.gie.2006.05.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Accepted: 05/22/2006] [Indexed: 02/08/2023]
Affiliation(s)
- Kenro Kawada
- Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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35
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Malignant Melanoma in the 21st Century, Part 1: Epidemiology, Risk Factors, Screening, Prevention, and Diagnosis. Mayo Clin Proc 2007. [PMID: 17352373 DOI: 10.1016/s0025-6196(11)61033-1] [Citation(s) in RCA: 267] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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36
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Markovic SN, Erickson LA, Rao RD, Weenig RH, Pockaj BA, Bardia A, Vachon CM, Schild SE, McWilliams RR, Hand JL, Laman SD, Kottschade LA, Maples WJ, Pittelkow MR, Pulido JS, Cameron JD, Creagan ET. Malignant melanoma in the 21st century, part 1: epidemiology, risk factors, screening, prevention, and diagnosis. Mayo Clin Proc 2007; 82:364-80. [PMID: 17352373 DOI: 10.4065/82.3.364] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Malignant melanoma is an aggressive, therapy-resistant malignancy of melanocytes. The incidence of melanoma has been steadily increasing worldwide, resulting in an increasing public health problem. Exposure to solar UV radiation, fair skin, dysplastic nevi syndrome, and a family history of melanoma are major risk factors for melanoma development. The interactions between genetic and environmental risk factors that promote melanomagenesis are currently the subject of ongoing research. Avoidance of UV radiation and surveillance of high-risk patients have the potential to reduce the population burden of melanoma. Biopsies of the primary tumor and sampling of draining lymph nodes are required for optimal diagnosis and staging. Several clinically relevant pathologic subtypes have been identified and need to be recognized. Therapy for early disease is predominantly surgical, with a minor benefit noted with the use of adjuvant therapy. Management of systemic melanoma is a challenge because of a paucity of active treatment modalities. In the first part of this 2-part review, we discuss epidemiology, risk factors, screening, prevention, and diagnosis of malignant melanoma. Part 2 (which will appear in the April 2007 issue) will review melanoma staging, prognosis, and treatment.
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Affiliation(s)
- Svetomir N Markovic
- Division of Hematology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA
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Furukawa H, Tsutsumida A, Yamamoto Y, Sasaki S, Sekido M, Fujimori H, Sugihara T. Melanoma of thumb: Retrospective study for amputation levels, surgical margin and reconstruction. J Plast Reconstr Aesthet Surg 2007; 60:24-31. [PMID: 17126263 DOI: 10.1016/j.bjps.2006.01.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Revised: 01/15/2006] [Accepted: 01/28/2006] [Indexed: 11/20/2022]
Abstract
For the treatment of melanoma of thumb, the evidence about amputation level (IP joint or MP joint) and cutaneous excision margin has not been fully presented. And reconstructions for lost thumbs need to be balanced against functional and aesthetic requirements of individual patients and overall prognosis. We report 15 patients, who underwent primary excision and reconstruction for thumb melanoma between 1986 and 2004 at Department of Plastic and Reconstructive Surgery, University of Hokkaido at Sapporo, Graduate School of Medicine. The patients were reviewed to evaluate the prognostic significance of variables including age and sex of the patient, tumour thickness, staging, level of amputation, and cutaneous excision margin. Our 15 cases were divided into two groups according to amputation level (MP or IP) and cutaneous excision margin (<40 mm or >or =40 mm) and prognosis was analysed statistically. The stage and thickness were identified as prognostic factors for disease-free survival; however, IP amputation and 10-30 mm margin did not compromise disease-free survival. Amputated thumb was reconstructed by pollicization, free toe to thumb transfer, reverse forearm flap, local flap, and skin graft. No major complication of reconstructed thumb occurred. Seven of eight cases of MP amputation were reconstructed by pollicization. On the other hand, five cases of IP amputation were reconstructed by volar skin flap in two cases, reverse forearm flap in two cases, and trimmed first toe transfer in one case. Although a small number of cases, our study is the first attempt focussing on melanoma of thumb, and evaluating amputation level and cutaneous margin separately. The reconstructive algorithm for the amputated thumb is proposed and has various tools including free toe to thumb transfer.
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Affiliation(s)
- Hiroshi Furukawa
- Department of Plastic and Reconstructive Surgery, University of Hokkaido at Sapporo, Graduate School of Medicine, Kita-15 Nishi-7, Kita-Ku, Sapporo, 060-8638, Japan.
