Malignant melanoma: a review

Molecular Mechanisms of Tumorgenesis and Metastasis of Long Non-coding RNA (lncRNA) NEAT1 in Human Solid Tumors; An Update

The expression of the nuclear paraspeckle assembly transcript 1 (NEAT1), as a well-known long non-coding RNA (lncRNA), is often upregulated in varied types of cancers and associated with poor survival outcomes in patients suffering from tumors. NEAT1 promotes the tumors growth by influencing the various genes' expression profile that regulate various aspects of tumor cell behavior, in particular tumor growth, metastasis and drug resistance. This suggests that NEAT1 are capable of serving as a new diagnostic biomarker and target for therapeutic intervention. Through interrelation with enhancer of zeste homolog 2 (EZH2), NEAT1 acts as a scaffold RNA molecule, and thus regulating the expression EZH2-associated genes. Additionally, by perform as miRNA sponge, it constrains suppressing the interactions between miRNAs-mediated degradation of target mRNAs. In light of this, NEAT1 inhibition by small interfering RNA (siRNA) hampers tumorgenesis. We summarize recent findings about the expression, biological functions, and regulatory process of NEAT1 in human tumors. It specifically emphasizes the clinical significance of NEAT1 as a novel diagnostic biomarker and a promising therapeutic mark for many types of cancers.

Uselessnes of Thermography for Diagnosis and Follow-Up of Cutaneous Malignant Melanoma

Thermography is useless for diagnosis of cutaneous malignant melanomas (CMM). In fact, false negative thermograms (29.9 %) are much more numerous than clinically suspicious cases. Thermography is useless for follow-up of CMM. False-negative and false-positive thermograms of metastatic lymph nodes, subcutaneous nodules and removal site of CMM are much too numerous.

Malignant melanoma in a patient with oculocutaneous albinism

BACKGROUND

Sun-induced malignancies (basal cell and squamous cell carcinomas) are common in oculocutaneous albinism, however, the incidence of malignant melanoma is a topic of controversy.

OBJECTIVE

We have reviewed the literature and report a case of a woman with oculocutaneous albinism with an amelanotic melanoma of the anterior chest wall.

RESULTS

There are only 26 previously reported cases (both case reports and African albino population studies) in 25 patients in the literature. A 27th case with immunohistochemical and ultrastructural evaluation is presented.

CONCLUSIONS

It appears that melanoma, a malignancy for which sun exposure and light colouration are felt to be major risk factors, has a low incidence among a population that is both hypopigmented and often exposed to high levels of ultraviolet light. This low incidence is poorly understood and frequently disputed.

Malignant melanoma of the vulva: a clinicopathologic study of 18 cases

In a study of 18 patients diagnosed with vulvar malignant melanoma between 1975 and 1991, the effect of clinical and pathologic variables on the survival was evaluated. The overall 5-year survival rate was 28.6%. In 14 cases the tumor was retrospectively microstaged with use of Breslow depth and Chung levels. International Federation of Gynecology and Obstetrics (FIGO) stage and Breslow depth did not correlate well with survival. Positivity of groin lymph nodes at initial surgery was associated with an insignificant worsening in survival. An inverse correlation, although statistically not significant, was demonstrated between advancing Chung levels and survival. It is concluded that since the data with respect to microstaging of vulvar malignant melanoma is, as yet, still limited, great caution should be used in electing less aggressive surgery than radical vulvectomy and bilateral groin lymphadenectomy for patients with early-microstage localized disease.

Effects of ultraviolet B light on cutaneous immune responses of humans with deeply pigmented skin

