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Daruish M, Kerr G, Taibjee S. A Combined Spindle Cell Melanoma and Sarcomatoid Squamous Cell Carcinoma: A Rather Unique Squamomelanocytic Tumor. Am J Dermatopathol 2024:00000372-990000000-00416. [PMID: 39288757 DOI: 10.1097/dad.0000000000002838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
ABSTRACT Squamomelanocytic tumor is a poorly defined term that indicates co-occurrence of malignant melanoma and squamous cell carcinoma within the same lesion. We present an unusual case of squamomelanocytic tumor in which both intermingling components showed predominantly spindle cell morphology and were confirmed with double staining for SOX-10 and AE1/AE3.
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Affiliation(s)
- Maged Daruish
- Cellular Pathology Department, Dorset County Hospital Foundation NHS Trust, Dorchester, United Kingdom
- Poundbury Cancer Institute, Dorchester, United Kingdom; and
| | - Graeme Kerr
- Histopathology Department, Salisbury District Hospital, Salisbury, United Kingdom
| | - Saleem Taibjee
- Cellular Pathology Department, Dorset County Hospital Foundation NHS Trust, Dorchester, United Kingdom
- Poundbury Cancer Institute, Dorchester, United Kingdom; and
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Massone C, Chiodi S, Zanette M, Sola S. Cutaneous Squamomelanocytic Tumor: An Additional Case Report With Dermoscopic Features. Am J Dermatopathol 2023; 45:207-208. [PMID: 36729107 DOI: 10.1097/dad.0000000000002367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/06/2022] [Indexed: 02/03/2023]
Affiliation(s)
| | | | - Marco Zanette
- Department of Dermatology, University of Trieste, Trieste, Italy; and
| | - Simona Sola
- Surgical Pathology, E.O. Ospedali Galliera, Genoa, Italy
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Mejbel HA, Nelson KC, Pradhan D, Ivan D, Zaleski M, Nagarajan P, Tetzlaff MT, Curry JL, Torres-Cabala CA, Prieto VG, Aung PP. Cutaneous neoplasms composed of melanoma and carcinoma: A rare but important diagnostic pitfall and review of the literature. J Cutan Pathol 2020; 47:36-46. [PMID: 31361351 DOI: 10.1111/cup.13551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 01/03/2023]
Abstract
We report two cases of combined cutaneous tumors composed of melanoma and carcinoma. The first tumor presented as a 5-mm pink-blue macule over the right zygomatic arch in an 85-year-old man. Shave biopsy and immunohistochemical studies revealed that the tumor was composed of melanoma (highlighted by SOX10 and MART-1, with high Ki-67 proliferative index) intermixed with nodular basal cell carcinoma (highlighted by pan-cytokeratin and Ber-EP4). The neoplastic melanocytes were confined to the basal cell carcinoma nodules, and a diagnosis of combined melanoma in situ and basal cell carcinoma was rendered. After therapeutic excision, the patient was disease-free at 9 months after the initial diagnosis. The second tumor presented as a 6-mm pink-brown crusted papule on the right forehead in an 89-year-old man. Shave biopsy and immunohistochemical studies revealed that the tumor was composed of malignant melanoma (MM) (highlighted by S100 and MART-1) intermixed with squamous cell carcinoma (SCC) (highlighted by cytokeratin and p63), and a diagnosis of combined MM-SCC was rendered. These two cases highlight the importance of recognizing these rare types of melanocytic-epithelial cutaneous neoplasms to arrive at an accurate diagnosis that may inform appropriate disease stage and therapy.
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MESH Headings
- Aged, 80 and over
- Biomarkers, Tumor/metabolism
- Carcinoma, Basal Cell/diagnosis
- Carcinoma, Basal Cell/metabolism
- Carcinoma, Basal Cell/pathology
- Diagnosis, Differential
- Humans
- Male
- Melanoma/diagnosis
- Melanoma/metabolism
- Melanoma/pathology
- Neoplasm Proteins/metabolism
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/metabolism
- Neoplasms, Second Primary/pathology
- Skin Neoplasms/diagnosis
- Skin Neoplasms/metabolism
- Skin Neoplasms/pathology
- Melanoma, Cutaneous Malignant
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Affiliation(s)
- Haider A Mejbel
- Department of Pathology, East Tennessee State University, Johnson City, Tennessee
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dinesh Pradhan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Doina Ivan
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael Zaleski
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan L Curry
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos A Torres-Cabala
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Victor G Prieto
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Rissi DR. Cutaneous Pilomatrical Carcinosarcoma in a Dog. J Comp Pathol 2019; 170:22-25. [PMID: 31375155 DOI: 10.1016/j.jcpa.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/02/2019] [Accepted: 05/06/2019] [Indexed: 12/01/2022]
Abstract
Malignant pilomatricomas are uncommon cutaneous neoplasms in veterinary and human medicine. Pilomatrical carcinosarcoma is a rare subset of malignant pilomatricoma that has been described in man. This article reports a neoplasm with morphological features of pilomatrical carcinosarcoma in a dog. The nodular neoplasm occurred on the left lateral hock and was partially alopecic. Microscopically, the tumour was composed of a cystic carcinomatous component surrounding areas of abrupt keratinization and a sarcomatous component exhibiting bundles of spindle cells and irregular, scalloped areas of mineralized and non-mineralized osteoid matrix. The carcinomatous and sarcomatous areas were immunoreactive for pan-cytokeratin and vimentin, respectively, while immunoreactivity for e-cadherin was restricted to the carcinomatous component of the neoplasm. The unique morphological features of this tumour were similar to those described in human pilomatrical carcinosarcoma.
