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Martín-Gorgojo A, Nagore E. Melanoma Arising in a Melanocytic Nevus. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:123-132. [PMID: 28818288 DOI: 10.1016/j.ad.2017.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/05/2017] [Accepted: 06/02/2017] [Indexed: 02/03/2023] Open
Abstract
The association of melanoma with a preexisting melanocytic nevus varies considerably between series, depending on whether the association is based on histological signs (4%-72%) or a clinically evident lesion (42%-85%). Histological association with a nevus correlates with favorable prognostic factors, whereas a clinical association correlates with unfavorable factors. In this review, we discuss the characteristics of nevus-associated melanoma from different perspectives: Whiteman's divergent pathway hypothesis for the development of cutaneous melanoma; and the factors involved in nevogenicity, including both the genetic and molecular factors involved in the development of the melanoma and its precursor lesions. Finally, a cumulative analysis of the 16 162 cases reported in the literature revealed that 29.8% of melanomas are histologically associated with a melanocytic nevus.
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Affiliation(s)
- A Martín-Gorgojo
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, España.
| | - E Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
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A clinicopathological analysis of 153 acral melanomas and the relevance of mechanical stress. Sci Rep 2017; 7:5564. [PMID: 28717212 PMCID: PMC5514126 DOI: 10.1038/s41598-017-05809-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/02/2017] [Indexed: 12/14/2022] Open
Abstract
The pathogenesis of melanomas emerging in plantar surfaces remains unclear; however, mechanical stress has been reported to increase the formation of melanomas. In this study, we conducted a multicenter retrospective analysis of 153 acral melanomas diagnosed between 2000 and 2015 in Taiwan. The male-to-female ratio of the patients in question was 1:1.28, and the mean age at diagnosis was 68 years. We examined whether melanomas which developed in different areas of the patients' soles differed in their associations with various clinicopathological characteristics and survival. Testing by goodness of fit indicated that stress-bearing areas were significantly more conducive to the generation of melanomas than non-stress-bearing areas (P < 0.0001). More specifically, compared to the arch, the rear of the foot and front of the foot were significantly more conducive to the generation of melanomas (P < 0.0001 and P < 0.0001, respectively). The distribution pattern was not associated with differences in age, gender, right/left foot involvement, ulceration, mitosis, lymph node metastasis, tumor thickness, or stage. The overall, distant metastasis-free, and recurrence-free survival rates did not differ significantly between the stress-bearing and non-stress-bearing areas. Furthermore, while acral melanomas tended to develop on stress-bearing areas, the distribution pattern was not associated with the prognostic index or survival.
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Clinicopathological features and prognosis of patients with de novo versus nevus-associated melanoma in Taiwan. PLoS One 2017; 12:e0177126. [PMID: 28472158 PMCID: PMC5417671 DOI: 10.1371/journal.pone.0177126] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/21/2017] [Indexed: 11/19/2022] Open
Abstract
Studies surveying melanomas associated with melanocytic nevi in Asia are rare. In this study, we examined whether nevus-associated melanomas differ from de novo melanomas in terms of their associations with clinical factors, histologic characteristics, and patient survival in Taiwan. Using data on cancer cases obtained from the Department of Pathology archives and the Cancer Registry of National Taiwan University Hospital, we conducted a retrospective analysis of 103 consecutive melanoma patients who were diagnosed between 2010 and 2015 and received follow-up through November 2016. Approximately 17.5% of the melanomas in question were associated with a nevus. In patients under 65 years of age, non-acral lentiginous melanomas were significantly associated with a higher percentage of nevus-associated melanomas. The superficial spreading subtype, younger patient age, thinner tumor, intermittent solar exposure, and early stage were significant predictors of a melanoma being histologically associated with a nevus. The appearance of a nevus associated with a melanoma predicted better recurrence-free survival compared with de novo melanomas. Although acral lentiginous melanomas (70.9%) constituted the most common histologic subtype, only 9.6% of the acral lentiginous melanomas were associated with a nevus. Furthermore, there was no statistically significant difference between the nevus-associated and de novo acral lentiginous melanomas with regard to clinicopathological factors and survival. In conclusion, nevus-associated melanomas were uncommon among acral lentiginous melanomas. Relatedly, because over half of all melanomas in Asians are acral lentiginous melanomas, Asians are less likely than Caucasians to have nevus-associated melanomas.