The incidence of skin cancers of the basal and squamous cell types is extremely low among genetically black-skinned human beings, whereas these types of skin cancers are common among Caucasians, especially those who live in geographic areas of high sun exposure. Ultraviolet B light (UVB) is thought to be the primary oncogenic agent in sunlight. We have recently demonstrated that acute, low-dose exposure of Caucasian skin to UVB impairs the induction of contact hypersensitivity to dinitrochlorobenzene (DNCB) in approximately 40% of normal individuals. Importantly, this trait--termed UVB susceptibility--was found to be a characteristic of virtually 100% of patients with a history of biopsy-proved skin cancer, implying that UVB susceptibility may be a risk factor for this disease. Because melanin pigment is thought to be protective of some of the deleterious effects of UVB radiation, we have examined the capacity of a low-dose regimen of UVB to alter induction of contact hypersensitivity in individuals with genetically melanized or heavily tanned skin. Our results indicate that UVB radiation depletes heavily pigmented skin of Langerhans cells, just as it does in Caucasian skin. Moreover, UVB-susceptibility exists as a polymorphic trait in individuals with genetically determined black skin, as well as in individuals with heavily tanned skin, and the incidence of this trait is similar to that found among normal Caucasian subjects. Thus, melanin does not appear to protect against the deleterious effects of an acute, low-dose regimen of UVB on induction of cutaneous immunity, and the UVB susceptibility trait is equally well-represented in both black- and Caucasian-skinned individuals. We conclude that although UVB susceptibility may function as a risk factor for skin cancer in Caucasians, it does not function similarly in black-skinned human beings, probably because melanin effectively protects against the mutagenic properties of UVB radiation.

Irradiation of malignant eyelid melanoma with iodine 125 plaque

We used contact irradiation with iodine 125 seeds to treat a large, exulcerative, nodular, amelanotic malignant eyelid melanoma with metastasis to the regional lymph nodes in an 80-year-old man. The procedure was similar to iodine 125 plaque irradiation of malignant choroidal melanoma; special equipment, however, was needed to protect the eye from radiation exposure. The response of the malignant eyelid melanoma to iodine 125 plaque irradiation was similar to that of malignant melanomas of the choroid. No complications were observed in a follow-up period of 15 months.

Malignant melanoma of the female genitalia

Fifteen women with genital malignant melanoma were studied. Their ages ranged from 19 to 66 years (mean 49.1 years); 12 were white, and three were black. The sites of involvement were the mons pubis (one patient), perineal body (one), labium majus (three), labium minus (three), and vagina (seven). Ten patients (66.6%) died of their disease, one is alive with disease, and four are alive without evidence of disease. For the living patients the duration of follow-up was 20 to 118 months (mean 63.6 months). Of those who died, survival ranged from 3 to 76 months (mean 25.1 months). The predominant type of malignancy was superficial spreading melanoma 50%. Nodular melanoma represented 22%, and the nodular polypoidal variant 14%. Melanoma of the squamous mucosa, also referred to as lentiginous melanoma, constituted 14%. By using Chung's method of determining levels of invasion, we found that no lesion was in situ (level I), two were level II (less than 1.0 mm thick), one was level III (between 1.0 and 2.0 mm) and the remaining 11 patients had lesions that were greater than 2.0 mm (levels IV and V). Because the subcutaneous fat is not consistently present in all sites of the female genitalia, all tumors thicker than 2.0 mm were included in level IV, and no level V tumors were classified in our study. Using Breslow's microstaging method, we found the thickness to range from 0.65 to 9.5 mm (mean 4.75 mm). When we correlated survival with level and thickness of tumor in nine patients who died, one tumor was level III and eight were level IV; thickness ranged from 1.65 to 9.0 mm (mean 5.64 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Sporadic dysplastic nevus syndrome in a tyrosinase-positive oculocutaneous albino

A case of dysplastic nevus syndrome in a 41-year-old tyrosinase-positive oculocutaneous albino man is presented. Clinically the patient exhibited multiple amelanotic lesions; histologic examination provided the diagnosis of dysplastic nevus syndrome. Fontana-Masson silver staining revealed the presence of melanin in the nevus cells. Hair bulbs incubated in tyrosine buffer produced melanin. This is the second reported case of dysplastic nevus syndrome in an oculocutaneous albino and the first case of dysplastic nevus syndrome in a tyrosinase-positive albino of which we are aware.

Primary malignant melanoma of the urethra in a black man: a case report

We report a unique occurrence of primary urethral melanoma in a black man. The biological relationships to melanocyte/melanin site densities or to precursor mucosal lesions are discussed as possible etiological factors in the occurrence of this rare neoplasm.

Hutchinson's sign

Hutchinson's sign--pigmentation of the periungual tissues--is a valuable clue to the diagnosis of subungual melanoma. When present, this sign indicates malignant melanoma, however minimal the pigmentation or the histology may be. An illustrative case is presented.