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Affiliation(s)
- D R Rissi
- Department of Pathology and Athens Veterinary Diagnostic Laboratory, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA.
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Association of subungual melanoma and subungual squamous cell carcinoma: A case series. J Am Acad Dermatol 2017; 78:760-768. [PMID: 28947295 DOI: 10.1016/j.jaad.2017.09.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Subungual squamous cell carcinoma (SSCC) and subungual melanoma (SUM) are rare tumors. Several case reports of association of SSCC with SUM (SSCC-SUM) have been published. OBJECTIVE We sought to document the clinical, dermoscopic, and histologic features in a case series of SSCC-SUMs and describe their relative frequency compared with those of SSCC and SUM. METHODS All patients who underwent surgical exploration of the nail apparatus with a dermatopathologic examination from 2012 to 2015 were reviewed retrospectively to identify all cases of SSCC, SUM, and SSCC-SUM. For patients with SSCC-SUM, clinical characteristics were obtained from electronic medical records. All histologic specimens were reviewed by 3 dermatopathologists. RESULTS The medical records of 456 patients were reviewed. SSCC was diagnosed in 78 (17%), SUM was diagnosed in 63 (14%), and SSCC-SUM was diagnosed in 9. Patients with SSCC-SUM accounted for 11% of those with a diagnosis of SSCC (9 of 78) and 14% of those with a diagnosis of SUM (9 of 63). LIMITATIONS This was a single-institution retrospective study. CONCLUSION The association of SSCC and SUM is relatively frequent in patients with SUM and warrants further consideration to understand the underlying mechanisms involved.
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Muscatello LV, Avallone G, Benazzi C, Sarli G, Porcellato I, Brachelente C, Brunetti B. Oral Squamomelanocytic Tumour in a Dog: a Unique Biphasic Cancer. J Comp Pathol 2016; 154:211-4. [PMID: 26805740 DOI: 10.1016/j.jcpa.2015.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/04/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
Abstract
In human medicine, squamomelanocytic tumour is a malignant cutaneous neoplasm composed of closely intermingled neoplastic squamous cells and melanocytes. A multinodular gingival tumour in a 16-year-old, mixed breed neutered female dog was examined microscopically. Two populations of neoplastic cells, melanocytic and squamous epithelial cells were intermingled. The melanocytic cells were melan-A positive and cytokeratin AE1-AE3 negative and the squamous component was cytokeratin AE1-AE3 positive and melan-A negative. Bovine papillomavirus was not identified by immunohistochemistry or polymerase chain reaction. A diagnosis of squamomelanocytic tumour was made.
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Affiliation(s)
- L V Muscatello
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy.
| | - G Avallone
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - C Benazzi
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - G Sarli
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - I Porcellato
- Department of Veterinary Medicine, University of Perugia, Perugia, Italy
| | - C Brachelente
- Department of Veterinary Medicine, University of Perugia, Perugia, Italy
| | - B Brunetti
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
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Abstract
BACKGROUND The histogenesis and clinical behavior of combined cutaneous tumors (CCTs) in which the mesenchymal component consists of melanoma remain unclear. OBJECTIVE We sought to characterize the clinical, histologic, and molecular findings in CCTs with an epithelial and a melanoma component. METHODS We retrospectively reviewed the records from 2 institutions for CCTs. Fluorescence in situ hybridization was performed to assess chromosomal copy number alterations in both components. RESULTS Sixteen CCTs were included. The most common subtype was the squamomelanocytic tumor (11), followed by the basomelanocytic tumor (3) and the trichoblastomelanoma (2). CCTs were more common in men (87%), on the head and neck (57%), and had extensive solar elastosis (81%). The median follow-up was 25 months (range, 8-167 months). One case had an adverse outcome. Fluorescence in situ hybridization revealed chromosomal alterations in approximately 55% of the cases. Five cases showed chromosomal gains only in the melanocytic component. One case showed 11q13 gains in both the epithelial and melanocytic components. LIMITATIONS Our study is retrospective and the sample is small. CONCLUSIONS The low incidence of adverse outcomes suggests that CCT may be more indolent than noncombined tumors. 11q13 amplification in both components supports the theory of dual differentiation from a common progenitor cell.