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Abstract
Nail pigmentation is defined by the presence of melanin in the nail plate. It most frequently has the appearance of a longitudinal pigmented band, called longitudinal mel-anonychia (LM). LM is an important aspect of ungual pathology because it can be the first sign of nail apparatus melanoma. The aim of this article is to help distinguish those types of melanonychia that are worrisome and should lead to biopsy from those that are reasonably reassuring and need only be followed clinically. Histology, differential diagnosis, and biopsy techniques also are considered.
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Affiliation(s)
- Josette André
- Department of Dermatology, CHU Saint-Pierre, Brugmann, HUDERF, 129, Bd de Waterloo, B-1000 Brussels, Free University of Brussels, Belgium.
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Regressed Subungual Melanoma Simulating Cellular Blue Nevus. Dermatol Surg 2006. [DOI: 10.1097/00042728-200604000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Nathaniel J Jellinek
- Assistant Professor, Department of Dermatology, Brown Medical School, Providence, Rhode Island, USA
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Soufir N, Lacapere JJ, Bertrand G, Matichard E, Meziani R, Mirebeau D, Descamps V, Gérard B, Archimbaud A, Ollivaud L, Bouscarat F, Baccard M, Lanternier G, Saïag P, Lebbé C, Basset-Seguin N, Crickx B, Cave H, Grandchamp B. Germline mutations of the INK4a-ARF gene in patients with suspected genetic predisposition to melanoma. Br J Cancer 2004; 90:503-9. [PMID: 14735200 PMCID: PMC2409576 DOI: 10.1038/sj.bjc.6601503] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Germline anomalies of the INK4a-ARF and Cdk4 genes were sought in a series of 89 patients suspected of having a genetic predisposition to melanoma. Patients were selected based on the following criteria: (a) familial melanoma (23 cases), (b) multiple primary melanoma (MPM; 18 cases), (c) melanoma and additional unrelated cancers (13 cases), (d) age at diagnosis less than 25 years (21 cases), and (e) nonphoto-induced melanoma (NPIM; 14 cases). Mutations of INK4a-ARF and Cdk4 were characterised by automated sequencing, and germline deletions of INK4a-ARF were also examined by real-time quantitative PCR. Seven germline changes of INK4a-ARF, five of which were novel, were found in seven patients (8%). Four were very likely to be pathogenic mutations and were found in three high-risk melanoma families and in a patient who had a pancreatic carcinoma in addition to melanoma. Three variants of uncertain significance were detected in one MPM patient, one patient <25 years, and one NPIM patient. No germline deletion of INK4a-ARF was found in 71 patients, and no Cdk4 mutation was observed in the 89 patients. This study confirms that INK4a-ARF mutations are infrequent outside stringent familial criteria, and that germline INK4a-ARF deletions are rarely involved in genetic predisposition to melanoma.
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Affiliation(s)
- N Soufir
- Laboratoire de Biochimie Hormonale et Génétique, Hôpital Bichat-Claude Bernard, 46 rue henri Huchard, Paris 75018, France.
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Parodi PC, Scott CA, De Biasio F, Pezzini I, Pertoldi B, Beltrami CA. Desmoplastic melanoma of the nail. Ann Plast Surg 2003; 50:658-62. [PMID: 12783025 DOI: 10.1097/01.sap.0000041481.21471.a9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Desmoplastic melanoma represents a variant of melanoma that is difficult to diagnose because 71% of patients have amelanotic skin lesions. In the acral region of the limbs, the clinical diagnosis is more difficult, especially in cases in which there are not clear, rapidly growing, pigmented nail streaks. Histopathological identification of desmoplastic melanoma is confusing because of the intense fibrous reaction in the dermis and minimal, atypical melanocytic proliferation at the dermal-epidermal junction. For these reasons, it is still misdiagnosed unfortunately as a variety of entities, including simple scar, fibrohistiocytic neoplasms, neural tumors, and superficial fibromatoses-with potentially devastating consequences. In equivocal cases, the use of immunohistochemistry (in particular S-100 and neuron-specific enolase) may be helpful in establishing the diagnosis. Because of the high local recurrence rate for desmoplastic melanoma of the finger, amputation is recommended in an effort to gain effective tumor control. Lymph node dissection may be reserved for patients with positive axillary nodes.