The clinical recognition and prognostic factors of primary cutaneous malignant melanoma

The incidence of melanoma continues to increase. In the absence of a defined and preventable etiology, early recognition and proper management offer the best hope for prolonged survival and cure. Clinically suspect lesions must be biopsied for diagnostic confirmation and histologic information. Reliable prognostic information can be gained from histologic and clinical parameters, which are described.

Iris melanoma. Nevus or malignancy?

Although iris melanomas have an excellent prognosis when diagnosed and treated early, they should not be considered benign lesions. The authors report the orbital recurrence of a melanoma in a patient whose eye had been enucleated 30 years earlier because of an iris melanoma. The clinical, epidemiological and pathological characteristics of iris melanomas are summarized and compared to those of other uveal melanomas. The similarities suggest that iris melanomas are not by nature more benign than other uveal melanomas and that their better prognosis is due to the earlier detection allowed by their more obvious location.

Malignant melanoma of the eyelid skin: histopathology and behaviour

Histological sections from 24 patients with malignant melanoma of the eyelid skin were studied and correlated with clinical follow-up for an average of 8.6 years. There was an average post-treatment follow-up of 7.4 years with a cure rate of 78% in the superficial spreading group. The average follow-up in the nodular melanoma group was 9.4 years with a cure rate of 75%. Nodular melanoma patients with the lesion in the lid margin have a worse prognosis than those with the lesion on the eyelid skin.

Pigmented basal cell carcinoma and superficial spreading malignant melanoma: an unusual combination

We report pigmented lesions in 2 white male patients, which were clinically diagnosed as superficial spreading malignant melanoma and histologically showed combined features of superficial spreading malignant melanoma in situ and pigmented basal cell carcinoma. The significance of this association is not known but is most likely very rare.

Which pigmented moles should be removed in prepubertal-age children? A case for a conservative approach

It is generally acknowledged that malignant melanoma is very rare in children before puberty, but recommendations for the treatment of pigmented moles often seem to discount this information. To document the frequency of malignant melanoma in Australian children of prepubertal age, several methods were used. These attempts showed the difficulty in obtaining completely valid figures, but sufficient information was collected to confirm the extreme rarity of malignant melanoma in this age group. It is, therefore, suggested that prophylactic removal of pigmented moles is generally not indicated in children before puberty, and that removal of a pigmented mole because of the possibility that malignant melanoma has developed should rarely be necessary in this age group. This information may help to reduce the concern that is often expressed about pigmented lesions in children, and to prevent unnecessary surgery.

Dysplastic nevus syndrome with multiple primary amelanotic melanomas in oculocutaneous albinism

Melanomas are rare in albinos, although the incidence of solar radiation-induced skin tumors is extremely high because of the absence of photoprotective melanin. This report describes a 40-year-old white woman with tyrosinase-negative oculocutaneous albinism who developed four primary amelanotic melanomas--three of the superficial spreading and one of the nodular type-and, in addition, displayed nevi that exhibited histologically the characteristic features of dysplastic nevi. The concomitant occurrence of multiple primary melanomas and several dysplastic nevi classifies the patient's condition as "dysplastic nevus syndrome," which to our knowledge has not been described in albinism so far.

Photocarcinogenesis, skin cancer, and aging

Nonmelanoma skin cancers, like most malignancies, increase in incidence with increasing age. However, in general they are not due to the aging process but are primarily due to solar radiation. Clinically, squamous cell carcinomas and basal cell epitheliomas are the most common cancers that occur in the Caucasian population in the United States. The role of radiation from the sun was suggested by a number of astute clinical observations reported around 1900 and subsequently has been established by epidemiologic and experimental studies. Action spectrum evaluations indicate that the ultraviolet B (UVB) rays are the most carcinogenic. However, recent studies indicate that the UVA rays can augment the cancer-producing effects of UVB rays. Other physical stimuli, including heat and wind, can also accelerate UVB carcinogenesis. Chemicals such as the polycyclic hydrocarbons, the nitrosoureas, and nitrogen mustard have an additive carcinogenic effect with UVB radiation. Also, some chemicals such as croton oil, the phorbol ester--TPA, and all-trans-retinoic (RA) acid can promote UVB-initiated carcinogenesis. RA can also inhibit UVB-induced cancer formation. The role of the immune status has received a great deal of attention. Both in experimental and clinical situations, nonspecific immune suppression results in increased cancer formation. Also, recent studies indicate that a specific T cell suppressor population can be induced in experimental animals with UVB which will inhibit rejection of tumors produced by UVB radiation. Finally, damage to DNA by UVB radiation is well established. Studies with the genetic disease xeroderma pigmentosum support the concept that such damage, if not repaired, will lead to cancer formation. It also has been suggested that unrepaired damage to deoxyribonucleic (DNA) and other macromolecules is at least in part responsible for the aging process in general.