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Abstract
Because of the large number of different tissues making up the distal phalanx of fingers and toes, a large variety of malignant tumors can be found in and around the nail apparatus. Bowen disease is probably the most frequent nail malignancy. It is usually seen as a verrucous plaque of the nail fold and nail bed in persons above the age of 40 years. It slowly grows over a period of years or even decades before degenerating to an invasive squamous cell carcinoma. The latter may also occur primarily often as a weeping onycholysis. The next most frequent nail malignancy is ungual melanoma. Those arising from the matrix are usually pigmented and often start with a longitudinal melanonychia whereas those originating from the nail bed remain amelanotic, are often nodular and mistaken for an ingrown nail in an elderly person. The treatment of choice for in situ and early invasive subungual melanomas is generous extirpation of the nail apparatus whereas distal amputation is only indicated for advanced melanomas. In addition to these frequent nail malignancies, nail-specific carcinomas, malignant vascular and osseous tumors, other sarcomas, nail involvement in malignant systemic disorders and metastases may occur. In most cases, they cannot be diagnosed accurately on clinical grounds. Therefore, a high degree of suspicion is necessary in all isolated or single-digit proliferations that do not respond to conservative treatment.
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Affiliation(s)
- E Haneke
- Dermaticum Freiburg, Schlippehof 5, 79110, Freiburg, Deutschland,
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Abstract
Pigmented and nonpigmented nail abnormalities often represent a challenge for clinicians because many, and sometimes potentially life-threatening differential diagnoses must be taken into consideration. Although many details of nail diseases can already be assessed with the naked eye, dermoscopy opens up a second microscopic level of inspection, which can be very useful for the diagnostic process. In the last 20 years dermoscopy has made rapid progress in the further development of criteria for the early recognition of melanoma. In addition, the use of dermoscopy has been extended to the examination of cutaneous adnexa, such as hairs (trichoscopy) and nails (onychoscopy). Many, sometimes highly specific criteria for the dermoscopic assessment of nail diseases have been described in a series of recently published articles. This review article provides important diagnostic aids for a well-founded dermoscopic assessment of nail diseases.
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Haenssle HA, Blum A, Hofmann-Wellenhof R, Kreusch J, Stolz W, Argenziano G, Zalaudek I, Brehmer F. When all you have is a dermatoscope- start looking at the nails. Dermatol Pract Concept 2014; 4:11-20. [PMID: 25396079 PMCID: PMC4230252 DOI: 10.5826/dpc.0404a02] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 05/16/2014] [Indexed: 12/15/2022] Open
Abstract
Pigmented and non-pigmented nail alterations are a frequent challenge for dermatologists. A profound knowledge of clinical and dermatoscopic features of nail disorders is crucial because a range of differential diagnoses and even potentially life-threatening diseases are possible underlying causes. Nail matrix melanocytes of unaffected individuals are in a dormant state, and, therefore, fingernails and toenails physiologically are non-pigmented. The formation of continuous, longitudinal pigmented streaks (longitudinal melanonychia) may either be caused by a benign activation of matrix melanocytes (e.g., as a result of trauma, inflammation, or adverse drug reactions) or by a true melanocytic proliferation (e.g., in a nevus or melanoma). In general, non-continuous nail alterations, affecting only limited parts of the nail apparatus, are most frequently of non-melanocytic origin. Important and common differential diagnoses in these cases are subungual hemorrhage or onychomycosis. In addition, foreign bodies, bacterial infections, traumatic injuries, or artificial discolorations of the nail unit may less frequently cause non-continuous nail alterations. Many systemic diseases that may also show involvement of the nails (e.g., psoriasis, atopic dermatitis, lichen planus, alopecia areata) tend to induce alterations in numerous if not all nails of the hands and feet. A similar extensive and generalized alteration of nails has been reported after treatment with a number of systemic drugs, especially antibiotics and cytostatics. Benign or malignant neoplasms that may also affect the nail unit include glomus tumor, Bowen's disease, squamous cell carcinoma, and rare collision tumors. This review aims to assist clinicians in correctly evaluating and diagnosing nail disorders with the help of dermatoscopy.
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Affiliation(s)
- Holger A Haenssle
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany ; Department of Dermatology, Venereology and Allergology, University Medical Center Heidelberg, Heidelberg, Germany
| | | | | | | | - Wilhelm Stolz
- Clinic of Dermatology and Allergology, Hospital Munich-Schwabing, Munich, Germany
| | - Giuseppe Argenziano
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova (IRCCS), Reggio Emilia, Italy
| | | | - Franziska Brehmer
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
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