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Shitara D, Tell-Martí G, Badenas C, Enokihara MMSS, Alós L, Larque AB, Michalany N, Puig-Butille JA, Carrera C, Malvehy J, Puig S, Bagatin E. Mutational status of naevus-associated melanomas. Br J Dermatol 2015; 173:671-80. [PMID: 25857817 DOI: 10.1111/bjd.13829] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND The origin of melanoma has always been a debated subject, as well as the role of adjacent melanocytic naevi. Epidemiological and histopathological studies point to melanomas arising either de novo or from a naevus. OBJECTIVES To evaluate the presence of mutations in genes from well-known melanomagenesis pathways in a large series of naevus-associated melanomas. MATERIALS AND METHODS Sixty-one melanomas found in association with a pre-existing naevus were microdissected, after careful selection of cell subpopulations, and submitted to Sanger sequencing of the BRAF, NRAS, c-KIT, PPP6C, STK19 and RAC1 genes. Each gene was evaluated twice in all samples by sequencing or by sequencing and another confirmation method, allele-specific fluorescent polymerase chain reaction (PCR) and capillary electrophoresis detection or by SNaPshot analysis. Only mutations confirmed via two different molecular methods or twice by sequencing were considered positive. RESULTS The majority of cases presented concordance of mutational status between melanoma and the associated naevus for all six genes (40 of 60; 66.7%). Nine cases presented concomitant BRAF and NRAS mutations, including one case in which both the melanoma and the adjacent naevus harboured V600E and Q61K double mutations. In two cases, both melanoma and associated naevus located on acral sites were BRAF mutated, including an acral lentiginous melanoma. CONCLUSIONS To our knowledge this is the largest naevus-associated melanoma series evaluated molecularly. The majority of melanomas and adjacent naevi in our sample share the same mutational profile, corroborating the theory that the adjacent naevus and melanoma are clonally related and that the melanoma originated within a naevus.
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Affiliation(s)
- D Shitara
- Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil.,Melanoma Unit, Dermatology, Biochemistry and Molecular Genetics Departments, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - G Tell-Martí
- Melanoma Unit, Dermatology, Biochemistry and Molecular Genetics Departments, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain.,CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - C Badenas
- Melanoma Unit, Dermatology, Biochemistry and Molecular Genetics Departments, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain.,CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - M M S S Enokihara
- Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil.,Department of Pathology, Federal University of São Paulo, São Paulo, Brazil
| | - L Alós
- Melanoma Unit, Pathology Service, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - A B Larque
- Melanoma Unit, Pathology Service, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - N Michalany
- Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil.,Department of Pathology, Federal University of São Paulo, São Paulo, Brazil
| | - J A Puig-Butille
- Melanoma Unit, Dermatology, Biochemistry and Molecular Genetics Departments, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain.,CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - C Carrera
- Melanoma Unit, Dermatology, Biochemistry and Molecular Genetics Departments, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain.,CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - J Malvehy
- Melanoma Unit, Dermatology, Biochemistry and Molecular Genetics Departments, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain.,CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - S Puig
- Melanoma Unit, Dermatology, Biochemistry and Molecular Genetics Departments, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain.,CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - E Bagatin
- Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil
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Shitara D, Nascimento MM, Puig S, Yamada S, Enokihara MMSS, Michalany N, Bagatin E. Nevus-associated melanomas: clinicopathologic features. Am J Clin Pathol 2014; 142:485-91. [PMID: 25239415 DOI: 10.1309/ajcp4l5cjgktjvdd] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES The clinical significance of nevus-associated melanoma compared with de novo melanomas remains controversial. It has been suggested that nevus-associated melanomas have a higher Breslow thickness and therefore worse prognosis. Over a 10-year period, this study evaluated the incidence of nevus-associated melanoma and its prognostic significance related to clinicopathologic features. METHODS Cross-sectional study from 1995 through 2004 in a dermatopathology referral center. With available data, we evaluated sex, primary location, histologic subtype, Breslow thickness, Clark level, presence of ulceration, associated lesion, and histologic subtype of the associated lesion. RESULTS Of 135,653 pathologic records from skin biopsy specimens over a 10-year period, 1,190 melanoma records were selected. Nevus-associated melanomas corresponded to 390 (32.8%) melanomas, with thin melanomas having a nevus 1.52 times the association observed with thick melanomas (>1.01 mm; 95% confidence interval, 1.16-1.99; P < .001). Superficial spreading melanoma was the most frequent, while no lentigo maligna melanoma was associated with nevi. The median Breslow thickness of nevus-associated melanomas was lower than that of de novo melanomas. CONCLUSIONS Nevus-associated melanomas, which represent one-third of the melanomas in southeast Brazil, are associated with intermittent sun exposure, superficial spreading melanomas, and lower Breslow thickness. This is one of the largest series describing nevus-associated melanomas in Latin America.
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Affiliation(s)
- Danielle Shitara
- From the Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil;
| | - Mauricio M Nascimento
- From the Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic of Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain and CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spainand
| | - Sérgio Yamada
- From the Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil
| | - Milvia M S S Enokihara
- From the Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil; Department of Pathology, Federal University of São Paulo, São Paulo, Brazil
| | - Nilceo Michalany
- From the Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil; Department of Pathology, Federal University of São Paulo, São Paulo, Brazil
| | - Ediléia Bagatin
- From the Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil
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