Cutaneous malignant melanoma in Alberta: 1967-1976

The records of 519 patients with cutaneous malignant melanoma (CMM) were analyzed for the period 1967 to 1976 from the population-based cancer registry of the Province of Alberta in Canada. During this period, the incidence of CMM rose more rapidly in men (especially those older than age 50 years) than in women. Five-year survival rates were 59% and 74% for men and women, respectively. Women survived longer mainly because of a longer disease-free interval. Once the disease recurred, however, the mean time to death was similar for both men and women. Primary lesions were most frequent on the trunk, and head and neck in men, and on the lower limbs in women. The proportion of trunk lesions is increasing in both sexes, especially in persons younger than age 50 years. The lack of a consistent upward trend for lesions on the lower limbs in women was unexpected. The data predict a growing contribution of trunk lesions is young men to the increasing incidence and mortality of CMM in Alberta.

Malignant melanoma of the skin in New Mexico 1969-1977

We assessed the occurrence of malignant melanoma of the skin in New Mexico from 1969-1977. Incidence data, collected by the New Mexico Tumor Registry, were supplemented with mortality data supplied by the State Bureau of Vital Statistics. These data were analyzed for variation by site, sex, and ethnic group. Malignant melanoma occurrence varied with ethnicity. Incidence rates for non-Hispanic whites (Anglos) exceeded comparison US rates, and were approximately six times higher than for other ethnic groups. Annual incidence rates for Hispanics, American Indians, and blacks of both sexes ranged from 0.0-1.8 cases per 100,000. As anticipated from other studies, the lower extremities were the most common site in Anglo women, and the trunk was the most common site in Anglo men. In contrast, the trunk was the most common site for both Hispanic men and women. A statistically significant trend of increasing incidence was demonstrated only for the Anglo women. Mortality rates varied widely during the study period and did not correlate with incidence rates.

Squamous-cell carcinoma of the nail bed

Carcinoma of the nail bed is rare. Two patients with squamous-cell carcinoma are presented. We recommend biopsies for recalcitrant lesions of the nail bed and treatment by amputation or Mohs' surgery if carcinoma is found.

Lentigo maligna of the lateral canthal skin

An elderly patient with a large, acquired macular pigmented lesion on the skin of the left lateral canthus is described. Clinically, the lesion was consistent with lentigo maligna and total excision was performed. Histopathologic examination revealed atypically melanocytic proliferation at the dermal-epidermal junction without dermal invasion. The premalignant nature of this lesion is discussed as well as the clinical diagnostic clues. A brief review is given of the different types of cutaneous melanoma and prognostic factors, diagnosis, and management.

Are concurrent or subsequent malignant melanomas in the skin and eye related or coincidental?

Malignant melanomas sometimes occur simultaneously or subsequently in the skin and in the eye, multicentrically, not metastatically. The phenomenon is understandable in the B-K mole syndrome, in which multiple malignant melanomas are the rule. Otherwise simultaneous or subsequent malignant melanomas in one organ alone or in two disparate organs are rare and by change.

Curability of melanoma: a 25-year retrospective study

On the basis of a study of 193 patients with localized melanoma followed for 25 years, it appears that such tumors are curable, in about 75% of the cases, by surgical removal alone. Of the 41 patients who died from this tumor, 92% succumbed during the first decade and the rest during the next five years. There were no deaths due to melanoma after 15 years of observation. Prophylactic lymph node dissection on these localized cases improved the survival statistics, but this may have been due to the elimination from this series of those with microscopic nodal metastases. A hopeless prognosis is unjustified in patients with primary melanoma because approximately only 25% of the patients in this series succumbed to this tumor during the 25 years of observation. Therapy in such individuals should be conservative until the diagnosis has been established by histopathologic examination. This policy minimizes unnecessary multilation and morbidity in benign lesions. The diagnosis should be suspected early and established or eliminated at the earliest possible time.