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Affiliation(s)
- Pier Camillo Parodi
- Department of Plastic and Reconstructive Surgery, University of Udine School of Medicine, Ferrara, Italy
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Johnson DS, Yamane S, Morita S, Yonehara C, Wong JH. Malignant melanoma in non-Caucasians: experience from Hawaii. Surg Clin North Am 2003; 83:275-82. [PMID: 12744610 DOI: 10.1016/s0039-6109(02)00093-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Data from the Hawaii Tumor Registry suggest that the incidence of melanoma in the non-Caucasian population of Hawaii is not substantially different from that of the remainder of the United States. Our experience indicates that melanoma in this population, although unusual, is not rare. Although lesions on the palms and soles are more common. as are subungal melanomas, primary tumors on other skin sites account for the majority of patients with cutaneous melanoma in the non-Caucasian population. The substantial difference in primary tumor thickness suggests the reported poorer outcomes for non-Caucasian patients with cutaneous melanoma may be explained, at least in part, by a delay in diagnosis. Given the evidence that preventive measures and educational efforts have dramatically impacted the diagnosis and outcome of melanoma patients, it is critical to recognize that similar efforts should be directed at the non-Caucasian population.
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Affiliation(s)
- David Scott Johnson
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, 1356 Lusitana Street, 6th Floor, Honolulu, HI 96813, USA
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Abstract
This article describes melanoma as an important health concern because of its rapid and continuous growth in many parts of the world. In the United States, a persistent increase in incidence is seen, which has started to slow in recent years. In some countries, differing trends are seen in younger people, with incidence and mortality rates leveling off or decreasing in this population. This article describes that despite this leveling off, melanoma incidence is likely to continue to rise in the near future, because rates are still increasing in older people who comprise most of those afflicted with melanoma.
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Affiliation(s)
- Caroline Bevona
- Department of Dermatology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Bali D, Casanova D, Aharoni C, Mutaftschiev N, Cilirie K, Legré R. [Longitudinal melanic nail bands (melanonychia): report of 22 cases]. CHIRURGIE DE LA MAIN 2002; 21:225-34. [PMID: 12357688 DOI: 10.1016/s1297-3203(02)00117-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Longitudinal melanonychia is a diagnostic and treatment problem for the surgeon. Fear of melanoma most frequently leads to total excision of nail bed, matrix and plate. METHOD Twenty two patients, aged from 7 to 77, were operated on from 89 to 98 in our department, using different techniques (total matrix biopsy, total excision of melanonichia with direct suture, Schernberg flap). RESULTS Thumb and index are predominant locations (11 out of 16). No malignant lesions were found histologically. Aesthetic sequellae were frequent and directly linked to the width and location of the melanonychia. Limited matrix biopsy produce the best aesthetic result. DISCUSSION Malignant lesions are rare and our series is short. Therefore an additional multicentric study is required. Our choice is to make a limited matrix biopsy in the first place with a minimal aesthetic prejudice. Histology determines the treatment choice: excision or follow up.
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Affiliation(s)
- D Bali
- Service de chirurgie plastique et réparatrice des membres, chirurgie de la main, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
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Matsutani T, Onda M, Miyashita M, Hagiwara N, Akiya Y, Takubo K, Yamashita K, Sasajima K. Primary malignant melanoma of the esophagus treated by esophagectomy and systemic chemotherapy. Dis Esophagus 2002; 14:241-4. [PMID: 11869329 DOI: 10.1046/j.1442-2050.2001.00193.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We describe herein a case of asymptomatic primary malignant melanoma of the esophagus. A 65-year-old man presented with a 4-cm filling defect in the middle third of the esophagus on a routine barium swallow. Subtotal esophagectomy accompanied by lymph node dissection was performed through a right thoracotomy. Postoperatively, the patient received five cycles of systemic chemotherapy with dacarbazine (DTIC), nimustine hydrochloride (ACNU), and vincristine (VCR) (DAV therapy), but ultimately died of generalized metastatic disease 15 months after surgery. Malignant melanoma of the esophagus has an extremely poor prognosis despite various therapeutic efforts.
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Affiliation(s)
- T Matsutani
- Department of Surgery I, Nippon Medical School, Tokyo, Japan.
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Cózar Ibáñez A, Jiménez Verdejo J, del Olmo Escribano M, Gómez Alvarez De Luna JL. [Subungueal amelanotic melanoma]. Rev Clin Esp 2001; 201:673-4. [PMID: 11786140 DOI: 10.1016/s0014-2565(01)70945-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- A Cózar Ibáñez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General de Especialidades Ciudad de Jaén, Jaén
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