Nail disorders. A review

The nail is capable of only a limited number of pathologic responses. Some of these alterations, including idiopathic disorders, infections, tumors, and drug-induced reactions, are reviewed in the light of recent observations. Whenever possible, clinicopathologic correlation has been emphasized. Specific suggestions are made for diagnostic technics and treatment modalities.

On the histological diagnosis and prognosis of malignant melanoma

This review deals with difficulties of diagnosis in cutaneous malignant melanoma encountered by histopathologists of variable seniority and is based on referred material at The Royal Marsden Hospital over a 20-year period and on the experience of more than two-and-a-half thousand cases referred to The World Health Organisation Melanoma Unit which I reviewed when chairman of the Pathologists' Committee. Though there is reference to the differential diagnosis of primary and metastatic tumour, the main concern is with establishing the diagnosis of primary melanoma to the exclusion of all other lesions. An appendix on recommended diagnostic methods in cutaneous melanomas is included.

Diagnosis, treatment and prognosis of early melanoma. The importance of depth of microinvasion

There are many clinicopathologic features of the lesion and host which influence the natural course of melanoma. Currently, the most important prognostic factor appears to be the depth of invasion of the primary lesion. Using either the Clark's level of microinvasion or the tumor thickness as measured by Breslow, there is good correlation of decreasing survival rates, and increasing incidence of occult metastasis in regional nodes with deeper invasion of the tumor. Thus, proper diagnosis and treatment of primary melanoma depends on the information of depth of microinvasion. And patients with high-risk of developing occult metastasis in regional nodes can be identified. Although two recent studies question the value of performing prophylactic regional lymphadenectomy, none of these studies utilized depth of microinvasion to select patients who have a high chance of having extension or relapse only in regional nodes.

Biopsy and prognosis for cutaneous malignant melanomas in clinical stage I

The material comprises 225 patients. In 79 patients 35.1%) the tumour was closely excised and in a few cases biopsied before the patients underwent radical surgery. 146 patients were radically operated primarily. These two groups of patients are comparable with regard to sex, distribution of tumours on anatomical sites and the distribution of tumours with a given histological classification. We have ascertained that neither excision biopsy nor non-radical operation influences the prognosis if followed by radical operation within about 3 weeks.

Vesiculation of focal acantholytic dyskeratosis in acral lentiginous malignant melanoma

A case of acral lentiginous malignant melanoma is presented in detailed clinical and histologic features because it showed an unusually large vesicle in which there were findings consistent with an exaggerated focal acantholytic dyskeratosis.

Congenital nevocytic nevi and malignant melanomas

The subject of the relationship between congenital nevocytic nevi and malignant melanomas has many controversial aspects. Data are insufficient to come to firm conclusions concerning how often melanomas supervene in such nevi and to determine the prognosis of those melanomas. What data are available indicate that malignant melanomas develop in a substantial percentage of large (giant) nevocytic nevi. This lends support to those who recommend surgical excision of such large lesions, when feasible. On the other hand, the information currently available concerning the association of malignant melanomas with medium- and small-sized congenital nevocytic nevi (i.e., those less than 20 cm in larges diameter) is scanty. Because of this lack of data on congenital nevocytic nevi, our current approach is to take into consideration the probability of cosmetic improvement by surgical removal in conjunction with education of the patient and/or family that malignant melanomas have been known to occur in congenital nevocytic nevi but are probably rare except in nevi of large size. Such information provided to the patient and/or family will often help in making the decision for removal or continued observation. A Congenital Nevocytic Nevus Registry has been established in the Oncology Section of the Skin and Cancer Unit at New York University Medical Center in the attempt to begin a long-term prospective study which might eventually provide some meaningful information concerning the natural history of such lesions, including the incidence of malignant melanomas.

A retrospective histological study of 669 cases of primary cutaneous malignant melanoma in clinical stage I. The consequences of a reclassification of the original group of lentigo maligna melanomas

A selected series of primary malignant melanoma of the skin, clinical stage I, was originally classified according to Clark's system. The consistency of this classification was tested by two Brisbane pathologists who indicated that we had misinterpreted some cases of superficial spreading malignant melanoma as lentigo maligna melanoma. We have therefore reclassified the original group of 86 lentigo maligna melanomas. This resulted in a total series of 37 (5.5%) lentigo maligna melanomas, 301 (45%) superficial spreading malignant melanomas, 194 (29%) nodular malignant melanomas (unchanged) and 137 (20.5%) unclassifiable malignant melanomas. The diagnosis of lentigo maligna melanoma was not made unless the epidermis was atrophic and dermal solar elastosis was present. The new group of lentigo maligna melanomas is dominated by cases on the head among patients over 50 years of age (especially women). This is in better agreement with other studies than our previous findings. The relationship with tumour cell type, pigmentation, mitotic count, atypia, transsectional profile, level of invasion, ulceration, vascular invasion, lymphocyte infiltration and prognosis shown by the new groups of lentigo maligna melanoma and superficial spreading malignant melanoma indicates that the cases by which the diagnosis has been changed are relatively benign. Our previous conclusions are still valid. The lentigo maligna melanoma is still the most benign type and nodular malignant melanoma still the most malignant type of melanoma. The superficial spreading malignant melanoma still represents an intermediate tumour type, although it has deviated in the benign direction.

Present role and future prospects for radiotherapy in the management of malignant melanomas

Malignant melanomas are not very radiosensitive neoplasms. Therefore, the prime management of such lesions is surgical. However, there are certain circumstances in which radiation therapy has been used and should be considered as useful. This article provides an overview of the literature on radiotherapy of primary and metastatic malignant melanomas in man. In addition, some unconventional methods like the use of radiation sensitizers, oxygen-independent radiation therapy, radiation combined with hyperbaric oxygen, and high-dose-perfraction irradiation are discussed. The beneficial responses to radiation that have been reported in the literature and that we have personally observed suggest that a prospective study to determine the proper role of radiation therapy in the management of all forms and stages of malignant melanomas is warranted.

Scalpel excision of primary cutaneous malignant melanomas without metastasis

Views and opinions about surgical treatment of primary malignant melanomas that are without local spread or metastasis are presented. An attempt is made to determine the limitations of office-based dermatologists in the treatment of malignant melanomas of this stage. Using accepted criteria for clinical recognition of malignant melanomas early, it is suggested that surgical excisions of small malignant melanomas that are judged to be complete obviate preliminary biopsies and furnish surgical specimens that can be read histopathologically for confirmation of clinical diagnosis and adequacy of excision.

Mangement of malignant melanomas: an overview

This paper presents an overview of the management of malignant melanoma. It considers the value of wide reexcision relative to the depth of invasion of the melanoma. It considers the indications for elective lymphadenectomy and presents a critical review of chemotherapy, immunotherapy and other procedures, such as X ray. The conclusion is that surgery, wherever feasible, is still the best approach.

Surgical management of advanced cutaneous malignant melanoma

In the past, surgical treatment of cutaneous melanoma has been determined largely by assessment of the regional nodes by clinical palpation. More recently, an increasing number of reports indicate that measurement of the histologic thickness of primary melanomas and evaluation of the level of penetration of tumor cells into the dermis can predict the likelihood of development of nodal metastases. In addition performance of fine needle aspiration of questionably involved regional nodes has provided cytologic data regarding nodal metastases. The role of certain procedures, such as prophylactic (elective) node dissection remains clouded because adequate numbers of properly controlled studies have not been reported. However, increasing knowledge of important prognostic factors, cytologic findings from needle aspiration of regional nodes, as well as the clinical assessment of regional nodes, can all aid formulation of more rational management recommendations.

Familial atypical multiple mole-melanoma syndrome

A family is described showing concordance for malignant melanoma and a cutaneous phenotype characterised by multiple large moles of variable size and colour (reddish-brown to bright red) with pigmentary leakage. Transmission of the cutaneous phenotype in the subject family, and in several others currently under investigation, shows an inheritance pattern consistent with a simple autosomal dominant factor. This cutaneous phenotype signifying melanoma risk may now be added to an increasing body of knowledge dealing with cancer-related genodermatoses.